I walk into the ward of my new job 10 minutes late, with a hangover, to be met by the professor. He grabs my arm. "Look, if you don't want to iron them, just use a bit more fabric conditioner, leave them to dry in the bathroom, nice bit of steam, let the creases fall out. You wouldn't catch me in a shirt that fucked up, cause I'm dapper, you know, I'm the dapper professor, Professor Dap, king of common sense, you're just the doctor, right, maybe, but you've got obligations, now fetch us some more of this terrible food." This is all, in many ways, fair comment.

Now Mr Wainwright is a local legend for any junior psychiatrist who has done on-calls in this tedious little town, and he's one reason I was pleased to get my job. He cycles into mania faster than anyone I know, but he knows exactly what's going on because he was in my new boss's study on patient education and knows more about manic depression than any doctor.

The first time I met him was in A&E at three in the morning, when he had counted up his symptoms on a piece of paper and written down exactly how much medication he thought he was going to need to come down. Most doctors feel slightly anxious about this kind of thing, especially because people always like being manic. Maybe it feels like a pay-off for the depressive phases: a part of them wants to stay up there. But this man knew his last three lithium levels and had a written list of his previous admissions. Money can't buy the love that brings at three in the morning.

I excuse myself (and there is no greater test of your cocktail party skills than disengaging from a manic patient) and make my way to the nursing station for a first impression. There are a lot of pitfalls that junior doctors can fall into with nurses, but the textbook classic is that they decide you're a snotty, workshy ex-public schoolboy who thinks he's better than God. In psychiatry, the nurses know the patients better than anyone. So you really don't want to give them that idea.

Before I get two paces I am headed off. "New doctor?" I prepare my helpful smile. "Patient short of breath in the clinic room." I chose psychiatry so I could leave this kind of thing behind. I don't want to work. I've got a hangover. The nurse points down the corridor and we trot (running? In psychiatry?) to the clinic room, where there is the sickest looking patient I have seen in six months. She's in a psychiatric hospital for anxiety, and she's short of breath. I am suspicious. I put on my "I understand but I am not going to conspire with hypochondriacal pathology" face and hope there's nothing wrong with her. Her pulse is 105: she has a swollen calf and chest pain. And with the £2.50 stethoscope from the ward, over the booming sound of a mental note to carry a proper stethoscope in future, I swear I can hear creaking leather.

You don't often hear creaking leather with a pulmonary embolism. That's a textbook sign of PE. And I dimly recall that they can be rather dangerous. I call the nearest proper hospital, and am met with every junior psychiatrist's nemesis: the sarcastic medical registrar.

I tell him I think I have a PE. "What makes you think that?" I blurt: "I can hear creaking leather." "Creaking leather? Like in the textbooks?" Creaking leather, like in the textbooks, I reaffirm. "That's good. I've never heard creaking leather like in the textbooks." Well, no. Neither had I until today.

"Well, I suppose I'd better take it then." Is that OK? "Oh God, it's fine. Anything else over there? Perhaps you've spotted some Roth's Spots and diagnosed SBE?" I put the phone down politely. So nurses think all doctors are arseholes? I take a breath and prepare to start again with my cheesy smile.