Day plus two - Sunday

Lazy morning consisting of food, packing all my stuff and loading up the car. Headed over to No 13 for the last time to say goodbye to everyone, had quick brew before heading over to the hospital. Dropped my keys off at reception and popped into A&E to say goodbye to any staff I'd missed earlier in the week. Then left Stornoway for the last time!

Drive down to Tarbert only took 40mins, really quick on empty Sunday roads (everyone's in church!) Definitely going to miss the traffic (/lack of) and the roads up here. Arrived with plenty of time for the ferry - bought ticket for Alice before going on a quick walk around the harbour. Incredibly wet ground, and loads of black furry caterpillars wondering around.

Lots of caterpillars in the grass near the harbour - Fox Moth caterpillars?

The ferry was a bit late but managed to watch it navigating through the islands on the way to the harbour before we headed back to the car. Leaving the Outer Hebrides - not sure when I'll be back but definitely more to do up here. Top of the list is some climbing on Sron Ulladail, along with more surfing and heading down to the Uists and maybe even as far as Mingulay. So that's it - elective finished!

The ferry back to Skye - signalling the end of my elective!

Day plus one - Saturday surfing

No lie-in on the first day after finishing - alarm went off at 8am for an early start! Quick breakfast before hitting the road for the 1h15m drive down to the absolutely stunning Seileboste beach down on Harris. Golden sands, crashing waves - the only thing missing was the blue skies; the weather was pretty overcast but wouldn't make too much of a difference as we were going to get very wet anyway! Minor panic when we overshot the turn off to the beach, only to round the corner and be greeted with huge waves smashing into the rocks... Alice said "Oh yeah, it'll be down there" to which I replied something on the lines of no flipping way was I getting in those waves! 5 mins doubling back and we located the correct beach with much smaller, more amenable waves for beginners!

Scary big waves and rocks - not the location for beginners!

Met up with Cheggs and Nicola from SurfLewis for our surfing lesson, 3hrs for £15 including all the equipment, pretty good value! Sized up the boards/suits, got kitted up and carried everything down to the beach. Alice opted for wetsuit gloves but as it turned out we didn't need them. Had a really good little education snippit from Cheggs about waves, rip currents, safety etc - made me realise that there's a lot of similarities between teaching surfing and delivering DofE/mountain leader stuff, all outdoors based education with lots of similar techniques. Quick bit on how to catch waves, position on board and starting off by just catching the wave and arching back without standing up and we were into the water! Not cold at all (the 5mm wetsuits may have had something to do with that!) and the bottom of the beach was beautiful smooth sand. Even about 50/100m out I could stand up, albeit to my chest on a smooth sandy bottom. Once in the water the waves looked a lot bigger!

Got practiced at catching the waves and bodyboarding them before another quick beach session on methods of going from back arched to standing - 3 types: the pop-up being the best but hardest, the step up or the kneel up. Main thing = don't split the knees! Back into the water for the main bit, must have spent over an hour practising and it was brilliant fun, everyone was really supportive of each other, cheering when we caught the waves! There were 8 of us there, all beginners. I managed to catch a few waves, although was definitely cheating by splitting my knees sometimes! Think the slackline balance helps a lot, and my board was so humungous that I could stand on it all day!

SurfLewis surfing lesson - my board was humungous!

Truly shattered we made our way back to the van, stripped off and got warm with spare clothes from the car. What a great morning! Driving back it just started to rain - we had timed it perfectly!

Back at the flat we were both knackered! Massive lunch before skyping my folks, not too long before I'll be back in Kendal and get to see them again now. Chilled out and started to pack up all my stuff in the afternoon.

Over to No 13 to see the Aberdeen lot - turns out the helicopter hadn't flown this morning so good job we'd gone surfing instead! Had a chinese takeaway for dinner, good beef chowmein. Turned into a bit of a send off with booze/homemade truffles/brownies out in the flat - delicious! Andrea had made these superb Oreo truffles - incredible. Then the other lot of students rocked up with homemade carrot cake and more booze, fuelling a games night in - salad bowl game, rapidough, even a round of blind man's buff which was pretty hilarious at times. With no early start the following day it was a pretty late night, good celebration to cap off the placement!

Day fifty-four - Friday, my last day!

My last day had arrived! Baked another banana bread the previous night to bring in again, along with a goodbye card I'd made to give to the staff in the dept. Went down well, and I even made it up onto the 'pin up boys of A&E' noticeboard in the coffee room - Stephen wasn't best pleased that I'd beaten him to it. Was only in for the morning, but saw an interesting head injury patient - ran through history, examination with full neuro (cranial nerves, upper/lower limb motor and sensory), cleaned the head wound, dressed with Opsite spray on dressing and discharged after checking with EDP. Great last patient really, tying up everything in one case! I think that summed up what I'd got out of the 4 week placement here - getting comfortable with doing an entire casualty assessment from start to finish on my own. Great experience for final year and I feel pretty confident now with most of my examinations, having had the chance to practice loads here.

Around midday I said my goodbyes to the staff - it had been a superb placement from which I'd gained a huge amount. Quick look in the doctors room to say bye to some of the junior staff before heading back to the flat to wake up Alice (~1pm!) and have some lunch.

Weather was pretty rubbish but at least not raining so we capitalised on the free afternoon to do some touristy stuff on the west coast. First stop the Callanais standing stones followed by a cream tea in the cafe - felt very old! Pet hate though - the scone and jam were amazing (handmade) but the cream was the rubbish spray can cream, total rubbish. If it had been proper clotted cream it would have been amazing. Does this mean I'm now old?

Alice at the Standing Stones of Callanais

Next to the centre stone - shame it was a bit of a grey day, but at least the wind kept the midges away!

Another tourist tick - the Carloway Broch

Headed straight from the broch down to Tarbert on Harris to meet everyone for dinner at 1830. Slight problem though as I couldn't get in touch with any of them! Eventually managed to make contact and discovered none of them had yet left, meaning they wouldn't be down in Harris until much later. Alice and I just decided to eat anyway, and they informed us they'd booked a table at the 'Heritage Hotel'. Didn't know where that was so asked at a pub = "There's no place in the Outer Hebrides called the Heritage Hotel" was the response. Right, sack this, everyone's useless - being over an hour late and not knowing the name of the place!

We headed to a nice looking place on the harbour front instead, called the Hebrides Hotel. Superb food, very funny Australian waitress who took no messing from this guy who accidently whacked her with his large rucksack! Very reasonable price too. Alice sampled the Lagavulin whiskey which I'd been recommended - bit of a misunderstanding when the waitress thought I'd asked for the entire bottle! Man at the bar laughed when he heard it and I agreed that I couldn't afford the bottle! Very smokey.

Eventually the others did arrive, turned out they meant this place anyway. They had dinner before we all headed over to the local community hall for the second ceilidh of my elective! Again, pretty rubbish space for it in an old gym style hall with absolutely zero atmosphere. Was good fun though, everyone was getting involved. I heard from some of the other elective students that they were going on the helicopter the following day - gutted! They didn't think there'd be enough space for me and Alice and I had booked a surfing lesson anyway as part of the Harris Mountain Festival. Bit of a shame but I know I'll get out on helicopters at some point during my career anyway! Alice drove the hour back to Stornoway :)

Day fifty-three - Thursday

Banana bread - Mk I

So as it was my penultimate day I decided to bake some banana bread for the A&E staff - it's my go-to baking recipe! Turned out pretty good, and went down extremely well in the dept! Quiet morning but a highlight was the unexpected return of one of my first patients, the man who's ear I'd stitched up in the first week. I spied him waiting outside one of the cubicles but couldn't place him, then when I walked past he said hi and pointed to his ear - the penny dropped! I have to say the scar looked incredible, it had healed really nicely and was barely visible. He was pleased with it which was the main thing. It's not often in A&E that you get to see the long term recovery of your patients, so I was very satisfied to find out in this case.

Before long it was midday and I nipped out to the ferry terminal to pick up Alice - she'd taken a sleeper train from Euston to Inverness the previous night, then a coach to Ullapool before the ferry over to Stornoway. Due in at 1245 I was there on time - obviously it was then delayed until 1315! Short wait, but was nice to see the ferry coming into the harbour knowing she was on it!

Alice arriving - after 10 weeks!

Drove back to the flat, had some lunch and caught up briefly before duty called me back to A&E for the afternoon - needlessly it turns out as no-one came in during the afternoon! Snuck off a bit early to chill with Alice before heading down to the Thai Cafe in town for dinner with everyone. On the way called into a really nice Harris Tweed shop called By Rosie (http://www.byrosie.co.uk/) where Alice had mysteriously arranged an item of clothing for which I was measured but not told what it was. Under duress I had to choose a tweed, went for a really nice deep green with flecks of gold. Not sure what it's for though! Stornoway was having a late night opening to promote the local shops so it was quite strange wondering round at 7pm with all the shops open - maybe they should try it on a Sunday occassionally!

Thai Cafe for a superb meal, Alice and I had the set menu which was perfect - great value and proper bona fide thai food. Lovely. Good turnout from the hospital as well, most of the med students and lots of the foundation doctors. Moved on to McNeil's irish pub in town afterwards with the Aberdeen med students to support Tim Martinez and the Charango Trio who were playing on the open mic night. Was good fun, nice to have a bit of a send off drinks, as tomorrow will be my last day!

Day fifty-two - Wednesday

Sorted out a few things before heading down to the ED in the morning: paid my £200 odd accommodation fee, scanned in my elective attendance forms and picked up a letter from reception that had been there for a week without me knowing (one of the Aberdeen students had seen it while collecting their own post!) Quiet in the morning, chatted to Stephen the receptionist about GTA V that's just come out, definitely gonna have to get a copy, looks awesome. Although still need to get into Skyrim - bought that for cheap off Amazon just before exams so deliberately didn't play it too much. Turns out one of the students brothers got a copy of GTA V delivered to their house on Uist on Saturday!! It was officially released on Tuesday, but amazon sent out a few copies early by mistake and the publishers Rockstar weren't too happy. I guess they thought it might take longer to get to Uist so sent it out a few days early?

Saw a chap who had come in the previous week having fractured two bones in his hand, the xray was quite dramatic however they had the option of conservative management with just splinting/buddy strapping or surgery where they'd fix the fragments in place with K-wires, which would then have to stay in place for 6 weeks. Buddy strapping is quite a useful trick, where you strap the injured finger to a neighbouring healthy one, keeping it immobilised without any cumbersome splints. Patient went for the conservative option.

Lunch in the doctors office, burger/chips. Got admonished by one of the canteen staff who said I needed to be 'careful with my portion control' - her exact words. I wouldn't have minded if she said it was a large portion and was going to charge me a bit extra, that's cool. But was a bit annoyed being told I'd basically got too much - they should serve out the portions then! Also got me thinking, would it be unfair to just target 'portion control' to overweight/obese people? If a tall slim young person comes in with a massive plate of food is that a bad thing? I wouldn't have thought so. But they could be performing a decent public health intervention by helping overweight/obese reduce their portion sizes... Maybe they should weigh people at the till and titrate their portion size accordingly... !! Oh dear.

Stomach contented I went back to A&E. Patient came in, took the history and examined them, was obvious straight away that they needed catheterising- a procedure that's pretty simple but has lots of little steps along the way. Also catheters are one of the biggest sources of infection, so everything has to be done in as sterile a way as possible - King's drills this into everyone no end. I had a 'prepare a catherisation' OSCE station in 3rd year (practical exams we have to do), where I did not do very well, partly due to the equipment being different to what I was used to (no tweezers provided meaning hands couldn't remain sterile = confusion in the stress of an exam about how to move things around!) Sometime's it feels like we have to be mindreaders to work out what the examiner wants you to do, and that was definitely one of those stations. Infuriatingly too it was not testing the skill, just testing the preparation! I had some pretty crushing feedback on that station but seeing as on the other more 'worthwhile' stations such as heart/lung exams I did well I didn't pay too much attention to it. I can see what they're getting at but feels a bit pedantic at the same time.

Anyway, was supervised by one of the nurses in the ED whilst put it in. Useful to have another person to help open packets and give tips on what to do. As I said, it's a straightforward procedure but lots of stages. Got nearly half a litre out straight away, and the patient started feeling alot better! Nice thing to tick off aswell. I'd done them before but only on patients in theatre where everything is sterile and the patient's asleep = much less pressure! I remember one of my friends who's now qualified saying they had to do their first ever catheterisation on a patient who went into acute retention, on a night shift, on their own... They managed it and the best part was the patient thought they were a superhero as they went from unbearable discomfort to blissful ease as soon as the pressure was released. It's the kind of thing where you can't really go too wrong, you've just got to do it!

Headed back to the house before nipping down to the pool. Forgot my goggles but borrowed a pair from one of the lifeguards, kind of them. Front crawl massively improved, almost at the point where can just keep going now. Did 6 lengths without stopping at one point = success! Technique is probably awful, that's the next thing to work on. At least I'm breathing every 3 strokes on alternate sides, which I've heard is the thing that alot of people find tricky. Forgot to mention too that I've self-diagnosed myself with de Quervains tenosynovitis on my left hand - had pain over the thumb extensor muscles for a few days and then today had palpable crepitus when moving my thumb. People in A&E straight away thought it was tendonitis. Some mild swelling too. Not really sure what's caused it,possibly the swimming so tonight probably didn't help! Tesco to pick up some Ibuprofen and banana bread ingredients before house and spag bol dinner. Bit of 4OD online then baked the banana bread, incredibly straightforward recipe and the oven's not too bad (rare for hospital accommodation) so turned out pretty good! This one's for all the juniors tomorrow, then I'll bake another one for the A&E staff on my last day :)

Day fifty-one - Tuesday

A&E in the morning again, selection of cases including some paediatric stuff, foot and elbow injuries requiring xrays etc. Was interesting talking them through with the ED staff, working through the management plans. Mac cheese lunch with the Aberdeen lot again before heading over to teaching by an anaesthetist on pain management. Very important topic but unfortunately the room was soporifically warm, in combination with a calming voice and slow turnover of powerpoint slides = eyelids were drooping around the room! I'd just had a coffee so was fine :)

In the downtime, casually smash out my top score on Boom Town! So addictive...

Back in the ED afterwards, did a cannula and some bloods. Fairly slow day, but quite nice variety of things. Headed back to the flat in early evening and rustled up a rissoto style rice/sausage/veg/cheesy concoction = lovely! Nipped to shops to stock up on booze and watched Side Effects with Aberdeen people in No.13, really intriguing film, about a psychiatrist (Jude Law) who puts a patient on a drug and strange things begin to happen - constantly rethinking who is actually the crazy one! Looked through their pics from Uist, looked like a great little weekend away. Shame that I won't get down there now but maybe I'll come back on another trip one day!

Day fifty - Monday

Last week in Western Isles hospital - come round so quick! In just before 10am to a quiet department. After catching up with Stephen about his recent trip to NYC I saw an acute exacerbation of asthma that came in by ambulance. They'd received excellent care in the community, had oxygen going, been given salbutamol nebs in the ambulance, GP had loaded them with prednisolone, ipratropium had been given. The only thing missing was theophylline but as they walked into the department smiling and chatting, with sats of 95% on room air I don't think they needed it! Was good revision though, got me thinking about O-SHIT and O-SHIM again (mnemonics for treating asthma/COPD).

Lunch with the Aberdeen lot in the mess, heard about their weekend on Uist and I regailed them with with tales of hardship and bravery on Skye. Back to A&E, everything was quiet until around 1500 when a patient came in that occupied all of our time until the early evening. This blog is so frustrating at times. It was a milestone for me in my time as a med student.

Rainbow on the walk back to the flat

Left back to the flat around 1830, beautiful rainbow on the way home. Hopped in car and drove to the pool to have a swim and chill out after a big few hours at the hospital. Bumped into the Aberdeen lot down there, random! Did some front crawl work again, definitely improving. Managed 75m without stopping, can do 50m comfortably now and not as out of breath. 10mins in the hot tub = amazing, followed by 10mins in the sauna = the perfect stress buster! Drove back via Co-Op to pick up some supplies. Chicken, then bangers and mash for dinner - double cream in the mash again, oh yeah! Gotta love the calories.

Chatted to Alice, she's just finishing her last few shifts as a student midwife = milestone! Went over the events of today as well, good to talk it through. Arranged drinks in Edinburgh for next Tuesday, the night before my Potential Leader Course with World Challenge - really psyched, the next step in becoming a leader for them! Meeting up two friends from London, hopefully crashing on one of their floors!