0:00:02 > 0:00:04Shetland, the most remote part of the UK.
0:00:06 > 0:00:10Here, you are closer to the Arctic Circle than you are to London,
0:00:10 > 0:00:12and nearer Norway than you are to Edinburgh.
0:00:14 > 0:00:16There are more puffins than people...
0:00:16 > 0:00:18..and more seals than supermarkets.
0:00:20 > 0:00:24But this wild landscape is also home to 23,000 islanders.
0:00:26 > 0:00:30They are 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 are all here to make sure that you are OK.
0:00:38 > 0:00:40..to serious medical mysteries...
0:00:40 > 0:00:42Can we get assistance in, please?
0:00:42 > 0:00:43Something's not right.
0:00:43 > 0:00:48..Shetland's island medics have to be ready for anything and everything.
0:00:48 > 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 > 0:01:02This might tickle.
0:01:03 > 0:01:06And they know just how to keep each other going...
0:01:06 > 0:01:08A wee treat for night shift.
0:01:08 > 0:01:12..so they are always ready for any island emergency.
0:01:20 > 0:01:23Today, an elderly lady is rushed into hospital
0:01:23 > 0:01:25with a suspected stroke.
0:01:26 > 0:01:30Doctor Saul Wilson has a broken hand to contend with.
0:01:30 > 0:01:33- There.- So, there. - And Lerwick resident Jimmy
0:01:33 > 0:01:37is helped into resus after falling off a wall whilst on holiday.
0:01:37 > 0:01:39Ready, set, slide.
0:01:46 > 0:01:49The Gilbert Bain Hospital has been serving the people of Shetland
0:01:49 > 0:01:51since 1961.
0:01:53 > 0:01:56Since then, the hospital's been continuously finding new ways
0:01:56 > 0:01:58to improve medical care for the island's residents.
0:02:01 > 0:02:06The Gilbert Bain is a consultant-led general medicine hospital.
0:02:06 > 0:02:10Along with A&E, and two operating theatres, it has a maternity ward,
0:02:10 > 0:02:14radiology, renal unit, medical wards,
0:02:14 > 0:02:16occupational and physiotherapy units.
0:02:17 > 0:02:22A CT scanner installed in 2007 reduces the need for patients to
0:02:22 > 0:02:23travel to the mainland.
0:02:25 > 0:02:30Since the nearest major hospital is 225 miles away in Aberdeen,
0:02:30 > 0:02:33the services on Shetland are life-changing for its inhabitants.
0:02:44 > 0:02:47At the Gilbert Bain A&E department,
0:02:47 > 0:02:49the night shift has enjoyed a quiet evening.
0:02:49 > 0:02:52Nothing major, always good.
0:02:52 > 0:02:56But there is no such luck for day shift nurse Dawn Umphrey
0:02:56 > 0:02:59and Dr Catherine Hawco.
0:02:59 > 0:03:00A&E, can I help you?
0:03:00 > 0:03:02No sooner have they handed over
0:03:02 > 0:03:05than the emergency line starts ringing.
0:03:05 > 0:03:07Hi, Cat, I was just giving you a heads up -
0:03:07 > 0:03:09the ambulance is going to be here about quarter past.
0:03:09 > 0:03:11We have an 82-year-old lady
0:03:11 > 0:03:13with left-side weakness and slurred speech.
0:03:14 > 0:03:16Yeah, we've got a lady...
0:03:16 > 0:03:18I've just had a notification for the ambulance
0:03:18 > 0:03:20saying that there is a lady
0:03:20 > 0:03:25with left-sided weakness and slurred speech, so she's a potential stroke.
0:03:25 > 0:03:29Paramedics Emma Davis and Angus Gilbraith have brought in a retiree,
0:03:29 > 0:03:33Kathleen, following an emergency call made by her grandson.
0:03:33 > 0:03:34Hello, is this Kathleen?
0:03:34 > 0:03:36- Yeah.- Hello, we're just going to go in here, OK?
0:03:39 > 0:03:42Feeling really poorly yesterday...
0:03:42 > 0:03:44OK. Any headache or anything?
0:03:44 > 0:03:47- No, she did yesterday, splitting headache.- OK.
0:03:49 > 0:03:51Well, it's better to get checked.
0:03:54 > 0:03:55Hopefully.
0:03:58 > 0:04:02And when you got up this morning, did you have a drink of anything?
0:04:02 > 0:04:04A drink of water or anything?
0:04:04 > 0:04:09Just, I took my morning blood pressure tablet.
0:04:10 > 0:04:15Not a big drink, but I would have had something to wash that down.
0:04:15 > 0:04:17And no problems swallowing that?
0:04:17 > 0:04:21- No, no problems.- It didn't spill out your mouth, or anything?
0:04:21 > 0:04:23No. Not at that point, no.
0:04:23 > 0:04:26- OK.- Will you just gie me a quick check, and let me...?
0:04:26 > 0:04:28Do a quick MOT on you?
0:04:28 > 0:04:31- OK.- I'll grab the paperwork.
0:04:31 > 0:04:33Kathleen is eager to get home,
0:04:33 > 0:04:37but her symptoms are all pointing toward a possible stroke.
0:04:37 > 0:04:38So it's up to the nursing staff
0:04:38 > 0:04:41and Dr Catherine Hawco to investigate further.
0:04:41 > 0:04:44Hi, there, my name is Dr Hawco, I am one of the doctors.
0:04:44 > 0:04:47I know the ambulance got you in today.
0:04:47 > 0:04:50What happened that you needed an ambulance?
0:04:50 > 0:04:54One of my grandchildren called an ambulance.
0:04:54 > 0:04:57I can speak now, I'm fine.
0:04:57 > 0:05:02But, earlier on, I started a sentence, but I couldn't...
0:05:02 > 0:05:05I couldn't get actually said what I wanted.
0:05:05 > 0:05:08- OK.- The ambulance has said there was quite a marked droop
0:05:08 > 0:05:10when they got there, that's resolved.
0:05:10 > 0:05:13And she can mind cooking bacon rolls at half seven,
0:05:13 > 0:05:16- and dropping the plate cos she couldn't coordinate it.- OK.
0:05:19 > 0:05:22We obviously check airway breathing, circulation.
0:05:22 > 0:05:24She's walked in, so obviously that's fine.
0:05:24 > 0:05:27Get a routine set of observations,
0:05:27 > 0:05:29see what her blood pressure is doing,
0:05:29 > 0:05:34and then get the doctor to assess as soon as possible.
0:05:34 > 0:05:38The signs and symptoms of a stroke vary from person to person,
0:05:38 > 0:05:41but usually begin suddenly, so prompt action is vital
0:05:41 > 0:05:43for all possible stroke victims.
0:05:43 > 0:05:45Now, do you think we could sit you forward,
0:05:45 > 0:05:47and I'll just have a listen to your back if that's OK?
0:05:47 > 0:05:50Oh, thank you. If you take nice deep breaths for me, OK?
0:05:50 > 0:05:52- OK?- Mm-hmm.
0:05:52 > 0:05:55And if you lie back for me?
0:05:55 > 0:05:57Right, so, what I want you to do,
0:05:57 > 0:06:01take my hands and squeeze them as hard as you can.
0:06:01 > 0:06:03Lovely, lovely.
0:06:03 > 0:06:07OK, now what I want you to do, hold your hands out in front of you,
0:06:07 > 0:06:09and close your eyes. OK, I want you to hold them there.
0:06:11 > 0:06:15Now, last thing, I'm going to run this up the sole of your foot, OK?
0:06:17 > 0:06:19- Tickling.- I've got tickly feet.
0:06:25 > 0:06:27Yeah, I've been out to the waiting area,
0:06:27 > 0:06:29he's in there with the rest of your family.
0:06:29 > 0:06:30Your daughter and that's arrived.
0:06:30 > 0:06:32- So, he's OK at the moment. - Oh, that's fine.
0:06:35 > 0:06:39So, what everybody was a bit worried about this morning
0:06:39 > 0:06:41is that you might have had a stroke.
0:06:41 > 0:06:45I think, it sounds like things have cleared up a lot.
0:06:45 > 0:06:46Absolutely, yes.
0:06:46 > 0:06:50So what it would be that might have happened is that you have possibly
0:06:50 > 0:06:52had what we would call a mini-stroke, or a TIA.
0:06:54 > 0:06:56Those are just when there is a wee blockage in your brain,
0:06:56 > 0:06:59just for a minute or so, and then it clears,
0:06:59 > 0:07:02but I think we should get a scan of your head and some blood tests
0:07:02 > 0:07:03before we let you go today.
0:07:07 > 0:07:09We'll need to wait and see what it shows,
0:07:09 > 0:07:11but that's the first step, OK?
0:07:13 > 0:07:17The effects of a TIA or mini-stroke can last just a few minutes,
0:07:17 > 0:07:20but it is essential Kathleen goes for a scan to check if she has
0:07:20 > 0:07:22had a stroke.
0:07:31 > 0:07:34Like most parents, senior A&E doctor Kushik Lalla's day starts
0:07:34 > 0:07:37- with getting the children ready for school...- Right, guys.
0:07:39 > 0:07:40Bye-bye.
0:07:41 > 0:07:45..before grabbing his packed lunch and starting the commute to work.
0:07:47 > 0:07:50I've worked in a lot of places and coming from South Africa...
0:07:52 > 0:07:56..where it was horrendously busy all the time,
0:07:56 > 0:07:59you never got a chance to actually sit and talk to patients...
0:08:01 > 0:08:04..to actually see them as patients,
0:08:04 > 0:08:06they were just diseases that you processed.
0:08:06 > 0:08:11Shetland is a very different in that we are not as busy and therefore
0:08:11 > 0:08:16that gives us a lot more time to actually sit and speak to patients.
0:08:16 > 0:08:18Patients are also very grateful.
0:08:18 > 0:08:22It's not unusual in Shetland to find a salmon sitting on your desk
0:08:22 > 0:08:25a few days after you've seen someone.
0:08:25 > 0:08:26Our patients get...
0:08:28 > 0:08:29..better, I would say, care.
0:08:29 > 0:08:33Our patients know us individually as people.
0:08:33 > 0:08:35We know them individually.
0:08:35 > 0:08:36I like that.
0:08:37 > 0:08:42Once a week, Dr Lalla runs a skin surgery clinic in the Gilbert Bain.
0:08:42 > 0:08:46The clinic allows Dr Lalla to do minor surgical procedures away from
0:08:46 > 0:08:50theatre and often gives GPs a chance to enhance their training.
0:08:50 > 0:08:54Every so often we have people joining us who are keen to learn.
0:08:54 > 0:08:56In this case it's Judith,
0:08:56 > 0:09:00who is one of our GPs that has just joined Shetland.
0:09:00 > 0:09:03She's got an interest in dermatology and has spent, how long?
0:09:03 > 0:09:05- Six...? No, nine?- Eight months.
0:09:05 > 0:09:07Eight months in dermatology prior to this.
0:09:07 > 0:09:11So she's very interested and it would be great to see her doing this
0:09:11 > 0:09:14across the road in one of the practices.
0:09:14 > 0:09:16Just put a bit more pressure on that.
0:09:16 > 0:09:18So, assisted by Dr Judith Pinnick,
0:09:18 > 0:09:22Dr Lalla has several patients waiting to be seen with varying
0:09:22 > 0:09:24dermatological concerns.
0:09:24 > 0:09:27I don't know whether she fully qualifies for an atypical mole.
0:09:27 > 0:09:29It doesn't sound like it because she has been seen by dermatology
0:09:29 > 0:09:31and they haven't mentioned that.
0:09:31 > 0:09:35But it sounds like she has got a lot of nevi, one of which has changed.
0:09:35 > 0:09:38So if she's here, I'll get her in.
0:09:38 > 0:09:40Hello.
0:09:40 > 0:09:43- My name is Dr Lalla. - South African born and bred,
0:09:43 > 0:09:47Dr Lalla first moved to Shetland 20 years ago and is now
0:09:47 > 0:09:50one of the longest-serving doctors in the hospital.
0:09:50 > 0:09:52So how long have you had that? As long as you can remember?
0:09:52 > 0:09:55- Yeah.- When did it start changing?
0:09:55 > 0:09:57A few months ago.
0:09:59 > 0:10:02Patient Louise has a mole that's been concerning her.
0:10:02 > 0:10:04It looks like it's got a bit irritated.
0:10:04 > 0:10:07Any itch? No itch at all.
0:10:07 > 0:10:11I'm reassured that there is a nice regular edge to it, there's not any
0:10:11 > 0:10:13obvious dark pigmentation there.
0:10:13 > 0:10:16So I'm not seeing any very alarm-bell features.
0:10:16 > 0:10:20If you had to lay bets, what would you say?
0:10:20 > 0:10:24- Just a benign nevus. - Benign, yes. Completely benign.
0:10:24 > 0:10:27Just to double check, it's a case of having that closer look.
0:10:27 > 0:10:32This is a special light that we use that gives us better magnification
0:10:32 > 0:10:34and allows us to see into the area
0:10:34 > 0:10:36to see if there's anything worrying there.
0:10:36 > 0:10:38I'm not seeing any worrying features.
0:10:40 > 0:10:43There's no areas of dark pigmentation there.
0:10:43 > 0:10:45You can just see there's some superficial growth.
0:10:48 > 0:10:51Yeah, I agree, nice and benign.
0:10:51 > 0:10:54So I think we can save you a needle...
0:10:55 > 0:11:00..and a scalpel and just reassure you and let you get away.
0:11:00 > 0:11:03Good news for Louise, and an opportunity for Dr Lalla
0:11:03 > 0:11:06to run through a handy mole-checking system.
0:11:06 > 0:11:09- Signs of skin cancer, do you know these?- No.
0:11:09 > 0:11:10No? Ah.
0:11:12 > 0:11:13OK. Right.
0:11:13 > 0:11:17There is what we call the ABCDE rule.
0:11:17 > 0:11:19So A is for asymmetry.
0:11:19 > 0:11:20B is for the border,
0:11:20 > 0:11:24you want to see whether the border is nice and regular.
0:11:24 > 0:11:27So you can see a nice clear, defined border.
0:11:27 > 0:11:33The colour, if it's got one even colour throughout, again, like that,
0:11:33 > 0:11:35nice evenly coloured, that's fine.
0:11:35 > 0:11:37Where you have lots of different colours -
0:11:37 > 0:11:39this one has black, red, white,
0:11:39 > 0:11:43brown, lots of different colours, we start to get more concerned.
0:11:43 > 0:11:44D for the diameter.
0:11:44 > 0:11:49Anything generally bigger than roughly about the size of that,
0:11:49 > 0:11:52that pen tip, anything bigger than that, again,
0:11:52 > 0:11:53we start to get more concerned.
0:11:53 > 0:11:57OK? And E is for evolution.
0:11:57 > 0:12:00Any change, then we want to know about it.
0:12:00 > 0:12:04And if any of this happens, see your GP and they will get you into us.
0:12:04 > 0:12:07With Louise well informed, it's job done,
0:12:07 > 0:12:10and onto the next patient for Dr Lalla.
0:12:10 > 0:12:11Thank you very much.
0:12:22 > 0:12:26On mainland Shetland, the Scottish Ambulance Service covers an area
0:12:26 > 0:12:28of over 350 square miles.
0:12:30 > 0:12:33On every shift there are two teams running the show.
0:12:33 > 0:12:37Paramedics and ambulance technicians make up a team of four,
0:12:37 > 0:12:39responsible for operating the two ambulances.
0:12:39 > 0:12:40OK?
0:12:40 > 0:12:42Along with the coastguard,
0:12:42 > 0:12:45they are the front line of medical emergency response.
0:12:45 > 0:12:49I actually don't remember deciding to become a paramedic,
0:12:49 > 0:12:53cos I've wanted to be a paramedic for as long as I can remember.
0:12:53 > 0:12:55Emma has been working in the service for five years.
0:12:57 > 0:13:01It's single-track roads, there's sheep, there's ponies on the road,
0:13:01 > 0:13:04there's all sorts of things, bad weather,
0:13:04 > 0:13:07these vehicles will rock quite a lot in the weather,
0:13:07 > 0:13:11so it can be a lot of pressure and you can be very aware sometimes,
0:13:11 > 0:13:15this patient's life is in your hands and there isn't really anybody else
0:13:15 > 0:13:17around that's going to help you.
0:13:17 > 0:13:22So I think you have to be good at your job
0:13:22 > 0:13:23to work up here in Shetland.
0:13:29 > 0:13:33And with the start of a new shift, it doesn't take too long before Emma
0:13:33 > 0:13:34is on her first call-out
0:13:34 > 0:13:37along with ambulance technician Kaylee Robertson.
0:13:37 > 0:13:38They are responding to a call that
0:13:38 > 0:13:41a patient has been evacuated by air ambulance from the Skerries.
0:13:41 > 0:13:45We are heading to Tingwall Airport to meet the coastguard
0:13:45 > 0:13:47search and rescue helicopter.
0:13:47 > 0:13:49They've retrieved a patient off of Skerries,
0:13:49 > 0:13:52which is one of the islands quite far out in Shetland.
0:13:52 > 0:13:55We don't have a huge amount of information on this gentleman,
0:13:55 > 0:13:57we just know that he's elderly.
0:13:57 > 0:13:59There will be a paramedic on the helicopter
0:13:59 > 0:14:01that will give us a good handover when we get to Tingwall
0:14:01 > 0:14:04and we'll take him back to the Gilbert Bain.
0:14:04 > 0:14:09The Skerries are a small archipelago with around 70 people inhabiting
0:14:09 > 0:14:14the two square miles of rock to the north-east of Lerwick.
0:14:14 > 0:14:17The coastguard search and rescue helicopter is transferring
0:14:17 > 0:14:20the casualty to Tingwall Airport.
0:14:20 > 0:14:23Some of our patients have to go by helicopter onto the mainland
0:14:23 > 0:14:26so we can get to them, and that in itself is unique.
0:14:26 > 0:14:28We also don't have HeliMed up here.
0:14:28 > 0:14:30If we need that kind of resource,
0:14:30 > 0:14:32it's a search and rescue helicopter that's used.
0:14:32 > 0:14:35We try and keep it a team cos we're all working towards the same goal.
0:14:35 > 0:14:36So it's good.
0:14:40 > 0:14:41Arriving ahead of the helicopter,
0:14:41 > 0:14:44paramedic Emma and ambulance technician Kaylee
0:14:44 > 0:14:45are ready to receive the casualty.
0:14:45 > 0:14:48The helicopter is just a few minutes away.
0:14:48 > 0:14:49We should see it coming in shortly.
0:14:49 > 0:14:51And then we'll just communicate with
0:14:51 > 0:14:53the paramedic on board the helicopter
0:14:53 > 0:14:56to see if the man is walking or if he needs a stretcher
0:14:56 > 0:14:57and we'll just go from there.
0:15:07 > 0:15:11Transferring the patient from the helicopter requires the two teams to
0:15:11 > 0:15:13work together to get him safely into the ambulance.
0:15:17 > 0:15:19The patient's wife, Louise,
0:15:19 > 0:15:23has travelled with him and will be able to fill in important details
0:15:23 > 0:15:24of what's happened.
0:15:35 > 0:15:38Do you remember feeling unwell or anything before it happened?
0:15:38 > 0:15:39I felt really weird.
0:15:39 > 0:15:41Just a bit fuzzy?
0:15:41 > 0:15:45- Just a bit funny.- Do you remember thinking you were going to pass out?
0:15:45 > 0:15:47- No.- No, you just felt weird?
0:15:54 > 0:15:57Have you any pain anywhere? How about your head where you banged it?
0:16:04 > 0:16:06So you're 83, is that right?
0:16:06 > 0:16:08And your home address...
0:16:09 > 0:16:12It's a long way to go for a trip to the hospital.
0:16:14 > 0:16:16Now then, just wait. If you come to the edge,
0:16:16 > 0:16:18we'll just wait for Kaylee to help you down the steps
0:16:18 > 0:16:21because they are quite steep. Do you want me to take your bags?
0:16:25 > 0:16:27I'll jump down because I don't want you to fall.
0:16:28 > 0:16:32- OK.- Once outside the Gilbert Bain A&E,
0:16:32 > 0:16:34Emma and Kaylee can get Jimmy off the ambulance
0:16:34 > 0:16:37and checked into the hospital.
0:16:37 > 0:16:39OK, Jimmy, a couple of bumps
0:16:39 > 0:16:42as we go out onto the lift.
0:16:44 > 0:16:45That's us.
0:16:48 > 0:16:50This is our brand-new one.
0:16:53 > 0:16:55You've had the full works today.
0:16:59 > 0:17:00Hello.
0:17:01 > 0:17:03- Yes.- In here.
0:17:06 > 0:17:10This is James, he was unconscious for two minutes the first time,
0:17:10 > 0:17:14then he had another collapse and was unconscious for a minute that time.
0:17:14 > 0:17:17Vital signs are all stable, ECG is normal.
0:17:17 > 0:17:21He was absolutely saturated in sweat at the time and he is very pale.
0:17:21 > 0:17:24He still remains pale. Has been quite nauseous since as well.
0:17:24 > 0:17:27He lives literally just down the road.
0:17:30 > 0:17:31It was day one of their holiday.
0:17:31 > 0:17:33Oh, no!
0:17:33 > 0:17:37Jimmy had been on holiday with his wife Louise when he collapsed.
0:17:37 > 0:17:41He had been sitting on a wall and banged his head when he fell.
0:17:41 > 0:17:42Ready, set, slide.
0:17:45 > 0:17:47His ECG and everything is here.
0:17:47 > 0:17:51The patient information paramedic Emma has gathered is crucial
0:17:51 > 0:17:54in helping the A&E team assess Jimmy correctly.
0:17:54 > 0:17:58Type 2 diabetic but no heart problems or any episodes like this.
0:18:00 > 0:18:01With the handover complete,
0:18:01 > 0:18:04the medical team can now take over Jimmy's care.
0:18:16 > 0:18:21Upstairs, above the A&E department, is the renal unit.
0:18:23 > 0:18:27Five days a week, the unit opens its doors to the island's patients
0:18:27 > 0:18:28who require dialysis.
0:18:29 > 0:18:33Dialysis is a procedure to remove waste products and excess fluid
0:18:33 > 0:18:37from the blood when the kidneys stop working properly.
0:18:37 > 0:18:38The kidneys do a couple of different things.
0:18:38 > 0:18:43One, they get rid of excess water from the body, but they also...
0:18:45 > 0:18:48..clean the blood, they're sort of the cleaning system.
0:18:48 > 0:18:52When somebody has kidney disease, kidneys that are failing,
0:18:52 > 0:18:54we can sort of take over the process
0:18:54 > 0:18:57and basically do what the kidneys used to do.
0:18:57 > 0:19:02Senior staff nurse Gary McMillan has worked in dialysis since 2011.
0:19:02 > 0:19:04Today he is looking after patient Willie,
0:19:04 > 0:19:07who has come in for one of his three weekly treatments.
0:19:07 > 0:19:12We weigh a patient before dialysis and after and we sort of have
0:19:12 > 0:19:16a weight that we're aiming to get to and we do a calculation
0:19:16 > 0:19:19as to how much fluid we need to remove during the day.
0:19:19 > 0:19:23The dialysis machine takes over the role of the kidneys.
0:19:23 > 0:19:26Basically, the machine is trying to equalise
0:19:26 > 0:19:31the blood chemistry to what we set it at.
0:19:31 > 0:19:34When somebody comes that is actually needing dialysis, it is what...
0:19:34 > 0:19:37They would be termed as an end-stage kidney failure.
0:19:37 > 0:19:41So what we're doing is we remove the excess fluid but we also clean
0:19:41 > 0:19:44the blood and bring the blood chemistry back down to normal.
0:19:44 > 0:19:47Dialysis is a very tiring process.
0:19:47 > 0:19:49Willie's will take around four hours,
0:19:49 > 0:19:51but the duration depends on
0:19:51 > 0:19:53each patient's condition when they arrive.
0:19:53 > 0:19:57The shortest period we've got for any patient in the unit here
0:19:57 > 0:20:01currently is three and a quarter hours,
0:20:01 > 0:20:04up to some on five-and-a-half-hour dialysis.
0:20:04 > 0:20:06And they will have that three days a week,
0:20:06 > 0:20:10so it's quite a big chunk out of your life.
0:20:10 > 0:20:12It's quite life-limiting.
0:20:12 > 0:20:16It's quite a big event to go onto dialysis.
0:20:16 > 0:20:20But it is life-saving and eventually a patient would die
0:20:20 > 0:20:22if they didn't have dialysis.
0:20:24 > 0:20:29The opening of the renal unit in 1999 transformed the lives of those
0:20:29 > 0:20:31that needed the service.
0:20:31 > 0:20:34In the past before there was a dialysis unit, patients would have
0:20:34 > 0:20:37to go to Aberdeen, they would have to live in Aberdeen.
0:20:37 > 0:20:41It means people can live at home and continue to feel well, really.
0:20:41 > 0:20:43Being able to stay at home with your family
0:20:43 > 0:20:47and not be isolated from your family for three months at a time.
0:20:47 > 0:20:50Travelling on and off the island can be quite expensive
0:20:50 > 0:20:53so it's been a big change for Shetland, really.
0:20:55 > 0:20:59But what the machine will do is it does a self-check calibration.
0:20:59 > 0:21:03So it is continuously mixing up a new prescription and delivering it
0:21:03 > 0:21:05to the patient every 15 minutes.
0:21:05 > 0:21:06It takes itself...
0:21:07 > 0:21:10..out of dialysis, so to speak,
0:21:10 > 0:21:13checks that everything is correct and then goes again.
0:21:19 > 0:21:21Willie has got...
0:21:21 > 0:21:23..28 minutes left.
0:21:23 > 0:21:28So when he comes to finish his dialysis we'll remove his needles
0:21:28 > 0:21:32and once we're happy that he's safe to be discharged we'll phone
0:21:32 > 0:21:37the local ambulance and the girls or guys or whoever it is
0:21:37 > 0:21:40will come and take Willie back to the care home.
0:21:49 > 0:21:51At the A&E Department,
0:21:51 > 0:21:55retiree Kathleen is having blood tests to determine possible reasons
0:21:55 > 0:21:57for her suspected mini-stroke.
0:21:59 > 0:22:01Sorry, Kathleen, I ken it's uncomfy there.
0:22:04 > 0:22:05One more and then we're done, OK?
0:22:06 > 0:22:08With the bloods complete,
0:22:08 > 0:22:11Kathleen is taken to the CT scanner for a better look at any effects
0:22:11 > 0:22:13the suspected mini-stroke might have had.
0:22:23 > 0:22:24- Hello.- Hello.
0:22:26 > 0:22:30So all you need to do is keep nice and still.
0:22:36 > 0:22:39The alarm was raised by her 11-year-old grandson Alexander,
0:22:39 > 0:22:42when he became concerned by his gran's limited movement
0:22:42 > 0:22:46and slurred speech. He also rang his elder sister, Hannah,
0:22:46 > 0:22:48who is training to be a nurse.
0:22:48 > 0:22:51I was staying the night over at my granny's,
0:22:51 > 0:22:55and I got up in the morning and she seemed to be fine when I was up
0:22:55 > 0:22:57but when I went through...
0:22:58 > 0:23:01When she came through to me she started trying to speak
0:23:01 > 0:23:04but no words were coming out and it was quite scary
0:23:04 > 0:23:07and I didn't really know what to do.
0:23:07 > 0:23:09He's very clever. You're a good little boy.
0:23:11 > 0:23:14He was really good. And he has always been good to his granny,
0:23:14 > 0:23:16looked after her.
0:23:16 > 0:23:18He did the right thing to phone me first.
0:23:19 > 0:23:22Very proud of you.
0:23:22 > 0:23:25CT head is done, so that's going to be sent to Aberdeen just now.
0:23:25 > 0:23:28It should be gone, so we'll wait for that result to come back,
0:23:28 > 0:23:30wait on her bloods coming back.
0:23:30 > 0:23:31Once all that is together,
0:23:31 > 0:23:35the doctor will probably confer with the consultant on call.
0:23:35 > 0:23:38She's quite keen to go and it looks like her symptoms have resolved
0:23:38 > 0:23:41so hopefully we can start her on some prophylactic medication
0:23:41 > 0:23:43and get her away home.
0:23:50 > 0:23:51Kathleen is pretty well at the minute.
0:23:51 > 0:23:54She doesn't have any ongoing weakness or symptoms so we think
0:23:54 > 0:23:57it might have been what we call a TIA or a mini-stroke.
0:23:57 > 0:23:59She will probably be able to get home today,
0:23:59 > 0:24:00with follow-up in the community,
0:24:00 > 0:24:02with some medicine to go home with
0:24:02 > 0:24:04and, like I say, some scans for a follow-up
0:24:04 > 0:24:06and some follow-up with the stroke team.
0:24:06 > 0:24:10With Dr Hawco and the team content that Kathleen is in good health,
0:24:10 > 0:24:12she finally gets her wish to go home.
0:24:22 > 0:24:25Shetland may be small but it generates big interest
0:24:25 > 0:24:27among the sailing community.
0:24:28 > 0:24:30With hundreds of boats tied to these shores,
0:24:30 > 0:24:32Shetland is a mecca for boat owners.
0:24:34 > 0:24:37In the summer months the islands host a regatta as well -
0:24:37 > 0:24:41the Bergen to Shetland and North Sea triangle races that feature dozens
0:24:41 > 0:24:43of large yachts.
0:24:44 > 0:24:49One sailing enthusiast is Kari from Toft in Norway.
0:24:49 > 0:24:52She took a tumble while on holiday on a tall ship which was berthed
0:24:52 > 0:24:55in Shetland. She's hoping Dr Saul Wilson
0:24:55 > 0:24:57can get her seaworthy again soon.
0:24:58 > 0:25:00So, what's been going on then?
0:25:00 > 0:25:03She fell on the deck in the evening.
0:25:03 > 0:25:10She tried to grab something and she hit her hand on the bench.
0:25:10 > 0:25:12I see. OK.
0:25:12 > 0:25:14Did you fall to the ground as well?
0:25:14 > 0:25:16Yes, I fell on my back but...
0:25:17 > 0:25:19..when I fell I...
0:25:20 > 0:25:21- Like this.- Yeah.
0:25:21 > 0:25:25And then immediately afterwards, how were you feeling?
0:25:25 > 0:25:26It hurt.
0:25:28 > 0:25:30- Very much.- Yeah.
0:25:30 > 0:25:32So the swelling, has it been getting bigger since then?
0:25:32 > 0:25:34- Yes.- OK, fine.
0:25:34 > 0:25:36And the pain, has the pain been OK?
0:25:37 > 0:25:40It doesn't hurt very much now.
0:25:40 > 0:25:42Just... It's...
0:25:42 > 0:25:44THEY SPEAK NORWEGIAN
0:25:45 > 0:25:47- Pressing. The pain is pressing. - Yeah, yeah.
0:25:47 > 0:25:50Are you able to move your hand and your fingers?
0:25:50 > 0:25:53- Yes.- OK, OK.
0:25:53 > 0:25:56Do you mind if I have a little feel?
0:25:56 > 0:25:59- I don't mind.- OK.
0:25:59 > 0:26:02Just let me know if it's sore at any point.
0:26:02 > 0:26:04I'm just going to have a little look first.
0:26:04 > 0:26:06- Oh, yes.- Is that sore there, yeah?
0:26:06 > 0:26:10OK. Just let me know if it's tender at any point.
0:26:10 > 0:26:11- Yeah.- Sore there? OK.
0:26:14 > 0:26:16You can feel me touching down here?
0:26:16 > 0:26:18- Yeah.- Here?- Yeah.
0:26:20 > 0:26:22That's fine. We'll give you some Ibuprofen,
0:26:22 > 0:26:24it will help with the swelling and the pain.
0:26:24 > 0:26:27We'll get this X-rayed and see what that shows and let you know where to
0:26:27 > 0:26:29take it from there. All right?
0:26:29 > 0:26:31We probably don't need to put it in a splint or anything at the moment
0:26:31 > 0:26:34because it seems OK. We'll get the X-ray done first
0:26:34 > 0:26:35and take it from there.
0:26:37 > 0:26:40With Kari sent to X-ray to get her injured hand checked over,
0:26:40 > 0:26:43Dr Wilson will hope the results are plain sailing.
0:26:51 > 0:26:56With over 25% of Shetlanders aged over 60 and the ageing population
0:26:56 > 0:26:59forecast to increase over the next ten years,
0:26:59 > 0:27:02the demands on the Gilbert Bain Hospital
0:27:02 > 0:27:05and the healthcare services of Shetland are set to rise.
0:27:07 > 0:27:11So treating the over 60s is becoming more important for the staff of A&E.
0:27:14 > 0:27:1783-year-old Jimmy is being assessed by Dr Lauren Cammaert
0:27:17 > 0:27:20and medical student Albert.
0:27:20 > 0:27:23I don't remember even going, to be honest.
0:27:23 > 0:27:26I just felt really, really woozy.
0:27:26 > 0:27:28OK. What do you mean by feeling strange?
0:27:30 > 0:27:32I thought I was dying for a minute.
0:27:32 > 0:27:33It was just a weird...
0:27:35 > 0:27:38..feeling, kind of intense feeling in my head.
0:27:38 > 0:27:40Has anything like this ever happened before?
0:27:40 > 0:27:41No, never.
0:27:42 > 0:27:44It's a bit of a medical mystery.
0:27:44 > 0:27:48But it's hoped assessing Jimmy this way will help Dr Cammaert pinpoint
0:27:48 > 0:27:51a cause or effect of the fall.
0:27:51 > 0:27:55This diagnosis is vital to determine the next stage of care.
0:27:55 > 0:27:57Good, it's nice and slow and regular.
0:27:59 > 0:28:01OK, and turn your hands over for me.
0:28:04 > 0:28:07OK, so it was the back of your head you hit, you said?
0:28:07 > 0:28:08Yeah.
0:28:12 > 0:28:15You've got a little tiny bit of swelling there but it's not too bad.
0:28:15 > 0:28:19That's what the doctor on the plane said.
0:28:19 > 0:28:20OK, good, good.
0:28:20 > 0:28:26I think because you've fallen backwards I think we will probably
0:28:26 > 0:28:31need to do a scan of your head just to see what's going on.
0:28:31 > 0:28:34All right? Now, there is just one more examination,
0:28:34 > 0:28:35one more test I'd like to do.
0:28:35 > 0:28:38OK? It's called a neurological examination
0:28:38 > 0:28:42and that will just tell me if there is any damage done to your head, OK?
0:28:43 > 0:28:45Until the examination is complete,
0:28:45 > 0:28:46Jimmy faces an anxious wait
0:28:46 > 0:28:49to learn if there is any long-term neurological damage.
0:28:58 > 0:29:01In his skin clinic, Dr Lalla is on to his next patient.
0:29:05 > 0:29:07Patient Fiona, a local schoolteacher,
0:29:07 > 0:29:11has a mole on her lower thigh which she would like removed.
0:29:11 > 0:29:14Right, let's get you to take a lie-down, make yourself comfy.
0:29:16 > 0:29:21Treating patients in Shetland is very different to elsewhere.
0:29:21 > 0:29:25Places like London, big major centres,
0:29:25 > 0:29:29you would get all these specialists and super specialist services
0:29:29 > 0:29:33available, and available all the time, 24 hours a day.
0:29:33 > 0:29:35And sometimes those patients
0:29:35 > 0:29:38just happen to be your children's schoolteacher.
0:29:38 > 0:29:40This is going to be the worst bit of it
0:29:40 > 0:29:41is getting the local anaesthetic.
0:29:41 > 0:29:46What's different over here is the variety that we see.
0:29:48 > 0:29:49So you're off school today?
0:29:49 > 0:29:52- I am, yes.- Great.
0:29:54 > 0:29:58Doctors in remote locations need to develop a wide range of skills.
0:29:58 > 0:30:01What you want to see is the lesion bulge like that when you get into
0:30:01 > 0:30:03- the fatty layer.- Mm-hmm.
0:30:04 > 0:30:07- What do you teach? - I'm a primary teacher.
0:30:07 > 0:30:08What class do you have?
0:30:08 > 0:30:10She teaches my kids.
0:30:10 > 0:30:11- Oh, really?- Yeah.
0:30:11 > 0:30:16Working on the mainland, you very often were limited to
0:30:16 > 0:30:18just one particular area.
0:30:18 > 0:30:20Over here we get to do everything,
0:30:20 > 0:30:23from gynaecological surgery,
0:30:23 > 0:30:27paediatric surgery, general lumps and bumps, dermatology.
0:30:27 > 0:30:32And so it's the broad range that it offers us over here
0:30:32 > 0:30:34that appeals to me.
0:30:34 > 0:30:36Although it's a fairly simple procedure,
0:30:36 > 0:30:39it's important when extracting the mole that all of it's removed,
0:30:39 > 0:30:41to prevent it from growing back.
0:30:44 > 0:30:46With the mole successfully taken off,
0:30:46 > 0:30:48it's just a case of stitching up the area.
0:30:51 > 0:30:52So, Fiona, how are you doing?
0:30:52 > 0:30:54- Good, yeah.- Good, good.
0:30:54 > 0:30:55We're almost done.
0:30:57 > 0:30:59What are you doing after this, going back to school or...
0:31:00 > 0:31:02..wine time?
0:31:03 > 0:31:05That was a very nice stitch.
0:31:06 > 0:31:10Although it's going to sting a bit once the anaesthetic wears off,
0:31:10 > 0:31:12the procedure was a complete success.
0:31:12 > 0:31:14Now, you've got some stitches in there
0:31:14 > 0:31:15and those will need to come away.
0:31:15 > 0:31:19What you will need to do is contact the local health centre...
0:31:20 > 0:31:24We see them twice a day on ward rounds,
0:31:24 > 0:31:29patients know us individually as people, we know them individually.
0:31:29 > 0:31:31We follow the entire patient journey,
0:31:31 > 0:31:34from the time they are admitted into theatre,
0:31:34 > 0:31:37out back on the ward and then in clinic for follow-up.
0:31:37 > 0:31:43So it is very different, compared to a mainland hospital.
0:31:44 > 0:31:52And I find that whole aspect of it much better in terms of working.
0:31:52 > 0:31:54All right, cheers.
0:32:04 > 0:32:05In the renal unit,
0:32:05 > 0:32:07senior nurse Gary and trainee Pamela
0:32:07 > 0:32:11are starting to bring patient Willie off his dialysis treatment.
0:32:11 > 0:32:13So I've just got three minutes left.
0:32:13 > 0:32:16OK, can we just lift that arm, just nice and straight, gently.
0:32:17 > 0:32:21- Shoulder is still sore?- Yeah.
0:32:21 > 0:32:24What is happening now is the blood is actually being washed back
0:32:24 > 0:32:25through the circuit and back in.
0:32:27 > 0:32:29It's a complicated process but it...
0:32:31 > 0:32:34..just becomes ingrained and you learn to just go through,
0:32:34 > 0:32:36as long as you go through the steps in order
0:32:36 > 0:32:39then everything is fine.
0:32:39 > 0:32:40Just coming there.
0:32:40 > 0:32:42It's starting to look translucent,
0:32:42 > 0:32:45so stop your pump and then clamp everything.
0:32:45 > 0:32:46So I'll clamp this one.
0:32:49 > 0:32:51Once the finishing process is complete,
0:32:51 > 0:32:53the next step is disconnecting the tubes
0:32:53 > 0:32:55from the fistula in Willie's arm.
0:32:57 > 0:32:59Because it involves tapping into a vein,
0:32:59 > 0:33:02removing the needle is a delicate process.
0:33:02 > 0:33:04Just as it comes. Yeah.
0:33:04 > 0:33:07That's him. That's one out, Willie.
0:33:07 > 0:33:09Because you've got your arterial and venous systems
0:33:09 > 0:33:14connected, everything... It's almost a bit supercharged.
0:33:14 > 0:33:21If you sort of miss just the exact spot where the fistula entry is,
0:33:21 > 0:33:24it's coming out under a good pressure so it's just a case of
0:33:24 > 0:33:28we'll hold for about ten minutes because the last thing we want is
0:33:28 > 0:33:31a patient's blood on the outside - it's better on the inside.
0:33:34 > 0:33:36Willie doesn't seem too traumatised.
0:33:38 > 0:33:42To get Willie home, the ambulance patient transfer service
0:33:42 > 0:33:45are called into action. Based at the ambulance station
0:33:45 > 0:33:47around the corner from the Gilbert Bain,
0:33:47 > 0:33:50the patient transfer service can be requested by any hospital ward
0:33:50 > 0:33:54or department to transfer patients to and from the hospital.
0:33:54 > 0:33:57It is a vital service for the Shetland islanders,
0:33:57 > 0:34:01with so many patients living in rural parts of the island.
0:34:01 > 0:34:04Today, nonemergency ambulance technicians Fiona Gilbertson
0:34:04 > 0:34:07and Marie Williamson are on the afternoon shift.
0:34:07 > 0:34:08So we've got a...
0:34:09 > 0:34:11..client up in renal.
0:34:14 > 0:34:16This is the renal department.
0:34:16 > 0:34:18The last thing for Willie is to be weighed...
0:34:22 > 0:34:25..and moved onto the trolley so he can get on his way home.
0:34:26 > 0:34:29You've got company on the way home again, Willie.
0:34:29 > 0:34:31- We're picking up a young lady. - I see.
0:34:42 > 0:34:44Having taken a tumble aboard a ship,
0:34:44 > 0:34:48Norwegian Kari came to the Gilbert Bain to have her hand checked over.
0:34:48 > 0:34:50And the results are in.
0:34:50 > 0:34:52Yeah, so this patient has had
0:34:52 > 0:34:55a fracture of the left side of her left hand,
0:34:55 > 0:34:59the outer side of her left hand called the metacarpal.
0:34:59 > 0:35:01It doesn't look too displaced, though,
0:35:01 > 0:35:04so we should be OK to get her away.
0:35:04 > 0:35:07We'll tape up the outer fingers for her comfort.
0:35:07 > 0:35:10It doesn't need any surgical intervention but we'll just
0:35:10 > 0:35:13encourage her to keep taking her ibuprofen, for the swelling.
0:35:13 > 0:35:17With the problem diagnosed, Dr Wilson delivers the news.
0:35:17 > 0:35:20So we've had a little look at the X-ray.
0:35:20 > 0:35:23It does show a fracture on the left side,
0:35:23 > 0:35:27the outer side of your left hand, in what we call the metacarpal.
0:35:27 > 0:35:31So it's one of the bones in your hand that's connected to the finger,
0:35:31 > 0:35:35obviously. It's not displaced too much, so it's still in place.
0:35:35 > 0:35:37- OK.- It doesn't need any sort of surgery or anything.
0:35:37 > 0:35:39That's good.
0:35:39 > 0:35:43- Yeah.- That is what we were afraid of.
0:35:43 > 0:35:47Oh, OK. We will get one of the nurses to tape up these two fingers
0:35:47 > 0:35:49because that may actually be more comfortable for you,
0:35:49 > 0:35:52if it just keeps it fixed in position.
0:35:52 > 0:35:53And it will heal by itself.
0:35:55 > 0:35:57What about paying?
0:35:57 > 0:35:59- Paying.- Paying money? Oh, you don't have to.
0:35:59 > 0:36:01You can give me a tip, I guess.
0:36:01 > 0:36:03LAUGHTER
0:36:03 > 0:36:06No, you don't need to pay. Don't worry about that.
0:36:06 > 0:36:10- Are you sure?- Yeah, yeah. Of course. - Very nice. Thank you.
0:36:10 > 0:36:15- Maybe you want a hug? - Whatever you want.
0:36:16 > 0:36:20- All right?- Thank you so much. - Thank you.- Thank you.
0:36:20 > 0:36:23- Thank you so much. - See you later.
0:36:28 > 0:36:33With smiles all round, Kari had a simple splint put in place
0:36:33 > 0:36:34and she soon headed back to
0:36:34 > 0:36:37the little dinghy that she'd sailed in on.
0:36:48 > 0:36:53In resus, Dr Cammaert has instructed medical student Albert to complete
0:36:53 > 0:36:55the neurological examination.
0:36:55 > 0:36:57Hello, my name is Albert. I'm one of the students.
0:36:57 > 0:37:00Albert is in the final year of medical school.
0:37:00 > 0:37:03In a year he will be a fully qualified junior doctor.
0:37:03 > 0:37:05Completing examinations like this
0:37:05 > 0:37:07provide him with that little extra experience.
0:37:10 > 0:37:12I'm just going to bend your arm and move it around a bit, OK?
0:37:16 > 0:37:18Your joints aren't stiff or anything?
0:37:18 > 0:37:21- No.- And just move your fingers out, just like that.
0:37:23 > 0:37:25That's fine. Nice and strong.
0:37:25 > 0:37:27No loss of power there. That's good.
0:37:27 > 0:37:30The neurological exam involves testing all 12 sets
0:37:30 > 0:37:33of cranial nerves to check there is no dysfunction
0:37:33 > 0:37:35in the central nervous system.
0:37:37 > 0:37:40Touch your nose, touch my finger, touch your nose.
0:37:41 > 0:37:44My finger. Same here, just push down.
0:37:46 > 0:37:49You're not ticklish on your feet, are you?
0:37:49 > 0:37:50This might tickle, then.
0:37:53 > 0:37:55That's all OK.
0:37:55 > 0:37:57You're passing all the tests so far.
0:37:59 > 0:38:02All right, so I think what I'm going to do at the moment,
0:38:02 > 0:38:05I'm going to go and try and organise a CT scan of your head.
0:38:05 > 0:38:07- Right.- OK?
0:38:07 > 0:38:10With Dr Cammaert still worried about patient Jimmy's injury,
0:38:10 > 0:38:13a CT scan should clear up any final concerns.
0:38:13 > 0:38:16It sounds like he had a loss of consciousness that caused him to
0:38:16 > 0:38:19fall backwards, but he fell off a wall that was three feet
0:38:19 > 0:38:22onto just a stone pavement.
0:38:22 > 0:38:25He had quite severe neck pain before the fall which I think is
0:38:25 > 0:38:29related to his... He normally has pain because of osteoarthritis,
0:38:29 > 0:38:31but just to see what has caused the fall.
0:38:31 > 0:38:35- Yeah, if that's OK. - Are they ready to come down?
0:38:35 > 0:38:36Yeah, they're ready to come.
0:38:36 > 0:38:39So Jimmy heads for a CT scan.
0:38:39 > 0:38:42And once the scans come through, Dr Cammaert checks them over.
0:38:42 > 0:38:43That looks pretty normal,
0:38:43 > 0:38:47but just have to wait for the radiologist to have a look.
0:38:47 > 0:38:49So James has been for a CT scan now.
0:38:49 > 0:38:53He went to have one just in case he suffered some injury to his head,
0:38:53 > 0:38:58if he had any bleeding, because he did fall a considerable distance.
0:38:58 > 0:39:00I've had a look. To me, it looks normal but I have to wait for
0:39:00 > 0:39:05the radiologist to report it and tell me all the finer details.
0:39:05 > 0:39:09It wasn't the start to his holiday Jimmy had expected, but at least
0:39:09 > 0:39:10he can rest easy and receive
0:39:10 > 0:39:13the best hospitality the Gilbert Bain can offer.
0:39:16 > 0:39:18Jimmy will go up to be ward.
0:39:18 > 0:39:20He'll have a cardiac monitor put on,
0:39:20 > 0:39:23just in case there is any cardiac cause of his collapse.
0:39:23 > 0:39:27And then he will just be observed and if all his tests are fine
0:39:27 > 0:39:29he will probably go home tomorrow
0:39:29 > 0:39:31after being seen by the consultant who is on call.
0:39:44 > 0:39:46In Lerwick, ambulance technicians Marie and Fiona
0:39:46 > 0:39:50are about to take patient Willie to Brae.
0:39:50 > 0:39:52He lives in the North Haven care home,
0:39:52 > 0:39:54about 23 miles north of Lerwick.
0:39:56 > 0:40:01- Are we all good to go just now? - We are, if you please.
0:40:01 > 0:40:03It's always an adventure when we set off.
0:40:03 > 0:40:05There's always something.
0:40:07 > 0:40:10Marie has been transferring patients for ten years.
0:40:10 > 0:40:12Since she sees most of them on a regular basis,
0:40:12 > 0:40:14a big part of the job
0:40:14 > 0:40:17is building a strong relationship with her patients.
0:40:17 > 0:40:19That is the best thing.
0:40:19 > 0:40:22Everybody has got a story, everybody has got skills.
0:40:22 > 0:40:25And we just get so many wonderful people.
0:40:25 > 0:40:28They are just really a pleasure, and great company.
0:40:30 > 0:40:32And I think that is the best thing about this job.
0:40:33 > 0:40:39You know, I have had so many laughs and been told so many stories.
0:40:42 > 0:40:45Driving around Shetland is always a good opportunity for Marie
0:40:45 > 0:40:47to catch up with her patients.
0:40:49 > 0:40:52Me and Willie always have conversations about my boat.
0:40:52 > 0:40:57I've just got an aluminium fold boat, among my many adventures.
0:40:57 > 0:41:00It may be a midlife crisis I'm having, I'm not sure.
0:41:00 > 0:41:02I've not got it in the water yet, you see.
0:41:02 > 0:41:06And it's just along here in the marina.
0:41:06 > 0:41:09It's a little one, it's a 4.3 metre.
0:41:09 > 0:41:12Willie knows more about boats than me, don't you?
0:41:12 > 0:41:14When we get by the power station here,
0:41:14 > 0:41:16it's just in here at the marina.
0:41:16 > 0:41:20- Oh, yes.- It's the smallest one.
0:41:21 > 0:41:23Right, there she is.
0:41:23 > 0:41:25There is a blue and white one next to her.
0:41:25 > 0:41:27You can't see... There it is.
0:41:29 > 0:41:33And with a few miles to go, it isn't too long before they reach
0:41:33 > 0:41:34the village of Brae.
0:41:36 > 0:41:38A nice garden they've got over here.
0:41:41 > 0:41:45And then it's just a case of getting Willie back into the care home.
0:41:51 > 0:41:53There we go. A wee bump.
0:41:55 > 0:41:56Hello.
0:41:56 > 0:41:59- We've brought him back for you. - Super.
0:42:01 > 0:42:05- Your frame's here already, Willie. - Yeah.- You just need your chair now.
0:42:09 > 0:42:10- Good day?- Yeah.- Good.
0:42:12 > 0:42:16Now then, let me help you. Give me that arm.
0:42:18 > 0:42:21- You all right?- Uh-huh. - Got your balance again.
0:42:23 > 0:42:26Push up from the right, that's it. One, two, three.
0:42:26 > 0:42:28OK.
0:42:28 > 0:42:30Just get your balance.
0:42:36 > 0:42:38You've landed, my darling.
0:42:38 > 0:42:40Are you wanting your jumper through
0:42:40 > 0:42:41or will I leave that with your folder?
0:42:41 > 0:42:43- No.- I'll just leave his notes here.
0:42:43 > 0:42:47- That's super, thanks very much. - No bother. We'll see you on Friday.
0:42:47 > 0:42:51- That's right, yeah. - Bye for now, Willie.
0:42:51 > 0:42:53- Bye.- Cheers just now, Willie.
0:42:53 > 0:42:55With Willie back home for tea,
0:42:55 > 0:42:57Marie and Fiona will see him again in two days' time
0:42:57 > 0:43:00for his next session of dialysis treatment.
0:43:03 > 0:43:06After spending the night on the ward, Jimmy made it home.
0:43:06 > 0:43:10He's planning another holiday to the Skerries in the near future.
0:43:10 > 0:43:13Kathleen is back making those special bacon rolls
0:43:13 > 0:43:15for grandson Alexander,
0:43:15 > 0:43:17and Kari is happily sailing around the world.