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And next doctor Patrick night, uh who's going to represent the uh Caribbean contingency. And uh certainly we've been privileged to have the Caribbean contingency in our unit because they bring their rhythm there flare and uh and certainly their smiles. Thank you, Patrick often, everybody. All right. So I came here from Trinidad in 2016 and it was a unique experience, you know, I call it neurosurgery as seen on TV, because back home, I mean, we do everything we can't sub specialize. And as a registrar in Trinidad, you know, you'll be on call, you do a subdural, you do a laminectomy any morning clip aneurysm. You do a vasectomy, you go to clinic, you come back when I came here, there was a robot in the theater. I was like, what is this thing here? First rotation was with Gil. Yeah, it's a dynamic surgeon. I call him the maverick. Yeah, he could do anything. Um uh My first experience with DBS, which was like magic. You know, you see these patient's coming in wheelchairs can't walk, you know, where they come by the family supporting them. Lots of, you know, all the stress are they go through with Parkinson's and then you see them in clinic when the nurse actually switches on DBS and get all the wheelchair for the first time. They actually, they smile and they cry all at the same time. So I didn't teach them with Professor Gila, as previously mentioned. And I went to the pediatric hospital. Pizzas are high stress scenario. You know, I took it for granted because I used to think we would just treat the patient and we'll be okay custom to adult neurosurgery importers been but that's back home and train that very work. The pediatric patient's we do there will usually be myelomeningocele repair, not be patient highly any tumor's. But here in Bristol, all the all the complicated patient's come here from the whole of Southwest in Glen and all over the world as well. So you will actually have a pediatric to matter treat. And it was, you know, a unique scenario dealing with the dynamic of uh managing the patient and their parents, you know, just dealing with the stress of the whole scenario. But I had a good team of consultants at Mr Carter. Yeah, Mr Edwards. Yeah, Greg fellows, I didn't see Greg to the as yet. And you know, the dynamic Mr Ian Poeple, the Pope as we call him did I, that was good support. And um uh the last six months of my time in Bristol, you know, was, was unique because I was with, um, mister to, but he, he was busy organizing his stuff and he came back eventually, I'll talk some more about that. So this is my whatsapp picture to this deer, right? So people often ask me which airport is that? Where, where did you go? That's a, that's a hospital in England. Yeah, you call it South need. Um, actually won a lot of awards for the best time architecture of the year. So that was quite interesting and it's also very confusing because you're really young. Work is a means, you know, you have to, you have to know it, you can't pretend. So this is theater setting up for DBS with proof pillow here. We have all the toys. So I was very interested in getting these toys in Trinidad. And they told me uh it will cost 8 million tt dollars, which is about 800,000 lbs and you have maintenance fees that you have to pay to support this stuff. You know, keep everything working, get the arm, which is like an interpretive city and this fancy neurosurgical robot that Pravachol developed, which is, you know, it made things easy but high stress at the same time because if you actually do this surgery beforehand, virtually, then we need to replicate that in theater without with old eras. These guys used to keep me company in the night. Yeah, me and these guys used to walk up and down the corridors, assault media busy, busy, right. You were going everywhere. I used to try and play and say, I wonder if they could see me, boy. So I was memorable was a spine with Puff Pill. And it was interesting because um in 2013 or 14, um one of my mentors, he's here there from the rain, he introduced me to where I called academic neurosurgery because before that I just, I just used to operate, you know, I just used to do everything was, it was like fun for me. And then he said, you know, you, you have to, you have to learn all these things. Yeah. Yeah, just come back. So he still had a British accent. Yeah. Uh he, he started doing academic sessions with us which he still maintains his day religiously every week. Uh We learned a lot of stuff from him and then let's go. Yeah, go back back one good pediatrics. I remember doing a case with Rexy as we call it Mr Edwards. Usually when we do a lumbar discectomy, right? For those who are not surgical if we open the dura matter in error and you have a boat and durotomy and you see a nerve root, you just get palpitations. Yeah. Nobody, nobody else knows it. But you do get palpitations. It's like a pilot. When you play in his crashing, he does not run up and down the aisle. You never see him. But we, we have that guy when it, go ahead saying, like, what do I do know? I have to spend another 30 minutes preparing this thing here. But Mr Edwards used to open. Did you? Oh, yeah. And do a selectivity also. Right after me, I cut the nerve root, I think. Amazing. Yeah. The patient's used to do better. Obviously, we had, we had a lot of support. We have orthopedics, you know, we had good physio. We have so patient's did well. And my last bit while I was in Pete's, I'd enjoyed Pete so much. I got three registered with WWFNS as an official pediatric rotation where we can get international fellows here to come from all over the world. So if you go onto WW finesse website, you would see Bristol pediatric and your surgery center listed there and I had to do a lot of work, you know. So I had to email the Presidente and she would go and take pictures of the robot, go and take pictures of the MRI. So I was just going to the hospital. Everybody watched me like Patrick. What are you doing and say, yeah, don't worry, just organizing something. Yeah. And then my last you a teacher with Mr to, I used to call myself the acting consultant because I had just done my fellowship exams, which is a mile student itself, you know. Yeah, I did, I did one in Sri Lanka. Mr Nelson was there. It was a unique experience because a week after all the Buddhists bombed in Muslim in Muslim Mosques. Yeah. So it was like, I was just there last week. Good thing. Then I did the UK exam which was, you know, a little bit more difficult because the consultants are examine, you are younger and they asked you genetics. Yeah. You have to know it. So that Mr T was away for four months. So I used to have to pretend I was a consultant and do the clinics. Then I talked to Mr Porter, Mr Nelson about the cases and they'll sort it out. Go to the MDTS cat took a picture of me and IMDT once it was very, very busy sleeping. Yeah. Oh my. But those, those were good days, you know, just busy. Do you know what cases? And, uh, I don't know if you all could guess what kids are going to do here. This is a patient of mine. Yeah. Let's see if we can get to play. So he was a musician for his church, right? And he presented with seizures and epilepsy and he saw, he saw, you know, different doctors but he never saw any recision. I said, I mean, something had to be going on there. So next line we did on a week cleaning up to me. But I did, I did one all a week. So you, you're not sleeping and then we wake up and send you back to sleep and stay awake for the whole procedure. So you get to go home sooner and had him playing his guitar in surgery. This is, this is my inter operative monitoring. Yeah, we didn't have any, any fancy tools we have here in Bristol. So I said just please Bob Marley for me. There. He played a new woman. No cry. This is where his tumor was. You know, it is where you don't want to have your tumor. If you didn't away cranial to me is it was left side dominant. Him is fair sm A which is just, you know, the important part of your brain that controls movement on the other side, but not as much as the motor strip. It's a complex here. He did have Estimates syndrome afterwards which resolved this is a image of his interpretive ultrasound, which I learned from Mr Carter and use, use the ultrasound right through, you know, used to say, you know, we'll compensate for brain shifted ways we could do it right there. You don't need to get my MRI. So that was good. And this is me giving a talk about it with a seizure association in Trinidad because basically the patient's don't know that you can have surgery. If you have epilepsy back home, we still, you still have some some bad traditions. So if you have a seizure, they call it a spirit lash and you will likely get a push bath with some milk, you know, especially if you live in an island called Tobago, which is more agricultural and you know, more route c, as we say, as opposed to Trinidad veteran that we is more industrialized. And who could guess what surgery are doing here as a VNS, a vagal nerve stimulator. So that's, that's a surgery that we do for, for seizure. We try. Well, actually learn that from Mr Carter and Pedes Mister Sander Money used to do it in 15 minutes. 15 minutes. I don't know. It's amazing that because you're just send electricity to the brain via the vehicle neuf and you, you, you send every five minutes and they cut the seizures and the patient's have a magnet and then on the rest to just wave it over the battery and it could just stimulate it. If they get an aura, you can stop the seizure from happening. So we did the first one and turn on Tobago. My mentor, Mr Ramnarine, we had a good result. We are good seizure reduction. No, no longer dependent on meds, frequency of the seizures. Any type procedure actually improved. I know we had to do. We got to let people know about it. So we put the same newspaper as you should. I learned that from Mr to Mr to doesn't do anything unless he takes a picture. Mhm And then uh I had a picture of a massive craniopharyngioma. So usually internet that we will do a sub frontal approach. Combined maybe with a transformational approach. But I did hear Mr Nelson mentioned once that if the patient, if they have, you know, like minimal vision, if you do all that surgery, you actually do more harm than good because if you leave them blind afterwards, because you can hardly see when you started. We do have to peel it you more of the optic nerve. So for this case, I opted to do what I learned hand Bristol, which was uh Newmyer reservoir. Yeah, actually go transcortical three brain and see the ventricular system and you could see the the craniopharyngioma open it during it and you have to be deaf too because unfortunately you don't have another working port to slide. You maya while you're looking at it needs to pull out. Everything is slightly you maya down and do this post subsidy to make sure you're on your right please. This was a massive myelomeningocele I had to repair in Trinidad. Maybe like other places in the world, ladies don't know they're pregnant until they missed a period. And that is usually after everything is supposed to form in the first month and have poured that. They have a KFC that we call it KFC. That is. But I guess, you know, fries and fried chicken. Yeah. No vitamins, no supplements, no folic acid. So this, this we get them in threes, as you say you get 123 experience. So that's a result of to repair. I did um it was extensive. So I had to do an advancement flap to get the edges to approximate. Maybe in Bristol will call plastic surgery to help us. We're in Trinidad, we have to do everything. And when I do these cases, I do them in Port of Spain General and then they go to Mr Rambler anymore to follow up where he has a proper pediatric clinic. So we have a unique scenario where I operate any patience and I might see them once but I don't get to see them again afterwards. He does give me feedback, you know, and how the patient's are going. This case was a unique case. Um The neonatologist actually told me about the patient beforehand in tribute. Er and I was like, yeah, that child is not going to survive. I mean, it's very unlikely you have to do anything there, you know, commentary family. And um I got a weird phone call, Patrick child, just born, baby crying, moving all four limbs are like send me a video and the child was appropriate, you know, you know, good up gas score and this is a high stress to now, you know, because now I have to deal with it. Yeah, now I have to have to treat this patient and it's not something I did before and then you get, you get an emotional response to the image initially and to the patient, they need to overcome that and think technically and, and sort it up. So this was the result. At the end, it was a difficult case. I had to argue with the anesthetist. So we don't, we don't have uh fancy soften theater. So then the success will usually turn off the air condition because it's a pediatric patient. So I said for this case, I need that. You see, yeah, more, more than the patient just, just use a bear hug. Uh Don't want to be sweating at all. So the baby had a good result and he's doing well. This is a pick we took by Sir Nelson's home just before we left. We couldn't get everybody there, but it was a good get together. Some of my colleagues who are not here today, you could see them when you pick. Um namely Andrew from Kenya, we work with Mr Nelson quite closely and this is a picture of Port of Spain, which is the capital of Trinidad, big city. That's just one area of China quite industrialized. They have, you know, you have good watching ceiling carnival. Most importantly. And I just want to formally invite everyone here to carnival next year and turn it out. Thanks Patrick.