0:00:02 > 0:00:03Shetland.
0:00:03 > 0:00:06The most remote part of the UK.
0:00:06 > 0:00:10Here, you're closer to the Arctic Circle than you are to London
0:00:10 > 0:00:13and nearer Norway than you are to Edinburgh.
0:00:13 > 0:00:16There are more puffins than people
0:00:16 > 0:00:18and more seals than supermarkets.
0:00:20 > 0:00:25But this wild landscape is also home to 23,000 islanders.
0:00:25 > 0:00:29They're so far from the mainland that when things go wrong...
0:00:29 > 0:00:32A&E. Can I help you?
0:00:32 > 0:00:35..from helicopter rescues and spinal injuries...
0:00:35 > 0:00:37We're all here to make sure that you're OK.
0:00:37 > 0:00:39..to serious medical mysteries...
0:00:39 > 0:00:41Can we get assistance in, please?
0:00:41 > 0:00:44Something's not right.
0:00:44 > 0:00:45..Shetland's Island medics have to
0:00:45 > 0:00:47be ready for anything and everything.
0:00:47 > 0:00:50- What happened?- Got in a fight with a seagull.
0:00:50 > 0:00:53- This was sheep shears, was it?- Yeah.
0:00:53 > 0:00:54SIREN BLARES
0:00:54 > 0:00:56It means the tight-knit team of medics,
0:00:56 > 0:01:00volunteers, and emergency services have a special bond.
0:01:00 > 0:01:03This might tickle, then.
0:01:03 > 0:01:06And they know just how to keep each other going...
0:01:06 > 0:01:08A wee treat for night shift.
0:01:08 > 0:01:11..so they're always ready for any island emergency.
0:01:19 > 0:01:21Today, the Gilbert Bain Hospital
0:01:21 > 0:01:24welcomes the latest intake of junior doctors.
0:01:24 > 0:01:27Everyone that I've spoken to that had been to Shetland enjoyed it,
0:01:27 > 0:01:29and I can see why.
0:01:30 > 0:01:34We meet Shetland's first line of defence in the war on drugs.
0:01:34 > 0:01:36HE LAUGHS
0:01:36 > 0:01:37And nurse Emma Williamson helps
0:01:37 > 0:01:40junior doctor Saul Wilson with a tough shift.
0:01:40 > 0:01:43We're all here to make sure that you're OK.
0:01:50 > 0:01:56The National Health Service is the world's fifth largest employer.
0:01:56 > 0:02:001.5 million people in the UK work for the NHS,
0:02:00 > 0:02:04more than one in 50 of the population.
0:02:04 > 0:02:06Central to the NHS's values are the support,
0:02:06 > 0:02:10education and training it gives to its employees.
0:02:10 > 0:02:12- Happier?- Yeah.
0:02:12 > 0:02:15From student doctors to consultants,
0:02:15 > 0:02:19from the most experienced nurse to the most newly qualified GP,
0:02:19 > 0:02:22everybody is either teaching or learning.
0:02:22 > 0:02:26And this ethos is woven into the very fabric of the Gilbert Bain.
0:02:26 > 0:02:27Fantastic.
0:02:35 > 0:02:39Central to the training they medics at the Gilbert Bain receive is
0:02:39 > 0:02:42senior A&E and surgical doctor, Kushik Lalla.
0:02:42 > 0:02:46Having worked around the UK and in South Africa,
0:02:46 > 0:02:49Dr Lalla moved to Shetland 20 years ago.
0:02:49 > 0:02:52He's the longest serving member of the senior team at the hospital.
0:02:56 > 0:03:02We carry out a lot of practical and theoretical training over here that
0:03:02 > 0:03:06is with myself teaching them, using a patient at the bedside.
0:03:06 > 0:03:10We will ring block her, keep the area clean,
0:03:10 > 0:03:13examine the area properly, and then decide.
0:03:13 > 0:03:16Dr Aideen Carroll has called on Dr Lalla
0:03:16 > 0:03:21to assist with a rather interesting toe injury.
0:03:21 > 0:03:23In terms of the juniors, they
0:03:23 > 0:03:26can come to me with absolutely anything.
0:03:26 > 0:03:29I don't know... I'm almost like a grandfather figure here, I think,
0:03:29 > 0:03:31sometimes. I feel like that sometimes.
0:03:31 > 0:03:35Is the flap facing that way? Or facing this way?
0:03:35 > 0:03:37This way. The flap goes like that.
0:03:37 > 0:03:40So it's open that way?
0:03:40 > 0:03:42- Yeah.- Right, that's bad
0:03:42 > 0:03:44because the only way you can get
0:03:44 > 0:03:48blood to the tip of that flap is from that end,
0:03:48 > 0:03:53and blood vessels don't go there and turn and come down.
0:03:53 > 0:03:56So, let's go and see her.
0:03:56 > 0:03:58Right. Now...
0:03:58 > 0:04:01Going to have a look at that toe.
0:04:01 > 0:04:0412 hours ago, this unlucky lady fell from a ladder,
0:04:04 > 0:04:07managing to slice her toe open in the process.
0:04:07 > 0:04:09So what we're going to have to do
0:04:09 > 0:04:11is give you what's called a ring block.
0:04:11 > 0:04:14We're going to inject some local anaesthetic into that toe to make it
0:04:14 > 0:04:15nice and numb and we're going to
0:04:15 > 0:04:18open that up and give it a good clean and
0:04:18 > 0:04:22see whether any of the deeper structures are injured
0:04:22 > 0:04:25and that will determine what we do.
0:04:25 > 0:04:28The injury has reduced the flow of blood to the area
0:04:28 > 0:04:31and now the flesh has started to die.
0:04:31 > 0:04:33If left untreated, the wound could
0:04:33 > 0:04:35become infected and even prove fatal.
0:04:35 > 0:04:38They need to clean it, but it's going to hurt.
0:04:38 > 0:04:41A small tourniquet is used on the toe
0:04:41 > 0:04:44to keep the anaesthetic within the injured area.
0:04:44 > 0:04:47It stings. It stings as it goes in,
0:04:47 > 0:04:51but once it's in, there will be no pain. OK?
0:04:51 > 0:04:54- OK.- Sharp scratch.- Sharp scratch now.
0:04:54 > 0:04:57And it's going to sting now.
0:04:59 > 0:05:02Turn it inwards.
0:05:02 > 0:05:05That's it.
0:05:05 > 0:05:09With the toe fully numbed, it's time to get stuck in.
0:05:09 > 0:05:12Give it a good... A good scrub.
0:05:12 > 0:05:15Open up the flap. Scrub this way.
0:05:15 > 0:05:19- Like that?- Yeah. That's why we give the local, OK?
0:05:19 > 0:05:22So that you can do scrubbing like this.
0:05:22 > 0:05:25Teaching someone something for the first time, for me,
0:05:25 > 0:05:27seeing them do it the first time,
0:05:27 > 0:05:30they're usually very shaky and not quite sure of themselves.
0:05:30 > 0:05:34Are you tickly? Yeah, I can see your foot.
0:05:34 > 0:05:37There's eventually this light bulb moment where they realise,
0:05:37 > 0:05:41"Hang on, this is not terribly difficult and I can do this."
0:05:41 > 0:05:45And it's at that point that you start to see, yeah,
0:05:45 > 0:05:48there is someone that has blossomed.
0:05:48 > 0:05:50This, we shouldn't try stitching that.
0:05:50 > 0:05:52More than 12 hours have passed,
0:05:52 > 0:05:55and so this wound is now what we call colonised,
0:05:55 > 0:05:57so bugs have started to live in this wound.
0:05:57 > 0:05:59And if you
0:05:59 > 0:06:03stitch the wound, you trap them all inside
0:06:03 > 0:06:05and then they start to invade.
0:06:05 > 0:06:08As the nurses give the wound a thorough wash with iodine,
0:06:08 > 0:06:12Dr Carroll has just completed her first toe ring block.
0:06:12 > 0:06:16I think part of why I came to Shetland was to see new things and
0:06:16 > 0:06:18get the opportunity to do new things,
0:06:18 > 0:06:22and the really nice thing is that the seniors are very good at coming
0:06:22 > 0:06:26down or supervising you and letting you try things for the first time.
0:06:26 > 0:06:30So, it's scary, but it's an awesome feeling when you've done it.
0:06:30 > 0:06:33Now Dr Lalla can get to his lunch.
0:06:33 > 0:06:36Yes. This is my wife trying to keep me...
0:06:36 > 0:06:41Keep me healthy. Do you want some?
0:06:41 > 0:06:43Seven a day, yeah.
0:06:43 > 0:06:45Yeah, seven a day. So, lunch is now.
0:06:48 > 0:06:53SQUAWKING
0:06:53 > 0:06:55Fundamental to the professional
0:06:55 > 0:06:58development of the medics within the NHS
0:06:58 > 0:07:01is the junior doctor training programme,
0:07:01 > 0:07:03a period of between four and seven years
0:07:03 > 0:07:05that turns graduates into GPs,
0:07:05 > 0:07:08specialists and consultants.
0:07:08 > 0:07:10During this period, junior doctors
0:07:10 > 0:07:12will travel the country to placements
0:07:12 > 0:07:15at different hospitals to broaden their experience.
0:07:15 > 0:07:20And today, the Gilbert Bain welcomes its latest cohort into the fold.
0:07:20 > 0:07:24Welcome to Shetland. We're quite a small hospital,
0:07:24 > 0:07:27but we're quite a close knit team.
0:07:27 > 0:07:31Consultant Pauline Wilson primes the new doctors on some of the unique
0:07:31 > 0:07:33challenges posed by the islands.
0:07:33 > 0:07:37So, say you get a child referral, a child's ill up in Unst,
0:07:37 > 0:07:39the GP wants you to see them.
0:07:39 > 0:07:42That could take them four hours to get here,
0:07:42 > 0:07:45so you do have to be quite sensible about even discharging people,
0:07:45 > 0:07:48because, actually, if that child did deteriorate,
0:07:48 > 0:07:51it's not as if they're just around the corner.
0:07:51 > 0:07:53Among the new members of the team is
0:07:53 > 0:07:5627-year-old Dr Cameron Innes from Aberdeen.
0:07:56 > 0:07:57Everyone that I've spoken to that
0:07:57 > 0:08:00had been to Shetland enjoyed it. And I can see why.
0:08:00 > 0:08:02We actually get to know the population.
0:08:02 > 0:08:07We will see generations of the same family in A&E.
0:08:07 > 0:08:10The biggest part of the job that I enjoy is speaking to patients, and
0:08:10 > 0:08:13getting to know patients, I find really enjoyable.
0:08:13 > 0:08:16The community aspect here that's massively different.
0:08:16 > 0:08:19Now, over the next four months, you will get to know people.
0:08:19 > 0:08:20Following that patient through the
0:08:20 > 0:08:24whole journey is an immense privilege.
0:08:24 > 0:08:26In resus, nurse Aimee Sutherland is
0:08:26 > 0:08:29preparing to give the low down to the new doctors.
0:08:29 > 0:08:32This is the day of doctor, junior doctor handover.
0:08:32 > 0:08:35Today we've got the new lot of doctors joining us.
0:08:35 > 0:08:37The nurses in A&E have worked here for a long time.
0:08:37 > 0:08:40They know how it works, so listen to them. It's really important.
0:08:40 > 0:08:43It's obviously stressful for them coming to a new
0:08:43 > 0:08:44hospital, new ways of working,
0:08:44 > 0:08:47especially when it is a small hospital,
0:08:47 > 0:08:49and maybe just a bit different from a big hospital.
0:08:49 > 0:08:51And that's them arriving now.
0:08:51 > 0:08:55Another new recruit is 26-year-old Dr Saul Wilson from London.
0:08:55 > 0:08:57It's just a new experience, really.
0:08:57 > 0:08:59A lot of my colleagues back in medical school,
0:08:59 > 0:09:01they probably wouldn't have the opportunity
0:09:01 > 0:09:03to work somewhere as remote as this.
0:09:03 > 0:09:06So, on the shelf here is most of your blood products.
0:09:06 > 0:09:07Your cannulation...
0:09:07 > 0:09:09Oh, it's quite daunting at the start.
0:09:09 > 0:09:12You're chucked into an environment you're not used to.
0:09:12 > 0:09:13We don't have a resus trolley as
0:09:13 > 0:09:16such that you have in some of the other hospitals.
0:09:16 > 0:09:18And I think you probably use eye gels.
0:09:18 > 0:09:20Is that what you are used to using? We use LMAs here.
0:09:20 > 0:09:23I think it's just good for my training in general.
0:09:23 > 0:09:27It means, you know, you get to cover all of the different departments and
0:09:27 > 0:09:29still maintain all the skills that I
0:09:29 > 0:09:31think are important for any doctor to have.
0:09:31 > 0:09:32And it will not be too long before
0:09:32 > 0:09:35those skills are put to the test for Dr Wilson.
0:09:42 > 0:09:43It might be small,
0:09:43 > 0:09:47but the A&E department at the Gilbert Bain is certainly busy.
0:09:47 > 0:09:49Working side by side through thick and thin
0:09:49 > 0:09:53means the small team have always got each other's backs.
0:09:53 > 0:09:55Just push it from the front.
0:09:55 > 0:09:58And they need little excuse to find something to celebrate.
0:09:58 > 0:10:03And today, it just happens to be the turn of one of A&E's unsung heroes.
0:10:03 > 0:10:05Anne, the ward cleaner.
0:10:05 > 0:10:08# Happy birthday to you! #
0:10:11 > 0:10:13- Wahey!- Woo!
0:10:16 > 0:10:19But it turns out to be the calm before the storm.
0:10:19 > 0:10:22SIREN BLARES
0:10:22 > 0:10:24An ambulance has arrived carrying
0:10:24 > 0:10:28a man found bleeding in the street after a suspected fall.
0:10:28 > 0:10:30What's the story, guys?
0:10:30 > 0:10:34Dr Wilson is tasked with assessing the damage.
0:10:34 > 0:10:36You come across, you know, loads of different medical problems.
0:10:36 > 0:10:38Sometimes, you know, all at once.
0:10:38 > 0:10:40And being the only doctor, you know,
0:10:40 > 0:10:43available on the island at the point of care
0:10:43 > 0:10:46is quite a stressful situation sometimes.
0:10:46 > 0:10:48No, just turn around and put him flat on his face, I think.
0:10:49 > 0:10:51It was a difficult situation with
0:10:51 > 0:10:54him because he was quite confused, quite agitated.
0:10:54 > 0:10:55How are you doing?
0:10:55 > 0:10:57I'm just not feeling good.
0:10:57 > 0:10:59Do you remember falling over?
0:10:59 > 0:11:00Falling over?
0:11:00 > 0:11:03- Yeah.- I think you have had a bit of a fall.
0:11:03 > 0:11:04We tried to assess his injuries.
0:11:04 > 0:11:06Is your nose sore?
0:11:06 > 0:11:09Your nose is bleeding, though. Let me sort that.
0:11:09 > 0:11:15But he was quite confused and slightly disorientated.
0:11:15 > 0:11:17Do you know where you are right now?
0:11:17 > 0:11:19No.
0:11:19 > 0:11:22After managing to speak to the patient's sister on the phone,
0:11:22 > 0:11:25the team finds out a crucial piece of his medical history.
0:11:25 > 0:11:29- He's got epilepsy.- Ah, now we're getting somewhere.
0:11:29 > 0:11:32We're saying that you sometimes have epilepsy, darling.
0:11:32 > 0:11:34Do you sometimes have a seizure, darling?
0:11:34 > 0:11:37This may offer a clue as to the cause of his fall.
0:11:37 > 0:11:39And if he has had a seizure,
0:11:39 > 0:11:42he can be feeling confused and disorientated for hours to come.
0:11:42 > 0:11:45To make sure he's not in any further danger,
0:11:45 > 0:11:48the team needs to run some tests.
0:11:48 > 0:11:50We're going to have to...
0:11:50 > 0:11:51We're going to have to maybe take
0:11:51 > 0:11:53some blood from you to see what's going on.
0:11:53 > 0:11:56But nurse Emma Williamson's years of experience tell her
0:11:56 > 0:11:59taking blood could be risky in this patient's condition.
0:11:59 > 0:12:00He's frightened, so...
0:12:00 > 0:12:02No, OK. This place wouldn't run
0:12:02 > 0:12:05without the nurses and the experience they've got.
0:12:05 > 0:12:07The advanced nurse practitioners
0:12:07 > 0:12:09are really good at pointing you in the right direction.
0:12:09 > 0:12:13We could only do so much because he was in such a state of confusion.
0:12:13 > 0:12:16He wasn't really sure what we were trying to do to him.
0:12:16 > 0:12:19It's just too dangerous at the moment, really.
0:12:19 > 0:12:20I would just hold off.
0:12:20 > 0:12:23I always think they're somebody's son, they're somebody's daughter,
0:12:23 > 0:12:25they're somebody's granny.
0:12:25 > 0:12:30And how would I like my family to be treated?
0:12:30 > 0:12:33And I really try to be kind and treat everybody the same.
0:12:33 > 0:12:36You could easily take it for granted up here,
0:12:36 > 0:12:39but I think it's important to remember that we're really lucky to
0:12:39 > 0:12:41have nurses that have all these skills up here.
0:12:41 > 0:12:44Now that nurse Emma has the situation in hand,
0:12:44 > 0:12:47Dr Wilson takes his chance.
0:12:47 > 0:12:50I'm going to put a little drip in your arm, OK?
0:12:50 > 0:12:52You are doing OK, darling.
0:12:52 > 0:12:55I'll get a bandage on here.
0:12:55 > 0:12:57You're going to look like Rab C Nesbitt
0:12:57 > 0:12:59with this thing on the heid.
0:13:00 > 0:13:06Now, then, remember how we said we needed to take a blood sample, OK?
0:13:06 > 0:13:10It will scratch, but you hold my hand and you just relax.
0:13:10 > 0:13:13HE COUGHS
0:13:13 > 0:13:15Now, then, you're better looking at me.
0:13:17 > 0:13:20Look at me, darling, and I'll tell you what they're going to do.
0:13:20 > 0:13:23Sharp scratch. Keep nice and still.
0:13:23 > 0:13:25HE COUGHS
0:13:25 > 0:13:27OK.
0:13:29 > 0:13:30You're doing really well there.
0:13:30 > 0:13:32- Nearly there.- Well done.
0:13:32 > 0:13:33Clean half your tummy.
0:13:33 > 0:13:35- Do we have a dressing? - It's right there.
0:13:38 > 0:13:41Well done! That's fantastic!
0:13:41 > 0:13:43These blood tests will help shed
0:13:43 > 0:13:45some light on the patient's condition,
0:13:45 > 0:13:47but Dr Wilson wants to take things further.
0:13:47 > 0:13:50Probably have to do a CT head scan as well.
0:13:50 > 0:13:52But is he going to need sedated for that?
0:13:52 > 0:13:54- Yeah, I think so.- He's not going to cope with going in the scanner.
0:13:54 > 0:13:57- Yeah.- But just as the situation appears to have calmed down...
0:13:57 > 0:14:01SIREN BLARES
0:14:03 > 0:14:05..a second ambulance arrives,
0:14:05 > 0:14:07carrying a victim from a road traffic accident.
0:14:09 > 0:14:12Dr Wilson is called away to the second patient.
0:14:12 > 0:14:17It's his second week on the island and he's now juggling two emergency
0:14:17 > 0:14:19situations as the doctor on duty.
0:14:20 > 0:14:24It's quite easy to panic, but I think it's important to remain calm,
0:14:24 > 0:14:27remember that you've got the support available if you need it,
0:14:27 > 0:14:29and make sure you've got all the equipment, all the staff there,
0:14:29 > 0:14:31so you can be ready.
0:14:42 > 0:14:45The United Kingdom's most northerly island is Unst,
0:14:45 > 0:14:50which sits at the top of Shetland's archipelago.
0:14:50 > 0:14:54It's a beautiful but wild place that 700 Shetlanders call home.
0:14:54 > 0:14:58Unst boasts just three small shops and has no restaurants,
0:14:58 > 0:15:00pubs or cinemas.
0:15:00 > 0:15:03But the lack of amenities is more than made up for by the sense of
0:15:03 > 0:15:05community on the island.
0:15:05 > 0:15:08On Unst, the residents love to get together,
0:15:08 > 0:15:11dress up in traditional and non-traditional costume,
0:15:11 > 0:15:13join in, and have fun.
0:15:13 > 0:15:15CHEERING
0:15:15 > 0:15:17Ordinarily, there'd be
0:15:17 > 0:15:19a permanent GP at the heart of this community,
0:15:19 > 0:15:23but Unst hasn't had a full-time doctor for 18 months.
0:15:23 > 0:15:26Filling that gap is Dr Sean Stansfield,
0:15:26 > 0:15:29a locum who's working as Unst's temporary GP.
0:15:29 > 0:15:32I've been here, oh, I think it's nearly two years now,
0:15:32 > 0:15:36coming to work here. I worked one day here back in 2012.
0:15:40 > 0:15:44They've had regular need for locums over the past
0:15:44 > 0:15:46two years, so on and off over that time.
0:15:50 > 0:15:53Recruitment in very rural areas has historically
0:15:53 > 0:15:57been a problem for the NHS, and things are particularly bad now.
0:15:58 > 0:16:02In the 18 months since Unst had a full-time GP,
0:16:02 > 0:16:05they've had to employ ten locums to cover the island,
0:16:05 > 0:16:06at some considerable expense.
0:16:08 > 0:16:11And although not a permanent resident on Unst,
0:16:11 > 0:16:15Dr Stansfield has started to settle into the community.
0:16:15 > 0:16:21It gets a lot easier when you know the community and the people,
0:16:21 > 0:16:24because by now you know most of the people that you're likely to see.
0:16:26 > 0:16:29It's better than working in the real world.
0:16:29 > 0:16:32There's about 700 permanent residents.
0:16:32 > 0:16:35They'll all be registered with us.
0:16:35 > 0:16:37Looking after 700 residents requires
0:16:37 > 0:16:40a much fuller week than the 48 hours most GPs do.
0:16:40 > 0:16:44Dr Stansfield's on-call 24 hours a day, seven days a week.
0:16:44 > 0:16:47In the evenings and weekends, you're still on-call,
0:16:47 > 0:16:49so you're pretty much the only
0:16:49 > 0:16:52on-call member of the health service here,
0:16:52 > 0:16:55so we all work with the volunteer ambulance crew to do all of the
0:16:55 > 0:16:57emergencies and problems on the island.
0:17:00 > 0:17:04Today looks set to be a typical day for Dr Stansfield.
0:17:04 > 0:17:06We're expecting ordinary everyday things
0:17:06 > 0:17:09from people with blood pressure problems
0:17:09 > 0:17:11to sore knees and backs.
0:17:11 > 0:17:15We don't have anything exciting planned yet.
0:17:15 > 0:17:18It may not be the high drama of the A&E ward,
0:17:18 > 0:17:22but what Dr Stansfield and GPs like him around the country offer
0:17:22 > 0:17:27is a primary care service, aimed at catching and fixing problems early.
0:17:27 > 0:17:29Come on in. Have a seat.
0:17:31 > 0:17:35For the last few days, I've been feeling really, like,
0:17:35 > 0:17:37shaky and light-headed.
0:17:37 > 0:17:41The other day I was out somewhere in the middle of nowhere,
0:17:41 > 0:17:42and my right knee just went.
0:17:42 > 0:17:45Is it OK if we have a quick feel of your pulse
0:17:45 > 0:17:47- and check your blood pressure and things?- Yeah.
0:17:47 > 0:17:50The primary care that GPs provide is vital.
0:17:50 > 0:17:52Prevention truly is better than cure,
0:17:52 > 0:17:56and treating patients before they become critically ill eases pressure
0:17:56 > 0:17:59on the emergency services and saves millions of pounds.
0:17:59 > 0:18:02It's very different to working in big town surgeries.
0:18:02 > 0:18:05You have a little bit more time with the patient,
0:18:05 > 0:18:08but you also have a huge big area to cover.
0:18:08 > 0:18:13Care like this makes up a whopping 90% of all care within the NHS,
0:18:13 > 0:18:16yet accounts for only 10% of annual spend.
0:18:16 > 0:18:19Anyone else in your family had any things like this at all?
0:18:19 > 0:18:22- I don't think so, no.- There's a bit of swelling there.
0:18:22 > 0:18:23It's not dramatic.
0:18:23 > 0:18:26You have to spend a lot more time thinking about decisions that you
0:18:26 > 0:18:30make when it could take three hours to get a patient to the hospital.
0:18:30 > 0:18:32An X-ray probably is worthwhile.
0:18:32 > 0:18:36We'd probably need to get you to book in for some blood tests.
0:18:36 > 0:18:38But we'll check everything out there -
0:18:38 > 0:18:40vitamins, minerals, sugars, the whole works.
0:18:40 > 0:18:42We do all the emergency cover here.
0:18:42 > 0:18:44You're working 24 hours a day and
0:18:44 > 0:18:47have to be contactable the whole time,
0:18:47 > 0:18:50which is something you'll never, never really see the same way in the
0:18:50 > 0:18:51bigger practices.
0:18:51 > 0:18:53- Is that all right? - Yeah, lovely. Thanks very much.
0:18:53 > 0:18:55- No problem.- That's fine.
0:18:55 > 0:18:57Any problems in the meantime, if it's getting worse,
0:18:57 > 0:18:59you can always come back in sooner.
0:18:59 > 0:19:00- OK. Perfect.- OK, then.
0:19:00 > 0:19:03- Thanks very much.- No problem. Bye.
0:19:03 > 0:19:06Locums like Dr Stansfield will keep on providing the crucial care
0:19:06 > 0:19:10for Unst's residents until a permanent doctor can be found.
0:19:10 > 0:19:13It's the perfect job for someone after a bucolic lifestyle,
0:19:13 > 0:19:15who values the quiet life,
0:19:15 > 0:19:19and possibly for someone with a penchant for dressing up from time to time.
0:19:19 > 0:19:21CHEERING
0:19:30 > 0:19:35Mum Amy has travelled 22 miles to hospital from Vidlin.
0:19:35 > 0:19:39She's brought her son Louis and brother Joey to A&E after being
0:19:39 > 0:19:42unable to get an appointment at her local health centre.
0:19:42 > 0:19:46It's a situation parents up and down the land can identify with.
0:19:46 > 0:19:50Louis has been running a worryingly high temperature for a few days,
0:19:50 > 0:19:53and has been having convulsions when going to sleep.
0:19:53 > 0:19:56Amy's concerned this could signal something more serious,
0:19:56 > 0:19:58and like only children can,
0:19:58 > 0:20:03the presence of Joey and Louis in A&E is causing a bit of a kerfuffle.
0:20:03 > 0:20:04Hello!
0:20:04 > 0:20:07Luckily, Shetland stalwart nurse Thelma Irvine
0:20:07 > 0:20:12is able to take control and deliver Louis to junior doctor Cameron Innes.
0:20:12 > 0:20:14Hello! We're just striding in here, are we?
0:20:14 > 0:20:18- I'll go and get some toys. - Straight to the bed.
0:20:18 > 0:20:20Hello. Nice to meet you.
0:20:21 > 0:20:23Are you going to sit down?
0:20:23 > 0:20:26So, what's been happening with Louis?
0:20:26 > 0:20:28Can you tell me a little bit about...
0:20:28 > 0:20:30He's had... He's been really hot.
0:20:30 > 0:20:34- Uh-huh.- And when he's starting get to sleep, his body's been jerking.
0:20:34 > 0:20:39- Yup.- Like, really big jerking movements.
0:20:39 > 0:20:41And he's just had a kind of...
0:20:41 > 0:20:45I don't know what to describe the cry.
0:20:45 > 0:20:47You just know when they're not well.
0:20:47 > 0:20:49Right, well, we may as well have a wee listen.
0:20:51 > 0:20:53Right, they usually grab this, don't you?
0:20:55 > 0:20:57Thank you.
0:20:59 > 0:21:02You're not keen on that, are you?
0:21:02 > 0:21:04Working with children is challenging at times.
0:21:04 > 0:21:06Take it off.
0:21:06 > 0:21:08That's OK. He's just listening to his heart.
0:21:08 > 0:21:11- HE CRIES - It's OK.
0:21:11 > 0:21:13It's actually easier if they're crying,
0:21:13 > 0:21:15because you can see in the back of their throat.
0:21:15 > 0:21:17HE CRIES
0:21:19 > 0:21:20OK.
0:21:20 > 0:21:22I'm sorry, Louis.
0:21:22 > 0:21:24I know. Has he even quite grumpy?
0:21:24 > 0:21:26I just thought it was his teeth
0:21:26 > 0:21:29because he's been getting a lot at once.
0:21:29 > 0:21:32HE CRIES
0:21:34 > 0:21:36You can read my mind.
0:21:36 > 0:21:38I can see what you mean, he is quite irritable
0:21:38 > 0:21:41and clingy and grumpy.
0:21:41 > 0:21:43He's a bit better now than what he was.
0:21:43 > 0:21:45- Oh, was he?- So I'm like, "Oh, maybe I shouldn't have come in."
0:21:45 > 0:21:48Oh, no. Don't worry about it. It's why we're here.
0:21:48 > 0:21:51Yeah, his throat's a wee bit red at the back
0:21:51 > 0:21:54when I had a wee look, so it's just a viral illness.
0:21:54 > 0:21:59When their temperatures go up, you will find that they can shake.
0:22:00 > 0:22:02But as long as he's drinking fluids,
0:22:02 > 0:22:04I'm not concerned whatsoever.
0:22:04 > 0:22:06Once again, reassurance comes in the
0:22:06 > 0:22:09form of wise words from experienced nurse Thelma.
0:22:09 > 0:22:11You can always come back at any point.
0:22:11 > 0:22:13If the Calpol's not keeping it down,
0:22:13 > 0:22:17then just bring him back and we'll check him over again.
0:22:17 > 0:22:20I'm sure he'll be happy to just get out of here, to be honest.
0:22:20 > 0:22:23A lot of the time with kids this age,
0:22:23 > 0:22:26a lot of it is to do with reassuring mum and dad.
0:22:26 > 0:22:28And I'm quite happy to do that,
0:22:28 > 0:22:31because I can understand it's quite...
0:22:31 > 0:22:35It can be quite stressful for the parents, quite worrying.
0:22:35 > 0:22:38This is the ideal scenario, to be honest.
0:22:38 > 0:22:40So...
0:22:40 > 0:22:41I'm happy.
0:22:41 > 0:22:43Bye.
0:22:43 > 0:22:45No.
0:22:45 > 0:22:46No, nothing.
0:22:46 > 0:22:48Story of my life!
0:22:50 > 0:22:53With mum Amy reassured all is well, the family can finally go home.
0:22:57 > 0:22:59That's if the staff can catch them!
0:23:07 > 0:23:09In A&E, Dr Wilson is snowed
0:23:09 > 0:23:13under with two emergency cases to contend with.
0:23:13 > 0:23:16One patient arrived in a state of confusion after falling and
0:23:16 > 0:23:18injuring his head in the street.
0:23:18 > 0:23:19With the help of nurse Emma,
0:23:19 > 0:23:22the team settled him down and took blood tests.
0:23:22 > 0:23:25We're all here to make sure that you're OK.
0:23:25 > 0:23:27Is that all right?
0:23:27 > 0:23:30We'll get you sorted.
0:23:30 > 0:23:31But before they could get him to X-ray
0:23:31 > 0:23:34to find out the extent of the damage,
0:23:34 > 0:23:35Dr Wilson was called to deal
0:23:35 > 0:23:37with the victim of a road traffic accident.
0:23:45 > 0:23:47Mrs Dade.
0:23:47 > 0:23:50Hi. My name's Saul. I'm one of the doctors,
0:23:50 > 0:23:52and this is two of the medical students.
0:23:52 > 0:23:55- I'm Beth. I'm from St Andrews. - Caitlin. Hiya.
0:23:55 > 0:23:56We're here for the week.
0:23:56 > 0:23:58So, what happened, then?
0:23:58 > 0:23:59A car crash.
0:23:59 > 0:24:01And how fast were you going?
0:24:03 > 0:24:0435, 40.
0:24:04 > 0:24:07So, what happened straight after the crash? What did you do?
0:24:07 > 0:24:08I stayed in the car. The policeman
0:24:08 > 0:24:11came to talk to me because the police were there really quick.
0:24:11 > 0:24:13- OK.- And then...
0:24:13 > 0:24:16I was obviously very shaky and
0:24:16 > 0:24:19couldn't really speak properly. It was weird.
0:24:19 > 0:24:21Couldn't string a sentence together.
0:24:21 > 0:24:25- OK.- My left knee's sore and where the seat belt was right across
0:24:25 > 0:24:30my chest up here, it came across, and that bit's sore as well.
0:24:30 > 0:24:32OK. And did you hit your head at all, from your memory?
0:24:32 > 0:24:35- No.- And have you got any neck pain at all?- No.
0:24:35 > 0:24:38- Fine. Any loss of consciousness at all?- No.
0:24:38 > 0:24:39- Feeling sick?- No.
0:24:39 > 0:24:43- No.- I'll just have a little look, if you don't mind.
0:24:43 > 0:24:45Are you able to lift this leg all the way up?
0:24:45 > 0:24:46That's great. That's fine.
0:24:46 > 0:24:49And if you just do the same with this one.
0:24:49 > 0:24:51Oh! That's getting sore.
0:24:51 > 0:24:53OK, fine.
0:24:53 > 0:24:55Okey doke.
0:24:55 > 0:24:57Much better position.
0:24:57 > 0:25:00You've obviously got some restricted movement there.
0:25:00 > 0:25:03Not sure... You're a bit tender and sore on the patella as well.
0:25:03 > 0:25:05There may be a sort of mini fracture or something,
0:25:05 > 0:25:07but there's not much we'd really do about that.
0:25:07 > 0:25:09- No.- Glad about that.
0:25:09 > 0:25:11Don't particularly want to be in a plaster cast.
0:25:11 > 0:25:13No, no. I don't think you will need to.
0:25:13 > 0:25:16- Yeah, so I think we can actually get you away.- Lovely.- Yeah.
0:25:16 > 0:25:17Nothing concerning.
0:25:17 > 0:25:19And even if they were fractures there,
0:25:19 > 0:25:21we wouldn't do anything about them anyway.
0:25:21 > 0:25:22They'll heal by themselves.
0:25:22 > 0:25:25So I'm not too concerned that there's anything too problematic.
0:25:25 > 0:25:28Carol has been lucky, and so has Dr Wilson,
0:25:28 > 0:25:29as this means he can turn his
0:25:29 > 0:25:33attention back to the more urgent patient and figure out how to get
0:25:33 > 0:25:36the crucial X-ray he hopes will shed some light on the situation.
0:25:43 > 0:25:46Shetland experiences dark, tough winters,
0:25:46 > 0:25:49where the sun barely crests the horizon
0:25:49 > 0:25:51and the wind can howl for days on end,
0:25:51 > 0:25:54forcing even the hardy locals to stay in.
0:25:54 > 0:25:57In summer, it's a different story.
0:25:57 > 0:26:00Long, long summer nights turn the islands into a massive playground.
0:26:02 > 0:26:05Many Shetlanders, with a love of fishing, wild swimming,
0:26:05 > 0:26:07sailing and rowing,
0:26:07 > 0:26:10take advantage of these long evenings to indulge their passions
0:26:10 > 0:26:13in some of the most beautiful landscapes on Earth.
0:26:20 > 0:26:22After a busy week on the wards,
0:26:22 > 0:26:25flatmates Dr Wilson and Dr Innes
0:26:25 > 0:26:27are keen to get a slice of this lifestyle.
0:26:27 > 0:26:30They've escaped the confines of the hospital to get a taste of what
0:26:30 > 0:26:33Shetland's great outdoors can offer.
0:26:33 > 0:26:36Both are kayaking novices and a tad nervous.
0:26:36 > 0:26:39Just worried about the temperature of the water, actually.
0:26:39 > 0:26:41I don't know where we're going.
0:26:41 > 0:26:42Probably underwater.
0:26:44 > 0:26:48It's... It's what I'm feeling of this.
0:26:48 > 0:26:52With kayaks chosen and technique polished, it's time to push off.
0:26:53 > 0:26:55Let's go. Wow!
0:26:55 > 0:26:57This is interesting.
0:26:58 > 0:26:59Whoa!
0:27:03 > 0:27:06What makes it even easier here is when you're living with somebody
0:27:06 > 0:27:07- that you get on with.- You get to
0:27:07 > 0:27:09know your roommates really quickly, and, yeah,
0:27:09 > 0:27:11me and Cammy got to know each other quite well.
0:27:11 > 0:27:13You know, our habits, our good ones, our bad ones.
0:27:13 > 0:27:16Saul and I are both pretty laid-back.
0:27:16 > 0:27:17Keep your distance from me.
0:27:17 > 0:27:20Seriously, keep your distance from me.
0:27:20 > 0:27:21Look at him. He's a rocket.
0:27:21 > 0:27:23I know.
0:27:23 > 0:27:26As both doctors find their sea legs,
0:27:26 > 0:27:28the bay's local inhabitants pay them a visit.
0:27:28 > 0:27:31Yeah, there's a seal literally just there.
0:27:31 > 0:27:35It's gone under now, so I'm just waiting for him to emerge,
0:27:35 > 0:27:37like, hit my boat.
0:27:39 > 0:27:42I've resigned myself to the fact it'll probably happen.
0:27:42 > 0:27:46It's on days like this, far from the bustle of a hospital shift,
0:27:46 > 0:27:49the doctors are able to relax and take in their surroundings.
0:27:49 > 0:27:53You get some sunny days and we try and make the most of it when we can.
0:27:53 > 0:27:56It's good to find a hobby or find something to do outside of work.
0:27:56 > 0:27:59This is ideal. I could get used to this.
0:27:59 > 0:28:00It's good to get away from the
0:28:00 > 0:28:04hospital environment and try something a bit new.
0:28:04 > 0:28:08But it's not long before Dr Wilson's competitive nature comes out.
0:28:08 > 0:28:11And it seems a little wager is in order.
0:28:11 > 0:28:14- 20 quid.- 20 quid's easy.
0:28:14 > 0:28:16Let's do it.
0:28:16 > 0:28:18I'll bet. Saul seems to think he'll be winning, but...
0:28:19 > 0:28:21- No.- I'll see you on the coast.
0:28:21 > 0:28:23All right. Away we go.
0:28:25 > 0:28:27And they're off!
0:28:27 > 0:28:28I'm vooming!
0:28:39 > 0:28:42That's £20 Dr Innes won't be seeing again.
0:28:43 > 0:28:45Tiring. It's tiring. More tiring than it looks.
0:28:45 > 0:28:48Oh, my God.
0:28:48 > 0:28:50OK.
0:28:50 > 0:28:53Can someone help me out now, please?
0:28:58 > 0:29:00The NHS has a strong teaching tradition
0:29:00 > 0:29:02that runs through the service.
0:29:02 > 0:29:05You want to get on that side of the bone.
0:29:05 > 0:29:08Passing on skills is central to the organisation.
0:29:08 > 0:29:12And while junior doctors are taught by the consultants,
0:29:12 > 0:29:14they're also involved in turn in the training
0:29:14 > 0:29:16of the next generation of medical students.
0:29:19 > 0:29:23This morning, what we're going to do is what we spoke about yesterday.
0:29:23 > 0:29:26We're going to run an OSCE type situation.
0:29:26 > 0:29:28Consultant Pauline Wilson has a
0:29:28 > 0:29:31testing task for this year's students.
0:29:31 > 0:29:34This isn't meant to be scary. It's really to try and give us
0:29:34 > 0:29:37a sense of where we're all at, basically.
0:29:37 > 0:29:41The students are on a work placement from university for eight weeks,
0:29:41 > 0:29:43where they'll learn general medicine
0:29:43 > 0:29:45from the staff at the Gilbert Bain.
0:29:45 > 0:29:46Today, they're going to find
0:29:46 > 0:29:49themselves in a mock exam environment -
0:29:49 > 0:29:53an Objective Structured Clinical Examination, or OSCE.
0:29:53 > 0:29:56This year's junior doctor team, including Dr Innes,
0:29:56 > 0:29:58are helping with the OSCE.
0:29:58 > 0:30:01They've written a programme of scenarios that the medical students
0:30:01 > 0:30:04are going to have to complete under the watchful eye of Dr Wilson.
0:30:04 > 0:30:06The pressure is on.
0:30:06 > 0:30:08- Are you ready to go?- Raring.
0:30:08 > 0:30:11All right, go on, then. All right, go on, then.
0:30:11 > 0:30:14Let's go. Splendid.
0:30:14 > 0:30:16The students have a minute to read the patient brief.
0:30:19 > 0:30:21OK, you can go in now.
0:30:24 > 0:30:25Hello.
0:30:25 > 0:30:27OK, so that's the start of the OSCE,
0:30:27 > 0:30:30so what they're now doing is they're obviously going into their stations,
0:30:30 > 0:30:32so they've read their instructions.
0:30:32 > 0:30:35They've now got eight minutes with their actor and examiner,
0:30:35 > 0:30:37and then we'll move them on to the next station.
0:30:37 > 0:30:41In each room, the students face junior doctors acting the part of
0:30:41 > 0:30:45the patient, and an examiner rating their performance.
0:30:45 > 0:30:48What can happen with certain head injuries is that you can deteriorate
0:30:48 > 0:30:52later on, so we just want to doubly make sure that that doesn't happen.
0:30:52 > 0:30:56In room one, junior doctor Cameron Innes is playing the part of a drunk
0:30:56 > 0:30:58patient with suspected concussion,
0:30:58 > 0:31:01eager to leave casualty against doctor's orders.
0:31:01 > 0:31:05At the end of the day, it is your choice.
0:31:05 > 0:31:09But if you were to decide to leave,
0:31:09 > 0:31:12then it would be strongly against medical advice.
0:31:12 > 0:31:14OK.
0:31:14 > 0:31:16But I'm fine. At the moment, my...
0:31:16 > 0:31:18The numbers are all OK.
0:31:18 > 0:31:21So, I mean, at the end of the day, we can't stop you.
0:31:21 > 0:31:24However, we would ask you to sign
0:31:24 > 0:31:27- a discharge against medical advice form...- All right.
0:31:27 > 0:31:29..when you're leaving, so is that OK?
0:31:29 > 0:31:32- Yeah.- OK.- Cool. Cool beans.
0:31:32 > 0:31:35I stress again that this is against medical advice.
0:31:35 > 0:31:37OK.
0:31:37 > 0:31:39But you're free to go.
0:31:39 > 0:31:43- Thank you.- Thank you very much. - Cheers, mate. Cheers.
0:31:45 > 0:31:47Did you manage to keep him in hospital?
0:31:47 > 0:31:49- No, I didn't.- OK.
0:31:49 > 0:31:51Are you able to keep him in?
0:31:51 > 0:31:53Not if he's got capacity.
0:31:53 > 0:31:57- Yeah.- It's about how you assess somebody's capacity.
0:31:57 > 0:32:00So, not making that decision on your own is really important.
0:32:00 > 0:32:03- So as an FY2 or an FY1... - TIMER BLEEPS
0:32:03 > 0:32:07- Here we go. You're not going to make that decision on your own.- OK.
0:32:07 > 0:32:08Right, that's us.
0:32:08 > 0:32:10Between the examinations,
0:32:10 > 0:32:13Dr Innes gets some notes on his performance.
0:32:13 > 0:32:15Could you play him more drunk?
0:32:15 > 0:32:18Do you want me more drunk? I could be more drunk,
0:32:18 > 0:32:22but I don't want to be so drunk that people think I can't have capacity.
0:32:22 > 0:32:24Do you think I could be more drunk than...
0:32:26 > 0:32:28- I don't want to be, like, too... - No, no,
0:32:28 > 0:32:32- but I guess that's the standard you want it at.- Yeah.
0:32:34 > 0:32:38For our medical students and our junior doctors,
0:32:38 > 0:32:41what we tell them when they come is that, you know,
0:32:41 > 0:32:43they are our face at the front door.
0:32:43 > 0:32:49So, you know, try and deal with this population as if, you know,
0:32:49 > 0:32:51you're living amongst them.
0:32:51 > 0:32:53And I think a few days in of being here,
0:32:53 > 0:32:56the students start to get a realisation
0:32:56 > 0:32:58of what the community of Shetland really means.
0:32:58 > 0:33:00You rotate to the next station, OK?
0:33:02 > 0:33:04So rotate round,
0:33:04 > 0:33:07and then if you stand outside your next station, have a wee read.
0:33:15 > 0:33:19The doctors and nurses on Shetland have to be flexible and adaptable,
0:33:19 > 0:33:22and often do more than one job.
0:33:22 > 0:33:24And the same is true for the other emergency services,
0:33:24 > 0:33:26including the police.
0:33:26 > 0:33:28Special constables Michael Coutts
0:33:28 > 0:33:33and Ewan Anderson aren't just bobbies on the island's beats.
0:33:33 > 0:33:35They also double as Shetland's sniffer dog handler.
0:33:35 > 0:33:37And today, they, along with their
0:33:37 > 0:33:40crack team, are at work at Sumburgh Airport.
0:33:43 > 0:33:48Working an island community, we have to be multitasking because
0:33:48 > 0:33:51there's points of entry at the airport and the ferry.
0:33:51 > 0:33:55But things can come in through the Post Office, through freight,
0:33:55 > 0:33:58through other boats, small boats, fishing boats.
0:33:58 > 0:34:01So there's lots of different avenues
0:34:01 > 0:34:03for the way that drugs can come into the island.
0:34:03 > 0:34:06Just like the medics at the Gilbert Bain,
0:34:06 > 0:34:11it's training that gets these canine cartel-busting skills up to scratch.
0:34:11 > 0:34:14And that training comes courtesy of Constable Coutts,
0:34:14 > 0:34:16Shetland's answer to Barbara Woodhouse.
0:34:16 > 0:34:20We have little Odin who's just starting his training,
0:34:20 > 0:34:22so at the moment, one of the things we're doing with him
0:34:22 > 0:34:24is we're taking him into places
0:34:24 > 0:34:27like this and just doing environmental training.
0:34:27 > 0:34:30Just making sure he's used to the noises and sounds and smells of an
0:34:30 > 0:34:33airport, so that when we start working here,
0:34:33 > 0:34:37then there's nothing that causes any issues.
0:34:37 > 0:34:39Good lad, come on.
0:34:39 > 0:34:43With over 350,000 passengers using Sumburgh Airport annually,
0:34:43 > 0:34:46it's vital the dog's skills are finely honed,
0:34:46 > 0:34:51which involves a complex and technical training regime.
0:34:51 > 0:34:53Good boy! What's this?
0:34:53 > 0:34:55Good boy!
0:34:55 > 0:34:58Come on, what's this?
0:34:58 > 0:34:59Good boy. Come on! The whole thing
0:34:59 > 0:35:02for the dogs is about them loving what they do.
0:35:02 > 0:35:05And the more we train, the more we do stuff like this,
0:35:05 > 0:35:08the more the dogs enjoy it, the more they want to do it,
0:35:08 > 0:35:09the better they work.
0:35:11 > 0:35:14Odin may be having a whale of a time,
0:35:14 > 0:35:17but now it's time for him to step aside and see how it's really done.
0:35:20 > 0:35:23OK, yeah, so we've got a flight coming in very shortly,
0:35:23 > 0:35:25so we're going to get the dog ready.
0:35:25 > 0:35:28We're going to get Thor ready and take him into the terminal building.
0:35:28 > 0:35:31Come on, then! Who's a good boy? Come on!
0:35:33 > 0:35:36Thor is a two-year-old Labrador specially trained to sniff out
0:35:36 > 0:35:39a wide array of drugs that may be concealed on incoming passengers.
0:35:41 > 0:35:43All the dog's doing here is he's just
0:35:43 > 0:35:47taking a snapshot of the smells that make up anybody.
0:35:47 > 0:35:51On a person who's still, he'll go into that person and indicate.
0:35:51 > 0:35:55If that person's moving, it's almost like we would imagine seeing smoke,
0:35:55 > 0:35:58like the Red Arrows going by and smoke coming out the back.
0:35:58 > 0:36:01The dog might not actually initially show interest in the person.
0:36:01 > 0:36:04He might pull into the scent trail behind them.
0:36:04 > 0:36:06What he's going to do is he's going
0:36:06 > 0:36:08to dip into that cloud as the folk go by.
0:36:08 > 0:36:11- Morning.- If that person has something on them that's interesting
0:36:11 > 0:36:13to the dog, the dog will let us know,
0:36:13 > 0:36:15and then we can have a conversation with that person.
0:36:15 > 0:36:17That's basically all it is.
0:36:17 > 0:36:20Just keep coming. You're all right.
0:36:20 > 0:36:21Morning.
0:36:27 > 0:36:30Thor's put in a good shift, and all is clear.
0:36:30 > 0:36:33And whilst he's a working dog, he's also a part of the family.
0:36:35 > 0:36:38The dogs stay with us 24/7.
0:36:38 > 0:36:41Some folk do think that we just leave them at the police station,
0:36:41 > 0:36:44or we pick them up in the morning.
0:36:44 > 0:36:46The dogs will work with us all day,
0:36:46 > 0:36:50and then sleep at the bottom of the couch while we're watching TV at night,
0:36:50 > 0:36:54so it's...a free dog.
0:36:54 > 0:36:55Come on, son.
0:37:05 > 0:37:09In A&E, Dr Wilson and Nurse Emma have been caring for a patient who
0:37:09 > 0:37:12fell and injured his head, possibly as a result of a seizure.
0:37:13 > 0:37:17Still unsure of the cause of his fall or the extent of the damage,
0:37:17 > 0:37:19the team have ordered an X-ray.
0:37:19 > 0:37:22But while he's more settled from when he arrived,
0:37:22 > 0:37:26Nurse Emma is worried the procedure might upset him.
0:37:26 > 0:37:28There's no way you're going to get a collar on him.
0:37:28 > 0:37:31I mean, he's calm now, but...
0:37:31 > 0:37:38OK. The next one, we need to do an X-ray of your back, darling, OK?
0:37:38 > 0:37:39We just want to make sure that
0:37:39 > 0:37:42you've not broken any bones in your back.
0:37:42 > 0:37:45The patient has a history of epilepsy,
0:37:45 > 0:37:47which means his fall may have been the result of a seizure.
0:37:47 > 0:37:49The team are carrying out a chest
0:37:49 > 0:37:53X-ray to investigate the extent of the damage.
0:37:53 > 0:37:56We need to get him a chest X-ray because sometimes when they fit
0:37:56 > 0:37:58and they can swallow...
0:37:58 > 0:38:01I'm just worried he's swallowed a lot of blood,
0:38:01 > 0:38:04and some of it might have gone into his airway.
0:38:06 > 0:38:09OK? OK.
0:38:09 > 0:38:11In order to get a good image of his neck,
0:38:11 > 0:38:13they must lie the patient flat on his back.
0:38:13 > 0:38:17- OK?- We're just popping you flat, sir. It's OK.
0:38:17 > 0:38:18But as soon as they do...
0:38:18 > 0:38:22- Sorry!- ..it's clear he's in a lot of discomfort.
0:38:22 > 0:38:23HE COUGHS
0:38:23 > 0:38:25Do you want us to sit you up, dear?
0:38:27 > 0:38:29Are you swallowing blood?
0:38:29 > 0:38:31It looks like another plan is needed,
0:38:31 > 0:38:33so they decide to attempt the X-ray
0:38:33 > 0:38:35with the patient sitting semi-upright.
0:38:35 > 0:38:38You're OK, darling.
0:38:38 > 0:38:40Because he's bleeding from the nose,
0:38:40 > 0:38:42we're not sure whether it's an
0:38:42 > 0:38:45external bleed or sort of the posterior vessels in his nose.
0:38:45 > 0:38:48He's not able to lie flat, which we'd normally recommend.
0:38:48 > 0:38:49He's also been quite agitated,
0:38:49 > 0:38:52so we're not actually able to stabilise his neck properly,
0:38:52 > 0:38:56so it's quite an unconventional way we're doing it,
0:38:56 > 0:38:59but it's the best we can do.
0:38:59 > 0:39:02This is the camera for your insides, basically.
0:39:02 > 0:39:07He's definitely less confused as what he was.
0:39:07 > 0:39:08I wonder if he's had a seizure
0:39:08 > 0:39:12- because it's almost like he's wakening up from it.- Yeah.
0:39:12 > 0:39:13It may have been unconventional,
0:39:13 > 0:39:17but Dr Wilson and his team can at last get a clean X-ray.
0:39:17 > 0:39:19- Chest X-ray done.- Excellent.
0:39:19 > 0:39:22Thank you. He's actually starting to feel tired now.
0:39:22 > 0:39:25Much better, he's more oriented, he knows where he is.
0:39:25 > 0:39:29He's not confused, not wanting us to work with him,
0:39:29 > 0:39:31but he's starting to get really tired now,
0:39:31 > 0:39:35so we'll get him to a bedroom, get him more comfortable, and see how he is.
0:39:35 > 0:39:38It's been a long day for our patient,
0:39:38 > 0:39:41but now that the team are confident he's not sustained any serious
0:39:41 > 0:39:45injuries, he can be taken up to the ward for some much-needed rest.
0:39:45 > 0:39:48They've got you in the posh suite on the ward.
0:40:02 > 0:40:05On the Ronas ward in the Gilbert Bain Hospital,
0:40:05 > 0:40:09medical students from Aberdeen University are being put through
0:40:09 > 0:40:11their paces by consultant Pauline Wilson
0:40:11 > 0:40:14and the hospital's team of junior doctors.
0:40:14 > 0:40:16I think we've had a good morning so far.
0:40:16 > 0:40:20They've seen a range of different stations and a range of different
0:40:20 > 0:40:23things, so it's... I think their nerves are settling, which is good,
0:40:23 > 0:40:25and they seem to be getting into this.
0:40:25 > 0:40:28That last one I was in just now, she did very well, so it was great.
0:40:28 > 0:40:30You know, it's just timings and getting everybody here.
0:40:30 > 0:40:33It's the real life of running a hospital when you're trying to
0:40:33 > 0:40:36- run an OSCE at the same time.- Yeah.
0:40:36 > 0:40:40A quick break gives Pauline a chance to offer some encouragement to the group.
0:40:40 > 0:40:42You're all very articulate.
0:40:42 > 0:40:45- You are, very good.- You sound so surprised.- No, you are, it's great!
0:40:45 > 0:40:50Yeah, you're all very articulate. It's very good.
0:40:50 > 0:40:52Well, it's the first time back, isn't it, after holiday?
0:40:52 > 0:40:54So it's the first day back into
0:40:54 > 0:40:56getting your brain back in gear, isn't it?
0:40:58 > 0:41:01And then, it's back to the scenario training.
0:41:01 > 0:41:03And after a bit more rehearsal time,
0:41:03 > 0:41:07Dr Innes has begun to really inhabit his role.
0:41:07 > 0:41:08To start, why don't you tell me a
0:41:08 > 0:41:10wee bit about why you're in hospital?
0:41:10 > 0:41:15Well, I was at a... I got tickets to a 24-hour rave.
0:41:15 > 0:41:18And he doesn't seem inclined to take it easy on the students,
0:41:18 > 0:41:20despite being in their shoes not so long ago.
0:41:21 > 0:41:26I remember it vividly, and it was a painful time of my life.
0:41:26 > 0:41:29But now I'm on the other side, it's glorious.
0:41:29 > 0:41:31I'm basking in the power.
0:41:31 > 0:41:35Then things get a little bit hazy, and
0:41:35 > 0:41:39I was found... I bumped my head in the toilet, I think.
0:41:39 > 0:41:42And how did you feel when you first came into the hospital?
0:41:42 > 0:41:44I felt pretty good. Pretty buzzed.
0:41:44 > 0:41:47And how would you describe your heart rate now?
0:41:47 > 0:41:48Could you sort of tap it out for me?
0:41:52 > 0:41:54- Good beat.- OK.
0:41:56 > 0:42:00Amateur dramatics aside, there's a serious point to this exercise.
0:42:00 > 0:42:03Medicine is not just about treating conditions,
0:42:03 > 0:42:05it's about treating people.
0:42:05 > 0:42:07I found it quite challenging at parts.
0:42:07 > 0:42:08Sometimes I find that the patients
0:42:08 > 0:42:10are a little bit harder than real patients,
0:42:10 > 0:42:12the actors, and that's good because
0:42:12 > 0:42:14then you're more prepared for patients
0:42:14 > 0:42:15who are perhaps not as willing to
0:42:15 > 0:42:19divulge information or tell you their signs and symptoms.
0:42:19 > 0:42:22I think what today has
0:42:22 > 0:42:24reinforced to me is how well they've
0:42:24 > 0:42:27been taught in how they approach patients,
0:42:27 > 0:42:31so I would say all of the students today have got a very,
0:42:31 > 0:42:32very open manner.
0:42:32 > 0:42:35So, what we need to now do is build on the things that we've picked up
0:42:35 > 0:42:37on that they need to brush up on.
0:42:37 > 0:42:41When I was would say to all of you is that what we found this morning
0:42:41 > 0:42:43is you're all very articulate, you're all very open,
0:42:43 > 0:42:47and you put everybody really at ease that you were questioning, which is great.
0:42:47 > 0:42:51What we've identified is there's certain things that we might
0:42:51 > 0:42:54need to improve in the scenarios which we can do, but equally,
0:42:54 > 0:42:58there's bits and pieces we've probably picked up on that we can structure
0:42:58 > 0:43:00our teaching over the next eight weeks.
0:43:00 > 0:43:04And then what we'll do in eight weeks' time is we'll run it again.
0:43:04 > 0:43:07- Same questions?- Same stations? - You never know! - LAUGHTER
0:43:07 > 0:43:11You never know. But you've had enough today.
0:43:11 > 0:43:14- OK?- Thank you.- Right.
0:43:22 > 0:43:27Baby Louie was back to normal a few days after he came in,
0:43:27 > 0:43:29and is still a bit of a handful.
0:43:29 > 0:43:31The dogs are still working and
0:43:31 > 0:43:34training hard to keep drugs out of Shetland.
0:43:34 > 0:43:38And the residents of Unst are still looking for a full-time GP.