Day thirty-one - Wednesday

Leisurely morning, grey day. Walked in for 0930, straight into it with a patient with extensive history of a surgical problem, which sounded like it hadn't been got on top of with their previous interactions with GP/hospital. Got stuck in, taking the history/examining, doing bloods, ordering/interpreting tests. Ended up sending them for a contrast CT scan, which I went along to to see what the radiologists get up to. Bit nervous when they hook up the contrast, hope the cannula I put in works ok! By the time they got back to ED and the report was on the system most of the morning had been taken up. Time really flies when you start doing everything for the patients - as the department is nurse led they are happy for me to see the patients and then call down the doctors if necessary, which means I fill out all the clerking paper work, do all the basic investigations, order them all, write up the results etc etc. So even though only had one patient in, as I was doing everything for them along with the documentation it took a lot of time up - good though, never twiddling thumbs!

Really nice baguette from the canteen for lunch. Wondered back via the mortuary, as I was quite keen on seeing what the pathologists get up to here; whilst searching for the entrance however I was informed by some helpful theatre staff that there aren't any pathologists here! I asked what happened to any postmortems, turns out they all get sent to the mainland, only a handful of them a year here. So not a goer then!

Back in A&E someone had changed the label on the ambulance 'red phone' to the bat phone, quite amusing! Not so amusingly though some of the calls that come through on it are trying to sell PPI - crazy that they can get the number, surely it should be on a special system so they can't call it? When it goes off everyone gets a bit twitchy, and annoying when it's a false alarm cold call.

The Bat phone - aka PPI phone...

Saw my first alcoholic after lunch, picked up by the ambulance crew and brought in. Pretty docile, if hard to understand! Left them in a cubicle, then one of the juniors came down to see them and suggested admitting for observation until they'd sobered up a bit. Unfortunately patient had other ideas and shortly self-discharged! There's only so much you can do I guess, make sure the alcohol isn't masking any more serious injuries/conditions, but if the patient is competent and wants to leave you can't really stop them - plus what's the alternative? Admit them when they'd most likely be disruptive and non-compliant, and end up self-discharging anyway...

Late in the afternoon a minor injury came in, someone who had a quite bad laceration. Again I got stuck in, history/exam, decided that it probably needed some sutures so got one of the ENPs to check it out. They agreed and left me to get on with it! Local anaesthetic in, 4 sutures, applied some mupirocin cream - recommended for that particular place on the body apparently. There were no suture kits, so had to use a minor ops kit which meant the only needle holders were massive! Ended up doing it with artery forceps as they were smaller and much easier to handle, although the curved ends made it a bit tricky. Think I did a fairly good job though. Gave them the advice about getting the sutures taken out, then spent 30 mins documenting everything - good prep for next year I guess!

Another satisfying day in the ED! Back to the flat by 2000, fairly long days so far but always felt busy, never slow. Don't mind being in when I'm doing stuff all the time. It's quite a contrast to Fort William as even though there are fewer patients here I'm much more involved in the care, often doing all of it and getting it signed off at the end, including all the paperwork, so feel busy.

Fresh pasta dinner then into Stornoway for drinks with another King's student up here, so random! Freezing and raining on the walk into the town - easy to imagine that I'm on a small island in the middle of the sea when the weathers like this! Met them in An Lanntair, the Arts Centre with a cinema - newly refurbished with digital projector and 3D facilities, will have to try and get a film in whilst here. Sampled some of the bottled Orkney ale along with an Oban whiskey - with some water to open up the flavours, very nice. Expensive though, those two drinks were £8.50 ish! No ales on tap either :( Went from there onto McNeill's, aka the 'husband creche'...

Sampled another of the Orkadian ales (again none on tap) and good chat with the two others, listening to how they'd got on over the past month on the island. One of them is a medic at King's, up here for part of their elective in GP land. The other came up too to write up their dissertation in the non-distracting surroundings! Parted ways and was back at the flat by 2330, slightly tipsy. Another great day!