'I don’t think we should be doing this.'
Sarah turned to face the group to say: 'I’m not going to, and I don’t think any of us should either.'
All eyes turned to our teacher, standing by the bedside of Mr Jones – a ball of curled breathing bedclothes with a shock of white hair just visible at the foot of the bed.
A foot clenched the standard-issue foam pillow, an embroidered NHS logo just visible in one distorted corner.
The proposal had seemed eminently reasonable, even generous.
'Mr Jones here, has a rectal tumour, something that you must all learn how to recognise if you want to save lives from cancer.
'He also has advanced dementia so I will need to hold him in position while you all examine his tumour. Remember what I taught you – a cancer feels craggy and hard, a benign enlarged prostate will feel smooth. You may see some blood on your gloved finger, this is not normal.
'Remember to use the lubrication jelly – this procedure is not comfortable. Because of his dementia, he will not remember any of this.'
Mr Jones was not very communicative. He had not responded to being enthusiastically hailed or even shaken by the surgical registrar. The ball of bedclothes moaned. A scrawny arm had disentangled itself and pushed the registrar's hand away.
Annoyance came first. How dare Sarah abstain on behalf of us all? We were in the first week of our introduction to clinical skills, wearing our white coats for the first time, stethoscopes and cheese-and-onion coloured clinical handbooks stuffed in pockets either side.
Annoyance swiftly yielded to unease. She was, unfortunately, right. Suddenly I did not want to participate in this learning experience either. Moral distress rippled past me into the rest of the group but we did not have words with which to defend our fledgling consciences.
'I’m sorry, what did you say?' I noticed that the registrar seemed taller, or I felt smaller.
'I don’t think we should be doing this. It’s wrong.' Sarah did not raise her voice, and seemed all the louder for it.
'Don’t be silly. This is a classic examination finding – you have to learn what this feels like if you want to pass your exam and be good doctors. He won’t remember.'
The registrar’s voice was louder now. He loomed. His face was flushed and he had the calm look of someone about to lose their temper. Unease was visible on the faces of the eight students clustered around him and Mr Jones. I found that my throat was dry – I wanted to come to Sarah’s defence but I also found I wanted to hide. My eyes pleaded with the others to chime in. Theirs pleaded back, 'after you'.
Mr Jones’s sheets settled into the almost imperceptible undulation of undisturbed sleep.
'He’s not in any position to give informed consent to an intimate examination and it’s an undignified and uncomfortable procedure. It’s not right and I think it might technically be illegal,' said Sarah.
At ‘Illegal’ we were ushered on to another patient, and no more was said. We looked at Sarah, who was flushed and taking deep breaths. Our eyes spoke, 'thank you'. No words came from our mouths, still dry.
I met Sarah and the registrar only the once – their true names are shrouded in two decades of learning and forgetting. I will never know what or if the registrar learned from the conscientious medical student, but many years later as a teacher I have shared the story time and again as one of integrity and bravery. My story’s hero also applied wisdom – it was not enough to say what the right thing to do was but why it was the right thing to. It is also a cautionary story – we all too easily fail to do the right thing.
When someone does not remind us of our ideals we risk trampling them in pursuit of ambition or flight from fear. The virtues and vices are sharpened in each retelling but the moral remains the same. Doing the right thing takes courage and wisdom – courage to do the right thing, and wisdom to do it well.
This is the winner of the 2017 BMA writing competition and is by Oxford GP and clinical lecturer in general practice Andrew Papanikitas
Find out more about the writing to competition
How all that entered did the right thing