Episode 1 Island Medics


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Episode 1

Behind the scenes at the UK's most remote hospital. An engineer on an oil rig is airlifted by helicopter to the hospital with suspected serious neck injuries.


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Shetland, the most remote part of the UK.

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Here, you're closer to the Arctic Circle than you are to London

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and nearer Norway than you are to Edinburgh.

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There are more puffins than people

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and more seals than supermarkets.

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But this wild landscape is also home to 23,000 islanders.

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They're so far from the mainland that when things go wrong...

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A&E, can I help you?

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From helicopter rescues and spinal injuries...

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We're all here to make sure that you're OK.

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..to serious medical mysteries...

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Can we get assistance in, please? Something's not right.

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..Shetland's island medics have to be ready

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for anything and everything.

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-What happened?

-I got in a fight with a seagull.

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-This was sheep sheared, was it?

-Yeah.

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It means the tight-knit team of medics, volunteers

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and emergency services have a special bond.

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This might tickle then.

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And they know just how to keep each other going...

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Wee treat for night shift.

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..so they're always ready for any island emergency.

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Today, an injured worker rushed in by helicopter from an oil rig...

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-I fell forward fast and I heard the crunch.

-You heard a crunch? OK.

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..a Shetland solution to a Shetland problem...

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..and the team welcome an old friend into A&E.

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Oh, you!

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Shetland is made up of over 100 islands

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which form a tough landscape of peaty moorland,

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savage rocks and surging tides,

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where you're never more than three miles from the sea.

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And, while life for the islanders can be challenging,

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it's a place they've chosen to call home.

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Yay!

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However, this remote location means there are unique challenges

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for Shetland's 100 medics,

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and especially for the staff at the islands' hospital, the Gilbert Bain.

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We see anything and everything here

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and we have to kind of be able to deal with it.

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Unlike on the mainland, the team here are generalist medics,

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meaning they can go from care of the elderly in the morning

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to paediatrics in the afternoon...

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..and all ages in between.

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A day in A&E can be much more varied

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because anything can walk through the door.

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Ooh!

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After working throughout most of the UK,

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this place has a lot of appeal.

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There's no comparison, really. It's lovely.

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Right, guys. Bye-bye.

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It's the start of the day

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for senior A&E and surgical doctor Kushik Lalla.

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South African Dr Lalla met his wife, Shetlander Sarah,

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when he came to the islands to work.

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My commute takes roughly five to seven minutes.

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When I worked in London, it took me a two-hour train journey

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to get into work.

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When I first got here,

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I was amazed to see the community spirit here.

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Very little in terms of crime.

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People stay with their doors open all the time.

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Coming from South Africa, that, for me, was unheard of.

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When I first got here, I kept locking the door

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and Sarah would get angry with me.

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We've got a small hospital.

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We're very generalist in what we do,

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so we're able to see and deal with most things.

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Clinically, we see so many different things here

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that you wouldn't see down south.

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We can see anything, so it is interesting.

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The case mix is very, very interesting.

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Dr Lalla and the team at Gilbert Bain Hospital

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don't just treat the islands' inhabitants.

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If anyone falls sick or gets injured on a boat or oil platform

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between Iceland and Norway, it's likely they'll be airlifted

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to Lerwick for life-saving treatment.

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Bringing those in peril on the seas to safety is the job

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of the islands' two lifeboats

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and the flight crews who operate the coastguard's helicopters,

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which are standing by to save lives 24/7,

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and fly 160 search and rescue missions every year.

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We get pretty fierce weather up here.

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It is dangerous but, you know, you're trained well

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and you just sort of get on with it, really.

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Shetland's coastguard operations centre, based in Lerwick,

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have scrambled a helicopter to rescue an injured worker

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from the Ninian Central Platform,

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located far off Shetland's east coast, towards Norway.

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-How many miles is it from Shetland, Gary?

-110.

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We took a call from a platform.

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We've got an injured crewman on board.

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He's had a fall and needs to be taken off the platform urgently,

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so what we've done now, is we've tasked

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coastguard helicopter rescue 900 to go up to the platform

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and evacuate the casualty.

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Because it's an emergency, they've chosen,

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or at the moment they're saying

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that they're going to the Clickimin emergency landing site.

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There are three designated sites

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the coastguard can land a helicopter on Shetland.

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If the case isn't serious or the weather severe,

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they land in the very south, at Sumburgh Airport,

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about 25 minutes by ambulance to the hospital.

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If it's a more pressing matter, they fly to Tingwall Airport,

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15 minutes from A&E in Lerwick.

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But if it's a life or death situation, they can land

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on the playing fields across from the hospital by the Clickimin Loch.

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Waiting at the Clickimin landing site are the coastguard volunteers,

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trained members of the local community,

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who give up their free time to help in rescue situations.

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Shetland coastguard. This is Lerwick mobile. Do you have an ETA? Over.

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-RADIO:

-The last ETA we had was 11.20 local. Over.

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Roger. That's understood.

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Coastguard volunteer Stuart secures the area.

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The first thing we do when we get here

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is make the ELS ready to receive.

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Because this is a combination of football pitches,

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we have to take all the goalposts and stuff to the side,

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make it ready, make it nice and safe.

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We need to be making sure that the public are safe as well,

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behind the fence, just because of the downdraught of the helicopter.

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Meanwhile, at the islands' ambulance HQ...

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-ALARM SOUNDS

-That's probably break over, right?

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..the call comes in, and paramedics Chris and Dan head for the site.

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-AMBULANCE COMMS:

-999 mode activated.

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SIREN WAILS

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So, we're going down to the emergency landing site at Clickimin.

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The helicopter's taken a patient off an oil rig.

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SIREN WAILS

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They only use the landing site at Clickimin

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when it's seen as life-threatening or limb-threatening.

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Otherwise they would use one of the airports.

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That was good driving, mate!

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I'm just going to pop on a helmet and stuff, because there's a chance

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that there's debris that can fly up when the rotors are turning.

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Just to keep us safe and make sure that we don't get hurt,

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cos then we end up with two casualties rather than one.

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I'm standing here being filmed and I'm not even sure if this fits.

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-You've never worn it before, have you?

-No. Well, never at a job.

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The handover from the coastguard medic is the first chance

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the team have to discover

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the extent of the injuries they'll be dealing with.

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All right, how's it going? What have we got?

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-Spinal injury. He ran into a pole.

-OK.

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He hit his head, he fell. He heard a massive crunch.

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-All right, OK.

-Yeah, really sore. Pain was ten out of ten, initially.

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The patient's possible spinal injuries mean

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the team must be extra careful

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when they move him from helicopter to ambulance.

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Spinal, so be careful with the back.

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-Brian, how are you getting on?

-I've been better.

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Brian, a 48-year-old ultrasound engineer from Liverpool,

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fell and injured his neck on his rig.

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The coastguard medic was concerned he may have broken it.

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I was immobilised. To be honest with you,

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when I went over, my neck snapped back.

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I hit the floor and I couldn't move.

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In the Gilbert Bain, the A&E team have been alerted

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to the incoming emergency and are preparing for the patient's arrival.

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All we've been told is we've got a 48-year-old man

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who's fallen on a rig and he's got neck and back pain.

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That's all the information we've been given,

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so we'll just have to assume the worst until we're proved otherwise.

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Lean back onto the pillow. Can you lean back?

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71-year-old shepherd John, who tends his flock in Dunrossness,

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in the very southern tip of the Islands, has arrived in A&E.

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He's been unable to pass water and is in agony.

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-So, is it coming on for sheep shearing time, is it?

-Yeah.

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-Knock knock.

-Hello.

-Hello, there.

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John, I hear we've got a problem with the waterworks.

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We're going to try and pop a new catheter in

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and, hopefully, that will clear everything out

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and make you feel a lot better.

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Treating John is Dr Helen Hare.

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She's one of the many locums who work on Shetland

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and came for a bit of a change.

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I like talking to people,

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I like fixing their problems

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and that's as true of medicine

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as it was when I worked in a gift shop

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and helped people find Christmas presents.

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You get very used to dealing with human bodies

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and one bit is the same as another, really.

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Break the seal for me. That would be grand.

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You get very used to doing catheters

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although, that said, it's been at least a year since I've done one,

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so it was a bit of a guddle today.

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-Sorry.

-No.

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But definitely necessary.

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Putting a catheter into somebody with urinary retention

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is one of the nicest things you can do, as a doctor or a nurse.

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It makes a huge difference to them.

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Just relax. We'll just hold it a moment.

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-In or out?

-Just breathe in and out.

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-Just keep breathing.

-All right.

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You need to have a huge range of skills at your fingertips.

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Deep breaths, in and out. Good man. Well done.

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Doctors coming from elsewhere don't necessarily have that.

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They're used to being able to hand over to experts,

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so that's why it's been a while since I've done that.

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After 15 minutes...

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..finally some relief for John...

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..almost two litres-worth.

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There are very few places in Shetland you can stand

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and not see the sea.

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This means the pull of the ocean is strong

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and messing about on boats is an islander session.

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From the yachts, tall ships and fishing boats

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that fill Lerwick harbour

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to the traditional yoals that race on summer evenings

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and the canoes that explore the coastline,

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Shetlanders are on the water almost as much as they're off it.

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Keeping an eye on the 1,697 miles of coastline,

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from their base high on the cliffs above the capital,

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are the coastguard, and no job is too big or too small.

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Another call has come in to the ops room.

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We had a radio call from a 25-foot pleasure vessel.

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It's got something wrapped around its props.

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The skipper of a boat, taking tourists out to see

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some of Shetland's amazing wildlife, has radioed in,

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after they lost power.

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They're drifting in strong currents and need rescuing fast.

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So, what we've done is we've called the Lerwick lifeboat.

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Lerwick lifeboat are now on scene.

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Coastal rescue teams should be on the jetty, ready to tie them up.

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The lifeboat has been scrambled

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and is towing in the good ship Christine May and her crew.

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Shetland has two lifeboat stations - one on the east coast, in Lerwick,

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and one based in Aith, on the west of the Islands.

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Both are vital lifelines for a community so reliant on the sea.

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Coastguard Liam is with the rest of the team,

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ready to help when she nears the harbour.

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Basically, we've been tasked

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by the Shetland operations centre

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to come down here and meet the Lerwick lifeboat.

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They've been tasked to go to a boat with a failed propeller,

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so they're just going to take them in

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and we'll basically assist the lifeboat in any way that we can.

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The lifeboat gently guides the Christine May safely to harbour,

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where her passengers can finally disembark,

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aided by Liam and his team.

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Sonia, the skipper of the Christine May,

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had been taking visitors on a day trip.

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From Burravoe, on the northern island of Yell,

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they sailed to watch the sea birds on the Isle of Noss.

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In seconds, we went from being extremely happy

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and taking photographs and enjoying the scenery

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to having a slight amount of panic set in when we realised

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we were about 60 feet from rocks and we weren't able to use our engines.

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Rope got caught up in a propeller shaft.

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Every time we put the boat into gear, it wouldn't drive at all.

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The attitude of the guys is phenomenal

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and it's just instinctive to them.

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The importance of having such services,

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not only for the islands of Shetland,

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but with the location of where we are

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and who they can get to from here, it's of vital importance.

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And, of course, this being Shetland,

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it shouldn't be too surprising

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if you recognise the person towing you to safety.

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My cousin Garry is actually coxswain of the Lerwick lifeboat.

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It's not often you tow your cousin in!

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My grandad is Garry's granduncle.

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And I couldn't believe it was him, so it was pretty cool.

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You're not needing any bottles of water or anything like that?

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No, no, thank you. We've got water on board.

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I think I'm going to need something stronger

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by the time I get home tonight.

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OK. Well, we'll head back and leave you to it then.

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-That's good, thank you very much.

-Perfect, no problem. Cheers.

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Happy customer again, yeah. That's good.

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At least we can do something to help, so everybody's happy.

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It was quite exciting, but we were a bit worried

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because we were very close to the rocks where the gannets were.

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It was quite an amazing sight,

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but we were a bit close to the rocks at that point.

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We were pleased to see the lifeboat, definitely.

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With skipper Sonia and her boat safely in harbour,

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Liam and the coastguard team can move onto their next job.

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But Sonia's going to have to work out

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how to get her boat moving again before she can go home.

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Brian, a 48-year-old ultrasound engineer, was airlifted to A&E,

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after falling and injuring his neck on an oil rig.

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Wonderful. I'm just going to take your shoes off.

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Brian was helicoptered off the rig

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and then transferred to the hospital by ambulance.

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He's now in the capable hands of nurse Kathy Duffus.

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-I fell.

-Right.

-And obviously I fell forward fast.

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-OK, and then your neck was pulled, was it?

-Yeah.

-Backwards, like that?

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-I heard the crunch.

-You heard a crunch? OK.

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That crunch sets alarm bells ringing for the A&E team.

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Neck injuries are a worry at the best of times

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and Brian may well have injured his spine.

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After making Brian comfortable, Kathy wants to run some tests.

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As well as the neck injury, he has an alarmingly low heart rate,

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well below the normal range of 60 to 100 beats per minute.

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Right, what I'm going to do is a proper ECG,

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which is a trace on your heart, just because it's quite slow there.

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All you have to do is lie still, which you're doing anyway. So...

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These results will be sent

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to the senior A&E consultant for inspection.

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OK.

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In the meantime,

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Dr Mihir Trivedi is keen to hear more about this neck injury.

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-What happened?

-I hit the floor and couldn't move.

-Yeah.

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But it's in my left arm.

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It was... I'd say pins and needles,

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but it was like a burning pins and needles.

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-I couldn't...

-OK, has anybody got a pen?

-It was horrendous.

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But Dr Lalla, the senior A&E surgical doctor,

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is worried about Brian's ECG results.

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No, no, no, his heart rate is 33, so can we get assistance in, please?

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Heart rate of 33, Cameron. This is the guy that fell at the oil rig.

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-Hi, there.

-Hi.

-What's your name?

-Brian.

-Brian.

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Have you been started on any new medication or anything like that?

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-Nothing.

-Nothing. How old are you?

-48.

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And you are otherwise generally fit and well?

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-Yeah, I keep myself very fit.

-Right, OK.

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The reason we're getting a bit excited

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is your heart rate is going quite low.

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Something's not right.

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Dr Lalla is worried that Brian's low heart rate could be

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the cause of his fall and it could point to something very serious.

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Can we get the heavy-duty scissors, please?

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-Sorry, Brian, that's the end of your T-shirt.

-That's OK.

-Right.

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-Now, do you exercise a lot?

-I do exercise, yeah.

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-A lot?

-Um...yeah, I think so.

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He looks like a pretty fit guy.

0:20:090:20:11

But his heart rate is very low, and it might explain why he fell.

0:20:130:20:20

Because the heart rate is that low, it's not pumping enough blood

0:20:210:20:25

to his brain and they tend to get almost like a faint.

0:20:250:20:28

This is down to 38 times, which is very, very low.

0:20:280:20:33

At this level, we sometimes want to start external massage

0:20:330:20:37

because they can go into cardiac arrest.

0:20:370:20:40

So, we've got some medication ready that can push his heart rate up.

0:20:400:20:45

Get out some atropine as well.

0:20:450:20:47

Don't give it but just get it ready, just get it out.

0:20:470:20:50

But we're hanging fire with that just now.

0:20:500:20:53

Brian, what we need to do in the interim,

0:20:550:20:57

while they're humming and hawing about your heart tracing,

0:20:570:21:01

what we're going to do in the interim,

0:21:010:21:03

-is just have a look at your neck.

-OK.

0:21:030:21:05

-I don't want you to move your head.

-OK.

-OK. So, don't move.

0:21:050:21:09

I'm going to have a feel at the back of your neck, OK?

0:21:090:21:11

Right, you tell me if anything is sore. Any pain there?

0:21:110:21:15

-Not painful.

-No.

0:21:160:21:19

-There?

-That's getting sharper.

-That's getting sore.

0:21:210:21:25

-And lower down there?

-Yeah.

-That's where you're feeling it?

-Yeah.

0:21:270:21:30

Right, OK. Brian, unfortunately,

0:21:300:21:32

you're going to be stuck on this collar

0:21:320:21:34

for a little while longer.

0:21:340:21:36

What's happening next is they're going to get

0:21:360:21:39

a CT scan of his neck

0:21:390:21:41

to see if there's any fractures or damage there.

0:21:410:21:45

In the meantime, we'll keep him under close observation.

0:21:450:21:48

Obviously, what we're concerned about is his heart rate

0:21:480:21:50

cos it's quite low.

0:21:500:21:52

So, it's a tense wait for Brian and the team in A&E,

0:21:520:21:55

who will need the result of some scans

0:21:550:21:57

before they can rule out serious neck injury

0:21:570:21:59

and find out the cause of his extremely low heart rate.

0:21:590:22:02

Skipper Sonia called the coastguard for assistance,

0:22:110:22:13

when her boat, the Christine May, lost power,

0:22:130:22:16

thanks to a rope caught in a propeller.

0:22:160:22:18

Having been safely towed to Lerwick harbour,

0:22:180:22:21

Sonia still has to find a way

0:22:210:22:22

to untangle the rope and check for any damage.

0:22:220:22:25

Lucky for her, the Lerwick locals aren't the type

0:22:270:22:29

to stand by and watch a seafarer struggle.

0:22:290:22:32

I just thought that a diver,

0:22:320:22:34

going to go down here at Victoria Pier,

0:22:340:22:38

for about ten minutes

0:22:380:22:40

to, hopefully, remove the rope from my prop shaft.

0:22:400:22:43

-RADIO:

-That's no problem.

0:22:430:22:46

Hopefully, it's in such a state that I can untangle it.

0:22:460:22:50

The water around Shetland is cold - seriously cold.

0:22:520:22:55

The only way to get down to inspect the damage to the propeller

0:22:560:23:00

is for a diver to suit up and jump into the icy water.

0:23:000:23:03

-For God's sake, don't turn it on.

-No, it's all off.

0:23:070:23:10

He's the knight in shining armour today, along with the lifeboat.

0:23:120:23:18

More of a knight in shining neoprene, if you ask me.

0:23:190:23:22

Hopefully, there's no damage done.

0:23:230:23:25

That's what we're ultimately looking for, that it's just bound up

0:23:250:23:30

but the shaft itself is actually OK.

0:23:300:23:33

So, we'll find out, with him, if all is all right.

0:23:330:23:36

He should be able to see it no problem at all

0:23:410:23:43

and see if there's anything come loose or bent.

0:23:430:23:46

It'll be pretty obvious.

0:23:460:23:48

So, fingers crossed.

0:23:480:23:50

That'll be the rudder problem.

0:24:030:24:04

-Does the shaft look OK to you, the shaft itself?

-It looks all right.

0:24:060:24:11

-It looks OK?

-It was wrapped round the rudder is well.

0:24:110:24:13

I'm no expert on props, but it didn't look...

0:24:130:24:16

A lot of the rope was quite loose around it,

0:24:160:24:19

-it was just wrapped around like that.

-It wasn't tight?

0:24:190:24:22

No, that's really good.

0:24:220:24:23

I did find that I didn't have steering,

0:24:230:24:25

so that would, obviously, make sense,

0:24:250:24:27

-why it's around the rudder as well.

-Yeah.

0:24:270:24:30

No, I really can't thank you enough. That's fantastic.

0:24:300:24:34

I hope this never happens again.

0:24:340:24:35

Well, if it does, you know where I am.

0:24:350:24:37

Thank you. One boat, ready for going home. A good result.

0:24:400:24:45

When it comes to getting casualties to Accident & Emergency,

0:24:540:24:57

the job more often than not falls to Shetland's team of paramedics

0:24:570:25:01

and ambulance technicians, who staff the two ambulances

0:25:010:25:04

which are on call 24 hours a day, 7 days a week.

0:25:040:25:08

SIREN WAILS

0:25:080:25:10

It's a pressurised job and can really take it out of you.

0:25:120:25:15

SHE MOUTHS

0:25:160:25:18

But it's one the team love.

0:25:180:25:21

We get to know the patients because of the small community

0:25:210:25:24

and we get to know friends and family of the patients.

0:25:240:25:28

ALARM SOUNDS

0:25:290:25:31

Chris and Emma have had a call.

0:25:320:25:35

Have you got the keys?

0:25:370:25:39

Burgh Road. Do you think that's a right turn or a left turn?

0:25:470:25:51

-I really don't know.

-EMMA LAUGHS

0:25:510:25:54

Number 25. Right.

0:25:570:26:00

Where is this house?

0:26:000:26:02

Chris, what way do I go, right or left?

0:26:020:26:05

-I'd go that way, just have a look.

-Number two is down there.

0:26:050:26:09

15... Chris, you sent me the wrong way!

0:26:090:26:12

Right, 25. Oh, here we go.

0:26:170:26:19

They've probably just watched us go the wrong way.

0:26:210:26:24

-Hello.

-Hello.

-Now, then.

-What's happened to you today?

0:26:270:26:31

I think I've had a slight stroke on this side.

0:26:310:26:34

And what makes you say that?

0:26:340:26:35

-Because it's not working properly.

-OK.

0:26:370:26:39

79-year-old Anna called 999 when she lost sensation in her right hand.

0:26:390:26:45

And when did this start, would you say?

0:26:450:26:47

-Three o'clock this morning.

-Three o'clock this morning.

0:26:470:26:50

She's worried she's had a stroke.

0:26:500:26:51

She suffered one a few weeks ago, while at a friend's house,

0:26:510:26:55

and recognises the symptoms.

0:26:550:26:57

Little wonder Chris doesn't want to leave her alone

0:26:570:26:59

and is keen to get her into hospital as soon as possible.

0:26:590:27:03

I think what we'll do then is we'll take you to hospital

0:27:030:27:06

and we'll get this arm looked at. What do you think?

0:27:060:27:10

-You're not convinced, are you?

-I am not staying in that place.

0:27:100:27:14

I worked in it for 40-odd years!

0:27:140:27:16

EMMA AND CHRIS LAUGH

0:27:160:27:18

Anna is a retired nurse

0:27:180:27:20

and four decades at the Gilbert Bain was more than enough for her.

0:27:200:27:24

But, with a bit of gentle persuasion, they coax her out.

0:27:260:27:29

Come on then. Into the ambulance.

0:27:290:27:33

-Are you ready, Chris?

-Yeah, whenever you are.

0:27:330:27:35

Fortunately, the route back to base is fresh in Emma's mind.

0:27:410:27:45

-Are you being shy?

-Are you camera shy?

0:27:510:27:54

No, I'm not camera shy.

0:27:540:27:56

Returning under duress to her old place of work,

0:27:560:28:00

Anna spies a familiar face.

0:28:000:28:02

Oh, you!

0:28:020:28:04

THEY LAUGH

0:28:040:28:06

She said that old fish is going to be here.

0:28:060:28:08

How are you doing?

0:28:080:28:10

-All the better for seeing you.

-Me, too.

0:28:100:28:13

Strokes are the result

0:28:130:28:15

of a restricted flow of blood to the brain

0:28:150:28:18

and can result in permanent damage or even death but, in many cases,

0:28:180:28:22

prompt medical attention can make all the difference.

0:28:220:28:25

She's quite an upbeat person.

0:28:250:28:27

She's in now and again, but she's usually quite good.

0:28:270:28:31

-I worked in hospitals all my life.

-Did you work at this hospital then?

0:28:310:28:35

Yeah, I did, mainly nights.

0:28:350:28:38

-So, you must know a lot of the staff still, do you?

-Yes, mm-hmm.

0:28:400:28:44

-Are they still familiar?

-Some of them are. If you go to A&E...

0:28:440:28:48

..that's where I see a lot of old staff.

0:28:490:28:54

While Anna gets comfy, the nurses she knows so well

0:28:540:28:57

prepare for the CT scan they hope will get some answers

0:28:570:29:00

as to the severity of her suspected stroke.

0:29:000:29:03

On Shetland,

0:29:150:29:16

knowing the people treating you is far from uncommon,

0:29:160:29:19

which is certainly the case for our next patient.

0:29:190:29:22

-Are you married to Miriam, by any chance?

-I am.

0:29:220:29:24

-I know Miriam through toddlers.

-Very good.

0:29:240:29:28

-Very cute bairns.

-Thank you.

0:29:280:29:30

So, I'm doing a kitchen renovation, working on the extractor fan,

0:29:300:29:33

and I wasn't happy with how it was lining up.

0:29:330:29:36

So, I tried to get the stainless steel shroud off the top of it

0:29:370:29:40

but it wouldn't come, and it wouldn't come, and then it did come.

0:29:400:29:44

And it got me, too.

0:29:460:29:48

Danny should be more careful of his own strength,

0:29:480:29:51

especially since, besides his work as a labourer,

0:29:510:29:54

he has an unusual hobby.

0:29:540:29:56

In my free time, I'm a strongman and I've just come back

0:29:580:30:01

from Europe's Strongest Man, where I placed fifth.

0:30:010:30:04

He certainly got the better of that extractor fan!

0:30:050:30:08

Or did he?

0:30:080:30:09

There was a lot of blood,

0:30:090:30:11

so I actually went to the van to try and superglue it up myself

0:30:110:30:15

but, when I had a look in the mirror,

0:30:150:30:16

I thought I'd better come in.

0:30:160:30:18

Well, I went to the van to superglue it.

0:30:180:30:21

When I looked in the mirror, there was just a big chunk hanging off,

0:30:210:30:25

so I thought I'd better come in.

0:30:250:30:27

I think maybe just a dab of glue on there might be the best thing.

0:30:270:30:31

But first of all, it'll need a good clean.

0:30:310:30:35

-If it's very sore just let me know.

-That is pretty sore.

-Sorry.

0:30:350:30:38

It's all right. Just go for it.

0:30:380:30:40

-Sorry, it might be a bit stingy.

-Mm-hmm.

0:30:400:30:43

He may be able to lift a third of a tonne,

0:30:430:30:45

but he's still got his sensitive side...

0:30:450:30:48

-OK, coping?

-Yeah.

0:30:480:30:49

Eleanor, could I get you to go and ask the nurses

0:30:490:30:52

if I can get one of the things of glue? Is that OK?

0:30:520:30:56

..even if it's just on his nose.

0:30:560:30:58

It could be a bit awkward. It's not really the easiest place.

0:30:580:31:02

You'll just have to not poke at it.

0:31:020:31:03

It doesn't look like it's gone too, too far.

0:31:030:31:06

They may be surrounded by millions of pounds of equipment,

0:31:070:31:10

but sometimes the simplest solutions are the best.

0:31:100:31:13

-OK. It might be a bit stingy.

-Sneezy.

-Sorry.

0:31:140:31:19

OK, I think that's the best

0:31:190:31:21

that we're going to manage with you, given its location.

0:31:210:31:24

-The difficult bit is going to be no touching it.

-Yeah.

0:31:240:31:28

I don't think it's too serious.

0:31:280:31:29

It's just an awkward place to get into,

0:31:290:31:32

so just a dab of superglue, which I had in the van anyway.

0:31:320:31:36

But it's clean. That's the main thing, so back to work.

0:31:360:31:40

SEAGULLS CRY

0:31:400:31:43

Brian was airlifted off an oil rig

0:31:490:31:51

after he slipped and banged his head.

0:31:510:31:54

Dr Lalla and his team have two concerns.

0:31:540:31:56

One is that Brian heard a loud crack from his neck when he fell,

0:31:560:32:00

which could mean a broken neck.

0:32:000:32:02

The other is Brian's heart rate is very low,

0:32:020:32:05

which could be extremely serious.

0:32:050:32:08

While he waits for his test results,

0:32:080:32:09

Brian is enjoying the benefits of Gilbert Bain's nursing hospitality.

0:32:090:32:13

Are you feeling OK? Brian, are you feeling OK? Yeah?

0:32:130:32:19

But there's a limit, even to Kathy's patience.

0:32:190:32:21

I haven't been to the Shetlands properly,

0:32:210:32:23

-so I thought I'd pay you a visit.

-Where had you not been?

0:32:230:32:25

-I haven't been here.

-What's it called?

-The Shetlands.

0:32:250:32:29

-KATHY GASPS

-No?

0:32:290:32:30

-Shetland.

-Shetland.

-Shetland.

-Ah, right.

0:32:300:32:33

-If you say the Shetlands, it's like nails down a blackboard.

-Ah, OK.

0:32:330:32:37

So, it's obvious you've never been here before.

0:32:370:32:39

You learn something new every day, don't you?

0:32:390:32:41

A lot of folk call it that but...

0:32:410:32:43

Any other questions?

0:32:430:32:45

-It's just the heart thing, isn't it?

-Yeah.

0:32:450:32:47

Well, actually, to be honest with you...

0:32:470:32:49

-..I feel I have all the answers. I'm in good hands.

-Yeah.

0:32:510:32:54

They're going to speak to a cardiologist.

0:32:540:32:56

-Nurses are fantastic anyway, aren't they?

-Yeah.

0:32:560:32:58

-My mum was a nurse.

-Well, there you go.

0:32:580:33:00

-Yeah.

-Underpaid and overworked.

-Yeah!

0:33:010:33:05

You should be on the highest pay scale, you really should.

0:33:050:33:09

-You do an amazing job.

-Thank you.

0:33:090:33:11

Do you fancy running for Parliament or anything like that?

0:33:110:33:14

Well, I run and I raise money, after my mum went, for the Macmillans.

0:33:140:33:20

Oh, very good, yeah. They're excellent.

0:33:200:33:22

-Yeah, I get thousands every year.

-Good for you.

0:33:220:33:25

Is that marathons and things?

0:33:250:33:27

-Yeah, I do silly Tough Mudders.

-So, you do that every year?

0:33:270:33:31

-I do a few, yeah.

-A few every year?

-Yeah.

0:33:310:33:34

-OK.

-I've just done the European one.

0:33:340:33:36

-That was eight hours through the night.

-Right.

-That wasn't too bad.

0:33:360:33:40

Kathy may have just had an idea

0:33:400:33:42

about what's causing Brian's low heart rate.

0:33:420:33:45

He's telling me that he does several Tough Mudders a year.

0:33:450:33:47

Would that go some way to explain his heart rate though,

0:33:470:33:50

cos that sounds like pretty superfit to me?

0:33:500:33:52

-There's 10.4 miles, there's 20 obstacles and a lot of mud.

-Yeah.

0:33:520:33:56

Right OK, CT is ready, so we'll take him around over there.

0:33:560:34:00

One, two, three, roll.

0:34:000:34:02

OK, one, two, three, back.

0:34:050:34:08

-He does multiple Tough Mudders a year.

-Yes?

-Tough Mudders.

0:34:100:34:14

Several times a year.

0:34:140:34:15

It's like a ten-and-a-half mile course with 20 obstacles in it

0:34:150:34:18

but it takes quite a bit of fitness to do.

0:34:180:34:20

-He does that multiple times a year.

-So, you ARE pretty fit.

0:34:200:34:23

-Yes, he is.

-BRIAN:

-What do you want me to do?

-Nothing.

0:34:230:34:26

We want you just to lie still and look pretty. We'll do everything.

0:34:260:34:30

Oh, I'm roasting. Is my face red?

0:34:330:34:36

While it may be well equipped, the Gilbert Bain's remote location

0:34:370:34:41

means specialist medics are in short supply.

0:34:410:34:45

Luckily, they're able to send scan results

0:34:450:34:47

to the specialists in Aberdeen for advice,

0:34:470:34:50

saving the cost of an air ambulance evacuation to the mainland.

0:34:500:34:54

I hope it's normal, for him.

0:34:540:34:56

-We're all done, Brian, you'll be glad to hear.

-OK, let's go.

0:34:570:35:01

And while Dr Lalla pores over the CAT scan,

0:35:030:35:05

he also requests an ultrasound to check Brian's heart.

0:35:050:35:08

We're looking at his neck at the moment

0:35:100:35:12

to see if there's any breaks over there.

0:35:120:35:14

It's very unlikely that that's going be the case,

0:35:140:35:16

but we need to make sure

0:35:160:35:18

before we can get him up and moving a little bit.

0:35:180:35:21

Dr Lalla seems confident, but the tests have been sent

0:35:210:35:24

to the orthopaedic experts in Aberdeen for confirmation.

0:35:240:35:28

The team will need to wait for this,

0:35:280:35:30

along with the results of the ultrasound on Brian's heart,

0:35:300:35:33

before they can settle on a final diagnosis.

0:35:330:35:36

Just keep focusing on him, OK, and ignore the light.

0:35:420:35:45

I'm just going to shine the light for each side, OK?

0:35:450:35:47

Anna, a 79-year-old Shetland native and former nurse at Gilbert Bain,

0:35:470:35:52

came into hospital earlier this morning, after a suspected stroke.

0:35:520:35:56

I'm getting Anna ready to go for a CT scan,

0:35:560:35:59

take her through, get a quick scan.

0:35:590:36:02

That scan has to go to Aberdeen for the radiologists to report.

0:36:020:36:06

They then send that back to us

0:36:060:36:08

and then we'll get our doctor and consultant to review it

0:36:080:36:12

and see what they're wanting to do from there.

0:36:120:36:14

But Anna isn't really in the mood to hang about

0:36:140:36:17

waiting for the specialists in Aberdeen.

0:36:170:36:20

They said I would go home at two and it's now quarter past.

0:36:200:36:24

She may be in a hurry to get home but, as a former nurse,

0:36:240:36:28

she knows it doesn't do to rush the NHS.

0:36:280:36:32

Can I pop this on your arm? OK, I'll be back in a minute, OK?

0:36:320:36:36

The CT scan will show if Anna, as suspected, has had a stroke

0:36:360:36:41

and the extent of any damage.

0:36:410:36:43

The doctors in Aberdeen can then determine

0:36:430:36:45

the best course of treatment

0:36:450:36:47

and, ultimately, if Anna will get home tonight.

0:36:470:36:50

There's no formal report back from Aberdeen yet,

0:36:520:36:54

so the doctor's waiting for that and blood results to come back

0:36:540:36:58

and, once we've got them, they can decide

0:36:580:37:00

whether she's going to be admitted to the ward

0:37:000:37:03

or if she would be safe to go home. She's OK in herself.

0:37:030:37:06

She's quite keen to go home, but they usually are.

0:37:060:37:10

She's in good humour as well, which always helps.

0:37:100:37:13

Has the doctor told you she's going to admit you up to the ward tonight?

0:37:130:37:16

-Why?

-Usually, they just want to keep an eye on you.

0:37:160:37:21

They're not keen to let you go.

0:37:210:37:23

Let me just go and see if she's in the office, OK,

0:37:230:37:26

and then we can get you upstairs and get your tea ready.

0:37:260:37:29

-I would like some duck in plum sauce.

-I'll put in a request, OK.

0:37:290:37:34

SHE LAUGHS

0:37:340:37:36

Dr Catherine Hawco is here to officially break the news to Anna.

0:37:360:37:40

The reason we want to keep you in is because you live by yourself

0:37:400:37:44

-and I know, if you've got weakness here...

-Yeah, I know.

0:37:440:37:47

..then I worry that you might struggle a little bit

0:37:470:37:50

and you don't look very steady on your feet.

0:37:500:37:52

-No, when I came off the bed...

-I know.

-..I fell.

0:37:520:37:55

I wouldn't like you to go home and fall and smack your head.

0:37:550:37:59

-And I know you don't want to be here...

-I might damage the monitor.

0:38:000:38:03

Well, exactly.

0:38:030:38:05

We've decided...

0:38:050:38:06

-What have you decided?

-LAUGHTER

0:38:080:38:12

-We want duck in plum sauce.

-Wow!

0:38:120:38:16

I don't know if we can quite promise duck in plum sauce.

0:38:160:38:20

-Oh, it's no use. We'll have to go.

-With the pancakes.

0:38:200:38:24

-But I still think you should bunk with us for tonight.

-OK.

0:38:240:38:28

It may not be home but, with views like this,

0:38:300:38:33

there are worse places to spend the night.

0:38:330:38:36

And, come the morning, Anna should have the results of her tests.

0:38:360:38:39

Do you want to come out here?

0:38:410:38:43

-No.

-Not really, OK. You just want to go home.

0:38:430:38:45

-I haven't been out since I came in, so...

-I know.

0:38:450:38:49

Right, Anna, I'm going to go and tell Leah what's been happening, OK?

0:38:490:38:53

-Where's Leah?

-This is Leah here.

-Oh, this is Leah.

-Yeah.

0:38:530:38:57

She's going to be looking after you tonight.

0:38:570:38:59

At long last, it's time for dinner

0:38:590:39:02

and - spoiler alert - it wasn't duck in plum sauce.

0:39:020:39:05

-Do you want some?

-LEAH LAUGHS

0:39:070:39:09

It does look good.

0:39:090:39:11

Hello. You OK?

0:39:210:39:24

Brian, who was airlifted off the oil rig,

0:39:240:39:26

is waiting for the results of the CT scan on his neck

0:39:260:39:29

and ultrasound on his heart and, while he waits,

0:39:290:39:33

he's continuing to charm the nursing staff.

0:39:330:39:36

My friend hates dogs and I can't understand how.

0:39:360:39:39

-We had a lab for 15 years.

-Labs are great, aren't they?

0:39:390:39:42

They're so lovely. They become part of the family.

0:39:420:39:46

-I used to see Floyd II when he went.

-Floyd II!

0:39:460:39:50

But I'd see him.

0:39:500:39:52

I'd come in the house and I'd see him walk past the door,

0:39:520:39:55

-after he was gone.

-Uh-huh.

-I'd see him walk past the doorway.

0:39:550:39:58

I know that's only imagination, it's only in your head.

0:39:580:40:02

-Yeah, yeah, yeah.

-I'm not on about ghosties or anything.

0:40:020:40:04

No, I believe in that kind of thing, though.

0:40:040:40:07

Right, so good news.

0:40:070:40:09

-It looks like you're just very fit.

-Yeah. That's brilliant.

0:40:090:40:12

Yes.

0:40:120:40:13

They're good. We're happy, We're all happy.

0:40:130:40:16

Um...

0:40:160:40:19

He doesn't need to go to the surgical ward.

0:40:190:40:20

He doesn't need to go to the medical ward

0:40:200:40:22

because I think he's just a pretty fit guy.

0:40:220:40:25

Yeah, so there's no damage?

0:40:250:40:27

No, there's nothing that they can see.

0:40:270:40:30

There was one area... Remember I was saying

0:40:300:40:32

the one area in the spine that looks a bit abnormal?

0:40:320:40:34

That, they think, is just congenital,

0:40:340:40:36

that you were born with that.

0:40:360:40:37

So, apart from being born wrong, everything else is OK.

0:40:370:40:41

DR LALLA LAUGHS

0:40:410:40:43

So, what we're going to do just now,

0:40:430:40:45

is get the collar off and that will make you feel a little better.

0:40:450:40:48

-Oh.

-OK.

-Oh, yeah.

0:40:500:40:53

-Is that better? Is that easier? Yeah?

-Yeah.

0:40:530:40:57

Yeah, look at that!

0:40:580:41:00

Heart rate has come back into your normal range again.

0:41:000:41:03

We'll make arrangements to get you into one of the hotels

0:41:030:41:06

and look at arranging flights and things like that

0:41:060:41:08

-for you back home again.

-That would be fantastic.

0:41:080:41:11

My dog will be made up to see me...

0:41:110:41:13

-and maybe my wife.

-Maybe your wife!

0:41:130:41:16

Just a bit stiff, but a lot better than I was earlier, definitely.

0:41:180:41:23

All the nurses have been fantastic. Kathy is a star and so is Jenny.

0:41:230:41:27

It all came out in the wash

0:41:290:41:30

that he does a Tough Mudder once every two months.

0:41:300:41:34

THEY LAUGH

0:41:340:41:37

Kathy is doing the next one with us anyway.

0:41:370:41:40

-Yeah, that will be fine.

-And, um... Ow, ow.

0:41:400:41:43

And so, bruised but not beaten, Brian's time on Shetland -

0:41:460:41:50

and that is Shetland, Brian - comes to an end.

0:41:500:41:54

-All the best.

-Thank you very much.

-We'll sort you out.

0:41:570:41:59

-Thank you very much. Take care.

-No worries.

-Take care.

0:41:590:42:01

-Bye-bye.

-All the best.

0:42:010:42:04

But, for nurse Kathy, it's straight back to work,

0:42:070:42:10

tending to the rest of the population

0:42:100:42:12

of this unique set of islands.

0:42:120:42:14

So, have you come from South Africa straight here?

0:42:140:42:17

No, I worked throughout the UK.

0:42:170:42:19

I worked over here and I liked it and that's how I ended up over here.

0:42:190:42:23

-It's hard work. Nowhere else in the UK, I think, works like this.

-Sorry?

0:42:230:42:29

Nowhere else in the UK works like this. I don't think...

0:42:290:42:32

I can't think of any place.

0:42:320:42:35

The team in A&E at Gilbert Bain are a close-knit bunch.

0:42:370:42:41

Ooh, a little bit of cream on the side.

0:42:410:42:43

And, like the tides that surround the islands,

0:42:430:42:46

there's definite ebb and flow to their workload.

0:42:460:42:49

Sometimes they're rushed off their feet and sometimes they're not.

0:42:490:42:53

This might tickle then.

0:42:540:42:56

But, whatever happens, they get each other through.

0:42:560:43:00

Anna's home, having made a good recovery from her stroke,

0:43:060:43:10

and is regularly enjoying her duck in plum sauce.

0:43:100:43:13

John was back out with his sheep a few days after coming into hospital.

0:43:130:43:17

Unfortunately, Brian's neck has continued to give him problems

0:43:170:43:20

but, with the help of some physio and some rest,

0:43:200:43:22

he's confident he'll be back raising money for charity in the New Year.

0:43:220:43:26

Behind the scenes at the UK's most remote hospital. At the Gilbert Bain in Shetland, a team of doctors and nurses work alongside GPs, paramedics, coastguard, lifeboat crews and police to provide emergency and medical care to the islands' 23,000 residents. They also deal with thousands of oil and gas workers, fishermen and tourists 24 hours a day, 365 days a year. Shetland throws up unique challenges for this tight-knit team.

In this episode Brian, an engineer on an oil rig, is airlifted by helicopter to the hospital with suspected serious neck injuries. It is an urgent case for Dr Lalla and his team in accident and emergency because, aside from his injury, Brian has a worryingly low heart rate which requires thorough investigation.

Coastguard and lifeboat teams are scrambled to the aid of a pleasure boat whose propeller has been fowled just feet from Shetland's jagged rocks.

The ambulance team race to the aid of a former nurse with a suspected stroke. Back in the hospital, one of Europe's strongest men comes in with an injury that has come about because of his incredible strength.