0:00:02 > 0:00:05Shetland, the most remote part of the UK.
0:00:07 > 0:00:10Here, you are closer to the Arctic Circle then you are to London...
0:00:10 > 0:00:13..and nearer Norway then you are to Edinburgh.
0:00:14 > 0:00:16There are more puffins than people
0:00:16 > 0:00:19and more seals than supermarkets.
0:00:20 > 0:00:26But this wild landscape is also home to 23,000 islanders.
0:00:26 > 0:00:29It is so far from the mainland that when things go wrong... SIRENS
0:00:30 > 0:00:32A&E, can I help you?
0:00:32 > 0:00:36..from helicopter rescues and spinal injuries...
0:00:36 > 0:00:38We are all here to make sure that you are OK.
0:00:38 > 0:00:40..to serious medical mysteries...
0:00:40 > 0:00:42Can we get assistance in, please?
0:00:42 > 0:00:44Something is not right.
0:00:44 > 0:00:48..Shetland's island medics have to be ready for anything and everything.
0:00:48 > 0:00:50- What happened?- I got in a fight with a seagull.
0:00:50 > 0:00:52- This was sheep shears, was it? - Yeah.
0:00:55 > 0:00:57It means the tight-knit team of medics,
0:00:57 > 0:01:00volunteers and emergency services have a special bond...
0:01:00 > 0:01:02This might tickle.
0:01:03 > 0:01:06..and they know just how to keep each other going.
0:01:06 > 0:01:08A wee treat for the night shift.
0:01:09 > 0:01:12So they're always ready for any island emergency.
0:01:21 > 0:01:24Today, a casualty from an oil rig with a back injury.
0:01:26 > 0:01:30It's possible that the bottom of your spine has been kind of crushed.
0:01:31 > 0:01:34Dr Lalla shows a junior doctor the ropes.
0:01:34 > 0:01:36It's going to sting now like hell.
0:01:37 > 0:01:41A Shetland GP travels to Britain's most remote community
0:01:41 > 0:01:44and a road traffic accident with a uniquely Shetland twist.
0:01:44 > 0:01:46And there's still feathers.
0:01:52 > 0:01:56The Shetland Islands are a tough landscape of windy moorland,
0:01:56 > 0:01:58daunting cliffs and savage tides,
0:01:58 > 0:02:01where you're never more than three miles from the sea.
0:02:04 > 0:02:07And while life for its inhabitants can be challenging,
0:02:08 > 0:02:10it's the place they have decided to call home.
0:02:17 > 0:02:20Its remote location means that there are also challenges
0:02:20 > 0:02:23for Shetland's 100 medics, and especially for the staff
0:02:23 > 0:02:25at the island's hospital,
0:02:25 > 0:02:27the Gilbert Bain.
0:02:27 > 0:02:29We see anything and everything here
0:02:29 > 0:02:31and we have to kind of be able to deal with that.
0:02:31 > 0:02:34Unlike on the mainland, the team here are generalist medics.
0:02:36 > 0:02:40Meaning they can go from care of the elderly in the morning
0:02:40 > 0:02:45to paediatrics in the afternoon - and all ages in between.
0:02:47 > 0:02:48Ooh!
0:02:48 > 0:02:53After working throughout most of the UK, this place has a lot of appeal.
0:02:53 > 0:02:55There is no comparison, really.
0:02:55 > 0:02:56It's lovely.
0:03:09 > 0:03:11Morning at the Gilbert Bain,
0:03:11 > 0:03:14and for senior A&E surgical doctor Kushik Lalla,
0:03:14 > 0:03:18it is the start of another shift at this extraordinary hospital.
0:03:18 > 0:03:21We never work like the rest of the UK.
0:03:21 > 0:03:26Here, we have to see and deal with everyone ourself.
0:03:26 > 0:03:29And so we have had senior A&E trainees
0:03:29 > 0:03:31that have come and worked here,
0:03:31 > 0:03:36and just can't do it because they have never manipulated
0:03:36 > 0:03:37a broken wrist,
0:03:37 > 0:03:41they have never reduced a fracture in, you know,
0:03:41 > 0:03:45a hip or dislocated shoulder.
0:03:48 > 0:03:52Nowadays in the UK that is becoming increasingly rare.
0:03:52 > 0:03:57I think a lot of people say that, "I'm not a specialist in this,
0:03:57 > 0:03:59"so I shouldn't be touching it."
0:03:59 > 0:04:05If we did that over here, then our patients would just see no-one.
0:04:14 > 0:04:16Despite its remote location,
0:04:16 > 0:04:19Shetland boasts some of the best roads in the whole of Britain.
0:04:22 > 0:04:25And the combination of breathtaking views and the lack of traffic
0:04:25 > 0:04:27make it a Mecca for motorcyclists.
0:04:28 > 0:04:31They travel from all around the country to attend bike rallies
0:04:31 > 0:04:35on the island and biking is also popular with the locals.
0:04:35 > 0:04:39But unfortunately, where there are bikes, there are accidents.
0:04:45 > 0:04:47Eddie, a 30-year-old scaffolder
0:04:47 > 0:04:50from the island of Bressay on the east coast,
0:04:50 > 0:04:53has come into A&E after being involved in a high-speed collision
0:04:53 > 0:04:56while on his motorbike.
0:04:56 > 0:04:57At the time it was all right
0:04:57 > 0:04:58but now from the bottom of my ear,
0:04:58 > 0:05:01down here and into my shoulder is rather painful.
0:05:01 > 0:05:03I can't really move my neck.
0:05:03 > 0:05:06Eddie's accident was a result of the kind of thing they don't exactly
0:05:06 > 0:05:08teach you on your motorbike test.
0:05:08 > 0:05:11I was taking my bike out to the garage.
0:05:11 > 0:05:14A seagull has come out from the ditch on the near side of the road
0:05:14 > 0:05:16and just got caught by a gust of wind.
0:05:16 > 0:05:18And flew straight into my face.
0:05:18 > 0:05:21I was doing 60-ish.
0:05:21 > 0:05:24So it was a fair old impact!
0:05:24 > 0:05:26I've got a new respect for seagulls after this.
0:05:26 > 0:05:28Nightmare, eh?
0:05:28 > 0:05:31Usually they're just trying to nick your chips, aren't they?
0:05:31 > 0:05:33Any tenderness?
0:05:33 > 0:05:34That's sore there. Yeah!
0:05:34 > 0:05:36Yeah, that's painful.
0:05:39 > 0:05:41Oh, no.
0:05:41 > 0:05:43- Oh!- Are you OK?
0:05:43 > 0:05:44- Yeah.- Sit a moment.
0:05:45 > 0:05:47Just... Are you light-headed?
0:05:48 > 0:05:51No. Just... I'm just trying not to move my neck.
0:05:51 > 0:05:53It feels like my neck is in a vice.
0:05:53 > 0:05:54Yeah.
0:05:56 > 0:05:58I'll help you get your leg up.
0:05:59 > 0:06:03Just keep your head still until we get you assessed properly, OK?
0:06:03 > 0:06:05OK. Are you reasonably comfortable like that?
0:06:05 > 0:06:07Yeah. I don't suppose there's any chance of a gin and bitter lemon,
0:06:07 > 0:06:11- is there?- Not at the moment. You might get one in half an hour!
0:06:12 > 0:06:15I'm sorry, I don't have your name.
0:06:15 > 0:06:17- It's Carly.- Carly?- Yep.
0:06:17 > 0:06:21Eddie's girlfriend has arrived to smooth his ruffled feathers.
0:06:21 > 0:06:23Carly can whisper sweet nothings into your ear.
0:06:23 > 0:06:27There's a first time for everything!
0:06:27 > 0:06:30You can see where it's lifted the helmet here.
0:06:30 > 0:06:31That should be pinned down.
0:06:31 > 0:06:33But it has just lifted it up
0:06:33 > 0:06:34and there are still feathers.
0:06:36 > 0:06:37That helmet was expensive.
0:06:38 > 0:06:40Never mind the helmet!
0:06:44 > 0:06:45Such hard work.
0:06:45 > 0:06:49That seagull has got a lot to answer for.
0:06:49 > 0:06:51I think his name was Steven.
0:06:52 > 0:06:54Oh, Eddie, no!
0:06:54 > 0:06:56"Steven Seagull."
0:06:56 > 0:07:00Not sure a career in comedy is awaiting, Eddie.
0:07:00 > 0:07:01Maybe just stick to the day job.
0:07:01 > 0:07:04He was wanting to go back scaffolding, he was wanting to go back to work.
0:07:04 > 0:07:11I would far rather go back to work in pain than come in here and take your advice.
0:07:11 > 0:07:15I would have far rather gone back to work.
0:07:17 > 0:07:20I'm just so pleased my bike is all right.
0:07:20 > 0:07:21It was close to hitting the bike,
0:07:21 > 0:07:23that would have really upset me.
0:07:23 > 0:07:26The seagull attack may be a good story to tell,
0:07:26 > 0:07:30but it won't be quite as funny if Eddie has sustained a serious injury to
0:07:30 > 0:07:35his neck. So, nurse Marie Stamp calls for Dr Lalla to ascertain what the damage might be.
0:07:35 > 0:07:37What happened?
0:07:37 > 0:07:39I got in a fight with a seagull.
0:07:39 > 0:07:42- On a motorcycle.- Right.
0:07:42 > 0:07:45By the time I made it back to my work, I was in quite a lot of pain.
0:07:45 > 0:07:50- Where was the pain?- From the underside of my right ear,
0:07:50 > 0:07:53going down my neck
0:07:53 > 0:07:56and it is basically following around to my right shoulder blade.
0:07:56 > 0:07:59I'm just had to have a quick look at you again.
0:07:59 > 0:08:02- OK.- Right, I am going to be testing your neck.
0:08:02 > 0:08:05Any pain there?
0:08:05 > 0:08:07No, not really.
0:08:07 > 0:08:08- No? There?- Yes, that is painful,
0:08:08 > 0:08:11it's sending shooting pains right down my shoulder blade.
0:08:11 > 0:08:14It is tender on the midline.
0:08:14 > 0:08:16- Midline, yeah.- OK.
0:08:16 > 0:08:19- You feel that there?- Yeah.
0:08:19 > 0:08:20There?
0:08:20 > 0:08:22- No.- There?
0:08:22 > 0:08:24- Yeah.- There?
0:08:25 > 0:08:27No.
0:08:27 > 0:08:31Dr Lalla requests a CT scan for Eddie to get a better look at any
0:08:31 > 0:08:33potential damage to his neck.
0:08:33 > 0:08:34Can you not feel your hand?
0:08:34 > 0:08:37No. I can feel you touching me but...
0:08:37 > 0:08:39Well, I am nipping really hard.
0:08:39 > 0:08:40Can you not feel any pain?
0:08:40 > 0:08:41- No.- Oh.
0:08:49 > 0:08:52The Shetland archipelago comprises over 100 islands,
0:08:52 > 0:08:55of which just 15 are inhabited.
0:08:56 > 0:09:00The NHS endeavours to provide comprehensive care to everyone in Britain,
0:09:00 > 0:09:02however remote their circumstances.
0:09:03 > 0:09:09Recruiting staff to live and work some 224 miles and a 12.5 hour ferry
0:09:09 > 0:09:13ride from the nearest mainland port can be an uphill struggle.
0:09:13 > 0:09:17And for the medics who serve these more far-flung islands,
0:09:17 > 0:09:20this means a working day quite unlike that of your average GP.
0:09:27 > 0:09:3047-year-old GP Mark Maudsley is preparing to travel
0:09:30 > 0:09:34from his practice in Levenwick, in the south of Shetland's mainland,
0:09:34 > 0:09:37to run a clinic on Fair Isle.
0:09:38 > 0:09:40There is no doctor on the Fair Isle.
0:09:40 > 0:09:42There is usually a resident nurse,
0:09:42 > 0:09:45although there isn't one at the moment,
0:09:46 > 0:09:51so once every month or so, we go in for the day.
0:09:52 > 0:09:55Mark and the other GPs at the Levenwick surgery
0:09:55 > 0:09:59share responsibility for visiting the 55-strong population
0:09:59 > 0:10:02who are situated 24 miles south-west of Shetland
0:10:02 > 0:10:05on Britain's most remote community.
0:10:05 > 0:10:11We try about once a month, but quite often the weather puts us off,
0:10:11 > 0:10:14so I don't know, we might manage to get out
0:10:14 > 0:10:17six or seven times a year, something like that.
0:10:19 > 0:10:22Bad weather frequently leaves the island cut off.
0:10:22 > 0:10:26Just flying in and out in a day to see patients can be an impossible task
0:10:26 > 0:10:31and could easily mean you are left stranded on Fair Isle without return transport.
0:10:32 > 0:10:36If the weather is looking poor, the plane might go this morning,
0:10:36 > 0:10:39but they might say there is an odds-on chance that they won't get back
0:10:39 > 0:10:42- in the afternoon.- But, with patients needing to be seen,
0:10:42 > 0:10:45for GP Mark Maudsley, it's a necessary trip.
0:10:50 > 0:10:53Fair Isle currently has no resident nurse, so today,
0:10:53 > 0:10:56Mark is bringing nurse Merran Nugent along for the ride,
0:10:56 > 0:11:00which is simply a matter of hailing an aeroplane and settling in to enjoy
0:11:00 > 0:11:03what has to be one of the best commutes around.
0:11:14 > 0:11:17Departing from Tingwall, on Shetland's mainland,
0:11:17 > 0:11:19on one of just 11 scheduled flights a week,
0:11:19 > 0:11:21it will take them half an hour to reach Fair Isle.
0:11:25 > 0:11:27Back on solid ground,
0:11:27 > 0:11:31the first job for Mark and Merran is to open up the GP clinic on the
0:11:31 > 0:11:32north of the island.
0:11:32 > 0:11:34Second task, get the kettle on.
0:11:36 > 0:11:38In the absence of a resident nurse,
0:11:38 > 0:11:40they will need to access their supplies themselves.
0:11:40 > 0:11:41Aha!
0:11:41 > 0:11:42Did you find them?
0:11:42 > 0:11:44That will do the job.
0:11:44 > 0:11:47But when they finally locate the keys to the fridge,
0:11:47 > 0:11:49there's good news and bad news.
0:11:49 > 0:11:51There's plenty of vaccines, but no milk.
0:12:07 > 0:12:12Oil is big business in Shetland, and a huge part of the economy.
0:12:12 > 0:12:16Oil workers make up nearly a fifth of Shetland's workforce.
0:12:16 > 0:12:19Working on the rigs or at the oil terminal in Sullom Voe
0:12:19 > 0:12:23can be a dangerous way to make a living. And when accidents happen,
0:12:23 > 0:12:26it is the Coastguard who get the injured off the rigs and onto the
0:12:26 > 0:12:27mainland for treatment.
0:12:33 > 0:12:37Coastguard helicopter rescue have been called to evacuate a worker
0:12:37 > 0:12:42from an oil rig some 105 miles north-east of Lerwick and carry him
0:12:42 > 0:12:45to Tingwall Airport, seven miles west of Gilbert Bain Hospital.
0:12:49 > 0:12:54Paramedics Emma and Kayleigh have been scrambled to transport them to the hospital.
0:12:59 > 0:13:02He is reported to have suffered a potential spinal injury,
0:13:02 > 0:13:04so with the help of the coastguard volunteers,
0:13:04 > 0:13:08they take extra care when transferring him into the ambulance.
0:13:25 > 0:13:27On arrival at the Gilbert Bain,
0:13:27 > 0:13:3129-year-old Phil from Aberdeen is taken to A&E to assess the extent of
0:13:31 > 0:13:34- his injuries.- Hello, Mr Mitchell. - Hello.
0:13:36 > 0:13:39Phil is clearly in great pain.
0:13:39 > 0:13:42They will need to get him out of his basket stretcher and onto a bed
0:13:42 > 0:13:44before they can examine him.
0:13:44 > 0:13:47But since the helicopter stretcher hasn't been supplied with a
0:13:47 > 0:13:52transferable lining, it's going to be trickier and more risky than usual.
0:13:52 > 0:13:55I don't how you want to get him out of this, because he is in a basket,
0:13:55 > 0:13:57he is not on a canvas or anything.
0:13:57 > 0:14:00I just want out. It is killing my sides.
0:14:00 > 0:14:06What we will do is we will roll this onto its side so there is no' an edge for you to come across.
0:14:06 > 0:14:08- You are OK.- OK?
0:14:08 > 0:14:09OK.
0:14:13 > 0:14:17Can you grip the other side of the blanket?
0:14:17 > 0:14:20HE GROANS IN PAIN
0:14:22 > 0:14:25- Well done.- That is you.
0:14:28 > 0:14:30No, no bother.
0:14:30 > 0:14:31Did you fall from a height?
0:14:31 > 0:14:34No, just flat out.
0:14:34 > 0:14:36Just from standing to flat.
0:14:43 > 0:14:46Having finally settled Phil into the resuscitation bay,
0:14:46 > 0:14:51it is time for Dr Jennifer Briggs to assess just how serious his injury is.
0:14:52 > 0:14:55I'm Jennifer, I am the surgical doctor.
0:14:55 > 0:14:57I hear you've had a rough night.
0:14:57 > 0:14:58I'm sorry.
0:14:58 > 0:15:01While Phil was working the night shift on the rig,
0:15:01 > 0:15:05he fell backwards onto a metal object where his back took the brunt of the fall.
0:15:05 > 0:15:08OK, so when it happened and you fell backwards,
0:15:08 > 0:15:10- was there immediate pain? - Oh, instant.
0:15:10 > 0:15:12OK, and was it quite severe?
0:15:12 > 0:15:13- Oh, really.- OK.
0:15:13 > 0:15:14Enough to make me cry.
0:15:14 > 0:15:15OK, OK.
0:15:15 > 0:15:19So, have you actually been able to stand since this happened?
0:15:19 > 0:15:22- I tried to.- And how did that feel?
0:15:22 > 0:15:26- Sore.- OK. Is the pain in the same place as it was when it happened?
0:15:26 > 0:15:28And is it down your actual spine?
0:15:28 > 0:15:33Yeah, right down the back and then over on my right cheek.
0:15:34 > 0:15:37Right, I am going to come round, I am just going to feel down your back.
0:15:40 > 0:15:42Does that hurt on the right side?
0:15:42 > 0:15:43- No.- No. OK.
0:15:43 > 0:15:49- Can you feel me touching you all the way down your right leg and here on your left leg?- Yeah.
0:15:50 > 0:15:52OK. Right down to your toes?
0:15:52 > 0:15:55- Mm-hm.- Does it feel the same on both sides?
0:15:55 > 0:15:56No, that one feels different.
0:15:56 > 0:16:00Can you feel me less on the left side?
0:16:00 > 0:16:01Less.
0:16:03 > 0:16:05After a cautious examination,
0:16:05 > 0:16:08Dr Briggs decides that Phil should have a chest and pelvic X-ray.
0:16:09 > 0:16:10Breathe in.
0:16:11 > 0:16:13And out. Hold it there.
0:16:15 > 0:16:16Breathe out.
0:16:19 > 0:16:21So, same again. Deep breath in.
0:16:23 > 0:16:24And out. Hold it there.
0:16:26 > 0:16:27And breathe on.
0:16:31 > 0:16:34Even when dealing with a case as serious as Phil's,
0:16:34 > 0:16:38it seems there is still one topic that dominates Shetland conversation...
0:16:38 > 0:16:39The weather.
0:16:39 > 0:16:42Have you seen the BBC article that we have got more sunshine
0:16:42 > 0:16:43- than Cornwall?- Yeah.
0:16:43 > 0:16:46- I was like, oh, my lord. - London is only two degrees warmer than us today.
0:16:46 > 0:16:50- Yeah, I know.- And Phil seems distracted as well.
0:16:50 > 0:16:51- All right?- Aye.
0:16:51 > 0:16:54Are you wanting something else for the pain?
0:16:54 > 0:16:55Can I go for a fag?
0:16:57 > 0:16:59Not right now.
0:16:59 > 0:17:00How? Now, before this.
0:17:00 > 0:17:04- You are in too much pain. - I'm all right.
0:17:07 > 0:17:09You're not really able to go out for a fag, are you?
0:17:09 > 0:17:11- I am.- Eh?
0:17:11 > 0:17:12I am.
0:17:12 > 0:17:13Dr Briggs returns,
0:17:13 > 0:17:16with the results of the chest and pelvic x-rays.
0:17:18 > 0:17:20So, if we look at the x-rays,
0:17:20 > 0:17:23there is a couple of bits we are just not sure about.
0:17:23 > 0:17:25It's possible that one,
0:17:25 > 0:17:30the very last discrete bone at the bottom of your spine has maybe been
0:17:30 > 0:17:33kind of crushed under, with the force of the fall.
0:17:34 > 0:17:37It's quite hard to see on the x-rays,
0:17:37 > 0:17:40so the next step up would be a CT scan.
0:17:40 > 0:17:42With the X-ray results inconclusive,
0:17:42 > 0:17:45the team have to arrange a CT scan to get to the bottom of his pain.
0:17:58 > 0:18:02It is a fact of life that some shifts in a small island A&E department
0:18:02 > 0:18:05can be, shall we say, less than stimulating.
0:18:07 > 0:18:11But there's nothing like a good medical mystery to liven things up.
0:18:11 > 0:18:13This room is free here.
0:18:15 > 0:18:1979-year-old Anne has come to the emergency ward having experienced
0:18:19 > 0:18:22severe stomach pains in the night.
0:18:22 > 0:18:23Your heart rate is fine.
0:18:25 > 0:18:26We'll just check...
0:18:27 > 0:18:29It is high for me.
0:18:29 > 0:18:34- Is it high?- It is normally a teenager's...
0:18:34 > 0:18:36Oh, like a youngster?
0:18:36 > 0:18:37Yeah.
0:18:37 > 0:18:40Her blood pressure offers no clues,
0:18:40 > 0:18:43so it falls to a doctor to do some detective work.
0:18:43 > 0:18:46- Hello there. Anne?- Yes.
0:18:46 > 0:18:47What happened tonight?
0:18:47 > 0:18:50Well, it was just suddenly this
0:18:50 > 0:18:52severe, severe pain.
0:18:52 > 0:18:57OK. And if you were rating the pain out of ten, what would you rate it?
0:18:58 > 0:19:01Well, it had its moments that I would have said it was ten.
0:19:01 > 0:19:06But then, you know, it was anything from four to seven, seven to ten, fluctuating.
0:19:06 > 0:19:08I would say it has certainly eased a bit.
0:19:08 > 0:19:13OK. Good. And was it on one side or both sides?
0:19:13 > 0:19:17I have a niggle on this side which is why I have been booked,
0:19:17 > 0:19:20I'm going to have a scan for a gallstone.
0:19:20 > 0:19:23Oh, yes, I saw that in your notes.
0:19:23 > 0:19:28So, severe ten out of ten abdominal pain recently subsided.
0:19:28 > 0:19:30Prime suspect - gallstones.
0:19:30 > 0:19:34But the doctor isn't finished gathering evidence and digs deeper.
0:19:34 > 0:19:36Had you been doing anything unusual today?
0:19:36 > 0:19:39Any heavy lifting? Any exercise?
0:19:39 > 0:19:42Nothing, nothing unusual, no.
0:19:42 > 0:19:45I did a little bit of gardening, but at my age you don't do much...
0:19:47 > 0:19:49No clues there.
0:19:49 > 0:19:51But she continues her line of questioning.
0:19:51 > 0:19:54What did you have for your dinner tonight, your evening meal?
0:19:54 > 0:19:55- Spaghetti Bolognese.- OK.
0:19:55 > 0:19:58It wasn't particularly rich are anything like that?
0:19:58 > 0:19:59No, it was just my normal...
0:19:59 > 0:20:02Just your normal, OK, OK.
0:20:02 > 0:20:04Do you take any alcohol?
0:20:04 > 0:20:06Yes, occasionally.
0:20:06 > 0:20:09- OK.- I have wine with my meal and that's maybe it.
0:20:09 > 0:20:14A gin and tonic on a Sunday and a brandy on a Thursday.
0:20:14 > 0:20:16OK!
0:20:16 > 0:20:19We are creatures of habit, you know.
0:20:19 > 0:20:22And do you feel like the pain has gone completely now?
0:20:22 > 0:20:24- Or do you feel...?- Can I stand up and I will tell you?
0:20:24 > 0:20:25OK.
0:20:27 > 0:20:29Yeah, I feel very bloated, but...
0:20:29 > 0:20:33- OK.- Yeah, I would say all that sharp pain has gone.
0:20:33 > 0:20:34- A little bit tender.- OK.
0:20:37 > 0:20:38The plot thickens.
0:20:38 > 0:20:42The doctor is starting to have her suspicions about the culprit.
0:20:42 > 0:20:47But before she points the finger, she wants to eliminate the main suspect.
0:20:47 > 0:20:50What I will do is I will get you up on this bed if that's all right.
0:20:51 > 0:20:55She checks Anne for any signs that a suspected gallstone could be
0:20:55 > 0:20:59- the perpetrator.- Now, I am feeling quite deeply, OK?
0:20:59 > 0:21:01So it will be normal to have a bit of discomfort.
0:21:01 > 0:21:04All right? So, around about here?
0:21:04 > 0:21:06Would you like to point to me with one finger?
0:21:06 > 0:21:08- OK.- I can't find it now!
0:21:08 > 0:21:09Well, that's OK.
0:21:09 > 0:21:11- That's all right.- It was just about here.
0:21:11 > 0:21:12OK. OK.
0:21:14 > 0:21:15She has heard enough.
0:21:15 > 0:21:19She has examined the evidence and is ready to identify the culprit.
0:21:19 > 0:21:21Actually, I think the most likely cause of this,
0:21:21 > 0:21:23although I don't want to make it sound trivial,
0:21:23 > 0:21:28but actually trapped wind can be very, very severe.
0:21:28 > 0:21:30And you have people coming in thinking
0:21:30 > 0:21:32they are having heart attacks and things.
0:21:33 > 0:21:38So I would be quite happy for you to go home given that you have not had
0:21:38 > 0:21:41any more pain, things have settled now.
0:21:41 > 0:21:43Anything else? Any other worries?
0:21:43 > 0:21:45- No?- Thanks very much indeed.
0:21:45 > 0:21:47That's all right. Thank you.
0:21:47 > 0:21:48- OK.- Have a good night.
0:21:48 > 0:21:51- Thank you. Bye now.- Bye.- Bye.
0:22:03 > 0:22:08You ought to change some of these ceiling tiles to ones with pictures on them.
0:22:08 > 0:22:13Biker Eddie came into A&E earlier after colliding with a seagull while
0:22:13 > 0:22:16travelling at 60mph on his motorbike.
0:22:16 > 0:22:19- Do you want head up, or...? - The head this side.- Yeah.
0:22:20 > 0:22:24- Hello.- One, two, three.
0:22:25 > 0:22:27After a quick examination,
0:22:27 > 0:22:30he has been sent for a CT scan to ascertain if there was any
0:22:30 > 0:22:32serious damage to his spinal cord.
0:22:32 > 0:22:33Two, three.
0:22:38 > 0:22:41Gilbert Bain is a full-service General Hospital.
0:22:41 > 0:22:44But if a patient needs specialist diagnosis or treatment,
0:22:44 > 0:22:49the medics need to work with Aberdeen Royal Infirmary, 225 miles away.
0:22:50 > 0:22:55Their consultant neurologist will examine Eddie's CT scan and liaise with
0:22:55 > 0:22:57Dr Lalla on the next step for treatment.
0:22:58 > 0:23:02Eddie will have to stay on the wards until the results of the CT scan can
0:23:02 > 0:23:04tell them if there is any damage to his neck.
0:23:04 > 0:23:06Can we do a quick detour for a cigarette?
0:23:07 > 0:23:10I heard what she said.
0:23:10 > 0:23:12I listened to what she said.
0:23:12 > 0:23:14Get some patches. Stick it over his mouth.
0:23:15 > 0:23:16That's a good idea.
0:23:20 > 0:23:21- Thumbs up.- Thumbs up.
0:23:23 > 0:23:25While they wait for word from Aberdeen...
0:23:27 > 0:23:32..Dr Lalla scans the images for evidence of the seagull's impact.
0:23:33 > 0:23:34Looks a bit dodgy over there, so...
0:23:34 > 0:23:37It's funny, though, why that would be affected...
0:23:37 > 0:23:41You can see the alignment does that under, then does that.
0:23:41 > 0:23:44He has lost the normal lordosis.
0:23:44 > 0:23:47Whilst it may be a call for the specialists in Aberdeen,
0:23:47 > 0:23:50Dr Lalla does have considerable experience dealing with the victims of
0:23:50 > 0:23:53Shetland's aggressive wildlife.
0:23:53 > 0:23:56We haven't had one like this before, I presume?
0:23:56 > 0:24:00- Falling off cliffs...- One lady got hit and basically head-butted by a cow
0:24:00 > 0:24:02and she went flying down the hill.
0:24:02 > 0:24:04That can be quite dangerous.
0:24:04 > 0:24:05Yeah.
0:24:05 > 0:24:10We had one kicked in the leg, broken tibia, kicked in the leg by a duck.
0:24:10 > 0:24:12- By a duck?- Mm-hm.
0:24:12 > 0:24:13We called it Duck Lee. Duck Lee.
0:24:13 > 0:24:15Duck Lee.
0:24:18 > 0:24:20We have had plenty of injuries.
0:24:20 > 0:24:22One, two, three.
0:24:24 > 0:24:26Oh, it is nice in here, isn't it?
0:24:26 > 0:24:29The ceiling is much the same as downstairs.
0:24:29 > 0:24:33- I was going to say, is it any different?- We are a lot nicer up here than downstairs.
0:24:33 > 0:24:35Looks like Eddie will be counting ceiling tiles until the
0:24:35 > 0:24:40- results get back from Aberdeen. - There is your phone, OK?- Cheers.
0:24:40 > 0:24:43With any luck, he will be back on his bike before long.
0:24:43 > 0:24:47GULLS CRY
0:24:49 > 0:24:52On Britain's most remote inhabited island, Fair Isle,
0:24:52 > 0:24:57GP Mark Maudsley has made the 55-mile journey by plane from Shetland...
0:24:57 > 0:25:00..opened up the island clinic and, most importantly,
0:25:00 > 0:25:03found some milk for his tea.
0:25:03 > 0:25:06He and nurse Merran are finally ready to see their first patient.
0:25:08 > 0:25:12I was getting a very red eye, and just below the eye,
0:25:12 > 0:25:13- there's a little lump. - Oh, yeah.
0:25:13 > 0:25:18Although Mark is still finding his feet out here on Fair Isle...
0:25:19 > 0:25:22They have confiscated our alcohol wipes on the way out.
0:25:25 > 0:25:28..he is also contending with the fact that Fair Isle has been without
0:25:28 > 0:25:32a permanent resident nurse for five months now.
0:25:32 > 0:25:39We are between nurses at the moment and it does make it a nonstandard day
0:25:39 > 0:25:41in the Fair Isle. Usually, when we arrive,
0:25:41 > 0:25:46the nurse would pick us up from the airstrip and they would open up all
0:25:46 > 0:25:51the cupboards that I was struggling with earlier and they'd would already
0:25:51 > 0:25:54be logged onto a computer and all that kind of thing.
0:25:54 > 0:25:56When I can get a look at your old prescriptions, John,
0:25:56 > 0:25:57then I will be able to do that.
0:25:57 > 0:26:00But at the moment...
0:26:02 > 0:26:03I've been struggling with that.
0:26:03 > 0:26:08Recruitment of medics to extremely remote areas is a constant struggle
0:26:08 > 0:26:13for the NHS, and one that hasn't gone unnoticed here on Fair Isle.
0:26:13 > 0:26:15Well, it is always good when you come here so at least we have got
0:26:15 > 0:26:17- somebody.- Yeah.
0:26:17 > 0:26:20I will mention that now and then leave it -
0:26:20 > 0:26:24this is the worst period of nurse cover since 1903.
0:26:24 > 0:26:26- Is that right?- That is the gap, it is the biggest.
0:26:26 > 0:26:30- Yeah.- And of course, as you know, I think it is an absolute disgrace.
0:26:30 > 0:26:32Don't get me started on these subjects.
0:26:32 > 0:26:34- Thank you very much.- No worries.
0:26:34 > 0:26:35- Good.- OK.
0:26:35 > 0:26:40- Yes.- That's one semi-satisfied customer dealt with.
0:26:40 > 0:26:43Next up, Fair Isle resident Stewart Thomson Junior,
0:26:43 > 0:26:45who is suffering from a persistent cough.
0:26:45 > 0:26:48And are you coughing up a lot of stuff?
0:26:48 > 0:26:50Not a lot, but...
0:26:50 > 0:26:53First thing in the morning,
0:26:53 > 0:26:55what I cough up is not really nice looking.
0:26:55 > 0:26:59It would be kind of useful to get a specimen.
0:26:59 > 0:27:01But yet again, without a resident nurse,
0:27:01 > 0:27:03these simple things turn into a headache.
0:27:03 > 0:27:06Ordinarily, you could get this, I suppose,
0:27:06 > 0:27:12any morning that there is a plane going out and the nurse would organise
0:27:12 > 0:27:15getting it off and the porters coming from the hospital and stuff,
0:27:15 > 0:27:17which is maybe more difficult for you to do.
0:27:17 > 0:27:21In the end, Mark leaves Stewart with a sample share to give to the next
0:27:21 > 0:27:23nurse that comes to the island.
0:27:23 > 0:27:24Good, good.
0:27:24 > 0:27:25- OK.- Thank you very much.
0:27:25 > 0:27:27No worries. Nice to see you, Stewart.
0:27:27 > 0:27:31- Cheerio.- That is everybody who's coming here for the day.
0:27:31 > 0:27:35So we've got one visit to do, so we will just
0:27:35 > 0:27:38try and lock everything away again
0:27:39 > 0:27:43amongst all this selection of keys.
0:27:45 > 0:27:47And we will get on our way.
0:27:58 > 0:28:02Aberdeenshire oil rig worker Phil was airlifted to Shetland after falling
0:28:02 > 0:28:04and hurting his back at work.
0:28:04 > 0:28:09So far, the spinal X-ray has shown a potential injury to his lower spine,
0:28:09 > 0:28:12but Dr Briggs wants to investigate further.
0:28:12 > 0:28:18We sent Phil for an X-ray and that showed a suspicious area
0:28:18 > 0:28:22on the lower end of his spine, so that needed further imaging.
0:28:22 > 0:28:25So we arranged for him to have a CT.
0:28:26 > 0:28:28However, this means moving him again
0:28:28 > 0:28:31and to do it safely takes a team effort.
0:28:40 > 0:28:42As the images come through,
0:28:42 > 0:28:45it seems Dr Briggs' suspicions have been confirmed.
0:28:46 > 0:28:51The base of the spine showed we had a burst type fracture in the
0:28:51 > 0:28:57lumbar fifth vertebrae which is something that we can't really deal with
0:28:57 > 0:29:02up here, it's more a specialised neurosurgical issue.
0:29:02 > 0:29:06So, we discussed him with the neurosurgical team in Aberdeen.
0:29:06 > 0:29:09Hi, good afternoon, this is Dr Briggs calling from the
0:29:09 > 0:29:11Gilbert Bain Hospital in Shetland.
0:29:11 > 0:29:14Could you put me through to whoever is on call for the spinal team?
0:29:14 > 0:29:18They have accepted him to be transferred down to their ward where he can get
0:29:18 > 0:29:19more specialist input,
0:29:19 > 0:29:23and I'm just in the process of doing his transfer paperwork.
0:29:23 > 0:29:26My pager is zero-one and I am on until late,
0:29:26 > 0:29:28so I should be able to answer your call any time.
0:29:30 > 0:29:34Phil is booked onto the next flight to Aberdeen to see a neurosurgical
0:29:34 > 0:29:38specialist. Unfortunately that flight isn't until tomorrow,
0:29:38 > 0:29:41which means a night on the wards and yet another move.
0:29:41 > 0:29:45But he's going to need some convincing.
0:29:45 > 0:29:49- At least it'll be a different scene from upstairs.- Oh great, hey? - You can get Wi-Fi as well.
0:29:51 > 0:29:52Free Wi-Fi.
0:29:53 > 0:29:55- Hi, Craig.- Hello.
0:29:56 > 0:29:59We are going to Ward One. Could you just go really, really slowly.
0:29:59 > 0:30:00Certainly.
0:30:02 > 0:30:05After an exhausting day being carted back and forth,
0:30:05 > 0:30:08Phil is finally rewarded with a room with a view.
0:30:09 > 0:30:14- Can you see?- Aye. It's perfect.
0:30:14 > 0:30:17- All right?- Yeah.- Watch for any killer whales.
0:30:17 > 0:30:20Watch for my plane to come.
0:30:20 > 0:30:23Phil would be advised to enjoy the peace and quiet while it lasts,
0:30:23 > 0:30:26as tomorrow's move to Aberdeen will be no walk in the park.
0:30:34 > 0:30:37Shetland offers some of the most sensational scenery to be found
0:30:37 > 0:30:39anywhere in the world.
0:30:39 > 0:30:43But its remote location and small population mean the hospital has to
0:30:43 > 0:30:49care for its patients with a fraction of the staff of a typical mainland hospital.
0:30:49 > 0:30:51Break the seal for me, that would be grand.
0:30:51 > 0:30:54Which is why it is so important for all of Shetland's doctors to be able
0:30:54 > 0:30:57to turn their hand to a variety of procedures.
0:30:58 > 0:31:03To this end, senior doctor Kushik Lalla has been asked for a little advice from
0:31:03 > 0:31:05junior doctor Aideen Carroll.
0:31:05 > 0:31:08Dr Carroll has removed a deep splinter from underneath a workman's
0:31:08 > 0:31:12fingernail, but the splinter has left behind debris
0:31:12 > 0:31:16- which could cause an infection. - He's an old customer.
0:31:16 > 0:31:19So he's managed to get a splinter under his nail...
0:31:20 > 0:31:23..that I assume has been there for a few days.
0:31:23 > 0:31:25- No, I did it yesterday.- Yesterday?
0:31:25 > 0:31:28But it is starting to fester a little bit over there.
0:31:28 > 0:31:32What we want to do is just open that up and clean the area out,
0:31:32 > 0:31:35but because it is under the nail, it is a difficult area to get to.
0:31:35 > 0:31:39This will be the first time Dr Carroll has completed this technique,
0:31:39 > 0:31:42so Dr Lalla is on hand to offer some pointers.
0:31:42 > 0:31:44Starting with the application of the anaesthetic,
0:31:44 > 0:31:48using what is known as the ring block method.
0:31:48 > 0:31:50Most of our juniors that come through now,
0:31:50 > 0:31:52especially if they have not done something like that,
0:31:52 > 0:31:56will want some supervision just to make sure they're not going to do
0:31:56 > 0:31:59anything wrong or cause more harm than good.
0:31:59 > 0:32:00So what you want to do is just go...
0:32:02 > 0:32:04..vertically in like that.
0:32:04 > 0:32:09Right? And inject as you are going in or as you are coming out.
0:32:09 > 0:32:12You aspirate to make sure you are not in a vessel.
0:32:12 > 0:32:14- Yeah.- And then just inject two moulds on that side.
0:32:14 > 0:32:16So you want to get on that side of the bone,
0:32:16 > 0:32:18inject two moulds across them like that.
0:32:18 > 0:32:21- And then two moulds on but... - And then two moulds on that side.
0:32:21 > 0:32:23OK, might be a sharp scratch coming up.
0:32:24 > 0:32:26- So, about here?- Yeah, that's fine.
0:32:26 > 0:32:28So, about there?
0:32:28 > 0:32:30- Yeah, and go in.- Go in.
0:32:30 > 0:32:31Go in, go in, go in.
0:32:31 > 0:32:33- Yeah, aspirate.- Aspirate.
0:32:33 > 0:32:35- And then inject.- Inject.
0:32:35 > 0:32:38As you are coming out, so it is going to sting now,
0:32:38 > 0:32:41- like hell.- Are you all right there, Sir?- Mm-hmm. No bother.
0:32:42 > 0:32:47Injecting, there is hardly anything going in.
0:32:47 > 0:32:49She's being very gentle with you.
0:32:49 > 0:32:50Yeah.
0:32:50 > 0:32:52Right, I will do the other side and teach you.
0:32:55 > 0:32:57So, the finger will start to swell up
0:32:57 > 0:32:59and you see it is starting to blanch?
0:32:59 > 0:33:01Yeah. You can come out.
0:33:01 > 0:33:03And then do the same on the other side now.
0:33:03 > 0:33:08You really have to press in to inject into this because sometimes it can
0:33:08 > 0:33:11be quite tight depending on how much you are injecting.
0:33:11 > 0:33:13That is fine.
0:33:13 > 0:33:15So that is your first ring block.
0:33:15 > 0:33:17Yeah, very good.
0:33:17 > 0:33:20With the anaesthetic successfully injected into the finger,
0:33:20 > 0:33:24it is just a case of waiting for it to take effect before they can cut
0:33:24 > 0:33:25open the nail.
0:33:37 > 0:33:40Having been diagnosed with a spine fracture,
0:33:40 > 0:33:44Phil is to be transferred by plane to see a specialist consultant in his
0:33:44 > 0:33:45home city of Aberdeen.
0:33:47 > 0:33:49However, with the wind and rain picking up,
0:33:49 > 0:33:52nurse Heather Wightman has to reassure the anxious patient.
0:33:52 > 0:33:55- You all right?- A bit nervous about...
0:33:55 > 0:33:58Don't be nervous. It will be OK.
0:33:58 > 0:34:01If you managed the helicopter you will manage the plane.
0:34:01 > 0:34:02The plane flies in a lot worse than this.
0:34:02 > 0:34:05- Yeah.- You will be absolutely fine.
0:34:06 > 0:34:07This is a nice day.
0:34:09 > 0:34:12In a move that Phil must now surely be getting used,
0:34:12 > 0:34:16the team carefully transfer him once again onto a trolley.
0:34:16 > 0:34:19How's that? Not too bad?
0:34:19 > 0:34:21Are you comfortable enough?
0:34:21 > 0:34:22- Yeah.- Yeah?
0:34:22 > 0:34:24When has he last had pain relief?
0:34:24 > 0:34:2820 minutes ago he has had...
0:34:28 > 0:34:30Right, all the best.
0:34:30 > 0:34:32- I will see you later.- See you later. - See you.
0:34:32 > 0:34:36Thanks very much.
0:34:36 > 0:34:40Paramedic Emma Davis drives the 25 mile trip to Sumburgh in the south
0:34:40 > 0:34:45of the island to meet the plane that will take Phil to be specialist treatment he needs.
0:34:47 > 0:34:49It is coming up to pick him up to take him to Aberdeen.
0:34:49 > 0:34:52It's actually where the patient is from.
0:34:52 > 0:34:55He is from Aberdeen, he got taken to Shetland cos he got taken off
0:34:55 > 0:34:59a rig yesterday, so he will go down for further treatment,
0:34:59 > 0:35:01and then discharged home from there.
0:35:01 > 0:35:04The weather is cold, wet,
0:35:04 > 0:35:08the wind's starting to pick up, drizzly, horrible,
0:35:08 > 0:35:09typical Shetland summer weather.
0:35:10 > 0:35:13But we have had, we had a few nice days, so can't complain.
0:35:13 > 0:35:15Better than last year.
0:35:16 > 0:35:18In fact, has the weather not been better in Shetland
0:35:18 > 0:35:20than in Cornwall this summer?
0:35:21 > 0:35:23That can't happen very often.
0:35:23 > 0:35:25Well, it hasn't today.
0:35:27 > 0:35:28With final checks done,
0:35:28 > 0:35:32Phil says goodbye to Shetland, and heads for home.
0:35:32 > 0:35:34It's really lovely.
0:35:49 > 0:35:52Shetland GP Mark Maudsley has finished seeing his patients
0:35:52 > 0:35:54at the surgery on Fair Isle,
0:35:54 > 0:35:57and is about to embark on his round of home visits.
0:36:01 > 0:36:02At this point in the day,
0:36:02 > 0:36:06the GP on the mainland may have 20 or 30 more patients to see.
0:36:06 > 0:36:10Today, Dr Maudsley's caseload is a little lighter.
0:36:10 > 0:36:15The two tasks we now have are to go and see Stewart,
0:36:15 > 0:36:18and get our lunch at the shop.
0:36:19 > 0:36:20Lovely.
0:36:24 > 0:36:26Stewart's the island's oldest resident now,
0:36:26 > 0:36:31so we're just off to see how he's getting along.
0:36:31 > 0:36:33Hello, Stewart.
0:36:33 > 0:36:36This isn't the first Stewart Thomson Dr Maudsley's seen today.
0:36:36 > 0:36:38Hopefully he's feeling better than his son,
0:36:38 > 0:36:41Stewart Thompson Junior, who came in with a cough earlier.
0:36:41 > 0:36:43Shut the door, please.
0:36:43 > 0:36:45- Keep the cold out.- Yeah.
0:36:45 > 0:36:48So, Stewart, how've you been getting on?
0:36:48 > 0:36:49All right, not bad.
0:36:49 > 0:36:52Getting breathless in the mornings sometimes...
0:36:54 > 0:36:57- I used to sleep well, 'til about six o'clock...- Yeah.
0:36:57 > 0:36:59But then after that, it's not so good.
0:36:59 > 0:37:04- And is it the breathlessness that is keeping you...?- Well...
0:37:04 > 0:37:07I don't know whether it is breathlessness or not, it's old age.
0:37:07 > 0:37:09Yeah, yeah.
0:37:09 > 0:37:11I was 94 in March.
0:37:11 > 0:37:13I reckon I am not doing bad for that.
0:37:13 > 0:37:15I think you're doing very well.
0:37:17 > 0:37:19Are you still managing to get a bit of spinning done?
0:37:19 > 0:37:20Yes, yes, spinning away.
0:37:20 > 0:37:22Yeah.
0:37:22 > 0:37:24For you mainlanders watching,
0:37:24 > 0:37:27it's possibly not the kind of spinning you were thinking of.
0:37:28 > 0:37:31And it's not the only thing our Stewart has a talent for.
0:37:32 > 0:37:35- Do you play the fiddle, then? - Yeah, I play.
0:37:35 > 0:37:36Any Fair Isle tunes?
0:37:36 > 0:37:38- OK.- I don't know any.
0:37:38 > 0:37:40- Do you?- Do you know The Headlands?
0:37:40 > 0:37:43- Yeah.- OK, play the Headlands.
0:37:43 > 0:37:44Is this it?
0:38:02 > 0:38:03THEY CHUCKLE
0:38:03 > 0:38:05Well done you two!
0:38:05 > 0:38:06Yeah!
0:38:06 > 0:38:07It is a good set.
0:38:07 > 0:38:09A nice fiddle, that.
0:38:10 > 0:38:13Visits like these offer proof, were it needed,
0:38:13 > 0:38:15that health care is about more than just prescribing pills.
0:38:17 > 0:38:20Is that your grandson, is Euan Thomson?
0:38:20 > 0:38:24- Yes.- He actually fixed up my auntie's fiddle that she gave me.
0:38:26 > 0:38:27As the day draws to a close,
0:38:27 > 0:38:30Merran and Dr Maudsley need to head back
0:38:30 > 0:38:32- to catch their flight home. - This is the scenic route.
0:38:33 > 0:38:36Yeah, one of two roads available.
0:38:39 > 0:38:42But they're not in that much of a hurry.
0:38:42 > 0:38:43Let's have a little detour.
0:38:52 > 0:38:56It's not a bad day at work when you get to come out here.
0:38:56 > 0:38:59Yes, I'd be looking pretty smug if I worked here too, doctor.
0:39:17 > 0:39:22In treatment room three, Magne, a 53-year-old builder from Lerwick,
0:39:22 > 0:39:24is having a portion of his fingernail removed
0:39:24 > 0:39:27in order to sterilise the area underneath.
0:39:27 > 0:39:31What'll happen is we will cut out a tiny wedge of the nail like that,
0:39:31 > 0:39:35and that nail will slowly grow in again as time goes on, OK?
0:39:35 > 0:39:38Dr Lalla is guiding Dr Carroll through the grisly procedure
0:39:38 > 0:39:40for the first time.
0:39:40 > 0:39:42So just across there, like that.
0:39:42 > 0:39:44- Mm-hm.- And just cut out...
0:39:44 > 0:39:46- With scissors?- Yeah.
0:39:46 > 0:39:49Magne had a splinter in his nail.
0:39:49 > 0:39:51Now removed, it's left debris inside.
0:39:51 > 0:39:55Dr Carroll needs to remove part of the nail in order to clean it out.
0:39:56 > 0:39:57So, go...
0:39:57 > 0:39:59Use your scissor sideways.
0:40:00 > 0:40:01Yeah, like that.
0:40:01 > 0:40:04And go under the nail,
0:40:04 > 0:40:06and spread the scissor.
0:40:06 > 0:40:07That opens,
0:40:07 > 0:40:09it separates the nail from the bed.
0:40:10 > 0:40:12OK, so close it.
0:40:12 > 0:40:13Yeah. Go in.
0:40:13 > 0:40:15Magne, tell us if it's sore.
0:40:15 > 0:40:16Open. Yeah.
0:40:16 > 0:40:18- Open.- Open, open, open.
0:40:18 > 0:40:19Open. Open, open, widely!
0:40:19 > 0:40:21Wide, wide, wide.
0:40:21 > 0:40:22Yeah.
0:40:23 > 0:40:27It's intricate work, but Dr Carroll is...nailing it.
0:40:27 > 0:40:31Right, so, you're separating... Close now. Close.
0:40:32 > 0:40:34Yeah, and go in a little more.
0:40:34 > 0:40:36- Mm-hm.- Yeah. And open a little bit.
0:40:36 > 0:40:37Yeah. That's good.
0:40:37 > 0:40:39That's good. Come out now.
0:40:39 > 0:40:42Yeah, come out. And then just cut the nail.
0:40:42 > 0:40:43So cut a wedge out, yeah.
0:40:43 > 0:40:44So not sideways?
0:40:44 > 0:40:47You want to go vertical now, and just cut a wedge out.
0:40:47 > 0:40:50Clean the area, so you can see what you're doing.
0:40:53 > 0:40:55You want one clean cut.
0:40:55 > 0:40:57You want a triangular piece taken out.
0:40:57 > 0:40:59Push in further. Push in further.
0:40:59 > 0:41:00Yeah. Keep going.
0:41:00 > 0:41:03That's it. And take that nail off.
0:41:03 > 0:41:05Use a swab.
0:41:05 > 0:41:07Just use a swab to break it off.
0:41:07 > 0:41:08Rub it off.
0:41:10 > 0:41:13That's right. That's you all done.
0:41:13 > 0:41:14OK.
0:41:14 > 0:41:16Right, I'm going to head back.
0:41:17 > 0:41:19Yeah, good. So, there you go.
0:41:19 > 0:41:23- One job's done.- Thanks very much, Kushik.- All right, Magne.
0:41:23 > 0:41:27I trained in South Africa where it was, you know...
0:41:28 > 0:41:31..a very different sort of attitude.
0:41:31 > 0:41:33It's see one, do one, teach one.
0:41:34 > 0:41:38Over here, I try to encourage that a little bit.
0:41:38 > 0:41:42It's more about her developing confidence in her own skills
0:41:42 > 0:41:43that we want to encourage,
0:41:43 > 0:41:46because they've got all the theory behind them at this stage,
0:41:46 > 0:41:49it's just putting that into practice.
0:41:49 > 0:41:52With her first ring block successfully completed,
0:41:52 > 0:41:54Dr Carroll passes on her experience.
0:41:54 > 0:41:57So in about there, down to about a centimetre.
0:41:57 > 0:41:59Aspirate it to make sure there's no blood.
0:41:59 > 0:42:02And then withdraw it, and then inject, about two mils,
0:42:02 > 0:42:03and the same on the other side.
0:42:03 > 0:42:05But it was, like, fully anaesthetised.
0:42:05 > 0:42:08I was, like, cutting his nail bed,
0:42:08 > 0:42:09didn't feel a thing.
0:42:11 > 0:42:12So, yeah.
0:42:12 > 0:42:15Gives me the heebie-jeebies. Gives me the heebie-jeebies.
0:42:17 > 0:42:18For Dr Carroll,
0:42:18 > 0:42:21every new experience is vital for her professional development.
0:42:21 > 0:42:25So, it's scary but it is an awesome feeling when you've done it.
0:42:25 > 0:42:27It is nice to have some support about,
0:42:27 > 0:42:31when you do it, and it works,
0:42:31 > 0:42:32it feels good.
0:42:32 > 0:42:37Especially Kushik, someone who's in A&E everyday is invaluable,
0:42:37 > 0:42:39because he's just seen everything,
0:42:39 > 0:42:40and done everything,
0:42:40 > 0:42:42and we've seen nothing and done nothing,
0:42:42 > 0:42:47so it's, like, a lovely person to be able to call on,
0:42:47 > 0:42:49just for when you're seeing stuff for the first time.
0:42:51 > 0:42:54Eddie recovered well from his collision with a seagull
0:42:54 > 0:42:57and was back on his bike a couple of weeks later,
0:42:57 > 0:43:00with an eagle eye trained on any low-flying birds.
0:43:01 > 0:43:03Back in Aberdeen, Phil spent a week in hospital,
0:43:03 > 0:43:07and is still waiting to find out if he'll need surgery on his back.
0:43:07 > 0:43:09But he's in good spirits.
0:43:09 > 0:43:12Fair Isle is still waiting for a full-time nurse,
0:43:12 > 0:43:14but hope to find someone soon.
0:43:14 > 0:43:16And Anne is still keeping well,
0:43:16 > 0:43:18thanks to a brandy on a Thursday,
0:43:18 > 0:43:19and a gin and tonic on a Sunday.