Day twenty-four - Wednesday

Alarm went off 0650, rapidly decided that was not happening. Back to sleep, woke up at 1330! Awesome, gotta love 13hr catch ups. Morning coffee/porridge ritual, during which I opened the curtains to realise that the sun was shining outside - quickly plotted a route up Glen Nevis and hit the road. Got stuck behind a Fiat doing 25mph on the road the whole way, frustrating.

Set off in my running kit from Achriabhach around 1500ish, headed up Allt coire a Mhusgain, sun was out, extremely wet underfoot. Basically running up stream beds most of the way! Hit the zigzags and popped round a corner to see a herd of deer munching away on the opposite scree slope. Got to the bealach by Lochan Coire nam Miseach just over an hour after setting off, then turned west for the steep climb up to the summit of Stob Ban at 999m. Couldn't see a thing from the top...

A sunny Glen Nevis

What a mountain!

Deer!

Looking east to the Devils Ridge, the second half of the Ring of Steall

Amazing cloud on the flanks of Stob Ban

Summit of Stob Ban, thick cloud

Followed the ridge along to Mullach nan Coirean, the second Munro of the day at 939m. Occassionally the cloud cleared to give glimpses south, but then closed in and started raining, soaked by the time I reached the summit. Started the descent off to the north before following the ridge down to the east. Awesome descent, legging it down alongside the deer fence. Got very wet at the bottom before crossing over the fence then following an incredible track through some felled forest - dropped about 200m to the foresty track. From there cut down through the forest on another great track to emerge out right by the car, just under 2h30m after setting off! Satisfied with that!

Occassional clearings in the cloud...

Dropping down into Glen Nevis, finally emerged from the cloud!

Drove back along the glen, and with no Fiat to slow me down I fear the black box might not have been too happy... Back at the house unpacked everything, jumped in shower and consumed an unhealthy amount of pasta. Caught John outside, mentioned I'd been on a run and he promptly asked if I fancied doing a half Ben tomorrow as he's in training for the Ben Race. Probably a good time to mention that he's done the race for 24 years, and every year has completed in sub 2hours. That's up and down. Ben Nevis. Said I'd been keen, will probably regret it tomorrow!

2013 World Bag Pipes Championship, enough to push the One Show off BBC One!

As BBC One had been taken over by Scottish men in kilts I headed to the Crofter with Brett and Tom to watch the Arsenal champions league game - won 3-0, great result. Chatted about how quick the 4 weeks at the Belford had gone, only got 2 more days!

Day twenty-three - Tuesday

Dragged myself in for the board round at 0830, shattered after the late film night. Thought today might be a bit of a write off as was so tired, quite how wrong I was! Went on the surgical round, no patients on the CAU so straight onto ward 1. Here the combined assessment unit (CAU) is essentially a place where people come if they come into A&E too sick to go straight away, or are referred in by their GPs for either investigations or routine stuff like venesection and infusions. Ward 1 works as a rehab ward, and ends up being mainly a geriatric ward from what I've seen, with lots of patients there having multiple health problems and awaiting transfer to nursing homes or similar.

Caught up with the exotic wound from yesterday, it was looking much better after the debridement and the consultant was discussing the therapeutic use of maggots... Sounds gross but apparently is very effective in cleaning dead material from wounds, much more so than surgery. The larvae can be bought in tea bag like containers, that are then left in the wounds for a few days to remove the non-viable tissue, leaving a clean healthy healing wound... Fancy it anyone?!

Pippa and Eleanor were leaving today, they were the two Edinburgh students on placement. They'd baked lots of cakes! Sadly they were going back for an exam on Thursday. If either of you are reading this GOOD LUCK! Eleanor's coming back to Fort William for surgery, she'll have an awesome time as the teaching's really good and they get you involved, as I experienced again today...

The theatre list started with a lap chole, a procedure I'd now seen a few times but each one is different. Same threading of the cystic duct, removal of the gallbladder. Then my patience was rewarded by being given the opportunity to suture up the right sided incisions - subcuticular stitches again. After that a chill in the coffee room with soom food to refuel, before another hernia operation = awesome, started to get the hang of these things now! Got to suture up that one with a straight needle and subcuticular stitches - getting better at it now.

Time for lunch after that, so made my way up to the canteen where scotch broth was the soup of the day. Pretty stodgey but tasty. Hollie, on of the GP STs, then 'assigned' (/forced upon) me a patient who had just come into the CAU, so after eating I dutifully made my way onto the ward to clerk them in. The history was slightly tricky to establish, however I examined and then documented everything, including what I thought was going on and a rough plan of action. I discussed it with one of the F2s, they agreed with all of it and added a few extras, before allowing me to just get on with implementing it! Sent off some bloods and arranged the investigations. Really satisfying to got through the process. At least it is when I only have to do one at a time, unlike the juniors who have to juggle many patients at once!

It was nearly time to head off when an emergency patient came in via A&E needing an operation. So I headed back to theatre for the third time of the day, and my persistence was again rewarded with more subcuticular suturing!! I love being in theatre, the people are great and the work is so enjoyable, just being focussed on one task and everyone there sharing the same goal. Had a good chat to the surgeon after, got some tips and good advice.

Finally made it out of the hospital and back home, shattered but content. Baked potato then quick trip to Morrisons to stock up. Skyped folks before the final installment of Lord of the Rings - epic in the best sense of the word! Early morning tutorial tomorrow, gonna be a struggle...

Day twenty-two - Monday

First thing in the morning I took my car for its MOT to a garage in Inverlochy, a place recommended by my hosts. Bit nervous, as this was the first time I’d taken it for a checkup! I walked into the hospital just after 0830 so missed the board round but went on the surgical ward round. I wasn't the only one missing as Tom had gone off to do the Ring of Steall, an awesome ridge walk up Glen Nevis that I'd done last summer. Nipped up to surgery quickly to see an exotic wound get debrided – was quite gruesome but satisfying to watch, as it looked a lot cleaner after finishing! After returning to the ward I found to my horror that my colleagues had divulged to the junior doctors that I hadn't yet 'got round' to doing an IDL - a discharge letter that that involves trawling through all the patient notes and manually entering all the information into a computer system.... a thankless task but one that needed doing. It is fair to say that I was dropped in it by the others!

30 minutes later I was free and went to see a patient recently admitted; I took a history and did a brief examination. They had an abscess that needed surgical drainage. After presenting the case to one of the doctors, we came up with an action plan and I cannulated, sent off the bloods and explained the situation to them. Seeing as they were going up to theatre later that afternoon I decided to follow them through the whole process. It was a good opportunity to do the complete ‘patient journey’ from admission, clerking, investigations and definitive management.

After nipping upstairs for some lunch I returned for the operation, before which the patient was anaesthetised with a nerve block rather than a general anaesthetic. The op was over fairly quickly and went well - didn’t get to scrub in on this one though as not much to do. It involved de-roofing the abscess and removing the dead tissue/slough to enable it to heal from the bottom upwards, a process known as secondary intention. After that they went off to recovery and discharged back to the ward for observation. Satisfying to have been involved in every step, and to see them come in with a problem, be assessed and managed definitively in the space of a few hours!

The day was over by the time I got out of theatre so I headed over to Inverlochy to pick up my car... It passed! And although I did have to purchase a new part, it was a bulb at the price of £1! Awesome. Back to the house for a quick violin practice and some pasta. Had a moment of realisation when practicing the Bach Double Violin II part that I'd accidently printed off the orchestral violin II part rather than the soloist violin II part - thought it was a bit too straightforward!! Massively overreaching myself, but fun to try the piece and get in under the fingers.

Had to wolf down my pasta in the end as John offered me a tour of the Lochaber mountain rescue team base - an opportunity I wasn't going to miss! We headed over in his van and he gave me a tour of the entire base, awesome! It's a brand new building just north of the hospital, in the middle of an industrial estate type area.

John Macrae, my host, outside the shiny new base!

Our enigmatic clinical lead and team doctor, Brian Tregaskis

The nerve centre of the base

Started off with the meeting room aka 'departure lounge' where the team all assemble following a call out. He took my through the ops room, explaining all the radios and computer tracking systems they can use. Some photos of helicopters on the walls prompted a story of a crash nearby, where they were actually filming a documentary at the same time. Youtube here: http://www.youtube.com/watch?v=rWUT2iLvZos. Then over into the gym and garage, complete with mini climbing wall - mainly for training purposes.

John in his younger days, far left. Been in the team since age 17!

The kit lockers, always stashed ready to go

Downstairs John took my through his locker and all the equipment he keeps down there, ready to go in case of a call out. Then onto the gear stores, full of rigging equipment, medical supplies, ropes, torches etc. Lastly a quick shifty round the vehicles and poke around the swanky facilities. Great to get the chance to have a look round - struck me as very similar to Kendal MRT's base, albeit much larger.

400m static rope on a spool - one of these is hidden in the bottom of the summit shelter on the Ben, not something most of the punters realise when walking past! Would be able to lower a casualty to the bottom of crag from pretty anywhere on the north face in one lower

Stretchers with wheels, for the tourist path

We got back to the house around 10ish, and I'd heard that Lord of the Rings: Two Towers was on in the doctors accomodation at the hospital so I headed over, on the way picking up some chips/cheese/curry sauce to satisfy my hunger. When in Rome (/Scotland)... Massively stunk out the room, probably to the annoyance of everyone else! Matt provided cakes for deserts. Got filled in on Tom's day too, didn't manage the ridge as once up on the ridge it was blowing a houlie and he couldn't carry on. After the film walked back with Brett, back home by 1am. Great day!

Day twenty-one - Sunday

So I’d made plans to drive over to Knoydart way today, and climb Sgurr na Ciche. This involved getting up at 0830 however, and when my alarm went off it was raining outside and I needed little persuasion to discard my phone and bury my head under the covers again. Around 3 hours later my day began...

After a lazy Sunday morning (/early afternoon) breakfast I wrote up my post from the ceilidh last night before hopping into the Polo and setting off towards Arisaig, on the road to Mallaig. It was still spitting rain and very windy – secretly I was glad that I’d not gone for the walk, even if it had been more out of laziness than planning! The drive was spectacular, along the banks of Loch Eil. The colours were spectacular; the bright oranges on the rocks around the shore giving way to deep greens of the pine forests before the greys and browns of the tousled tops of the hills – Scotland is so beautiful in its wildness.

Before long I arrived at the Glenfinnan memorial and viaduct. There’s a little visitor centre there, which I managed to park up in avoiding a ticket! The view was amazing down Loch Shiel, one of the deepest lochs in Scotland. The north ridge of Sgurr Ghiubhsachain (849m) looked impressive, and the whole place exuded a deep sense of calm. Looking the other way was the equally impressive Glenfinnan viaduct – the scene for the Harry Potter Hogwarts Express train journey.

Further along the road the next spectacle was near the Prince’s Cairn, where the road emerges from the land to weave a path along the brink of the sea, and in the process passing under a smaller rail viaduct, framing the view west along Loch Nan Uamh. Wow. Continuing north I turned off left to Glenancross a few miles short of Mallaig. After a quick stop to paddle in the golden sands of the Morar Sounds I parked the car in Glenancross and set off up the highest nearby hill, Beinn an Achaidh Mhoir, at the modest height of 88m. The summit gave great views of the beaches and across to the islands of Eigg and Rum. I also caught my first glimpse of the Black Cuillin, this time shrouded in rain clouds.

Bahama's eat your heart out!

Amazing deserted beaches! Rum in the cloud, with Eigg on the far left

Not a person in sight

I descended the northwest side to gain a fantastic sandy beach, empty. Strolling along the sands, looking out towards the islands with the ferocious winds feeding the waves crashing into the rocks I couldn’t believe I had the whole place to myself! After rounding a rocky headland I caught sight of the main attraction, Camusdarach beach, one the best beaches in this area of Scotland. Walking along that stretch of sand there were some gorgeous border collies out – three adult dogs and a puppy that must only have been a few months old, probably having its first taste of sea air! I want one...

The dramatic outline of Eigg

Back in the car I headed down into Arisaig town, before enjoying the drive back to Fort William. Possibly enjoyed it a little too much, and my thoughts occasionally turned to the black box sitting in my dashboard, wondering how the last corner would affect my weekly rating! I had one installed as part of my insurance, as it halved the cost of a year’s insurance. So far my scores haven’t been too bad, although trying to keep pace with the BMW infront along the banks of Loch Eil may have dented them slightly for this week.

I nipped back to the house briefly before heading to the Crofter in town for a Sunday dinner with Brett, Tom and Eleanor. The gourmet burger went down a treat as we watched Barcelona smashing their opponents in the Spanish league, 6-0 at half time... Drinks continued at Cobbs bar afterwards, where the conversation encompassed everything from personal happiness to religion, good light discussion topics over a pint! Tom provided the lift back to the house and I managed to catch John for a quick catch up. Skyped home and then MOTD2, first weekend of the premiership – always comes around so fast. Had to watch on iPlayer though as they had Scottish football first at 2230 followed by MOTD2 at 2315 on BBC! Outrageous. Car going in for MOT tomorrow...

Day twenty - celidh Saturday

Very lazy start to the day, eventually got out of bed at 1230... Coffee/breakfast and listened to 6Music for a bit. Did about an hours violin, not as good today. Think I need a proper chin rest, it's getting a bit annoying as violin moves around when I'm changing hand position. Also my bowing is just terrible, fingers are fine but the bowing is so different and I'm finding it really hard to get a decent sound out. Probably holding it wrong too!

The main event of the day was the ceilidh in the evening, which initially I hadn't planned on going to. I sought some advice from my sister and she persuaded me to go, bona fide scottish ceilidh, might not get another chance! I was picturing a grand hall, with big ceilidh band and a caller, and I'd heard food mentioned...

Bagpipes are pretty loud when you stand this close

All of us students went in the end, I got a lift with Tom along with Brett and Helen. After following Eleanor down a few wrong turns we eventually found the ceilidh. Following the dulcit sounds of the bag pipe helped (cue cringe English photo next to a bagpiper, thanks Pippa!). Held in a community hall, as soon as we walked in realisation dawned that we may have misjudged it slightly. Brett made the apt comment that we may actually have been bringing the average age up, a clue being the selling of small bags of sweets on the reception desk. After navigating through a sea of children we settled at a table, complete with fake candle (no fire risk for the children) and spill proof paper lining.

Once the evening got going however it was actually pretty good fun. The ceilidh band were local kids, one accordian player and two violins. They did pretty well, could have used some drums (which did arrive later on). A few dances down, we then got stuck into the finger buffet food. I felt like I'd regressed to a primary school disco! Paper plates included. Also the ceilidh band didn't have a caller, but in true scottish style 'nay bother' - turns out all the scots in our group learnt celidh dances in PE!!! Unbelievable. So they were teaching me the steps the whole way through. Good life skills really, would have been more fun than the bleep test.

What country am I in again? Oh yes, the 10m wide flag on the wall...

Following food we had an insight into the public health problems facing Scotland. The first of the so-called 'games' involved gambling kids competing against each other to win a bottle of Ben Nevis whiskey in a game of pound coin curling - they all stand about 10m away and roll a pound coin towards the bottle of whiskey, the closest coin winning the bottle. Silver lining = all procedes to mountain rescue!

After the nuturing of future gambling/alcohol addictions we were then treated to an acapella performance of two traditional songs in Gaelic. Although being pretty random and initially slightly awkward, everyone listened attentively and massive kudos to the woman singing on her own, I wouldn't do it! The whole evening felt like I was watching the efforts of the locals people to preserve their heritage and culture - men in kilts, singing in gaelic, youngsters playing in the band. Was nice though, and I was glad I'd come along in the end.

After an exodus of the youngsters (well past bed time) the second half was a bit more racous with faster tunes, faster dancing and the arrival of the hospital consultants. They've obviously got the right idea - avoid the kids/picnic food at the start and just rock up for the drunken dancing and merriment! More dancing (boston two step, stripping the willow, the orkadian and one to do with a homosexual/happy man named Gordon) before we finished off in true Scottish style with a rendition of Loch Lomond.

Got a lift back with Tom again - drove past the consultants walking home and gave them a quick beep on the horn. Quite amusing! Listened to some phat tunes on the drive back, one being Jessie J's new track: http://www.youtube.com/watch?v=hjh_y25vCMk - crap verse, great chorus! Hit the hay at 0030, fun evening!

Day nineteen - Friday

Up early again, in for tutorial at 0745. Managed to get up before 0730 for this one though! ECG's by one of the consultants = really useful recap over third year stuff, definitely brought a lot of it back. Was taught really well, informal atmosphere where we could ask questions and really interactive. Annoying wasp in the room though, I attempted to swat it but missed, just had to put up with it buzzing around for the 45min session!

Board round 0830, then went on the medical round this time. Following that nipped up to the canteen for a bacon sandwidge mid-morning snack (ok, early morning). I ran a few errands on the wards before clerking in a patient referred in by a GP, who turned out to have quite a complex medical history. No-one seemed to know what was going on (me included) so after presenting to one of the docs I sent off some bloods to the lab then it was time for lunch, soup and apple crumble!

Back on the ward, went to see the mystery patient with one of the consultants. Quickly recapped the history, examined and then came up with an action plan. After sorting out the prescriptions and documenting in the notes, the patient was free to go. I then headed up to theatre to see an A&E admission that needed an op on a penetrating injury. Scrubbed in and got involved, the surgeons are all really nice here! Explained things as they went along, answered my questions, allowed me to participate and feel involved = great. The rest of the theatre staff (ODPs, scrub nurses etc) have always been very friendly, prompting me to get involved if I’m hanging back a little. Very supportive atmosphere. This was the same surgeon who earlier in the week had run a fracture clinic and done a list of scopes, now doing trauma surgery. Such massive variety – requiring such a large skill base. Going to be difficult to replace surgeons like this once they retire, as new trainees won’t have anywhere near the same repertoire of operations.

Following that patients surgery it was pretty much time to leave. I headed back to the house, did 30min scales practice on violin then onto a BBQ at one of the consultants houses in the evening = great evening! Weather managed to hold for the outdoor grilling of chicken/sausage/burger before we retreated inside for a piano based sing-a-long session led by one of the enigmatic consultants here. Lots of barriers got broken down – can’t imagine ever going to a similar thing anywhere else, where medical students, juniors, STs and consultants are all grouped round a roaring fire and a piano, singing borderline-offensive ‘traditional’ Scottish songs = hilarious! Great for getting to know the new F2s and STs a little better too. Rolled back to my accomodation at 0230... (hence why I'm writing this the morning after!)

Day eighteen - Thursday

Up at the more amenable hour of 0730, in for the board round at 0830. Followed the surgical ward round afterwards, which was pretty brief, before the surgeon mentioned the theatre list today and wondered if anyone wanted to go. After checking with the other two students on the round I headed back up to the theatre end of the hospital for another day in surgery!

The first two cases on the list were the same operation as one yesterday, however the approaches by the surgeons were radically different. Yesterday I'd had the chance to close on of the incisions with continuous sutures, and mentioned on the blog that I really wanted to practice subcuticular - then just like that today I got offered two opportunities in exactly the same situation! Amazing. First one the surgeon started off and I finished the incision, using a straight needle and very thin suture material. The stitches go just underneath the top layer of skin - it's quite tricky to get the balance between not poking out of the top of the skin but also not burying them too deep in the dermis. They run along the sides of the incision, and you alternate which side they go in with each stitch, so that when pulled tight the wound closes with no stitches visible = much better cosmetic result, with no puncture marks at either side of the scar. At the end there's a neat trick to tie of the knot and then bury it under the skin, good to learn. With the second case I had the chance to practice again, gradually started to get the hang of it. Felt more straightforward than the previous time I had tried on a post C-section woman!

Whislt I was concentrating on the surgical side there was an interesting anaesthetic event with one of the patients, where they had put a laryngeal mask airway in but on getting into theatre it wasn't working very well. This led to some problems which if left unsolved could have been really bad news for the patient - however it was quickly identified and rectified with some rocuronium (a muscle relaxant) and intubation with an endotracheal tube. Minor panic over! It's amazing though, as if you weren't really paying attention you wouldn't have realised anything was wrong - the anaesthetic team were so cool. Very little phases anaesthetists, and in this case even though it had potential to be very serious everyone managed it in such a calm way that I barely realised anything had happened! One of the things I really like about anaesthetics, the ability to be calm under pressure.

Coffee break and some food, then onward with the theatre list. This is one aspect of theatre's I really like, having intense well defined periods of activity, interspersed with chill out breaks where everyone involved gets the chance to sit down for a few minutes, have a brew and get to know each other. There's rarely a time on the ward when everyone is free at the same time for a quick break, it just doesn't happen. In theatres though you have these discrete periods of time where you can totally relax, before the next case starts and you have to get your game face on and concentrate. I like it, and the day absolutely flies by!

There were a few minor procedures on the list before the last big one, another laparoscopic cholecystectomy! I was cameraman, manouevering the camera around in the abdomen whilst the surgeon was using the instruments to perform the operation. Incidently after scrubbing in for this I spent 20 minutes with the scrub nurse, who kindly took me through all the instruments on the trolley. Everything has eponymous names - Langenbecks, Cockers, Babcocks etc. Getting to know them is a bit of a challenge! There was a really awesome bit in this operation where, using the tiny laparoscopic instruments, the surgeon cut halfway through the bile duct and then threaded a tube into it, all to inject contrast and take an xray of the draining system. It's quite hard to appreciate what happened without seeing it, I've tried to think of an analogy to explain it but can't! Very impressive in reality though, especially when done at speed. After the operation was done I got the chance to suture up again, this time using subcuticular horizontal mattress sutures to close up the small ports - another new stitching technique for me! Learnt so much in theatres this week, been a really good experience working with different surgeons and having the opportunities to practice a bit of suturing. I'm seriously considering surgery now as an option, more so than in the past. Will have to start looking into it once back in London.

After the list was finished I went back onto the wards, when walking down the corridor I spotted a patient I'd seen in the first week but had been discharged - now they were back! Had a quick chat and then read his admission notes - same reason for admission this time as last. Hopefully we'll be able to forge a more lengthy solution this time round. With it being a Thursday the evening tutorial was conducted at Cobbs after home time. Good chance to unwind and discuss the day, and later on be regailed with outrageous stories of Belford-ians past. Quick Morrisons trip then home, dinner and chill. Rhod Gilbert work experience on TV, attemptimg to be a scout leader for a weekend camp - very amusing! Great day, great week so far, only got one more to go after tomorrow!