Episode 5 Island Medics

Shetland, the most remote part of the UK.

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

and nearer Norway than you are to Edinburgh.

There are more puffins than people,

and more seals than supermarkets.

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

..and so far from the mainland that when things go wrong...

A&E, can I help you?

..from helicopter rescues and spinal injuries...

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

..to serious medical mysteries...

Can we get assistance in, please? Something's not right.

Shetland's island medics have to be ready for anything and everything.

-What happened?

-I had a fight with a seagull.

-This was sheep shears, was it?

-Yes.

It means the tight-knit team of medics, volunteers

and emergency services have a special bond...

This might tickle!

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

Wee treat for night shift.

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

Today, a fisherman is rescued from his trawler in the North Sea...

..a schoolteacher has a unique piercing problem...

Dangers, dangers of ear piercings, yes?

..and a patient needs to be medivacked to Aberdeen

for urgent coronary care.

I think the worst weather was over 100mph gales.

For centuries, fishing has underpinned the Shetland economy.

And though there's been a decline in the industry since the 1970s,

whether commercial or recreational...

Not bad.

..fishing is a special part of Shetland culture...

..and a livelihood for many.

Surrounded on all sides by some of the most treacherous seas in the UK,

it's no wonder that emergency services are no stranger

to fishing-related incidents.

In Lerwick, Shetland Coastguard HQ have been alerted to an incident

on a fishing trawler in the North Sea.

We have Coastguard rescue helicopter,

he's evacuated a crewman from a fishing vessel.

He's inhaled chemicals and had a reaction,

so they are now airborne and taking him

to an emergency landing site in the town.

The helicopter's currently here.

Just transiting up to Lerwick.

While the fisherman is evacuated, in the Gilbert Bain Hospital

in Lerwick, nurses Kathy Duffus and Thelma Irvine

have been alerted to their imminent arrival.

We've just received a call from the Coastguard to say that

there's a fisherman suffering from headache and breathing difficulties.

And we're just waiting for them to land just any minute, really.

With Resus prepped and a consultant notified,

an ambulance with paramedic Emma Davies on board has been dispatched.

So we're on our way to a male of an unknown age

that works on board a fishing boat.

He's inhaled some sort of chemical and is having, well,

it says he's got a compromised airway and difficulty breathing.

So this is landing at the Clickimin site,

which is just two seconds from the hospital.

So we'll see what we get when we get there.

The Shetland island search and rescue Coastguard helicopter lands

on three main sites. When it's considered life-threatening

they'll always land here - the Clickimin playing fields,

just across from the hospital.

Unsure if the patient might quickly deteriorate,

the Coastguard aren't taking any chances.

The Coastguard winchman and paramedic John Thompson gives

the ambulance team an update before they leave for the hospital.

Thankfully, it seems the patient is stable.

But having inhaled toxic fumes on board the trawler,

he's still having discomfort breathing...

..and is a long way from being given the all clear.

To open up his airways and ease his breathing Brian's been given

salbutamol as well as a nebuliser.

Both will help open his airways.

How are you feeling now?

Not too bad. Still finding it difficult?

That's fine. The hospital is just one minute away so we'll just,

we'll just go, OK?

We can hear the helicopter taking off from here,

so once it takes off it won't take them long to get the patient here.

Were you working with the chemicals for quite a while?

So you weren't actually in contact with them for an awful long time?

OK.

OK, OK.

Chair, so that's a good sign.

It is reassuring for nurse Thelma and nurse Kathy

to see a patient arrive in a chair and not on a stretcher.

But they'll only know if there's any lasting damage from

the chemical fumes once they run a series of tests.

Fishing is big business in Shetland,

and it's also a recreational pastime.

A variety of fishing injuries come through the doors of A&E.

Recently, retired Grace and her husband were fishing near their home

in Burra and Grace seems to have got more than she bargained for.

Well, we were catching that many fish it was hard to go ashore.

-A good catch today, then?

-Yep, plenty of mackerel.

Oh, well, the fish were too good to come in.

Oh, no, we got in and went home and put on a clean pair of trousers!

Just sit tight for a moment

and we'll get the doctor to come and have a look.

Casting her eye over the injury is Shetland native Doctor Jennifer Briggs.

-We'll just get set up here.

-Yes, yes, that's good.

I'll just explain to you what we're planning to do.

I'll just put in a bit of local anaesthetic round where its come out

-and then we'll just continue going...

-Go back that way.

Because yon barb on the end of the tip,

if I try to come back it's going to drag...

-Take it this way then?

-Yes.

-Yes.

Shetlanders are a sturdy breed,

and tend to take these things in their stride.

I tried to take them out myself with ice but it didn't work.

Good try. Good try.

-This might sting.

-Yes, well, it's only a sting.

I was here ten weeks ago with a broken elbow.

-OK.

-Same room!

THEY LAUGH

You're a frequent flyer!

I'm just going to nip this off here.

If it's very uncomfortable, let me ken.

-Oh.

-Oh!

Where did he go?

-Are you OK? Can you feel anything?

-No, no, that's fine.

I'll tell you something, it's well and truly stuck.

I think the barb is just under the skin here.

-Yes.

-It's just really catching and I cannae get him curled out.

It could be a new fashion trend.

One of these new fashionable piercings.

No, I think I'll not bother.

No, no. When the infection sets in, it won't be very attractive.

Using medical pliers, the hook is delicately removed.

-Yay.

-Well done.

Good for you. Well done.

Give him a bit of a clean-up.

-Would you like to keep this hook as a souvenir?

-No, thank you.

So, patient Grace is off the hook.

OK. Good.

At the Gilbert Bain Hospital, patients are given

as much care as possible, but sometimes they need to move on

to more specialised care on the mainland.

Every year, there are up to 500 organised patient transfers from the

Gilbert Bain to the mainland and it's not just getting to hospital

that's unusual on Shetland.

Transferring to another is just as much of a challenge.

Patients are often transferred to Aberdeen or Glasgow for specialist

treatment, and when the call comes to send the patient off Shetland,

it's the responsibility of the medical team

to prepare the patient for transport...

on an aeroplane.

I'll go and grab the stuff that I need, OK?

Nurse Emma Williamson will often work on call

as a patient transfer nurse when she's not working in A&E.

Have we got any flushes?

What have we got here?

A few bits and bobs.

We'll just draw a couple up, Amanda.

Today, there's gentleman needing to get to the core coronary care unit

in Aberdeen as quickly as possible.

So Emma's been called in.

I've been called in. I was actually in the middle of a circuit class,

so that's why I look so sweaty and minging.

And it's urgent transfer because this gentleman's had

an inferoposterior MI and we need to get him to CCU.

Alec was brought in this morning with a heart problem from Sumburgh in the south of the island.

He's been under the care of nurse Amanda Brown and has received

treatment to decrease the risk of a heart attack.

I've been doing a lot of walking this summer cos it's the first year

since I retired, and I felt...

I felt just uncomfortable.

Quite a lot of pain between the shoulder blades and both arms.

Completed the walk, and went home,

and when I got up this morning

I was making some tea and toast and then it just started again,

exactly the same. So my wife took me in here very quickly.

The plan is the air ambulance to Aberdeen and they'll have

a look at me there and decide what...

It looks like a stent, I think,

so I think that what they've done here appears to be,

it's had a very good effect.

It's been a clot that's...

The drugs that they've given me, they've reduced it,

so it sounds very good.

Yeah, he came in this morning and had an ECG

and some bloods done, and it showed ST elevation,

so he's had a posterior MI,

so they had to get the doctor immediately and

the consultant informed,

and we got him thrombolysed in the connect place.

So it's a clot buster.

Alec's heart problem can only be fully treated by a coronary specialist.

With the procedures he'll need, the best course of action is

to send him to the nearest specialist unit in Aberdeen.

So what I'm doing is I'm just preparing.

I'm getting painkillers ready, some anti-sickness.

Fingers crossed, nice day for flying,

so hopefully we'll just get him there ASAP, safe and sound.

The patient transfer works on a voluntary basis,

When nurses opt in to take part in their spare time.

I don't ken how many of us. There's not actually that many of us.

There's about six of us maybe that volunteer, seven, Amanda?

-Yeah.

-You don't have to do this, if you work here.

It's kind of your choice.

Aha! Isoprenaline.

I thought it was in the fridge. OK.

Having trained in Aberdeen and worked in larger medical centres,

Emma has a wealth of experience, built up from years of working as a nurse.

When I did my training, going back to 20-odd years ago now,

so I chose to do general nursing.

So when I picked that, then I thought I would be going

and looking after adults, so that's what I went off and did,

in the big hospital at ARI.

I think we have a really sort of broad spectrum of experience,

the staff here. And lucky that we have a lot of nurses,

with a lot of years of experience.

The Gilbert Bain is well-equipped for general care

but serving a population of just 23,000 people,

the hospital can't cater for every level of specialist care.

165 miles from the mainland and 230 from Aberdeen airport,

Alec will be flown direct to the Aberdeen Royal Infirmary.

We don't have the services here that we'd have on the mainland.

Here we have to get him stabilised

and then get him down to the next level of care,

which is coronary care.

Needing to get Alec to coronary care in Aberdeen,

Amanda has requested an air ambulance.

They're going to be at Sumburgh, which is a 30-minute drive,

40-minute drive with the ambulance from the hospital down to Sumburgh,

and then it will be about 45 minutes on the plane.

So what we do when we look at blood results.

For an MI there's a thing called Troponin I.

So when you're looking at the blood results you're looking at

the Troponin, I which is a specific enzyme to the cardiac muscle,

and the bigger that rise is,

then the bigger really the extent of the damage.

He's had a rise, so that's just confirming

that has done a wee bit of damage there to the muscle,

but the sooner we get him to Aberdeen and he gets

the investigation and the procedures

then the better for his, like, heart.

So we'll just get the ambulance sorted and we'll be offski.

So a few things to prepare before Alec can get on his way to Aberdeen.

Emma is Shetland born and bred,

and has been working at the Gilbert Bain for ten years.

It was the lifestyle of being a Shetlander that pulled Emma back home.

I went to school here, so when I went away,

like, a lot of my friends were nurses.

But when I came back to Shetland,

then all my friends were the friends I had before I did nursing.

The schools are good.

Definitely I would say it's a lifestyle choice for folk coming here.

The summer is fantastic.

The winters are long, and they're dark and they're cold

and wet and I would say if folk do probably more than three winters,

then they might stay.

A wife, mum and nurse,

Shetland and the Gilbert Bain is where the future lies.

I think I would struggle not to be by the sea as well.

But my kids absolutely love it here as well, and all my family is here.

I'd actually find it weird to live somewhere with trees now, I think!

When she does get a break from the hospital,

Emma likes to take advantage of the best of what Shetland has to offer.

Like many Shetlanders,

Emma's choice of relaxation is enjoying wild swimming

along the rugged coastline.

On those rare days off, she can be found dipping her toes

in the North Sea with her sister-in-law and friend.

I'm going for it.

Woo!

It's just good, wild swimming, just to come here and be in the water,

feel pretty wild, just helps clear your mind.

I actually found the best sport ever,

because you actually need to be reasonably fat, I think,

to swim in the water,

cos otherwise you'll freeze,

cos it is cold, I won't lie.

Yeah!

As is the case for most nurses, the long hours can take their toll,

but getting in the water makes it all worthwhile.

Time out, nobody nagging me with, "Mum, can you do this?

"Mum, can you do that?"

No phones, no nothing.

It's a fine day.

Another special part of Shetland,

and the reason that so many people love to visit here,

is its rich diversity of wildlife.

And, just like the tourists they attract,

sometimes these animals get into trouble and need rescuing.

Since 1987 it's been down to the Hillswick Wildlife Sanctuary

to care for those animals that need it. Husband-and-wife team

Pete and Jan Bevington have been running the charity, where they

patch up the island's injured otters, and care for orphaned seals.

Have you seen an otter?

Today they've been called out to Vidlin, 22 miles north of Lerwick.

There's a pilot whale that's been spotted in one of the inlets,

and it's behaving strangely.

Its behaviour's rather strange, you know, to be coming up

and popping up like this every 15-20 seconds or so.

Rather than swimming normally, it's spy hopping, going up and down,

which can be a cause for concern.

It's come so far inland that we're worried now that

it's going to strand, you know.

If we could just get it out to sea, it should be fine.

But there's some bad news.

The boat they were relying on has broken down.

So, now, we're just desperately trying to find someone,

because that's far too close in.

It looks like he might strand, if we don't try to nudge him out.

We just hope and pray that we can find something.

You don't know anyone with a boat that could help us push him out?

-I don't, no.

-No.

-Do you know anybody with a boat nearby?

We would need two or three boats. Even one would help.

The shallower water it gets into, the less likely we are to get it out.

But on Shetland it's never too long before someone reaches out with a helping hand.

They're going to come around and see if they can...

..er, lead the whale out.

Come on, boys.

Come on, the boys, they can do it!

Despite the best intention of the boat owners,

the whale can't be persuaded to move away.

Please go. Please go.

Being close to the shore affects the whale's echolocation,

causing it to become confused.

With the pilot whale, they don't arrive in slowly.

It'll come so far in,

and then they panic and then they just hit the beach like torpedoes.

When everything looks hopeless, there's more help on the horizon.

I hope they are coming to us - I think they must be.

Two kayakers have come to help.

The main thing we want is to make some kind of...

blockade to stop him circling ever and ever closer.

It seems to be doing the job.

Splash the paddles a bit, maybe.

That's it, that's perfect.

Oh, no, he's gone by you.

Careful. Yeah, but he'll get frightened.

Come away. I think you ought to come back. Come back.

It's a delicate operation.

The kayakers don't want to accidentally scare him closer to the shore.

Still dangerous, Pete, because he could use that tail.

He could panic and use that tail.

Thank you, boys!

They've helped to move him away, but with night falling,

Jan and Pete have a nervous wait to see if he'll swim out to sea.

Hardy folk they might be,

but often the severity of an injury or accident means no amount

of Shetland grit can prevent someone from coming in to A&E.

-Hello, Mr Johnson.

-Hello.

-How are you doing?

I'd be better if I wasn't here.

-Better if...!

-SHE LAUGHS

Fisherman Brian has been evacuated from a trawler

after inhaling chemical fumes onboard.

First to assess Brian is the senior medical consultant, Dr Tuma.

At about six o'clock, Brian's been working with...

Bilgex? Bilgex.

..and he's accidentally mixed it with chlorous,

which has given off hazardous...

He reckons he was only sort of in contact with it

in a confined space for about 15 seconds.

-OK.

-But he's had shortness of breath,

pain from his throat down to his sternum.

Brian has mixed two chemicals which have given off noxious fumes.

Though he was exposed only for a short time, the team

still need to assess if there's any long-term damage to his airways.

How is that right now? How is your breath?

Is it much the same or is it a little bit better than it was?

-A slight bit better.

-OK.

-And still you feel any pain or anything here in the...?

-Yeah.

Swap masks.

Nurse Cathy needs to check his breathing and circulation

before running a number of tests.

Have you ever used one of these before?

As hard and as fast as you can.

Junior doctor Saul Wilson has arrived to help with Brian's assessment.

Yeah, we need to... Go for it, just do your best.

That's fine.

So, 220.

Having requested a number of tests, including an ECG and a chest X-ray,

the consultant hands over to Dr Wilson.

The team's first priority, though,

is to work out just how toxic the chemicals are.

So, he was working with Bilgex, which I guess is like a...

-Bilgex.

-I guess that's like a brand-name.

..and then he's mixed it with chlorous, by accident.

OK, I'll go and do that.

One chemical is a grease and scum removing product.

And chlorous is granulated chlorine, used to control bacteria and algae.

What no-one knows is how they react together.

So, a call to the experts is needed.

I'll phone...

the Poisons Information Service,

and see what we should be doing.

OK.

-Thank you.

-Thank you.

-See you later.

-See you later.

Hi, I'm Dr Wilson, one of the junior doctors here.

Do you mind if I take blood first from your wrist?

-No.

-So, we'll just swap hands and I'll take it off.

The blood tests are vital to show if there are any unusual chemicals present in his blood.

He's about to get an X-ray shortly, yeah.

He's had a blood... He's getting a blood test done -

it's in the machine as we speak, yeah.

I've done a peak flow, yeah.

It was 320, so a little bit low, but...

The consultant is aware of that.

Poisons are saying chest X-ray, EBG, peak flow,

ECG and monitor him for four hours.

We have to watch out for increasing wheeze, if he starts drooling,

any difficulty swallowing.

If there's swallowing difficulties he'll need an endoscopy.

-OK.

-So, they're saying maybe be a bit more cautious

than what they're saying, because it's a bit unknown.

-Yeah. Right.

-This was really the

sort of chlorine-type inhalation they were going with.

-Yeah.

-So, just the ECG.

-The ECG.

Yeah, and the X-ray.

Unsure of the exact effects of these chemicals together,

the Poisons Information Service advises close monitoring of the patient.

Not out of danger yet, Brian still has an anxious wait

to see if the test results will show any permanent damage.

Lerwick is the largest town on Shetland.

The capital of the islands, it has an industrial heart to it,

the foundation of its fishing heritage.

But it's not always fish hooks and fisherman coming through

the doors of the town's hospital.

Can you feel that at all, is it very painful?

It's not painful, no.

In treatment room two, Dr Aideen Carroll and Nurse Thelma

are having a rather tricky problem with an ear piercing.

-You can see the opening there, if you...

-Yeah.

You're tolerating that better than you did.

Yeah, I'm not feeling that.

I just don't know... It's a ball?

Yeah.

Is there a ball on each side? A bit like a tummy piercing?

Two months ago, local primary school teacher Jennifer had her ear pierced.

Since then, it's got infected,

and the skin has grown over the back of the earring.

It's very close to the surface.

-OK.

-But obviously, because it's a bit...

it's not a little ball, it's more like a back.

What I'm going to do is I'm going to have a quick chat with my senior

about the best way to get it out. It's very close to the surface.

-Right, OK.

-And we'll go from there.

-OK.

-I'll just get things ready for you.

This lady has had her ear pierced,

and it's gotten a little bit infected,

and you can see the area is swollen.

So, what we need to do is, we need to...

..reveal that end of the earring

and then try and remove that end of it

so we can get the earring out. What we've done so far is,

we've put some local anaesthetic cream on -

what we would use when somebody's getting a cannula, Ametop cream,

to try and numb the area a wee bit for her.

So we're probably going to need to make a little incision

to remove the earring.

Dr Aideen is a third-year junior doctor,

and although she's fully qualified,

this type of piercing problem is a first for her.

As the senior A&E and surgery doctor,

Kushik Lalla is on hand to support her during the procedure.

-So, you actually...

-So, it's the back end that has embedded itself.

Exactly. And we can't get it. And the front unscrews,

-but the back is embedded.

-Aha.

Make a small nick at the back, and then unscrew the front and just...

-Push it.

-Push it out.

-That's no nice way to do it, really.

-I'm just like, this is a bit brutal.

-No, there is no nice way to do it.

It's quite common. We see it every so often.

Er...

But it's a fairly common occurrence, this, where earrings get embedded.

We do see some unusual piercings that go wrong every so often, yeah.

-Hello.

-Hi.

-Jennifer.

-Yes.

-Hi there.

-Hi.

Dangers. Dangers of ear piercings, yeah?

Oh, I've had the lecture from my husband!

Right. When did you do this?

-When did I get it pierced?

-Yeah.

-About six or seven weeks ago.

Right, OK.

If you just look at me...

With Dr Lalla overseeing, it'll be up to junior doctor Aideen

to perform the procedure for the very first time.

In Resus, patient Alec has a problem with his heart

and is preparing to be transferred to the Aberdeen coronary care unit.

The air ambulance patient transfer service is responsible

for transporting patients off the island.

The service is supported by nurses working at the Gilbert Bain.

It's their job to chaperone patients to hospitals on the mainland.

But, as always, travelling on and off Shetland brings with it

weather concerns for Nurse Emma, who'll be travelling with Alec.

I think the worst weather was over 100mph gales.

Flying from Sumburgh, and we were like, "Will we go, will we go, will we go?"

And then eventually there was a break in the wind and we went.

But it was pretty...

It wasn't for the faint-hearted, that was for sure.

It was looking very nice coming up this morning anyway.

It's actually, the...

-The sun is just threatening to come through.

-Is it?

Yeah. Hint of blue sky.

-Good.

-So...

I was going to plant beetroot today, so this has got me out of that!

Emma, are you going to connect him to your own monitoring

-or do you want...?

-No, I'd like your staff...

-Do you want us to take it in and connect it?

-Yes.

So we're just on the trolley, all connected up and ready to go,

-that would be good.

-OK.

To get Alec on the ambulance stretcher,

the team need to transfer his ECG monitoring.

That's just if you have any pain,

then when we can print off a picture and kind of see what's going on.

-Yeah.

-Plus, I've got painkillers in my bag that I can give you, OK?

-Mm-hm.

-OK!

-Okey doke.

Obviously, we're moving him around and things like that,

and we're putting him under a bit more stress,

just cos we're going to Aberdeen.

So, we'd just like to keep a really close eye on this patient.

So, the nursing and ambulance staff just need to get Alec transferred

and ready for his journey to Sumburgh airport.

-Just towards Sam a wee bit, that's it.

-OK.

-How does that feel, Alec, there?

-That's good.

We'll just phone his wife once you leave.

So she kens? Yeah. So...

-Inferior...

-Inferoposterior MI, being thrombolysed,

had all the goodies, and been accepted to CCU for probably angios,

hopefully today. Hopefully, hopefully.

Before we go, are you still feeling OK, Alec?

Yeah? Yeah.

-All the best.

-Thank you very much.

-Thank you.

-I'll phone you, ladies.

-Let us know how you get on, Alec.

-Thanks.

-I'll give you a...

-Yeah.

-Shall we shout to them?

-Yeah, let's go.

Yeah, good, good. Yeah. I've got me kit.

I actually quite like once you're on the air ambulance cos,

especially if it's a fine...

-Yeah, yeah.

-It's quite smooth.

A lot of the bairns that we get in that need to fly out,

they can... Some of them are a complete handful in A&E,

and then you get them on the air ambulance and it must be

-just the hum and the...

-Mm-hm.

-They have a bit of a...

and then they just usually fall asleep.

-But it'll be fine to get you to Aberdeen.

-Yeah, yeah.

And you might be, well, depending how fast when we go in,

-they might be waiting to tach you. So...

-Yeah, yeah.

Yeah. Sometimes, I think it might even be faster is

-if you're right on the outskirts of Aberdeen.

-Yeah, yeah.

Sumburgh airport is located in the south of mainland Shetland.

With the drive to the airport taking 30 minutes,

there's plenty of time for Emma to keep reassuring Alec

and put him at his ease.

If you get your angios, and if the blockage is stentable,

basically, what it is is,

kind of inside of a biro, where the ink sits,

-that's the kind of size that you're looking at.

-Mm-hm.

And it's like a tiny bit of chicken wire,

that's what it looks like. It's still that they're using.

And what they do is, they just go in through the arm now,

and they'll just open that up

and that'll just sort of squish the blockage.

Safely on the tarmac at Sumburgh airport,

Emma and the crew can get Alec on the plane.

-How are you doing?

-Fine, how are you?

-Haven't seen you for ages!

-I know.

-I've been cruising around the isles

in the summer, sorry. Yeah, really fine.

Blood pressure is still a bit low, but his heartbeat is good.

He looks well, his colour is good.

So, yeah, pleased, up until now. So...

With the sun shining,

there's no sign of those famous Shetland winds.

You can imagine what it's like in 100mph winds, pouring with rain.

Today, it's like luxury.

With Alec loaded and his wife Marjorie ready to board,

the first part of the patient transfer is complete.

The 230-mile flight to Aberdeen will normally take around 45 minutes.

With engines warmed up and a short taxi for the air ambulance,

Emma, Alec and the crew can get on their way.

Commercial fisherman Brian was airlifted

to the Gilbert Bain Hospital after inhaling poisonous fumes.

Although stable in Resus, there's still concern that

the chemicals may have caused long-term damage.

Brian's ECG results are back.

Dr Wilson checks them over.

It looks fine to me, he's not complaining of chest pain,

so we're not worried about any sort of cardiac event.

Sometimes chemical abnormalities can cause some abnormalities

on the ECG reading, but there's no sign of that at the moment.

But we'll probably have to repeat that to see if there's any changes later on.

With the ECG looking clear, Brian is now having the last of his tests.

A chest X-ray will show if the chemical inhalation

has caused fluid to leak onto his lungs.

OK, if you breathe in now...

Hold your breath.

And breathe away normally again.

OK. That's you all done.

With the scans complete and back in Resus,

Brian is going to be moved onto the ward overnight.

He'll continue to be monitored, but so far, all the team's

investigations, including the chest X-ray, have come back satisfactory.

It's quite likely that he could be discharged tomorrow.

It depends... If he stays like this, certainly,

I'm sure he'll be fine to go.

We'll have a chat with the consultant tomorrow, though,

just to see whether he wants to do a repeat X-ray, for example,

or repeat the bloods to see if there's any abnormalities.

But, clinically, if he remains like this,

he should be OK to get away tomorrow.

He's all done and dusted as far as we're concerned,

so he can just go up to the ward

and the nurses will observe him overnight up there,

and keep giving him his fluids, and...

..hopefully he'll get some sleep.

With any luck, after a peaceful night's sleep on dry

land and a few final checks tomorrow, Brian will be free

to get back to his fishing trawler in the morning.

In consulting room two, senior doctor Kushik Lalla is supervising

a delicate and awkward procedure for junior doctor Aideen Carroll.

Having had a piercing six weeks ago, local primary school teacher

Jennifer has come in to have it removed,

after it became infected over the past couple of days.

What we're going to do is just turn the ear over like that.

-Mm-hm.

-Yeah? And we'll work with it like that.

-Now, Jennifer, I'm just going to raise you a little bit. So...

-OK.

..don't try rolling off!

Just go to one side, if you go to the...

Yeah, down there. And go fairly superficial, so don't point down.

Yeah.

OK. A bit stingy now.

Sharp scratch.

Go in more. Go in more.

Don't go deep, go parallel to the skin.

Lower your needle.

And come all the way out now.

-Yeah.

-Because she won't feel very much now.

And then... So...

..like I said. Yeah, that's a good blood supply. Yep.

So that will be the ear well anaesthetised now, just in this area.

Right, so that's the worst of it done.

OK.

With the anaesthetic administered,

it's time for Dr Carroll to start the procedure.

Single incision. Yeah.

Go from one edge of the lump to the other.

-You're doing really well.

-Mm-hm.

Yeah. Keep going, keep going.

That's it.

That's it.

-Sore if I do that?

-Yeah.

Yeah.

-I'm just putting the local in.

-Nice deep breaths.

You're doing really well.

So...

Now that we've got that one controlled here...

Is it coming off?

And...

Put it on the back over here.

Clip it on.

Yeah. Clip it.

Just trying to secure the bit at the back, cos it's not going.

Yeah.

Put that over there. Good.

So, that's the earring out now.

OK, that's good.

Give it a clean. Give it a clean and then just squeeze with a dry swab.

-Mm-hm.

-And then...

-Just for haemostasis?

-Yeah.

And then Thelma will fashion one of her executive dressings!

Having eventually unscrewed the earring and removed it,

Dr Carroll can tick another procedure off the list.

That was fine, that was your first one.

-It was tricky.

-You know, as time goes on,

you're just giving the local, make your incision, that's it.

The tricky bit is actually holding on to both of them...

-It was holding both of them together and unscrewing them.

-..without it...

And for Jennifer, it might be some time before she'll be visiting a body piercing studio again.

Glad it's over.

I thought getting the piercing was bad enough, but...

getting it out is even worse!

In Vidlin, 22 miles north of Lerwick,

Jan and Pete from Hillswick Animal Sanctuary have been battling

to save a pilot whale which has become confused and disoriented.

It's come so far inland

that we're worried now that it's going to strand.

They've tried to shepherd the whale out to sea with the help of local boat owners.

You don't know anyone with a boat that could help us, do you?

Thanks to a pair of kayakers,

they've been able to move the whale away from the shore,

preventing it from beaching itself overnight.

Have we got a signal...?

A new dawn.

No new luck.

The whale still appears confused.

We got a phone call at four o'clock this morning to say that

the whale had stranded on the slipway,

and when we got here, it was swimming about further in,

but now it's just doing constant circles.

They have one boat,

but Jan isn't convinced it's enough to drive the whale out to sea.

What we need is more than one boat, preferably three or four,

to try and get it out into the open sea.

Because if it carries on just lying here, circling,

it's not going to be a happy ending.

And Jan's prayers have been answered.

A second inflatable boat has arrived.

A second boat, hooray!

Whether we'll even manage it with two, I don't know,

but I know I want to be able to walk away from here saying

we did everything we could for it.

The pilot whale rescue team get on the water.

Here we go.

But even with two boats, the whale's proving impossible to usher out of the marina.

Wherever Jan and Pete position the boat, they can't seem

to guide the whale around the headland and into the open water.

But to add wind to their sails,

three local lads appear in a rowing boat,

and are immediately pressed into service.

You boys, could you go in the corner

and try and keep him out of the shallow bit?

Good lads. Sit there, that's it, sit there.

Careful, guys.

Oh, it's coming in again.

It's a delicate operation.

Does not want to go out of there.

The boats are so close to the whale, they're in danger of it

swimming into a propeller, which could cause a serious injury.

Off you go, off you go. Off you go.

Thankfully, with a bit of encouragement...

-Come on!

-..the whale finally gets the idea.

Hooray!

After two days of persuasion,

now it's just a matter of guiding it back out towards the open water.

Hooray! Hooray!

The rescue operation is a success, with the whale safely out to sea.

Well, we did it!

After spending the night in Lerwick,

Brian made it back to his fishing trawler the next day.

School teacher Jennifer doesn't have any plans for a new ear piercing.

And after spending eight weeks in Aberdeen Royal Infirmary,

Alec had a successful triple heart bypass,

and is now safely back home on Shetland.