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 > 0:00:30They're so far from the mainland that when things go wrong...
0:00:30 > 0:00:32A&E, can I help you?
0:00:32 > 0:00:35..from helicopter rescues and spinal injuries...
0:00:35 > 0:00:38We're all here to make sure that you're OK.
0:00:38 > 0:00:40..to serious medical mysteries...
0:00:40 > 0:00:41Can we get assistance in, please?
0:00:41 > 0:00:43Something's not right.
0:00:43 > 0:00:46..Shetland's island medics have to be ready
0:00:46 > 0:00:48for anything and everything.
0:00:48 > 0:00:50- What happened?- Got in a fight with a seagull.
0:00:50 > 0:00:52- This was sheep shears, was it? - Yes.
0:00:54 > 0:00:56It means the tight-knit team of medics,
0:00:56 > 0:01:00volunteers and emergency services have a special bond.
0:01:00 > 0:01:02This might tickle, then.
0:01:03 > 0:01:06And they know just how to keep each other going...
0:01:06 > 0:01:07A wee treat for night shift.
0:01:07 > 0:01:12..so they're always ready for any island emergency.
0:01:20 > 0:01:22Today on Shetland,
0:01:22 > 0:01:25there's a case that piques nurse Emma Williamson's interest...
0:01:25 > 0:01:28I've got a problem with my pacemaker.
0:01:28 > 0:01:30That already sounds a bit exciting!
0:01:30 > 0:01:33..crofter Andy has an accident with his sheep shears...
0:01:33 > 0:01:36Got a shower and came here, but I can still smell sheep on me!
0:01:36 > 0:01:40..and offshore worker Ryan has some worrying appendicitis symptoms.
0:01:47 > 0:01:50On Shetland, it's fair to say there's plenty to do
0:01:50 > 0:01:52for locals and tourists alike.
0:01:55 > 0:01:57This rugged group of over 100 islands
0:01:57 > 0:02:00provide residents with opportunities
0:02:00 > 0:02:02like few other places in the British Isles.
0:02:04 > 0:02:07As well as the offshore industries and a growing tourism sector,
0:02:07 > 0:02:11traditional jobs like farming and fishing are having a renaissance.
0:02:11 > 0:02:14With such an eclectic mix of industries,
0:02:14 > 0:02:17it means an array of unique injuries and ailments can come through the
0:02:17 > 0:02:19doors of the Gilbert Bain Hospital.
0:02:25 > 0:02:27In the accident and emergency department,
0:02:27 > 0:02:29a patient has walked through the doors
0:02:29 > 0:02:31with a distinctly Shetland injury.
0:02:31 > 0:02:34I was just clipping sheep and it kicked the shears out of my hand
0:02:34 > 0:02:39and I think, instantly, by instinct, I tried to grab it with this
0:02:39 > 0:02:42and just caught the end of the shears.
0:02:42 > 0:02:44Just snipped the end of my finger.
0:02:44 > 0:02:47- Carried on shearing. - Aye, course you did!
0:02:47 > 0:02:50I've had worse. I've had sheep shears up my arm
0:02:50 > 0:02:52and that was stitches.
0:02:52 > 0:02:54Seems a waste of time,
0:02:54 > 0:02:55to waste a doctor's time on that.
0:02:57 > 0:02:59Andy, who is originally from Leeds,
0:02:59 > 0:03:02moved to Shetland almost 40 years ago.
0:03:02 > 0:03:05He now lives on the isle of Brae to the north-west of Lerwick.
0:03:06 > 0:03:08Together with his wife, Barbara,
0:03:08 > 0:03:10they work the 90 acres of her family's croft.
0:03:12 > 0:03:13It can be a dangerous business
0:03:13 > 0:03:16looking after their 40 sheep and Highland cattle.
0:03:17 > 0:03:20Oh! So this was sheep shears, was it?
0:03:20 > 0:03:22Yes, electrical ones, yes.
0:03:22 > 0:03:23Oh.
0:03:23 > 0:03:27It'll be up to Dr Kirsty Sneddon and nurse Lauren Kerr to treat the
0:03:27 > 0:03:31wound and, most importantly, make it safe from infection.
0:03:31 > 0:03:33So you've got the flap, but the flap's split in two.
0:03:33 > 0:03:36- Oh, yes?- And see this side, the darker side,
0:03:36 > 0:03:39I think you're probably going to lose that
0:03:39 > 0:03:41- and that's going to scab over.- OK.
0:03:41 > 0:03:43I think a Steri will probably hold it.
0:03:43 > 0:03:45It's kind of splitting three ways.
0:03:45 > 0:03:48- Mm-hm.- This flap.- And I could do one from there right over.
0:03:48 > 0:03:49You could try that.
0:03:49 > 0:03:52And then what do you think for follow-up?
0:03:52 > 0:03:54How dirty were the shears?
0:03:55 > 0:03:57Er, not TOO bad.
0:03:57 > 0:03:59Were they in use?
0:03:59 > 0:04:00They were in use, yeah.
0:04:00 > 0:04:02I had clipped about five...
0:04:02 > 0:04:05So I think we need to be a bit more careful.
0:04:06 > 0:04:09We'll give it a good wash-out, but there is a risk that, you know,
0:04:09 > 0:04:11it's not like you've just pulled them out of the packet.
0:04:11 > 0:04:14- No.- They've been used on livestock. - They've been used, yeah.
0:04:14 > 0:04:18- The issue is that if the bone underneath gets infected.- Yes.
0:04:18 > 0:04:20Maybe try not to cut any more limbs!
0:04:20 > 0:04:24No, I've finished! I carried on and finished them,
0:04:24 > 0:04:27then got a shower and came here, but I can still smell sheep on me.
0:04:27 > 0:04:29I can't!
0:04:29 > 0:04:32Steri-strips are used for small lacerations
0:04:32 > 0:04:35and are a useful alternative to stitches.
0:04:35 > 0:04:37But before the strips can be applied,
0:04:37 > 0:04:39a thorough clean by nurse Lauren Kerr is needed.
0:04:39 > 0:04:43So, this is a Betadine solution, so it's just an antiseptic solution.
0:04:43 > 0:04:47Just cos he's cut it on shearing shears that's been used with
0:04:47 > 0:04:49livestock, so they are dirty,
0:04:49 > 0:04:52so we just need to make sure it's got a good clean
0:04:52 > 0:04:55so that it hopefully doesn't get infected.
0:04:55 > 0:04:59If it stings as much as under the tap, you're going to see me cry!
0:05:01 > 0:05:04Soak it in there. Is it stinging?
0:05:04 > 0:05:06Yes, a little bit. It's OK.
0:05:06 > 0:05:09- I think it is actually quite clean. - Yeah, and it bled a little.
0:05:09 > 0:05:12- And it bled.- Yeah, so that should have flushed something out.
0:05:12 > 0:05:15And then you've had a pressure bandage on it till you've got here,
0:05:15 > 0:05:17so you've done everything.
0:05:17 > 0:05:19With the laceration thoroughly cleaned,
0:05:19 > 0:05:22nurse Lauren applies the Steri-strips.
0:05:24 > 0:05:27- Is that OK right there?- Yeah, yeah, that's fine.
0:05:28 > 0:05:32So that should keep it together quite nicely.
0:05:32 > 0:05:35I think that will be fine, cos that's the main bits
0:05:35 > 0:05:37we're trying to keep together.
0:05:37 > 0:05:40This comes down so it doesn't... so when we take it off,
0:05:40 > 0:05:42it doesn't stick as much when they take it off.
0:05:42 > 0:05:45So it's going to come down like that.
0:05:48 > 0:05:52It's fine and neat as well, so it's not really bulky.
0:05:52 > 0:05:56- This just rolls down, OK? Sorry if it's uncomfortable.- That's OK.
0:05:56 > 0:05:59- No, it's fine.- So if you can try and keep this dry, obviously.
0:05:59 > 0:06:02- Is that OK?- Yeah, that looks lovely, thanks.
0:06:07 > 0:06:10If there's any signs of infection, like redness, swelling,
0:06:10 > 0:06:12extreme pain or anything out of the ordinary,
0:06:12 > 0:06:15then I would say to get to your GP sooner,
0:06:15 > 0:06:18or come back here if you can't get an appointment,
0:06:18 > 0:06:20just because it has been cut with dirty scissors.
0:06:20 > 0:06:25- Yeah.- And I'll go and get you that information sheet.- OK.
0:06:27 > 0:06:30Andy's sheep shearing injury's cleaned and dressed.
0:06:30 > 0:06:32Yeah. And I didn't cry!
0:06:34 > 0:06:37He is under strict instructions to give the woolly clippers a break
0:06:37 > 0:06:39for at least a little while.
0:06:39 > 0:06:42- Much appreciated, thank you. - See you later. Bye.
0:06:44 > 0:06:45Happy customer!
0:06:52 > 0:06:54CAWING
0:06:58 > 0:07:01Whether you're a crofter or a tourist, if you need
0:07:01 > 0:07:03medical care on Shetland,
0:07:03 > 0:07:06you'll have the option of visiting the only hospital,
0:07:06 > 0:07:07the Gilbert Bain in Lerwick.
0:07:07 > 0:07:09Up there for me.
0:07:09 > 0:07:12Or you can visit one of the ten health centres
0:07:12 > 0:07:14among the communities of Shetland.
0:07:14 > 0:07:16The health centres provide GP surgeries
0:07:16 > 0:07:20and several community-care services to residents.
0:07:20 > 0:07:24Maintaining stocks of vital vaccines and medical supplies is a job
0:07:24 > 0:07:26organised from the Gilbert Bain.
0:07:26 > 0:07:28Morning, morning.
0:07:28 > 0:07:31So, first part of the day is mail.
0:07:33 > 0:07:35Another day, another dollar.
0:07:36 > 0:07:39It's the start of the day for hospital porter John Hallam.
0:07:39 > 0:07:43Today, he's the man responsible for keeping Shetland's health centres
0:07:43 > 0:07:46supplied with important vaccines and medication.
0:07:46 > 0:07:50First of all, I've got to pick up all the supplies from the stores.
0:07:50 > 0:07:52Drugs from pharmacy.
0:07:52 > 0:07:54Yeah, we do about 300 miles a week.
0:07:55 > 0:07:58And three ferries.
0:07:58 > 0:08:01John moved up to Shetland 16 years ago from the Peak District,
0:08:01 > 0:08:04looking for a quieter life.
0:08:04 > 0:08:06We came up here in 2001...
0:08:08 > 0:08:11..and I don't miss the commotion.
0:08:11 > 0:08:13I mean, look at this.
0:08:13 > 0:08:15This is it.
0:08:15 > 0:08:18So, that's rush-hour. About ten minutes, yeah.
0:08:18 > 0:08:22It's just amazing. Carolyn, my wife's, a midwife
0:08:22 > 0:08:26and we lived in the Peak District
0:08:26 > 0:08:29with a million-plus visitors a year,
0:08:29 > 0:08:33so they say. We couldn't get out of the house at the weekend.
0:08:33 > 0:08:35Yeah, we'd had enough.
0:08:35 > 0:08:38It was something better for the kids.
0:08:39 > 0:08:41So here we go.
0:08:42 > 0:08:45To get on the road, John needs to load up his van
0:08:45 > 0:08:47with medical supplies from the hospital depot.
0:08:47 > 0:08:50OK, so we've got today's.
0:08:51 > 0:08:54That's for tomorrow and they've not started on Friday's yet.
0:09:00 > 0:09:02I'll take this back and we'll be away.
0:09:05 > 0:09:08I think it's going to be a quiet day today.
0:09:08 > 0:09:09Right.
0:09:09 > 0:09:11Porters, see what they've got.
0:09:13 > 0:09:14- Just gas?- Yeah.
0:09:14 > 0:09:16John visits different hospital departments
0:09:16 > 0:09:19to collect anything that's been requested by the remote surgeries.
0:09:20 > 0:09:22- Oxygen?- Oxygen.- Yeah.
0:09:22 > 0:09:25- All yours, John.- Thank you very much.
0:09:25 > 0:09:27- And one bit of paper for them to sign.- Ta.
0:09:27 > 0:09:30With just a few more pick-ups required,
0:09:30 > 0:09:32John needs to collect the internal post.
0:09:32 > 0:09:35- ELEVATOR:- Doors closing.
0:09:36 > 0:09:38- Good morning.- Morning.
0:09:39 > 0:09:41The early bird catches the worm.
0:09:42 > 0:09:44Good morning. You've got a cold?
0:09:44 > 0:09:47- Yeah.- Well, stay where you are. Don't come near me.
0:09:47 > 0:09:50And finally, the all-important vaccines.
0:09:50 > 0:09:52Okey dokey. Thanks very much.
0:09:52 > 0:09:54Cheers, now.
0:09:54 > 0:09:57So, this is... There's just some for Bixter today,
0:09:57 > 0:09:59in what I call my lunchbox.
0:09:59 > 0:10:04This is the drugs that have to be kept cool.
0:10:05 > 0:10:07Got about an eight-hour lifespan in here.
0:10:10 > 0:10:11That one's going to Bixter,
0:10:11 > 0:10:15so it's my second port of call after Levenwick.
0:10:15 > 0:10:19Finally on his way, John has three main clinics to visit today.
0:10:20 > 0:10:22So, this is us on the way to Levenwick, yeah.
0:10:25 > 0:10:2620 minutes.
0:10:28 > 0:10:30The weather, changeable.
0:10:31 > 0:10:33Very changeable.
0:10:34 > 0:10:35Yeah, it's nice.
0:10:35 > 0:10:38I just miss trees
0:10:38 > 0:10:40and I miss mountains.
0:10:41 > 0:10:43I don't miss the traffic jams.
0:10:43 > 0:10:45Well, I've been up here 15 years.
0:10:45 > 0:10:49And a lot of people I know have been to this island a couple of times,
0:10:49 > 0:10:51visited it on holiday,
0:10:51 > 0:10:53and they go, "Oh, I'd love to come and live here."
0:10:53 > 0:10:55Fabulous. Yeah.
0:10:56 > 0:11:00Yeah. No hold-ups, no problems.
0:11:01 > 0:11:03Laid-back.
0:11:03 > 0:11:04Yeah.
0:11:04 > 0:11:09Laid-back. You haven't got the stress of down south.
0:11:09 > 0:11:13With a stop in Levenwick in the south and Bixter and Walls
0:11:13 > 0:11:16in the north-west, John will be travelling the length and breadth
0:11:16 > 0:11:17of mainland Shetland.
0:11:25 > 0:11:29With so many oil and gas rigs lying off the shores of Shetland,
0:11:29 > 0:11:31it's no surprise that the Gilbert Bain A&E department
0:11:31 > 0:11:34often plays host to their workers.
0:11:34 > 0:11:3619-year-old Ryan has been medevac'd
0:11:36 > 0:11:39from the rig he works on after several
0:11:39 > 0:11:41days of vomiting and abdominal pain.
0:11:41 > 0:11:44Nurse Kathy Duffus is the first to assess him.
0:11:44 > 0:11:48The medic on board thinks he might have appendicitis.
0:11:48 > 0:11:49He felt a bit faint on the helicopter
0:11:49 > 0:11:51and dropped his blood pressure,
0:11:51 > 0:11:55so I slid him across because when he sat up in here,
0:11:55 > 0:11:56he passed out again.
0:11:56 > 0:11:58So just quickly get him checked out.
0:11:58 > 0:12:01But he's fully conscious and speaking to us
0:12:01 > 0:12:04and he's not in any pain, so we'll see how he is.
0:12:05 > 0:12:07- Right, take care, mate.- Thank you.
0:12:09 > 0:12:10Cheers.
0:12:10 > 0:12:14- Thank you.- Appendicitis is an inflammation of the appendix
0:12:14 > 0:12:19and left untreated or misdiagnosed, it can be a very serious condition.
0:12:19 > 0:12:22It's up to Dr Caitlin Brennan to assess Ryan.
0:12:23 > 0:12:26I think we need to get some blood tests to see whether he does have an
0:12:26 > 0:12:28infection on board and we'll examine him
0:12:28 > 0:12:30and see if he does have a sore tummy.
0:12:33 > 0:12:34Hello. So is it Ryan?
0:12:34 > 0:12:37Yeah. I started getting pain from my right side to my left side
0:12:37 > 0:12:39in the middle of my belly.
0:12:41 > 0:12:45And then, yesterday, the pain just got worse on the right side.
0:12:45 > 0:12:48And how many times have you had diarrhoea now?
0:12:48 > 0:12:51Quite a few times. I've not been able to count.
0:12:51 > 0:12:53So, more than ten, or...?
0:12:54 > 0:12:56It was maybe less than ten, I would say.
0:12:56 > 0:12:59- Maybe.- And vomiting as well? - Quite a few times, yes.
0:12:59 > 0:13:02Have you been able to keep anything down that you've eaten or drank?
0:13:02 > 0:13:04No, no.
0:13:04 > 0:13:06Dr Brennan inspects Ryan's abdomen.
0:13:06 > 0:13:08My hands are freezing. They're always freezing!
0:13:08 > 0:13:12So if I press on this side, is it sore on the other side at all?
0:13:12 > 0:13:14- Just a wee bit.- A wee bit.
0:13:14 > 0:13:15- Mm-hm.- OK.
0:13:15 > 0:13:17It starts to get...
0:13:17 > 0:13:20- Yeah.- And that's quite painful?
0:13:20 > 0:13:24- Mm-hm.- It's a bit horrible, but is it sorer if I press...
0:13:24 > 0:13:26- Yeah.- ..or if I let go?
0:13:26 > 0:13:29- When you press.- So, if you just lift this leg up.
0:13:31 > 0:13:33- Any pain there?- Yeah. - Where do you feel it?
0:13:33 > 0:13:35Just in here, I think.
0:13:35 > 0:13:37- Down there.- And when we're doing that?- Yeah.
0:13:37 > 0:13:39Good.
0:13:45 > 0:13:47So, it's all a bit up in the air at the moment, but once we know,
0:13:47 > 0:13:50- we'll let you know, OK?- Okey doke. - All right.
0:13:50 > 0:13:53With Dr Brennan's initial examination complete,
0:13:53 > 0:13:57she turns to senior A&E doctor Kushik Lalla for advice
0:13:57 > 0:13:59on diagnosing Ryan's symptoms.
0:14:01 > 0:14:03That's the problem with appendicitis.
0:14:03 > 0:14:07No matter how experienced you are, you will get caught out,
0:14:07 > 0:14:10and if you haven't been caught out by appendicitis,
0:14:10 > 0:14:12you haven't seen enough appendicitis.
0:14:12 > 0:14:14You have to be very, very suspicious.
0:14:14 > 0:14:18Appendicitis can be difficult to diagnose due to the position
0:14:18 > 0:14:20of the appendix and its size
0:14:20 > 0:14:23and symptoms can be similar to other inflammatory problems.
0:14:24 > 0:14:28Dr Lalla needs all the information Dr Brennan has gathered.
0:14:28 > 0:14:31Pain seemed to come on at the same time as the diarrhoea.
0:14:31 > 0:14:35OK, so it wasn't pain first and then diarrhoea?
0:14:35 > 0:14:37So, pain and diarrhoea concurrent.
0:14:37 > 0:14:40- OK, yeah, OK.- He's been away for ten days on the rig
0:14:40 > 0:14:43and no-one else is unwell. Family history,
0:14:43 > 0:14:47some sort of bowel history, which he doesn't think was cancer.
0:14:47 > 0:14:50- So, it could also be colitis. - Could.
0:14:50 > 0:14:54Could. It's sounding more like that sort of picture,
0:14:54 > 0:14:56rather than appendicitis.
0:14:57 > 0:14:59But, yeah. The family history's important here.
0:14:59 > 0:15:03It's very likely that he is going to end up with either,
0:15:03 > 0:15:06it's going to be Crohn's or ulcerative colitis,
0:15:06 > 0:15:07one of those two.
0:15:07 > 0:15:11Crohn's disease is an inflammation of the digestive tract
0:15:11 > 0:15:14and can cause serious complications for sufferers.
0:15:14 > 0:15:18If it IS Crohn's, it could be life-changing for Ryan.
0:15:30 > 0:15:34Staff nurse and Shetland native Emma Williamson is on the day shift
0:15:34 > 0:15:36in A&E. As can often be the case,
0:15:36 > 0:15:40it's not long before a patient is knocking on her door.
0:15:40 > 0:15:42- Oh, hello.- Hello. - Hi, how can we help?
0:15:42 > 0:15:45I've got a little problem with my pacemaker.
0:15:45 > 0:15:49- Oh!- Oh!- That already sounds a bit exciting!
0:15:49 > 0:15:51Me wires have come through the skin.
0:15:51 > 0:15:53Ooh! When did you get it put in?
0:15:53 > 0:15:56- November?- Last November.- Has it been gradually coming through?
0:15:56 > 0:15:57- Yes.- Yeah.- Well...
0:15:57 > 0:16:01I've been keeping an eye on it but this morning, when he had a shower,
0:16:01 > 0:16:05there was like a clear, liquidy-stained plasma coming out.
0:16:05 > 0:16:06Coming out of it.
0:16:06 > 0:16:08It looks like a little hole.
0:16:08 > 0:16:09Oh, OK.
0:16:11 > 0:16:14Alan and Janine have travelled in from Sandwick,
0:16:14 > 0:16:1613 miles south of the Gilbert Bain.
0:16:17 > 0:16:20They are concerned the wires of Alan's pacemaker
0:16:20 > 0:16:22have started to protrude through his skin.
0:16:22 > 0:16:26For nurse Emma, it's another unusual story to add to the list.
0:16:27 > 0:16:29If you actually take time, you get
0:16:29 > 0:16:31so much more for your patient in here.
0:16:31 > 0:16:35Their background, their story, and what has brought them in.
0:16:35 > 0:16:39And often there are really some very fascinating stories
0:16:39 > 0:16:42from these folk and I love to hear them.
0:16:43 > 0:16:45Does it feel like it's working all right?
0:16:45 > 0:16:49- Yeah.- Doesn't feel like it's doing anything weird and wonderful?
0:16:49 > 0:16:51No. I've had problems with wires in the past,
0:16:51 > 0:16:53where it's come off,
0:16:53 > 0:16:57and it's been short-circuiting through my shoulder.
0:16:57 > 0:17:01Alan had his first pacemaker installed in 1998.
0:17:01 > 0:17:04Since then, it's fair to say he's been through quite a few.
0:17:04 > 0:17:06Well, I've had nine pacemakers in.
0:17:06 > 0:17:09- In total?- Yeah. - Oh, my goodness!
0:17:09 > 0:17:12I think that's a record for me looking after somebody.
0:17:12 > 0:17:15The first one I got came out the skin underneath my armpit.
0:17:15 > 0:17:18Your body obviously likes to work it out!
0:17:18 > 0:17:21Yeah. I need a bit more fat on me, I think.
0:17:21 > 0:17:24We'll feed you up. Me and Amanda don't have that problem,
0:17:24 > 0:17:27- we were saying that to somebody else.- Thanks!
0:17:28 > 0:17:30I'll going and phone the doctor, then.
0:17:30 > 0:17:32- OK.- Oh, I'll give you a buzzer, actually.
0:17:32 > 0:17:35If you feel funny at all, or you need us...
0:17:35 > 0:17:37What's your wife's name?
0:17:37 > 0:17:40- Janine.- I'll let Janine come and sit with you, all right?
0:17:40 > 0:17:44This is a gentleman who has had lots and lots of contact
0:17:44 > 0:17:46with NHS services. He's had a nine pacemakers.
0:17:46 > 0:17:48I don't think I've ever looked after somebody
0:17:48 > 0:17:51who's had that many pacemakers, and I used to work in cardiology.
0:17:54 > 0:17:57A pacemaker sends electrical pulses to the heart
0:17:57 > 0:17:59to keep it beating regularly.
0:18:00 > 0:18:03The device can significantly improve quality of life
0:18:03 > 0:18:06and can be life-saving for some patients.
0:18:06 > 0:18:07Okey dokey.
0:18:08 > 0:18:11Nurse Emma calls on the junior medical doctor on shift,
0:18:11 > 0:18:15Dr Kirsty Sneddon, to take a look at the problem area.
0:18:15 > 0:18:17- Can I ask your name?- Yes. Alan.- Hello.
0:18:17 > 0:18:20I'm Kirsty, one of the doctors.
0:18:20 > 0:18:22Dr Sneddon is originally from Aberdeen,
0:18:22 > 0:18:25but has been working at the Gilbert Bain for four months -
0:18:25 > 0:18:27and it's certainly left an impression.
0:18:29 > 0:18:32You do know the patients more, I feel,
0:18:32 > 0:18:35just because you've got the time to take and get to know them
0:18:35 > 0:18:39and often you're treating relatives, you know, so they'll come back in.
0:18:39 > 0:18:41There is a huge community up here.
0:18:41 > 0:18:42I think you feel that...
0:18:44 > 0:18:45..from day one, when you come in.
0:18:47 > 0:18:51In and outside of the hospital, there's that.
0:18:51 > 0:18:53You feel at home. Yeah.
0:18:53 > 0:18:56So what's been happening today?
0:18:56 > 0:18:58I've just got a little bit of a leak.
0:18:58 > 0:19:01So I've been hearing. How long's it been going on for?
0:19:01 > 0:19:05Probably about a month or so, maybe a tiny bit longer.
0:19:05 > 0:19:06OK.
0:19:09 > 0:19:11How much fluid do you think's come out?
0:19:12 > 0:19:14Just as much as is on the dressing?
0:19:15 > 0:19:17Yeah, and a little bit more that was wiped up.
0:19:17 > 0:19:19OK. And is it tender round...
0:19:19 > 0:19:22- Yeah.- ..round here where I'm pushing?
0:19:22 > 0:19:25- Not so much there, just mainly on the site.- Just where it is.
0:19:25 > 0:19:29- OK.- There's always been this, like, this knot up here...
0:19:31 > 0:19:33..which I presumed was the wires.
0:19:34 > 0:19:38Because, I mean, I've still got wires in this side
0:19:38 > 0:19:40from the other pacemakers.
0:19:40 > 0:19:43It seems to be the actual site of insertion seems very healthy.
0:19:43 > 0:19:48It seems to be a possible old site that's infected.
0:19:48 > 0:19:51I'm unsure at this stage how deep the infection goes,
0:19:51 > 0:19:54so I've called the consultant and together we'll see where we go.
0:19:54 > 0:19:57He's been treated with antibiotics,
0:19:57 > 0:19:59which seem to have been pretty effective,
0:19:59 > 0:20:03so we're going to investigate it with some bloods and a scan
0:20:03 > 0:20:05of the site to see if there's an abscess under the skin
0:20:05 > 0:20:06and take it from there.
0:20:06 > 0:20:09So, feeling a bit more relieved about it?
0:20:09 > 0:20:12Yeah. Did you always want to be a doctor?
0:20:12 > 0:20:14I did, actually.
0:20:14 > 0:20:18Since about four years old. My grandparents were doctors,
0:20:18 > 0:20:22so playing with stethoscopes and plastic syringes on a Sunday
0:20:22 > 0:20:25at their house was quite normal.
0:20:25 > 0:20:26- Shaving the cat.- Yeah!
0:20:28 > 0:20:30You had the tea set, you had the doctor set.
0:20:31 > 0:20:34So, that's all the blood I'm going to take off you today.
0:20:34 > 0:20:36I promise.
0:20:37 > 0:20:41With bloods taken to double-check there isn't a deeper problem,
0:20:41 > 0:20:45and Dr Sneddon happy that the antibiotics are taking effect,
0:20:45 > 0:20:47Alan and Janine are allowed to return home.
0:20:47 > 0:20:52- Okey dokey. Yeah.- Just come back or call if you have any questions or
0:20:52 > 0:20:54- issues or anything.- Yeah, yeah. Brilliant. Thanks for your help.
0:20:54 > 0:20:57- That's all right. See you later! - Thank you.- See you then. Bye.
0:21:05 > 0:21:08It's the weekend and all over the islands,
0:21:08 > 0:21:11Shetlanders are enjoying their Saturday,
0:21:11 > 0:21:14which, for a lot of them, means sporting activities -
0:21:14 > 0:21:18and sometimes a visit to A&E.
0:21:18 > 0:21:20So, are you able to tell me exactly what happened?
0:21:22 > 0:21:24Just going over the hill with my bike
0:21:24 > 0:21:26and I pulled a wheelie and it flipped.
0:21:26 > 0:21:29John's a fan of Motocross.
0:21:29 > 0:21:32He is seeing A&E nurse Lauren Kerr after coming off his off-road
0:21:32 > 0:21:35motorbike and crushing the little finger on his right hand.
0:21:38 > 0:21:43John lives in Whiteness, nine miles north-west of the Gilbert Bain.
0:21:43 > 0:21:45Oh, cos your foot hit into the...
0:21:45 > 0:21:49Yes, I came off, then I came down on my foot and bounced off the ground
0:21:49 > 0:21:51and knocked this out.
0:21:52 > 0:21:56Nurse Lauren reports her initial assessment to Dr Ashley Thomson,
0:21:56 > 0:21:59today's A&E surgical doctor.
0:21:59 > 0:22:01So, he was on the hill on his motorbike,
0:22:01 > 0:22:04doing a wheelie, and kind of lost control of the bike.
0:22:04 > 0:22:05As you do!
0:22:05 > 0:22:08And he says he kind of did the splits
0:22:08 > 0:22:13and his right pinkie finger has hit into his foot
0:22:13 > 0:22:15and it does look dislocated.
0:22:15 > 0:22:17Where do you think it is dislocated, here or here?
0:22:19 > 0:22:21- What do you think?- Lower? - Down there?
0:22:21 > 0:22:23At the metacarpal?
0:22:23 > 0:22:26Not that I am any professional.
0:22:26 > 0:22:28And he's unable to move it.
0:22:28 > 0:22:29- Hello!- Hello.
0:22:29 > 0:22:32- Mr Burns.- That's me. - Hello, how are you doing?
0:22:32 > 0:22:33I'm doing wonderful. You?
0:22:33 > 0:22:36Good. My name's Ashley Thomson, one of the surgical doctors.
0:22:36 > 0:22:39I understand you've injured your finger.
0:22:39 > 0:22:41- Got it bent.- Tell me what's happened.
0:22:41 > 0:22:43I just fell off me bike.
0:22:43 > 0:22:45You were on a Motocross bike?
0:22:45 > 0:22:48Yeah, and I just kind of pulled a wheelie and fell off
0:22:48 > 0:22:50and when I fell off, this hand hit the back of my foot.
0:22:50 > 0:22:52OK, fine.
0:22:52 > 0:22:53And that was the result of that.
0:22:53 > 0:22:56What we need to do is just confirm that on X-ray,
0:22:56 > 0:22:57so we'll get a picture of it.
0:22:57 > 0:23:01- OK.- And then it looks like we're going to have to pull it
0:23:01 > 0:23:02- back into place.- Oooh.- OK?
0:23:02 > 0:23:04Super. I know.
0:23:04 > 0:23:06Sounds worse than it is.
0:23:07 > 0:23:10We'll get an X-ray then I'll come and explain fully what we'll do.
0:23:10 > 0:23:12Yeah, that's no bother.
0:23:12 > 0:23:13Can you feel me touching here?
0:23:13 > 0:23:16- Mm-hm.- And if I was to touch the other side, does it feel the same?
0:23:16 > 0:23:18- Yeah.- Yeah? Feel me touching there?
0:23:18 > 0:23:19- Yeah.- Feel the same there?
0:23:19 > 0:23:22- Yeah.- Yeah. Perfect, fine.
0:23:22 > 0:23:26OK. It looks to me like it's this joint here that's been affected,
0:23:26 > 0:23:29but we'll just make sure that there is nothing further...
0:23:29 > 0:23:31- OK, yeah.- ..that's been injured there.
0:23:31 > 0:23:33- Any questions at all with that? - No, no. That's good.
0:23:33 > 0:23:35Super. I'll go ahead and get that sorted for you, OK?
0:23:35 > 0:23:37- Super.- Perfect.
0:23:37 > 0:23:39- Thank you very much. - No bother at all.
0:23:43 > 0:23:46A&E isn't busy and, after a short wait,
0:23:46 > 0:23:48John gets his little finger x-rayed.
0:23:48 > 0:23:52And as the Gilbert Bain uses digital technology for its X-ray imaging,
0:23:52 > 0:23:54Dr Thomson gets the results swiftly.
0:23:57 > 0:24:00So, you can see that all the other fingers...
0:24:00 > 0:24:01Our fingers should be nicely aligned
0:24:01 > 0:24:04and all in a nice, straight line together,
0:24:04 > 0:24:08whereas this one has taken a step forwards here.
0:24:08 > 0:24:10But you can see it more clearly on the lateral.
0:24:10 > 0:24:13And you can see that it has just jumped forward,
0:24:13 > 0:24:17so it's essentially shortened the finger down, so it's gone backwards,
0:24:17 > 0:24:20and then it slipped upwards,
0:24:20 > 0:24:23so we'll pull it back into position and give him a nice,
0:24:23 > 0:24:25straight finger again.
0:24:25 > 0:24:28I guess it's confirming what we thought, just on examination,
0:24:28 > 0:24:31that it's dislocated there, so we'll go and let him know
0:24:31 > 0:24:34and explain what we're going to do and pop it back into place for him,
0:24:34 > 0:24:36get it all nice and straight.
0:24:48 > 0:24:51Offshore rig worker Ryan has been brought into the Gilbert Bain after
0:24:51 > 0:24:54suffering days of abdominal pain.
0:24:54 > 0:24:58Dr Brennan and Dr Lalla are trying to diagnose Ryan's symptoms.
0:24:58 > 0:25:01They'd thought that it might be appendicitis,
0:25:01 > 0:25:03but due to Ryan's family history,
0:25:03 > 0:25:05they now think it could be Crohn's disease.
0:25:08 > 0:25:09Hi there.
0:25:09 > 0:25:11- Hello.- Ryan?- Yeah.
0:25:11 > 0:25:14- Hi there. How are you doing? - Not too good, not too bad.
0:25:14 > 0:25:16Not too good, not too bad.
0:25:16 > 0:25:17OK. How old are you, Ryan?
0:25:17 > 0:25:1919.
0:25:19 > 0:25:23Crohn's disease affects over 100,000 people in the UK.
0:25:23 > 0:25:26Most cases develop between the ages of 16 and 30.
0:25:28 > 0:25:29When did this start?
0:25:30 > 0:25:31Well, the pain started on...
0:25:34 > 0:25:35..Sunday.
0:25:35 > 0:25:37And it started with pain first, did it?
0:25:37 > 0:25:40- Yeah.- Right.- Well, the pain had started on Sunday,
0:25:40 > 0:25:42but everything had started on the Saturday.
0:25:43 > 0:25:49Diagnosis involves history, examination and then tests
0:25:49 > 0:25:51and, depending on what you find,
0:25:51 > 0:25:54you constantly go back and forth,
0:25:54 > 0:25:58deciding what your diagnosis is going to be.
0:25:58 > 0:26:02It's usually a combination of factors,
0:26:02 > 0:26:06looking at everything together, that helps you decide.
0:26:06 > 0:26:10Right, OK. Just try and blow your belly up and touch my hand.
0:26:10 > 0:26:12Try and blow it out as much as you can.
0:26:13 > 0:26:15- That sore?- Yeah.
0:26:15 > 0:26:17Yeah. Let's do the opposite.
0:26:17 > 0:26:20Let's try and suck it all the way in.
0:26:20 > 0:26:22All the way in. That sore?
0:26:22 > 0:26:24- Just a wee bit, yeah.- Which is worse, blowing out or sucking it in?
0:26:24 > 0:26:26- Blowing it out.- Blowing it out.
0:26:26 > 0:26:29So, what we are going to do, then, Ryan,
0:26:29 > 0:26:31is get some blood tests just now.
0:26:31 > 0:26:33- Yeah.- They've taken some bloods off you.
0:26:33 > 0:26:35- Yeah.- We'll see what those show.
0:26:35 > 0:26:38The question for us is whether we need to take you to theatre or not.
0:26:38 > 0:26:40OK? Have you had anything to eat or drink?
0:26:40 > 0:26:42Not since dinner time.
0:26:42 > 0:26:46Don't have anything to eat or drink just now, OK? Until we tell you.
0:26:46 > 0:26:47Blood?
0:26:47 > 0:26:49White cells 13.7.
0:26:50 > 0:26:52Yeah. Any thoughts?
0:26:54 > 0:26:58- Appendicitis.- Yeah, pointing towards appendicitis now, isn't it?
0:26:58 > 0:27:00Right.
0:27:00 > 0:27:02But, let's see.
0:27:02 > 0:27:05We might still get caught out. It might be colitis.
0:27:05 > 0:27:07Still don't know.
0:27:07 > 0:27:10So, what we're going to do is get some x-rays on you just now
0:27:10 > 0:27:13and then take things from there.
0:27:13 > 0:27:17With Ryan's symptoms and initial blood tests now indicating possible
0:27:17 > 0:27:21appendicitis, Dr Lalla must perform more tests to be sure.
0:27:21 > 0:27:24There's two distinct possibilities.
0:27:24 > 0:27:26After seeing and examining him,
0:27:26 > 0:27:28appendicitis is very high on that list.
0:27:28 > 0:27:30If it is appendicitis,
0:27:30 > 0:27:34it may end up being quite a complicated appendicitis.
0:27:34 > 0:27:39If it's not appendicitis, it's very likely to be Crohn's disease,
0:27:39 > 0:27:42but we are now leaning more towards appendicitis,
0:27:42 > 0:27:46given the examination findings and the bloods.
0:27:46 > 0:27:47It is still not clear, though.
0:27:47 > 0:27:50The question is whether we go on to take him to theatre
0:27:50 > 0:27:52and open up the tummy, or not.
0:28:05 > 0:28:07Eight of Shetland's inhabited islands
0:28:07 > 0:28:08are connected to mainland Shetland
0:28:08 > 0:28:10by the island's ferry service.
0:28:12 > 0:28:16The ferry service connects the islands of Fair Isle, Foula, Fetlar,
0:28:16 > 0:28:19Bressay, Unst, Whalsay and Yell.
0:28:19 > 0:28:24Employing 103 people and operating 365 days a year,
0:28:24 > 0:28:28the service is vital to Shetland's communities.
0:28:28 > 0:28:30But working on such a service can bring with it
0:28:30 > 0:28:32a lot of seafaring hazards.
0:28:34 > 0:28:38Ferry worker Shona has come into A&E with a suspected broken ankle.
0:28:40 > 0:28:43Shona tripped and fell while working on the ferry to and from Fair Isle.
0:28:46 > 0:28:50Nurse Amanda Brown is first to assess Shona and her injured ankle.
0:28:50 > 0:28:53So, what were you doing yesterday?
0:28:53 > 0:28:55I was working in the hold of the boat.
0:28:55 > 0:28:57OK.
0:28:57 > 0:28:59And there's the floor...the bottom of the hold,
0:28:59 > 0:29:02and then there's the sloping side.
0:29:02 > 0:29:06And there's just like little loops that are kind of inlaid
0:29:06 > 0:29:09just at the bottom of that edge, half in,
0:29:09 > 0:29:12and I turned and caught my foot on that.
0:29:12 > 0:29:14It twisted and went over.
0:29:14 > 0:29:17So would you say you twisted it in?
0:29:17 > 0:29:21- I'm not sure how.- Do you think it went like this or like that?
0:29:21 > 0:29:24It went in.
0:29:24 > 0:29:27- Inversion?- Yeah.- OK.
0:29:27 > 0:29:29Did you think you'd come down a step?
0:29:29 > 0:29:32I didn't come down a step, I came down a slope.
0:29:32 > 0:29:34Down a slope. OK.
0:29:38 > 0:29:42Shona comes from Brae, which lies 23 miles north-west of Lerwick.
0:29:44 > 0:29:47I'm a relief deckhand for the Shetland Council Ferries,
0:29:47 > 0:29:52so I go around all the council ferries in Shetland.
0:29:52 > 0:29:57And I went in on Tuesday to work until tomorrow.
0:29:57 > 0:29:59Supposed to come out tomorrow.
0:30:01 > 0:30:04Yeah, I was working and went over on my ankle in the hold of the boat.
0:30:06 > 0:30:07There we go.
0:30:10 > 0:30:13- Hi there. Is it Shona Williamson? - Yeah.- Hi, I'm Saul,
0:30:13 > 0:30:14I'm one of the doctors here.
0:30:14 > 0:30:16As the surgical doctor on shift,
0:30:16 > 0:30:20Dr Saul Wilson and medical student Albert Myerscough need to determine
0:30:20 > 0:30:22whether Shona has broken her ankle.
0:30:23 > 0:30:27- It's quite sore. - Yeah, no, I can imagine.
0:30:29 > 0:30:32- So I'll have a little look...- It's really, really tender around here.
0:30:32 > 0:30:35- And here.- Around there. Both sides.- Just here, mostly.
0:30:35 > 0:30:39- OK.- It's not as sore as it was last night.- Yeah. OK.
0:30:39 > 0:30:41So I'm having a little feel.
0:30:41 > 0:30:44Obviously, just let me know when it's painful.
0:30:44 > 0:30:47I can tell from the look on your face, you don't want me doing this.
0:30:49 > 0:30:51- OK, so there?- That was sore, yeah.
0:30:51 > 0:30:52That was sore, OK.
0:30:52 > 0:30:55- Still tender when I'm pressing here? - It's quite tender, yeah.- OK.
0:30:56 > 0:30:58How about here?
0:30:58 > 0:30:59Yeah.
0:31:01 > 0:31:02- That's not so bad.- OK.
0:31:06 > 0:31:10Right. Yeah, so I think we'll need to do an X-ray,
0:31:10 > 0:31:15just to see if there's any fractures at all.
0:31:15 > 0:31:18I guess it depends on what the x-rays show, what we do after that.
0:31:22 > 0:31:26And just looking generally, I can't see anything too obvious,
0:31:26 > 0:31:30but I think I'll probably run it past my senior just to check there's
0:31:30 > 0:31:31nothing that I'm missing.
0:31:31 > 0:31:34Dr Wilson's consultant confirms his assessment.
0:31:34 > 0:31:36There is no fracture.
0:31:36 > 0:31:39It seems Shona is off the hook.
0:31:39 > 0:31:44Well, the x-rays look fine, so it must be a soft tissue injury.
0:31:44 > 0:31:47I'll get him to come and speak to you before you go.
0:31:47 > 0:31:50Are you happy for me to put on a Co-Plus support?
0:31:50 > 0:31:51Yeah.
0:31:51 > 0:31:55Now, if this feels too tight, then you just chop it off.
0:31:55 > 0:31:57The bandage, not the leg!
0:31:58 > 0:32:02There's just time to try out a set of crutches before Dr Wilson returns
0:32:02 > 0:32:03to confirm the good news.
0:32:03 > 0:32:05Hiya, how are you getting on?
0:32:05 > 0:32:06- Fine, yeah.- Good.
0:32:06 > 0:32:09So, I think maybe the nurses have come in and told you.
0:32:09 > 0:32:13We couldn't see any fractures, which is good news, yeah, yeah.
0:32:13 > 0:32:15So it means you won't have to do anything too dramatic.
0:32:15 > 0:32:18No surgery or anything, no manipulation.
0:32:19 > 0:32:22But, yes, it will probably be tender for quite a while.
0:32:22 > 0:32:25And, obviously, you probably won't be able to work for a little bit.
0:32:25 > 0:32:26Yeah.
0:32:27 > 0:32:30So you can rest a bit.
0:32:30 > 0:32:32I'll try!
0:32:32 > 0:32:35- Well, nice to meet you, anyway. - Yes, nice to meet you, too.
0:32:35 > 0:32:38- See you later.- Thank you very much. - No worries. Bye.
0:32:38 > 0:32:39We'll go and find your mam.
0:32:39 > 0:32:41- Yeah, she's somewhere around.- Yeah.
0:32:41 > 0:32:44With another patient successfully discharged,
0:32:44 > 0:32:47nurse Amanda sees Shona out to the car.
0:32:47 > 0:32:50It's all part of the Gilbert Bain service.
0:32:50 > 0:32:52You're welcome. Bye.
0:32:57 > 0:33:00- Job done. - CAR ENGINE STARTS
0:33:06 > 0:33:09On the road, 16 miles south of Lerwick,
0:33:09 > 0:33:12John has arrived at his first stop in Levenwick.
0:33:12 > 0:33:14So, this is Levenwick Health Centre.
0:33:15 > 0:33:16First drop.
0:33:20 > 0:33:22Get my little life-saver.
0:33:29 > 0:33:30I'll come back for those.
0:33:34 > 0:33:35Hello!
0:33:35 > 0:33:38Just check that there's anything to go back.
0:33:40 > 0:33:42That's just one sharps bin.
0:33:42 > 0:33:46You can get one to half a dozen to 12.
0:33:46 > 0:33:49And then the bags go inside that big bin.
0:33:49 > 0:33:51But you can see it is separated from the back.
0:33:54 > 0:33:56And then John's back on the road
0:33:56 > 0:33:59with Bixter, 30 miles to the north-west, his next port of call.
0:33:59 > 0:34:03We're off to Bixter now, over on the west side.
0:34:03 > 0:34:05Everybody knows everybody, really.
0:34:05 > 0:34:09You come across everybody at some stage in your time here.
0:34:09 > 0:34:12The people that have been born and bred here, they'll know so-and-so
0:34:12 > 0:34:15and they go, "Oh, I know so-and-so!" Yeah.
0:34:17 > 0:34:18They just know everybody.
0:34:21 > 0:34:23This is Bixter Health Centre.
0:34:23 > 0:34:25The one and only drug stop.
0:34:32 > 0:34:36These are vaccines. Well, I don't know what they are, actually.
0:34:36 > 0:34:37There we go, young lady.
0:34:39 > 0:34:40- Thank you.- Thank you.
0:34:44 > 0:34:48On the west coast, Walls Health Centre is John's last drop
0:34:48 > 0:34:50and the sun finally shines on his day.
0:34:52 > 0:34:53Oh, fabulous in Walls, yeah.
0:34:56 > 0:34:57Yeah, fantastically sunny.
0:35:01 > 0:35:04I can manage these without the trolley.
0:35:07 > 0:35:10Hello. That's the one, that's done.
0:35:12 > 0:35:15OK. That's it, then.
0:35:15 > 0:35:17- Yeah.- Thank you very much.
0:35:17 > 0:35:18See you again. Bye.
0:35:26 > 0:35:30With his vital medical jobs complete and deliveries done,
0:35:30 > 0:35:32John heads back to HQ.
0:35:35 > 0:35:37I'm back in the town centre.
0:35:38 > 0:35:41And just heading to the hospital now.
0:35:41 > 0:35:43Plan ahead for tomorrow
0:35:43 > 0:35:46and discharge anything I've picked up today
0:35:46 > 0:35:49back to relevant departments.
0:35:53 > 0:35:56Yeah, back to HQ with the mail for the...
0:35:57 > 0:35:59..community nurses.
0:35:59 > 0:36:01Getting to live and work in Shetland
0:36:01 > 0:36:03brings with it a certain appreciation.
0:36:03 > 0:36:05Travel, outside...
0:36:07 > 0:36:09..on days like this. Fantastic.
0:36:10 > 0:36:12Although, on horrendous days, it can be good.
0:36:14 > 0:36:15Yeah.
0:36:28 > 0:36:30John Burns from Whiteness has come into A&E
0:36:30 > 0:36:34after hurting his hand falling off his Motocross bike.
0:36:35 > 0:36:39Dr Thomson has had his hand x-rayed and confirmed her diagnosis.
0:36:41 > 0:36:42It's time to tell John.
0:36:44 > 0:36:46- Hello, John.- Hello.
0:36:46 > 0:36:49That X-ray confirms what we were speaking about.
0:36:49 > 0:36:56- OK.- It's dislocated out of the joint space here and it's gone forwards,
0:36:56 > 0:36:58so this bit of the finger, instead of being in a nice,
0:36:58 > 0:37:03- straight line here, has jumped forwards and has gone back.- OK.
0:37:03 > 0:37:06So essentially, that's why this finger's shorter
0:37:06 > 0:37:09- than your little finger on this side.- Uh-huh.
0:37:09 > 0:37:12So what we'll do is put that back into the right position.
0:37:12 > 0:37:14- You just do what you have to do. - Is that OK?- Yeah, yeah.
0:37:14 > 0:37:16- Carry on.- Do you want to lie down for it?
0:37:16 > 0:37:18You've got laughing gas and all!
0:37:18 > 0:37:20Do you think... Do you want to lie down?
0:37:20 > 0:37:23- I'm not fussed. Whatever you want me to do.- Are you OK with needles?
0:37:23 > 0:37:24- Yeah, yeah.- Yeah?
0:37:28 > 0:37:31Yeah, that's probably... That's actually probably quite helpful.
0:37:31 > 0:37:33You hold on to that.
0:37:33 > 0:37:36INAUDIBLE
0:37:36 > 0:37:39A wee bar to stick in my mouth or something?
0:37:39 > 0:37:43We'll give you the gas and air that you can pop in.
0:37:43 > 0:37:45So it's this stuff that'll make you happy, then?
0:37:45 > 0:37:47- It's called laughing gas. - HE TAKES A DEEP BREATH
0:37:47 > 0:37:50Well, wait till we do something first!
0:37:50 > 0:37:51Otherwise we'll just be...
0:37:51 > 0:37:53- Just be giggling.- Just be merry!
0:37:53 > 0:37:56Before we've done anything.
0:37:56 > 0:37:58Save a hangover, would it not?
0:38:00 > 0:38:03Just going to give the skin a little bit of a clean, OK?
0:38:06 > 0:38:10- INAUDIBLE - Yeah, that would be good, actually.
0:38:10 > 0:38:13So you've got the Entonox there, so just puff away on that
0:38:13 > 0:38:16as you need to, OK? Okey doke?
0:38:16 > 0:38:18- Ready for me to start?- Yeah.
0:38:18 > 0:38:20Sharp scratch. Well done.
0:38:20 > 0:38:23This laughing gas is kind of kicking in a bit.
0:38:28 > 0:38:31So, I'm just going to pull this back into place now.
0:38:33 > 0:38:36Well done. OK.
0:38:36 > 0:38:38- That's it.- Keep blowing, in and out.
0:38:38 > 0:38:41- Is that it? - Yeah, that's it.- That's it.
0:38:41 > 0:38:42- That's good stuff.- Did you feel...
0:38:42 > 0:38:45- I like that stuff!- You can feel it going back into place, probably.
0:38:45 > 0:38:47- Yes, I can feel it popping.- It's a little bit of a...
0:38:47 > 0:38:48Yeah, a clunky type of noise.
0:38:48 > 0:38:51- Jeezo, that stuff works.- Well done! That's it.
0:38:51 > 0:38:53Are you feeling a bit funny?
0:38:53 > 0:38:55And then you can see that the finger,
0:38:55 > 0:38:58it's lengthened back up to the length that it should be
0:38:58 > 0:39:01and that it's now back in the right joint space
0:39:01 > 0:39:03and moving quite freely there.
0:39:03 > 0:39:06All that's left is a precautionary X-ray
0:39:06 > 0:39:10to check if John's pinkie is in full working order.
0:39:10 > 0:39:13OK, we are all done.
0:39:13 > 0:39:15That's good. I'm pleased it's nice and back in the joint,
0:39:15 > 0:39:17but it definitely felt like it went back into the joint,
0:39:17 > 0:39:19so that just confirms that,
0:39:19 > 0:39:24so we can go and let him know that he's got two good fingers now.
0:39:24 > 0:39:27Ten good fingers, actually! Ten fingers.
0:39:27 > 0:39:29It's back in the joint.
0:39:29 > 0:39:32Looks better when it's meant to be in the right place.
0:39:32 > 0:39:34Yeah, and it looks perfect on the X-ray.
0:39:34 > 0:39:36So I'm pleased with that. What we'll do is
0:39:36 > 0:39:38we'll strap it to your next-door finger.
0:39:38 > 0:39:41- OK.- It's called buddy strapping.
0:39:41 > 0:39:44- Oh, boy.- So, we'll just strap it here and strap it here,
0:39:44 > 0:39:47and that just is to give it a bit of extra support.
0:39:47 > 0:39:49- OK.- And it's to try and limit the amount of mobility
0:39:49 > 0:39:52through that finger for the next couple of weeks.
0:39:52 > 0:39:53- Super.- Is that OK?
0:39:53 > 0:39:55- Thank you very much.- Any questions at all?
0:39:55 > 0:39:57- No.- No?- No, that's wonderful.
0:39:57 > 0:40:00Perfect. So we'll just strap it up and then you're free to go.
0:40:02 > 0:40:05And with that, John is left to enjoy the rest of his weekend.
0:40:17 > 0:40:2119-year-old offshore worker Ryan was medevac'd to the Gilbert Bain A&E
0:40:21 > 0:40:23suffering from abdominal pain.
0:40:25 > 0:40:28He's been sent to have his stomach and bowels x-rayed in an effort
0:40:28 > 0:40:29to diagnose his condition.
0:40:29 > 0:40:32OK, that's the first one done.
0:40:36 > 0:40:39And breathe all the way out.
0:40:41 > 0:40:42Hold your breath.
0:40:43 > 0:40:44And breathe away.
0:40:47 > 0:40:49Having thought Ryan had appendicitis,
0:40:49 > 0:40:53Dr Lalla has now had a full set of blood results back.
0:40:53 > 0:40:57One of the inflammatory markers, something called the CRP,
0:40:57 > 0:40:59has come back normal, completely normal.
0:41:01 > 0:41:04Usually, if this has been going on for three days, by now
0:41:04 > 0:41:08we would expect the CRP, if it was appendicitis, to be quite high,
0:41:08 > 0:41:09at least two or three hundred.
0:41:10 > 0:41:15So it means everything we thought so far, we have to go back and revisit.
0:41:15 > 0:41:18Not even Crohn's. It's very unlikely to be either of them now.
0:41:21 > 0:41:24Dr Lalla visits the X-ray department to check on Ryan's results.
0:41:27 > 0:41:29There is some faecal loading over here.
0:41:34 > 0:41:36The x-rays are fine.
0:41:36 > 0:41:41Your bloods, actually, surprisingly, are OK.
0:41:41 > 0:41:44What we want to do is keep you in, keep an eye on things,
0:41:44 > 0:41:45and see how you go.
0:41:45 > 0:41:49- OK.- Right, but it doesn't look like there is anything nasty going on at
0:41:49 > 0:41:50the moment. OK?
0:41:50 > 0:41:54- That's good news.- It is good news for you, but what it means is,
0:41:54 > 0:41:56long-term, you need to change your diet.
0:41:56 > 0:42:00- Yeah.- Well, we'll get you up to the ward, take things from there,
0:42:00 > 0:42:01and see how you go.
0:42:03 > 0:42:05The more senior you become,
0:42:05 > 0:42:08the more you start to realise that things are not clear-cut.
0:42:08 > 0:42:10The more you know, the more you realise you don't know.
0:42:12 > 0:42:17He looked very clearly like possible appendicitis or something called
0:42:17 > 0:42:20Crohn's disease, colitis, but it wasn't.
0:42:20 > 0:42:25So what it means is that you should go back and revisit that history and
0:42:25 > 0:42:27start to consider alternative diagnoses
0:42:27 > 0:42:30that you may not have considered the first time round.
0:42:31 > 0:42:33Next thing to do is to make sure
0:42:33 > 0:42:36that there's nothing underlying that.
0:42:36 > 0:42:38So, what could be causing constipation
0:42:38 > 0:42:40in a young guy like this?
0:42:40 > 0:42:44We will want to do a few more tests to decide if there's anything
0:42:44 > 0:42:45underlying that.
0:42:46 > 0:42:48With surgical intervention avoided,
0:42:48 > 0:42:51Dr Lalla and the staff of the Gilbert Bain
0:42:51 > 0:42:54will be keeping a close eye on Ryan over the next 24 hours.
0:43:03 > 0:43:06Hospital porter John is still travelling
0:43:06 > 0:43:08the length and breadth of Shetland.
0:43:08 > 0:43:11Crofter Andy's hand healed successfully
0:43:11 > 0:43:13and he managed to shear the rest of his sheep.
0:43:15 > 0:43:17And after spending the night in the Gilbert Bain,
0:43:17 > 0:43:22Ryan is back to full health and getting ready to head back offshore.