Day three

This will be a fairly short post as I'm knackered - mainly because Tom, one of the other elective students, thought there was a tutorial at 0750, so I got up at 0630 to make it in on time but it turns out it had been cancelled! Not his fault but resulted in very early start by my standards.

After that the board round went well, although lots of people in the room again, with the new F1s starting shadowing properly today. I was meant to avoid the ward work by going into theatre with the anaesthetist, however the op was cancelled as when we hooked up the patient to the monitoring it was discovered they weren't fit for surgery. Could (/should) have been picked up in a more thorough pre-op assessment, and wastes everyone's time and money in terms of booking theatre staff and facilities. Frustrating.

Spent the rest of the morning in A&E which was great, saw a few patients and felt like I was helping the docs a little. It was pretty busy with some complex cases, however as the forecast was good I decided to take the afternoon off and maximise my use of the good weather opportunites by heading off into the hills!

Number 5 gully

The ledge of Ledge Route, massive exposure!

I parked up at the Ben Nevis hotel carpark, and smashed it out to the CIC hut. Weather not perfect, cloudy with occassional drizzle. After leaving the tourist path barely saw anyone else. I ascended the north face of the Ben via Ledge Route, a grade 1 scramble which was awesome! Starts off up number 5 gully, moves right onto Carn Dearg buttress and then a long ridge walk/scramble to the summit from where it was an easy hop to the Ben. The exposure was pretty mind blowing, the whole of the north face is just so impressive, so much rock. Definitely hoping to explore it alot more!

Being on the hill makes Martin a happy man!

The upper ridge section of Ledge Route

From the summit it was 1h18m back to the car, where I met my host John who had just returned from some training for the Ben Nevis fell race -  an annual race up and down the Ben. He's done it for the past 24 years, incredible. Although even more incredible, the record up AND down is a total of 1h25m... Insane.

Back to the house, food/tv and relaxing, then skyped everyone. So good Skype - free and video, makes the distance a lot easier to deal with. But pretty knackered now, especially as got up at 0630!

On the top!

Day two

Up pretty early, 0730... More successful porridge adventure this morning, courtesy of a plastic mixing bowl purchased yesterday from Morrison's = exploding porridge proof! Set of with Helen for the hospital again, attempting to make the 0830 board round but obviously needed to leave more than 15mins as arrived a few minutes late. Sidled in through the door to a packed doctor's office to hear the tail end of the patient reviews. After that tagged onto a surgical ward round, saw 2 patients! Ward rounds here tend to be a bit quicker than the 4 hour endurance fests in London!

I then decided to stick with the surgeon who did the round and followed him to a minor ops outpatient clinic where I spent the morning and early afternoon. Saw an incredible variety of patients, ranging from perianal problems and IBS to dermatology and medically unexplained symptoms. I guess one of the consequences of being a general surgeon in the rural highlands is that you have an wide variety of cases walk in your door. I 'assisted' him with some suspicious mole excisions which was fun, before being freed at 1330 for a late lunch; I was pretty hungry after not eating since my 8am porridge!

After lunch I went back onto the ward and watched a venesection, which involves the therapeutic drainage of a bag of blood from a patient. Basiically the same as when you give blood. Including the MASSIVE needle! Also observing this were the two new F1s, who have just started shadowing week. So now in the hospital there's 2 about-to-leave F1's, 2 new F1's shadowing them, and 6 students, all vying for patients... Hopefully there'll be enough to go round over the coming weeks. I was then introduced to one of the anaesthetists, who kindly went through some notes for tomorrows surgery with me.

Noel having fun at the wall!

It was mid afternoon by this point and things were pretty slow, so I took off back to the house, grabbed my climbing stuff and hit the road to Kinlochleven to meet Noel for a climb at the Ice Factor wall there. Noel had spent the day walking a stage of the West Highland Way from Fort William to Kinlochleven, and in the process had caught the sun! We then hit the wall there - I'd never been to it before and was expecting quite big things - it's the biggest wall in the area and serves the outdoor capital of the UK, Fort William. However once in I was pretty surprised by the small size. I guess the big attraction is the indoor ice wall, similar to Brigham's in London. Peering in through the window it was obvious it gets a lot of use from the multiplicity of pockmarks in the ice from tool placements. We started on some autobelays, some routes having been set over 6 months ago, to get warmed up before moving onto some top roping. I don't have a lead rope with me, so unfortunately had to top rope - I made it more of a training session by downclimbing routes as well. So I'd climb the 6c, downclimb the 6b, climb the 6b, downclimb the 6a, then climb the 6a before being lowered off. Definitely got a pump going and it was pretty warm in the centre! This was another thing I was surprised by, the low grades. I didn't see a route in the centre above 7a. The vast majority were in the 6's, which I was surprised by given (presumably?) the number of climbers in the area operating at a high level. Also the route setting seemed pretty poor, endless 'right hand up, left hand up, right hand up' sequences, you could draw an almost perfect zigzag up the middle of some of the routes, joining hand holds together. There were a few nice routes set by Dave Macleod that had some cross overs, bits of traversing, hands swaps, undercuts etc. but the rest were pretty dull. After smashing out most of the rop rope routes Noel and I sampled the bouldering, but this was a real let down - a tiny room with what looked like a potentially decent 45 degree board, but on which the holds looked they hadn't been changed in about 3 years. No finger boards. Some of the holds were obviously used for dry tooling as they had squares of carpet behind. The room was also pretty dark, with these strange LED lights that cast a really unnatural white light over parts of the wall, leaving others in shade. Felt a bit weird - needless to say didn't boulder for very long! Overall impression not that great, and for £8 concession, plus 35+ min drive each way from Fort William I probably won't be heading back. Apparently there's a small bouldering wall in Fort William itself that I'll be sure to check out. But anyway, the weather WILL improve so I'll be able to go outside instead!

Amazing views over the sea

Bit of self timer action

Drove back through some awesome landscapes, we stopped to take some photos of the rain on the other side of the sea, illuminated by shafts of sunlight piercing the cloud. It was pretty spectacular. That's one of the things I love about the West Coast of Scotland, the way mountains just erupt straight out of the sea, resulting in incredible combinations of rugged hill scapes and ridges with coast lines and sea. We went back to Noel's hostel to cook a massive carb fest - pasta with a veggie tomato based sauce containing peppers, onions, garlic, courgettes, mushrooms... lovely and exactly what we both needed! Poor Noel, he'd done 15 miles walking and then been dragged to the wall for 2 hours - he was knackered! Amusingly whilst we were knocking up a culinary feast there was a group of 3 mountain bikers attempting to cook a pizza in the electric worktop oven. Turns out one of them swore there was an oven in the kitchen whilst they were in Morrisons, and so they bought 2 massive pizzas, but on arrival back discovered there was an oven of sorts, however it was a tiny work top electric one! Consequently the only way they could fit the pizzas in the oven was to cut each one into quarters and cook them seperately, meaning in the entire time it took Noel and I to prep, cook, eat and wash up our meal they just managed to cook and eat 2 pizzas!

Double rainbow!

After dinner I said farewell to Noel - he has friends from London arriving tomorrow that he's going camping with and so I might not see him again before he leaves. It's been great to have a friendly face up here to meet up with, just until I get settled down and into the swing of things here. I headed back to the house in torrential rain, but saw a spectacular double rainbow appear over Fort William in the thundery showers. I could see the entire rainbow, both ends and a second paler rainbow curving outside the main one! Once back at the house I quickly Skyped Alice and home to catch up with everything before getting my head down. Early start tomorrow to get to the hospital for a 0750 tutorial... On the plus side the weather is meant to be good tomorrow, so might see if I can get out on some real rock!

Dramatic skies on the drive home

Day one - woo!

Started elective – woo hoo! So how was it? Honestly? A little slow, but a good introduction. Started off with a mini adventure trying to cook porridge in the microwave oven – have always done porridge on a hob before, so when after 2 minutes my porridge started exploding round the sides of the bowl I was not off to the best start in the morning. After a quick coffee to power me through the morning I set off with Helen to walk into the Belford. Pretty pleasant really to be able to walk to the hospital in 15 minutes, with great views of Loch Linnhe on the way!

We were due to meet in the canteen at 9am, so arrived a few minutes early. On the way we hooked up with Tom, one of the other lads from Glasgow, before meeting Brett, from Leeds, at the hospital. There are 4 of us in total on the placement, Brett and I have just finished fourth year whereas Tom and Helen have just finished third year. Janet arrived and gave us a warm welcome, followed by paperwork and a brief intro to the computer systems. It’s a bit crazy; the elective placement here is administrated by Edinburgh uni, so I’m now the proud owner of an Edinburgh University photo ID card that apparently lets me into all the uni libraries in Edinburgh... Useful for my 4 week placement in Fort William ;) A tour of the hospital followed, where we were deposited in the doctors office to be tended to by the F1s and F2s. I think there are 2 F1s here, and 3 F2s. Interestingly there are no middle grades though, so it goes from maybe one GP ST1 straight to consultant! Consequently overnight the whole hospital is covered by one F2 – crazy! Got consultants on call who can come in, but still pretty intimidating I imagine to be faced with running a hospital for 12 hours, including the A&E, just 12 months after graduating. Guess you’d learn quickly!

I spent the morning in the CAU, or combined assessment unit, where Tom and I were taking histories from patients coming in, either scheduled admissions or referrals from GPs. Not really sure how much I’m going to be able to write about the patients on this blog, as obviously it’s not a massive hospital so in terms of confidentiality it might be a bit tricky! But the patients were interesting, mix of conditions and it was good to get back into medic mode and start thinking about investigations and differentials to exclude. Quick lunch in the canteen and then spent the afternoon in A&E – steady trickle of minor stuff followed by a helicopter admission which sounded exciting but on arrival was actually fine, just a bit battered and bruised! It was good to get back into the flow of things, taking and writing histories, interpreting blood results, examining patients etc. The team is really friendly, and there will definitely be opportunities to get involved with stuff if it comes through the door. So at 1630 we clocked off and headed back to the house – successful, calm, welcoming first day!

After relaxing at the house for an hour or so we headed back into town for 1900 to the Grog and Gruel, an award winning pub on the main street. Noel came down, and I introduced him to the other students, including Eleanor and Pippa who are on a longer placement here from Edinburgh uni. Food was consumed (pretty good venison burger), beer was drunk and good conversation flowed – really fun evening! Noel had had a fun day out in the drizzle mountain biking, he was showing off his wounds after going over the handle bars – fortunately didn’t end up in A&E! Some of the evening was spent talking about the different uni’s medicine courses, and foundation placement areas and applications. After a few pints we were debating whether to stay for another and Noel asked what time it was – only 2130, oh dear! Decided to call it an evening anyway and headed off.

So tomorrow will be more of the same I think. Get to meet some more of our consultants on Wednesday, they are just on leave for the first two days of the placement unfortunately. Also realised today that we’re going to be here for the craziness of F1/2 change overs! Didn’t think of that. So on Wednesday the newly qualified F1s (me in a year hopefully!) will be starting, and the old ones moving on – expect lots of confusion and disorientation! Have to play it be ear basically. Also hopefully later this week we’ll get to find out what’s going on with theatres in terms of getting involved with some surgery and anaesthetics. Overall a successful first day, great evening out getting to know everyone and looking forward to the rest of the placement – just hope the weather improves!

Day minus one

A more typical Scottish morning

Today started in more expected Scottish style – waking up to rain. A brief breakfast washed down by a cafetierre coffee and I was ready to start violin practice! My cafetierre is my luxury item, my desert island disc object; made of unbreakable material (not glass, as I’ve had 2 previous cafetierres both smashed, both not by me (cough claire cough rob) and both kindly replaced) it’s the perfect size as a one cup, and is completely indispensible. I think it comes from when I watched Ueli Steck give a talk and he revealed that ‘proper coffee’ was his one luxury, surely if it’s mine too I might hope to emulate a fraction of his incredible climbing prowess. Anyway, onto the violin – I’ve made it my elective mission to try to get a handle on it. My mum provided me with the loan of an instrument, complete with folk tune song books. I’ve got the theory from playing piano and cello, so it’s just translating it onto an instrument I hold horizontally rather than vertically. Hopefully I didn’t annoy my host family too much with early morning jigs played quite badly! Plus it helps get me into the Scottish mood, and maybe by the time I land on Lewis I might be up to a pub folk session!

After that it was off to Morrisons, mainly to get food but also to meet up with Noel, a friend from London who completely conincidently is also in Fort William at the moment on a camping trip. After battling through the aisles (it was rammed with tourists, guess it was a Sunday) and feeling elated when I eventually managed to track down the couscous (not with the pasta, rice, porridge as one staff member told me or pasta’n’sauce) we piled ourselves and shopping into my Polo and drove through the rain back to his hostel in Banavie. The Polo’s amazing, a second hand car bought earlier this year that I just tipped over 100,000 miles on the way up; sadly I missed the exact moment, instead glancing down to see 100,001 miles, tragic.

An incredibly healthy dinner of diced beef with sweet potato on a bed of rocket (thanks Noel!) we headed back into town to peruse some shops. Ellis Brighams was our first port of call, where I purchased a Glen Nevis map (of course I left mine in Kendal) and a scrambling book (in case I can’t find people to climb with). Then we headed over the road to poke our heads into the hospital – Noel is an A&E nurse so he wasn’t totally disinterested in a look! First impressions from the outside are not good, pretty ugly building but once inside very impressed by the interior. A quick attempt to track down the canteen, my meeting place tomorrow, ended in failure – just have to try again in the morning when hopefully more people to ask. We stepped back out into the drizzle to venture further up the high street, opting to step back out of the drizzle and into a cafe for some excellent carrot cake and coffee.

Bit knackered at the top

I bade farewell to Noel, forgetting that he owed me £10 that he claimed he’d get out of a cash point. Obviously the next round's on him. Back to the house I was spotted by the children who promptly ran off down the road shouting ‘Dad, Dad!’ – bit strange but all was explained when barely had I walked into my room than there was a knock on the door from John, my other host who I’d missed on arrival yesterday. Strong Scottish accent, hands that showed many rock climbs and member of the mountain rescue team – awesome. A quick change and I went for a run up the local mound, Cow Hill. At 287m it blocks out the view of Ben Nevis from Fort William itself, but provided superb views of the town and Loch Linnhe from its modest summit. From the house it took 27mins to gain the summit, yielding to a 47min round trip – that’s the benchmark time to improve on now! On the way caught first glimpses of the Ben’s zigzag tourist path that I’d perspired on over Easter with my family.

Amazing view of Fort William, with Loch Linnhe

On returning to the house my fellow elective student arrived, a 3^rd year Glasgow medical student called Helen. After some brief introductions I cooked some dinner and managed to eat outside in the glimmers of evening sunshine – the rain had finally abated and amazingly there were no midges! Baked potato in the microwave oven worked surprisingly well, accompanied by tuna/sweetcorn/mayo, washed down with hard-found couscous before a 3^rd course of mushroom soup – I was hungry! Passed most of the evening making some more progress with Frankenstein – getting into it now and amazing that Shelley was only 19 when she wrote it. Bumped into John again as I was reading, he was off out in his van. Off hand I asked him if he had a spare map of Glen Coe by any chance, explaining that I had left mine in Kendal. He promptly got out of the van and shot off into his house, despite my protestations that he needn’t get it right away. I read a few words more of my book before he appeared again, clutching a battered old brown leather suitcase which he flung down onto the bench. Popping the catches revealed a veritable treasure trove – it was full of 1:50,000 maps of what must have been the entire Scottish mainland, certainly every area in thelocal vicinity. After identifying my requested Glen Coe map he returned the suitcase to its resting place in the attic and went off on his business. Amazing!

So I start tomorrow at 9am. Pretty excited, wondering what I’ll be able to do and how flexible it will be. I’m really keen to get some anaesthetic procedure experience (airway stuff, intubation, cannulation etc) and also try and get hands on in A&E and surgery. We’ll see how it goes!

Day minus two

I've arrived in Fort William! Day started slowly, had to sort car out in Kendal, and pack all my stuff. Quite impressed with myself, not that much... All fitted in boot except for big bag full of clothes on back seat. Had stereo set up with good tunes, duck taped phone to windscreen as sat nav, all set.

In Scotland - cue flags!

Had a small lunch at home in Kendal, said goodbye to folks and then hit the road North. Estimated journey time of 4h30m, had a quick break south of Glasgow before navigating the maze of motorways through the city - crazy road design! Glad I had my android phone to get me through ;) Interesting note, with GPS on and in google maps navigation mode, the battery still goes down even when plugged in! Very slowly mind, but doesn't seem to draw enough power from usb cable to power everything it needs, weird.

Once north of Glasgow the roads get smaller, navigating way up the side of Loch Lomond - beautiful weather and scenery. Picked up two Belgian hitchhikers with big bags, turns out they were walking the West Highland Way but had had an epic day and couldn't manage/be arsed with last 10km to next campsite so were hitching! Chatted in car about the Scottish referendum on independence (prompted by 'so does England own Scotland?') before dropping them in the campsite at Inverarnan. I've got enough lifts in the past round the Lakes, now I've got a car I guess I have to return the good karma!

Onwards north through Crianlarich, Tyndrum and then over Rannoch Moor - been over this 3 times now in the last year but it's still absolutely mind blowing. So desolate and then leading into the utterly spectacular Glencoe, guarded by Buachaille Etive Mor - the 'shepherd of the glen'. Incredible mountain greeting you to the highlands!

Amazing room!

With less than an hour to go I powered on, fuelled by Bob Marley and a sausage roll, arriving in Fort William in perfect weather at around 7pm, moving journey time of 5h13m, not too bad. Let's hope this good weather sticks around!
Parking up outside the address I'd been given in an email from the hospital I wasn't really sure what to expect, but no sooner had I pulled the handbrake on then a lady stuck her head out of the house to greet me! I was shown round my accommodation for the next 4 weeks - it's incredible! B+B style, with massive bedroom, en suite, and small catering area with microwave oven/grill, toaster and fridge. No hobs or sink though, so cooking for the next month might take a bit of imagination, or just eat fish and chips every night... which is what I did after making myself at home and having a quick shower. Nico's in Fort William was the takeaway venue of choice, although I had to run the gauntlet of the main street on a Saturday night, including what looked like a group of hen party women dressed in tutu's dragging a blow up doll around behind them. I guess if you're not into the outdoors there's not much else to do round here!

Saturday night in Fort William

Back at the house I tucked into the take away, lovely. Skyped parents and Alice then listened to 6Music for a bit on my minirig - one of the best presents anyone's ever got me! Check them out here: http://minirigs.co.uk/. Basically a portable rechargeable speaker, but they're crazily loud and really good sound quality - I take it everywhere with me now as a substitute for my stereo!

So I've arrived, settled in and starting to think about the upcoming placement. I'm really keen to meet John, the owner of the house, as apparently he's involved with the mountain rescue team and will surely be able to put me in touch with some climbers around, maybe even be a possibility of helping out with some of the team training - who knows!

Pre-elective thoughts...

So, welcome to my blog about my upcoming medical elective to Scotland! In this first post I want to quickly give some background about me, what I'm into and the events that have lead up to me doing my elective in Scotland. Most of the stuff below was adapted from our 'elective portfolio', a piece of work we had to do for King's to make us think about our electives - and even though at the time is was derided as being ridiculous (some bits of it still are ridiculous), alot of it provided lots of food for thought...

From when I first arrived at medical school I heard stories of how medical students travelled far and wide on their electives, visiting some of the most deprived areas in the world, with most involving horrific tales of poverty and inequality in a country in Africa and how the students were humbled by their experiences. When I started to think about my elective around Christmas time last year I came to consider my own motivations for the elective, and began to realise that I did not necessarily have to conform to the semi-accurate stereotype of 'nearly-a-doctor-but-not-really going to poor country to rescue locals'.

I always saw the elective as an opportunity to explore an area of medicine that I might be interested in pursuing as a career. I grew up in the Lake District spending lots of time outdoors, and I started rock climbing during secondary school. Once at King’s I joined the KCL Mountaineering Club and over 4 years worked my way up the committee before finally becoming President in 2011-12. As I was then getting into the later years of the medical course I decided to bring together these two interests, the outdoors and medicine, by getting involved with KCL Wilderness Medicine Society, and last year became President after a year on their committee. During the breaks in med school I spent a long time logging 'quality mountain days' to help me qualify as a Summer Mountain Leader in 2012. Also I completed the Far from Help: Part 2 course run by Wilderness Medical Training in Oxford during a weekend in November,  at the same time as taking the first Wilderness Medicine 'student selected component' at King’s. So I wanted an elective plan that could pull together most, if not all, of these different interests.

On a separate note, my clinical partner Andy has been key in shaping my ideas, although I don't think I've admitted as much to him! Andy studied Global Health as an intercalated BSc, and as such has a deeper insight into developing world issues than most. He's heavily involved in KCL Medsin, an organisation that raises awareness about developing world issues (sorry, issues of the 'global south') and many times following KCL Medsin events I’ve had (alcohol fuelled) discussions with him regarding the ethics of electives in developing countries. These helped me realise that I did not want to be a burden on an already struggling health care system, be that by requiring an in-country member of staff as an interpreter or by simply diverting valuable teaching time and clinical cases away from in-country medical students. With English as my only fluent language I was conscious of the potential ethical dilemmas of being involved in the care of patients with whom I could not consent to my involvement. Also, I understood that as a 4^th year medical student I would not be competent to carry out many medical tasks, and thus the issue of who would benefit most from a placement in a developing country was at the front of my mind.

After thinking about all of this I decided to do my elective in an English speaking developed country. With all of my interests in the outdoors the obvious choice was right on my doorstep – Scotland. With some of the most remote mountainous terrain in Europe, an elective in Scotland ticked all the boxes, allowing me to pursue my medical interests in an English speaking country, in a healthcare system I knew with the knowledge that I would be presented with numerous opportunities to combine my medicine with the outdoors.

Having decided on a country I then began exploring the placement opportunities. From two previous trips to the Orkney Islands I had been blown away by the dramatic Scottish islands and coastline, and was massively excited at the prospect of being immersed in their wildness. A quick search on King's' 'Elective Abstract Records System' (a database of all electives taken by King's students) revealed that Lewis, the most northerly of the Outer Hebrides on Scotland’s wild Atlantic west coast, did in fact have a hospital serving the population of 18,500 islanders, and that a student from King’s completed a placement there only the previous summer. Following a short email exchange with Rhoda from the Western Isles Hospital I had my 4 week placement confirmed; one down, one to go.

After confirming an island placement I thought that a placement on the mainland would compliment my experience on the isles and present me with a more rounded experience of what Scotland had to offer. I knew of a hospital in Fort William, the outdoor capital of the UK situated right underneath Ben Nevis, having spent time in the surrounding hills logging days for my mountain leader qualification. Following an internet search in early January I emailed the Belford hospital, and received a quick response informing me to apply through the University of Edinburgh. Following a trip to the Academic Centre at Guy’s to acquire a transcript of grades along with a few other bits of paperwork, I sent off my application. The following month I received the confirmation that my application had been successful, meaning my elective was sorted!

I know I was fortunate to have arranged my placements with such ease. When hearing the difficulties that friends were having organising their placements I felt relieved that mine had come together in such a short space of time, with the additional satisfaction of knowing the placements would perfectly fit my interests. I was excited by the prospect of actually increasing my skill base during my elective, as opposed to passively observing the provision of health care in a foreign system, language and culture. I was set for 2 months in Scotland!

At the same time as arranging the placement I had to think about what areas of medicine I wanted to pursue during the placements. Through the course at King's we've had the chance to do SSC's, which allow us to focus in on an area of medicine that we're particularly interested in. In my first year I took an SSC looking at the role of free radicals in acute mountain sickness, and this was followed in second year by an SSC looking in more depth into current and future methods of imaging hypoxia. Both have strong connections to mountain medicine and high altitude physiology and research. After this I intercalated in Physiology, during which I took an extreme physiology module looking at human adaptation to extreme environments such as outer space, high altitude, scuba diving and deserts. During this time I began to consider anaesthetics as a potential career, as I found the physiology fascinating and it was suggested by colleagues that anaesthetics would fulfil such an interest. As a result I completed an SSC in day surgery anaesthesia in third year, which helped consolidate anaesthetics as an early front runner. I found the combination of advanced practical procedures with the application of physiological knowledge really exciting and stimulating, and enjoyed the instant physiological results of interventions. During the wilderness medicine SSC earlier this year I had the chance to explore pre hospital medicine, which complimented my involvements with the Mountaineering Club and Wilderness Medicine Society. 

As I said above, anaesthetics is high on my list of specialities at the moment. Also having done A&E during 4th year I really enjoyed the unpredictable nature this, with the need for quick decisions and immediate actions. Combining all these aspects of the speciality with the need for effective communication and competent team work I think leaves a very attractive speciality. I find playing a leading role in a team immensely satisfying too, and I've developed this outside of my studies during my qualification as a Summer Mountain Leader and my current forays into Duke of Edinburgh supervisor and assessor roles. Also during third year I found the manual tasks, such as airway procedures and intravenous cannulation, very rewarding. My most recent clinical attachment to Worthing hospital opened my mind to the possibility of surgery as a career, as I found myself presented for the first time with the opportunities to perform simple surgical procedures. I surprised myself with how much I enjoyed surgery, and how satisfying I found it. And so at the moment anaesthetics, emergency medicine and surgery are the three areas of medicine that I think I'm most interested in.

Finally, my thoughts on potential specialities heavily influenced where to do my elective, whilst conversely the location of my elective influenced which specialities to undertake. In order to experience emergency medicine I needed to be able to communicate easily with patients and integrate meaningfully into an existing team, factors which logically led to an English speaking country. Likewise anaesthesia requires good team communication, but furthermore I felt that in order to maximise my learning from such a placement I needed to operate in an environment similar to that in which I may eventually work, and so carrying out an elective within the NHS seemed ideal. Also such a system would be well set up in terms of training, supervision and support - areas vital to gaining skills both effectively and safely. The Outer Hebrides would provide the perfect location for my interest in pre-hospital care, whilst Fort William, with its busy A&E department, would enable me to explore the careers of emergency medicine and anaesthetics.

So that concludes my pretty long first post on motivations for elective! Apologies if some of that was a bit formal, as I said at the start I nabbed most of it from my elective portfolio which was written a bit more formally than I intend this blog to be! I leave for Fort William tomorrow, around midday, although the time could get pushed back depending on how packing goes in the morning! That's one of the good things about doing the elective in the UK with a car - I don't have to worry too much about packing :) ~250 miles, ~5 hours according to the omniscient Google. I'll let you know how the journey goes...