“The sky is just big, I can’t explain it, you’ll see when you get there”  – Orkadian farmer

I found out how true this was a few days ago as we arrived here in the Orkney Islands. The people are magnificent, the community is inspiring and the sky is certainly big.

We’re on mainland Orkney, an island belonging to an archipelago off the northeastern coast of Scotland. I came here for a rural generalist experience and by crikey is it rural and general. Balfour hospital is the hub of medical care for the Orkneys and a good dose of rural GPs are scattered throughout the mainland and the isles (translation: islands).

Balfour hospital has seventeen acute beds, one theatre, an A & E (translation: ED), a three bed HDU, a large rehab ward and a dialysis unit. I could also list the various doctors that staff the hospital but that would not do justice to the variety of roles that they take on. For example a surgeon may carry out a caesarean section and GPs may staff the A & E.

Our unique experience here starts at the beginning of our day, when all the doctors in the hospital gather in one room to discuss acute cases, complex cases and imaging from the previous day. This is also used as a teaching opportunity, to highlight acute management points for the junior staff (and what to do when the on-call doctor lives 20 minutes away on his sheep farm).

We take the lead seeing patients on the rounds while the consultant scribes and steers us in the right direction. After the round we share the jobs for the day and see patients in A & E (with an excellent cooked lunch somewhere in the middle). On day one we were greeted with ‘you can carry the pagers, but we’ll give you a day to settle in first’ – so we’re not short on clinical experiences out here.

Everything comes through the doors at Balfour. The variety of cases I‘ve seen in just a few days has been fascinating. I won’t go into detail about the various presentations, given this is a very small community. But hopefully I can give you a sense of what the work is like, what the challenges are, and how well these stoic folk take care of each other.