Episode 2 Island Medics

Shetland, the most remote part of the UK.

Here, you are closer to the Arctic Circle then you are to London...

..and nearer Norway then you are to Edinburgh.

There are more puffins than people

and more seals than supermarkets.

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

It is so far from the mainland that when things go wrong... SIRENS

A&E, can I help you?

..from helicopter rescues and spinal injuries...

We are all here to make sure that you are OK.

..to serious medical mysteries...

Can we get assistance in, please?

Something is 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?

-Yeah.

It means the tight-knit team of medics,

volunteers and emergency services have a special bond...

This might tickle.

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

A wee treat for the night shift.

So they're always ready for any island emergency.

Today, a casualty from an oil rig with a back injury.

It's possible that the bottom of your spine has been kind of crushed.

Dr Lalla shows a junior doctor the ropes.

It's going to sting now like hell.

A Shetland GP travels to Britain's most remote community

and a road traffic accident with a uniquely Shetland twist.

And there's still feathers.

The Shetland Islands are a tough landscape of windy moorland,

daunting cliffs and savage tides,

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

And while life for its inhabitants can be challenging,

it's the place they have decided to call home.

Its remote location means that there are also challenges

for Shetland's 100 medics, and especially for the staff

at the island's hospital,

the Gilbert Bain.

We see anything and everything here

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

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

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

to paediatrics in the afternoon - and all ages in between.

Ooh!

After working throughout most of the UK, this place has a lot of appeal.

There is no comparison, really.

It's lovely.

Morning at the Gilbert Bain,

and for senior A&E surgical doctor Kushik Lalla,

it is the start of another shift at this extraordinary hospital.

We never work like the rest of the UK.

Here, we have to see and deal with everyone ourself.

And so we have had senior A&E trainees

that have come and worked here,

and just can't do it because they have never manipulated

a broken wrist,

they have never reduced a fracture in, you know,

a hip or dislocated shoulder.

Nowadays in the UK that is becoming increasingly rare.

I think a lot of people say that, "I'm not a specialist in this,

"so I shouldn't be touching it."

If we did that over here, then our patients would just see no-one.

Despite its remote location,

Shetland boasts some of the best roads in the whole of Britain.

And the combination of breathtaking views and the lack of traffic

make it a Mecca for motorcyclists.

They travel from all around the country to attend bike rallies

on the island and biking is also popular with the locals.

But unfortunately, where there are bikes, there are accidents.

Eddie, a 30-year-old scaffolder

from the island of Bressay on the east coast,

has come into A&E after being involved in a high-speed collision

while on his motorbike.

At the time it was all right

but now from the bottom of my ear,

down here and into my shoulder is rather painful.

I can't really move my neck.

Eddie's accident was a result of the kind of thing they don't exactly

teach you on your motorbike test.

I was taking my bike out to the garage.

A seagull has come out from the ditch on the near side of the road

and just got caught by a gust of wind.

And flew straight into my face.

I was doing 60-ish.

So it was a fair old impact!

I've got a new respect for seagulls after this.

Nightmare, eh?

Usually they're just trying to nick your chips, aren't they?

Any tenderness?

That's sore there. Yeah!

Yeah, that's painful.

Oh, no.

-Oh!

-Are you OK?

-Yeah.

-Sit a moment.

Just... Are you light-headed?

No. Just... I'm just trying not to move my neck.

It feels like my neck is in a vice.

Yeah.

I'll help you get your leg up.

Just keep your head still until we get you assessed properly, OK?

OK. Are you reasonably comfortable like that?

Yeah. I don't suppose there's any chance of a gin and bitter lemon,

-is there?

-Not at the moment. You might get one in half an hour!

I'm sorry, I don't have your name.

-It's Carly.

-Carly?

-Yep.

Eddie's girlfriend has arrived to smooth his ruffled feathers.

Carly can whisper sweet nothings into your ear.

There's a first time for everything!

You can see where it's lifted the helmet here.

That should be pinned down.

But it has just lifted it up

and there are still feathers.

That helmet was expensive.

Never mind the helmet!

Such hard work.

That seagull has got a lot to answer for.

I think his name was Steven.

Oh, Eddie, no!

"Steven Seagull."

Not sure a career in comedy is awaiting, Eddie.

Maybe just stick to the day job.

He was wanting to go back scaffolding, he was wanting to go back to work.

I would far rather go back to work in pain than come in here and take your advice.

I would have far rather gone back to work.

I'm just so pleased my bike is all right.

It was close to hitting the bike,

that would have really upset me.

The seagull attack may be a good story to tell,

but it won't be quite as funny if Eddie has sustained a serious injury to

his neck. So, nurse Marie Stamp calls for Dr Lalla to ascertain what the damage might be.

What happened?

I got in a fight with a seagull.

-On a motorcycle.

-Right.

By the time I made it back to my work, I was in quite a lot of pain.

-Where was the pain?

-From the underside of my right ear,

going down my neck

and it is basically following around to my right shoulder blade.

I'm just had to have a quick look at you again.

-OK.

-Right, I am going to be testing your neck.

Any pain there?

No, not really.

-No? There?

-Yes, that is painful,

it's sending shooting pains right down my shoulder blade.

It is tender on the midline.

-Midline, yeah.

-OK.

-You feel that there?

-Yeah.

There?

-No.

-There?

-Yeah.

-There?

No.

Dr Lalla requests a CT scan for Eddie to get a better look at any

potential damage to his neck.

Can you not feel your hand?

No. I can feel you touching me but...

Well, I am nipping really hard.

Can you not feel any pain?

-No.

-Oh.

The Shetland archipelago comprises over 100 islands,

of which just 15 are inhabited.

The NHS endeavours to provide comprehensive care to everyone in Britain,

however remote their circumstances.

Recruiting staff to live and work some 224 miles and a 12.5 hour ferry

ride from the nearest mainland port can be an uphill struggle.

And for the medics who serve these more far-flung islands,

this means a working day quite unlike that of your average GP.

47-year-old GP Mark Maudsley is preparing to travel

from his practice in Levenwick, in the south of Shetland's mainland,

to run a clinic on Fair Isle.

There is no doctor on the Fair Isle.

There is usually a resident nurse,

although there isn't one at the moment,

so once every month or so, we go in for the day.

Mark and the other GPs at the Levenwick surgery

share responsibility for visiting the 55-strong population

who are situated 24 miles south-west of Shetland

on Britain's most remote community.

We try about once a month, but quite often the weather puts us off,

so I don't know, we might manage to get out

six or seven times a year, something like that.

Bad weather frequently leaves the island cut off.

Just flying in and out in a day to see patients can be an impossible task

and could easily mean you are left stranded on Fair Isle without return transport.

If the weather is looking poor, the plane might go this morning,

but they might say there is an odds-on chance that they won't get back

-in the afternoon.

-But, with patients needing to be seen,

for GP Mark Maudsley, it's a necessary trip.

Fair Isle currently has no resident nurse, so today,

Mark is bringing nurse Merran Nugent along for the ride,

which is simply a matter of hailing an aeroplane and settling in to enjoy

what has to be one of the best commutes around.

Departing from Tingwall, on Shetland's mainland,

on one of just 11 scheduled flights a week,

it will take them half an hour to reach Fair Isle.

Back on solid ground,

the first job for Mark and Merran is to open up the GP clinic on the

north of the island.

Second task, get the kettle on.

In the absence of a resident nurse,

they will need to access their supplies themselves.

Aha!

Did you find them?

That will do the job.

But when they finally locate the keys to the fridge,

there's good news and bad news.

There's plenty of vaccines, but no milk.

Oil is big business in Shetland, and a huge part of the economy.

Oil workers make up nearly a fifth of Shetland's workforce.

Working on the rigs or at the oil terminal in Sullom Voe

can be a dangerous way to make a living. And when accidents happen,

it is the Coastguard who get the injured off the rigs and onto the

mainland for treatment.

Coastguard helicopter rescue have been called to evacuate a worker

from an oil rig some 105 miles north-east of Lerwick and carry him

to Tingwall Airport, seven miles west of Gilbert Bain Hospital.

Paramedics Emma and Kayleigh have been scrambled to transport them to the hospital.

He is reported to have suffered a potential spinal injury,

so with the help of the coastguard volunteers,

they take extra care when transferring him into the ambulance.

On arrival at the Gilbert Bain,

29-year-old Phil from Aberdeen is taken to A&E to assess the extent of

-his injuries.

-Hello, Mr Mitchell.

-Hello.

Phil is clearly in great pain.

They will need to get him out of his basket stretcher and onto a bed

before they can examine him.

But since the helicopter stretcher hasn't been supplied with a

transferable lining, it's going to be trickier and more risky than usual.

I don't how you want to get him out of this, because he is in a basket,

he is not on a canvas or anything.

I just want out. It is killing my sides.

What we will do is we will roll this onto its side so there is no' an edge for you to come across.

-You are OK.

-OK?

OK.

Can you grip the other side of the blanket?

HE GROANS IN PAIN

-Well done.

-That is you.

No, no bother.

Did you fall from a height?

No, just flat out.

Just from standing to flat.

Having finally settled Phil into the resuscitation bay,

it is time for Dr Jennifer Briggs to assess just how serious his injury is.

I'm Jennifer, I am the surgical doctor.

I hear you've had a rough night.

I'm sorry.

While Phil was working the night shift on the rig,

he fell backwards onto a metal object where his back took the brunt of the fall.

OK, so when it happened and you fell backwards,

-was there immediate pain?

-Oh, instant.

OK, and was it quite severe?

-Oh, really.

-OK.

Enough to make me cry.

OK, OK.

So, have you actually been able to stand since this happened?

-I tried to.

-And how did that feel?

-Sore.

-OK. Is the pain in the same place as it was when it happened?

And is it down your actual spine?

Yeah, right down the back and then over on my right cheek.

Right, I am going to come round, I am just going to feel down your back.

Does that hurt on the right side?

-No.

-No. OK.

-Can you feel me touching you all the way down your right leg and here on your left leg?

-Yeah.

OK. Right down to your toes?

-Mm-hm.

-Does it feel the same on both sides?

No, that one feels different.

Can you feel me less on the left side?

Less.

After a cautious examination,

Dr Briggs decides that Phil should have a chest and pelvic X-ray.

Breathe in.

And out. Hold it there.

Breathe out.

So, same again. Deep breath in.

And out. Hold it there.

And breathe on.

Even when dealing with a case as serious as Phil's,

it seems there is still one topic that dominates Shetland conversation...

The weather.

Have you seen the BBC article that we have got more sunshine

-than Cornwall?

-Yeah.

-I was like, oh, my lord.

-London is only two degrees warmer than us today.

-Yeah, I know.

-And Phil seems distracted as well.

-All right?

-Aye.

Are you wanting something else for the pain?

Can I go for a fag?

Not right now.

How? Now, before this.

-You are in too much pain.

-I'm all right.

You're not really able to go out for a fag, are you?

-I am.

-Eh?

I am.

Dr Briggs returns,

with the results of the chest and pelvic x-rays.

So, if we look at the x-rays,

there is a couple of bits we are just not sure about.

It's possible that one,

the very last discrete bone at the bottom of your spine has maybe been

kind of crushed under, with the force of the fall.

It's quite hard to see on the x-rays,

so the next step up would be a CT scan.

With the X-ray results inconclusive,

the team have to arrange a CT scan to get to the bottom of his pain.

It is a fact of life that some shifts in a small island A&E department

can be, shall we say, less than stimulating.

But there's nothing like a good medical mystery to liven things up.

This room is free here.

79-year-old Anne has come to the emergency ward having experienced

severe stomach pains in the night.

Your heart rate is fine.

We'll just check...

It is high for me.

-Is it high?

-It is normally a teenager's...

Oh, like a youngster?

Yeah.

Her blood pressure offers no clues,

so it falls to a doctor to do some detective work.

-Hello there. Anne?

-Yes.

What happened tonight?

Well, it was just suddenly this

severe, severe pain.

OK. And if you were rating the pain out of ten, what would you rate it?

Well, it had its moments that I would have said it was ten.

But then, you know, it was anything from four to seven, seven to ten, fluctuating.

I would say it has certainly eased a bit.

OK. Good. And was it on one side or both sides?

I have a niggle on this side which is why I have been booked,

I'm going to have a scan for a gallstone.

Oh, yes, I saw that in your notes.

So, severe ten out of ten abdominal pain recently subsided.

Prime suspect - gallstones.

But the doctor isn't finished gathering evidence and digs deeper.

Had you been doing anything unusual today?

Any heavy lifting? Any exercise?

Nothing, nothing unusual, no.

I did a little bit of gardening, but at my age you don't do much...

No clues there.

But she continues her line of questioning.

What did you have for your dinner tonight, your evening meal?

-Spaghetti Bolognese.

-OK.

It wasn't particularly rich are anything like that?

No, it was just my normal...

Just your normal, OK, OK.

Do you take any alcohol?

Yes, occasionally.

-OK.

-I have wine with my meal and that's maybe it.

A gin and tonic on a Sunday and a brandy on a Thursday.

OK!

We are creatures of habit, you know.

And do you feel like the pain has gone completely now?

-Or do you feel...?

-Can I stand up and I will tell you?

OK.

Yeah, I feel very bloated, but...

-OK.

-Yeah, I would say all that sharp pain has gone.

-A little bit tender.

-OK.

The plot thickens.

The doctor is starting to have her suspicions about the culprit.

But before she points the finger, she wants to eliminate the main suspect.

What I will do is I will get you up on this bed if that's all right.

She checks Anne for any signs that a suspected gallstone could be

-the perpetrator.

-Now, I am feeling quite deeply, OK?

So it will be normal to have a bit of discomfort.

All right? So, around about here?

Would you like to point to me with one finger?

-OK.

-I can't find it now!

Well, that's OK.

-That's all right.

-It was just about here.

OK. OK.

She has heard enough.

She has examined the evidence and is ready to identify the culprit.

Actually, I think the most likely cause of this,

although I don't want to make it sound trivial,

but actually trapped wind can be very, very severe.

And you have people coming in thinking

they are having heart attacks and things.

So I would be quite happy for you to go home given that you have not had

any more pain, things have settled now.

Anything else? Any other worries?

-No?

-Thanks very much indeed.

That's all right. Thank you.

-OK.

-Have a good night.

-Thank you. Bye now.

-Bye.

-Bye.

You ought to change some of these ceiling tiles to ones with pictures on them.

Biker Eddie came into A&E earlier after colliding with a seagull while

travelling at 60mph on his motorbike.

-Do you want head up, or...?

-The head this side.

-Yeah.

-Hello.

-One, two, three.

After a quick examination,

he has been sent for a CT scan to ascertain if there was any

serious damage to his spinal cord.

Two, three.

Gilbert Bain is a full-service General Hospital.

But if a patient needs specialist diagnosis or treatment,

the medics need to work with Aberdeen Royal Infirmary, 225 miles away.

Their consultant neurologist will examine Eddie's CT scan and liaise with

Dr Lalla on the next step for treatment.

Eddie will have to stay on the wards until the results of the CT scan can

tell them if there is any damage to his neck.

Can we do a quick detour for a cigarette?

I heard what she said.

I listened to what she said.

Get some patches. Stick it over his mouth.

That's a good idea.

-Thumbs up.

-Thumbs up.

While they wait for word from Aberdeen...

..Dr Lalla scans the images for evidence of the seagull's impact.

Looks a bit dodgy over there, so...

It's funny, though, why that would be affected...

You can see the alignment does that under, then does that.

He has lost the normal lordosis.

Whilst it may be a call for the specialists in Aberdeen,

Dr Lalla does have considerable experience dealing with the victims of

Shetland's aggressive wildlife.

We haven't had one like this before, I presume?

-Falling off cliffs...

-One lady got hit and basically head-butted by a cow

and she went flying down the hill.

That can be quite dangerous.

Yeah.

We had one kicked in the leg, broken tibia, kicked in the leg by a duck.

-By a duck?

-Mm-hm.

We called it Duck Lee. Duck Lee.

Duck Lee.

We have had plenty of injuries.

One, two, three.

Oh, it is nice in here, isn't it?

The ceiling is much the same as downstairs.

-I was going to say, is it any different?

-We are a lot nicer up here than downstairs.

Looks like Eddie will be counting ceiling tiles until the

-results get back from Aberdeen.

-There is your phone, OK?

-Cheers.

With any luck, he will be back on his bike before long.

GULLS CRY

On Britain's most remote inhabited island, Fair Isle,

GP Mark Maudsley has made the 55-mile journey by plane from Shetland...

..opened up the island clinic and, most importantly,

found some milk for his tea.

He and nurse Merran are finally ready to see their first patient.

I was getting a very red eye, and just below the eye,

-there's a little lump.

-Oh, yeah.

Although Mark is still finding his feet out here on Fair Isle...

They have confiscated our alcohol wipes on the way out.

..he is also contending with the fact that Fair Isle has been without

a permanent resident nurse for five months now.

We are between nurses at the moment and it does make it a nonstandard day

in the Fair Isle. Usually, when we arrive,

the nurse would pick us up from the airstrip and they would open up all

the cupboards that I was struggling with earlier and they'd would already

be logged onto a computer and all that kind of thing.

When I can get a look at your old prescriptions, John,

then I will be able to do that.

But at the moment...

I've been struggling with that.

Recruitment of medics to extremely remote areas is a constant struggle

for the NHS, and one that hasn't gone unnoticed here on Fair Isle.

Well, it is always good when you come here so at least we have got

-somebody.

-Yeah.

I will mention that now and then leave it -

this is the worst period of nurse cover since 1903.

-Is that right?

-That is the gap, it is the biggest.

-Yeah.

-And of course, as you know, I think it is an absolute disgrace.

Don't get me started on these subjects.

-Thank you very much.

-No worries.

-Good.

-OK.

-Yes.

-That's one semi-satisfied customer dealt with.

Next up, Fair Isle resident Stewart Thomson Junior,

who is suffering from a persistent cough.

And are you coughing up a lot of stuff?

Not a lot, but...

First thing in the morning,

what I cough up is not really nice looking.

It would be kind of useful to get a specimen.

But yet again, without a resident nurse,

these simple things turn into a headache.

Ordinarily, you could get this, I suppose,

any morning that there is a plane going out and the nurse would organise

getting it off and the porters coming from the hospital and stuff,

which is maybe more difficult for you to do.

In the end, Mark leaves Stewart with a sample share to give to the next

nurse that comes to the island.

Good, good.

-OK.

-Thank you very much.

No worries. Nice to see you, Stewart.

-Cheerio.

-That is everybody who's coming here for the day.

So we've got one visit to do, so we will just

try and lock everything away again

amongst all this selection of keys.

And we will get on our way.

Aberdeenshire oil rig worker Phil was airlifted to Shetland after falling

and hurting his back at work.

So far, the spinal X-ray has shown a potential injury to his lower spine,

but Dr Briggs wants to investigate further.

We sent Phil for an X-ray and that showed a suspicious area

on the lower end of his spine, so that needed further imaging.

So we arranged for him to have a CT.

However, this means moving him again

and to do it safely takes a team effort.

As the images come through,

it seems Dr Briggs' suspicions have been confirmed.

The base of the spine showed we had a burst type fracture in the

lumbar fifth vertebrae which is something that we can't really deal with

up here, it's more a specialised neurosurgical issue.

So, we discussed him with the neurosurgical team in Aberdeen.

Hi, good afternoon, this is Dr Briggs calling from the

Gilbert Bain Hospital in Shetland.

Could you put me through to whoever is on call for the spinal team?

They have accepted him to be transferred down to their ward where he can get

more specialist input,

and I'm just in the process of doing his transfer paperwork.

My pager is zero-one and I am on until late,

so I should be able to answer your call any time.

Phil is booked onto the next flight to Aberdeen to see a neurosurgical

specialist. Unfortunately that flight isn't until tomorrow,

which means a night on the wards and yet another move.

But he's going to need some convincing.

-At least it'll be a different scene from upstairs.

-Oh great, hey?

-You can get Wi-Fi as well.

Free Wi-Fi.

-Hi, Craig.

-Hello.

We are going to Ward One. Could you just go really, really slowly.

Certainly.

After an exhausting day being carted back and forth,

Phil is finally rewarded with a room with a view.

-Can you see?

-Aye. It's perfect.

-All right?

-Yeah.

-Watch for any killer whales.

Watch for my plane to come.

Phil would be advised to enjoy the peace and quiet while it lasts,

as tomorrow's move to Aberdeen will be no walk in the park.

Shetland offers some of the most sensational scenery to be found

anywhere in the world.

But its remote location and small population mean the hospital has to

care for its patients with a fraction of the staff of a typical mainland hospital.

Break the seal for me, that would be grand.

Which is why it is so important for all of Shetland's doctors to be able

to turn their hand to a variety of procedures.

To this end, senior doctor Kushik Lalla has been asked for a little advice from

junior doctor Aideen Carroll.

Dr Carroll has removed a deep splinter from underneath a workman's

fingernail, but the splinter has left behind debris

-which could cause an infection.

-He's an old customer.

So he's managed to get a splinter under his nail...

..that I assume has been there for a few days.

-No, I did it yesterday.

-Yesterday?

But it is starting to fester a little bit over there.

What we want to do is just open that up and clean the area out,

but because it is under the nail, it is a difficult area to get to.

This will be the first time Dr Carroll has completed this technique,

so Dr Lalla is on hand to offer some pointers.

Starting with the application of the anaesthetic,

using what is known as the ring block method.

Most of our juniors that come through now,

especially if they have not done something like that,

will want some supervision just to make sure they're not going to do

anything wrong or cause more harm than good.

So what you want to do is just go...

..vertically in like that.

Right? And inject as you are going in or as you are coming out.

You aspirate to make sure you are not in a vessel.

-Yeah.

-And then just inject two moulds on that side.

So you want to get on that side of the bone,

inject two moulds across them like that.

-And then two moulds on but...

-And then two moulds on that side.

OK, might be a sharp scratch coming up.

-So, about here?

-Yeah, that's fine.

So, about there?

-Yeah, and go in.

-Go in.

Go in, go in, go in.

-Yeah, aspirate.

-Aspirate.

-And then inject.

-Inject.

As you are coming out, so it is going to sting now,

-like hell.

-Are you all right there, Sir?

-Mm-hmm. No bother.

Injecting, there is hardly anything going in.

She's being very gentle with you.

Yeah.

Right, I will do the other side and teach you.

So, the finger will start to swell up

and you see it is starting to blanch?

Yeah. You can come out.

And then do the same on the other side now.

You really have to press in to inject into this because sometimes it can

be quite tight depending on how much you are injecting.

That is fine.

So that is your first ring block.

Yeah, very good.

With the anaesthetic successfully injected into the finger,

it is just a case of waiting for it to take effect before they can cut

open the nail.

Having been diagnosed with a spine fracture,

Phil is to be transferred by plane to see a specialist consultant in his

home city of Aberdeen.

However, with the wind and rain picking up,

nurse Heather Wightman has to reassure the anxious patient.

-You all right?

-A bit nervous about...

Don't be nervous. It will be OK.

If you managed the helicopter you will manage the plane.

The plane flies in a lot worse than this.

-Yeah.

-You will be absolutely fine.

This is a nice day.

In a move that Phil must now surely be getting used,

the team carefully transfer him once again onto a trolley.

How's that? Not too bad?

Are you comfortable enough?

-Yeah.

-Yeah?

When has he last had pain relief?

20 minutes ago he has had...

Right, all the best.

-I will see you later.

-See you later.

-See you.

Thanks very much.

Paramedic Emma Davis drives the 25 mile trip to Sumburgh in the south

of the island to meet the plane that will take Phil to be specialist treatment he needs.

It is coming up to pick him up to take him to Aberdeen.

It's actually where the patient is from.

He is from Aberdeen, he got taken to Shetland cos he got taken off

a rig yesterday, so he will go down for further treatment,

and then discharged home from there.

The weather is cold, wet,

the wind's starting to pick up, drizzly, horrible,

typical Shetland summer weather.

But we have had, we had a few nice days, so can't complain.

Better than last year.

In fact, has the weather not been better in Shetland

than in Cornwall this summer?

That can't happen very often.

Well, it hasn't today.

With final checks done,

Phil says goodbye to Shetland, and heads for home.

It's really lovely.

Shetland GP Mark Maudsley has finished seeing his patients

at the surgery on Fair Isle,

and is about to embark on his round of home visits.

At this point in the day,

the GP on the mainland may have 20 or 30 more patients to see.

Today, Dr Maudsley's caseload is a little lighter.

The two tasks we now have are to go and see Stewart,

and get our lunch at the shop.

Lovely.

Stewart's the island's oldest resident now,

so we're just off to see how he's getting along.

Hello, Stewart.

This isn't the first Stewart Thomson Dr Maudsley's seen today.

Hopefully he's feeling better than his son,

Stewart Thompson Junior, who came in with a cough earlier.

Shut the door, please.

-Keep the cold out.

-Yeah.

So, Stewart, how've you been getting on?

All right, not bad.

Getting breathless in the mornings sometimes...

-I used to sleep well, 'til about six o'clock...

-Yeah.

But then after that, it's not so good.

-And is it the breathlessness that is keeping you...?

-Well...

I don't know whether it is breathlessness or not, it's old age.

Yeah, yeah.

I was 94 in March.

I reckon I am not doing bad for that.

I think you're doing very well.

Are you still managing to get a bit of spinning done?

Yes, yes, spinning away.

Yeah.

For you mainlanders watching,

it's possibly not the kind of spinning you were thinking of.

And it's not the only thing our Stewart has a talent for.

-Do you play the fiddle, then?

-Yeah, I play.

Any Fair Isle tunes?

-OK.

-I don't know any.

-Do you?

-Do you know The Headlands?

-Yeah.

-OK, play the Headlands.

Is this it?

THEY CHUCKLE

Well done you two!

Yeah!

It is a good set.

A nice fiddle, that.

Visits like these offer proof, were it needed,

that health care is about more than just prescribing pills.

Is that your grandson, is Euan Thomson?

-Yes.

-He actually fixed up my auntie's fiddle that she gave me.

As the day draws to a close,

Merran and Dr Maudsley need to head back

-to catch their flight home.

-This is the scenic route.

Yeah, one of two roads available.

But they're not in that much of a hurry.

Let's have a little detour.

It's not a bad day at work when you get to come out here.

Yes, I'd be looking pretty smug if I worked here too, doctor.

In treatment room three, Magne, a 53-year-old builder from Lerwick,

is having a portion of his fingernail removed

in order to sterilise the area underneath.

What'll happen is we will cut out a tiny wedge of the nail like that,

and that nail will slowly grow in again as time goes on, OK?

Dr Lalla is guiding Dr Carroll through the grisly procedure

for the first time.

So just across there, like that.

-Mm-hm.

-And just cut out...

-With scissors?

-Yeah.

Magne had a splinter in his nail.

Now removed, it's left debris inside.

Dr Carroll needs to remove part of the nail in order to clean it out.

So, go...

Use your scissor sideways.

Yeah, like that.

And go under the nail,

and spread the scissor.

That opens,

it separates the nail from the bed.

OK, so close it.

Yeah. Go in.

Magne, tell us if it's sore.

Open. Yeah.

-Open.

-Open, open, open.

Open. Open, open, widely!

Wide, wide, wide.

Yeah.

It's intricate work, but Dr Carroll is...nailing it.

Right, so, you're separating... Close now. Close.

Yeah, and go in a little more.

-Mm-hm.

-Yeah. And open a little bit.

Yeah. That's good.

That's good. Come out now.

Yeah, come out. And then just cut the nail.

So cut a wedge out, yeah.

So not sideways?

You want to go vertical now, and just cut a wedge out.

Clean the area, so you can see what you're doing.

You want one clean cut.

You want a triangular piece taken out.

Push in further. Push in further.

Yeah. Keep going.

That's it. And take that nail off.

Use a swab.

Just use a swab to break it off.

Rub it off.

That's right. That's you all done.

OK.

Right, I'm going to head back.

Yeah, good. So, there you go.

-One job's done.

-Thanks very much, Kushik.

-All right, Magne.

I trained in South Africa where it was, you know...

..a very different sort of attitude.

It's see one, do one, teach one.

Over here, I try to encourage that a little bit.

It's more about her developing confidence in her own skills

that we want to encourage,

because they've got all the theory behind them at this stage,

it's just putting that into practice.

With her first ring block successfully completed,

Dr Carroll passes on her experience.

So in about there, down to about a centimetre.

Aspirate it to make sure there's no blood.

And then withdraw it, and then inject, about two mils,

and the same on the other side.

But it was, like, fully anaesthetised.

I was, like, cutting his nail bed,

didn't feel a thing.

So, yeah.

Gives me the heebie-jeebies. Gives me the heebie-jeebies.

For Dr Carroll,

every new experience is vital for her professional development.

So, it's scary but it is an awesome feeling when you've done it.

It is nice to have some support about,

when you do it, and it works,

it feels good.

Especially Kushik, someone who's in A&E everyday is invaluable,

because he's just seen everything,

and done everything,

and we've seen nothing and done nothing,

so it's, like, a lovely person to be able to call on,

just for when you're seeing stuff for the first time.

Eddie recovered well from his collision with a seagull

and was back on his bike a couple of weeks later,

with an eagle eye trained on any low-flying birds.

Back in Aberdeen, Phil spent a week in hospital,

and is still waiting to find out if he'll need surgery on his back.

But he's in good spirits.

Fair Isle is still waiting for a full-time nurse,

but hope to find someone soon.

And Anne is still keeping well,

thanks to a brandy on a Thursday,

and a gin and tonic on a Sunday.