As a registrar in a regional respiratory referral centre I was exhausted. I was determined to do better than my predecessor—so each day I arrived early (so early that the porters thought I was a surgeon)—and stayed late. I dutifully examined my patients, made comprehensive daily entries in their notes, and my discharge summaries were always up to date.

The holiday was booked and as I got more and more tired I began the count down with increasing care. I also noted the increasing discomfort in my right armpit. After a couple of days the discomfort had become a throbbing pain and sleep was disturbed. Self examination revealed an obvious reddened non-fluctuant swelling, without a punctum in the right axilla.

Too busy to visit my GP, I raided the bathroom cupboard and found the remains of a course of erythromycin which had been prescribed a year or so previously. For once I obeyed the instructions on the bottle and avoided alcohol before starting the antibiotic. The wave of nausea hit me 40 minutes later (surely DTs don't start this soon). Visualisation and the drive to work by car helped control the “somatic” event!

The next day the SHO and I were faced with the outpatient clinic from hell—overbooked, the other registrar on leave (and no locum), and the consultant away at a meritorious meeting at Region! I arrived and began to plough through the pile of notes. After an hour I realised I had forgotten to take the erythromycin. I gulped it down with water and carried on seeing patients.

The next new patient was quite a character—mid-50s, an ex-smoker (by all of 15 minutes) with a chronic cough and sputum, peroxide blonde, silicone implants, and an all over tan. Midway through examining her and establishing the above facts, I was suddenly faced with the overwhelming feeling that I was about to vomit. Visualisation—useless, deep breathing—no help. The sweat on my forehead marked the onset of inevitability. I rushed across the consulting room and vomited spectacularly into the sink. My embarrassment and attempted explanation/apology, “I am so sorry—you see I have an infection in my armpit and I am on antibiotics”—were met with a huge grin and the observation “you young doctors just can't hold your drink, can you.” She dressed to the accompaniment of my increasingly desperate excuses and left chuckling “your secret is safe with me, doctor, don't worry, I won't tell a soul.”

Having completed the clinic clerking in her notes and regained my composure, I got up and opened the consulting room door in order to call in the next patient. The hub-hub noise in the waiting room stilled almost immediately and all eyes were on me. The silence lasted barely more than a second and was replaced by an increasingly loud and widespread sniggering.

My reputation ruined (or made) I retreated to my room—armpit throbbing and red faced. Three days later, after incision of the axillary abscess (under local anaesthetic—an experience on the pleasure scale equating with the interview for my consultant post) and a course of more appropriate antibiotics, I began to feel better.

Sixteen years later—a sideways move into infectious diseases/genitourinary medicine and I wonder—does my reputation still follow me? When I walk into clinic why is it always so quiet?