Episode 3 Island Medics


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Episode 3

Behind the scenes at the UK's most remote hospital, the Gilbert Bain in Shetland. The islands' new crop of junior doctors arrives in Shetland.


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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,

0:17:500:17:52

and treating patients before they become critically ill eases pressure

0:17:520:17:56

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

The islands' new crop of junior doctors arrives in Shetland - this episode follows their first days and sees how they adjust to a very different type of medicine from what they are used to.

Junior and newcomer Dr Wilson is thrown in at the deep end with two serious cases that arrive simultaneously into Accident and Emergency. Dr Wilson must use all his skills and rely on the vast experience of Shetland's native nursing staff if he is to provide the care the NHS expects.

Away from the hospital, a doctor is working on Unst - the most northerly practice in the United Kingdom. And two of the new junior doctors take to the water to try out a popular Shetland hobby.