He was about my age and I could really empathise with his situation - and I really liked him - several times he'd really cried on my shoulder and we felt close. Psychological disturbance post stoma surgery is well recognised (White and Hunt 1997) and support and recognition of this pre and post operatively from the medical team is recommended (SIGN Guideline 2004). During the critical incident where I was with a doctor as he discussed discharge from hospital with James, I realised that James wanted to say something, but wasn't able to, probably because it was on the open ward and everyone could hear. I walked away from James' bed, but felt terrible about what had happened as I did so, it was a small incident really, but it probably took on a greater impact in my mind because of my affection for James. 

I think I could have acted more professionally and as a patient advocate, if, when I noted his need to say something, I had been able to step in and establish what he required in order to speak as he wished, and arrange for these needs (a quiet and private room perhaps) to be met.