0:00:02 > 0:00:05Shetland, the most remote part of the UK.
0:00:06 > 0:00:09Here, you're closer to the Arctic Circle than you are to London
0:00:09 > 0:00:12and nearer Norway than you are to Edinburgh.
0:00:13 > 0:00:16There are more puffins than people
0:00:16 > 0:00:18and more seals than supermarkets.
0:00:20 > 0:00:24But this wild landscape is also home to 23,000 islanders.
0:00:25 > 0:00:29They're so far from the mainland that when things go wrong...
0:00:29 > 0:00:32A&E, can I help you?
0:00:32 > 0:00:35From helicopter rescues and spinal injuries...
0:00:35 > 0:00:38We're all here to make sure that you're OK.
0:00:38 > 0:00:39..to serious medical mysteries...
0:00:39 > 0:00:43Can we get assistance in, please? Something's not right.
0:00:43 > 0:00:45..Shetland's island medics have to be ready
0:00:45 > 0:00:47for anything and everything.
0:00:47 > 0:00:50- What happened? - I got in a fight with a seagull.
0:00:50 > 0:00:52- This was sheep shears, was it? - Yeah.
0:00:54 > 0:00:57It means the tight-knit team of medics, volunteers
0:00:57 > 0:01:00and emergency services have a special bond.
0:01:00 > 0:01:01This might tickle then.
0:01:03 > 0:01:06And they know just how to keep each other going...
0:01:06 > 0:01:08Wee treat for night shift.
0:01:08 > 0:01:11..so they're always ready for any island emergency.
0:01:21 > 0:01:23Today, a seriously ill sailor,
0:01:23 > 0:01:26plucked from his boat and rushed to A&E.
0:01:26 > 0:01:29Your blood pressure's a wee bit on the low side.
0:01:29 > 0:01:32We meet Britain's most northerly full-time GP.
0:01:32 > 0:01:34Shetlanders tend to be huge stalwarts.
0:01:34 > 0:01:38Four weeks after having a stroke, they arrive at the surgery.
0:01:38 > 0:01:42And 56 years of marriage are on the line.
0:01:42 > 0:01:44Is this your wedding ring?
0:01:44 > 0:01:47- Yeah, 56 years. - We'll try and save it.
0:01:49 > 0:01:52SEAGULL CRIES
0:01:55 > 0:01:58For the thousands of visitors that alight on Shetland each year,
0:01:58 > 0:02:02its rugged landscape is as fascinating as it is daunting.
0:02:04 > 0:02:09But for its 23,000 inhabitants, it's simply home,
0:02:09 > 0:02:12a home that comes with its own unique pleasures and pressures.
0:02:15 > 0:02:18When things go wrong, as they do...
0:02:18 > 0:02:20I fell off a Shetland pony.
0:02:21 > 0:02:25..they turn to the good men and women of the Gilbert Bain Hospital
0:02:25 > 0:02:29and the emergency services who keep these remarkable islands running.
0:02:33 > 0:02:37Leading the team in A&E is Dr Kushik Lalla.
0:02:37 > 0:02:40Your guess is as good as mine.
0:02:40 > 0:02:42Dr Lalla is originally from South Africa
0:02:42 > 0:02:44but has settled in Shetland
0:02:44 > 0:02:47- because it offers a unique medical challenge.- I love it
0:02:47 > 0:02:49because of the combination of patients,
0:02:49 > 0:02:52so we have very nice patients.
0:02:52 > 0:02:54I've worked throughout the UK
0:02:54 > 0:02:57and the quality of patients we have here is fantastic.
0:02:57 > 0:02:59Patients actually say thank you.
0:02:59 > 0:03:03The other reason I like it here is it is unstructured,
0:03:03 > 0:03:07in that anything could walk through the door,
0:03:07 > 0:03:11so it's a very wide range of things that we see.
0:03:11 > 0:03:14Every day is different. I like that.
0:03:14 > 0:03:18Right, Mr Irvin, let me get you onto that couch.
0:03:18 > 0:03:21James, a 72-year-old shopkeeper from Levenwick,
0:03:21 > 0:03:24is next on Dr Lalla's list for treatment.
0:03:24 > 0:03:27He's a guy that had a knee replacement
0:03:27 > 0:03:30carried out two weeks ago in Glasgow.
0:03:30 > 0:03:34He was seen today by GPs.
0:03:34 > 0:03:37They noticed that the knee looks infected.
0:03:37 > 0:03:42Quick thinking by James's GP got him into hospital in the nick of time.
0:03:42 > 0:03:47If it is infected, it's going to be a nightmare for him
0:03:47 > 0:03:50because the only way we'd be able to settle that infection
0:03:50 > 0:03:52is to remove the prosthesis.
0:03:52 > 0:03:55Although he looks OK, he's actually quite unwell at the moment.
0:03:55 > 0:03:59He is tachycardic which means his heart is racing.
0:03:59 > 0:04:03It's running at a rate of about 130 at the moment,
0:04:03 > 0:04:06so what we need to do is examine that knee,
0:04:06 > 0:04:08swab there and see what we grow,
0:04:08 > 0:04:11and that will help us target the antibiotics we use.
0:04:18 > 0:04:21Being a medic here isn't just about accidents and emergencies.
0:04:23 > 0:04:27Shetlanders are scattered across 15 different islands,
0:04:27 > 0:04:30which requires a network of 20 far-flung GPs to look after them.
0:04:37 > 0:04:42Britain's most northerly permanent GP is Dr Susan Bowie.
0:04:45 > 0:04:49Her practice covers 77 square miles of Northmavine Peninsula,
0:04:49 > 0:04:51right at the top of Shetland's mainland.
0:04:53 > 0:04:56Unlike many GPs these days,
0:04:56 > 0:05:00she knows each and every one of her 760 patients personally.
0:05:01 > 0:05:04- Alison.- Hi.- Come on through.
0:05:07 > 0:05:10First patient in at quarter to ten, which I've not changed
0:05:10 > 0:05:13since my children were at nursery,
0:05:13 > 0:05:15and I see patients every 15 minutes.
0:05:15 > 0:05:19I can't do it really any sooner. I tried but I just can't.
0:05:19 > 0:05:20They need the full 15 minutes.
0:05:20 > 0:05:23Now, big open mouth. Can you say, "Ah" for me?
0:05:23 > 0:05:27- Ah.- And again.- Ah. - Stick your tongue out for me.
0:05:27 > 0:05:30Looks all right, it's just a bit red. It's looking a bit viral.
0:05:30 > 0:05:33- Thank you very much.- It's OK. Are you happy with that?
0:05:33 > 0:05:36- It's nice to see you again. - Yeah, nice to see you too.
0:05:36 > 0:05:40- Oh, dear. Lovely. And the weather's clearing up.- I know.
0:05:40 > 0:05:44- It's lovely, so you might get out in the garden.- Out in the garden.- Yes.
0:05:44 > 0:05:45THEY LAUGH
0:05:49 > 0:05:52Before she honed her impeccable bedside manner,
0:05:52 > 0:05:54her first encounter with the Shetland Isles
0:05:54 > 0:05:56had a distinctly fishy start.
0:05:58 > 0:05:59This is one of my favourite places.
0:05:59 > 0:06:01It took me a while to discover it though.
0:06:01 > 0:06:07Originally, I came to Shetland when I was a student.
0:06:07 > 0:06:10I got a job in the fish factory, making kippers.
0:06:10 > 0:06:15And we had just the best... It was just the best summer job.
0:06:15 > 0:06:17It was just great fun.
0:06:17 > 0:06:22A few years later, when I was a GP, I was in between jobs
0:06:22 > 0:06:24and there was a job came up in Shetland and I thought,
0:06:24 > 0:06:30"I'll just go for six months, a year, just see how I get on."
0:06:30 > 0:06:34And I just loved it and I just stayed and stayed and stayed
0:06:34 > 0:06:37and that was 33, 34 years ago.
0:06:40 > 0:06:42It's a rock and roll lifestyle.
0:06:42 > 0:06:43Not!
0:06:43 > 0:06:48- Now, Stuart.- Come on down. - Come on down.- The price is right.
0:06:48 > 0:06:50Come on through.
0:06:51 > 0:06:53Let's see what your weight's doing.
0:06:53 > 0:06:55The main thing is keeping your weight down.
0:06:57 > 0:07:00- I'd like to be half a stone lighter. - Mm-hmm.
0:07:00 > 0:07:03Some people will run to their local GP
0:07:03 > 0:07:05at the merest suggestion of a sniffle, but not here.
0:07:07 > 0:07:09Shetlanders tend to be huge stalwarts
0:07:09 > 0:07:13so, four weeks after having what they thought might be a stroke,
0:07:13 > 0:07:15they arrive at the surgery,
0:07:15 > 0:07:20rather than coming on the same day or the day later,
0:07:20 > 0:07:24so that can be really tricky, trying to sort things out.
0:07:24 > 0:07:28You know me. I'll suffer for a while before I take action.
0:07:28 > 0:07:30I know, you're not a complainer.
0:07:30 > 0:07:33And eight years is probably enough
0:07:33 > 0:07:36to mean that we should ask for a wee bit of help with that.
0:07:36 > 0:07:38- OK. Thank you.- OK, Stuart. - Thank you, Susan.
0:07:38 > 0:07:41- See you later.- Cheerio. Thank you.
0:07:53 > 0:07:55Doctors at the Gilbert Bain can deal
0:07:55 > 0:07:58with life-threatening situations one moment
0:07:58 > 0:08:00and something more minor the next.
0:08:00 > 0:08:02But even the less serious cases make
0:08:02 > 0:08:04a world of difference to their patients.
0:08:04 > 0:08:07I've been asked to see a lady that's got a swollen finger.
0:08:07 > 0:08:10Her ring is very tight on her finger and it needs to be removed
0:08:10 > 0:08:12because it's going to stop the circulation.
0:08:12 > 0:08:14Sometimes we can remove that
0:08:14 > 0:08:15but it's far too tight for that.
0:08:15 > 0:08:17We're going to have to cut it off, in this case.
0:08:19 > 0:08:20Hello?
0:08:22 > 0:08:26- Hi, it's just me. Have you ever had a ring removed before?- No, no.
0:08:29 > 0:08:33- Is the finger sore?- Sore? - Is it sore, is it painful?
0:08:33 > 0:08:37- In the joint, when I move it, yeah. - So, that's going to be broken there.
0:08:37 > 0:08:39- You think so?- Yeah.
0:08:39 > 0:08:44- Is this your wedding ring? - Yeah, 56 years it's been on there.
0:08:44 > 0:08:46We'll try and save it, OK.
0:08:46 > 0:08:49I don't think there's any way that's going to come with the tape.
0:08:49 > 0:08:53Despite all the medical technology and equipment on offer,
0:08:53 > 0:08:55sometimes the simplest of solutions
0:08:55 > 0:08:57and materials can make all of the difference.
0:08:59 > 0:09:01It's very, very tight.
0:09:01 > 0:09:06We're not promising that we can, but let's see what we can do.
0:09:10 > 0:09:14- You'll try and pull it up?- Yeah, you drive the fluid out of the finger.
0:09:15 > 0:09:18Just bend your little pinky. There you are.
0:09:18 > 0:09:22Sorry, it might...it will be getting sore
0:09:22 > 0:09:24because that finger is probably broken,
0:09:24 > 0:09:27but the alternative is to cut the ring.
0:09:32 > 0:09:34Just pull on this, because as you pull on this,
0:09:34 > 0:09:36it will slide the ring down.
0:09:38 > 0:09:41- Can I have some more soap, please? - Mm-hmm.
0:09:42 > 0:09:46- I don't think it's going to come. - It's very, very swollen, isn't it?
0:09:46 > 0:09:50That's because we're letting the pressure round that side.
0:09:52 > 0:09:53That's a small ring, isn't it?
0:10:02 > 0:10:0456 years?
0:10:04 > 0:10:05You're going.
0:10:07 > 0:10:11- Right, well at least the wedding ring's saved.- Yay.
0:10:11 > 0:10:1456 years, I think... We can take it from there.
0:10:14 > 0:10:18Patience and dedication - the recipe for a ring removal,
0:10:18 > 0:10:19as well as a long marriage.
0:10:27 > 0:10:32We're expecting a patient in who's having a fit, a seizure.
0:10:32 > 0:10:35So, we're just preparing everything for that.
0:10:35 > 0:10:36It's 09, Kathy. It's Michael.
0:10:36 > 0:10:38They'll be here in about five minutes,
0:10:38 > 0:10:40so we'll just get as much prepared as we can.
0:10:42 > 0:10:4635-year-old Shetlander David has been rushed into resus,
0:10:46 > 0:10:48after suffering a seizure.
0:10:50 > 0:10:53The team have to settle him in and order a raft of tests
0:10:53 > 0:10:56to ascertain what effects the fit has had on his body.
0:11:00 > 0:11:03On duty today is junior doctor Michael Stewart,
0:11:03 > 0:11:05who's originally from Aberdeen,
0:11:05 > 0:11:07but has fallen in love with the islands,
0:11:07 > 0:11:10since he came for a year-long placement.
0:11:10 > 0:11:11Shetland's amazing.
0:11:11 > 0:11:15You get completely varied stuff every day.
0:11:15 > 0:11:16It's always different stuff
0:11:16 > 0:11:18and we have to kind of be able to deal with it.
0:11:18 > 0:11:21OK, so how many seizures have you had?
0:11:21 > 0:11:23And do you remember what medicines you take?
0:11:23 > 0:11:25Well, epilepsy drugs at the minute.
0:11:25 > 0:11:29- Right. And do you know if you took it today?- Yeah, I've taken it.
0:11:29 > 0:11:34- Yeah. How are you feeling now? - I don't feel that great.
0:11:34 > 0:11:38It's possible that David is suffering from epilepsy,
0:11:38 > 0:11:40which affects half a million people in the UK,
0:11:40 > 0:11:43and the effects of the fits can be life-threatening.
0:11:43 > 0:11:45There you go, I'll just lift this up.
0:11:45 > 0:11:48If you take some deep breaths in and out through your mouth for me.
0:11:48 > 0:11:50Epilepsy most often begins in childhood.
0:11:50 > 0:11:54Unusually, David's fits have only started in the last few months
0:11:54 > 0:11:56but have had such a severe effect,
0:11:56 > 0:11:58he's been forced to give up his day job.
0:11:58 > 0:12:00I was just walking out my room.
0:12:00 > 0:12:04I was walking downstairs and I just got paralysed.
0:12:04 > 0:12:08I got paralysis today, first and foremost in the left arm,
0:12:08 > 0:12:11and then the rest of my body can't move. It's horrible.
0:12:11 > 0:12:15It lasts about ten seconds and then I just blank.
0:12:15 > 0:12:20And next I know...the ambulance people are there.
0:12:20 > 0:12:22The results of David's tests are good.
0:12:22 > 0:12:25While they don't explain his fit,
0:12:25 > 0:12:28they show that his seizures have not had a serious effect on his health.
0:12:28 > 0:12:30All of your blood results are back
0:12:30 > 0:12:32and they're totally fine, which is excellent.
0:12:32 > 0:12:36And the ECG, the tracing of your heart, is fine as well.
0:12:36 > 0:12:42So, I think that nothing, there's nothing new which has changed,
0:12:42 > 0:12:44compared to your other seizures.
0:12:44 > 0:12:47However, obviously, we still have the problem
0:12:47 > 0:12:50that you've had a seizure and we still don't know why.
0:12:50 > 0:12:53You've now had three and we don't know why.
0:12:54 > 0:12:56It's going to take specialist diagnosis
0:12:56 > 0:12:58to get to the root of what's causing these fits -
0:12:58 > 0:13:02a diagnosis that can only take place on the mainland.
0:13:02 > 0:13:05The nearest neurologist is based in Aberdeen,
0:13:05 > 0:13:07a 12-hour ferry ride away
0:13:07 > 0:13:10and, since David has an appointment scheduled there next week,
0:13:10 > 0:13:13there's little else Dr Stewart can do for him.
0:13:13 > 0:13:15He doesn't need anything fancy today from us,
0:13:15 > 0:13:20just we're going to increase his anti-epileptic medication
0:13:20 > 0:13:23and make sure that he's safe to go home,
0:13:23 > 0:13:25he's got someone to look after him when he gets there.
0:13:25 > 0:13:28The seizures are quite distressing to witness, you know.
0:13:28 > 0:13:30They look horrible
0:13:30 > 0:13:34but, actually, you can let them run their course
0:13:34 > 0:13:39and there's no need for you to stay in hospital.
0:13:40 > 0:13:43David heads home to rest and recover,
0:13:43 > 0:13:45hoping his neurological appointment next week
0:13:45 > 0:13:47will give him the answers he needs.
0:13:55 > 0:13:58The North Sea is a treacherous place to work,
0:13:58 > 0:14:01even for the thousands of highly trained sailors, fishermen
0:14:01 > 0:14:04and oil workers, who make a living off Shetland's coast.
0:14:07 > 0:14:08When accidents happen,
0:14:08 > 0:14:12it's often the job of the volunteers from the RNLI
0:14:12 > 0:14:15and the expert flyers in the coastguard's helicopters
0:14:15 > 0:14:17who can be the difference between life and death.
0:14:17 > 0:14:21Rescues are tricky enough in calm seas and on sunny days
0:14:21 > 0:14:23but, when the weather closes in,
0:14:23 > 0:14:26that's when things can become challenging.
0:14:32 > 0:14:36The staff at Coastguard HQ have been alerted to an evolving situation
0:14:36 > 0:14:39100 miles offshore in the North Sea.
0:14:41 > 0:14:45They elect to scramble one of their helicopters to the incident.
0:14:46 > 0:14:49Morten Sorensen, a Danish cook, has been taken ill
0:14:49 > 0:14:53on a supply vessel and the great distance to Bergen in Norway
0:14:53 > 0:14:56and storms in Aberdeen mean the only option
0:14:56 > 0:14:58is to fly him to Shetland.
0:14:58 > 0:15:01It is dangerous.
0:15:01 > 0:15:03Fear's the wrong word to use but you're always sort of
0:15:03 > 0:15:07conscious of what you're doing. It's pretty tasking sometimes.
0:15:08 > 0:15:11Paramedics are rushing to meet the coastguard at Tingwall Airport,
0:15:11 > 0:15:13which is nestled in a sheltered valley,
0:15:13 > 0:15:15six and a half miles north of Lerwick.
0:15:15 > 0:15:17We got a call
0:15:17 > 0:15:20to say a gentleman was being flown into Tingwall Airport
0:15:20 > 0:15:24by the coastguard helicopter, that he'd been unwell for some days
0:15:24 > 0:15:27and they felt he needed to be medevacked off.
0:15:28 > 0:15:31Normally for the landing site at Tingwall Airport,
0:15:31 > 0:15:34coastguards will have quite a few people there
0:15:34 > 0:15:37and quite often they help with off-loading patients.
0:15:40 > 0:15:44It's a delicate operation, as he's barely conscious and is very ill,
0:15:44 > 0:15:47so it's vital he's moved smoothly.
0:15:59 > 0:16:01With the patient safely onboard,
0:16:01 > 0:16:04the ambulance sets off on the winding journey to A&E,
0:16:04 > 0:16:08where nurse Thelma Irvine and the team have been alerted
0:16:08 > 0:16:09and are preparing for their arrival.
0:16:09 > 0:16:12As soon as he's out of the ambulance,
0:16:12 > 0:16:14Morten is straight into resus,
0:16:14 > 0:16:16where nurse Thelma makes him comfortable.
0:16:18 > 0:16:23- He's a diabetic gentleman. Blood sugar's 9.3.- OK.
0:16:23 > 0:16:24Blood pressure less.
0:16:24 > 0:16:28- He just seems not himself. - Not himself.
0:16:28 > 0:16:30- Do you want him out of his...?- Yeah.
0:16:30 > 0:16:32- Hi, I'm Thelma.- Hi, Thelma.
0:16:32 > 0:16:36- And your name was?- Morten.- Morten.
0:16:36 > 0:16:39Any past medical history we should know about?
0:16:39 > 0:16:43- There's your diabetes. You're diabetic.- Yeah, I'm diabetic.
0:16:43 > 0:16:46- Type II diabetic or...? - Type II.- Yes.
0:16:49 > 0:16:51Your blood pressure's a wee bit on the low side,
0:16:51 > 0:16:55- so I'm going to pop a wee cannula in the back of your hand, OK?- Yes.
0:16:55 > 0:16:57I'm going to take some blood tests as well
0:16:57 > 0:17:00but I'll have that cannula there, should we need to give you
0:17:00 > 0:17:04- any medication or any fluids through that. Is that OK?- Yes, that's OK.
0:17:04 > 0:17:07Morten is stable but is very sick
0:17:07 > 0:17:09and the team still have to find out
0:17:09 > 0:17:11what the root cause of his condition is.
0:17:15 > 0:17:17SEAGULL CRIES
0:17:22 > 0:17:26Shetland's economy is based around three industries -
0:17:26 > 0:17:29North Sea oil, tourism and fishing.
0:17:29 > 0:17:33The islands fleet lands £79 million-worth of fish a year,
0:17:33 > 0:17:35meaning it's big business.
0:17:37 > 0:17:40But fishing is also a popular island pastime for many,
0:17:40 > 0:17:43who take to the water whenever they can to take advantage
0:17:43 > 0:17:46of some of the best fishing marks in the UK.
0:17:46 > 0:17:50Amongst that number is A&E's nurse Thelma.
0:17:51 > 0:17:54- Morning.- Today, she is meeting her old friend David.
0:17:54 > 0:17:57- It's still morning.- Afternoon. - Is it? Oh, it is afternoon.
0:17:57 > 0:18:00They're taking his boat out on a fishing expedition
0:18:00 > 0:18:02from Lerwick Marina.
0:18:02 > 0:18:06It's always a nice feeling going off fishing, just on the open water.
0:18:06 > 0:18:09It's a nice bit of relaxation after a busy shift.
0:18:09 > 0:18:11I've been fishing since I was quite young.
0:18:11 > 0:18:15I used to go fishing with my dad, just off on a wee open boat.
0:18:29 > 0:18:31Safely out of the harbour,
0:18:31 > 0:18:34nurse Thelma can't resist getting her foot down.
0:18:34 > 0:18:37We're on the way. It's a little bit breezy but it's not too bad.
0:18:37 > 0:18:40And before long, they've reached Flossy Knowes,
0:18:40 > 0:18:42some 20 miles from Lerwick,
0:18:42 > 0:18:46and prime hunting ground for mackerel, pollack, haddock and ling.
0:18:46 > 0:18:48It's lovely. It's really nice.
0:18:48 > 0:18:50It's nice to get off in the boat,
0:18:50 > 0:18:56just to be in that sort of nice sea air. It's so relaxing.
0:18:56 > 0:18:58But nurse Thelma and David aren't the only ones
0:18:58 > 0:19:00hoping to catch their tea today.
0:19:00 > 0:19:03SEAGULLS CAW
0:19:06 > 0:19:10It's amazing. You can understand why I enjoy going out here.
0:19:10 > 0:19:14With the bait set, all that remains is to wait.
0:19:31 > 0:19:36Two weeks ago, I caught a 133-pound common skate,
0:19:36 > 0:19:39which was two metres long
0:19:39 > 0:19:44and it was three kilograms heavier than me, so it was quite a big fish.
0:19:46 > 0:19:48And it looks like she's in luck again.
0:19:51 > 0:19:53Easy, Thelma, easy.
0:19:54 > 0:19:56Easy.
0:19:56 > 0:19:58Go on, pull it up.
0:20:04 > 0:20:05Yeah, a big one.
0:20:16 > 0:20:21It's not bad! Fillet it and smoke it, hot smoke.
0:20:22 > 0:20:24Quite tasty.
0:20:24 > 0:20:26That's tea sorted.
0:20:26 > 0:20:30So, it's pedal to the metal, back to the marina,
0:20:30 > 0:20:32where they find some familiar locals
0:20:32 > 0:20:35who are more than happy to share in the day's triumph.
0:20:38 > 0:20:39Aw...
0:20:41 > 0:20:44- The best man wins. - THEY LAUGH
0:20:53 > 0:20:56David, who was discharged less than an hour previously,
0:20:56 > 0:20:58following a seizure, is back,
0:20:58 > 0:21:00after hitting his head during another fit.
0:21:02 > 0:21:04Dr Helen Hare is on duty.
0:21:04 > 0:21:07- Hi, there. Is it David?- Yeah. - Hello, my name's Dr Hare.
0:21:07 > 0:21:11I understand that you were in with us, having had a seizure,
0:21:11 > 0:21:15- and then you've had another one since going home?- Yeah.
0:21:15 > 0:21:19Yeah, I went home, I ate my tea and then I had a...
0:21:19 > 0:21:25- My left arm just shot up and I went into a horrible spasm.- Yeah.
0:21:25 > 0:21:28It was like the whole left arm was completely paralysed.
0:21:28 > 0:21:31- It was like my left arm's been hit by lightning.- OK.
0:21:31 > 0:21:34- And the rest of my body, I can't move it at all.- Yep.
0:21:34 > 0:21:36And how you feeling at the moment?
0:21:36 > 0:21:39I'm feeling a bit sick and feeling a bit nauseous.
0:21:40 > 0:21:42I'm struggling to swallow for some reason.
0:21:42 > 0:21:44Obviously, you've been examined already,
0:21:44 > 0:21:47so I won't replicate too much of that, but we better have
0:21:47 > 0:21:51a bit of a look at your head and the bits that are sore just now.
0:21:51 > 0:21:55Yeah, you've got a nasty whack on the top of your scalp here.
0:21:55 > 0:21:57An egg there.
0:21:58 > 0:22:01Can you sit up for me, David? Turn yourself over a wee bit in the bed.
0:22:01 > 0:22:04- I'm struggling. - What's the difficulty?
0:22:04 > 0:22:06Moving my left...
0:22:08 > 0:22:10Yeah, moving, moving the left...
0:22:10 > 0:22:13Does it feel that it won't move or is it just painful?
0:22:13 > 0:22:17- It's just a bit... It feels weak.- Weak, OK.
0:22:18 > 0:22:22Oh, God... Sorry, it felt like it was going to go again.
0:22:23 > 0:22:26Let me move this arm first of all. So, just let it go totally floppy.
0:22:26 > 0:22:29Obviously, he's feeling a bit rotten.
0:22:29 > 0:22:34He's grappling with this new not-quite diagnosis at the moment.
0:22:34 > 0:22:38So, he knows he's having seizures but we don't really know why.
0:22:40 > 0:22:44It's still unclear if it is epilepsy that's causing David's seizures.
0:22:44 > 0:22:48But Dr Hare is adamant that he keeps taking his medication.
0:22:48 > 0:22:50It's very important that you take these drugs,
0:22:50 > 0:22:52even if we don't get you seizure-free,
0:22:52 > 0:22:54because there is a risk
0:22:54 > 0:22:57- of what's called sudden unexplained death in epilepsy.- Right.
0:22:57 > 0:23:00So that, as it sounds, is death,
0:23:00 > 0:23:03out of the blue, in people who have epilepsy.
0:23:03 > 0:23:07And we know that even if you don't get seizure-free on medicines,
0:23:07 > 0:23:11your risk of dying is much, much reduced if you're taking medicines.
0:23:11 > 0:23:13- Right.- So, even if it doesn't feel like we're winning,
0:23:13 > 0:23:15there's still a benefit to taking these drugs.
0:23:16 > 0:23:19Because he's had a head injury, we need to bring him in,
0:23:19 > 0:23:20just to keep an eye on him.
0:23:20 > 0:23:24We'll make sure that his head injury doesn't cause any problems.
0:23:24 > 0:23:27And fingers crossed, we'll get him home tomorrow.
0:23:29 > 0:23:31That's good.
0:23:36 > 0:23:40James the shopkeeper has responded well to antibiotics
0:23:40 > 0:23:42and his heart rate has settled enough for him
0:23:42 > 0:23:46to be transferred to Glasgow for further treatment on his knee.
0:23:49 > 0:23:52- OK? All the best. - I hope I don't need it.
0:23:52 > 0:23:54You'll be fine, you'll be fine.
0:23:54 > 0:23:57We are going to get the air ambulance going out today.
0:23:57 > 0:23:59This is the gentleman with the infected knee.
0:23:59 > 0:24:04There are over 220 flights a year taking the sick and injured
0:24:04 > 0:24:05from Shetland to the mainland.
0:24:05 > 0:24:07So, he's going to go back down to Glasgow,
0:24:07 > 0:24:09where they did the original operation
0:24:09 > 0:24:12and they're going to take him and probably wash out that knee today
0:24:12 > 0:24:15and see what they can do for him.
0:24:15 > 0:24:18And it's a first-class service all the way.
0:24:21 > 0:24:25Night shifts aren't the most popular in A&E, as they can drag.
0:24:25 > 0:24:28Nurse Thelma's baking often helps get the team
0:24:28 > 0:24:30through the wee small hours.
0:24:30 > 0:24:32A wee treat for night shift.
0:24:32 > 0:24:35- Pudding?- Thank you very much. - You don't have to eat it.
0:24:35 > 0:24:37Mm, it's still warm.
0:24:37 > 0:24:39Our nurses are fantastic.
0:24:40 > 0:24:42Better not let them hear me saying that.
0:24:42 > 0:24:45There's nowhere else where you get home bakes.
0:24:45 > 0:24:48They bake tons of stuff and they bring it in.
0:24:49 > 0:24:51Thank you, Thelma.
0:24:51 > 0:24:53This is lovely.
0:24:56 > 0:24:58OWL HOOTS
0:24:58 > 0:25:02And this night was proving to be an especially long one for John.
0:25:02 > 0:25:07John was a 56-year-old gentleman who had been having some pain
0:25:07 > 0:25:10that he'd been having for two days,
0:25:10 > 0:25:12varying in severity,
0:25:12 > 0:25:14and then this evening, had been very severe.
0:25:14 > 0:25:17- Where's your pain at? Is it in a specific point?- It's here.
0:25:17 > 0:25:21- So, it's just in the back, right side.- Yeah.
0:25:21 > 0:25:23He's in agony.
0:25:23 > 0:25:24Before a doctor can see him,
0:25:24 > 0:25:27the nurses need to make him more comfortable.
0:25:27 > 0:25:28OK, lay back.
0:25:28 > 0:25:30OK.
0:25:30 > 0:25:35Is that more comfortable for you lying down or not really?
0:25:35 > 0:25:38- Hello. - I'll just be back in a moment.- Hi.
0:25:38 > 0:25:42Dr Ashley Thomson comes in to try to get to the cause of the pain.
0:25:42 > 0:25:44Did it start suddenly or gradually?
0:25:44 > 0:25:47- Yesterday it started in the early evening.- OK.
0:25:47 > 0:25:51So, it comes sudden, but it builds up.
0:25:51 > 0:25:54Can you describe the pain for me? What does it feel like?
0:25:54 > 0:25:56Is it a sharp pain or an ache?
0:25:56 > 0:25:58- Bloody sore.- Bloody sore.
0:26:00 > 0:26:03What I need to do is just lie you down flat,
0:26:03 > 0:26:06so I'll just pop the head of the bed down. Ooh, sorry.
0:26:06 > 0:26:09Now, I'm going to have a feel of your back here.
0:26:09 > 0:26:14- Any pain on this side?- Some. - Is that a bit tender there?- Yes.
0:26:14 > 0:26:16John has a history of kidney stones
0:26:16 > 0:26:19and Dr Thomson suspects they may have returned.
0:26:19 > 0:26:23This, from what you're telling me, sounds very much like renal colic,
0:26:23 > 0:26:26which is the fancy word for kidney stones.
0:26:28 > 0:26:31They can be extremely excruciatingly painful and they're more common,
0:26:31 > 0:26:35if you've had them in the past, to reappear.
0:26:35 > 0:26:38The patients who you see with kidney stones are quite often
0:26:38 > 0:26:42writhing around in pain, very excruciating.
0:26:42 > 0:26:44Not that anybody has ever stabbed me before,
0:26:44 > 0:26:49but you feel as if somebody is sticking a knife into your back
0:26:49 > 0:26:51and grinding it around.
0:26:51 > 0:26:54But treatment for the pain has a catch.
0:26:54 > 0:27:00A very good pain relief for this type of pain is a medication
0:27:00 > 0:27:02that we give up the back passage
0:27:02 > 0:27:05so, if you're happy to do that yourself and insert it,
0:27:05 > 0:27:08we've got that right here for you.
0:27:08 > 0:27:12- I'll leave you in peace to administer this.- OK.
0:27:12 > 0:27:15We'll see how that helps things. Would that be OK?
0:27:15 > 0:27:16- That'll be fine.- OK.
0:27:19 > 0:27:21What's that? No!
0:27:21 > 0:27:24We tested his urine, which showed that he had quite a lot of blood
0:27:24 > 0:27:28in his urine that wasn't able to be seen by the naked eye.
0:27:28 > 0:27:31And that, again, is another marker of kidney stones.
0:27:31 > 0:27:33We'll keep him in overnight, observe him,
0:27:33 > 0:27:36make sure that he is kept nice and comfortable,
0:27:36 > 0:27:39with a view to getting the CT scan in the morning
0:27:39 > 0:27:41which is the gold standard investigation.
0:27:41 > 0:27:46The scan will show us if there is any effect or injury to the kidney.
0:27:46 > 0:27:50For Shetlanders like John, the hospital really is a lifeline,
0:27:50 > 0:27:54allowing him to access first-class treatment close to home.
0:27:54 > 0:27:56But then, we're in good hands here.
0:27:56 > 0:28:01The nurses are all very friendly and the doctors as well.
0:28:01 > 0:28:04Um... And you sometimes tend to know some of them,
0:28:04 > 0:28:06or other people that's in,
0:28:06 > 0:28:11because it's a small local hospital and that makes a big difference.
0:28:11 > 0:28:13John's CT scan will allow doctors
0:28:13 > 0:28:15to see a three-dimensional image of his body.
0:28:15 > 0:28:19- Hello, John Inkster?- Yes. - I'll get you through.
0:28:20 > 0:28:23It works by taking hundreds of X-rays and then modelling them,
0:28:23 > 0:28:26by computer, to show what's going on underneath his skin.
0:28:28 > 0:28:30Surgeons rely on these scans
0:28:30 > 0:28:33to decide which procedures are the most effective.
0:28:35 > 0:28:38It's likely John will need a stent inserted into his kidney
0:28:38 > 0:28:40to help him pass the stone.
0:28:40 > 0:28:43Performing operations like the one John needs
0:28:43 > 0:28:45are a very special breed of surgeon,
0:28:45 > 0:28:48like consultant surgeon Gordon MacFarlane.
0:28:48 > 0:28:51- Carol, is that at the right angle? What do you think?- That's good.
0:28:51 > 0:28:53You're looking very smart now.
0:28:53 > 0:28:56I've started off with a laparoscopic cholecystectomy,
0:28:56 > 0:28:58so that's a keyhole removal of the gall bladder.
0:28:58 > 0:29:01I next have a TURP to take out prostate,
0:29:01 > 0:29:04and then I've got a colonoscopy to finish.
0:29:04 > 0:29:07This breadth of experience means John will be in good hands
0:29:07 > 0:29:09when he enters Mr MacFarlane's theatre tomorrow.
0:29:13 > 0:29:16Danish cook Morten was rescued from a ship
0:29:16 > 0:29:18100 miles out into the North Sea
0:29:18 > 0:29:21by Shetland's coastguards and ambulance,
0:29:21 > 0:29:23and has been stabilised in resus.
0:29:23 > 0:29:25My name is Dr Hare. I'm on call this evening.
0:29:25 > 0:29:28While he's stable, he's very ill,
0:29:28 > 0:29:31and it falls to Dr Hare to find out what's making him so unwell.
0:29:33 > 0:29:36- Have you had any difficulty breathing?- No.
0:29:36 > 0:29:39Any difficulty eating or swallowing?
0:29:42 > 0:29:45- Does anything make the stomach pain worse?- No, actually not.
0:29:45 > 0:29:50- No, OK. Do you feel that you know where you are just now?- Yeah.
0:29:50 > 0:29:52Yeah, OK, OK.
0:29:52 > 0:29:55You're a bit dehydrated at the moment, OK.
0:29:55 > 0:29:57- If we can get stats.- Yeah.
0:30:11 > 0:30:15I think we need to treat this as a sepsis.
0:30:18 > 0:30:19All right.
0:30:19 > 0:30:22- I can't get up.- I'll get your hand.
0:30:22 > 0:30:25Sepsis is an extremely dangerous condition
0:30:25 > 0:30:29where the body's immune system goes into overdrive
0:30:29 > 0:30:30to try and fight an infection.
0:30:31 > 0:30:33It can be fatal.
0:30:37 > 0:30:40While the team are confident that Morten has sepsis,
0:30:40 > 0:30:43they can't pinpoint the cause, which is concerning,
0:30:43 > 0:30:46and a raft of tests need to be carried out.
0:30:46 > 0:30:49Hi, there, is that the lab tech? Hi, it's Helen, the SHO on.
0:30:49 > 0:30:51I'm afraid we need you to come in and do some bloods, please.
0:30:51 > 0:30:55In any big hospital, getting tests and X-rays done
0:30:55 > 0:30:58at any time of the day or night is straightforward.
0:30:58 > 0:31:02But in Shetland, at 1am, it means getting the on-call lab technician
0:31:02 > 0:31:04and radiographer out of their beds.
0:31:04 > 0:31:07Hi, it's Thelma in Casualty. Sorry to wake you at this hour.
0:31:07 > 0:31:10Could we get you in to do some X-rays, please? OK, thank you.
0:31:10 > 0:31:15Bye, bye. Oh, she's just been woken up.
0:31:15 > 0:31:18Yes, I don't think I was quite sympathetic enough to the lab tech.
0:31:20 > 0:31:23People are always a little bit grumpy to be woken but, actually,
0:31:23 > 0:31:26they're entirely keen to be here. They know it's important.
0:31:26 > 0:31:31It also, as a doctor, sort of hones your skills in considering
0:31:31 > 0:31:34whether or not investigations are really necessary.
0:31:34 > 0:31:36In this circumstance, we need answers now
0:31:36 > 0:31:42to assess how unwell Morten is and how we can treat him.
0:31:44 > 0:31:47Fresh out of bed, the radiographer's arrived
0:31:47 > 0:31:50and she wastes no time getting the crucial chest X-rays done.
0:31:51 > 0:31:54Great. Shouldn't be too many of them.
0:31:54 > 0:31:56This is his chest X-ray and it's totally normal,
0:31:56 > 0:31:59but it's important to exclude when someone's unwell
0:31:59 > 0:32:01and you're not sure where it's coming from.
0:32:01 > 0:32:06- It's not chest. Once we've dipped his urine...- Did we get a urine?
0:32:06 > 0:32:08No, I think we're moving to catheterisation.
0:32:08 > 0:32:11But even if it is urine, the amox will hopefully cover that.
0:32:11 > 0:32:14We're not very sure where the infection is.
0:32:14 > 0:32:19Um...he described some pain in his tummy
0:32:19 > 0:32:21and in his shoulder that makes it likely
0:32:21 > 0:32:23that, actually, it's his gall bladder
0:32:23 > 0:32:25that's the source of the infection,
0:32:25 > 0:32:28so that's what we're treating him for at the moment.
0:32:28 > 0:32:31We've got him stable now and we're going to move him up to the ward,
0:32:31 > 0:32:33where the fluids and the antibiotics will continue overnight.
0:32:33 > 0:32:36So, a night on the wards beckons for Morten.
0:32:36 > 0:32:38Hopefully those antibiotics will kick in
0:32:38 > 0:32:40and he'll make a speedy recovery.
0:32:40 > 0:32:43SEAGULL CRIES
0:32:49 > 0:32:5267-year-old Barbara has been rushed from her remote home
0:32:52 > 0:32:56in North Roe, some 40 miles from the hospital,
0:32:56 > 0:32:59suffering from severe chest pains and a suspected heart attack.
0:32:59 > 0:33:04I'd just gone to bed, possibly ten minutes previously.
0:33:04 > 0:33:08I started to get pain in the left-hand side,
0:33:08 > 0:33:10which got worse and worse,
0:33:10 > 0:33:13and it started to move up my shoulder and the side of my neck.
0:33:14 > 0:33:17My chest was feeling very tight.
0:33:17 > 0:33:20I called out to my granddaughter to get my husband.
0:33:20 > 0:33:23He phoned for an ambulance and it came straight out.
0:33:23 > 0:33:27With Barbara's remote location, the rapid response
0:33:27 > 0:33:29from the emergency services to the hospital is vital.
0:33:29 > 0:33:34Where we live is the very north of mainland Shetland.
0:33:34 > 0:33:37I think it's roughly about a mile from where we live
0:33:37 > 0:33:39to falling off the top end.
0:33:40 > 0:33:46But it's so remote, there's no shop, there's no post office.
0:33:46 > 0:33:49Um...it can be very dangerous.
0:33:49 > 0:33:52Barbara, I'm Lauren, I'm the doctor that's on tonight.
0:33:52 > 0:33:56Having noted that Barbara has a history of heart problems,
0:33:56 > 0:33:59Dr Lauren Cammaert is keen to find out more.
0:33:59 > 0:34:01What does the pain feel like?
0:34:01 > 0:34:04It's a heavy, sharp pain
0:34:04 > 0:34:08- that goes sort of right round and then up.- OK.
0:34:08 > 0:34:13It was moving up the side of my face. It was all tingly and funny.
0:34:13 > 0:34:17I know that you've got COPD, you've got the problems with your heart.
0:34:17 > 0:34:21You have type II diabetes but you're insulin-dependent now,
0:34:21 > 0:34:23- is that right?- Yes.
0:34:23 > 0:34:26You've got your kind of degenerative arthritis problems.
0:34:26 > 0:34:29Are there any other medical problems?
0:34:29 > 0:34:32- Hip replacement, spine fusion.- OK.
0:34:32 > 0:34:34- Toe fusion.- Oh, goodness.
0:34:34 > 0:34:39- I'm falling to pieces. Held together with titanium.- Oh, dear.
0:34:39 > 0:34:41I'm just going to have a little listen in to your heart
0:34:41 > 0:34:43first of all, so just breathe away normally.
0:34:43 > 0:34:45I'll feel your pulse at the same time.
0:34:46 > 0:34:48I checked her over.
0:34:48 > 0:34:50I had a listen in to her heart,
0:34:50 > 0:34:52I listened in to her lungs, which were nice and clear.
0:34:52 > 0:34:55Take a big deep breath in for me. And out.
0:34:55 > 0:34:58There was no signs that she was having any ongoing chest pain
0:34:58 > 0:35:01or any other problems. She seemed, perhaps, a little bit anxious
0:35:01 > 0:35:05that she was wasting our time, which I reassured her that she wasn't.
0:35:05 > 0:35:09Barbara's remote location and complex health problems
0:35:09 > 0:35:11mean she was right to come to hospital.
0:35:11 > 0:35:16She is an hour away on small, single-track roads from the hospital
0:35:16 > 0:35:20and, if she was having a heart attack,
0:35:20 > 0:35:23it's really critical that we get the thrombolysis treatment,
0:35:23 > 0:35:25which is treatment to dissolve blood clots
0:35:25 > 0:35:28that can form in arteries, which causes a heart attack.
0:35:28 > 0:35:31So, we need to be able to give that as soon as possible
0:35:31 > 0:35:33to make sure people have a good recovery.
0:35:33 > 0:35:36It doesn't look like you've had a heart attack, which is really good.
0:35:36 > 0:35:39And, even though we've missed the time
0:35:39 > 0:35:43when you had the severe chest pain, even if you had had a heart attack,
0:35:43 > 0:35:46then we would still be able to see some change on the ECG.
0:35:46 > 0:35:50I think she probably had non-cardiac chest pains,
0:35:50 > 0:35:53which means we don't have a diagnosis of what's causing
0:35:53 > 0:35:56her chest pains, but we're fairly certain
0:35:56 > 0:35:58that it's not because she's having a heart attack
0:35:58 > 0:36:00or anything too serious.
0:36:00 > 0:36:05I don't think there's a lot they can do for the problem...
0:36:06 > 0:36:08..apart from I've got to lose weight,
0:36:08 > 0:36:11which will take some of the strain off my heart.
0:36:11 > 0:36:15Otherwise, it's just a case of it could happen one day
0:36:15 > 0:36:16and you're gone.
0:36:16 > 0:36:19It's something you don't get a lot of warning with.
0:36:21 > 0:36:24So, I suppose, really, I should start a bucket list.
0:36:40 > 0:36:42John came into A&E last night in agony
0:36:42 > 0:36:45and was admitted with suspected kidney stones.
0:36:45 > 0:36:48- What does it feel like? - Bloody sore.- Bloody sore.
0:36:48 > 0:36:52Surgeon Mr MacFarlane operated to put a stent into John's kidney
0:36:52 > 0:36:56and, following some rest, is taking John through the treatment,
0:36:56 > 0:36:58prior to him being discharged.
0:36:59 > 0:37:03That is your CT scan that you had when you first came in.
0:37:03 > 0:37:07And there is a stone sitting in the kidney on the right.
0:37:07 > 0:37:09We measured that and it's about seven millimetres.
0:37:11 > 0:37:15Which means that it may or may not pass itself.
0:37:15 > 0:37:19So, as you know, we took you to theatre to put a stent in.
0:37:19 > 0:37:22And that's the stent, finally in place.
0:37:22 > 0:37:25It curls up itself which keeps it in place
0:37:25 > 0:37:29and allows the kidney to drain. The other end curls up in your bladder.
0:37:29 > 0:37:32So it has a clear passage to the end.
0:37:32 > 0:37:35Yeah, it allows the urine to drain down the tube
0:37:35 > 0:37:38and the effect of it sitting in the ureter
0:37:38 > 0:37:40actually makes the ureter dilate,
0:37:40 > 0:37:43so it makes it more likely that your stone's going to pass itself.
0:37:43 > 0:37:48- I'll be watching for it to come out. - Yes.- I'm sure I'll feel it coming.
0:37:48 > 0:37:51Um, you don't always, but it's a reasonable size,
0:37:51 > 0:37:54so you might notice it, both a bit painful as you pee,
0:37:54 > 0:37:56and also it might clunk in the pan.
0:37:56 > 0:37:59OK, if I catch hold of it, I'll get it framed.
0:37:59 > 0:38:02Yes, you can fish it out and keep it. That's right.
0:38:02 > 0:38:05Without general surgeons like Mr MacFarlane,
0:38:05 > 0:38:08John's treatment would have gone very differently.
0:38:08 > 0:38:12A patient with this sort of problem is becoming increasingly difficult
0:38:12 > 0:38:14to handle in rural areas
0:38:14 > 0:38:17because there is no longer general surgeons
0:38:17 > 0:38:19who are doing urology as well
0:38:19 > 0:38:22and that would have meant this gentleman would have had to fly
0:38:22 > 0:38:24down to Aberdeen on an urgent basis
0:38:24 > 0:38:27to have his stone dealt with in Aberdeen.
0:38:27 > 0:38:31Patients obviously prefer if they can be treated
0:38:31 > 0:38:33on-site at the local hospital.
0:38:33 > 0:38:38It saves them and their relatives perhaps having to travel.
0:38:39 > 0:38:42And he's a very satisfied customer.
0:38:42 > 0:38:46- It's good to come into a hospital like this...- It's great, isn't it?
0:38:46 > 0:38:49..where you're looking out the window and you've got a view
0:38:49 > 0:38:53that people would pay premium prices for in hotels around the world.
0:38:53 > 0:38:54That's part of our therapy.
0:39:10 > 0:39:12- Barbara.- How are you?
0:39:12 > 0:39:15What a time you've been having. What a time.
0:39:15 > 0:39:17Come on through.
0:39:17 > 0:39:20Barbara, who came into A&E with a suspected heart attack,
0:39:20 > 0:39:22has come to the Hillswick surgery
0:39:22 > 0:39:25for a follow-up appointment with Dr Bowie.
0:39:25 > 0:39:27But first on the agenda is a surprise.
0:39:27 > 0:39:30I've got a little present for you.
0:39:30 > 0:39:34A urine specimen. Wee-wee.
0:39:34 > 0:39:37- Cystitis.- Right.
0:39:37 > 0:39:39And was that since you were in hospital?
0:39:39 > 0:39:42- It started the night I went in and came out Sunday afternoon.- Uh-huh.
0:39:42 > 0:39:45- So, it was the following Thursday. - Right.
0:39:45 > 0:39:49Before Dr Bowie can find out more about Barbara's stay in hospital,
0:39:49 > 0:39:52she decides to check her urine sample.
0:39:52 > 0:39:54I'm just checking Barbara's urine.
0:39:54 > 0:39:56She's diabetic, so there's a bit of sugar,
0:39:56 > 0:40:03but it's coming up pink and purple, so it shows lots of blood,
0:40:03 > 0:40:07so it shows that she's got a definite urinary tract infection.
0:40:07 > 0:40:12We'll send that away because, with us being so far away from hospital,
0:40:12 > 0:40:13I'd be a wee bit anxious
0:40:13 > 0:40:16about just treating her blindly with antibiotics.
0:40:16 > 0:40:19We'll give her antibiotics but we just want to make sure
0:40:19 > 0:40:22we know what bug's growing there.
0:40:22 > 0:40:25Now that Barbara's urinary infection has been dealt with,
0:40:25 > 0:40:27Dr Bowie can get on with delving into the events
0:40:27 > 0:40:29that led to her admission into hospital.
0:40:29 > 0:40:32And they didn't find out that you'd had any heart attack.
0:40:32 > 0:40:35- It was just the same as the last one.- Severe pain.
0:40:35 > 0:40:37- I couldn't breathe properly.- OK.
0:40:37 > 0:40:40It's just like me, I can't breathe, but I'm OK.
0:40:40 > 0:40:41It doesn't show up when you look.
0:40:41 > 0:40:45- Well, it only shows up if you've had an actual heart attack.- Yes.
0:40:45 > 0:40:48So, you can get angina pain
0:40:48 > 0:40:53that lasts for anything up to nearly an hour.
0:40:53 > 0:40:56What happens in angina is you get a bit of spasm in the artery
0:40:56 > 0:40:59or you get a wee clot in the artery. Sometimes it passes.
0:40:59 > 0:41:03If people had a wee aspirin in their pocket to use,
0:41:03 > 0:41:05it can just prevent you
0:41:05 > 0:41:09from going on to have a full-blown heart attack.
0:41:09 > 0:41:12They've put it down as non-cardiac chest pain
0:41:12 > 0:41:14but, given your history,
0:41:14 > 0:41:17I think it may well have been cardiac chest pain,
0:41:17 > 0:41:19but just not to the extent
0:41:19 > 0:41:21- that you've ended up having a heart attack.- Yeah.
0:41:21 > 0:41:24- So, I'll maybe contact the doctor, see what the plan is.- Yeah.
0:41:24 > 0:41:30But, in the meantime, we'll do that liver function check in four weeks.
0:41:30 > 0:41:34When we repeat your liver tests, we'll do a repeat BAP as well.
0:41:34 > 0:41:37If things get worse, if you get more short of breath,
0:41:37 > 0:41:43then you need to let me know, if anything is deteriorating,
0:41:43 > 0:41:47sooner rather than later. Nip it in the bud.
0:41:48 > 0:41:50With all the necessary checks and appointments made,
0:41:50 > 0:41:54Dr Bowie is now happy to pass Barbara on to the surgery nurse
0:41:54 > 0:41:57for a final blood test, before sending her home.
0:41:57 > 0:42:02- We've got to pick medicine up.- Yeah. - Right, see you again.- Bye, bye.
0:42:06 > 0:42:09SEAGULL CRIES
0:42:12 > 0:42:14Two days after being airlifted off a fishing boat
0:42:14 > 0:42:18and rushed to A&E, Danish cook Morten is on the mend.
0:42:18 > 0:42:20He's been discharged
0:42:20 > 0:42:22and is on the first leg of a trip home to Denmark.
0:42:25 > 0:42:28They were very nice. They treat me very well.
0:42:29 > 0:42:33Polite. It was a good experience.
0:42:33 > 0:42:36I'm really looking forward to come home,
0:42:36 > 0:42:39to be together with my family and my dog.
0:42:45 > 0:42:48James the shopkeeper is back on Shetland
0:42:48 > 0:42:50and has made a full recovery.
0:42:50 > 0:42:54David travelled to Aberdeen for his specialist appointment,
0:42:54 > 0:42:58where he was unfortunately diagnosed with a brain tumour, not epilepsy.
0:42:58 > 0:43:01He's undergoing radiotherapy and chemotherapy
0:43:01 > 0:43:03and we wish him a full recovery.
0:43:03 > 0:43:06And Morten got home safely to Denmark.
0:43:06 > 0:43:08Both his family and his dog were delighted
0:43:08 > 0:43:10to have him back safe and well.