Northern Exposure
First day.
After 3 days of shadowing and probably being quite annoying to Mike, the outgoing GP, it was time to hand over full responsibility to me. It was a Thursday morning, and we met at Unst Health Centre at half eight for a relaxed handover. The idea is that the outgoing locum can then leave by 10am to head to Lerwick on the main island, for the evening ferry back to Aberdeen.
He had helpfully written a list of concerning patients and follow up plans which was very useful, as within a few days I had been in touch with quite a number of them.
The car keys and controlled drugs were all signed over to me, and I kid you not, by 9.03am the doorbell goes with a patient saying “It’s an emergency, I’ve chopped my thumb off.” Thankfully Mike was still in the building and was able to guide me through my first ever case as the island’s GP!
A 23 year old man who was working on Unst but resident down in Lerwick had arrived in his lorry and within 5 minutes of starting work had a large sheet of steel fall onto his hand and sever half his thumb off. He was so calm and surprisingly not in much pain despite the mashed up (technical term) nature of his left thumb. So Mike put in a digital nerve block to numb what was left of the thumb, as it was highly likely it would become very painful in the next couple of hours which is how long it would take to get him to the Emergency Department. I put in a cannula (the lad made much more of a fuss about this than his thumb - and I didn’t even mess it up. I got it in first time, so can’t blame me for that one!), he had a stat dose of intravenous antibiotics as the bone was exposed and a dose of tetanus vaccine. The wound was covered with tranexamic-soaked gauze to reduce the bleeding and a make shift dressing was applied. He was packed off in the island’s only ambulance to ED after I called them to let them know.
When I say ambulance - it is an old fashioned truck with two first aiders. So a step above a taxi, with an amazing response time and it also has priority on the inter island ferries.
You can see why a lot of the locals are keen for tunnels to be built between the islands - there is a campaign getting some traction for this, especially with the new Saxavord Spaceport on the Island (not sure how you transport a satellite on the small ferries?).
The rest of my day was not entirely stress free. There was a teachers strike so the Practice Manager wasn’t at work, having to look after her kids. Inevitably I had usual IT teething issues and was not able to prescribe or refer anyone for most of my day - the receptionist did her best to sort it out and we got there eventually. Everything took twice as long as it should have done and I got home by about 7pm (which is early compared to my normal GP day in Dorset).
I managed to eat my dinner and no sooner had I put my fork down the home phone went. It was the community nurse on call asking for advice about an elderly lady who’d had a couple of falls and was acutely confused.
This is much more my cup of tea and comfort zone…. so off I went in the dark, to a house on the south of the island (it was the one with the “white wall and iron gate” - amazing I found it so quickly 😂). The lady, we shall call her Ethel, not her real name, was born and bred on Unst. She had the most amazing dialect and as a result of being a bit deaf she couldn’t understand anything I said and I couldn’t understand a word she said. Fortunately, Donna the local nurse was able to translate, backwards and forwards. In the end we all decided that admission to hospital was going to be the best option for Ethel. She was adamant she wasn’t going to the local care home so she was also packed off in the ambulance to Lerwick. A busy day for the ambulance crew.
Peerie means small or wee, ken means know and du means you, that’s the extent of my Shetland dialect knowledge so far.
At the end of what turned out to be a long day, I felt a sense of relief to get back to our house at about 10pm which was quickly replaced by the dawning realisation that I was still working and now I was fully on my own for the rest of the night.
I was so tired I actually slept all night - I’d anticipated not being able to sleep, worrying about the phone going off. Thankfully this hasn’t turned out to be the case. The peace, darkness and cooler temperatures seem conducive to a decent amount of shut eye.
My husband pointed out that I need to try and pace myself - there’s 19 more days and nights to go. I’ll let you know how that one goes in a couple of weeks time.
To end this chapter, current view from the bedroom:
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