Tuesday, 20 October 2009

Another weekend, another excursion

Do you realize that I come home in week? How ridiculously fast has this trip gone?

This past weekend Lizzy came up to Edinburgh for the weekend. I had been saving a lot of my local “touristy” things for this weekend as it was good to have someone else to do them with rather than traveling alone again. Friday we took a daytrip through Haggis Tours (Stoner and Helter will remember them from our last trip) to see Loch Ness and Glencoe. If you haven’t seen the facebook pictures yet then stop right now and go take as look, because the scenery was absolutely stunning and we had as bright and sunny of a day as they ever get in Scotland. Note: a bunch of the pictures have a dark blue tint to them as they were taken through the tinted windows of the bus.

The trip started early on Friday (here’s the link to the path, we did it in reverse: http://www.haggisadventures.com/Scotland/Day-Tours/Loch-Ness.html). Much of the day was spent on the bus, which at first sounds horrible, but turns out to be amazing. The tour guide was a native Scot named Dan who spent the entire day telling story after story regarding the history and geography of what we were seeing, as well as an endless number of jokes. The scenery was amazing and even Dan said he had never been on this trip during the fall while it was this sunny. Most of the land we were driving through was devoid of any signs of human inhabitation, a fact most people love about this area. I’m not so sure where I fall as far as that argument, because this land used to be absolutely teeming with highlanders. Almost all of them were driving out of their ancestral homelands during the 19th century highland clearings and the area has clearly never recovered. Even the towns that still exist are beginning to fail as their younger people head off to university and never return, and who can blame them? There isn’t much in the way of jobs there outside of tourism or what few farms are left, and so the younger generations are all heading off to the city. Dan did tell us that there have been a number of government efforts to repopulate the land but I wonder if that will ever happen. It reminds me of the empty spaces up in the mountains in Pennsylvania, places that used to be thriving but have all but become abandoned since the coal and steel industries have moved elsewhere. I found myself saddened looking at the country side and wondering what it would have looked like a few hundred years ago, with clan dwellings and animal herds spotting the landscape instead of an empty (but beautiful) landscape.

Anyway, enough of my pondering and back to the trip. First stop was a little town called Dunkeld, consisting of not much more than an old half ruined cathedral sitting next to a river, and it was STILL a wonderful stop. I am in love with old stone buildings, and you don’t get much more picturesque than this. It sits right in the bend of the river Forth overlooking a beautiful stone bridge and looks like something pulled out of a movie. Apparently we were making good time to that point because afterwards Dan took us on an extra stop to the site of a Scottish War Memorial, though not for the memorial. It was our first view of many of the mountains of we were going to be driving through that day, as well as Ben Nevis, the highest point in the UK (those are the pictures of the mountains that end looking at a parking lot with an RV in it…I promise I’ll get around to tagging them some day). We hoped back on the bus and headed to Fort Augustine and Loch Ness for lunch and a boat tour. I didn’t come to Loch Ness the last time because we decided that the only people who went there were stupid American tourists looking to be amazed by some stories of a Loch Ness Monster. I couldn’t have been more wrong. The loch is HUGE, several hundred feet deep in some places, and bordered by sheer cliffs on both sides throughout most of the portion that we got to tour. The water appears almost black due to the runoff from the peat bogs that surround it, which apart from reducing the visibility through the water to almost nothing (and I’m sure ,fueling the legends about a monster) has the effect of turning the loch into a perfect mirror. A boat ride of an hour felt like 10 minutes as I did nothing but take in the surroundings. It’s amazing I even remembered to take pictures, so check them out.

After Loch Ness we had one more small detour before driving through the amazing Glen Coe. We stopped next as a small town called Inverlochy to see the remains of 13th century castle again positioned in a bend in the river on beautiful ground (got to give it to the medieval Scots, they knew their landscape). It was at this point that I decided that although we were in the middle of nowhere and at least an hour bus ride from the nearest hospital, it had apparently drizzled here a bit that morning and the stones were wet, the walls of the castle rise about 20 ft high, and I have poor health care covered here, the best way for me to experience the castle would be to climb to the top….obviously the owners of the castle had experiences with stupid kids like me before and all of the easy ways up were gated off (though I would like to let the organizers know that all this did was force me to find more dangerous routes to the top). Unfortunately the stop was short and I never made it to the top of the outside curtain wall, but Lizzy has some grand pictures of me attempting the climb and I’m sure the other travelers are now judging all Americans very poorly after watching me do it.

The final part of the day was spent driving through Glen Coe, a huge beautiful valley right in the middle of the highlands. The hills here (I have trouble calling the mountains, because they are small even compared to what we have in Virginia) jut up steeply and have peaks that look like they were carved with a knife. Apparently the land here was formed when a piece of prehistoric Canada broke off from North American and came crashing into Scotland. Most of the peaks were formed by volcanoes, which were cooled quickly as huge glaciers moved across the landscape and scrubbed the peaks clean. I can’t describe how sharp the outlines of the hills are here so you’ll have to look at the pictures to get a real idea of what I’m talking about.

Saturday we spent doing some of the things I have had on my to do list but have been holding off on. We started early in the morning and headed up to Edinburgh Castle (have mentioned I love castles?) with a girl named Kathy that we had met on the tour the day before. Not much to say here, it’s a castle, and I loved it, though if you’re here and you want to see a castle, Stirling is the place to go. We spent the better part of the afternoon on a FREE 3.5 hour walking tour of the city. I had been on this before the last time we were here but Lizzy hadn’t seen much of the city and I didn’t remember enough to be a good tour guide (plus it was FREE!). Completely worth doing again, and did I mention it was FREE? We had intended on going to a museum in the afternoon but were sort of museum-ed out after the previous weekend so we took a hike up Calton Hill. We were pleasantly surprised to discover that the sun was setting behind the castle while we were up there so I got some great pictures. After Calton Hill we had a quick bite to eat at the Elephant House, the cafĂ© where JK Rowling wrote much of the first Harry Potter book. After dinner we took a short trip to a great little pub called Sandy Bells which has a trad music session every night, and where I managed to look like the most popular kid in Edinburgh as I knew the entire group standing just inside of the door (total coincidence I promise. Just happened to be a bunch of the Triathalon club, which most of my flatmates are in).

One of the last things on my list was to take a trip a bit further north in Scotland to see the coast and the North Sea, so we decided to take a couple of hours and trek about St. Andrews (only an hour train ride away). St. Andrews is a beautiful little town that you can walk end to end in 20 minutes, sitting right on the eastern coast of Scotland, and famous for having one of the oldest golf courses in the states. I don’t play golf but it was still pretty sweet to walk the Old Course (its open to the public on Sundays because they don’t allow play on Sundays). We also spent some time walking the huge expanse of beach that sits between the golf course and the North Sea, which also happens to be the place that the famous beach scene in Chariots of Fire was filmed.

At this point most of you are probably thinking something to the effect of “Damn that sounds like a great weekend, and I’m very jealous I wasn’t there”, and you would be right to do so…but we haven’t even gotten to the best part of the weekend. Have I mentioned yet that my flatmates are awesome? Sunday night they arranged a family style dinner of Haggis, Neeps, and Tatties. The food was amazing and it again made me feel like I was part of their crew, which I have been unbelievably grateful for. I have a secret plan to force all of them to move to the states with me when I go back, but I’m not sure it will work.

That’s it for now. There’s only one more week until I fly home! Tomorrow night we’re doing a going away dinner for me and this weekend I’m heading to Ireland for a 3 day trip down the west coast of Ireland (Galway, Doolin, Cliffs of Mohr).

Tuesday, 13 October 2009

Stirling, Glasgow, London

Man it’s been a whirlwind the last couple of days. I’ll start with just after my last post. Last weds I managed to skip out on work for the afternoon (more or less with approval) and I decided to head to see Stirling Castle. I love how close everything here is, as it only took me 35 minutes on the train to get there, and was well worth the trip. First, let’s talk about European public transport…its unbelievable. I almost didn’t want to get off the train at the end of the trip. The whole thing cost me 7 pounds, there was drink/snack service equivalent to a good flight, comfortable seats, and a table to sit at. All of this for a 35 minute ride! Jumping the gun a bit I took the overnight bus to London Friday and then back on Sunday night. My flatmates all described how terrible the experience was, how small the bus and seats were, how much it smelled, and how long it would take. Wanna know what? It was better in every way than the greyhound bus I had to take home from college all 4 years I was there without a car.

Anyway, back to Stirling. Stirling castle is built on a site that has been used for a castle as early as the 11th century. It sits on the only major medieval north-south route in Scotland, commanding what was from roman times until the 1700s the only bridge across the River Forth. As such it has a huge amount of history and for much of Scotland’s past was the capital and seat of a monarch. The castle sits above a beautiful riverside town that I imagine would be a great place to retire to. The hills in this place are epic, worse than cardiac hill in Oakland, but it’s worth the climb. The castle is huge, with a gigantic cliff face on one side and the keep and massive castle wall on the other. In case you didn’t know I love all things medieval, in particular castles, so this place was a great experience for me. Take a look at the pictures up on facebook to fully appreciate what it looked like. Note: the big tower that you can see in the distance in many of the pictures is the William Wallace memorial, erected in Victorian times to honor the real William Wallace (not that crap Mel Gibson story, though it is a phenomenal movie) as he won his greatest battle on the field outside of Stirling castle. Stoner, Helter, and I visited that memorial on the last trip so when I get home I’ll dig up some pictures of it.

I skipped out of work again on Friday to head to Glasgow for the day. The only problem with being here during the school year instead of tourist-holiday season is that no one else has the time to just skip out for a day so I had to make this trip by myself. Glasgow is a very different city than Edinburgh. Where Edinburgh is a beautiful historic city that retains much of its history, Glasgow is an industrial capital, built in that way, and with many of its older buildings having been torn down at some point to make way for more industry. Apparently the town hit hard times when the shipping industry failed here some years ago and is slowly rebuilding. I took a bus tour of the city but definitely did not enjoy it as much as I have Edinburgh. I imagine it would be a great place to go out in on a Saturday night, as I’ve heard its where many of the young professionals live, but to visit I was glad I wasn’t there much longer than a day. However, I DID get to see some pretty amazing things while I was there. My first big stop was at the Hunterian Museum; made mainly from the collections of Dr. William Hunter. He lived in the 18th century and was one of the first great professors of anatomy and pathology. He also pioneered some of the techniques for preserving bodies and specimens, so people came from all over the world to see the collections of pathology that he had preserved. If you’re interested I posted many of the pictures, but if you haven’t been through anatomy lab then you probably shouldn’t look. I’ll get around to tagging what they are eventually. I finished up the day there at the Kelvingrove Art and Natural History Museum. The building is huge (see the big red building with the large harry potter style pillars) and contains more than I could probably see in an entire day. I stuck mostly to the art side as I have seen a million natural history museums and very few arts ones, and because the displays here were of art that I could actually appreciate. I have trouble with many modern art exhibits because not only do I not get them, I have trouble appreciating the skill it took to make the art. Most of the art at the Kelvingrove is in the form of paintings, with great descriptions of them beside so I actually got what the heck they were. I took pictures of all of the paintings I liked (still not sure if this was legal or not) and posted the descriptions with them. All in all a great day, but it had nothing on what was to come.

At 1030 pm on Friday night I hopped on the overnight bus to London to meet my friend Lizzie (a counselor at Camp Holiday Trails this summer, student at BC, and studying abroad in Bath). Someone else to actually travel with while I’m here? Result! It was an absolutely epic weekend. We started Saturday morning after checking into our hostel by heading to the centre of London to see the typical touristy things. Saw Westminster Abbey from the outside (weren’t paying to get in), Parliament from the outside (weren’t paying to get in), Big Ben from the outside (not even sure if we had to pay to get in, but the inside of a clock doesn’t interest us), Buckingham palace from the outside (seeing a pattern here), reenacted the scene from National Lampoon’s European vacation at least 8 times (look kids, Big Ben! Parliament! Look kids, Big Ben, Parliament…look kids…big…ben…parliament…). London is beautiful and I’m very glad I’ve gotten to see those parts of it. After lunch of traditional british fish and chips with a pint of real ale we headed off to the British Museum. Not much to say about this thing. Its huge, has some amazing exhibits of items extracted during the British Imperial expansion including a gigantic collection of Egyptian art and sarcophagi, and is probably one of the best museums in the world. I loved it, but let’s be honest, I was way more excited that we got to see Avenue Q that night with very steeply discounted tickets. Phenomenal musical even though the premise sounds a bit odd (it’s a spoof on sesame street, with the actors actually carrying puppets on stage) but its well done and with songs like “It sucks to be me” and “The internet is for porn” how can you go wrong? Loved it. We got up early on Sunday to get to the Tower of London when it opened. For those who don’t know the Tower is actually a full and proper castle still sitting in the middle of London (again, we have NOTHING like this in the states). It was the seat of power in England for much of its history, holding rulers such at Richard the Lionheart and Henry the VIII, and is still in very good condition. The castle is staffed by Yeoman Warders, persons who have spent at least 22 years in military service to England and historically were charged with guarding the castle and crown jewels but now serve as (very good, funny, well spoken, smart-ass) tour guides. Inside of the tower are the crown jewels (no pictures as that is DEFINLTEY illegal) containing the largest perfectly cut diamond of the highest clarity, an entire tower worth of Henry VIII’s armaments, and exhibits about the history of violence and hangings at the tower. I think we spent a solid 4.5 hours there and again could have spent more. The afternoon was spent at the Victoria and Albert Art museum and finishing off something we found called the Real Ale Trail. Basically there are groupings of bars in different areas of London that all participate in a program where if you have pints at each of 5 of the pubs then they’ll give you a free t-shirt. Yes it makes it an expensive, oversized t-shirt but it’s a good excuse/reward for trying local ales. We finished off Sunday night by going to see Stomp, again at a crazy discount price. I had seen it before in Pittsburgh but the show was almost 100% different so I was glad to see it again. I hoped on the overnight bus at 1130 pm, arrived back in Edinburgh at 8 am, and went straight to work.

How amazing is it that I am in a place where I can just head to London for the weekend? I love it here, but I miss all of you very much, so I hope you’ll be ready for my return in 2 weeks!

Thursday, 8 October 2009

The weekend that was: pub golf, birthday's, haggis, and music

I apologize for the big gap in posts. We’ve had spotty internet access for the last several days so I have a wee (aside: this is an amazingly useful word) bit to catch you up on. This past weekend I stuck in Edinburgh again instead of traveling, and did a bit more exploring. After I got back from Rosslyn on Friday my flatmates invited me out to their triathlon club’s Pub Golf outing. For those who don’t know what this is I will give a brief explanation. The game consists of nine “holes” (=pubs). Each has a specific drink to purchase at that pub, and your score is based on the number of quaffs it takes you to finish. Par for the hole is adjusted by the difficulty of the drink and at the end of the night the lowest score wins an entire year’s worth of gloating and a nasty hangover. Requisite in the entire matter is traditional golf clothing, with extra credit for looking as ridiculous as possible. This is me and several of my flatmates out in the middle of the night. Many thanks to Blair Tweedie for outfitting me with all of that fancy dress. Unfortunately because we got to the game late I only competed in 5 holes but I am happy to say that I did you all proud with 4 hole in ones (Guinness, ale, vodka mixer, lager), and a 2 stroke on a rather difficult par 5 two part “dog-leg” hole which required 2 Smirnoff ice’s back to back.

Saturday was jam packed. I got up and traipsed around the city, finding the hostel we had stayed in the last time as well as our (Stoner, Helter, and I) favorite doner kebab shop. Had a coffee in the Elephant House which is famous for being where JK Rowling wrote much of the first Harry Potter but I think it should be much more famous for its unbelievable view of the castle. Sauntered down the royal mile listening to bagpipers, stopping for a pint or two, and then headed home. Unfortunately I forgot my camera on this outing so I have nothing to show for it but trust that I will not make that mistake again.

Saturday night was the planned celebration for Lisa’s birthday, but first I was invited out to dinner by Sarah and the vet school ladies for a traditional meal of Haggis and Tatties. I had never tried haggis before as I was scared to death to pay for an entire dinner of what I thought amounted to the Scottish version of hot dogs. I am man enough to admit that not only was I completely wrong about this dish, I am seriously considering petitioning the US to allow Haggis to be made back home (interesting fact: it’s illegal in the states because it contains sheep lung and that has been deemed unsafe for human consumption in the states). It’s incredible. It has a texture similar to ground meat but stickier so it’s easier to eat with a fork, and tastes a bit like a spiced combination of venison and buffalo meat. I loved it so much that I’ve managed to convince my flatmates to cook it for me before I go. After Haggis I returned to my flat where a night of American style drinking games was afoot and I captained my rag tag team of mostly first-timers to absolute domination in flip cup. Went dancing with the flatmates as well as Sarah and the vet girls after that at Garibaldi’s again (same place I was at before, and just as enjoyable).

At this point I should explain British dancing, or at least my experience with it. Brits don’t dance like we do. The club plays the same music, people dress the same, there’s a pole in the middle of the dance floor at Garibaldi’s…but dancing in Edinburgh is strictly a no-contact event. Everyone just bobs up and down in the middle of the dance floor doing their absolute best not to even slightly brush their fellow dancers. As far as I can tell there are only four acceptable times for you to touch someone else on the dance floor: 1) if the two people are dating, and have been for at least a wee while, but perhaps not even then; 2) the other person has essentially already agreed to “pull” with you (note: pull is the slang word here for kissing/hooking up/dancing); 3) the other person is a prostitute; 4) you are an American that several people are friends with and see as a sort of novelty, such that dancing with you is equivalent to a tourist experience for them; 4a) you are a Brit who has traveled to America and is nostalgic for frat parties, and find yourself an American in Britain. I describe these rules in detail in hopes that future travelers to the UK will understand why the clubs look so weird, but can also find a way to take advantage of their “novelty” status.
Sunday was spent taking it easy, editing the Mulholland Clerkship report, and watching the Pats-Ravens game at the Pear Tree with the fine gentlemen I met in the Meadows last weekend. Monday was a long day at work followed by a trek down the Royal Mile again and topped off with movie night at the flat (aside: Seven Pounds is a phenomenal movie, but almost more depressing that it is uplifting).

The gem of the week so far was Tuesday night. I have been searching for a great live music venue since I got here and was finally told about a FREE once-a-month live acoustic show at a small club called Medina. Result! (coupling reference, hope you enjoyed that one) This is no lame open mic night at your local pub. This a bunch of seriously great entertainers who perform proper gigs throughout the city and some of whom tour the UK, who decide once a month to perform a free gig in a small, intimate setting for people who actually appreciate their music. The experience there was outstanding, even though we only got to hear 2 of the 4 acts. The first was an African guy who performed modern versions of traditional folk songs from his village. He sings them all in the native tongue, but his music is so evocative, and his descriptions of what the songs about so detailed, that the language barrier is not a bother and is almost a benefit. You are free to seek your own visions of what he is singing about without the intrusion of lyrics. I only wish he had CD’s to sell or website so that I could share the experience with you.

Believe it or not, the headlining act was even better. They are a 3 piece band called townhouse composed of a male bassist; a female lead singer who also plays ukulele, guitar, and an unnamed accordion like instrument that I will describe later; and another guy who plays guitar as well as what he called a “corin”. It’s a plywood box that you sit on as you play it, and inside it has different sized chambers that give different pitches when struck. Very simple instrument but I’ve seen it twice before (Gaelic storm uses it during the dueling Bodhran piece and A Good Natured Riot, which plays occasionally at Maya, uses it as their primary percussion) and this one included snares in the top chamber. The girl was an absolute powerhouse and had she not mentioned during the show that she was engaged I would likely have offered to marry her on the spot. Her voice was incredible with a ridiculously wide pitch range and packed full of emotion. She performed a solo song on a crazy instrument she had picked up in a bazaar in Darjeeling that was so good that when she finished it took several seconds for the entire crowd to pick their jaws up, return to reality, and join in to thunderous applause. She instrument looked like a plain wooden box, perhaps 8 inches by 4 inches by 3 inches. The panels on the long side fold down to reveal a squeezing apparatus similar to an accordion or Irish bagpipes (if you’ve seen them). The smaller long side contained dials which would alter the pitch. The instrument produced a constant drone similar to a bagpipe, with the dials altering the upper pitches (as many as 5 different pitches at a time that I could count). I can’t impress on you enough how difficult this instrument looked to play as there were no “fingerings” per se. She had to squeeze the box with one hand and alter the dials with the other but without fixed positions for defined notes and with the need to alter more than one dial simultaneously to not slur the pitch. I’ve never seen anything like it. Apart from the novelty of their instruments they play very good music which I will hopefully be able to post a sample of for you later (though they do have a myspace page if you care to look: search for townhouse sound). It’s a combo of indie (but the good kind); funk, a little bit of the blues, and trad music that I’ve been listening to nonstop for the last day. Incredible.

Saturday, 3 October 2009

The first week on the wards

I've told you a bit about the differences in British training, so now I guess would be an appropriate time to let you know what I've actually been up to. I showed up this past monday for my first day of work to find that the attending I was assigned to was not even in the country and the ward I was assigned to had no idea I was coming. Not a great start but it ended up working out well, as the junior doctors on the ward have been great to me.

To be honest, the day feels much like a typical day for me back at UVA, except that my hours are better (9-4!) and I don't have to preround as the medical students here are not expected to see their own patients. In fact the junior doctors are also not expected to have seen their patients before ward rounds because ward rounds are horribly disorganized and not planned out well. The ward I'm working on operates almost like an older private hospital ward, with multiple different attendings but no one "in house" all of the time as they also run clinics or work in the emergency room. Interestingly the consultants are not required to see each of their patients every day, and the junior doctors have said some of them will go an entire week before checking back on a patient. They never inform the junior doctors when they are coming to do ward rounds and when they are not, which I imagine is very stressful and leads to some dropped care for the patients. The junior doctors come in at 8 and proceed to complete their own rounds, though very rarely as a team, which again leads to disorganized care because each member of the team doesn't even know the names and diagnoses of the patients let alone their treatment plan. They do keep a sort of log of things that need to be completed but not a good database like i am accustomed to. Because I'm used to carrying more responsibility than many of the med students here they almost treat me like a junior doctor who just doesn't have prescribing power. I come in at 9 and get assigned to 3 or 4 patients to go round on and report back. If a consultant shows up I drop what i'm doing and go shadow his rounds, which has actually been educational to see how they will complete things. My only difficult experience with that was on my 2nd day when a full professor with a large personality came to rounds. He's a brilliant man, serving as a general medicine attending and a toxicologist over here, but is very intense. He also asks questions which you have no hope of answering such as "Why do I hate metoprolol but everyone else uses it" (answer:apparently in some parts of the UK up to 10% of the population has an enzyme mutation that leads to a longer half life) and "Why do alcoholics develop a macrocytic anemia even if they are not nutritionally deficient" (answer, after me fumbling in front of 10 people for 5 or so minutes..."nobody knows". are you kidding me?). He ate me alive for an entire morning during rounds, and only on my 2nd day, leaving me feeling like I had made a mistake coming here until 2 things happens: first, a junior doctor said to me "Thank you for being here today, because he always chooses the lowest person in the ranks to grille, and without you that would have been me", and second, the same consultant showed up on thursday and asked me the EXACT SAME QUESTIONS. I answered them all and he looked at me like I was some sort of genius, obviously having no idea he had asked them just 2 days prior.

My afternoons are spent doing a first H&P on the new patients, though it is much different here than in the states. Here they have both an emergency room (called A&E, accidents and emergencies) and the "combined assessment" ward (essentially a holding area for patients needing to be admitted or observed overnight, to get them out of the ER). While in combined assessment their initial workup is begun and the patients ALWAYS seen a consultant. By the time they hit the wards they often already have a diagnosis, multiple lab and radiographic studies, and a treatment plan. Our responsibilities are to continue with that plan and manage anything else that comes up, but this difference is the reason why its not quite as imperative that a consultant comes to see the patients the day of admission or even the day after, and the reason it works that the first year junior doctors are only 23 or 24.

Apart from that, the most exciting thing for me is that I've gotten to do much more hands on work than I would have in the states. I'm not doing central lines or anything but any blood draw, IV, ABG etc that needs to be completed comes to me. I've already placed more IVs in a week than I have in the last 2 years and have completed 3 ABGs. I'm hoping to get a few shifts in the A&E and Combined Asessment and perhaps get even more attempts at the technical skills.

Friday, 2 October 2009

Rosslyn...is awesome

Today I skipped out of work early (almost with permission) and with a free afternoon I decided to head down to Rosslyn chapel, only a 20 minute ride from Edinburgh. I knew of the chapel prior to the Dan Brown books, but especially after they came out I felt like I had to go see what it was all about. The ride through the country out to the town of Roslin (different spelling but pronounced the same) is spectacular. The bus drops you off a wee bit from the chapel but the walk has great views as well (see the pics on facebook, as always). The chapel itself is depressingly rundown after years of abuse and poor attempts at repair so the entire building is surrounded by scaffolding and a huge canopy. The work at restoring the chapel has been going on for several years now and is expected to take up to another decade. If you look at the pictures you'll see why. I can imagine this building once being an absolute masterpiece and an example of the best craftsman the entire world had to offer at one time. Much of that skill is still obvious but the history of the chapel is full of destruction and neglect, often due to overly zealous religious reform.

Anyway, enough commentary about what was wrong. The experience was amazing and I was thoroughly impressed by what I saw. The Chapel is huge considering the time it was built and that it was meant originally to serve a single family. Even as large as it is the original design apparently was for a chapel 4-5 times larger and constructed in the shape of a crucifix (the current building is just the top of the planned crucifix). The outside is scattered with statues, faces, and stone sconces and the pillars on the sides arch gracefully up to form what looks almost like a rib cage from some giant beast of ages past. Inside every inch of the entire chapel is covered in amazing artwork, much of it almost hidden if there hadn't been signs to direct me where to look. Beautiful flower designs are everywhere but with faces, angels, depictions of the 7 virtues and 7 deadly sins, north american maize (a mystery as it was carved 100 years before Columbus supposedly introduced maize to Europe), scenes from the bible, and graceful pillars scattered amongst them. Unfortunately there are no pictures allowed inside and it costs at least 20 pounds for the cheapest of pictures, so I can't show you how amazing it was. The level of detail inside of the chapel was astounding, and I have trouble imagining the number of different craftsmen who would have had to work on it as each of the pieces listed above is done it what appears to be a different artists. Its no wonder that so much mystery surrounds the place as much of what is inside DOES look like it belongs to some sort of secret code or society.

I didn't get there in time for a tour so I didn't get to hear any more of the history of the chapel than what I could gather from the signs and from listening in to the tail end of the previous tour (and no, before you ask because several people already have, i did not see the famous portion of the chapel where the cup meets the chalice as the rose line. The ceiling is obscured by a scaffold and is under repair, and the floor is covered by a rug to protect the floor from the pews that had been set up there for a church service. I did look though). The most interesting thing I did read is that the chapel has a vault underneath of it that was sealed several hundred years ago, and that is where many of the stories about the chapel come from. The Earls of Rosslyn have nevera llowed it to be reopened, though several years ago the current Earl did allow conservation experts to xray the vault from above to check for structural damage, and the discovered that the vault is as large underground as the chapel is above it. Perhaps one day they'll open it and when they do I'll absolutely be back to see it. All in all it was a worthwhile trip despite the fact that the entire chapel has been commercialized and the signs, movies, and docents make so many references to Dan Brown that it becomes uncomfortable.

Thursday, 1 October 2009

The british training system

I know its halfway through my first week and I haven't written anything about my experience at the hospital yet, but a you can see from my posts I've been a bit busy. I was worried about coming here and not finding anything to do but the exact opposite has been true and I find myself fighting to cut my hours at the hospital so I can just go traipse around the city.

I arrived at the Royal Infirmary on Monday morning to find out that the physician I'm supposed to be working for wasn't even in the country and the ward staff had no idea I was supposed to be there (disorganization here will be a common theme in my posts). It sounds like this happens for a lot of the students here so the staff never knows when they are supposed to have students and when they aren't. I was a bit astounded by this at first because back home the students are expected to carry their own patients and help do a considerable amount of the work and so not knowing when they are to be there would be a bit of a problem. Here however the students responsibilities are minimal, and they spend much of their time on the wards shadowing rounds. It is only in their 5th year (their 3rd doing clinical responsibilities) that they start to be given the task of writing H&P's (called clerking, pronounced in the native accent as "clarking") and still they are not expected to cover the patients in the manner I was expected (i.e. prerounding, presenting on rounds, daily notes etc.) I have not been bothered by these differences though as they have manifested in two very positive ways for me: first, no one really knows when I am to be there and what I am to be doing so I am free to take time to go sightsee or travel when I want to; second, I have just jumped right in and covered patients like I normally would have and since this is not what most students do here, I have been accepted as part of the team and gained respect quickly.

I guess now would be the appropriate time to tell you about the differences in the training in the UK vs the States (please note that these are just my general obs from my already massive ::sarcasm:: one week of experience. I am attempting to describe things only here, without judgement, as I have not come to man conclusions about how I feel about the training scheme). Over here medical school is 5 years and is normally done as the first year out of high school. After medical school there are two general years (called "foundations years", so they are designated FY1 and 2 similiar to our PGY designation) that included a variety of rotations similiar to our 3rd year. Each person completes six 4 month long rotations that cover medicine and surgery, and possibly OB, Psych, Peds, and Neuro. The responsibilities of the foundations years are similar to a 4th year medical student back in the states, except that they have the power to order tests and prescribe. However they are rarely the primary decision maker on the care of a patient and generally have much more supervision and support from upper lever "junior doctors", the equivalent term to resident. After those two years you much choose a specialty go through an application process very similar to our match, and get assigned to a geographic area as a Specialist Trainee, "ST". They spend 3 years as a general ST (essentially the equivalent to our 3 year residencies) and then go on for 4 more years in a sub-specialty. I am not completely sure how they train general practitioners, whether they stop after 3 ST years or whether they do all 7 years, but I plan to find out.

Another huge change? The weekly average hour limit for the junior doctors is FORTY EIGHT!?!

Many of the differences in the training system are due to the students starting 4 years earlier. I can't imagine having to go through boards and do the same patient care things we do back home at the age of 21 or 22. They do 2 years of all class, 2 years of clinical rotations where they do mostly shadowing, and then in their 5th year they begin to do what we do in our 3rd year though it seems with a bit less responsibility. The two foundations years are a brilliant idea, as they are essentially identical to our 3rd and 4th years with a few less rotations and the ability to prescribe. They get to be "residents" in a very real sense but still get to rotate through a variety of positions to figure out what they want to spend the rest of their lives doing. The total amount of years after high school is the same as ours would be to get the whole way through fellowship (non surgical that is) but they don't have to spend 4 years completing a first degree that may have nothing to do with their eventual careers.

So what do I think about the training here? The benefits: more total time on clinical rotations, more real experience before they have to chose a specialty, and are perhaps (though this is speculation) better prepared to become attendings their first year out. The down sides? Not as sure about this one. For me personally I was not ready to choose medicine as a career at 18, and would not have been ready for patient responsibilities at age 22. I loved my experience in undergrad and would not have given it up for the world. For those students who do a first degree and then come to medicine as a grad student it is a much longer road than for us. Largely i believe that it puts them in the same place as we end up in the end, but by a different road, and they do so with more clinical years which is a necessity with a 48 hour work week.

All in all I'm loving my time here. I'll post tomorrow about what I've actually been doing on the wards and what I've noticed about the hospital running a bit differently. I'm hoping to get into an outpatient clinic as well as the emergency room and "combined assessment" (essentially a holding area for patients needing admitted from the ER, a great idea after you've seen our ED) . I think I may also get to spend a day in the NICU and a day on the general peds floor.