Despite the activities of the night before, I had had a good nights sleep and woke up feeling peculiarly relaxed. I had breakfast of flat bread and natural yoghurt before setting off for the hospital complex, which was only a block away. It was hot outside and the streets were already busy with white taxis with orange panels who stalked me looking for business ignoring the men and young boys on the sidewalks who trailed their long dishdashas through the sandy dust. As I made my way along the dusty road, it struck me how remarkably peaceful everything appeared to be. I had travelled in many Middle Eastern countries, and it was difficult to believe that Iraq could be associated with so many tales of repression and suffering. I stood for a while and watched a group of barefooted children playing together. One of them, probably a grandson, left the group and carried a glass of sweet tea, in one of those Turkish pear shaped glasses, a piyala, to an old man seated on a shabby armchair by the side of the side of the roadway. He then sat crossed legged by a low wall until his elder was finished. I was aware that the unexpected clink of a spoon in a proffered piyala, as is the nature of the customary greeting given to strangers in eastern Turkey, probably didn’t carry over the Hakkiri Mountains as far south as Baghdad. The old man, nodded to me in a unperturbed manner, and I responded with the traditional greeting,

"Marhaban" "Kayf haluk"

"Shukran, al hamdu li-lah, bi-kher-bay", he replied, murmuring a string of greetings in Arabic and Kurdish, and leaving me totally unsure of which language I had originally greeted him with. In the mid eighties, I had travelled through Kurdistan and was aware of the great suffering to which these people were subjected to.

I then passed the International Communications Centre, an important military complex that was strategically situated across from the hospital. The building was guarded by a group of young soldiers, who appeared different to the others that I had seen. They stood aloof, athletic and neatly dressed, their black boots glinting in the bright sunlight, their red epaulettes defining their status as the Praetorian Guard of the regime. I discovered afterwards that the soldiers were members of the Republican Guard, an elite unit tasked to protect the President and the important military buildings in the capital. The building itself would later become the main target of "Operation Desert Storm", the horrendous bombing campaign launched by the United States and her Allies against the people of Baghdad a few months after.

The hospital was a whitewashed low slung building set in a tiny garden lined with pomegranate trees. There was a tiny open courtyard with a tiled pavement that led to the Staff Health Clinic. The morning started easily, with Patricia, the Staff Nurse, having dealt with of the trivial problems concerning the staff. She took a deep breath as she opened another door and showed me some Indian porters sitting shivering, their little brown faces peering out at me from the depths of the woolen blankets they had wrapped themselves up in. They were waiting for some antibiotics and hopefully a day or two off work. This was a common occurrence, even when the outside temperature climbed over one hundred degrees, but in time, however, I grew used to the performances and even found a certain charm in the way that differing cultures portrayed their illnesses.

Today, one of them actually had a fever. His name was Anwar, an assistant chef, who had a severe Giardia gastro-enteritis, requiring immediate release from work and a hefty course of Metronidazole. It taught me to examine everybody and not to stereotype the different nationalities too easily.

Part of my duties required me to also see former Iraqi patients as part of a walk-in casualty service. Late in the afternoon the first of these patients, a couple from Najaf, a town south of Baghdad, arrived. The husband, a slight man with refined features led in his wife and told us she had previously been one of our renal dialysis patients. His command of English was proficient and we didn’t need the assistance of Nadia, our interpreter. His wife, clearly uncomfortable, deferred lying down, preferring to remain in a distorted position in front of my desk. I noted how she tried to smile, but looked too exhausted even to let go of a black handbag, which she grasped, with the clasped fingers of an older rheumatoid patient.

"She can’t open her mouth!" he said, his eyes that were loving and sad at the same time. "How long has she been like this?" I inquired.

"For a few hours, we just drove up from Najaf" he replied.

"Last night she went numb in her face and said that she couldn’t breathe or see"

"Can she open her right hand" I asked, realising that she couldn’t let go of her handbag.

"No" he answered.

"I think she’s got tetanus" said Patricia, mentioning a case that she had previously seen.

I had to admit it certainly looked like tetanus but the patient presented with no prodrome of fever, malaise or even headache prior to the symptoms appearing. It certainly was a baffling case and I could see that in the context of cultural subjectivity this new job would have its moments.

"Has she any numbness around her lips now?" I asked.

The patient nodded and for the first time I realised that she also spoke English.

"Patricia, we’ll draw off some bloods" "I think I know what’s happening"

"How soon can we have the bloods done?"

"Straight away ... the lab is only next door"

After a while, the results were back and my suspicions were confirmed. The patient was suffering from reduced levels of calcium in her blood, causing the nerve endings to fire continually and producing a constant spasm. In a western setting the symptoms would have been presented in a less thespian manner and the condition would be easier to diagnose. I informed the Renal Registrar, who agreed that we should give her some calcium gluconate slowly over three to four minutes. The effect was immediate and the patient regained her normal countenance within a few minutes…. I could see this new job would have its moments.

The day continued and I had the pleasure of meeting the Iraqis’ only Olympic Gold medal winner, an older man who was once a weight lifter and now was one of our patients. He was gracious and presented me with a large Arabic ring when he was leaving. Maybe it was a morning for Iraq’s unusual personage to grace my clinic but my next case proved equally challenging.

Before me sat a well-built woman with a delicate bone structure, and skin that had smoothness that comes from years of care. She wore a padded red dress and imitation jewellery, her well combed hair fell around her shoulders in a seductive fashion.

"I’ve come for my injection!" she said.

The nurse had left the room, and I searched through the patient’s chart for some reference to her malady. Just then Patricia returned with the patient’s medicine and proceeded to inject t her. The patient left with an embracing gesture leaving one in no doubt about her other inclinations. I looked at Patricia imploring an explanation.

"Well now you have met Mary!" she said smiling.

"Do you know who she is?"

"Haven’t a clue, but she appears a little strange"

"Mary is Iraq’s only transsexual and she comes here every few months for her hormone injections" "She had the job done in London, but God love her… she must have an uphill battle to exist in Baghdad"