Episode 3 Island Medics


Episode 3

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Transcript


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Shetland.

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The most remote part of the UK.

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

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and nearer Norway than you are to Edinburgh.

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There are more puffins than people

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and more seals than supermarkets.

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

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

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A&E. Can I help you?

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..from helicopter rescues and spinal injuries...

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

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..to serious medical mysteries...

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Can we get assistance in, please?

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Something's not right.

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..Shetland's Island medics have to

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be ready for anything and everything.

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-What happened?

-Got in a fight with a seagull.

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-This was sheep shears, was it?

-Yeah.

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SIREN BLARES

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It means the tight-knit team of medics,

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volunteers, and emergency services have a special bond.

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This might tickle, then.

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

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A wee treat for night shift.

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

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Today, the Gilbert Bain Hospital

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welcomes the latest intake of junior doctors.

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Everyone that I've spoken to that had been to Shetland enjoyed it,

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and I can see why.

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We meet Shetland's first line of defence in the war on drugs.

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HE LAUGHS

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And nurse Emma Williamson helps

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junior doctor Saul Wilson with a tough shift.

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

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The National Health Service is the world's fifth largest employer.

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1.5 million people in the UK work for the NHS,

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more than one in 50 of the population.

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Central to the NHS's values are the support,

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education and training it gives to its employees.

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-Happier?

-Yeah.

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From student doctors to consultants,

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from the most experienced nurse to the most newly qualified GP,

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everybody is either teaching or learning.

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And this ethos is woven into the very fabric of the Gilbert Bain.

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Fantastic.

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Central to the training they medics at the Gilbert Bain receive is

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senior A&E and surgical doctor, Kushik Lalla.

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Having worked around the UK and in South Africa,

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Dr Lalla moved to Shetland 20 years ago.

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He's the longest serving member of the senior team at the hospital.

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We carry out a lot of practical and theoretical training over here that

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is with myself teaching them, using a patient at the bedside.

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We will ring block her, keep the area clean,

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examine the area properly, and then decide.

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Dr Aideen Carroll has called on Dr Lalla

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to assist with a rather interesting toe injury.

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In terms of the juniors, they

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can come to me with absolutely anything.

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I don't know... I'm almost like a grandfather figure here, I think,

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sometimes. I feel like that sometimes.

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Is the flap facing that way? Or facing this way?

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This way. The flap goes like that.

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So it's open that way?

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-Yeah.

-Right, that's bad

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because the only way you can get

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blood to the tip of that flap is from that end,

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and blood vessels don't go there and turn and come down.

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So, let's go and see her.

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Right. Now...

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Going to have a look at that toe.

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12 hours ago, this unlucky lady fell from a ladder,

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managing to slice her toe open in the process.

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So what we're going to have to do

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is give you what's called a ring block.

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We're going to inject some local anaesthetic into that toe to make it

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nice and numb and we're going to

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open that up and give it a good clean and

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see whether any of the deeper structures are injured

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and that will determine what we do.

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The injury has reduced the flow of blood to the area

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and now the flesh has started to die.

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If left untreated, the wound could

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become infected and even prove fatal.

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They need to clean it, but it's going to hurt.

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A small tourniquet is used on the toe

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to keep the anaesthetic within the injured area.

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It stings. It stings as it goes in,

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but once it's in, there will be no pain. OK?

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-OK.

-Sharp scratch.

-Sharp scratch now.

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And it's going to sting now.

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Turn it inwards.

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That's it.

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With the toe fully numbed, it's time to get stuck in.

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Give it a good... A good scrub.

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Open up the flap. Scrub this way.

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-Like that?

-Yeah. That's why we give the local, OK?

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So that you can do scrubbing like this.

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Teaching someone something for the first time, for me,

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seeing them do it the first time,

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they're usually very shaky and not quite sure of themselves.

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Are you tickly? Yeah, I can see your foot.

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There's eventually this light bulb moment where they realise,

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"Hang on, this is not terribly difficult and I can do this."

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And it's at that point that you start to see, yeah,

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there is someone that has blossomed.

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This, we shouldn't try stitching that.

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More than 12 hours have passed,

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and so this wound is now what we call colonised,

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so bugs have started to live in this wound.

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And if you

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stitch the wound, you trap them all inside

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and then they start to invade.

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As the nurses give the wound a thorough wash with iodine,

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Dr Carroll has just completed her first toe ring block.

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I think part of why I came to Shetland was to see new things and

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get the opportunity to do new things,

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and the really nice thing is that the seniors are very good at coming

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down or supervising you and letting you try things for the first time.

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

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Now Dr Lalla can get to his lunch.

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Yes. This is my wife trying to keep me...

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Keep me healthy. Do you want some?

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Seven a day, yeah.

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Yeah, seven a day. So, lunch is now.

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SQUAWKING

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Fundamental to the professional

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development of the medics within the NHS

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is the junior doctor training programme,

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a period of between four and seven years

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that turns graduates into GPs,

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specialists and consultants.

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During this period, junior doctors

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will travel the country to placements

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at different hospitals to broaden their experience.

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And today, the Gilbert Bain welcomes its latest cohort into the fold.

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Welcome to Shetland. We're quite a small hospital,

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but we're quite a close knit team.

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Consultant Pauline Wilson primes the new doctors on some of the unique

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challenges posed by the islands.

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So, say you get a child referral, a child's ill up in Unst,

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the GP wants you to see them.

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That could take them four hours to get here,

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so you do have to be quite sensible about even discharging people,

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because, actually, if that child did deteriorate,

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it's not as if they're just around the corner.

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Among the new members of the team is

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27-year-old Dr Cameron Innes from Aberdeen.

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Everyone that I've spoken to that

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had been to Shetland enjoyed it. And I can see why.

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We actually get to know the population.

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We will see generations of the same family in A&E.

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The biggest part of the job that I enjoy is speaking to patients, and

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getting to know patients, I find really enjoyable.

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The community aspect here that's massively different.

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Now, over the next four months, you will get to know people.

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Following that patient through the

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whole journey is an immense privilege.

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In resus, nurse Aimee Sutherland is

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preparing to give the low down to the new doctors.

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This is the day of doctor, junior doctor handover.

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Today we've got the new lot of doctors joining us.

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The nurses in A&E have worked here for a long time.

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They know how it works, so listen to them. It's really important.

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It's obviously stressful for them coming to a new

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hospital, new ways of working,

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especially when it is a small hospital,

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and maybe just a bit different from a big hospital.

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And that's them arriving now.

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Another new recruit is 26-year-old Dr Saul Wilson from London.

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It's just a new experience, really.

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A lot of my colleagues back in medical school,

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they probably wouldn't have the opportunity

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to work somewhere as remote as this.

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So, on the shelf here is most of your blood products.

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Your cannulation...

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Oh, it's quite daunting at the start.

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You're chucked into an environment you're not used to.

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We don't have a resus trolley as

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such that you have in some of the other hospitals.

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And I think you probably use eye gels.

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Is that what you are used to using? We use LMAs here.

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I think it's just good for my training in general.

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It means, you know, you get to cover all of the different departments and

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still maintain all the skills that I

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think are important for any doctor to have.

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And it will not be too long before

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those skills are put to the test for Dr Wilson.

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It might be small,

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but the A&E department at the Gilbert Bain is certainly busy.

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Working side by side through thick and thin

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means the small team have always got each other's backs.

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Just push it from the front.

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And they need little excuse to find something to celebrate.

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And today, it just happens to be the turn of one of A&E's unsung heroes.

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Anne, the ward cleaner.

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# Happy birthday to you! #

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-Wahey!

-Woo!

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But it turns out to be the calm before the storm.

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SIREN BLARES

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An ambulance has arrived carrying

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a man found bleeding in the street after a suspected fall.

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What's the story, guys?

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Dr Wilson is tasked with assessing the damage.

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You come across, you know, loads of different medical problems.

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Sometimes, you know, all at once.

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And being the only doctor, you know,

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available on the island at the point of care

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is quite a stressful situation sometimes.

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No, just turn around and put him flat on his face, I think.

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It was a difficult situation with

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him because he was quite confused, quite agitated.

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How are you doing?

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I'm just not feeling good.

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Do you remember falling over?

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Falling over?

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-Yeah.

-I think you have had a bit of a fall.

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We tried to assess his injuries.

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Is your nose sore?

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Your nose is bleeding, though. Let me sort that.

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But he was quite confused and slightly disorientated.

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Do you know where you are right now?

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No.

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After managing to speak to the patient's sister on the phone,

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the team finds out a crucial piece of his medical history.

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-He's got epilepsy.

-Ah, now we're getting somewhere.

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We're saying that you sometimes have epilepsy, darling.

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Do you sometimes have a seizure, darling?

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This may offer a clue as to the cause of his fall.

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And if he has had a seizure,

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he can be feeling confused and disorientated for hours to come.

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To make sure he's not in any further danger,

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the team needs to run some tests.

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We're going to have to...

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We're going to have to maybe take

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some blood from you to see what's going on.

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But nurse Emma Williamson's years of experience tell her

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taking blood could be risky in this patient's condition.

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He's frightened, so...

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No, OK. This place wouldn't run

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without the nurses and the experience they've got.

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The advanced nurse practitioners

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are really good at pointing you in the right direction.

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We could only do so much because he was in such a state of confusion.

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He wasn't really sure what we were trying to do to him.

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It's just too dangerous at the moment, really.

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I would just hold off.

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I always think they're somebody's son, they're somebody's daughter,

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they're somebody's granny.

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And how would I like my family to be treated?

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And I really try to be kind and treat everybody the same.

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You could easily take it for granted up here,

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but I think it's important to remember that we're really lucky to

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have nurses that have all these skills up here.

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Now that nurse Emma has the situation in hand,

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Dr Wilson takes his chance.

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I'm going to put a little drip in your arm, OK?

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You are doing OK, darling.

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I'll get a bandage on here.

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You're going to look like Rab C Nesbitt

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with this thing on the heid.

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Now, then, remember how we said we needed to take a blood sample, OK?

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It will scratch, but you hold my hand and you just relax.

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HE COUGHS

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Now, then, you're better looking at me.

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Look at me, darling, and I'll tell you what they're going to do.

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Sharp scratch. Keep nice and still.

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HE COUGHS

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OK.

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You're doing really well there.

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-Nearly there.

-Well done.

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Clean half your tummy.

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-Do we have a dressing?

-It's right there.

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Well done! That's fantastic!

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These blood tests will help shed

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some light on the patient's condition,

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but Dr Wilson wants to take things further.

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Probably have to do a CT head scan as well.

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But is he going to need sedated for that?

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-Yeah, I think so.

-He's not going to cope with going in the scanner.

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-Yeah.

-But just as the situation appears to have calmed down...

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SIREN BLARES

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..a second ambulance arrives,

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carrying a victim from a road traffic accident.

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Dr Wilson is called away to the second patient.

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It's his second week on the island and he's now juggling two emergency

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situations as the doctor on duty.

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It's quite easy to panic, but I think it's important to remain calm,

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remember that you've got the support available if you need it,

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and make sure you've got all the equipment, all the staff there,

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so you can be ready.

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The United Kingdom's most northerly island is Unst,

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which sits at the top of Shetland's archipelago.

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It's a beautiful but wild place that 700 Shetlanders call home.

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Unst boasts just three small shops and has no restaurants,

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pubs or cinemas.

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But the lack of amenities is more than made up for by the sense of

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community on the island.

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On Unst, the residents love to get together,

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dress up in traditional and non-traditional costume,

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join in, and have fun.

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CHEERING

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Ordinarily, there'd be

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a permanent GP at the heart of this community,

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but Unst hasn't had a full-time doctor for 18 months.

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Filling that gap is Dr Sean Stansfield,

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a locum who's working as Unst's temporary GP.

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I've been here, oh, I think it's nearly two years now,

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coming to work here. I worked one day here back in 2012.

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They've had regular need for locums over the past

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two years, so on and off over that time.

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Recruitment in very rural areas has historically

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been a problem for the NHS, and things are particularly bad now.

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In the 18 months since Unst had a full-time GP,

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they've had to employ ten locums to cover the island,

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at some considerable expense.

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And although not a permanent resident on Unst,

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Dr Stansfield has started to settle into the community.

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It gets a lot easier when you know the community and the people,

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because by now you know most of the people that you're likely to see.

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It's better than working in the real world.

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There's about 700 permanent residents.

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They'll all be registered with us.

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Looking after 700 residents requires

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a much fuller week than the 48 hours most GPs do.

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Dr Stansfield's on-call 24 hours a day, seven days a week.

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In the evenings and weekends, you're still on-call,

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so you're pretty much the only

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on-call member of the health service here,

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so we all work with the volunteer ambulance crew to do all of the

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emergencies and problems on the island.

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Today looks set to be a typical day for Dr Stansfield.

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We're expecting ordinary everyday things

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from people with blood pressure problems

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to sore knees and backs.

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We don't have anything exciting planned yet.

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It may not be the high drama of the A&E ward,

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but what Dr Stansfield and GPs like him around the country offer

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is a primary care service, aimed at catching and fixing problems early.

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Come on in. Have a seat.

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For the last few days, I've been feeling really, like,

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shaky and light-headed.

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The other day I was out somewhere in the middle of nowhere,

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and my right knee just went.

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Is it OK if we have a quick feel of your pulse

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-and check your blood pressure and things?

-Yeah.

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The primary care that GPs provide is vital.

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Prevention truly is better than cure,

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and treating patients before they become critically ill eases pressure

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on the emergency services and saves millions of pounds.

0:17:560:17:59

It's very different to working in big town surgeries.

0:17:590:18:02

You have a little bit more time with the patient,

0:18:020:18:05

but you also have a huge big area to cover.

0:18:050:18:08

Care like this makes up a whopping 90% of all care within the NHS,

0:18:080:18:13

yet accounts for only 10% of annual spend.

0:18:130:18:16

Anyone else in your family had any things like this at all?

0:18:160:18:19

-I don't think so, no.

-There's a bit of swelling there.

0:18:190:18:22

It's not dramatic.

0:18:220:18:23

You have to spend a lot more time thinking about decisions that you

0:18:230:18:26

make when it could take three hours to get a patient to the hospital.

0:18:260:18:30

An X-ray probably is worthwhile.

0:18:300:18:32

We'd probably need to get you to book in for some blood tests.

0:18:320:18:36

But we'll check everything out there -

0:18:360:18:38

vitamins, minerals, sugars, the whole works.

0:18:380:18:40

We do all the emergency cover here.

0:18:400:18:42

You're working 24 hours a day and

0:18:420:18:44

have to be contactable the whole time,

0:18:440:18:47

which is something you'll never, never really see the same way in the

0:18:470:18:50

bigger practices.

0:18:500:18:51

-Is that all right?

-Yeah, lovely. Thanks very much.

0:18:510:18:53

-No problem.

-That's fine.

0:18:530:18:55

Any problems in the meantime, if it's getting worse,

0:18:550:18:57

you can always come back in sooner.

0:18:570:18:59

-OK. Perfect.

-OK, then.

0:18:590:19:00

-Thanks very much.

-No problem. Bye.

0:19:000:19:03

Locums like Dr Stansfield will keep on providing the crucial care

0:19:030:19:06

for Unst's residents until a permanent doctor can be found.

0:19:060:19:10

It's the perfect job for someone after a bucolic lifestyle,

0:19:100:19:13

who values the quiet life,

0:19:130:19:15

and possibly for someone with a penchant for dressing up from time to time.

0:19:150:19:19

CHEERING

0:19:190:19:21

Mum Amy has travelled 22 miles to hospital from Vidlin.

0:19:300:19:35

She's brought her son Louis and brother Joey to A&E after being

0:19:350:19:39

unable to get an appointment at her local health centre.

0:19:390:19:42

It's a situation parents up and down the land can identify with.

0:19:420:19:46

Louis has been running a worryingly high temperature for a few days,

0:19:460:19:50

and has been having convulsions when going to sleep.

0:19:500:19:53

Amy's concerned this could signal something more serious,

0:19:530:19:56

and like only children can,

0:19:560:19:58

the presence of Joey and Louis in A&E is causing a bit of a kerfuffle.

0:19:580:20:03

Hello!

0:20:030:20:04

Luckily, Shetland stalwart nurse Thelma Irvine

0:20:040:20:07

is able to take control and deliver Louis to junior doctor Cameron Innes.

0:20:070:20:12

Hello! We're just striding in here, are we?

0:20:120:20:14

-I'll go and get some toys.

-Straight to the bed.

0:20:140:20:18

Hello. Nice to meet you.

0:20:180:20:20

Are you going to sit down?

0:20:210:20:23

So, what's been happening with Louis?

0:20:230:20:26

Can you tell me a little bit about...

0:20:260:20:28

He's had... He's been really hot.

0:20:280:20:30

-Uh-huh.

-And when he's starting get to sleep, his body's been jerking.

0:20:300:20:34

-Yup.

-Like, really big jerking movements.

0:20:340:20:39

And he's just had a kind of...

0:20:390:20:41

I don't know what to describe the cry.

0:20:410:20:45

You just know when they're not well.

0:20:450:20:47

Right, well, we may as well have a wee listen.

0:20:470:20:49

Right, they usually grab this, don't you?

0:20:510:20:53

Thank you.

0:20:550:20:57

You're not keen on that, are you?

0:20:590:21:02

Working with children is challenging at times.

0:21:020:21:04

Take it off.

0:21:040:21:06

That's OK. He's just listening to his heart.

0:21:060:21:08

-HE CRIES

-It's OK.

0:21:080:21:11

It's actually easier if they're crying,

0:21:110:21:13

because you can see in the back of their throat.

0:21:130:21:15

HE CRIES

0:21:150:21:17

OK.

0:21:190:21:20

I'm sorry, Louis.

0:21:200:21:22

I know. Has he even quite grumpy?

0:21:220:21:24

I just thought it was his teeth

0:21:240:21:26

because he's been getting a lot at once.

0:21:260:21:29

HE CRIES

0:21:290:21:32

You can read my mind.

0:21:340:21:36

I can see what you mean, he is quite irritable

0:21:360:21:38

and clingy and grumpy.

0:21:380:21:41

He's a bit better now than what he was.

0:21:410:21:43

-Oh, was he?

-So I'm like, "Oh, maybe I shouldn't have come in."

0:21:430:21:45

Oh, no. Don't worry about it. It's why we're here.

0:21:450:21:48

Yeah, his throat's a wee bit red at the back

0:21:480:21:51

when I had a wee look, so it's just a viral illness.

0:21:510:21:54

When their temperatures go up, you will find that they can shake.

0:21:540:21:59

But as long as he's drinking fluids,

0:22:000:22:02

I'm not concerned whatsoever.

0:22:020:22:04

Once again, reassurance comes in the

0:22:040:22:06

form of wise words from experienced nurse Thelma.

0:22:060:22:09

You can always come back at any point.

0:22:090:22:11

If the Calpol's not keeping it down,

0:22:110:22:13

then just bring him back and we'll check him over again.

0:22:130:22:17

I'm sure he'll be happy to just get out of here, to be honest.

0:22:170:22:20

A lot of the time with kids this age,

0:22:200:22:23

a lot of it is to do with reassuring mum and dad.

0:22:230:22:26

And I'm quite happy to do that,

0:22:260:22:28

because I can understand it's quite...

0:22:280:22:31

It can be quite stressful for the parents, quite worrying.

0:22:310:22:35

This is the ideal scenario, to be honest.

0:22:350:22:38

So...

0:22:380:22:40

I'm happy.

0:22:400:22:41

Bye.

0:22:410:22:43

No.

0:22:430:22:45

No, nothing.

0:22:450:22:46

Story of my life!

0:22:460:22:48

With mum Amy reassured all is well, the family can finally go home.

0:22:500:22:53

That's if the staff can catch them!

0:22:570:22:59

In A&E, Dr Wilson is snowed

0:23:070:23:09

under with two emergency cases to contend with.

0:23:090:23:13

One patient arrived in a state of confusion after falling and

0:23:130:23:16

injuring his head in the street.

0:23:160:23:18

With the help of nurse Emma,

0:23:180:23:19

the team settled him down and took blood tests.

0:23:190:23:22

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

0:23:220:23:25

Is that all right?

0:23:250:23:27

We'll get you sorted.

0:23:270:23:30

But before they could get him to X-ray

0:23:300:23:31

to find out the extent of the damage,

0:23:310:23:34

Dr Wilson was called to deal

0:23:340:23:35

with the victim of a road traffic accident.

0:23:350:23:37

Mrs Dade.

0:23:450:23:47

Hi. My name's Saul. I'm one of the doctors,

0:23:470:23:50

and this is two of the medical students.

0:23:500:23:52

-I'm Beth. I'm from St Andrews.

-Caitlin. Hiya.

0:23:520:23:55

We're here for the week.

0:23:550:23:56

So, what happened, then?

0:23:560:23:58

A car crash.

0:23:580:23:59

And how fast were you going?

0:23:590:24:01

35, 40.

0:24:030:24:04

So, what happened straight after the crash? What did you do?

0:24:040:24:07

I stayed in the car. The policeman

0:24:070:24:08

came to talk to me because the police were there really quick.

0:24:080:24:11

-OK.

-And then...

0:24:110:24:13

I was obviously very shaky and

0:24:130:24:16

couldn't really speak properly. It was weird.

0:24:160:24:19

Couldn't string a sentence together.

0:24:190:24:21

-OK.

-My left knee's sore and where the seat belt was right across

0:24:210:24:25

my chest up here, it came across, and that bit's sore as well.

0:24:250:24:30

OK. And did you hit your head at all, from your memory?

0:24:300:24:32

-No.

-And have you got any neck pain at all?

-No.

0:24:320:24:35

-Fine. Any loss of consciousness at all?

-No.

0:24:350:24:38

-Feeling sick?

-No.

0:24:380:24:39

-No.

-I'll just have a little look, if you don't mind.

0:24:390:24:43

Are you able to lift this leg all the way up?

0:24:430:24:45

That's great. That's fine.

0:24:450:24:46

And if you just do the same with this one.

0:24:460:24:49

Oh! That's getting sore.

0:24:490:24:51

OK, fine.

0:24:510:24:53

Okey doke.

0:24:530:24:55

Much better position.

0:24:550:24:57

You've obviously got some restricted movement there.

0:24:570:25:00

Not sure... You're a bit tender and sore on the patella as well.

0:25:000:25:03

There may be a sort of mini fracture or something,

0:25:030:25:05

but there's not much we'd really do about that.

0:25:050:25:07

-No.

-Glad about that.

0:25:070:25:09

Don't particularly want to be in a plaster cast.

0:25:090:25:11

No, no. I don't think you will need to.

0:25:110:25:13

-Yeah, so I think we can actually get you away.

-Lovely.

-Yeah.

0:25:130:25:16

Nothing concerning.

0:25:160:25:17

And even if they were fractures there,

0:25:170:25:19

we wouldn't do anything about them anyway.

0:25:190:25:21

They'll heal by themselves.

0:25:210:25:22

So I'm not too concerned that there's anything too problematic.

0:25:220:25:25

Carol has been lucky, and so has Dr Wilson,

0:25:250:25:28

as this means he can turn his

0:25:280:25:29

attention back to the more urgent patient and figure out how to get

0:25:290:25:33

the crucial X-ray he hopes will shed some light on the situation.

0:25:330:25:36

Shetland experiences dark, tough winters,

0:25:430:25:46

where the sun barely crests the horizon

0:25:460:25:49

and the wind can howl for days on end,

0:25:490:25:51

forcing even the hardy locals to stay in.

0:25:510:25:54

In summer, it's a different story.

0:25:540:25:57

Long, long summer nights turn the islands into a massive playground.

0:25:570:26:00

Many Shetlanders, with a love of fishing, wild swimming,

0:26:020:26:05

sailing and rowing,

0:26:050:26:07

take advantage of these long evenings to indulge their passions

0:26:070:26:10

in some of the most beautiful landscapes on Earth.

0:26:100:26:13

After a busy week on the wards,

0:26:200:26:22

flatmates Dr Wilson and Dr Innes

0:26:220:26:25

are keen to get a slice of this lifestyle.

0:26:250:26:27

They've escaped the confines of the hospital to get a taste of what

0:26:270:26:30

Shetland's great outdoors can offer.

0:26:300:26:33

Both are kayaking novices and a tad nervous.

0:26:330:26:36

Just worried about the temperature of the water, actually.

0:26:360:26:39

I don't know where we're going.

0:26:390:26:41

Probably underwater.

0:26:410:26:42

It's... It's what I'm feeling of this.

0:26:440:26:48

With kayaks chosen and technique polished, it's time to push off.

0:26:480:26:52

Let's go. Wow!

0:26:530:26:55

This is interesting.

0:26:550:26:57

Whoa!

0:26:580:26:59

What makes it even easier here is when you're living with somebody

0:27:030:27:06

-that you get on with.

-You get to

0:27:060:27:07

know your roommates really quickly, and, yeah,

0:27:070:27:09

me and Cammy got to know each other quite well.

0:27:090:27:11

You know, our habits, our good ones, our bad ones.

0:27:110:27:13

Saul and I are both pretty laid-back.

0:27:130:27:16

Keep your distance from me.

0:27:160:27:17

Seriously, keep your distance from me.

0:27:170:27:20

Look at him. He's a rocket.

0:27:200:27:21

I know.

0:27:210:27:23

As both doctors find their sea legs,

0:27:230:27:26

the bay's local inhabitants pay them a visit.

0:27:260:27:28

Yeah, there's a seal literally just there.

0:27:280:27:31

It's gone under now, so I'm just waiting for him to emerge,

0:27:310:27:35

like, hit my boat.

0:27:350:27:37

I've resigned myself to the fact it'll probably happen.

0:27:390:27:42

It's on days like this, far from the bustle of a hospital shift,

0:27:420:27:46

the doctors are able to relax and take in their surroundings.

0:27:460:27:49

You get some sunny days and we try and make the most of it when we can.

0:27:490:27:53

It's good to find a hobby or find something to do outside of work.

0:27:530:27:56

This is ideal. I could get used to this.

0:27:560:27:59

It's good to get away from the

0:27:590:28:00

hospital environment and try something a bit new.

0:28:000:28:04

But it's not long before Dr Wilson's competitive nature comes out.

0:28:040:28:08

And it seems a little wager is in order.

0:28:080:28:11

-20 quid.

-20 quid's easy.

0:28:110:28:14

Let's do it.

0:28:140:28:16

I'll bet. Saul seems to think he'll be winning, but...

0:28:160:28:18

-No.

-I'll see you on the coast.

0:28:190:28:21

All right. Away we go.

0:28:210:28:23

And they're off!

0:28:250:28:27

I'm vooming!

0:28:270:28:28

That's £20 Dr Innes won't be seeing again.

0:28:390:28:42

Tiring. It's tiring. More tiring than it looks.

0:28:430:28:45

Oh, my God.

0:28:450:28:48

OK.

0:28:480:28:50

Can someone help me out now, please?

0:28:500:28:53

The NHS has a strong teaching tradition

0:28:580:29:00

that runs through the service.

0:29:000:29:02

You want to get on that side of the bone.

0:29:020:29:05

Passing on skills is central to the organisation.

0:29:050:29:08

And while junior doctors are taught by the consultants,

0:29:080:29:12

they're also involved in turn in the training

0:29:120:29:14

of the next generation of medical students.

0:29:140:29:16

This morning, what we're going to do is what we spoke about yesterday.

0:29:190:29:23

We're going to run an OSCE type situation.

0:29:230:29:26

Consultant Pauline Wilson has a

0:29:260:29:28

testing task for this year's students.

0:29:280:29:31

This isn't meant to be scary. It's really to try and give us

0:29:310:29:34

a sense of where we're all at, basically.

0:29:340:29:37

The students are on a work placement from university for eight weeks,

0:29:370:29:41

where they'll learn general medicine

0:29:410:29:43

from the staff at the Gilbert Bain.

0:29:430:29:45

Today, they're going to find

0:29:450:29:46

themselves in a mock exam environment -

0:29:460:29:49

an Objective Structured Clinical Examination, or OSCE.

0:29:490:29:53

This year's junior doctor team, including Dr Innes,

0:29:530:29:56

are helping with the OSCE.

0:29:560:29:58

They've written a programme of scenarios that the medical students

0:29:580:30:01

are going to have to complete under the watchful eye of Dr Wilson.

0:30:010:30:04

The pressure is on.

0:30:040:30:06

-Are you ready to go?

-Raring.

0:30:060:30:08

All right, go on, then. All right, go on, then.

0:30:080:30:11

Let's go. Splendid.

0:30:110:30:14

The students have a minute to read the patient brief.

0:30:140:30:16

OK, you can go in now.

0:30:190:30:21

Hello.

0:30:240:30:25

OK, so that's the start of the OSCE,

0:30:250:30:27

so what they're now doing is they're obviously going into their stations,

0:30:270:30:30

so they've read their instructions.

0:30:300:30:32

They've now got eight minutes with their actor and examiner,

0:30:320:30:35

and then we'll move them on to the next station.

0:30:350:30:37

In each room, the students face junior doctors acting the part of

0:30:370:30:41

the patient, and an examiner rating their performance.

0:30:410:30:45

What can happen with certain head injuries is that you can deteriorate

0:30:450:30:48

later on, so we just want to doubly make sure that that doesn't happen.

0:30:480:30:52

In room one, junior doctor Cameron Innes is playing the part of a drunk

0:30:520:30:56

patient with suspected concussion,

0:30:560:30:58

eager to leave casualty against doctor's orders.

0:30:580:31:01

At the end of the day, it is your choice.

0:31:010:31:05

But if you were to decide to leave,

0:31:050:31:09

then it would be strongly against medical advice.

0:31:090:31:12

OK.

0:31:120:31:14

But I'm fine. At the moment, my...

0:31:140:31:16

The numbers are all OK.

0:31:160:31:18

So, I mean, at the end of the day, we can't stop you.

0:31:180:31:21

However, we would ask you to sign

0:31:210:31:24

-a discharge against medical advice form...

-All right.

0:31:240:31:27

..when you're leaving, so is that OK?

0:31:270:31:29

-Yeah.

-OK.

-Cool. Cool beans.

0:31:290:31:32

I stress again that this is against medical advice.

0:31:320:31:35

OK.

0:31:350:31:37

But you're free to go.

0:31:370:31:39

-Thank you.

-Thank you very much.

-Cheers, mate. Cheers.

0:31:390:31:43

Did you manage to keep him in hospital?

0:31:450:31:47

-No, I didn't.

-OK.

0:31:470:31:49

Are you able to keep him in?

0:31:490:31:51

Not if he's got capacity.

0:31:510:31:53

-Yeah.

-It's about how you assess somebody's capacity.

0:31:530:31:57

So, not making that decision on your own is really important.

0:31:570:32:00

-So as an FY2 or an FY1...

-TIMER BLEEPS

0:32:000:32:03

-Here we go. You're not going to make that decision on your own.

-OK.

0:32:030:32:07

Right, that's us.

0:32:070:32:08

Between the examinations,

0:32:080:32:10

Dr Innes gets some notes on his performance.

0:32:100:32:13

Could you play him more drunk?

0:32:130:32:15

Do you want me more drunk? I could be more drunk,

0:32:150:32:18

but I don't want to be so drunk that people think I can't have capacity.

0:32:180:32:22

Do you think I could be more drunk than...

0:32:220:32:24

-I don't want to be, like, too...

-No, no,

0:32:260:32:28

-but I guess that's the standard you want it at.

-Yeah.

0:32:280:32:32

For our medical students and our junior doctors,

0:32:340:32:38

what we tell them when they come is that, you know,

0:32:380:32:41

they are our face at the front door.

0:32:410:32:43

So, you know, try and deal with this population as if, you know,

0:32:430:32:49

you're living amongst them.

0:32:490:32:51

And I think a few days in of being here,

0:32:510:32:53

the students start to get a realisation

0:32:530:32:56

of what the community of Shetland really means.

0:32:560:32:58

You rotate to the next station, OK?

0:32:580:33:00

So rotate round,

0:33:020:33:04

and then if you stand outside your next station, have a wee read.

0:33:040:33:07

The doctors and nurses on Shetland have to be flexible and adaptable,

0:33:150:33:19

and often do more than one job.

0:33:190:33:22

And the same is true for the other emergency services,

0:33:220:33:24

including the police.

0:33:240:33:26

Special constables Michael Coutts

0:33:260:33:28

and Ewan Anderson aren't just bobbies on the island's beats.

0:33:280:33:33

They also double as Shetland's sniffer dog handler.

0:33:330:33:35

And today, they, along with their

0:33:350:33:37

crack team, are at work at Sumburgh Airport.

0:33:370:33:40

Working an island community, we have to be multitasking because

0:33:430:33:48

there's points of entry at the airport and the ferry.

0:33:480:33:51

But things can come in through the Post Office, through freight,

0:33:510:33:55

through other boats, small boats, fishing boats.

0:33:550:33:58

So there's lots of different avenues

0:33:580:34:01

for the way that drugs can come into the island.

0:34:010:34:03

Just like the medics at the Gilbert Bain,

0:34:030:34:06

it's training that gets these canine cartel-busting skills up to scratch.

0:34:060:34:11

And that training comes courtesy of Constable Coutts,

0:34:110:34:14

Shetland's answer to Barbara Woodhouse.

0:34:140:34:16

We have little Odin who's just starting his training,

0:34:160:34:20

so at the moment, one of the things we're doing with him

0:34:200:34:22

is we're taking him into places

0:34:220:34:24

like this and just doing environmental training.

0:34:240:34:27

Just making sure he's used to the noises and sounds and smells of an

0:34:270:34:30

airport, so that when we start working here,

0:34:300:34:33

then there's nothing that causes any issues.

0:34:330:34:37

Good lad, come on.

0:34:370:34:39

With over 350,000 passengers using Sumburgh Airport annually,

0:34:390:34:43

it's vital the dog's skills are finely honed,

0:34:430:34:46

which involves a complex and technical training regime.

0:34:460:34:51

Good boy! What's this?

0:34:510:34:53

Good boy!

0:34:530:34:55

Come on, what's this?

0:34:550:34:58

Good boy. Come on! The whole thing

0:34:580:34:59

for the dogs is about them loving what they do.

0:34:590:35:02

And the more we train, the more we do stuff like this,

0:35:020:35:05

the more the dogs enjoy it, the more they want to do it,

0:35:050:35:08

the better they work.

0:35:080:35:09

Odin may be having a whale of a time,

0:35:110:35:14

but now it's time for him to step aside and see how it's really done.

0:35:140:35:17

OK, yeah, so we've got a flight coming in very shortly,

0:35:200:35:23

so we're going to get the dog ready.

0:35:230:35:25

We're going to get Thor ready and take him into the terminal building.

0:35:250:35:28

Come on, then! Who's a good boy? Come on!

0:35:280:35:31

Thor is a two-year-old Labrador specially trained to sniff out

0:35:330:35:36

a wide array of drugs that may be concealed on incoming passengers.

0:35:360:35:39

All the dog's doing here is he's just

0:35:410:35:43

taking a snapshot of the smells that make up anybody.

0:35:430:35:47

On a person who's still, he'll go into that person and indicate.

0:35:470:35:51

If that person's moving, it's almost like we would imagine seeing smoke,

0:35:510:35:55

like the Red Arrows going by and smoke coming out the back.

0:35:550:35:58

The dog might not actually initially show interest in the person.

0:35:580:36:01

He might pull into the scent trail behind them.

0:36:010:36:04

What he's going to do is he's going

0:36:040:36:06

to dip into that cloud as the folk go by.

0:36:060:36:08

-Morning.

-If that person has something on them that's interesting

0:36:080:36:11

to the dog, the dog will let us know,

0:36:110:36:13

and then we can have a conversation with that person.

0:36:130:36:15

That's basically all it is.

0:36:150:36:17

Just keep coming. You're all right.

0:36:170:36:20

Morning.

0:36:200:36:21

Thor's put in a good shift, and all is clear.

0:36:270:36:30

And whilst he's a working dog, he's also a part of the family.

0:36:300:36:33

The dogs stay with us 24/7.

0:36:350:36:38

Some folk do think that we just leave them at the police station,

0:36:380:36:41

or we pick them up in the morning.

0:36:410:36:44

The dogs will work with us all day,

0:36:440:36:46

and then sleep at the bottom of the couch while we're watching TV at night,

0:36:460:36:50

so it's...a free dog.

0:36:500:36:54

Come on, son.

0:36:540:36:55

In A&E, Dr Wilson and Nurse Emma have been caring for a patient who

0:37:050:37:09

fell and injured his head, possibly as a result of a seizure.

0:37:090:37:12

Still unsure of the cause of his fall or the extent of the damage,

0:37:130:37:17

the team have ordered an X-ray.

0:37:170:37:19

But while he's more settled from when he arrived,

0:37:190:37:22

Nurse Emma is worried the procedure might upset him.

0:37:220:37:26

There's no way you're going to get a collar on him.

0:37:260:37:28

I mean, he's calm now, but...

0:37:280:37:31

OK. The next one, we need to do an X-ray of your back, darling, OK?

0:37:310:37:38

We just want to make sure that

0:37:380:37:39

you've not broken any bones in your back.

0:37:390:37:42

The patient has a history of epilepsy,

0:37:420:37:45

which means his fall may have been the result of a seizure.

0:37:450:37:47

The team are carrying out a chest

0:37:470:37:49

X-ray to investigate the extent of the damage.

0:37:490:37:53

We need to get him a chest X-ray because sometimes when they fit

0:37:530:37:56

and they can swallow...

0:37:560:37:58

I'm just worried he's swallowed a lot of blood,

0:37:580:38:01

and some of it might have gone into his airway.

0:38:010:38:04

OK? OK.

0:38:060:38:09

In order to get a good image of his neck,

0:38:090:38:11

they must lie the patient flat on his back.

0:38:110:38:13

-OK?

-We're just popping you flat, sir. It's OK.

0:38:130:38:17

But as soon as they do...

0:38:170:38:18

-Sorry!

-..it's clear he's in a lot of discomfort.

0:38:180:38:22

HE COUGHS

0:38:220:38:23

Do you want us to sit you up, dear?

0:38:230:38:25

Are you swallowing blood?

0:38:270:38:29

It looks like another plan is needed,

0:38:290:38:31

so they decide to attempt the X-ray

0:38:310:38:33

with the patient sitting semi-upright.

0:38:330:38:35

You're OK, darling.

0:38:350:38:38

Because he's bleeding from the nose,

0:38:380:38:40

we're not sure whether it's an

0:38:400:38:42

external bleed or sort of the posterior vessels in his nose.

0:38:420:38:45

He's not able to lie flat, which we'd normally recommend.

0:38:450:38:48

He's also been quite agitated,

0:38:480:38:49

so we're not actually able to stabilise his neck properly,

0:38:490:38:52

so it's quite an unconventional way we're doing it,

0:38:520:38:56

but it's the best we can do.

0:38:560:38:59

This is the camera for your insides, basically.

0:38:590:39:02

He's definitely less confused as what he was.

0:39:020:39:07

I wonder if he's had a seizure

0:39:070:39:08

-because it's almost like he's wakening up from it.

-Yeah.

0:39:080:39:12

It may have been unconventional,

0:39:120:39:13

but Dr Wilson and his team can at last get a clean X-ray.

0:39:130:39:17

-Chest X-ray done.

-Excellent.

0:39:170:39:19

Thank you. He's actually starting to feel tired now.

0:39:190:39:22

Much better, he's more oriented, he knows where he is.

0:39:220:39:25

He's not confused, not wanting us to work with him,

0:39:250:39:29

but he's starting to get really tired now,

0:39:290:39:31

so we'll get him to a bedroom, get him more comfortable, and see how he is.

0:39:310:39:35

It's been a long day for our patient,

0:39:350:39:38

but now that the team are confident he's not sustained any serious

0:39:380:39:41

injuries, he can be taken up to the ward for some much-needed rest.

0:39:410:39:45

They've got you in the posh suite on the ward.

0:39:450:39:48

On the Ronas ward in the Gilbert Bain Hospital,

0:40:020:40:05

medical students from Aberdeen University are being put through

0:40:050:40:09

their paces by consultant Pauline Wilson

0:40:090:40:11

and the hospital's team of junior doctors.

0:40:110:40:14

I think we've had a good morning so far.

0:40:140:40:16

They've seen a range of different stations and a range of different

0:40:160:40:20

things, so it's... I think their nerves are settling, which is good,

0:40:200:40:23

and they seem to be getting into this.

0:40:230:40:25

That last one I was in just now, she did very well, so it was great.

0:40:250:40:28

You know, it's just timings and getting everybody here.

0:40:280:40:30

It's the real life of running a hospital when you're trying to

0:40:300:40:33

-run an OSCE at the same time.

-Yeah.

0:40:330:40:36

A quick break gives Pauline a chance to offer some encouragement to the group.

0:40:360:40:40

You're all very articulate.

0:40:400:40:42

-You are, very good.

-You sound so surprised.

-No, you are, it's great!

0:40:420:40:45

Yeah, you're all very articulate. It's very good.

0:40:450:40:50

Well, it's the first time back, isn't it, after holiday?

0:40:500:40:52

So it's the first day back into

0:40:520:40:54

getting your brain back in gear, isn't it?

0:40:540:40:56

And then, it's back to the scenario training.

0:40:580:41:01

And after a bit more rehearsal time,

0:41:010:41:03

Dr Innes has begun to really inhabit his role.

0:41:030:41:07

To start, why don't you tell me a

0:41:070:41:08

wee bit about why you're in hospital?

0:41:080:41:10

Well, I was at a... I got tickets to a 24-hour rave.

0:41:100:41:15

And he doesn't seem inclined to take it easy on the students,

0:41:150:41:18

despite being in their shoes not so long ago.

0:41:180:41:20

I remember it vividly, and it was a painful time of my life.

0:41:210:41:26

But now I'm on the other side, it's glorious.

0:41:260:41:29

I'm basking in the power.

0:41:290:41:31

Then things get a little bit hazy, and

0:41:310:41:35

I was found... I bumped my head in the toilet, I think.

0:41:350:41:39

And how did you feel when you first came into the hospital?

0:41:390:41:42

I felt pretty good. Pretty buzzed.

0:41:420:41:44

And how would you describe your heart rate now?

0:41:440:41:47

Could you sort of tap it out for me?

0:41:470:41:48

-Good beat.

-OK.

0:41:520:41:54

Amateur dramatics aside, there's a serious point to this exercise.

0:41:560:42:00

Medicine is not just about treating conditions,

0:42:000:42:03

it's about treating people.

0:42:030:42:05

I found it quite challenging at parts.

0:42:050:42:07

Sometimes I find that the patients

0:42:070:42:08

are a little bit harder than real patients,

0:42:080:42:10

the actors, and that's good because

0:42:100:42:12

then you're more prepared for patients

0:42:120:42:14

who are perhaps not as willing to

0:42:140:42:15

divulge information or tell you their signs and symptoms.

0:42:150:42:19

I think what today has

0:42:190:42:22

reinforced to me is how well they've

0:42:220:42:24

been taught in how they approach patients,

0:42:240:42:27

so I would say all of the students today have got a very,

0:42:270:42:31

very open manner.

0:42:310:42:32

So, what we need to now do is build on the things that we've picked up

0:42:320:42:35

on that they need to brush up on.

0:42:350:42:37

When I was would say to all of you is that what we found this morning

0:42:370:42:41

is you're all very articulate, you're all very open,

0:42:410:42:43

and you put everybody really at ease that you were questioning, which is great.

0:42:430:42:47

What we've identified is there's certain things that we might

0:42:470:42:51

need to improve in the scenarios which we can do, but equally,

0:42:510:42:54

there's bits and pieces we've probably picked up on that we can structure

0:42:540:42:58

our teaching over the next eight weeks.

0:42:580:43:00

And then what we'll do in eight weeks' time is we'll run it again.

0:43:000:43:04

-Same questions?

-Same stations?

-You never know!

-LAUGHTER

0:43:040:43:07

You never know. But you've had enough today.

0:43:070:43:11

-OK?

-Thank you.

-Right.

0:43:110:43:14

Baby Louie was back to normal a few days after he came in,

0:43:220:43:27

and is still a bit of a handful.

0:43:270:43:29

The dogs are still working and

0:43:290:43:31

training hard to keep drugs out of Shetland.

0:43:310:43:34

And the residents of Unst are still looking for a full-time GP.

0:43:340:43:38

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