Episode 6 Island Medics

Shetland, the most remote part of the UK.

Here, you're closer to the Arctic Circle than 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.

They're 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 got in a fight with a seagull.

-This was sheep shears, was it?

-Yeah.

It means the tight-knit team of medics, volunteers

and emergency services have a special bond.

This might tickle then.

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 seriously ill sailor,

plucked from his boat and rushed to A&E.

Your blood pressure's a wee bit on the low side.

We meet Britain's most northerly full-time GP.

Shetlanders tend to be huge stalwarts.

Four weeks after having a stroke, they arrive at the surgery.

And 56 years of marriage are on the line.

Is this your wedding ring?

-Yeah, 56 years.

-We'll try and save it.

SEAGULL CRIES

For the thousands of visitors that alight on Shetland each year,

its rugged landscape is as fascinating as it is daunting.

But for its 23,000 inhabitants, it's simply home,

a home that comes with its own unique pleasures and pressures.

When things go wrong, as they do...

I fell off a Shetland pony.

..they turn to the good men and women of the Gilbert Bain Hospital

and the emergency services who keep these remarkable islands running.

Leading the team in A&E is Dr Kushik Lalla.

Your guess is as good as mine.

Dr Lalla is originally from South Africa

but has settled in Shetland

-because it offers a unique medical challenge.

-I love it

because of the combination of patients,

so we have very nice patients.

I've worked throughout the UK

and the quality of patients we have here is fantastic.

Patients actually say thank you.

The other reason I like it here is it is unstructured,

in that anything could walk through the door,

so it's a very wide range of things that we see.

Every day is different. I like that.

Right, Mr Irvin, let me get you onto that couch.

James, a 72-year-old shopkeeper from Levenwick,

is next on Dr Lalla's list for treatment.

He's a guy that had a knee replacement

carried out two weeks ago in Glasgow.

He was seen today by GPs.

They noticed that the knee looks infected.

Quick thinking by James's GP got him into hospital in the nick of time.

If it is infected, it's going to be a nightmare for him

because the only way we'd be able to settle that infection

is to remove the prosthesis.

Although he looks OK, he's actually quite unwell at the moment.

He is tachycardic which means his heart is racing.

It's running at a rate of about 130 at the moment,

so what we need to do is examine that knee,

swab there and see what we grow,

and that will help us target the antibiotics we use.

Being a medic here isn't just about accidents and emergencies.

Shetlanders are scattered across 15 different islands,

which requires a network of 20 far-flung GPs to look after them.

Britain's most northerly permanent GP is Dr Susan Bowie.

Her practice covers 77 square miles of Northmavine Peninsula,

right at the top of Shetland's mainland.

Unlike many GPs these days,

she knows each and every one of her 760 patients personally.

-Alison.

-Hi.

-Come on through.

First patient in at quarter to ten, which I've not changed

since my children were at nursery,

and I see patients every 15 minutes.

I can't do it really any sooner. I tried but I just can't.

They need the full 15 minutes.

Now, big open mouth. Can you say, "Ah" for me?

-Ah.

-And again.

-Ah.

-Stick your tongue out for me.

Looks all right, it's just a bit red. It's looking a bit viral.

-Thank you very much.

-It's OK. Are you happy with that?

-It's nice to see you again.

-Yeah, nice to see you too.

-Oh, dear. Lovely. And the weather's clearing up.

-I know.

-It's lovely, so you might get out in the garden.

-Out in the garden.

-Yes.

THEY LAUGH

Before she honed her impeccable bedside manner,

her first encounter with the Shetland Isles

had a distinctly fishy start.

This is one of my favourite places.

It took me a while to discover it though.

Originally, I came to Shetland when I was a student.

I got a job in the fish factory, making kippers.

And we had just the best... It was just the best summer job.

It was just great fun.

A few years later, when I was a GP, I was in between jobs

and there was a job came up in Shetland and I thought,

"I'll just go for six months, a year, just see how I get on."

And I just loved it and I just stayed and stayed and stayed

and that was 33, 34 years ago.

It's a rock and roll lifestyle.

Not!

-Now, Stuart.

-Come on down.

-Come on down.

-The price is right.

Come on through.

Let's see what your weight's doing.

The main thing is keeping your weight down.

-I'd like to be half a stone lighter.

-Mm-hmm.

Some people will run to their local GP

at the merest suggestion of a sniffle, but not here.

Shetlanders tend to be huge stalwarts

so, four weeks after having what they thought might be a stroke,

they arrive at the surgery,

rather than coming on the same day or the day later,

so that can be really tricky, trying to sort things out.

You know me. I'll suffer for a while before I take action.

I know, you're not a complainer.

And eight years is probably enough

to mean that we should ask for a wee bit of help with that.

-OK. Thank you.

-OK, Stuart.

-Thank you, Susan.

-See you later.

-Cheerio. Thank you.

Doctors at the Gilbert Bain can deal

with life-threatening situations one moment

and something more minor the next.

But even the less serious cases make

a world of difference to their patients.

I've been asked to see a lady that's got a swollen finger.

Her ring is very tight on her finger and it needs to be removed

because it's going to stop the circulation.

Sometimes we can remove that

but it's far too tight for that.

We're going to have to cut it off, in this case.

Hello?

-Hi, it's just me. Have you ever had a ring removed before?

-No, no.

-Is the finger sore?

-Sore?

-Is it sore, is it painful?

-In the joint, when I move it, yeah.

-So, that's going to be broken there.

-You think so?

-Yeah.

-Is this your wedding ring?

-Yeah, 56 years it's been on there.

We'll try and save it, OK.

I don't think there's any way that's going to come with the tape.

Despite all the medical technology and equipment on offer,

sometimes the simplest of solutions

and materials can make all of the difference.

It's very, very tight.

We're not promising that we can, but let's see what we can do.

-You'll try and pull it up?

-Yeah, you drive the fluid out of the finger.

Just bend your little pinky. There you are.

Sorry, it might...it will be getting sore

because that finger is probably broken,

but the alternative is to cut the ring.

Just pull on this, because as you pull on this,

it will slide the ring down.

-Can I have some more soap, please?

-Mm-hmm.

-I don't think it's going to come.

-It's very, very swollen, isn't it?

That's because we're letting the pressure round that side.

That's a small ring, isn't it?

56 years?

You're going.

-Right, well at least the wedding ring's saved.

-Yay.

56 years, I think... We can take it from there.

Patience and dedication - the recipe for a ring removal,

as well as a long marriage.

We're expecting a patient in who's having a fit, a seizure.

So, we're just preparing everything for that.

It's 09, Kathy. It's Michael.

They'll be here in about five minutes,

so we'll just get as much prepared as we can.

35-year-old Shetlander David has been rushed into resus,

after suffering a seizure.

The team have to settle him in and order a raft of tests

to ascertain what effects the fit has had on his body.

On duty today is junior doctor Michael Stewart,

who's originally from Aberdeen,

but has fallen in love with the islands,

since he came for a year-long placement.

Shetland's amazing.

You get completely varied stuff every day.

It's always different stuff

and we have to kind of be able to deal with it.

OK, so how many seizures have you had?

And do you remember what medicines you take?

Well, epilepsy drugs at the minute.

-Right. And do you know if you took it today?

-Yeah, I've taken it.

-Yeah. How are you feeling now?

-I don't feel that great.

It's possible that David is suffering from epilepsy,

which affects half a million people in the UK,

and the effects of the fits can be life-threatening.

There you go, I'll just lift this up.

If you take some deep breaths in and out through your mouth for me.

Epilepsy most often begins in childhood.

Unusually, David's fits have only started in the last few months

but have had such a severe effect,

he's been forced to give up his day job.

I was just walking out my room.

I was walking downstairs and I just got paralysed.

I got paralysis today, first and foremost in the left arm,

and then the rest of my body can't move. It's horrible.

It lasts about ten seconds and then I just blank.

And next I know...the ambulance people are there.

The results of David's tests are good.

While they don't explain his fit,

they show that his seizures have not had a serious effect on his health.

All of your blood results are back

and they're totally fine, which is excellent.

And the ECG, the tracing of your heart, is fine as well.

So, I think that nothing, there's nothing new which has changed,

compared to your other seizures.

However, obviously, we still have the problem

that you've had a seizure and we still don't know why.

You've now had three and we don't know why.

It's going to take specialist diagnosis

to get to the root of what's causing these fits -

a diagnosis that can only take place on the mainland.

The nearest neurologist is based in Aberdeen,

a 12-hour ferry ride away

and, since David has an appointment scheduled there next week,

there's little else Dr Stewart can do for him.

He doesn't need anything fancy today from us,

just we're going to increase his anti-epileptic medication

and make sure that he's safe to go home,

he's got someone to look after him when he gets there.

The seizures are quite distressing to witness, you know.

They look horrible

but, actually, you can let them run their course

and there's no need for you to stay in hospital.

David heads home to rest and recover,

hoping his neurological appointment next week

will give him the answers he needs.

The North Sea is a treacherous place to work,

even for the thousands of highly trained sailors, fishermen

and oil workers, who make a living off Shetland's coast.

When accidents happen,

it's often the job of the volunteers from the RNLI

and the expert flyers in the coastguard's helicopters

who can be the difference between life and death.

Rescues are tricky enough in calm seas and on sunny days

but, when the weather closes in,

that's when things can become challenging.

The staff at Coastguard HQ have been alerted to an evolving situation

100 miles offshore in the North Sea.

They elect to scramble one of their helicopters to the incident.

Morten Sorensen, a Danish cook, has been taken ill

on a supply vessel and the great distance to Bergen in Norway

and storms in Aberdeen mean the only option

is to fly him to Shetland.

It is dangerous.

Fear's the wrong word to use but you're always sort of

conscious of what you're doing. It's pretty tasking sometimes.

Paramedics are rushing to meet the coastguard at Tingwall Airport,

which is nestled in a sheltered valley,

six and a half miles north of Lerwick.

We got a call

to say a gentleman was being flown into Tingwall Airport

by the coastguard helicopter, that he'd been unwell for some days

and they felt he needed to be medevacked off.

Normally for the landing site at Tingwall Airport,

coastguards will have quite a few people there

and quite often they help with off-loading patients.

It's a delicate operation, as he's barely conscious and is very ill,

so it's vital he's moved smoothly.

With the patient safely onboard,

the ambulance sets off on the winding journey to A&E,

where nurse Thelma Irvine and the team have been alerted

and are preparing for their arrival.

As soon as he's out of the ambulance,

Morten is straight into resus,

where nurse Thelma makes him comfortable.

-He's a diabetic gentleman. Blood sugar's 9.3.

-OK.

Blood pressure less.

-He just seems not himself.

-Not himself.

-Do you want him out of his...?

-Yeah.

-Hi, I'm Thelma.

-Hi, Thelma.

-And your name was?

-Morten.

-Morten.

Any past medical history we should know about?

-There's your diabetes. You're diabetic.

-Yeah, I'm diabetic.

-Type II diabetic or...?

-Type II.

-Yes.

Your blood pressure's a wee bit on the low side,

-so I'm going to pop a wee cannula in the back of your hand, OK?

-Yes.

I'm going to take some blood tests as well

but I'll have that cannula there, should we need to give you

-any medication or any fluids through that. Is that OK?

-Yes, that's OK.

Morten is stable but is very sick

and the team still have to find out

what the root cause of his condition is.

SEAGULL CRIES

Shetland's economy is based around three industries -

North Sea oil, tourism and fishing.

The islands fleet lands £79 million-worth of fish a year,

meaning it's big business.

But fishing is also a popular island pastime for many,

who take to the water whenever they can to take advantage

of some of the best fishing marks in the UK.

Amongst that number is A&E's nurse Thelma.

-Morning.

-Today, she is meeting her old friend David.

-It's still morning.

-Afternoon.

-Is it? Oh, it is afternoon.

They're taking his boat out on a fishing expedition

from Lerwick Marina.

It's always a nice feeling going off fishing, just on the open water.

It's a nice bit of relaxation after a busy shift.

I've been fishing since I was quite young.

I used to go fishing with my dad, just off on a wee open boat.

Safely out of the harbour,

nurse Thelma can't resist getting her foot down.

We're on the way. It's a little bit breezy but it's not too bad.

And before long, they've reached Flossy Knowes,

some 20 miles from Lerwick,

and prime hunting ground for mackerel, pollack, haddock and ling.

It's lovely. It's really nice.

It's nice to get off in the boat,

just to be in that sort of nice sea air. It's so relaxing.

But nurse Thelma and David aren't the only ones

hoping to catch their tea today.

SEAGULLS CAW

It's amazing. You can understand why I enjoy going out here.

With the bait set, all that remains is to wait.

Two weeks ago, I caught a 133-pound common skate,

which was two metres long

and it was three kilograms heavier than me, so it was quite a big fish.

And it looks like she's in luck again.

Easy, Thelma, easy.

Easy.

Go on, pull it up.

Yeah, a big one.

It's not bad! Fillet it and smoke it, hot smoke.

Quite tasty.

That's tea sorted.

So, it's pedal to the metal, back to the marina,

where they find some familiar locals

who are more than happy to share in the day's triumph.

Aw...

-The best man wins.

-THEY LAUGH

David, who was discharged less than an hour previously,

following a seizure, is back,

after hitting his head during another fit.

Dr Helen Hare is on duty.

-Hi, there. Is it David?

-Yeah.

-Hello, my name's Dr Hare.

I understand that you were in with us, having had a seizure,

-and then you've had another one since going home?

-Yeah.

Yeah, I went home, I ate my tea and then I had a...

-My left arm just shot up and I went into a horrible spasm.

-Yeah.

It was like the whole left arm was completely paralysed.

-It was like my left arm's been hit by lightning.

-OK.

-And the rest of my body, I can't move it at all.

-Yep.

And how you feeling at the moment?

I'm feeling a bit sick and feeling a bit nauseous.

I'm struggling to swallow for some reason.

Obviously, you've been examined already,

so I won't replicate too much of that, but we better have

a bit of a look at your head and the bits that are sore just now.

Yeah, you've got a nasty whack on the top of your scalp here.

An egg there.

Can you sit up for me, David? Turn yourself over a wee bit in the bed.

-I'm struggling.

-What's the difficulty?

Moving my left...

Yeah, moving, moving the left...

Does it feel that it won't move or is it just painful?

-It's just a bit... It feels weak.

-Weak, OK.

Oh, God... Sorry, it felt like it was going to go again.

Let me move this arm first of all. So, just let it go totally floppy.

Obviously, he's feeling a bit rotten.

He's grappling with this new not-quite diagnosis at the moment.

So, he knows he's having seizures but we don't really know why.

It's still unclear if it is epilepsy that's causing David's seizures.

But Dr Hare is adamant that he keeps taking his medication.

It's very important that you take these drugs,

even if we don't get you seizure-free,

because there is a risk

-of what's called sudden unexplained death in epilepsy.

-Right.

So that, as it sounds, is death,

out of the blue, in people who have epilepsy.

And we know that even if you don't get seizure-free on medicines,

your risk of dying is much, much reduced if you're taking medicines.

-Right.

-So, even if it doesn't feel like we're winning,

there's still a benefit to taking these drugs.

Because he's had a head injury, we need to bring him in,

just to keep an eye on him.

We'll make sure that his head injury doesn't cause any problems.

And fingers crossed, we'll get him home tomorrow.

That's good.

James the shopkeeper has responded well to antibiotics

and his heart rate has settled enough for him

to be transferred to Glasgow for further treatment on his knee.

-OK? All the best.

-I hope I don't need it.

You'll be fine, you'll be fine.

We are going to get the air ambulance going out today.

This is the gentleman with the infected knee.

There are over 220 flights a year taking the sick and injured

from Shetland to the mainland.

So, he's going to go back down to Glasgow,

where they did the original operation

and they're going to take him and probably wash out that knee today

and see what they can do for him.

And it's a first-class service all the way.

Night shifts aren't the most popular in A&E, as they can drag.

Nurse Thelma's baking often helps get the team

through the wee small hours.

A wee treat for night shift.

-Pudding?

-Thank you very much.

-You don't have to eat it.

Mm, it's still warm.

Our nurses are fantastic.

Better not let them hear me saying that.

There's nowhere else where you get home bakes.

They bake tons of stuff and they bring it in.

Thank you, Thelma.

This is lovely.

OWL HOOTS

And this night was proving to be an especially long one for John.

John was a 56-year-old gentleman who had been having some pain

that he'd been having for two days,

varying in severity,

and then this evening, had been very severe.

-Where's your pain at? Is it in a specific point?

-It's here.

-So, it's just in the back, right side.

-Yeah.

He's in agony.

Before a doctor can see him,

the nurses need to make him more comfortable.

OK, lay back.

OK.

Is that more comfortable for you lying down or not really?

-Hello.

-I'll just be back in a moment.

-Hi.

Dr Ashley Thomson comes in to try to get to the cause of the pain.

Did it start suddenly or gradually?

-Yesterday it started in the early evening.

-OK.

So, it comes sudden, but it builds up.

Can you describe the pain for me? What does it feel like?

Is it a sharp pain or an ache?

-Bloody sore.

-Bloody sore.

What I need to do is just lie you down flat,

so I'll just pop the head of the bed down. Ooh, sorry.

Now, I'm going to have a feel of your back here.

-Any pain on this side?

-Some.

-Is that a bit tender there?

-Yes.

John has a history of kidney stones

and Dr Thomson suspects they may have returned.

This, from what you're telling me, sounds very much like renal colic,

which is the fancy word for kidney stones.

They can be extremely excruciatingly painful and they're more common,

if you've had them in the past, to reappear.

The patients who you see with kidney stones are quite often

writhing around in pain, very excruciating.

Not that anybody has ever stabbed me before,

but you feel as if somebody is sticking a knife into your back

and grinding it around.

But treatment for the pain has a catch.

A very good pain relief for this type of pain is a medication

that we give up the back passage

so, if you're happy to do that yourself and insert it,

we've got that right here for you.

-I'll leave you in peace to administer this.

-OK.

We'll see how that helps things. Would that be OK?

-That'll be fine.

-OK.

What's that? No!

We tested his urine, which showed that he had quite a lot of blood

in his urine that wasn't able to be seen by the naked eye.

And that, again, is another marker of kidney stones.

We'll keep him in overnight, observe him,

make sure that he is kept nice and comfortable,

with a view to getting the CT scan in the morning

which is the gold standard investigation.

The scan will show us if there is any effect or injury to the kidney.

For Shetlanders like John, the hospital really is a lifeline,

allowing him to access first-class treatment close to home.

But then, we're in good hands here.

The nurses are all very friendly and the doctors as well.

Um... And you sometimes tend to know some of them,

or other people that's in,

because it's a small local hospital and that makes a big difference.

John's CT scan will allow doctors

to see a three-dimensional image of his body.

-Hello, John Inkster?

-Yes.

-I'll get you through.

It works by taking hundreds of X-rays and then modelling them,

by computer, to show what's going on underneath his skin.

Surgeons rely on these scans

to decide which procedures are the most effective.

It's likely John will need a stent inserted into his kidney

to help him pass the stone.

Performing operations like the one John needs

are a very special breed of surgeon,

like consultant surgeon Gordon MacFarlane.

-Carol, is that at the right angle? What do you think?

-That's good.

You're looking very smart now.

I've started off with a laparoscopic cholecystectomy,

so that's a keyhole removal of the gall bladder.

I next have a TURP to take out prostate,

and then I've got a colonoscopy to finish.

This breadth of experience means John will be in good hands

when he enters Mr MacFarlane's theatre tomorrow.

Danish cook Morten was rescued from a ship

100 miles out into the North Sea

by Shetland's coastguards and ambulance,

and has been stabilised in resus.

My name is Dr Hare. I'm on call this evening.

While he's stable, he's very ill,

and it falls to Dr Hare to find out what's making him so unwell.

-Have you had any difficulty breathing?

-No.

Any difficulty eating or swallowing?

-Does anything make the stomach pain worse?

-No, actually not.

-No, OK. Do you feel that you know where you are just now?

-Yeah.

Yeah, OK, OK.

You're a bit dehydrated at the moment, OK.

-If we can get stats.

-Yeah.

I think we need to treat this as a sepsis.

All right.

-I can't get up.

-I'll get your hand.

Sepsis is an extremely dangerous condition

where the body's immune system goes into overdrive

to try and fight an infection.

It can be fatal.

While the team are confident that Morten has sepsis,

they can't pinpoint the cause, which is concerning,

and a raft of tests need to be carried out.

Hi, there, is that the lab tech? Hi, it's Helen, the SHO on.

I'm afraid we need you to come in and do some bloods, please.

In any big hospital, getting tests and X-rays done

at any time of the day or night is straightforward.

But in Shetland, at 1am, it means getting the on-call lab technician

and radiographer out of their beds.

Hi, it's Thelma in Casualty. Sorry to wake you at this hour.

Could we get you in to do some X-rays, please? OK, thank you.

Bye, bye. Oh, she's just been woken up.

Yes, I don't think I was quite sympathetic enough to the lab tech.

People are always a little bit grumpy to be woken but, actually,

they're entirely keen to be here. They know it's important.

It also, as a doctor, sort of hones your skills in considering

whether or not investigations are really necessary.

In this circumstance, we need answers now

to assess how unwell Morten is and how we can treat him.

Fresh out of bed, the radiographer's arrived

and she wastes no time getting the crucial chest X-rays done.

Great. Shouldn't be too many of them.

This is his chest X-ray and it's totally normal,

but it's important to exclude when someone's unwell

and you're not sure where it's coming from.

-It's not chest. Once we've dipped his urine...

-Did we get a urine?

No, I think we're moving to catheterisation.

But even if it is urine, the amox will hopefully cover that.

We're not very sure where the infection is.

Um...he described some pain in his tummy

and in his shoulder that makes it likely

that, actually, it's his gall bladder

that's the source of the infection,

so that's what we're treating him for at the moment.

We've got him stable now and we're going to move him up to the ward,

where the fluids and the antibiotics will continue overnight.

So, a night on the wards beckons for Morten.

Hopefully those antibiotics will kick in

and he'll make a speedy recovery.

SEAGULL CRIES

67-year-old Barbara has been rushed from her remote home

in North Roe, some 40 miles from the hospital,

suffering from severe chest pains and a suspected heart attack.

I'd just gone to bed, possibly ten minutes previously.

I started to get pain in the left-hand side,

which got worse and worse,

and it started to move up my shoulder and the side of my neck.

My chest was feeling very tight.

I called out to my granddaughter to get my husband.

He phoned for an ambulance and it came straight out.

With Barbara's remote location, the rapid response

from the emergency services to the hospital is vital.

Where we live is the very north of mainland Shetland.

I think it's roughly about a mile from where we live

to falling off the top end.

But it's so remote, there's no shop, there's no post office.

Um...it can be very dangerous.

Barbara, I'm Lauren, I'm the doctor that's on tonight.

Having noted that Barbara has a history of heart problems,

Dr Lauren Cammaert is keen to find out more.

What does the pain feel like?

It's a heavy, sharp pain

-that goes sort of right round and then up.

-OK.

It was moving up the side of my face. It was all tingly and funny.

I know that you've got COPD, you've got the problems with your heart.

You have type II diabetes but you're insulin-dependent now,

-is that right?

-Yes.

You've got your kind of degenerative arthritis problems.

Are there any other medical problems?

-Hip replacement, spine fusion.

-OK.

-Toe fusion.

-Oh, goodness.

-I'm falling to pieces. Held together with titanium.

-Oh, dear.

I'm just going to have a little listen in to your heart

first of all, so just breathe away normally.

I'll feel your pulse at the same time.

I checked her over.

I had a listen in to her heart,

I listened in to her lungs, which were nice and clear.

Take a big deep breath in for me. And out.

There was no signs that she was having any ongoing chest pain

or any other problems. She seemed, perhaps, a little bit anxious

that she was wasting our time, which I reassured her that she wasn't.

Barbara's remote location and complex health problems

mean she was right to come to hospital.

She is an hour away on small, single-track roads from the hospital

and, if she was having a heart attack,

it's really critical that we get the thrombolysis treatment,

which is treatment to dissolve blood clots

that can form in arteries, which causes a heart attack.

So, we need to be able to give that as soon as possible

to make sure people have a good recovery.

It doesn't look like you've had a heart attack, which is really good.

And, even though we've missed the time

when you had the severe chest pain, even if you had had a heart attack,

then we would still be able to see some change on the ECG.

I think she probably had non-cardiac chest pains,

which means we don't have a diagnosis of what's causing

her chest pains, but we're fairly certain

that it's not because she's having a heart attack

or anything too serious.

I don't think there's a lot they can do for the problem...

..apart from I've got to lose weight,

which will take some of the strain off my heart.

Otherwise, it's just a case of it could happen one day

and you're gone.

It's something you don't get a lot of warning with.

So, I suppose, really, I should start a bucket list.

John came into A&E last night in agony

and was admitted with suspected kidney stones.

-What does it feel like?

-Bloody sore.

-Bloody sore.

Surgeon Mr MacFarlane operated to put a stent into John's kidney

and, following some rest, is taking John through the treatment,

prior to him being discharged.

That is your CT scan that you had when you first came in.

And there is a stone sitting in the kidney on the right.

We measured that and it's about seven millimetres.

Which means that it may or may not pass itself.

So, as you know, we took you to theatre to put a stent in.

And that's the stent, finally in place.

It curls up itself which keeps it in place

and allows the kidney to drain. The other end curls up in your bladder.

So it has a clear passage to the end.

Yeah, it allows the urine to drain down the tube

and the effect of it sitting in the ureter

actually makes the ureter dilate,

so it makes it more likely that your stone's going to pass itself.

-I'll be watching for it to come out.

-Yes.

-I'm sure I'll feel it coming.

Um, you don't always, but it's a reasonable size,

so you might notice it, both a bit painful as you pee,

and also it might clunk in the pan.

OK, if I catch hold of it, I'll get it framed.

Yes, you can fish it out and keep it. That's right.

Without general surgeons like Mr MacFarlane,

John's treatment would have gone very differently.

A patient with this sort of problem is becoming increasingly difficult

to handle in rural areas

because there is no longer general surgeons

who are doing urology as well

and that would have meant this gentleman would have had to fly

down to Aberdeen on an urgent basis

to have his stone dealt with in Aberdeen.

Patients obviously prefer if they can be treated

on-site at the local hospital.

It saves them and their relatives perhaps having to travel.

And he's a very satisfied customer.

-It's good to come into a hospital like this...

-It's great, isn't it?

..where you're looking out the window and you've got a view

that people would pay premium prices for in hotels around the world.

That's part of our therapy.

-Barbara.

-How are you?

What a time you've been having. What a time.

Come on through.

Barbara, who came into A&E with a suspected heart attack,

has come to the Hillswick surgery

for a follow-up appointment with Dr Bowie.

But first on the agenda is a surprise.

I've got a little present for you.

A urine specimen. Wee-wee.

-Cystitis.

-Right.

And was that since you were in hospital?

-It started the night I went in and came out Sunday afternoon.

-Uh-huh.

-So, it was the following Thursday.

-Right.

Before Dr Bowie can find out more about Barbara's stay in hospital,

she decides to check her urine sample.

I'm just checking Barbara's urine.

She's diabetic, so there's a bit of sugar,

but it's coming up pink and purple, so it shows lots of blood,

so it shows that she's got a definite urinary tract infection.

We'll send that away because, with us being so far away from hospital,

I'd be a wee bit anxious

about just treating her blindly with antibiotics.

We'll give her antibiotics but we just want to make sure

we know what bug's growing there.

Now that Barbara's urinary infection has been dealt with,

Dr Bowie can get on with delving into the events

that led to her admission into hospital.

And they didn't find out that you'd had any heart attack.

-It was just the same as the last one.

-Severe pain.

-I couldn't breathe properly.

-OK.

It's just like me, I can't breathe, but I'm OK.

It doesn't show up when you look.

-Well, it only shows up if you've had an actual heart attack.

-Yes.

So, you can get angina pain

that lasts for anything up to nearly an hour.

What happens in angina is you get a bit of spasm in the artery

or you get a wee clot in the artery. Sometimes it passes.

If people had a wee aspirin in their pocket to use,

it can just prevent you

from going on to have a full-blown heart attack.

They've put it down as non-cardiac chest pain

but, given your history,

I think it may well have been cardiac chest pain,

but just not to the extent

-that you've ended up having a heart attack.

-Yeah.

-So, I'll maybe contact the doctor, see what the plan is.

-Yeah.

But, in the meantime, we'll do that liver function check in four weeks.

When we repeat your liver tests, we'll do a repeat BAP as well.

If things get worse, if you get more short of breath,

then you need to let me know, if anything is deteriorating,

sooner rather than later. Nip it in the bud.

With all the necessary checks and appointments made,

Dr Bowie is now happy to pass Barbara on to the surgery nurse

for a final blood test, before sending her home.

-We've got to pick medicine up.

-Yeah.

-Right, see you again.

-Bye, bye.

SEAGULL CRIES

Two days after being airlifted off a fishing boat

and rushed to A&E, Danish cook Morten is on the mend.

He's been discharged

and is on the first leg of a trip home to Denmark.

They were very nice. They treat me very well.

Polite. It was a good experience.

I'm really looking forward to come home,

to be together with my family and my dog.

James the shopkeeper is back on Shetland

and has made a full recovery.

David travelled to Aberdeen for his specialist appointment,

where he was unfortunately diagnosed with a brain tumour, not epilepsy.

He's undergoing radiotherapy and chemotherapy

and we wish him a full recovery.

And Morten got home safely to Denmark.

Both his family and his dog were delighted

to have him back safe and well.