Bit of a lazy morning, reset the alarm a few times. Unlike Fort William, there's no specific time to be in here, but as the morning's are generally quiet I can justify to myself not going in until 0930/1000ish - in the knowledge that often I'll stay till 2000ish if I've started with a patient. Coffee/porridge then walking in, bit clearer today, still overcast. Arrived in A&E, Steven buzzed me through. He's the front man of the department, booking people in, collecting medical notes from the hospital record archive, making brews etc. Top guy! One of the nice things about working in the ED is that I can wear a scrubs top - so much better than shirts. I reckon all doctors should wear scrubs, and they should be colour coded to their grade - be much easier to pick out the juniors from the regs etc. Also be smarter I reckon, definitely cleaner and more hygienic. Doctors are the only health care profession to not have an official uniform - doesn't make sense.
First patient was in, referred from GP land with a potentially serious provisional diagnosis that needed to be excluded. Clerked them in, examined, did baseline bloods/ECG. Presented to one of the docs, then sent the patient for CT. They were pretty stable, and the diagnosis was pretty unlikely given the patients observations but the history was suggestive so needed to rule it out. Whilst that was being sorted I saw a patient with a minor injury, sustained on a cruise ship a few days ago. They'd been referred in by the ships doctor for follow-up, query xray. I took history/examined, thought it didn't need xray. Checked with ENP, agreed. Discharged after filling in the paperwork, which included a section that they needed to take back to the ship's doctor. Interesting as hadn't seen one before - it's mainly for medical treatment in other countries I think, in case the payments need to be sorted out by insurance companies.
After that another man came in 'under the influence', this one much more comatose than yesterdays. Got them in a bay, weren't going to get much of a history off them, so examined and then trawled through the computer system to get some history. Can get these good 'Emergency Care Summaries' which included a list of current medications, usually from the GP. Was useful, as this patient was on quite a few relevant meds that needed to be looked at. They ended up staying for a few hours, and was interesting to watch them sober up with subsequent visits to make sure they were ok and improving. Eventually they self-discharged as well.
A bit of a lull followed, interrupted only by four pre-nursing students coming for a tour of the department. Steven was hauled into the resus room to be a manikin for the Autopulse machine - wrapped it round his legs to demonstrate the force required for adequate CPR. Was fascinating to see, pretty mental bit of equipment! I think he only agreed in the hope of impressing the ladies... !!
Later on in the afternoon had yet another alcohol related case in, this one in pretty bad shape. Needed a lot doing, cannulated/bloods/group+save/cultures, fluids up, full examination from the docs, consultant around. Can't really write that much, they would be staying overnight. One really confusing thing came up - two people of the same name had been treated in the department today, both of whom had xrays! So when looking up the image had to be really careful that got the right person, as same name on the same day - happens quite often up here apparently because of the ubiquity of certain clan surnames.
Left just after 1800, walked into town to a restaurant called Digby Chick where some of the juniors were meeting for dinner. Arrived at 1830, first one there as they'd all been held up in the hospital! Before long got sat down and ordered, they have a great deal where get 3 superb courses for under £20, and the food was sublime. I went for soup of the day, a chicken main and then gorgeous treacle tart desert, all immaculately turned out. Well worth the money, and great chat with the docs, finding out what brought them all to the island.
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| Mmmmmmmmmmmmmm, sublime treacle tart desert! |
Wondered back, bumped into my new neighbour whilst coming into the flat. A guy who's just about to start nursing here - there's a Western Isles campus run as part of University of Stirling. So here's just at the start of a 3 year course on the island! Had a brew and chat with him before turning in for the night. Really interesting day, learnt alot of useful stuff and covering lots of common emergency and also routine presentations. The responsibility you get given here is immense, and sometimes pretty daunting. Yesterday the patients were generally less serious than today's, so I felt comfortable doing stuff whereas today the cases were potentially a bit more serious, especially the last one, so I was glad to have the other docs around to check what I was doing and seeing the patients too. Really feel like part of the team, and like I'm doing something useful - got good feedback from some of the juniors today and good teaching from the consultants. It's fantastic here so far, very well supported even though being pushed to take on more responsibility than ever before!
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