Episode 10 Island Medics

Shetland, the most remote part of the UK.

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

And nearer Norway

than you are to Edinburgh.

There are more puffins than people.

ALL CHEER And more seals than supermarkets.

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

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

A&E, can I help you?

..from helicopter rescues and spinal injuries...

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

..to serious medical mysteries...

Can we get assistance in, please?

Something's not right.

..Shetland's island medics

have to be ready for anything and everything.

-What happened?

-I got in a fight with a seagull.

-This was sheep shears, was it?

-Yes.

SIREN WAILS

It means the tight-knit team of medics,

volunteers and emergency services have a special bond.

This might tickle, then.

LAUGHTER

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

A wee treat for night shift.

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

BOTH LAUGH

Today, the Gilbert Bain Hospital works hard to win over hearts...

..and minds.

Providing care for the young...

Perfect.

..and comfort for Shetland's more senior residents.

Home, sweet home.

In Shetland's capital, Lerwick,

the Gilbert Bain Hospital serves some 23,000 hardy islanders.

As with all hospitals, its lifeblood is the talented,

dedicated nursing team...

SHE LAUGHS

One, two, three...

..who work tirelessly to provide top-quality care...

-Ow!

-Oh, sorry, petal.

..day and night, all year round.

Our nursing staff...

have a great range of skills.

Nurses are becoming more and more relied upon

to provide care in different settings.

So they will put in cannulas, do ECGs, take your bloods.

So we are spoilt in a way

that we've got nursing staff that do all of that.

It's Saturday morning, but there's no lie-in

for senior charge nurse Aimee Sutherland.

Caring for all and sundry from the moment she wakes.

Me and my partner's got two Jack Russells

and my daughter's got a Jack Russell and my son's got a German shepherd,

who's just turned one.

Down.

I was born and brought up in Shetland,

so I've been here all my life.

Nearly 43 years.

Beautiful scenery. I personally couldn't live in a city.

I couldn't live anywhere else.

Sort of thinking, what kind of day is it going to be?

Are we going to walk into busy-ness

or...walk into quiet?

I'm the senior charge nurse,

which used to be what was known as the sister.

So in charge of the department and the staff.

It was something I never, ever thought I would do, if I'm totally honest.

Morning. Morning!

As a senior charge nurse,

Aimee manages the care teams,

but also directs a patient's pathway from admission,

through examination and treatment, to eventual discharge.

Got a really good team, so everybody's...

Everybody's really good at doing their own role

and we have senior staff nurses as well

that take on a lot of responsibility, as well as myself.

Even my little Hannah Banana!

But weekend or not, mornings can be busy.

And long summer days on Shetland mean younger folks are outdoors

from first light.

12-year-old Bruce has been brought in by his mum

with a pain in his leg.

Hop in to this middle room here, dear, OK?

Bruce has been running around outside -

A LOT - during his school holiday.

Do you want to pop yourself up on the bed?

I'm Aimee. I'm just going to ask you a pile of questions first,

is that all right?

I'll ask it between you and Mum, OK?

And when did this happen?

Yesterday. He was out for a training run with me

and after about eight miles, he just had horrendous pain...

-OK.

-..in his left knee, as if something had gone.

-Uh-huh.

-So we got...

-Was that in the evening?

-No, yesterday morning.

-Yesterday morning.

Eight miles is a relatively long run,

but nurse Aimee's keen to find out if there are other problems.

Like a small fracture or dislocation.

So does the pain travel anywhere else?

No, it's just like down this side.

Are you able to raise the leg off the bed?

How does that feel?

-Well, here it's not as bad...

-OK.

-..but it's a bit sore.

Can you bend the knee?

Just slowly.

And is the pain in here when you do that?

In here, yeah.

OK. What we'll do first is get you some pain relief, OK?

-OK.

-Before the doctor comes and properly examines it,

-so it's got a fair bit of pain relief onboard. OK?

-OK.

I think nursing in Shetland is different in that it's...

It's a small community and everybody knows everybody in some form.

You just have to take people as they are and try and help them,

cos what might be something quite simple to us

might be a big deal to them.

Nurse Aimee wants a more detailed examination of Bruce's leg,

so she fetches Dr Kirsty Sneddon.

Hello, I'm Kirsty. I'm one of the doctors.

-What's happened?

-He injured it for a run with me yesterday.

-OK.

About eight miles in, he had to suddenly stop

-with pain at the back of the left knee.

-OK.

So has the pain relaxed a bit with the painkillers?

-Yeah.

-Yeah? OK.

-It's made it definitely bearable.

OK.

OK. Can you straighten that out?

Like this one is. Is that sore?

-Yeah.

-OK.

I'm just going to... Can you manage that?

-Yeah.

-Yeah?

But it's sore to keep it that way?

I'm just going to feel gently.

Try not to kick me.

-Yeah.

-There.

-It's that side.

So it's more tender where we're pushing?

-Yeah.

-Yeah.

-Like, that's the worst bit there.

-Right there?

-Yeah.

How often do you run at eight miles?

Well, he does train with me quite a bit.

-I do... I do a bit of running with Mum...

-OK.

..and I play football at least five...

A good four times a week.

OK.

Right, this bit may hurt.

OK?

-Yeah.

-Is that worse?

-Yeah.

-Yeah. OK.

-OK. Good news is, the bones are fine.

-Yeah.

OK? The bad news is... I think you've pulled...

This, here, is where the muscle in your leg comes down

and joins across the knee.

It helps the knee bend and move.

I think what you've done is you've irritated that.

Hopefully, with a bit of rest,

some Ibuprofen, paracetamol for the pain, um...

and your cold compresses, your ice packs, I think it will settle,

it will start to settle.

See how it goes in the next couple of days

and then you can start to build it back up.

But I wouldn't be running one mile,

-let alone eight on it straightaway, OK?

-Thank you.

Given that he's so young, I...

I think the muscle itself is going to be healthy enough.

It will just take time.

If it worsens, if it swells up, if it...suddenly becomes very sore,

if you notice a lump, just come straight back.

I think in the long run, he'll be fine.

He just needs to rest it up and let the muscle out.

I suspect he's probably overused it being the summer holidays and

playing football five times a week.

I think doing an eight-mile run has probably overdone it a little bit.

Um, just let it settle

and then he can take up his running and his football again.

On Shetland, kids are more likely to be admitted to hospital from

overactivity than lack of activity.

With nearly 1,700 miles of stunning coastline,

there's fun to be had around these rugged rocks.

Shetland is a giant outdoor playground, with wild,

stunning nature on the doorstep offering a childhood like no other.

It's a place for getting outside and seeking adventure.

SEAGULL CRIES

Dr Kushik Lalla arrived on Shetland from South Africa.

Now he's the senior A&E and surgery doctor at the Gilbert Bain Hospital.

What I want is for you not to move your neck.

Cathy is just going to support your head.

But it's not all serious medical emergencies.

On this island paradise,

Dr Lalla has found a home he loves for himself and his family.

I was absolutely amazed the first time I got to Shetland.

The community is very close-knit, a fantastic place for kids.

DISTANT CHEERING

Right, guys. Now, today will be football.

I actively help out every weekend,

but I didn't take up a formal position

because they expect you to be there every weekend

and I can't give that guarantee.

Right, get your boots on.

-Are you going to play well today?

-Mm-hm.

-Yeah?

Today the local kids' teams are having a mini tournament,

with Dr Lalla's son Josh playing up front for Whitedale FC.

-Where are we, on the grass pitch?

-Yeah.

And because it's summer in Shetland,

the eager teams will definitely need to warm up first.

WHISTLE TRILLS

First game, we are on pitch four.

This one. Come on, over here. Whose jacket is this?

Dr Lalla volunteers as occasional team coach, team medic

and, of course, passionate touchline dad.

It's nice being out of the hospital.

HE CHUCKLES

That's it, Josh. Go in.

Oh, unlucky.

Yeah! Well done, Josh.

That's OK, up you get.

Nice, Joe.

Yep.

An initial victory for Whitedale FC.

And it's straight onto game two.

Take it in!

It's fantastic for kids, I think.

It's a safe place, you get them out, you get them active.

Positions, guys.

Josh, positions.

The wins keep coming.

It's turning into a great day for the team,

for Josh and for all the proud dads.

They've won so far every match.

So, yeah, doing fine.

ALL CHEER

Well done. Good playing there.

Being a doctor is considered to be

one of the most stressful jobs in Britain.

So there are perks to living in a small, far-flung community,

with the great outdoors on your doorstep.

Kids, it's safe for them to go out and run around.

You really don't see it nowadays, but, you know,

you'll find little kids wearing their welly boots,

playing in little lochs and streams.

Dr Lalla and his family

are certainly living the dream on Shetland.

Getting all the outdoors has to offer them

on and off the football pitch.

Get the foot in!

But while football is the beautiful game,

it can occasionally end in tears.

15-year-old Saul has been brought in from school after the ball awkwardly

struck his knee, causing much pain.

Dr Etaoin Carroll wants to find out more.

I was just running and then the ball hit me and my leg just completely...

I couldn't move it at all.

And I just kind of fell to the ground.

And I tried putting weight on it and I just couldn't.

So some friends helped me hobble to the janitor's at school and get it

-seen to.

-So apart from the knee that you've told me about,

is there anything else you see a doctor regularly for?

I've had problems with, like,

both my knees and, like, my hips and my back.

What I think we'll do is, I think we'll get an X-ray of the knee

and then when you've had your X-ray, we'll move you back into somewhere with a bed.

Because Saul has problems with his knees, as well as his hips and back,

the medical staff want to see if there's other damage

or irregularities in his knee joints.

But taking the X-rays won't be easy.

Saul's already in a lot of pain.

So, what we wanted to do is to make you comfortable enough

that you'll let me straighten your leg a wee bit more than it is now.

Do you want to give it a shot?

Yeah.

Suck hard...and blow it.

The knee now requires manipulation to straighten the leg and examine

the meeting point of the thigh and shinbone.

SAUL INHALES DEEPLY

Now Dr Lalla can cast his experienced eye

over the troublesome joint.

-Yeah, unusual configurations.

-Yeah.

-Yeah.

-Just this whole configuration just looks odd.

-Yeah.

And this on the lateral, you know,

-you can see the growth plate over there.

-Yep.

-That looks...

-That's it over there,

-and that corresponds to this area here.

-Yeah.

-But what is that, then?

-I don't know.

The football injury has caused Saul's current discomfort,

but there's a potential problem

with the configuration of his knee joint.

I think that this is just the way he's actually rotated.

Your X-rays...

We'll discuss these at one of our, what's called

a paediatric meeting.

So we link in with the guys in Aberdeen,

the paediatric orthopaedic doctors,

and they have a look at all these X-rays and tell us, you know,

"Do that" or "It sounds like this."

In the meantime, Saul is fitted with a special plaster that will keep his

knee bent but slowly straighten over time as the pain subsides.

They'll have note of you as well,

and if they think they should see you, then we'll arrange that.

There isn't a specialist paediatrician

at the Gilbert Bain Hospital, or on the island.

So, anatomical conundrums like Saul's knee

can be referred to specific units on the mainland

for a second opinion, if required.

If you see people on Shetland,

the vast majority of them do not want to leave the island

to receive their care.

Sometimes patients travel by boat and that's a 14-hour journey.

If the sea is rough, you can be, you know, throwing up the entire time.

So it makes sense to try and provide as much care as possible

on the island.

The clinic is just in there

-when you come back in a couple of weeks' time.

-Yeah.

Saul may need an operation to remove excess cartilage from his knee.

But in the meantime, he can return home to rest.

Football glory will have to wait.

59-year-old Theresa suffers from regular debilitating migraines.

But she was recently struck by a more severe and troubling throb

in the side of her head.

Dr Michael Stewart's on the case, but he needs to find out more.

-What's been happening?

-Um...

-Well, Saturday I had this...

-Mm-hm.

..massive pain in my head and it...

was sort of like a whooshing sort of feeling in me head.

-Right, OK.

-Me eyeballs sort of rolled back

and I went really dizzy and lost me balance.

-Right, OK.

-And I've had this headache since.

It's just been a really crushing headache.

Does it feel like your normal migraine?

-No, it doesn't.

-No?

-No.

-No.

And do your migraines normally always feel the same?

-Yes.

-Yes, OK.

-Yeah, yeah.

-So it's a NEW headache?

-It is, it's... It's a real severe headache.

-Mm-hm.

Regular migraines are an unpleasant condition, and surprisingly common -

affecting one in seven people across Britain.

That's over nine million sufferers.

But for Theresa, this new and more severe headache,

along with a loss of balance,

could be a sign of something worse.

She's had a sudden onset headache a few days ago

and she thought it would just get better because she normally has migraines.

Um, but the GP's worried... A sudden onset headache is worrying,

but then also she's got some funny signs, like poor balance,

which are kind of worrying her as well,

that there might be a bleed in the brain.

So, Theresa will need a CT scan and a series of cognitive tests.

A loss of strength, sensation or reflex could indicate

that her brain has been damaged.

-Any double vision at all?

-No.

Any new changes in the vision since you've had this headache?

Slightly blurrier.

OK, can you put your fingers out wide?

Squeeze my finger, as hard as you can. Come on.

-I am!

-OK. Can you lift this leg straight up for me?

And don't let me push it down...

Don't let me push it down.

OK. Now this one. Don't let me push it down.

OK, grand. Can we get your shoes and socks off?

-THERESA LAUGHS

-Is that allowed?!

If there's been a bleed on Theresa's brain,

reflex reaction times will be slower.

Pop your leg out to the side.

There we go.

So I'll need to get some blood samples.

We need to know how your kidneys are doing first before we do the scan.

-OK.

-Um, and then we'll take it from there.

All right.

-So, it takes about an hour for the kidney tests to get back.

-OK.

OK, right.

So we'll get all that sorted.

Are you happy to wait in the waiting room just whilst we get the results?

Pop your shoes on before you go!

-HE LAUGHS

-I don't want you to stand on something by accident.

-OK.

Theresa will have a potentially long series of tests

to determine what's happened inside her head.

And she'll need to spend an anxious night in hospital under observation

before a brain scan in the morning.

Shetland's location in the North Sea means there's a lot of offshore

employment for local people.

56-year-old Gary is an able seaman aboard a North Sea supply vessel,

currently docked in Lerwick.

Overnight, Gary developed difficulty breathing

and worrying pains in his chest.

Nurse Emma Williamson takes on one of the many vital,

yet unsung medical tasks -

to prepare the patient for examination.

Put on that attractive gown. I see you've a rather hairy chest!

We might have to do a bit of shaving.

But the first thing that we really need to exclude

is that it's come from your heart.

-So this is just a heart tracing that I'm going to do.

-Mm-hm.

So, um, I have to put wee stickers on your chest.

-Hence the shaving.

-Mm-hm.

A heart trace test, or electrocardiogram,

measures the rhythms of the heart to check it's operating normally.

But it must be taken into account

that Gary is a 60-a-day cigarette smoker.

Dr Lauren Camet has her concerns.

I think he spoke to the ship medic about it just briefly.

The ship medic, quite, I think, responsibly, reported this to the captain,

who wanted Gary to come and get checked out in A&E.

-Hi, Lauren.

-So, Gary, when did this sensation come on last night?

-Three o'clock in the morning.

-Three o'clock in the morning.

And were you awake already or did it waken you up from your sleep?

-I was wakened.

-OK.

-You couldn't sleep for it, would that be fair to say?

-Mm-hm.

Is it normal for you to be up at that time in the morning, or...?

-No.

-No, OK.

Why were you awake, if you don't mind me asking?

Were you feeling unwell in any other way?

No. Any palpitations?

-What's that?

-Feeling your heart beating fast.

-No, not that I can remember, no.

-No. OK, that's fine. That's fine.

Breathing problems and heart palpitations

could point to something more serious...

Nice big breath in now, please.

..especially for a heavy smoker like Gary.

Time for a nervous chest X-ray. MACHINE DINGS

Perfect, that's all done, thank you.

There's a chance that Gary has unstable angina,

a very serious condition where the heart has restricted blood flow

and doesn't get enough oxygen.

This can lead to a heart attack.

So Gary can't be discharged yet.

But that doesn't stop him going AWOL.

Another job for hard-working nurse Emma.

Yeah, have you seen him going anywhere? He's got a cannula in, so...

Unless he's at the toilet.

Gary?

Stepping out for a phone call,

Gary managed to light up another cigarette...

before nurse Aimee ushers him back in.

Obviously, I can't force people to stay in hospital,

but when I think it's definitely for their benefit...

And if he had a heart attack on a ship,

which is a 60-minute helicopter ride from the nearest hospital,

that's a lot more danger to his life than if he has a heart attack,

you know, within ten minutes.

With Gary back indoors

and his condition still potentially very serious,

Dr Camet is keen to run more tests.

What we'd like to do is get another ECG,

but while you're on a treadmill walking, OK?

So what we do is, we have you on the treadmill and get you kind of going

faster and faster,

-but record your heart through that to see what happens, OK?

-Yeah.

If you do have angina or if you have a narrowing in one of the arteries

in your heart, what we might see is changes on the ECG,

and that would be really helpful for us.

-Try and behave yourself.

-I know.

-SHE LAUGHS

-See you!

-It's OK.

Now, is that...? Happy for us to do this?

That's super.

OK, so if you just rest your right hand on here

and keep the left arm nice and straight.

Monitoring Gary's heart at pace will show the medical team

how this vital organ functions while he's on the move and at work.

HE COUGHS

Well done. The reason you stopped is because your blood pressure has gone

-a wee bit higher than we'd like it to be. OK?

-Yeah.

So what we need to do is rest you down on the bed and let you recover.

So, Gary will need a little lie down and a bit of a breather,

as well as medication to bring down his blood pressure

and unblock his arteries.

But he's well enough to officially leave the hospital.

SEAL SNORTS

Not every medical problem can be solved at the hospital.

And not every patient can make it to the Gilbert Bain.

One such case is on the books for occupational therapist Jill Beswick.

Occupational therapists work, um,

in both mental health and physical health,

and we're trained, we're dual trained,

so we look at the whole person,

looking at both the physical needs and the mental health needs,

and we work across all age ranges as well,

from very newborn babies to the very elderly,

and certainly within our services,

we've still been supporting people at home that are 97, 98,

back home from the care homes to live independently at home.

So, Jill's work takes her to many a far-flung destination,

providing support to the very young and old.

One of the things, for me, when I first arrived in Shetland

was trying to work out how we were going to get there.

You've got to look at your ferry timetables...

This visit was planned for tomorrow,

but we've looked at the weather forecast,

we know it's going to be 47mph wind tomorrow with driving rain.

There's no way we can take an 80-year-old lady out in that.

And the lady in question... is 80-year-old Stella,

who had a bit of a fall and broke her hip.

Stella's itching to get back on her feet and living independently,

having received treatment at a residential nursing home.

So we'll just pull up here,

so that we're nice and close for getting her into the car.

Oh, good morning, Stella!

Oh, hold on!

I'm taking pills!

I'm getting used to having a slave!

-I'll get the Zimmer...

-That surely isn't true!

We're going to have to get you home and whip you into shape

if that's the case, Stella!

It's breezy out there.

-Will you be able to carry your bag?

-Yes.

There we go.

-OK.

-Can I take your handbag?

Lovely, yes.

It's probably better to go up and over, isn't it?

Whilst Stella's been enjoying some R&R,

her house has been receiving some TLC.

Stella's concerned about her restricted mobility,

so a team has been in making essential adaptations.

Now Stella gets to inspect their handiwork.

-How's that?

-Lovely!

Whay-hay!

Oh, I can't see, hang on.

Step in as close as you can.

It's an emotional moment for Stella,

who's been away from home now for several weeks

and is not entirely sure

how much the interior has changed in her absence.

OK? In you go.

-Home, sweet home.

-Well done!

-Perfect.

-Whoa! I need a holiday!

ALL LAUGH

Now Stella must gauge how she'll cope with living on her own.

The Gilbert Bain A&E Department is no different to any other hospital -

open 24 hours a day, seven days a week, 52 weeks of the year.

Patients can arrive at any time of the night.

-So, my name's Dr Hare.

-How are you?

What have you been doing to yourself?

-I was at training tonight...

-Uh-huh.

-..and, um, it was just from... And someone jumped over...

-Yep.

-..and as they jumped, something must've fell off them, and went in my eye.

-OK.

It's almost midnight

and Dr Helen Hare has a patient with an eye problem.

Whilst 17-year-old Warren was playing football,

he got whacked in the eye and is in some discomfort.

What we'll do is, we'll get you through

and we've got a special light that we use to examine the eyes

and see if there's anything we can wash out or lift out.

Dr Hare will use a slider camera to inspect the eye and socket.

Um, and I need to put some... I'll have a look first,

and then I need to put some fluorescent in your eyes.

Chin forward.

Dr Hare needs to have a closer inspection of Warren's eye,

and she has a special way of doing it.

So what I've got here is a wee orange dye.

So I will pop some of this into your eye.

-It's going to make your eye look a bit weird and orange.

-Yeah.

And hopefully, when I then shine the blue light on it,

we'll see something we can deal with.

The nearest ophthalmic department is 226 miles away on mainland Scotland.

And although Dr Hare is not an eye specialist, in Shetland,

having general expertise is a specialism in itself.

What I need you to do is just look up for me...

OK. And then just hold it in your eye for a wee minute and then blink.

The medical team at the Gilbert Bain all have a vast knowledge of general care.

Where does it feel like it is, sorry?

Right at the top, like past my eyelid, right there.

OK.

OK.

Right, I think we'll need to stop this for a minute.

Sorry, Warren, I'm not especially good at this,

as you may be able to tell, and I'm not having a lot of luck.

I'm going to see if I can find a colleague

to give me a bit of assistance, all right?

-No worries.

-Sorry about that.

Sometimes, though, there are times where you just need to call upon

a more experienced colleague.

The problem is, this is a piece of equipment that I haven't used since

medical school, and I've made a bit of a cack-handed job of it.

Fortunately, one of the nurses is actually quite experienced in using this kit,

so she's going to step in for me.

Fortunately, the multi-skilled nurse, Thelma Irving, is on hand

to take up the baton.

-You all right?

-Mm-hm.

-I didn't actually see any... You can just relax if you want.

-Yeah.

I didn't really see anything.

Um, I didn't really see any optic at the stem

-that would indicate that you've scratched your eye.

-Mm-hm.

But when modern technology reveals nothing,

nurse Thelma decides to take a look the old-fashioned way.

Oh...

What I'm going to do is, I'm just going to take a wee cotton bud...

-Mm-hm.

-..and I'm going to just turn your eyelid back.

It's a kind of uncomfortable feeling but it shouldn't be too painful.

-That's all right.

-And just look underneath your eyelid, OK?

It's the second most complex organ after the brain

and composed of more than two million working parts.

A potential injury to the eye demands close attention.

You just relax.

I'm just going to turn your eyelid back.

And wipe anything that's there.

And it's not one of the easiest parts of the body to inspect.

I'm squeamish as well. Like, my eyes are like the worst things I could...

Oh, I know. But nothing else...

Both hi-tech and low-tech examinations

reveal no perceptible damage.

So what to do with poor Warren and his stricken eye?

-There's no uptake at the stem that I can see.

-Yep.

Have a look at the slip mark.

Unless it's really, really high up and I can't see it.

-So I've suggested that he maybe goes to the optician tomorrow.

-Optician? Yeah, absolutely.

-Do you want me to give him some chloramphenicol ointment in the meantime?

-Might as well.

-And patch cos of the local?

-Yeah. Mm-hm, mm-hm.

-Yeah, good.

-Will that be fine?

-Perfect.

-OK.

-Thank you, Thelma.

No problem.

-OK.

-Cheers.

-Bye just now.

So after a long night's wait,

it's a trip to the local opticians for Warren.

And he just needs to wash and rest the eye.

59-year-old Theresa came into the Gilbert Bain Hospital

following a severe migraine episode and a worrying loss of balance.

She already suffers from regular debilitating migraines,

so medics were eager to arrange a CT head scan to make sure Theresa's

not had a bleed on the brain.

Dr Stewart has been overseeing this troubling case.

PHONE RINGS

So, her scan of her head was negative, it didn't show anything.

Um, but it's not ruled it out completely.

We need to do a bit of a more detailed scan tomorrow.

So I'm just going to try and admit her overnight,

although she's not too keen on that,

and we'll see how that goes.

We'll get this more detailed scan here

and then if that's still negative,

she might need an even more detailed scan in Aberdeen.

And she might need a lumbar puncture, which is just a needle in the back,

to look for some blood there as well,

but we'll see, we'll see.

A few different avenues to go down depending on what we find.

-So, what's happening?

-I've spoken to the boss

and he agrees that it's probably best to keep you overnight,

just cos we are worried about this.

Albeit a small risk.

Um, we... We just want to err on the side of caution.

So it's really up to you.

-I'll stay.

-Are you sure?

-Yeah.

-OK.

-Otherwise I'll get an earache.

DR STEWART LAUGHS

That's often the reason that people end up staying!

Um... So, yeah, we'll hopefully get the other scan early tomorrow

and then take it from there.

-OK.

-OK?

-All right.

I'll get everything sorted.

-Grand. And if you need any more painkillers, just let us know.

-Yeah.

-And we'll try and not make you wait so long next time.

-OK.

OK?

Dr Stewart wants another CT scan

and input from the specialist units on the mainland

before giving the all clear.

In the meantime, sadly, it's more anxious waiting time for Theresa.

SEAGULL CRIES

Margaret has arrived in the A&E Department

with some worrying chest pains.

Nurse Amanda Brown is on the case

to check the background of Margaret's condition.

A friendly chat also helps put a worried patient at ease.

You've been on holiday. When was that?

Uh... We came back two weeks ago, two weeks ago tomorrow.

There was me...

I didn't even have alcohol as an excuse to be daft,

but the next day I felt really ill.

Do you feel like it's coming from your stomach,

or is it in the centre of your chest?

It was in the chest, but it was very uncomfortable.

OK, I'll do some observations like they did in the ambulance,

and then I'll do an ECG

-just to check that there's nothing going on with your heart.

-Yeah.

But you've been here before,

so you ken what I'm going to be doing?

Nurse Amanda helps with the diagnosis.

Blood pressure can identify possible cardiac issues

and the ECG examines the heart's performance.

Dr Cameron Innes is also on hand to assist.

For a couple of... Just a peerie minute, we'll keep still and...

I won't speak.

-You stop asking questions.

-Aye. Don't worry.

SHE CHUCKLES

The ECG records electrical activity in the heart,

which the doctor or nurse can cross-reference

and compare with patterns of proven heart conditions.

To make it accurate, it requires the patient to remain fairly still.

OK, you're free to speak now.

Do you mind if I have a wee listen to your chest?

-No, not at all.

-Have you got any chest pain at the moment?

-No, just a slight burn there, it's nothing...

-A burn.

Do you get breathless at all when you're lying flat?

-A little bit.

-Do you ever wake up gasping for breath

-in the middle of the night?

-No.

-No.

So when I'm listening to the back, it's easiest to hear all the lung fields.

So, essentially, you get them to breathe in and out.

If they've got any infection, it kind of sounds a bit like a crisp packet.

You can hear it bubbling away.

-Are you quite comfortable sitting like that?

-Yeah.

-OK.

Hers is perfectly clear, which...I was expecting.

And then when you come round to the front, you listen to the heart,

so listening for murmurs...

This is just a kind of turbulent blood flow within the heart

and it might mean, like, leaky valves.

You know, the volume and stuff of the heartbeat and also making sure that

it's all regular and everything's hunky-dory.

Do you notice your ankles swelling up at all?

-They're no bad, no.

-No?

-That foot's a bit swollen because I have a bad ankle there, but...

-Yeah.

You ask a lot of patients about their ankles swelling up

because it can be a sign of...

Or IS a sign of heart failure.

All the fluid that kind of stagnates in the leg

because the heart's not pumping all the blood around,

it just seeps out into the tissues and swells up

and it can seep out into the lungs as well.

Oh, was that a wee bit sore there?

-It was.

-Oop!

With Margaret's vitals checked and the ECG results reviewed,

Dr Innes has a plan of action.

Good. OK.

So what we're going to do is...

So all your numbers and things, with the monitoring, look good.

-Mm-hm.

-Uh, what we're going to do is,

the tracing of your heart that we just did a minute ago,

there's something that I just want to double check,

so we'll have to get a blood sample.

If everything is fine,

I'm quite confident that you'll be able to get away.

As good as the service is at the Gilbert Bain Hospital

and as wonderful as the medical team are, most patients are very,

very happy to finally go home.

Like the rest of Britain, Shetland does have an ageing population,

with around 25% already aged over 60.

And whilst the island is the perfect, gorgeous setting for retirement,

or growing old disgracefully,

it does present extra challenges

for the talented teams providing health care.

80-year-old Stella has been away from her home for several weeks.

Whilst her damaged hip was being repaired,

adaptations were made to her home to enable independent living.

It's an emotional return for Stella,

but occupational therapist Jill is on hand to help.

So keep your hand on it, you need to keep it pushing in that direction.

STAIRLIFT BLEEPS

-Are you feeling OK?

-Mm-hm.

And it's not just an exciting, brand-new stairlift.

The whole house has become more suited

to Stella's restricted mobility.

Hands down to the bed before you sit down.

That's it. Lovely. Yeah. Yeah.

-Whay-hay!

-Just saves this moving on you.

-OK?

-Yeah.

-So I'll just move that out of the way,

-so I'm here while you get yourself...

-I've got to lie down, have I?

Yeah, when you're ready. Yeah. In your own time.

Oh, yeah.

-OK.

-Right, take a minute.

And then have a go at getting into bed properly.

Get nice and comfy, like you were settling in for the night.

Do you think you would like to get into the middle a bit more or roll over?

-Roll over!

-Mm-hm.

-STELLA LAUGHS

Trying out your new bed is always fun,

but supported living could be difficult

for a party girl like Stella.

Do you think if you had support coming in,

would you like to come upstairs and be able to use your bedroom?

Mmm...

Yeah, but, I mean, somebody will come

about one o'clock in the morning to make sure I'm going to bed.

Yeah, and that's what we don't have, yeah.

The last visit, really, tends to be nine, half nine.

I'm not going to bed then!

-I know, you're quite a late lady, aren't you?

-Yeah.

Perfect.

Home visits might be tricky for this night owl.

But overall, Stella seems pleased with her newly-adapted home.

It didn't kill me, or...

Getting on and off that bed was the easiest thing ever.

-It was easy.

-Wasn't it?

-Yeah, brilliant.

Yeah. So much easier than the beds in the care home.

I think it shows, really,

that we need to do the home visit to anticipate any difficulties.

I thought I'd prepared for most things.

The stairlift was trickier than I was expecting.

-Slow and steady.

-Whay-hay!

Stella will finally return home for good in a few weeks' time.

This will be the most activity you've done in a long, long time.

-Yeah.

-Yeah.

Until then, it's back to the care home

for a spot of lunch and a bit of a lie down.

Lovely.

OK.

Bye-bye!

SEAL SNORTS

Margaret arrived in the A&E Department

with worrying chest pains.

She received a physical examination from Dr Innes

and another from the ECG machine.

Next, nurse Amanda provides another vital medical procedure -

taking blood for analysis.

-Just one more. Are you OK?

-I'm grand.

Doesn't faze you, then?

Not one little bit.

So you said you're allergic to stuff, are you?

Or is it just sensitivities?

-They're severe sensitivities...

-Uh-huh.

..but I am allergic to...penicillin.

Do you get anaphylaxis, like you actually swell up?

I can, yeah, come out in...

So were you having a cup of tea?

-Please. Just black tea.

-Black tea?

-Nae milk, nae sugar?

-No, thanks.

OK.

I shall go and sort that out, I'll label up these.

I'll give you the bell just in case you're needing me.

-OK.

-Then you can give it a buzz and I'll not be far away.

The dedicated nurses offer full-spectrum care,

from medical procedures to a comforting chat,

to a cracking hot cup of tea.

So Margaret is settled to receive blood test results from Dr Innes.

OK, Margaret, so all your bloods are back.

-Good.

-And everything is completely normal.

The blood test we did to check starvation of oxygen to the heart...

-Uh-huh.

-That's completely zero.

-Good.

-So that's good.

-OK?

-Lovely.

-So happy to let you away.

-Thank you.

-With the advice that you go see your GP.

Great news for Margaret.

And she can now return home worry-free.

Have you got any way of getting home?

I'll phone some of my folks or family might be around...

-OK.

-..I think, and, um,

hopefully they'll be willing to see the old lady up the road.

-I'm sure they will. All right?

-SHE LAUGHS

-Well, it's been lovely to meet you.

-Yeah, you too.

-Thank you.

-You're welcome.

Saul is awaiting his knee surgery to have excess cartilage removed.

But the medics are confident he'll have no future hip or knee issues.

Theresa had a further CT scan

and, after consultation with specialists from the mainland,

was finally given the all clear to return home.

After several weeks,

Stella was able to permanently return home

and is finding her new adapted house most satisfactory.