It was 22:30 and I was having a half hour chill in front of the guesthouse TV before bed. Just as Dr House was about to reveal his latest elaborate theory I suddenly became aware of pots and pans wrattling about in the kitchen. I froze and listened more closely. I heard a few squeaks and a few more clatters. The only way for me to get out of the lounge is through the kitchen where the noise was coming from, through the dining room and up the long corridor to my room at the end. The clanging and squeaking was drawing closer and I knew at some point in the ensuing couple of minutes I was going to encounter a rodent. I was trapped, no way out and i stood up from the couch and held up a pillow ready to wield it when the rodent came through the door and came after me. Its a good job I was wearing brown boxers. After what seemed an eternity 3 creatures in the darkness charged through the door into the living room. i started to make cat like noises in the hope that I could divert them away from me and jumped up and down to make my presence known. They darted in 3 seperate directions under the bookshelf, sofa etc I could hear them still in the room and in a moment of panic I ran, and never looked back. I banged my bedroom door shut. All night I kept thinking about the creatures and swore I could hear them in my room. I was later told they were probably shrews. I honestly dont mind what they are, shrews are rats with pinty noses and carry the same level of menace. Just as I was falling asleep a cricket flew into my face at some velocity and i screamed. It was an uneasy night.

As far as the medicine has gone so far things have been jam packed. I watched my intern Mahesh do a lumbar puncture and when we arrived in emergency he said "right you do the next one". I have never been taught the art of LP however i figured "why not". Using only what I had seen I did the next lumbar puncture. I would have never have got to do this at home! In Nepal they use no local anaesthetic which I find quite brutal. Quite often the patient is in agony as you slowly advance a needle into their spinal column. This must be a financial decision, but how much does 2ml of lignocaine really cost?

On the ward I saw two patients with alcoholic liver disease bleed to death. It seemed so unnatural to say "there is nothing we can do" but this is the reality in the medical ward here at Tansen. End stage alcoholic liver disease is a terminal diagnosis. I found the cheapness of life quite frightning and in my view both patients died in undignified surroundings as every man and his dog peered in and around in the final few moments. I don't know if I can get used to that.

I am seeing and learning so much.

Tonight we had a table tennis tournament, I didn't win a game. Pathetic. I can only improve!

A lot of houses have there own 'Didi'. This is like a maid. Mine is called lakshmi and she makes me huge cakes that I gobble on all day. im going to try and bring her back to university to look after us next year although I am not sure whether she will be able to get a visa. I am happy to fight this out in court.

Much love