Private medicine makes me sick. It doesn't do the patients too much good either. Because, in general, while nurses on private wards are all very good at showing you their cleavage while serving up house red with your medallions de veau, when it comes to doing anything vaguely medical they tend to fall flat on their perfectly manicured arses.

Usually we only have to tolerate the private ward when our consultant, rather time-consumingly, drags his troop of NHS minions up there behind him at the end of the ward round, in order to make himself look even more important than he already clearly is. But now, since they closed down about a million beds in the main hospital and merrily sacked the regular staff, the NHS bed manager insists on sub-letting beds off the private wing, which as well as being vastly expensive is also miles away, often through torrential rain, from the rest of the hospital, and hence an immense pain in the arse for myself, the most junior member of the surgical team and hence the organisational donkey of the oufit.

But the main problem, when you have a patient who is kicking off quite as badly as Mrs Wilson was yesterday, is that frankly I wouldn't trust the nurses on Princes Ward to look after my cat. I tell Pippa, the rather glamorous medical SHO, about my sick punter on the private patients wing. "Oh Christ, not that lot," she rolls her eyes. "I wouldn't let them look after my coat while I went for a shit. I'd bleep the bed manager if I were you," she pauses and looks at the size of my immense patient list. "Unless she's definitely going to die anyway, of course, in which case you might as well leave her there..."

She smiles. Obviously neither of us has ever made that kind of decision and acted on it, although part of us wishes we had, because that would make us as enormously hard as the kind of battle-weary registrars who can do it without thinking. For example, only the hardened soul of a registrar can order a Hollywood call for a patient who, for local political reasons or oversight, is inappropriately marked down for resuscitation when they inevitably arrest; and a Hollywood call, in case you didn't know, is where everybody shows up to the cardiac arrest panting dramatically and bounces up and down on the patient's chest, not even pretending to give them an electric shock, and giving the all-time greatest performance of their stage career until such time as it is politically acceptable to pronounce the patient dead. Don't pretend to be shocked: be grateful we don't break your granny's ribs in the course of an inappropriate resuscitation just because you watch too many unrealistic medical dramas on telly to believe us when we tell you on the ward round that resuscitation never ever (ever) works.

Often that kind of decision depends on your boss's personal investment in the case. "Oh yeah," the registrar says when I called him about Mrs Wilson. "She's that cholecystectomy that Mr Cobb fucked up last week. Very embarassing. Fit as a fiddle beforehand. Better get the old girl a bed on ITU to die in."

Now, inevitably, when ITU turn up to see this kind of patient they can smell a rat, because ITU doctors are far from stupid. "This patient's fucked," they smile, having rapidly assessed the situation, and then there follows an elaborate game of mutual denial and stake raising, much like poker. Except in my case, because discretion at five in the morning is utterly beyond me, and seems especially pointless when the doctor admitting to ITU that evening is someone you were screamingly drunk with the night before. You can't lie with that kind of bond, particularly when it's less than 24 hours since they leant on your shoulder in the loos of some godforsaken smalltown nightclub and giggled: "Can you believe I'm in charge of fucking ITU in five hours time?"

So I call ITU. "John," I say, "I've got this punter." He whinges. "You're always full," I say. "Kick someone out. Cobb fucked up this lady's cholecystectomy. She's going to die. Can we have a bed on ITU please?" He wants to know what for. "So she can die in it, John. It probably won't take long. It's all very embarrassing. Apparently. I don't understand these things. I'm just a house officer." But inside I know it: he's not going to give me the bed on ITU, and she's going to die, and she's going to do it slowly and grudgingly at five in the morning absolutely miles away in that ridiculous private wing, my legs will hurt, and the rain will mess up my new haircut.