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 …