Episode 8 Island Medics

Shetland, the most remote part of the UK.

Here, you are closer to the Arctic Circle than you are to London,

and nearer Norway than you are to Edinburgh.

There are more puffins than people...

..and more seals than supermarkets.

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

They are so far from the mainland that when things go wrong...

A&E, can I help you?

..from helicopter rescues and spinal injuries...

We are all here to make sure that you are OK.

..to serious medical mysteries...

Can we get assistance in, please?

Something's not right.

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

-What happened?

-I got in a fight with a seagull.

-This was sheep shears, was it?

-Yeah.

It means the tight-knit team of medics, volunteers,

and emergency services have a special bond.

This might tickle.

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

A wee treat for night shift.

..so they are always ready for any island emergency.

Today, an elderly lady is rushed into hospital

with a suspected stroke.

Doctor Saul Wilson has a broken hand to contend with.

-There.

-So, there.

-And Lerwick resident Jimmy

is helped into resus after falling off a wall whilst on holiday.

Ready, set, slide.

The Gilbert Bain Hospital has been serving the people of Shetland

since 1961.

Since then, the hospital's been continuously finding new ways

to improve medical care for the island's residents.

The Gilbert Bain is a consultant-led general medicine hospital.

Along with A&E, and two operating theatres, it has a maternity ward,

radiology, renal unit, medical wards,

occupational and physiotherapy units.

A CT scanner installed in 2007 reduces the need for patients to

travel to the mainland.

Since the nearest major hospital is 225 miles away in Aberdeen,

the services on Shetland are life-changing for its inhabitants.

At the Gilbert Bain A&E department,

the night shift has enjoyed a quiet evening.

Nothing major, always good.

But there is no such luck for day shift nurse Dawn Umphrey

and Dr Catherine Hawco.

A&E, can I help you?

No sooner have they handed over

than the emergency line starts ringing.

Hi, Cat, I was just giving you a heads up -

the ambulance is going to be here about quarter past.

We have an 82-year-old lady

with left-side weakness and slurred speech.

Yeah, we've got a lady...

I've just had a notification for the ambulance

saying that there is a lady

with left-sided weakness and slurred speech, so she's a potential stroke.

Paramedics Emma Davis and Angus Gilbraith have brought in a retiree,

Kathleen, following an emergency call made by her grandson.

Hello, is this Kathleen?

-Yeah.

-Hello, we're just going to go in here, OK?

Feeling really poorly yesterday...

OK. Any headache or anything?

-No, she did yesterday, splitting headache.

-OK.

Well, it's better to get checked.

Hopefully.

And when you got up this morning, did you have a drink of anything?

A drink of water or anything?

Just, I took my morning blood pressure tablet.

Not a big drink, but I would have had something to wash that down.

And no problems swallowing that?

-No, no problems.

-It didn't spill out your mouth, or anything?

No. Not at that point, no.

-OK.

-Will you just gie me a quick check, and let me...?

Do a quick MOT on you?

-OK.

-I'll grab the paperwork.

Kathleen is eager to get home,

but her symptoms are all pointing toward a possible stroke.

So it's up to the nursing staff

and Dr Catherine Hawco to investigate further.

Hi, there, my name is Dr Hawco, I am one of the doctors.

I know the ambulance got you in today.

What happened that you needed an ambulance?

One of my grandchildren called an ambulance.

I can speak now, I'm fine.

But, earlier on, I started a sentence, but I couldn't...

I couldn't get actually said what I wanted.

-OK.

-The ambulance has said there was quite a marked droop

when they got there, that's resolved.

And she can mind cooking bacon rolls at half seven,

-and dropping the plate cos she couldn't coordinate it.

-OK.

We obviously check airway breathing, circulation.

She's walked in, so obviously that's fine.

Get a routine set of observations,

see what her blood pressure is doing,

and then get the doctor to assess as soon as possible.

The signs and symptoms of a stroke vary from person to person,

but usually begin suddenly, so prompt action is vital

for all possible stroke victims.

Now, do you think we could sit you forward,

and I'll just have a listen to your back if that's OK?

Oh, thank you. If you take nice deep breaths for me, OK?

-OK?

-Mm-hmm.

And if you lie back for me?

Right, so, what I want you to do,

take my hands and squeeze them as hard as you can.

Lovely, lovely.

OK, now what I want you to do, hold your hands out in front of you,

and close your eyes. OK, I want you to hold them there.

Now, last thing, I'm going to run this up the sole of your foot, OK?

-Tickling.

-I've got tickly feet.

Yeah, I've been out to the waiting area,

he's in there with the rest of your family.

Your daughter and that's arrived.

-So, he's OK at the moment.

-Oh, that's fine.

So, what everybody was a bit worried about this morning

is that you might have had a stroke.

I think, it sounds like things have cleared up a lot.

Absolutely, yes.

So what it would be that might have happened is that you have possibly

had what we would call a mini-stroke, or a TIA.

Those are just when there is a wee blockage in your brain,

just for a minute or so, and then it clears,

but I think we should get a scan of your head and some blood tests

before we let you go today.

We'll need to wait and see what it shows,

but that's the first step, OK?

The effects of a TIA or mini-stroke can last just a few minutes,

but it is essential Kathleen goes for a scan to check if she has

had a stroke.

Like most parents, senior A&E doctor Kushik Lalla's day starts

-with getting the children ready for school...

-Right, guys.

Bye-bye.

..before grabbing his packed lunch and starting the commute to work.

I've worked in a lot of places and coming from South Africa...

..where it was horrendously busy all the time,

you never got a chance to actually sit and talk to patients...

..to actually see them as patients,

they were just diseases that you processed.

Shetland is a very different in that we are not as busy and therefore

that gives us a lot more time to actually sit and speak to patients.

Patients are also very grateful.

It's not unusual in Shetland to find a salmon sitting on your desk

a few days after you've seen someone.

Our patients get...

..better, I would say, care.

Our patients know us individually as people.

We know them individually.

I like that.

Once a week, Dr Lalla runs a skin surgery clinic in the Gilbert Bain.

The clinic allows Dr Lalla to do minor surgical procedures away from

theatre and often gives GPs a chance to enhance their training.

Every so often we have people joining us who are keen to learn.

In this case it's Judith,

who is one of our GPs that has just joined Shetland.

She's got an interest in dermatology and has spent, how long?

-Six...? No, nine?

-Eight months.

Eight months in dermatology prior to this.

So she's very interested and it would be great to see her doing this

across the road in one of the practices.

Just put a bit more pressure on that.

So, assisted by Dr Judith Pinnick,

Dr Lalla has several patients waiting to be seen with varying

dermatological concerns.

I don't know whether she fully qualifies for an atypical mole.

It doesn't sound like it because she has been seen by dermatology

and they haven't mentioned that.

But it sounds like she has got a lot of nevi, one of which has changed.

So if she's here, I'll get her in.

Hello.

-My name is Dr Lalla.

-South African born and bred,

Dr Lalla first moved to Shetland 20 years ago and is now

one of the longest-serving doctors in the hospital.

So how long have you had that? As long as you can remember?

-Yeah.

-When did it start changing?

A few months ago.

Patient Louise has a mole that's been concerning her.

It looks like it's got a bit irritated.

Any itch? No itch at all.

I'm reassured that there is a nice regular edge to it, there's not any

obvious dark pigmentation there.

So I'm not seeing any very alarm-bell features.

If you had to lay bets, what would you say?

-Just a benign nevus.

-Benign, yes. Completely benign.

Just to double check, it's a case of having that closer look.

This is a special light that we use that gives us better magnification

and allows us to see into the area

to see if there's anything worrying there.

I'm not seeing any worrying features.

There's no areas of dark pigmentation there.

You can just see there's some superficial growth.

Yeah, I agree, nice and benign.

So I think we can save you a needle...

..and a scalpel and just reassure you and let you get away.

Good news for Louise, and an opportunity for Dr Lalla

to run through a handy mole-checking system.

-Signs of skin cancer, do you know these?

-No.

No? Ah.

OK. Right.

There is what we call the ABCDE rule.

So A is for asymmetry.

B is for the border,

you want to see whether the border is nice and regular.

So you can see a nice clear, defined border.

The colour, if it's got one even colour throughout, again, like that,

nice evenly coloured, that's fine.

Where you have lots of different colours -

this one has black, red, white,

brown, lots of different colours, we start to get more concerned.

D for the diameter.

Anything generally bigger than roughly about the size of that,

that pen tip, anything bigger than that, again,

we start to get more concerned.

OK? And E is for evolution.

Any change, then we want to know about it.

And if any of this happens, see your GP and they will get you into us.

With Louise well informed, it's job done,

and onto the next patient for Dr Lalla.

Thank you very much.

On mainland Shetland, the Scottish Ambulance Service covers an area

of over 350 square miles.

On every shift there are two teams running the show.

Paramedics and ambulance technicians make up a team of four,

responsible for operating the two ambulances.

OK?

Along with the coastguard,

they are the front line of medical emergency response.

I actually don't remember deciding to become a paramedic,

cos I've wanted to be a paramedic for as long as I can remember.

Emma has been working in the service for five years.

It's single-track roads, there's sheep, there's ponies on the road,

there's all sorts of things, bad weather,

these vehicles will rock quite a lot in the weather,

so it can be a lot of pressure and you can be very aware sometimes,

this patient's life is in your hands and there isn't really anybody else

around that's going to help you.

So I think you have to be good at your job

to work up here in Shetland.

And with the start of a new shift, it doesn't take too long before Emma

is on her first call-out

along with ambulance technician Kaylee Robertson.

They are responding to a call that

a patient has been evacuated by air ambulance from the Skerries.

We are heading to Tingwall Airport to meet the coastguard

search and rescue helicopter.

They've retrieved a patient off of Skerries,

which is one of the islands quite far out in Shetland.

We don't have a huge amount of information on this gentleman,

we just know that he's elderly.

There will be a paramedic on the helicopter

that will give us a good handover when we get to Tingwall

and we'll take him back to the Gilbert Bain.

The Skerries are a small archipelago with around 70 people inhabiting

the two square miles of rock to the north-east of Lerwick.

The coastguard search and rescue helicopter is transferring

the casualty to Tingwall Airport.

Some of our patients have to go by helicopter onto the mainland

so we can get to them, and that in itself is unique.

We also don't have HeliMed up here.

If we need that kind of resource,

it's a search and rescue helicopter that's used.

We try and keep it a team cos we're all working towards the same goal.

So it's good.

Arriving ahead of the helicopter,

paramedic Emma and ambulance technician Kaylee

are ready to receive the casualty.

The helicopter is just a few minutes away.

We should see it coming in shortly.

And then we'll just communicate with

the paramedic on board the helicopter

to see if the man is walking or if he needs a stretcher

and we'll just go from there.

Transferring the patient from the helicopter requires the two teams to

work together to get him safely into the ambulance.

The patient's wife, Louise,

has travelled with him and will be able to fill in important details

of what's happened.

Do you remember feeling unwell or anything before it happened?

I felt really weird.

Just a bit fuzzy?

-Just a bit funny.

-Do you remember thinking you were going to pass out?

-No.

-No, you just felt weird?

Have you any pain anywhere? How about your head where you banged it?

So you're 83, is that right?

And your home address...

It's a long way to go for a trip to the hospital.

Now then, just wait. If you come to the edge,

we'll just wait for Kaylee to help you down the steps

because they are quite steep. Do you want me to take your bags?

I'll jump down because I don't want you to fall.

-OK.

-Once outside the Gilbert Bain A&E,

Emma and Kaylee can get Jimmy off the ambulance

and checked into the hospital.

OK, Jimmy, a couple of bumps

as we go out onto the lift.

That's us.

This is our brand-new one.

You've had the full works today.

Hello.

-Yes.

-In here.

This is James, he was unconscious for two minutes the first time,

then he had another collapse and was unconscious for a minute that time.

Vital signs are all stable, ECG is normal.

He was absolutely saturated in sweat at the time and he is very pale.

He still remains pale. Has been quite nauseous since as well.

He lives literally just down the road.

It was day one of their holiday.

Oh, no!

Jimmy had been on holiday with his wife Louise when he collapsed.

He had been sitting on a wall and banged his head when he fell.

Ready, set, slide.

His ECG and everything is here.

The patient information paramedic Emma has gathered is crucial

in helping the A&E team assess Jimmy correctly.

Type 2 diabetic but no heart problems or any episodes like this.

With the handover complete,

the medical team can now take over Jimmy's care.

Upstairs, above the A&E department, is the renal unit.

Five days a week, the unit opens its doors to the island's patients

who require dialysis.

Dialysis is a procedure to remove waste products and excess fluid

from the blood when the kidneys stop working properly.

The kidneys do a couple of different things.

One, they get rid of excess water from the body, but they also...

..clean the blood, they're sort of the cleaning system.

When somebody has kidney disease, kidneys that are failing,

we can sort of take over the process

and basically do what the kidneys used to do.

Senior staff nurse Gary McMillan has worked in dialysis since 2011.

Today he is looking after patient Willie,

who has come in for one of his three weekly treatments.

We weigh a patient before dialysis and after and we sort of have

a weight that we're aiming to get to and we do a calculation

as to how much fluid we need to remove during the day.

The dialysis machine takes over the role of the kidneys.

Basically, the machine is trying to equalise

the blood chemistry to what we set it at.

When somebody comes that is actually needing dialysis, it is what...

They would be termed as an end-stage kidney failure.

So what we're doing is we remove the excess fluid but we also clean

the blood and bring the blood chemistry back down to normal.

Dialysis is a very tiring process.

Willie's will take around four hours,

but the duration depends on

each patient's condition when they arrive.

The shortest period we've got for any patient in the unit here

currently is three and a quarter hours,

up to some on five-and-a-half-hour dialysis.

And they will have that three days a week,

so it's quite a big chunk out of your life.

It's quite life-limiting.

It's quite a big event to go onto dialysis.

But it is life-saving and eventually a patient would die

if they didn't have dialysis.

The opening of the renal unit in 1999 transformed the lives of those

that needed the service.

In the past before there was a dialysis unit, patients would have

to go to Aberdeen, they would have to live in Aberdeen.

It means people can live at home and continue to feel well, really.

Being able to stay at home with your family

and not be isolated from your family for three months at a time.

Travelling on and off the island can be quite expensive

so it's been a big change for Shetland, really.

But what the machine will do is it does a self-check calibration.

So it is continuously mixing up a new prescription and delivering it

to the patient every 15 minutes.

It takes itself...

..out of dialysis, so to speak,

checks that everything is correct and then goes again.

Willie has got...

..28 minutes left.

So when he comes to finish his dialysis we'll remove his needles

and once we're happy that he's safe to be discharged we'll phone

the local ambulance and the girls or guys or whoever it is

will come and take Willie back to the care home.

At the A&E Department,

retiree Kathleen is having blood tests to determine possible reasons

for her suspected mini-stroke.

Sorry, Kathleen, I ken it's uncomfy there.

One more and then we're done, OK?

With the bloods complete,

Kathleen is taken to the CT scanner for a better look at any effects

the suspected mini-stroke might have had.

-Hello.

-Hello.

So all you need to do is keep nice and still.

The alarm was raised by her 11-year-old grandson Alexander,

when he became concerned by his gran's limited movement

and slurred speech. He also rang his elder sister, Hannah,

who is training to be a nurse.

I was staying the night over at my granny's,

and I got up in the morning and she seemed to be fine when I was up

but when I went through...

When she came through to me she started trying to speak

but no words were coming out and it was quite scary

and I didn't really know what to do.

He's very clever. You're a good little boy.

He was really good. And he has always been good to his granny,

looked after her.

He did the right thing to phone me first.

Very proud of you.

CT head is done, so that's going to be sent to Aberdeen just now.

It should be gone, so we'll wait for that result to come back,

wait on her bloods coming back.

Once all that is together,

the doctor will probably confer with the consultant on call.

She's quite keen to go and it looks like her symptoms have resolved

so hopefully we can start her on some prophylactic medication

and get her away home.

Kathleen is pretty well at the minute.

She doesn't have any ongoing weakness or symptoms so we think

it might have been what we call a TIA or a mini-stroke.

She will probably be able to get home today,

with follow-up in the community,

with some medicine to go home with

and, like I say, some scans for a follow-up

and some follow-up with the stroke team.

With Dr Hawco and the team content that Kathleen is in good health,

she finally gets her wish to go home.

Shetland may be small but it generates big interest

among the sailing community.

With hundreds of boats tied to these shores,

Shetland is a mecca for boat owners.

In the summer months the islands host a regatta as well -

the Bergen to Shetland and North Sea triangle races that feature dozens

of large yachts.

One sailing enthusiast is Kari from Toft in Norway.

She took a tumble while on holiday on a tall ship which was berthed

in Shetland. She's hoping Dr Saul Wilson

can get her seaworthy again soon.

So, what's been going on then?

She fell on the deck in the evening.

She tried to grab something and she hit her hand on the bench.

I see. OK.

Did you fall to the ground as well?

Yes, I fell on my back but...

..when I fell I...

-Like this.

-Yeah.

And then immediately afterwards, how were you feeling?

It hurt.

-Very much.

-Yeah.

So the swelling, has it been getting bigger since then?

-Yes.

-OK, fine.

And the pain, has the pain been OK?

It doesn't hurt very much now.

Just... It's...

THEY SPEAK NORWEGIAN

-Pressing. The pain is pressing.

-Yeah, yeah.

Are you able to move your hand and your fingers?

-Yes.

-OK, OK.

Do you mind if I have a little feel?

-I don't mind.

-OK.

Just let me know if it's sore at any point.

I'm just going to have a little look first.

-Oh, yes.

-Is that sore there, yeah?

OK. Just let me know if it's tender at any point.

-Yeah.

-Sore there? OK.

You can feel me touching down here?

-Yeah.

-Here?

-Yeah.

That's fine. We'll give you some Ibuprofen,

it will help with the swelling and the pain.

We'll get this X-rayed and see what that shows and let you know where to

take it from there. All right?

We probably don't need to put it in a splint or anything at the moment

because it seems OK. We'll get the X-ray done first

and take it from there.

With Kari sent to X-ray to get her injured hand checked over,

Dr Wilson will hope the results are plain sailing.

With over 25% of Shetlanders aged over 60 and the ageing population

forecast to increase over the next ten years,

the demands on the Gilbert Bain Hospital

and the healthcare services of Shetland are set to rise.

So treating the over 60s is becoming more important for the staff of A&E.

83-year-old Jimmy is being assessed by Dr Lauren Cammaert

and medical student Albert.

I don't remember even going, to be honest.

I just felt really, really woozy.

OK. What do you mean by feeling strange?

I thought I was dying for a minute.

It was just a weird...

..feeling, kind of intense feeling in my head.

Has anything like this ever happened before?

No, never.

It's a bit of a medical mystery.

But it's hoped assessing Jimmy this way will help Dr Cammaert pinpoint

a cause or effect of the fall.

This diagnosis is vital to determine the next stage of care.

Good, it's nice and slow and regular.

OK, and turn your hands over for me.

OK, so it was the back of your head you hit, you said?

Yeah.

You've got a little tiny bit of swelling there but it's not too bad.

That's what the doctor on the plane said.

OK, good, good.

I think because you've fallen backwards I think we will probably

need to do a scan of your head just to see what's going on.

All right? Now, there is just one more examination,

one more test I'd like to do.

OK? It's called a neurological examination

and that will just tell me if there is any damage done to your head, OK?

Until the examination is complete,

Jimmy faces an anxious wait

to learn if there is any long-term neurological damage.

In his skin clinic, Dr Lalla is on to his next patient.

Patient Fiona, a local schoolteacher,

has a mole on her lower thigh which she would like removed.

Right, let's get you to take a lie-down, make yourself comfy.

Treating patients in Shetland is very different to elsewhere.

Places like London, big major centres,

you would get all these specialists and super specialist services

available, and available all the time, 24 hours a day.

And sometimes those patients

just happen to be your children's schoolteacher.

This is going to be the worst bit of it

is getting the local anaesthetic.

What's different over here is the variety that we see.

So you're off school today?

-I am, yes.

-Great.

Doctors in remote locations need to develop a wide range of skills.

What you want to see is the lesion bulge like that when you get into

-the fatty layer.

-Mm-hmm.

-What do you teach?

-I'm a primary teacher.

What class do you have?

She teaches my kids.

-Oh, really?

-Yeah.

Working on the mainland, you very often were limited to

just one particular area.

Over here we get to do everything,

from gynaecological surgery,

paediatric surgery, general lumps and bumps, dermatology.

And so it's the broad range that it offers us over here

that appeals to me.

Although it's a fairly simple procedure,

it's important when extracting the mole that all of it's removed,

to prevent it from growing back.

With the mole successfully taken off,

it's just a case of stitching up the area.

So, Fiona, how are you doing?

-Good, yeah.

-Good, good.

We're almost done.

What are you doing after this, going back to school or...

..wine time?

That was a very nice stitch.

Although it's going to sting a bit once the anaesthetic wears off,

the procedure was a complete success.

Now, you've got some stitches in there

and those will need to come away.

What you will need to do is contact the local health centre...

We see them twice a day on ward rounds,

patients know us individually as people, we know them individually.

We follow the entire patient journey,

from the time they are admitted into theatre,

out back on the ward and then in clinic for follow-up.

So it is very different, compared to a mainland hospital.

And I find that whole aspect of it much better in terms of working.

All right, cheers.

In the renal unit,

senior nurse Gary and trainee Pamela

are starting to bring patient Willie off his dialysis treatment.

So I've just got three minutes left.

OK, can we just lift that arm, just nice and straight, gently.

-Shoulder is still sore?

-Yeah.

What is happening now is the blood is actually being washed back

through the circuit and back in.

It's a complicated process but it...

..just becomes ingrained and you learn to just go through,

as long as you go through the steps in order

then everything is fine.

Just coming there.

It's starting to look translucent,

so stop your pump and then clamp everything.

So I'll clamp this one.

Once the finishing process is complete,

the next step is disconnecting the tubes

from the fistula in Willie's arm.

Because it involves tapping into a vein,

removing the needle is a delicate process.

Just as it comes. Yeah.

That's him. That's one out, Willie.

Because you've got your arterial and venous systems

connected, everything... It's almost a bit supercharged.

If you sort of miss just the exact spot where the fistula entry is,

it's coming out under a good pressure so it's just a case of

we'll hold for about ten minutes because the last thing we want is

a patient's blood on the outside - it's better on the inside.

Willie doesn't seem too traumatised.

To get Willie home, the ambulance patient transfer service

are called into action. Based at the ambulance station

around the corner from the Gilbert Bain,

the patient transfer service can be requested by any hospital ward

or department to transfer patients to and from the hospital.

It is a vital service for the Shetland islanders,

with so many patients living in rural parts of the island.

Today, nonemergency ambulance technicians Fiona Gilbertson

and Marie Williamson are on the afternoon shift.

So we've got a...

..client up in renal.

This is the renal department.

The last thing for Willie is to be weighed...

..and moved onto the trolley so he can get on his way home.

You've got company on the way home again, Willie.

-We're picking up a young lady.

-I see.

Having taken a tumble aboard a ship,

Norwegian Kari came to the Gilbert Bain to have her hand checked over.

And the results are in.

Yeah, so this patient has had

a fracture of the left side of her left hand,

the outer side of her left hand called the metacarpal.

It doesn't look too displaced, though,

so we should be OK to get her away.

We'll tape up the outer fingers for her comfort.

It doesn't need any surgical intervention but we'll just

encourage her to keep taking her ibuprofen, for the swelling.

With the problem diagnosed, Dr Wilson delivers the news.

So we've had a little look at the X-ray.

It does show a fracture on the left side,

the outer side of your left hand, in what we call the metacarpal.

So it's one of the bones in your hand that's connected to the finger,

obviously. It's not displaced too much, so it's still in place.

-OK.

-It doesn't need any sort of surgery or anything.

That's good.

-Yeah.

-That is what we were afraid of.

Oh, OK. We will get one of the nurses to tape up these two fingers

because that may actually be more comfortable for you,

if it just keeps it fixed in position.

And it will heal by itself.

What about paying?

-Paying.

-Paying money? Oh, you don't have to.

You can give me a tip, I guess.

LAUGHTER

No, you don't need to pay. Don't worry about that.

-Are you sure?

-Yeah, yeah. Of course.

-Very nice. Thank you.

-Maybe you want a hug?

-Whatever you want.

-All right?

-Thank you so much.

-Thank you.

-Thank you.

-Thank you so much.

-See you later.

With smiles all round, Kari had a simple splint put in place

and she soon headed back to

the little dinghy that she'd sailed in on.

In resus, Dr Cammaert has instructed medical student Albert to complete

the neurological examination.

Hello, my name is Albert. I'm one of the students.

Albert is in the final year of medical school.

In a year he will be a fully qualified junior doctor.

Completing examinations like this

provide him with that little extra experience.

I'm just going to bend your arm and move it around a bit, OK?

Your joints aren't stiff or anything?

-No.

-And just move your fingers out, just like that.

That's fine. Nice and strong.

No loss of power there. That's good.

The neurological exam involves testing all 12 sets

of cranial nerves to check there is no dysfunction

in the central nervous system.

Touch your nose, touch my finger, touch your nose.

My finger. Same here, just push down.

You're not ticklish on your feet, are you?

This might tickle, then.

That's all OK.

You're passing all the tests so far.

All right, so I think what I'm going to do at the moment,

I'm going to go and try and organise a CT scan of your head.

-Right.

-OK?

With Dr Cammaert still worried about patient Jimmy's injury,

a CT scan should clear up any final concerns.

It sounds like he had a loss of consciousness that caused him to

fall backwards, but he fell off a wall that was three feet

onto just a stone pavement.

He had quite severe neck pain before the fall which I think is

related to his... He normally has pain because of osteoarthritis,

but just to see what has caused the fall.

-Yeah, if that's OK.

-Are they ready to come down?

Yeah, they're ready to come.

So Jimmy heads for a CT scan.

And once the scans come through, Dr Cammaert checks them over.

That looks pretty normal,

but just have to wait for the radiologist to have a look.

So James has been for a CT scan now.

He went to have one just in case he suffered some injury to his head,

if he had any bleeding, because he did fall a considerable distance.

I've had a look. To me, it looks normal but I have to wait for

the radiologist to report it and tell me all the finer details.

It wasn't the start to his holiday Jimmy had expected, but at least

he can rest easy and receive

the best hospitality the Gilbert Bain can offer.

Jimmy will go up to be ward.

He'll have a cardiac monitor put on,

just in case there is any cardiac cause of his collapse.

And then he will just be observed and if all his tests are fine

he will probably go home tomorrow

after being seen by the consultant who is on call.

In Lerwick, ambulance technicians Marie and Fiona

are about to take patient Willie to Brae.

He lives in the North Haven care home,

about 23 miles north of Lerwick.

-Are we all good to go just now?

-We are, if you please.

It's always an adventure when we set off.

There's always something.

Marie has been transferring patients for ten years.

Since she sees most of them on a regular basis,

a big part of the job

is building a strong relationship with her patients.

That is the best thing.

Everybody has got a story, everybody has got skills.

And we just get so many wonderful people.

They are just really a pleasure, and great company.

And I think that is the best thing about this job.

You know, I have had so many laughs and been told so many stories.

Driving around Shetland is always a good opportunity for Marie

to catch up with her patients.

Me and Willie always have conversations about my boat.

I've just got an aluminium fold boat, among my many adventures.

It may be a midlife crisis I'm having, I'm not sure.

I've not got it in the water yet, you see.

And it's just along here in the marina.

It's a little one, it's a 4.3 metre.

Willie knows more about boats than me, don't you?

When we get by the power station here,

it's just in here at the marina.

-Oh, yes.

-It's the smallest one.

Right, there she is.

There is a blue and white one next to her.

You can't see... There it is.

And with a few miles to go, it isn't too long before they reach

the village of Brae.

A nice garden they've got over here.

And then it's just a case of getting Willie back into the care home.

There we go. A wee bump.

Hello.

-We've brought him back for you.

-Super.

-Your frame's here already, Willie.

-Yeah.

-You just need your chair now.

-Good day?

-Yeah.

-Good.

Now then, let me help you. Give me that arm.

-You all right?

-Uh-huh.

-Got your balance again.

Push up from the right, that's it. One, two, three.

OK.

Just get your balance.

You've landed, my darling.

Are you wanting your jumper through

or will I leave that with your folder?

-No.

-I'll just leave his notes here.

-That's super, thanks very much.

-No bother. We'll see you on Friday.

-That's right, yeah.

-Bye for now, Willie.

-Bye.

-Cheers just now, Willie.

With Willie back home for tea,

Marie and Fiona will see him again in two days' time

for his next session of dialysis treatment.

After spending the night on the ward, Jimmy made it home.

He's planning another holiday to the Skerries in the near future.

Kathleen is back making those special bacon rolls

for grandson Alexander,

and Kari is happily sailing around the world.