Episode 4 Island Medics


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Episode 4

Behind the scenes at the UK's most remote hospital, the Gilbert Bain in Shetland. A closer look at life for Shetland's new and expectant mothers.


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Shetland - the most remote part of the UK.

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Here, you are 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 are 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? Something's not right.

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..Shetland's island medics

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have to 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 WAILS

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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, a midwife tours the islands

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to meet the newest batch of Shetlanders...

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Yeah. You're not going to pee on me, OK?

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..a man is rushed from a rig with a suspected heart attack...

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..and the most Shetland injury imaginable.

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I fell off a Shetland pony.

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Unlike hospitals on the mainland,

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the Gilbert Bain Hospital is busiest in summer when tourists flock to the

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islands in their droves.

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In winter, however, the pace of life slows as the nights draw in.

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It can be dark for 18 hours or more,

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and long, cold nights mean just one thing.

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BABY CRIES

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Babies.

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Lots of 'em.

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Shetland has the highest birth rate in Scotland and last year,

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Gilbert Bain's maternity unit handled 278 pregnancies.

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It is staffed by a merry band of midwives who meet the needs of the

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archipelago's new and expectant mothers.

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At the hospital, head midwife

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Elaine McCover has been called in to check on an anxious

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soon-to-be first-time mum.

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So we are doing your scan today because you haven't felt baby moving

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-quite as much.

-Yeah. It's happened twice.

-OK.

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Caitlin from Lerwick is eight months pregnant and hasn't felt her baby

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move for some time.

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Yeah, just lie yourself back.

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What we're going to do...

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In order to see the scan pictures clearly,

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Elaine turns down the lights.

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This is Caitlin and her partner Robbie's first baby, and they are

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understandably worried about what lack of movement might mean.

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Elaine does her best to reassure Caitlin.

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I'm just going to pop some lovely gel on your tummy.

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As Elaine attempts to find a good image of the baby,

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it's a tense moment.

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So, obviously, with baby getting that wee bit bigger,

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we're maybe not going to see quite as much.

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But there is your baby's lovely wee face.

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Look at that. You can see its lips.

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So we will get a wee quick photo done first.

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I've seen baby's heart beating away,

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so I have got baby's heart beating away in there quite happily.

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With a clear view of the baby's heart beating well,

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everyone can relax.

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It's looking quite cramped, your baby, now, isn't it?

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It's running out of room, isn't it?

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To be sure the baby is growing at the right pace,

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Elaine takes a range of measurements from head to thigh,

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and also checks the blood flow from the placenta.

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Right, and now we will get the wee tummy measurement.

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It's all looking absolutely fine so far.

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Yeah.

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Still looking a little stunned,

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dad-to-be Robbie moves in for a closer look.

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You can see it quite clearly on that one. There you go.

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It's a nice amount of fluid all round about your baby,

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and because you have been having those episodes of less movement,

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we will just have a wee check of the blood flow

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-from the placenta through the cord, if that's OK?

-Yeah.

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We are going to need your baby to stay still.

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-HEART BEAT ECHOES

-There we go. Absolutely fine.

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So what we are looking at, it's not this kind of top peak,

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we are looking at this bottom bit there,

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something called the end diastolic flow,

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and it just reassures us that your placenta is working normally.

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-OK.

-Your baby today is 5lb 2oz.

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Oh, my goodness! Last time we were in here, what was it? 4lb 5oz.

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-Yeah. It's fairly grown.

-Yeah, it has.

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It is amazing.

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I feel a bit silly coming in, and the baby starts moving

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and then you are like, oh, you know.

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See in reality, though, we would far, far rather that you came in

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-and we quickly reassured you that everything was fine...

-Yeah.

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..than you sat at home worried about it or waited too long.

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With the future parents reassured,

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all that's left to do is offer a scan picture of the healthy baby.

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-There you go.

-Thank you.

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Caitlin's scan today was absolutely fine.

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It shows the baby is really well grown.

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There is a normal amount of fluid

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and that blood flow through the cord is absolutely fine.

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It is also about being able to provide a bit of reassurance,

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but also let her know that if she has another episode, that she needs

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to come back and see us again.

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Yeah, it's exciting!

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Thank you very much. OK, have a nice day.

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Cheerio, Caitlin. Bye-bye.

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The maternity unit is one of the few specialised units

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at the Gilbert Bain Hospital.

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Here, a team of 13 midwives and three doctors help bring the next

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generation of Shetlanders into the world.

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It's a job that takes them to every inhabited corner of these islands.

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For many, it's a calling.

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And today, 26-year-old Hannah, a recent arrival on Shetland,

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is doing the rounds to check on the island's newest bundles of joy.

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I'll hopefully not get too lost...

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..today.

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I trained as a midwife in Aberdeen, and one part of the

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training is to do placements in the community,

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and I was put to Shetland.

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And I really, really loved it up here.

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So when the job came up for Shetland,

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I immediately applied and I felt like it

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was coming home to who I was as a midwife,

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and who I am as a person,

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that I really, really enjoyed being with women throughout the journey of

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being pregnant and having a baby.

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I love puffins, so it was the best place to come.

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Today, Hannah is off to visit new mum Louise and her baby boy Wilhem,

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12 miles from Lerwick, in Sandwick.

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Sounds simple enough,

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but for an island newbie, Shetland can be a little tricky to navigate.

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There is no street names, there is no house names or house numbers.

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You've just got to follow their directions,

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like, "Go up this lane.

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"Go past the big bush and find, like, a yellow house."

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And you've just got to hope that you are in the right yellow house.

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I bet you it's that house next door to the Cabin Museum.

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Hello!

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Hello!

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Hello. How are you?

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I'm at the wrong house, aren't I?

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Right, we'll go find our house.

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All right. Sorry about that.

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That was funny.

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Those were the instructions.

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Undeterred, she's back on the road.

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And this time, she's got the right house.

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Hiya. How are you doing?

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I'm fine. He's a lovely baby.

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I haven't seen them yet. I am excited to see them.

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-How are you doing?

-Good, really well.

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-Congratulations.

-Thank you.

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-Happy one-week birthday!

-Yeah.

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I cannot believe he's a week already.

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-He's still a little jaundiced, I would say.

-Yeah.

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But over the next couple of days, it will hopefully go.

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You've got lots of nice windows,

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so try and keep him close to the windows.

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-OK.

-Light helps it go away.

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Oh!

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What a face.

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It's amazing how many faces they pull, isn't it?

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Has he done a smile yet?

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Well, we think he has.

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But I think it's just wind.

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-Or happy about being fed.

-Yeah.

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You seem like you are doing really, really well.

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Yeah, it feels quite natural.

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It feels...

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It feels good.

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Righty-o. I'm off now.

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While Hannah may be living the dream,

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pursuing it rarely comes without a cost.

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In this case, it meant leaving her friends and family behind.

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I have been quite homesick.

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It's been quite tough because, obviously,

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it's a very community-orientated place,

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everyone knows everyone, so you're kind of the outsider.

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But once you get to know people, they are very, very friendly.

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But if there's one thing guaranteed to get you into a Shetlander's good

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books, it's a trip to one of the islands' favourite institutions.

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Near East Burrafirth,

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on a single-track road between Voe and Aith,

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it's patisserie par excellence, Da Cake Cupboard.

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Oh!

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Oh!

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Cake.

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Lemon cake.

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And some Tiffin.

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I'll get some for a treat for everyone in the ward.

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So you write down what you've taken

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and just leave some money.

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Looks like Hannah's getting

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the hang of Shetland life pretty quickly.

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As the only hospital on Shetland,

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the Gilbert Bain is the destination for any islanders unlucky enough

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to need emergency care at any time of day or night.

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But it doesn't just open its doors to island residents.

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Anyone who has taken ill or injured on one of the many fishing boats,

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cargo vessels or oil rigs within 100 miles of the island

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is likely to be airlifted to Shetland for treatment,

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meaning that the quiet of a night shift could be shattered

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at any moment.

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At Tingwall Airport, a helicopter is flying in

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with an oil rig worker with a suspected heart attack.

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We have just got a notification to say we are getting a medevac from an

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offshore oil rig with a man with chest pain.

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So you're immediately thinking it's something cardiac,

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so we'll just do what we'd usually do for anybody that comes in with

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chest pain - get ECGs and observation, bloods,

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get the doctor to see them, and then take it from what we find.

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Shetland's isolated North Sea location means the Gilbert Bain

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is well prepared for cases like this.

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Once or twice a week, we might get a medevac because we are the closest

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area to the offshore.

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So we do get a lot of offshore.

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With over 20 oil and gas rigs off the coast of Shetland,

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the emergency services provided by the island are a lifeline for

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thousands of workers.

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It is essential that patients are transferred to the resus unit at

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Gilbert Bain as quickly and efficiently as possible.

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Usually they are possibly 100 miles away.

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Coming in a boat, it would take the best part of a day or two

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to get them ashore,

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so the coastguard helicopter is the only way.

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With the patient safely transferred into the ambulance,

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it won't be long before he arrives at Gilbert Bain to be assessed.

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That's the thing with A&E, you never know what is going to come in

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through the door, and sometimes folk will come in and appear well,

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but can deteriorate quite quickly. Night shift is a bit more daunting.

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And you know you've not got people immediately on hand to shout for.

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So... But we try. We get there.

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The casualty, Donald from Peterhead, near Aberdeen,

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is brought into resus.

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Nurses Dawn and Lauren are on hand to admit him and begin

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their assessment.

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What has been happening?

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I've just got a sharp pain sitting on my chest.

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-OK. What time was that?

-About half three.

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-Half three today?

-Yeah.

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I didn't think anything about it at the time.

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I'm just going to pop the blood pressure cuff on.

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Then about...just after four, the same again

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but a lot stronger.

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Sorry. I'm just going to pop this on a finger, as well.

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I went to my bed really early because I felt tired.

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And, er...

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For about 45 minutes, it was just constant.

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Donald has no history of heart problems,

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but with his chest pains beginning nine hours ago,

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the team take blood samples and an ECG to try and rule out

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a heart attack.

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While they await the test results,

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the on-duty junior doctor looks for other clues as to what might be

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causing Donald's symptoms.

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Has the pain...

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You'll need to press it again, it's saying it's loose.

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Half past three.

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-It's still there?

-Yeah.

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And can you point to where it is?

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It's just in here.

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And is that where it's been all day?

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-Yeah.

-What did it feel like?

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Just sort of gradually came up and felt like it was just being

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-pushed, you know?

-OK.

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Like a vice-type thing.

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Sure. And at any point did it suddenly start, or get worse?

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-It seemed to get worse if I lay on any side.

-OK.

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Because I tried to turn, thinking I was just uncomfortable, you know.

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From what you're telling me, this kind of tight feeling,

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when people say that, we get worried about people's hearts.

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Yeah.

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With Donald's ECG readings looking normal,

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his chest pain is proving difficult to diagnose.

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We're just doing bloods.

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And we have done an ECG, so the doctor has had a look at them.

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We have our cardiac pathway that we follow

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if anybody presents with chest pain.

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So we are just working with that at the moment.

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Here we go.

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Looks OK.

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With Donald stable and the condition under control,

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the decision is made to move him to the medical ward,

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where he will continue to be assessed.

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But with blood tests still pending,

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they won't know until morning exactly what the problem is.

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To cope with a variety of ailments that come through the sliding doors

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at the Gilbert Bain, its small medical staff need

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a broad skill set.

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To this end, senior A&E surgical doctor Kushik Lalla

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runs a weekly minor operations clinic.

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Here, he not only sees anyone in need of day surgery,

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but he also uses it to teach other doctors new skills.

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-You've looked through all of these?

-Yes, I was peeking.

-That's fine.

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Today, Dr Lalla is going to show GP Judith Pinnick,

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how to perform a typical minor operation,

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the idea being that she will then be able to carry out this procedure at

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her own surgery, alleviating some of the strain on the hospital clinic.

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Mrs Anderson. Hi there.

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Right, we got a letter from your GP asking us to see you with regards to

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-a number of cysts, is it, sebaceous cysts?

-Yeah.

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-Have you had that for a while?

-I've had them before.

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And this is probably about the fifth or sixth time that I've had to have

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-some removed.

-Unfortunately, this will not be your last time, either.

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-Probably not.

-No.

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Is there anyone else in your family that has them?

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My mother has them.

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Sebaceous cysts are common cysts of the skin

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that, although noncancerous, can recur and are often hereditary.

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A quick look at this area.

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So it is one very easily...

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That's one there.

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That's fine.

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The cysts are slow growing but can become uncomfortable if

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they go unchecked.

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Which one is the most troublesome? The one at the back?

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The one at the back, yes.

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By removing them surgically,

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it's hoped they will be less likely to return.

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OK. We will go ahead and get those removed for you today.

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-OK.

-Yeah.

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Jennifer.

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Hello! How are you doing?

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Midwife Emma is meeting Jennifer from Quendale,

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in the south of Shetland's mainland,

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whose first baby is now ten days overdue.

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So any signs of this baby coming?

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-No.

-No. Any signs of anything?

-I can feel it just stretching.

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Just wriggling around.

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That's it. And it's so important at this stage that you keep a really

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close eye on baby's movements,

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because our best way of knowing how baby is is through its movements.

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Overdue births are not uncommon.

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In fact, fewer than one in 20 babies are born on their due date.

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But here on Shetland, a missed

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due date calls for a bit of extra caution.

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You are now ten days past your due date,

0:19:030:19:08

and what we now need to do is just assess you for induction of labour.

0:19:080:19:13

Oh, what a beautiful bump you've got.

0:19:130:19:17

It's lovely.

0:19:170:19:18

We've got this lady, she is now ten days past her due date.

0:19:180:19:24

This is where we do an examination. Where do you feel your kicks?

0:19:240:19:28

-Just about here.

-Around there.

0:19:280:19:30

And what it does is, it gives us a score that tells us how likely women

0:19:300:19:34

are to go into labour.

0:19:340:19:36

We will go and examine her and we

0:19:360:19:38

will work out what her Bishop score is.

0:19:380:19:41

A Bishop score of less than five in women having their first baby may

0:19:410:19:45

indicate that the induction process will take longer

0:19:450:19:48

and require more intervention.

0:19:480:19:51

As there is no epidural service on the island,

0:19:510:19:54

women are transferred to an obstetric unit in Aberdeen to

0:19:540:19:57

increase their chances of a natural birth.

0:19:570:20:00

It's always slightly different in Shetland

0:20:000:20:03

because we are remote and rural, so to stay in Shetland,

0:20:030:20:07

she needs to have a Bishop score of five and above.

0:20:070:20:11

I would say that, basically,

0:20:110:20:14

the kind of top of the baby's head is into the pelvis.

0:20:140:20:16

It's definitely fixed in the pelvis,

0:20:160:20:19

it's not bobbing away or anything like that.

0:20:190:20:22

And sometimes, particularly with

0:20:220:20:24

first babies, it just takes, you know,

0:20:240:20:27

the contractions to actually physically push the baby's head

0:20:270:20:30

down into the pelvis.

0:20:300:20:32

Jennifer's Bishop score is two,

0:20:320:20:35

meaning she will have to travel to the mainland to give birth

0:20:350:20:38

under specialist supervision.

0:20:380:20:39

Yeah, hi, it's Dr Murphy up in Shetland.

0:20:390:20:42

Hi, I just wondered if I can arrange for a lady to come down to you

0:20:420:20:45

-for induction?

-Knock-knock. I've got Dr Murphy.

0:20:450:20:50

I've spoken to the ward in Aberdeen,

0:20:500:20:52

they've got a slot for induction tomorrow.

0:20:520:20:54

We've arranged for you to go on the first flight.

0:20:540:20:57

You will be going to Westburn Ward.

0:20:570:20:59

I will sign a fit-to-travel for you,

0:20:590:21:02

and the next time we see you will be with a lovely baby at home,

0:21:020:21:06

because that's what we like.

0:21:060:21:08

Whilst some patients have to be transferred to the mainland for

0:21:200:21:24

treatment, the staff at Gilbert Bain try to do as much as they possibly

0:21:240:21:27

can right here on Shetland, and at the hospital's outpatient clinic,

0:21:270:21:31

senior A&E and surgical doctor Kushik Lalla is training local GP

0:21:310:21:36

Dr Pinnick to remove sebaceous cysts from a patient's scalp.

0:21:360:21:39

A sharp scratch coming up now.

0:21:390:21:41

Sorry.

0:21:440:21:46

And it will sting.

0:21:460:21:48

It's Mrs Anderson's sixth time having this surgery and

0:21:480:21:51

with a local anaesthetic administered,

0:21:510:21:54

she is taking it all quite calmly.

0:21:540:21:55

Right, so, if you look, Judith,

0:21:570:21:59

what I've done is just made a single incision overlying the top.

0:21:590:22:03

A veteran of this procedure,

0:22:050:22:07

Dr Lalla is demonstrating how it's done to GP Dr Pinnick,

0:22:070:22:10

who has never removed a cyst.

0:22:100:22:12

And I'm not taking it too deep.

0:22:120:22:15

I will start from this edge down here,

0:22:150:22:18

rather than directly overlying the cyst, and just try and gently...

0:22:180:22:23

-It's OK?

-Hm-mm.

0:22:230:22:25

Just open that up.

0:22:250:22:27

-I've got your head in a vice-like grip.

-It's OK.

0:22:320:22:34

-Are you OK?

-Yep.

0:22:410:22:42

-OK?

-If a cyst is removed in one piece,

0:22:480:22:51

there is a good chance it won't reappear in the same place.

0:22:510:22:54

Right, so a couple of stitches in there now.

0:22:540:22:57

And that's the first one done.

0:22:570:23:00

Did you manage that?

0:23:000:23:02

-It was fine.

-Good.

0:23:020:23:03

She's so lying!

0:23:040:23:06

With one of the cysts removed,

0:23:060:23:07

Dr Lalla sews up the incision and hands over to Dr Pinnick...

0:23:070:23:11

..a newbie to this procedure.

0:23:130:23:15

Good. Don't go deep.

0:23:150:23:17

Yeah, that's good. Now that's fine.

0:23:200:23:23

What you do now is use the edge of the blade, rather than the tip.

0:23:240:23:29

Just use the edge. Use the edge of the blade.

0:23:290:23:32

If Dr Pinnick can master this and other minor surgeries,

0:23:320:23:36

she'll relieve pressure on this clinic by running her own service.

0:23:360:23:40

Yeah, that's the cyst coming up there.

0:23:400:23:43

-You see it?

-Mm-hm.

0:23:430:23:45

Your assistant is not doing a good enough job!

0:23:520:23:55

I'll do the swabbing for you. If you just...

0:23:580:24:01

That's it. That's it. That's it.

0:24:030:24:06

Another offending cyst gone, and now it's just a few final stitches.

0:24:060:24:10

Good. I can see, even in your hand movements, Judith,

0:24:140:24:18

you are getting more confident, more familiar.

0:24:180:24:22

-Yeah, I think it takes practice.

-Yeah. Everything takes practice!

0:24:230:24:28

Procedure complete.

0:24:280:24:29

With one relieved patient and one doctor more confident at handling a

0:24:290:24:33

new procedure, it's a good result for Dr Lalla.

0:24:330:24:36

-OK. Thank you very much.

-OK.

0:24:360:24:38

-That's no bother.

-See you later.

0:24:380:24:41

The morning after being medevac'd to Gilbert Bain from an

0:24:510:24:54

oil rig, 54-year-old Donald's chest pains have subsided,

0:24:540:24:58

but before discharging him,

0:24:580:25:00

the team want to take an X-ray in the hope of being able to diagnose

0:25:000:25:03

last night's pain.

0:25:030:25:06

-Are you OK to stand for the X-ray?

-Yeah.

-Right.

0:25:100:25:13

Unlike many X-rays which are carried out lying down...

0:25:130:25:17

So if I get you to stand just here...

0:25:170:25:19

..the chest X-ray gives a clearer image of the lungs

0:25:190:25:22

if the subject is standing.

0:25:220:25:25

So you're just right up against the board.

0:25:250:25:27

The team in A&E have already carried out ECGs and blood tests to

0:25:290:25:33

see if Donald's chest pains are being caused by his heart.

0:25:330:25:36

These X-rays will show if his pain is actually the result of a problem

0:25:380:25:41

with his lungs.

0:25:410:25:43

So, if you take a nice deep breath in, please.

0:25:440:25:48

And hold.

0:25:480:25:50

Breathe normally.

0:25:500:25:51

-Excellent.

-OK, that's all done.

0:25:530:25:55

All the best.

0:26:000:26:01

-Thanks.

-Thank you.

0:26:010:26:03

Having taken over from the night shift,

0:26:060:26:08

Dr Catherine Hawco has gone over Donald's notes and X-rays.

0:26:080:26:12

He has not had any more chest pain, he's not had any more

0:26:130:26:16

episodes where he's felt unwell at all.

0:26:160:26:19

His blood pressure has been OK.

0:26:190:26:20

That was one of the things I think that they were worrying overnight,

0:26:200:26:23

is that he had a difference in blood pressure in both his arms.

0:26:230:26:26

That's now non significant, really.

0:26:260:26:30

There's not any big change between them.

0:26:300:26:33

We've repeated his ECGs,

0:26:330:26:34

which is a tracing of his heart, and they are totally normal.

0:26:340:26:37

They don't show any signs of any heart attacks or problems with his

0:26:370:26:40

heart. We also checked a blood test

0:26:400:26:42

to check for any damage to his heart muscle, which came back normal.

0:26:420:26:46

And he has just had an X-ray of his chest, just to make sure there's

0:26:460:26:49

nothing going on in his lungs that could be causing this pain.

0:26:490:26:52

That has come back normal as well.

0:26:520:26:53

But it might be that it was just a bit of muscular pain that he was

0:26:530:26:57

experiencing. That's really common and sometimes people worry

0:26:570:27:00

about that when it's their chest.

0:27:000:27:01

Because it's your chest and it was painful and that,

0:27:010:27:04

it's the first thing that comes into your head, no matter who you are.

0:27:040:27:08

So it was just a case of eliminating things.

0:27:080:27:11

And this is the best place to be.

0:27:110:27:14

He is being discharged today,

0:27:140:27:16

just with some kind of pain spray if it comes back.

0:27:160:27:20

-But hopefully it won't.

-Home tomorrow. See my own doctor.

0:27:200:27:24

Got to go through some tests for angina.

0:27:240:27:28

Do some physical tests for fatigue, and that.

0:27:280:27:32

And take it from there. I've had two hours' sleep.

0:27:320:27:36

So... I'll probably sleep well tonight.

0:27:370:27:41

In hospitals across the British Isles,

0:27:510:27:53

there are dedicated paediatric departments that treat the nation's

0:27:530:27:56

sick and injured children.

0:27:560:27:58

Due to its size and Shetland's small population,

0:27:580:28:01

the Gilbert Bain has to do without.

0:28:010:28:04

Instead, each and every one of their team must be ready

0:28:040:28:07

to roll up their sleeves and treat any sick kids who are brought in.

0:28:070:28:10

Did anybody see what happened?

0:28:150:28:17

Did you?

0:28:170:28:18

Yeah? What, did she...

0:28:180:28:20

-Did she land?

-She pulled his hand and he came back.

0:28:200:28:24

Accident-prone three-year-old Darina from Nesting has been brought into

0:28:240:28:28

A&E for the second time in a week.

0:28:280:28:31

Did somebody land on top of her?

0:28:340:28:37

-No, he was pulling her around.

-Oh, he was pulling her around.

0:28:370:28:40

-Yeah.

-And has she fallen and maybe got a pull...

0:28:400:28:43

-Yes.

-Pulled her arm.

-Yes.

0:28:430:28:46

The little child, she was in a week ago,

0:28:460:28:49

playing on trampoline and had a pulled elbow,

0:28:490:28:53

which is a dislocated elbow, which was reduced in the department.

0:28:530:28:57

She's been playing

0:28:590:29:01

with her friends, and somebody's had a hold of her arm,

0:29:010:29:05

pulled her arm again, so her elbow, I think,

0:29:050:29:08

has probably dislocated again.

0:29:080:29:12

And it happens and it happens a lot.

0:29:120:29:16

-Yeah?

-Yeah. With this-age children, it does happen a lot.

0:29:160:29:19

It certainly seems to happen to Darina a lot.

0:29:190:29:22

Just games. Just games.

0:29:220:29:25

-Yeah.

-Jumping on the trampoline.

0:29:250:29:27

Yeah. You know, it's kids...just...

0:29:270:29:31

While brother and sister play together,

0:29:310:29:33

nurse Amanda Brown gets that all-important

0:29:330:29:36

-pain relief sorted out.

-Is she good at taking medicine?

0:29:360:29:39

This for the pain.

0:29:390:29:41

Do you want to give it to her?

0:29:410:29:42

Yum-yum.

0:29:420:29:44

Oh, you're so clever.

0:29:450:29:47

Now, that will help with the pain.

0:29:470:29:50

Tasked with relocating Darina's

0:29:500:29:52

elbow is third-year junior doctor Aideen Carroll.

0:29:520:29:54

The only problem is, this will be the first time she's done this

0:29:540:29:58

procedure, so she's called on consultant surgeon Gordon McFarlane

0:29:580:30:02

to cast an eye over proceedings.

0:30:020:30:04

-Morning.

-A lot of our junior doctors are going to be GPs.

0:30:040:30:08

Particularly, they may be GPs in rural areas.

0:30:090:30:13

-Mm.

-So if they can do this themselves, without having to send a

0:30:130:30:19

child miles and miles to a bigger centre, then that's really valuable.

0:30:190:30:25

And that's what we try and encourage here.

0:30:250:30:27

-Hey there.

-Hi.

-Hi. I'm Mr McFarlane.

-Hello.

-One of the surgeons.

0:30:270:30:31

So this is Darina.

0:30:330:30:34

-Hi.

-We talked about trying to reduce the elbow.

0:30:340:30:39

OK? So we're just going to do that now. Is that all right?

0:30:390:30:43

OK. OK.

0:30:430:30:45

Just hold on to Darina.

0:30:450:30:47

OK, you're doing really well.

0:30:470:30:48

The doctor needs to push the elbow back into the socket.

0:30:480:30:52

So at the moment...

0:30:520:30:55

Mm-hm. Yeah. That's right.

0:30:550:30:57

I know.

0:30:570:30:59

-I heard it, yeah.

-Oh, did you feel it click?

0:30:590:31:01

Well, there you are. Job done.

0:31:010:31:03

-I think that's it.

-That's what you need.

0:31:030:31:05

A nice click. That's exactly what you need.

0:31:050:31:07

Fantastic. Oh.

0:31:070:31:09

Better?

0:31:090:31:11

-Not convinced.

-Not sure.

0:31:110:31:14

That's great. Well, just give her something to play with and see if

0:31:140:31:17

she's using it and... If she's happy, she can go home.

0:31:170:31:20

Yeah. Pop into the waiting room, play with lots of toys.

0:31:200:31:22

-Yeah.

-And see if she'll use the arm.

-OK, thank you very much.

0:31:220:31:26

OK. There you go.

0:31:260:31:29

The doctor knew what to do, and just needed a little bit of presence,

0:31:310:31:37

maybe, to give her some confidence.

0:31:370:31:39

More than happy to use her elbow again, Darina can head home.

0:31:390:31:43

Hopefully, it'll be some time before she's back in A&E.

0:31:440:31:49

-Bye, thank you.

-All right, bye.

0:31:490:31:54

However, like most A&E departments,

0:31:580:32:00

it's never too long before they're greeting another youngster who's

0:32:000:32:04

come unstuck due to misadventure.

0:32:040:32:06

Today, it's the turn of six-year-old Daniel, whose mum Sarah

0:32:060:32:10

has brought him in from Voe.

0:32:100:32:12

Here we go. He ran into a wooden banister.

0:32:140:32:18

The stairs, it kind of points out a little bit and he's just ran round

0:32:180:32:21

-the corner from the kitchen.

-All right, OK.

-Ow.

0:32:210:32:24

Oh, it's going to be painful coming off, sweetheart.

0:32:240:32:27

-We had this from...

-Why don't you tell me your name, eh?

0:32:270:32:30

-Daniel.

-Eh?

0:32:300:32:31

It's quite a big split. Sorry.

0:32:330:32:36

You've been running wild at home, have you?

0:32:360:32:38

Tell them what happened, Daniel.

0:32:410:32:43

I ran out the kitchen with something and I...

0:32:430:32:50

My head...got caught on the banister, then it started bleeding.

0:32:500:32:56

-Aw.

-I just have to go slowly now.

-Go slowly.

0:32:560:32:59

To make matters worse,

0:33:000:33:02

his injuries were sustained in the execution of a robbery.

0:33:020:33:05

They took some straws out of the kitchen,

0:33:050:33:08

they've got milkshake little balls in them.

0:33:080:33:11

-Yeah, and...

-So you drink the milk and the milk goes the flavour of the

0:33:110:33:15

straw. So they were sneaking.

0:33:150:33:17

-And when...

-So they were thinking they were getting away with

0:33:170:33:20

something, so they've all ran out the kitchen at full speed.

0:33:200:33:23

The banister stopped you, didn't it?

0:33:230:33:25

After any head injury, but particularly with children,

0:33:270:33:30

it's important to check for any signs of concussion.

0:33:300:33:34

We've had kids with head injuries and it's vitally important for us to

0:33:340:33:40

be able to deal with these things locally.

0:33:400:33:42

Squeeze my fingers as hard as you can.

0:33:420:33:46

Because very often the weather turns bad

0:33:460:33:49

and we can't get them out in time.

0:33:490:33:51

Harder. Oh, well done.

0:33:510:33:54

Now, can you push my hand away?

0:33:540:33:57

I'll not do two hands because you're only little.

0:33:570:34:00

Can you push my hand away?

0:34:000:34:02

Oh, well done. What a strong boy.

0:34:020:34:04

Push this one away?

0:34:040:34:06

Thank you.

0:34:060:34:08

With Daniel showing no signs of concussion,

0:34:080:34:11

it's time for the doctor to deal with his cut head.

0:34:110:34:15

Did you feel dizzy, or anything?

0:34:150:34:18

Yeah? Aw.

0:34:180:34:19

And has he been sick at all?

0:34:190:34:22

OK, that's fine.

0:34:220:34:24

Whoops. All right.

0:34:240:34:25

All right, let me have a quick look here.

0:34:250:34:28

That's good. OK.

0:34:280:34:30

I think we'll maybe put a little bit of glue on there.

0:34:300:34:32

No? You don't want glue?

0:34:320:34:34

No? It's not that bad, honestly.

0:34:340:34:36

It'd hurt more to have this done.

0:34:360:34:39

OK? It's not going to hurt that much.

0:34:390:34:41

There's no needles. OK? No needles at all.

0:34:410:34:44

OK, no sticky bits.

0:34:440:34:46

Just a tiny bit of glue over the top.

0:34:460:34:49

And then it's finished, OK?

0:34:490:34:51

Do you think you can be brave enough for that?

0:34:510:34:53

-Good stuff. All right.

-Well done, Daniel.

0:34:530:34:55

-You all right, darling?

-Mm-hm.

0:34:570:34:59

-It sore?

-No.

-You're so brave.

-No, he's doing fine.

0:34:590:35:02

Oh, you're very good boy, aren't you?

0:35:020:35:05

There you go.

0:35:050:35:07

That's it. We're just letting it dry, OK?

0:35:070:35:10

That's all.

0:35:100:35:12

That's as bad as it gets, OK?

0:35:130:35:15

He's been with us for quite some time

0:35:150:35:18

and his, you know, behaviour hasn't deteriorated,

0:35:180:35:20

he hasn't become more sleepy in the meantime,

0:35:200:35:23

so that's all very reassuring. He's been with us for an hour-and-a-half

0:35:230:35:26

and so, in that time,

0:35:260:35:28

he's not showing any signs of any serious concussion.

0:35:280:35:31

So that's very good stuff, and all his eye movements,

0:35:310:35:34

how he's been playing and interacting, it's been great.

0:35:340:35:37

-OK.

-Yeah.

-That's good to know.

-Yeah.

0:35:370:35:40

Skin glue is administered when wounds are deemed too small or minor

0:35:400:35:43

to go through the discomfort of stitches or staples.

0:35:430:35:47

And now that Daniel's patched up, it's time to head home,

0:35:470:35:51

where he will take things much slower. Or so he says.

0:35:510:35:54

Thank you very much, Doctor. Will you say thank you, Daniel?

0:35:540:35:58

-All right.

-Thank you.

-Bye.

-Thank you.

0:35:580:36:01

Shetland's most famous inhabitants are undoubtedly the Shetland ponies.

0:36:110:36:15

These hardy horses have been roaming

0:36:170:36:19

the islands for at least 4,000 years.

0:36:190:36:21

While in the past they were used in farming and coal-mining,

0:36:240:36:27

today Shetland's diminutive stalwarts are often

0:36:270:36:30

ridden by local children.

0:36:300:36:32

One of those pony enthusiasts, who competes in shows all over Scotland,

0:36:330:36:37

is Emily from Bigton in the south of Shetland.

0:36:370:36:40

She's had to pay a visit to Gilbert Bain A&E.

0:36:400:36:43

I fell off my horse.

0:36:430:36:44

It was a Shetland pony and I was cantering

0:36:440:36:48

and then he put his head down and I fell off.

0:36:480:36:52

Even though the average pony stands at just 42 inches tall,

0:36:520:36:56

taking a tumble from one can be a bruising affair.

0:36:560:36:59

You were practising for the show, weren't you?

0:37:000:37:03

The doctor said that he thinks it might be a fracture.

0:37:030:37:07

That's your collarbone, it's up here. Yeah.

0:37:070:37:11

It will be a while before you're on a horse again.

0:37:130:37:16

With Emily's hopes of competing in a local show looking slim,

0:37:160:37:19

it's up to nurse Emma to make her as comfortable as possible.

0:37:190:37:23

So we'll just pop this on and see if it's any comfier.

0:37:230:37:26

Could you stand up for me, darling?

0:37:260:37:29

Right, and you slip that through there.

0:37:290:37:33

Now, this is kind of stretchy, this material. Have you got him?

0:37:330:37:36

-Mm-hm.

-So, erm...

0:37:360:37:39

it might kind of loosen off a bit and, if that happens,

0:37:390:37:43

you can just tighten him up.

0:37:430:37:46

If you just kind of make sure it's...

0:37:460:37:48

there. And it'll take the weight across your back rather than on your

0:37:480:37:52

neck. Have you got your full weight on that?

0:37:520:37:55

Cos I can make it a bit tighter if you want. Does that feel OK?

0:37:550:37:57

What we'll do is keep you in that,

0:37:570:37:59

give you some painkillers and then we'll get you back tomorrow.

0:37:590:38:02

If the pain is too sore at home,

0:38:020:38:05

then you can come back and we could see about getting

0:38:050:38:08

some more pain relief. Usually, once it's in the sling,

0:38:080:38:11

paracetamol and brufen, you should be all right.

0:38:110:38:14

OK? And is the horse forgiven?

0:38:140:38:18

-Always!

-Thank you.

-No bother.

0:38:190:38:23

24 hours later,

0:38:250:38:26

the silent cowgirl returns to find out when exactly she can get back on

0:38:260:38:30

her pony.

0:38:300:38:32

So you have broken your clavicle,

0:38:320:38:34

that's your collarbone, just sits here.

0:38:340:38:37

I don't think that's surprising, because we can feel that it's

0:38:370:38:40

-broken, pretty much, can't you?

-And what about going back on the horse?

0:38:400:38:43

How long is that going to take?

0:38:430:38:44

It will be at least six to eight weeks

0:38:440:38:47

before you have a full range of movement.

0:38:470:38:49

-That's all she is worried about.

-I know.

0:38:490:38:52

Thank you very much.

0:38:520:38:54

You'll be back on your pony before you know it.

0:38:540:38:56

She may play her cards close to her chest, but you wouldn't want to bet

0:38:560:39:00

against her being back in the saddle before long.

0:39:000:39:02

Anna the midwife is back out on her rounds,

0:39:150:39:18

and on her list today is Jennifer in Quendale, 22 miles south of Lerwick.

0:39:180:39:22

Jennifer was flown to Aberdeen just over a week ago

0:39:230:39:26

to have her overdue baby induced.

0:39:260:39:29

In the end, her baby was delivered by C-section and, like most babies,

0:39:290:39:33

began to lose weight in the days that followed.

0:39:330:39:36

Today, we are going to see how she's getting on with feeding and we're

0:39:360:39:40

going to weigh the baby because the last time the baby was weighed,

0:39:400:39:45

she had lost over 9% of her body weight,

0:39:450:39:49

so we're hoping today that she's started to put on some weight.

0:39:490:39:53

Hello.

0:39:560:39:58

We found it. We were like, "I hope we don't get lost."

0:39:580:40:02

-Do you want me to take my shoes off or...?

-No, you're OK.

0:40:020:40:05

-How is she doing?

-Oh, she's doing amazing.

0:40:100:40:14

I like your little tufts this morning.

0:40:160:40:19

And is she waking up for feeds herself, are you waking her up?

0:40:190:40:23

Yeah, last night, then I just let her wake herself up.

0:40:230:40:26

Mm-hm. Oh!

0:40:260:40:29

I know, I'm sorry.

0:40:290:40:31

I know! These mean midwives just come and see you and torture you.

0:40:310:40:35

Yeah. You're not going to pee on me, OK?

0:40:380:40:40

Yes, so this is going to be a bit chilly. 3-0-8-0.

0:40:400:40:45

So she's doing brilliantly, and you are as well, obviously,

0:40:460:40:49

with the feeding. Well done.

0:40:490:40:52

After all that torture, eh?

0:40:530:40:55

After a few teething troubles,

0:40:550:40:58

Jennifer and the baby are settling in nicely.

0:40:580:41:00

In fact, baby seems to have just one thing on her mind.

0:41:000:41:04

And you can tell that she's thinking about milk at all times.

0:41:040:41:09

-Dreaming about it just now!

-A one-track mind.

0:41:090:41:12

Yeah.

0:41:120:41:14

On Shetland, it takes more than a broken clavicle

0:41:290:41:32

to keep a good girl down, and six weeks after her fall,

0:41:320:41:36

Emily is keen to show she's no one-trick pony.

0:41:360:41:39

We're just going to go for a ride up on the road.

0:41:410:41:45

It was meant to be six weeks but I think I started riding in,

0:41:470:41:52

like, five weeks.

0:41:520:41:53

She may have had five weeks off riding, but nothing comes

0:41:530:41:57

between a Shetland girl and her Shetland pony.

0:41:570:42:00

She's been here nearly every single day since she did it

0:42:000:42:02

and she's never looked back, it's not put her off at all.

0:42:020:42:05

Caitlin went into labour and eventually gave birth to a baby boy,

0:42:320:42:36

Leo, by emergency C-section, weighing in at a whopping 9lb 1oz.

0:42:360:42:41

Both are doing well. Leo's sleeping through the night, and smiling.

0:42:410:42:46

Dr Pinnick is still shadowing Dr Lalla's clinics,

0:42:460:42:50

getting more experience in minor operations,

0:42:500:42:52

and hopes to be running clinics of her own very soon.

0:42:520:42:55

And Darina was back on her trampoline in no time.

0:42:550:42:59

Behind the scenes at the UK's most remote hospital, the Gilbert Bain in Shetland. Episode four takes a closer look at life for Shetland's new and expectant mothers. In the Gilbert Bain's maternity department, first time mum-to-be Caitlin has come in as she is eight months pregnant and can't feel her baby moving. They also see a woman who, ten days past her due date, has to be flown from Shetland to the mainland for specialist assistance giving birth.

Meanwhile, two young girls visit A&E - one having fallen off her Shetland pony and breaking her collarbone and another with a badly injured arm following a trampolining accident. The staff at the Gilbert Bain, who are not specialist paediatricians, have to use all their skills and training to treat them.

Away from the hospital, the programme follow a midwife from Aberdeen who has recently moved to the islands and is struggling to find her way around, all while making house calls to Shetland's newest mothers.