0:00:02 > 0:00:05Shetland - the most remote part of the UK.
0:00:06 > 0:00:10Here, you're closer to the Arctic Circle than you are to London.
0:00:10 > 0:00:12And nearer Norway than you are to Edinburgh.
0:00:13 > 0:00:15There are more puffins than people.
0:00:16 > 0:00:18And more seals than supermarkets.
0:00:20 > 0:00:24But this wild landscape is also home to 23,000 islanders.
0:00:25 > 0:00:29They're so far from the mainland that when things go wrong...
0:00:30 > 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- I suppose, sheep shears, was it? - Yeah.
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 > 0:01:06..and they know just how to keep each other going...
0:01:06 > 0:01:07Wee treat for night shift.
0:01:08 > 0:01:12..so they're always ready for any island emergency.
0:01:20 > 0:01:22Today, there's an extra special arrival
0:01:22 > 0:01:26- for maternity receptionist Marie Jamieson...- Oh!
0:01:26 > 0:01:28Not gonna cry.
0:01:28 > 0:01:31..nurse Gwen Angus attends to a lady with a nasty head injury...
0:01:31 > 0:01:33It's quite a flap.
0:01:33 > 0:01:37..And the Fetlar islanders receive a visit from a new locum GP.
0:01:37 > 0:01:40- We've got to fix you.- Yes.
0:01:45 > 0:01:48Alongside the fishing, farming and oil industries,
0:01:48 > 0:01:52the emergency and medical services are one of the biggest employers
0:01:52 > 0:01:53- on Shetland...- Deep breath.
0:01:53 > 0:01:56..providing jobs for over 500 of the island's residents.
0:01:58 > 0:02:01Living and serving in such a tight-knit community means
0:02:01 > 0:02:03there's a special closeness,
0:02:03 > 0:02:05unlike anywhere else in the UK.
0:02:06 > 0:02:08Oh, my darling!
0:02:08 > 0:02:10Staff of the Gilbert Bain Hospital
0:02:10 > 0:02:14often end up treating relatives or people they know.
0:02:15 > 0:02:19Every year on Shetland, around 250 babies are born into the world.
0:02:21 > 0:02:24The maternity team are continually working together to help deliver
0:02:24 > 0:02:28infants for both new and experienced parents.
0:02:28 > 0:02:31And being such a small community means patients and staff
0:02:31 > 0:02:34get to know each other rather well.
0:02:34 > 0:02:37None more so than maternity receptionist Marie.
0:02:37 > 0:02:39OK, that's...
0:02:39 > 0:02:43There's a rather special familiar face on the ward today.
0:02:43 > 0:02:44Her daughter Sonja is expecting
0:02:44 > 0:02:48her third child and has been admitted to the labour ward.
0:02:48 > 0:02:52Well, my daughter has come in in labour today,
0:02:52 > 0:02:53so it is kind of exciting.
0:02:53 > 0:02:56She's a few days' overdue.
0:02:56 > 0:02:59But she was late with both her other bairns,
0:02:59 > 0:03:01so we presumed she'd be later with this one.
0:03:01 > 0:03:04I wasn't expecting the baby to come till the weekend.
0:03:04 > 0:03:06So, it's kind of a strange feeling.
0:03:06 > 0:03:09Dinnae ken whether to be here or go home.
0:03:09 > 0:03:11Senior midwife Emma Courtier needs
0:03:11 > 0:03:13to double check everything is prepared for the delivery
0:03:13 > 0:03:14in the birthing pool.
0:03:14 > 0:03:16Make sure that the pool's warm enough.
0:03:16 > 0:03:18So I'll pop a bit more...
0:03:20 > 0:03:22..water in it.
0:03:22 > 0:03:24It helps relax the ladies.
0:03:26 > 0:03:32It helps more with their mobility and positioning.
0:03:32 > 0:03:35So, in the water, the water allows...
0:03:35 > 0:03:38..easier for the weight-bearing so that they're not having...
0:03:38 > 0:03:41On the bed, sometimes it's more difficult
0:03:41 > 0:03:43to get into different positions.
0:03:43 > 0:03:45Whilst the pool, it's warm water,
0:03:45 > 0:03:48so kind of helps with the releasing of the endorphins.
0:03:48 > 0:03:50And it's just good at relaxing the women.
0:03:50 > 0:03:52So...
0:03:52 > 0:03:54We find it's very popular here.
0:03:54 > 0:03:58A lot of our ladies choose to use the pool at some stage
0:03:58 > 0:04:01- during the labour. - But, still on shift,
0:04:01 > 0:04:04Sonja's mum Marie has to wait it out like everyone else.
0:04:04 > 0:04:08I'm not a midwife, so I'm not in the know with what's happening.
0:04:08 > 0:04:11And because of patient confidentiality,
0:04:11 > 0:04:14the midwives can't actually tell me how she's doing.
0:04:14 > 0:04:15Which is quite...
0:04:15 > 0:04:17You dinnae ken...
0:04:17 > 0:04:21I'm not sure whether to go home now or go home in five hours' time.
0:04:21 > 0:04:24Or what the best thing is to do.
0:04:26 > 0:04:30But they've all got smiley faces, so I think something's happening soon.
0:04:30 > 0:04:33So what we're going to do is we're just going to walk from here
0:04:33 > 0:04:36just across the labour room and we'll take you into the pool.
0:04:36 > 0:04:37OK?
0:04:38 > 0:04:40As this is Sonja's third pregnancy,
0:04:40 > 0:04:44midwife Emma expects it to be a smooth and quick labour.
0:04:45 > 0:04:48As Sonja's contractions have increased,
0:04:48 > 0:04:50it's time to move through to the birthing pool
0:04:50 > 0:04:53and to get as comfortable as possible for the birth.
0:04:56 > 0:04:58There we are.
0:04:58 > 0:05:01I did pop in to see her before she went into the labour ward
0:05:01 > 0:05:04to give her a big hug. And just to say that...
0:05:04 > 0:05:06..she can do it.
0:05:07 > 0:05:10So I'll just leave Roseanne to get her actually into the pool.
0:05:10 > 0:05:14She's doing really well so hopefully it'll not be long
0:05:14 > 0:05:16and we'll have a little baby.
0:05:16 > 0:05:18I've every faith in the staff here, as well.
0:05:18 > 0:05:20So...I'm quite calm, considering.
0:05:23 > 0:05:26On reception, Marie is hoping it won't be too long a wait.
0:05:27 > 0:05:30In the meantime, she'll have to keep herself busy.
0:05:38 > 0:05:40Despite Shetland's rugged coastline,
0:05:40 > 0:05:43diverse wildlife and incredible people,
0:05:43 > 0:05:45the islands have struggled to attract GPs
0:05:45 > 0:05:48to some of its more remote posts.
0:05:49 > 0:05:51Island beauty alone hasn't been enough to keep staff
0:05:51 > 0:05:53in the furthest parts of Shetland.
0:05:55 > 0:05:59One temporary solution has been to employ locum doctors to work in
0:05:59 > 0:06:02far-flung surgeries and clinics.
0:06:02 > 0:06:05Remote islands like Fair Isle, Unst, Foula and Fetlar
0:06:05 > 0:06:09are ALL employing locum doctors and nurses to fill empty posts.
0:06:11 > 0:06:15It's expensive, but vital for the rural communities.
0:06:25 > 0:06:28It's 6.15 in the morning on the island of Yell.
0:06:28 > 0:06:31And Dr Gerard Bulger has a ferry to catch.
0:06:32 > 0:06:35Well, we're going round to the ferry terminal,
0:06:35 > 0:06:37on to Fetlar, which is a small island.
0:06:37 > 0:06:40I think it's a population of about 50 on there.
0:06:40 > 0:06:42And there's a clinic every fortnight.
0:06:44 > 0:06:47So... It's the first time for me to do it.
0:06:47 > 0:06:51So, it's adventure for both of us.
0:06:51 > 0:06:53Posted to Yell Health Centre one week ago,
0:06:53 > 0:06:56Dr Bulger sees patients from Yell and Fetlar.
0:06:56 > 0:07:00Being a locum doctor, it's his first visit to Shetland,
0:07:00 > 0:07:02and a long way from his clinical roots in London.
0:07:03 > 0:07:06Doctors that are here, anything about on-call nowadays,
0:07:06 > 0:07:10they get terrified. Partly because I think what on-call they do,
0:07:10 > 0:07:13they do from these very large centres,
0:07:13 > 0:07:16where they might be looking after a population of, you know,
0:07:16 > 0:07:1910, 20, 30, 40, 50 thousand. And there is pandemonium.
0:07:19 > 0:07:23One of the reasons out-of-hours is pandemonium is because GPs...
0:07:23 > 0:07:26Patients can't get to see the GP easily during the day.
0:07:26 > 0:07:29Here, people are seen the same day.
0:07:29 > 0:07:32Having worked in practices as diverse as Antarctica
0:07:32 > 0:07:34and the Falkland Islands,
0:07:34 > 0:07:37the problems that arise in a remote island community aren't
0:07:37 > 0:07:39unfamiliar to Dr Bulger.
0:07:39 > 0:07:42We've got an excellent nurse over there, full-time, called Becky.
0:07:42 > 0:07:44We use the same clinical system,
0:07:44 > 0:07:46so, messaging each other about patients.
0:07:46 > 0:07:49I sent a patient in remotely the other day,
0:07:49 > 0:07:51and I want to see how she's doing.
0:07:51 > 0:07:56It's a three-hour round-trip to get on and off the island for Dr Bulger,
0:07:56 > 0:07:59with his surgery starting nice and early at 8am.
0:08:01 > 0:08:02Although it's Shetland,
0:08:02 > 0:08:05so there's no guarantee it will all be plain sailing.
0:08:05 > 0:08:07Want the right lane. Well, I'm booked.
0:08:08 > 0:08:09And it's Fetlar.
0:08:09 > 0:08:12Er, Fetlar, three and four, there we are, we've done it.
0:08:13 > 0:08:17Navigating unfamiliar ferry lines comes with the territory.
0:08:17 > 0:08:21But Dr Bulger's well aware of how crucial his expertise may be.
0:08:21 > 0:08:24I mean, the car here is kitted out with full...
0:08:26 > 0:08:27..advanced life support,
0:08:27 > 0:08:29and defibs and everything,
0:08:29 > 0:08:32because, you know, this is possible.
0:08:32 > 0:08:35We're remote and we need to look after a patient
0:08:35 > 0:08:38until help can get to us, which may be some hours.
0:08:38 > 0:08:40And on a day like this, I think it would be very problematic,
0:08:40 > 0:08:42even to fly someone out.
0:08:42 > 0:08:45So, here we are. I think this is our boat coming in.
0:08:45 > 0:08:46It's rather sweet, isn't it?
0:08:50 > 0:08:51Hello.
0:08:51 > 0:08:53I need a bit of paper, apparently.
0:08:53 > 0:08:56I've no receipts, I'm afraid,
0:08:56 > 0:08:58but I can give you a ticket.
0:08:58 > 0:08:59Brilliant.
0:09:04 > 0:09:07Pleasantly surprised how warm it is.
0:09:07 > 0:09:10Even though it must look very bleak, it's actually quite warm.
0:09:10 > 0:09:14And I understand it never gets quite that terribly cold here.
0:09:14 > 0:09:17So, you know, it is an adventure.
0:09:17 > 0:09:19It's an astonishing place.
0:09:19 > 0:09:23And I can't understand why they can't find a GP
0:09:23 > 0:09:27to do it full-time because it's just...
0:09:27 > 0:09:29..a unique set of experiences.
0:09:29 > 0:09:31A unique little practice.
0:09:41 > 0:09:46GPs and nurses travel to Shetland's remote island communities,
0:09:46 > 0:09:49but if any of the inhabitants require hospital care,
0:09:49 > 0:09:51there's only one place to go -
0:09:51 > 0:09:54the Gilbert Bain in Lerwick, on mainland Shetland.
0:09:56 > 0:09:59William has travelled to A&E from the island of Burra,
0:09:59 > 0:10:00to the south-west of Lerwick.
0:10:04 > 0:10:06I was pulling up plasterboard.
0:10:06 > 0:10:08Got a big splinter off it.
0:10:08 > 0:10:11Bit of wood. I tried to cut it out but it just...
0:10:12 > 0:10:13..snapped off.
0:10:15 > 0:10:18It might appear trivial, but sometimes the smallest of injuries
0:10:18 > 0:10:20are worthy of a trip to A&E.
0:10:20 > 0:10:26Something senior A&E and surgical Dr Kushik Lalla is only too aware of.
0:10:26 > 0:10:28The problem is, this guy got some
0:10:28 > 0:10:32splinters into his finger and the finger began to swell.
0:10:34 > 0:10:40And you've got little tendon sheets within your fingers,
0:10:40 > 0:10:42tendon sheets are potential spaces.
0:10:42 > 0:10:47So, their function is to lubricate the area and allow the tendon
0:10:47 > 0:10:49to slide nice and easily within them.
0:10:51 > 0:10:53But if you get an infection into the tendon sheet,
0:10:53 > 0:10:56then it spreads very rapidly.
0:10:56 > 0:10:58The tendon sheet is just a space,
0:10:58 > 0:11:02so as soon as the infection gets into that space,
0:11:02 > 0:11:04it just spreads very rapidly down it
0:11:04 > 0:11:08and then it spreads into the entire hand and can spread up
0:11:08 > 0:11:10the other fingers, as well.
0:11:10 > 0:11:13You end up with a very bad hand infection
0:11:13 > 0:11:16which you could end up losing your hand for.
0:11:18 > 0:11:19Following the examination,
0:11:19 > 0:11:22Dr Caitlin Brennan is going to prep him for surgery,
0:11:22 > 0:11:25to make sure any remains of the splinter is removed.
0:11:26 > 0:11:29So, what we'll do, we'll just put in some anaesthetic
0:11:29 > 0:11:31either side of the finger. And it will feel a bit weird,
0:11:31 > 0:11:34because you'll see us cutting and pulling, but you won't feel it.
0:11:34 > 0:11:35So, essentially, in the finger,
0:11:35 > 0:11:39you got digital nerves that run either side of the finger,
0:11:39 > 0:11:41and if you anaesthetise those nerves,
0:11:41 > 0:11:44it means that from there downwards is anaesthetised,
0:11:44 > 0:11:47so it's a good block, because it means you can put in a small amount
0:11:47 > 0:11:49of anaesthetic and numb a larger area,
0:11:49 > 0:11:52whereas if you put in a local anaesthetic around the tissues,
0:11:52 > 0:11:54you just anaesthetise the tissues.
0:11:54 > 0:11:57It's good for fish hooks as well, which is a common presentation.
0:11:57 > 0:11:59Dr Brennan is a junior doctor,
0:11:59 > 0:12:03so she'll carry out the procedure supervised by Dr Lalla.
0:12:03 > 0:12:06Right. OK, you're not allergic to anything, you said?
0:12:06 > 0:12:11OK. What I'm going to do is just tie this round the base of your finger.
0:12:11 > 0:12:14In nice, big hospitals, you have these lovely tourniquets.
0:12:15 > 0:12:18Over here, we have to make our own.
0:12:20 > 0:12:22OK.
0:12:22 > 0:12:25The makeshift tourniquet suppresses the blood supply and keeps
0:12:25 > 0:12:27the anaesthetic where the doctors want it.
0:12:28 > 0:12:30You'll still feel pressure,
0:12:30 > 0:12:32but there should be nothing sharp, no pain.
0:12:34 > 0:12:36No? OK. That's good.
0:12:39 > 0:12:40I would go more distal.
0:12:40 > 0:12:44No, no. Distal. Yeah, yeah. From about there.
0:12:44 > 0:12:48Just open it up. If you're finding anything sore, let us know.
0:12:48 > 0:12:50Yeah? Carry on, carry on, carry on.
0:12:50 > 0:12:53Use your swab now, and just using your swab,
0:12:53 > 0:12:55squeeze any excess blood out.
0:12:55 > 0:12:57Once you get rid of the excess blood,
0:12:57 > 0:13:00then you get a nice bloodless field,
0:13:00 > 0:13:03and then you can actually see what you're doing after that.
0:13:03 > 0:13:07Is that a splinter fragment over there that we see?
0:13:07 > 0:13:08No, I think that's a vein.
0:13:10 > 0:13:12Yeah. Use your mosquito now.
0:13:12 > 0:13:15And just get into the wound, and just try and open that up.
0:13:15 > 0:13:17The finger's infected.
0:13:17 > 0:13:21There is a query as to whether there is a foreign body.
0:13:21 > 0:13:26So, whether he's got a piece of wood that's sitting in there...
0:13:26 > 0:13:30..and that's what's resulted in the finger becoming swollen like this.
0:13:30 > 0:13:35Doctor Brennan checks carefully for any foreign debris in William's infected finger...
0:13:36 > 0:13:37..but can find nothing.
0:13:39 > 0:13:42So, what we should do, then, is just leave the wound open.
0:13:42 > 0:13:45- Yeah.- Get the nurses to dress that.
0:13:45 > 0:13:48And then you're going to stay in with us.
0:13:48 > 0:13:51You need some antibiotics for just a couple...
0:13:51 > 0:13:54..probably one or two days until we can get that under control
0:13:54 > 0:13:57and then take it from there. All right?
0:13:57 > 0:13:59We're going to leave that wound open,
0:13:59 > 0:14:02because if there is a small bit of wood or something like that in it,
0:14:02 > 0:14:05your body will just get rid of it and push it out.
0:14:05 > 0:14:10OK, if we try and close that wound, it will all get stuck in again.
0:14:10 > 0:14:11If things don't settle, William,
0:14:11 > 0:14:16then we might take you to theatre and open this up again in theatre
0:14:16 > 0:14:18on the other side as well.
0:14:18 > 0:14:20OK?
0:14:20 > 0:14:25Finger injuries can go from looking very trivial to very bad
0:14:25 > 0:14:27very quickly,
0:14:27 > 0:14:31and if you're not careful, it involves the entire palm,
0:14:31 > 0:14:34and then you've really got problems.
0:14:34 > 0:14:37So, we'll get him up to the ward just shortly.
0:14:39 > 0:14:42With no debris found, and the wound needing to be left open,
0:14:42 > 0:14:45William will enjoy the hospitality of the Gilbert Bain
0:14:45 > 0:14:46for another couple of days.
0:14:55 > 0:14:59In the UK, the most common place for accidents to happen is at home,
0:14:59 > 0:15:02so while island life can produce unusual injuries,
0:15:02 > 0:15:05there are plenty of domestic bumps and bruises too.
0:15:06 > 0:15:10In A&E, 57-year-old Anne has travelled from Sandwick,
0:15:10 > 0:15:13around 12 miles south of the Gilbert Bain, with a head injury.
0:15:13 > 0:15:16Anne, are you wanting to come through and we'll get your details?
0:15:16 > 0:15:18She's accompanied by her husband, Pete,
0:15:18 > 0:15:20who's determined to stay by her side.
0:15:20 > 0:15:22Are you coming in as well?
0:15:22 > 0:15:26- Aye, yep.- First to assess Anne is nurse Gwen Angus.
0:15:28 > 0:15:30Now, I'm Gwen, one of the nurses here.
0:15:30 > 0:15:32So, do you want to tell me what's happened?
0:15:32 > 0:15:34I tripped up this morning in the kitchen.
0:15:34 > 0:15:36I don't know what I'd tripped on,
0:15:36 > 0:15:38but we're having a new kitchen fitted,
0:15:38 > 0:15:41and there's four dogs there, so I could have tripped over a dog,
0:15:41 > 0:15:43or just the fact there's stuff around, and I hit my head.
0:15:43 > 0:15:48Originally from Essex, Anne's lived in Shetland for 29 years,
0:15:48 > 0:15:50and has been referred to A&E by her GP,
0:15:50 > 0:15:52who suspects she may need stitches.
0:15:54 > 0:15:55I think it has stopped bleeding now.
0:15:56 > 0:15:59But they just bandaged me up to make me look good.
0:15:59 > 0:16:02Nurse Gwen must decide whether Anne needs to be sewn up.
0:16:02 > 0:16:04But it's not going down well.
0:16:06 > 0:16:07- OK...- Oooh, even I saw that.
0:16:07 > 0:16:11I'm not going to tell you.
0:16:11 > 0:16:15I think we're definitely going to be needing some stitches.
0:16:15 > 0:16:17Our doctor's busy just now, but we'll get her in,
0:16:17 > 0:16:19and we'll need to patch you back up again.
0:16:19 > 0:16:22Can you hit me on the back of the head and knock me out so I don't
0:16:22 > 0:16:26feel the stitches? Yeah, I'm just more worried about the stitches.
0:16:27 > 0:16:29Have you ever had stitches before?
0:16:29 > 0:16:32I cracked my head open a few years ago and they glued it,
0:16:32 > 0:16:34and I think that was pretty sore,
0:16:34 > 0:16:36- so the stitches are maybe not any worse.- OK.
0:16:40 > 0:16:44Erm, it is quite... It is quite a flap,
0:16:44 > 0:16:47and it's going down to the skull,
0:16:47 > 0:16:49so she's had quite a knock,
0:16:49 > 0:16:52so it is certainly going to be needing put together.
0:16:52 > 0:16:55I'll get the doctor to come and have a look.
0:16:55 > 0:16:59Who would have thought fitting a new kitchen would be so painful?
0:16:59 > 0:17:02And it's up to Doctor Ashley Thomson to break some more bad news.
0:17:04 > 0:17:08Anne, you're going to be left with a scar from this, unfortunately.
0:17:08 > 0:17:12- That's all right. I'm not worried about that.- We'll get it
0:17:12 > 0:17:15as best we can together. Is it a new kitchen you're having done?
0:17:15 > 0:17:18- Yeah. And I've waited 24 years. I wish I'd kept waiting.- Bless you.
0:17:21 > 0:17:24Aware Anne is nervous about the stitches,
0:17:24 > 0:17:27Doctor Thomson administers a local anaesthetic
0:17:27 > 0:17:28to help numb the affected area.
0:17:28 > 0:17:31Now, this is going to be the stingy bit, OK?
0:17:31 > 0:17:34Well done. You're doing really well.
0:17:34 > 0:17:35When you get wounds to the head,
0:17:35 > 0:17:38because there's lots of blood vessels,
0:17:38 > 0:17:40it's very vascular, so it bleeds a lot.
0:17:40 > 0:17:42Yeah, I noticed that when the dogs were trying
0:17:42 > 0:17:44to lick it up off the floor!
0:17:44 > 0:17:46It means that it heals very quickly,
0:17:46 > 0:17:49but it does mean that there is quite a lot of bleeding.
0:17:49 > 0:17:53- Yeah.- Despite the news that she'll be left with a scar,
0:17:53 > 0:17:56Anne's Essex banter still shines through.
0:17:56 > 0:17:58Right, let's see how we go with that.
0:17:58 > 0:18:01Now, we're going to start in the middle,
0:18:01 > 0:18:04- and then we'll bring the sides together nicely, OK?- OK.
0:18:07 > 0:18:11- Ready for me to start?- How many do you think there will be?
0:18:11 > 0:18:14- Hmm...- 30?- Shut your face!
0:18:14 > 0:18:17Difficult to say. It could easily be about 12.
0:18:17 > 0:18:20Blimey.
0:18:20 > 0:18:23Yeah, we definitely couldn't have glued this one together.
0:18:24 > 0:18:27Can you do embroidery stitches while you're there?
0:18:27 > 0:18:30Put a fancy pattern or something.
0:18:30 > 0:18:34I think this is where my sewing skills come in use from school.
0:18:34 > 0:18:36Oh, cool.
0:18:36 > 0:18:37I'm glad you're not a carpenter.
0:18:41 > 0:18:42It's dressed up now.
0:18:42 > 0:18:45Satisfied that Anne has been thoroughly checked over,
0:18:45 > 0:18:48and happy with her neat needlework,
0:18:48 > 0:18:50Doctor Thomson concludes her appointment
0:18:50 > 0:18:51with a very grateful patient.
0:18:51 > 0:18:54- That OK?- Thank you, Doctor... - No bother at all, no bother.
0:18:54 > 0:18:57I hope that's all fine and you have no problems.
0:18:57 > 0:18:58- Thank you.- OK?
0:19:01 > 0:19:03Erm, it didn't hardly hurt at all.
0:19:03 > 0:19:08I was really nervous about getting stitches and that, but it was fine,
0:19:08 > 0:19:13so, I don't know what else to say, except for thanks to the doctors.
0:19:13 > 0:19:16If you're noticing anything concerning
0:19:16 > 0:19:19- that's out of the ordinary... - If I start frothing...
0:19:19 > 0:19:22- I don't normally do that.- ..then you can obviously take her back,
0:19:22 > 0:19:25- or give us a phone.- Oh, yeah, that goes without saying.- OK?
0:19:26 > 0:19:28And that's you. I hope your kitchen's looking beautiful
0:19:28 > 0:19:31- by the time you get there.- Yes, so do I. It better be after all this.
0:19:32 > 0:19:34- Thank you so much.- No problems.
0:19:34 > 0:19:38- Okey dokey, thank you.- Thank you.
0:19:38 > 0:19:40- Bye.- Right, bye.
0:19:40 > 0:19:43Thank you, bye.
0:19:51 > 0:19:55In the maternity ward, receptionist Marie is awaiting news
0:19:55 > 0:19:57on the birth of her third grandchild.
0:20:01 > 0:20:04With her daughter in labour for the last hour and 20 minutes,
0:20:04 > 0:20:05it's been an anxious wait.
0:20:07 > 0:20:08Shortly before two o'clock,
0:20:08 > 0:20:11her son-in-law David appears from the delivery room.
0:20:13 > 0:20:17- It's a girl.- What?!- Yeah.- I thought it was going to be a boy!
0:20:17 > 0:20:20- I know.- Oh, congratulations.
0:20:20 > 0:20:21Yeah.
0:20:21 > 0:20:26Baby Carina, born at 1.25pm, has weighed in at just shy of 8lbs.
0:20:26 > 0:20:28It's tough work being a baby.
0:20:28 > 0:20:30Mum and baby are both doing fine.
0:20:32 > 0:20:34I'm not going to cry.
0:20:42 > 0:20:45And after finally getting to see her new granddaughter,
0:20:45 > 0:20:47it's into full-time granny mode,
0:20:47 > 0:20:51looking after Carina's big sisters, Chloe and Ailidh.
0:20:51 > 0:20:53Was she big?
0:20:53 > 0:20:55Tiny.
0:20:55 > 0:20:57Are you excited to change her nappy?
0:20:57 > 0:20:58No.
0:21:01 > 0:21:04With Sonja and baby Carina both doing well,
0:21:04 > 0:21:06it's not long before they're allowed to head home.
0:21:09 > 0:21:11They'll now be cared for by a team of midwives
0:21:11 > 0:21:14who provide postnatal care to the new mums across Shetland.
0:21:30 > 0:21:32Doctor Bulger is at the final stage
0:21:32 > 0:21:35of his journey from Yell to the Fetlar surgery.
0:21:39 > 0:21:42It's taken him an hour and a half to make the 19-mile journey,
0:21:42 > 0:21:46but the 60 islanders on Fetlar rely on the fortnightly clinic.
0:21:48 > 0:21:51Well, the clinic apparently starts bang on eight o'clock,
0:21:51 > 0:21:53so I'm already late.
0:21:53 > 0:21:54That's why she was calling.
0:21:56 > 0:21:58That's it. We're here.
0:22:00 > 0:22:02Well, that's pretty good, isn't it?
0:22:02 > 0:22:04Look at that. Look at the view out there.
0:22:06 > 0:22:11- Hi, Becky.- Working as a locum means Doctor Bulger will probably only see
0:22:11 > 0:22:13a patient for one short surgery.
0:22:14 > 0:22:16I assume it was you ringing me.
0:22:16 > 0:22:18It might be a remote clinic,
0:22:18 > 0:22:20but it's kitted out like any other on Shetland.
0:22:21 > 0:22:24It's a proper clinic, GP room.
0:22:24 > 0:22:27Lots of equipment, so we can do stuff locally.
0:22:27 > 0:22:31And such an essential thing - the sticky label printer.
0:22:31 > 0:22:33- It doesn't work! - Oh, doesn't it?
0:22:33 > 0:22:36- Not at the moment, no.- Oh, right.
0:22:36 > 0:22:39We're now logging in. It always takes a couple of minutes to log in.
0:22:39 > 0:22:41And we're going to start this clinic,
0:22:41 > 0:22:45because we need to get back on that ferry at 10 past 11,
0:22:45 > 0:22:46so we haven't got long here.
0:22:50 > 0:22:52That's it, we've worked. It's logged in.
0:22:59 > 0:23:02Fetlar resident Rose has been keen to see Doctor Bulger,
0:23:02 > 0:23:05and she has some island medical history of her own.
0:23:07 > 0:23:10Hello, Rose. I understand you used to be the nurse here?
0:23:10 > 0:23:12I did. Many years ago.
0:23:12 > 0:23:14- Right.- Yes.- So, when did you stop that?
0:23:14 > 0:23:16Early 2000s.
0:23:16 > 0:23:18- So, born here?- Hm?
0:23:18 > 0:23:20- Born here, or just got stuck here? - No, I was born in Australia.
0:23:20 > 0:23:23Really? I've been working in Australia for seven years.
0:23:23 > 0:23:24- Oh, really?- I was in Cairns.
0:23:24 > 0:23:26Oh. High up.
0:23:26 > 0:23:28Rose has an ongoing gastric condition
0:23:28 > 0:23:30that's been causing her discomfort,
0:23:30 > 0:23:32and has been waiting for test results
0:23:32 > 0:23:34that might identify the cause.
0:23:34 > 0:23:37I saw the specialist about pain in the stomach.
0:23:37 > 0:23:39I've had trouble with it for ages,
0:23:39 > 0:23:41and I've been treated for it once already,
0:23:41 > 0:23:44so I had to send three specimens off,
0:23:44 > 0:23:46and I've heard nothing since then.
0:23:46 > 0:23:49Was the hospital sending it, or were you sending it?
0:23:49 > 0:23:50No, it was the hospital.
0:23:50 > 0:23:52It's gone to the consultant and he didn't write to us.
0:23:52 > 0:23:54- Let me check.- The thing is,
0:23:54 > 0:23:57I'm booked to go to Australia in two weeks' time.
0:23:57 > 0:23:58So, we've got to fix you.
0:23:58 > 0:24:01- Huh?- We've got to fix you.
0:24:01 > 0:24:02- Yes.- Quickly.
0:24:03 > 0:24:06With a holiday to Australia planned in only a couple of weeks' time,
0:24:06 > 0:24:09Rose hopes Doctor Bulger finds a fix for her problem.
0:24:12 > 0:24:14Duncan, isn't it?
0:24:14 > 0:24:18When I had a gastroscopy, I had seen her before.
0:24:18 > 0:24:22They saw helicobacter, and she gave me some medication.
0:24:22 > 0:24:25- So, you took antibiotics. How long ago was that now?- No, but I...
0:24:25 > 0:24:29I couldn't, because after two days, I just couldn't take any more,
0:24:29 > 0:24:32because I thought it was going to kill me.
0:24:32 > 0:24:34So, in other words, your last treatment wasn't successful
0:24:34 > 0:24:36- because it wasn't full?- No.- Right.
0:24:36 > 0:24:39- Have you lost weight? It says a kilogram.- Yes.
0:24:39 > 0:24:42Rose's extreme reaction to the previous treatment means
0:24:42 > 0:24:44Dr Bulger finds an alternative
0:24:44 > 0:24:47that will hopefully have her fit enough to travel.
0:24:48 > 0:24:52- Amoxicillin 500.- Yeah. And she takes two of those twice a day.
0:24:56 > 0:24:58Take these. Same idea, twice a day.
0:24:58 > 0:25:02- Yes.- Right?- Yes. - That's one, twice a day.
0:25:02 > 0:25:03This one's two, twice a day.
0:25:04 > 0:25:06I'm here for another week and a bit,
0:25:06 > 0:25:10so I can always sort something out in the meantime.
0:25:10 > 0:25:12And those... Oh, those are your omeprazole.
0:25:12 > 0:25:16- Yes, there's some in there. - Yeah, yeah.
0:25:16 > 0:25:17- That's fine.- Excellent.
0:25:17 > 0:25:19- Thank you.- No trouble.
0:25:36 > 0:25:40Thousands of patients visit the Gilbert Bain every year,
0:25:40 > 0:25:43and the X-ray department is a vital service for many of them.
0:25:43 > 0:25:45Today is no different.
0:25:47 > 0:25:48Chin up high there, for me.
0:25:50 > 0:25:53Now, if you could put your hands on your hips
0:25:53 > 0:25:55and roll your elbows forward. That's it.
0:25:57 > 0:26:01Ex-RAF officer Jason has come into A&E with chest pains
0:26:01 > 0:26:05- and a low heart rate. - Take a big breath in for me now.
0:26:06 > 0:26:08Hold it there. And breathe away normally.
0:26:10 > 0:26:12Yeah, I see you've got metalwork in there as well.
0:26:12 > 0:26:15- Did you break your collarbone? - Erm, yeah, in May.
0:26:18 > 0:26:19Great, well, that's us all done.
0:26:19 > 0:26:22You can take a seat back in your chair there.
0:26:23 > 0:26:25Normally fit and healthy,
0:26:25 > 0:26:28Jason has been struggling with a chest infection.
0:26:28 > 0:26:31While visiting family on Unst with his wife and children,
0:26:31 > 0:26:32his condition deteriorated.
0:26:32 > 0:26:34Hi, Dad.
0:26:35 > 0:26:39- Bye, Dad.- Bye. See you later. - See you later.
0:26:39 > 0:26:41Why are you here?
0:26:45 > 0:26:49- Causing trouble!- Jason is already on antibiotics for the chest infection,
0:26:49 > 0:26:52and there are some worrying signs for Doctor Kirsty Sneddon.
0:26:52 > 0:26:55So, tell me the story as you know it.
0:26:55 > 0:26:57You said you were feeling...
0:26:57 > 0:26:59- I fall asleep an awful lot. - So you're tired?
0:26:59 > 0:27:03Yeah, all the time, yeah. I just constantly fall asleep.
0:27:03 > 0:27:05What is terrible? What were you feeling?
0:27:05 > 0:27:08Just, I want to sit down, I want to lie down.
0:27:08 > 0:27:10My chest is really tight, really sore.
0:27:10 > 0:27:13It's about the size of my fist, I guess, just there,
0:27:13 > 0:27:15and that's where... it's just really tight.
0:27:15 > 0:27:17I can't get a full breath in.
0:27:17 > 0:27:19Where exactly is the pain?
0:27:19 > 0:27:21There. Right there.
0:27:21 > 0:27:23Right there. And anything make it better?
0:27:24 > 0:27:26No. Sleep.
0:27:26 > 0:27:28Just, if I go to sleep, I don't feel it.
0:27:31 > 0:27:35Jason's heart rate is low, but as he is quite fit and healthy,
0:27:35 > 0:27:39Doctor Sneddon's priority is to check his troublesome chest.
0:27:39 > 0:27:44So, this patient has had about two weeks of chest infection
0:27:44 > 0:27:49signs and symptoms. He had been investigated with it.
0:27:50 > 0:27:53Your observations are looking OK.
0:27:53 > 0:27:59I mean, I know that your heart runs slightly slower than everyone else,
0:27:59 > 0:28:02being someone that is fairly fit and running around.
0:28:05 > 0:28:06I'm just going to examine you now, OK?
0:28:06 > 0:28:09- OK.- That hurts when I'm doing that?
0:28:09 > 0:28:12- Does it hurt...?- I think it's because you're pushing that...
0:28:12 > 0:28:14- That way?- That goes against there, yeah.
0:28:24 > 0:28:25The pain...
0:28:28 > 0:28:33It doesn't quite seem muscle that's causing that pain.
0:28:33 > 0:28:36It would hurt as I'm pushing in the muscle, so I think we do need
0:28:36 > 0:28:39to keep you in to investigate a bit further
0:28:39 > 0:28:41as to what's causing this discomfort.
0:28:43 > 0:28:47Though, looking at the scan, I can't see anything particularly worrying,
0:28:47 > 0:28:50there is still evidence of the effusion,
0:28:50 > 0:28:53so I'm going to call the consultant for a second opinion.
0:29:06 > 0:29:10It's quite normal for the nurses and doctors at the Gilbert Bain's A&E
0:29:10 > 0:29:12to regularly see the same patients.
0:29:14 > 0:29:16So, working in Shetland's really different
0:29:16 > 0:29:19because you can treat someone here,
0:29:19 > 0:29:21or treat their mum and dad,
0:29:21 > 0:29:23and then, after you shift,
0:29:23 > 0:29:25go down to Tesco and you bump into them.
0:29:25 > 0:29:28So, it's the community aspect here that's massively different.
0:29:28 > 0:29:32So, I'm used to working in Glasgow, which is an enormous hospital.
0:29:32 > 0:29:35You know, you treat your patient, you probably never see them again
0:29:35 > 0:29:39for the four or five months that you're there. You treat your patient here, you know,
0:29:39 > 0:29:42you might see them three more times and get to know them pretty well.
0:29:42 > 0:29:45So, there's that aspect.
0:29:48 > 0:29:50Hi, how's it going?
0:29:50 > 0:29:53Hi, Paula. Hello, how are you feeling?
0:29:53 > 0:29:56Paula has travelled in from Scalloway,
0:29:56 > 0:29:58six miles west of Lerwick.
0:29:58 > 0:30:00She's recently been in and out of hospital
0:30:00 > 0:30:04with ongoing health concerns complicated by her diabetes.
0:30:04 > 0:30:07A familiar face, nurse Hannah Coutts is first to assess her.
0:30:07 > 0:30:10What's been going on, Paula, can you tell me?
0:30:10 > 0:30:15This past week, beginning of last week....
0:30:15 > 0:30:17Phoned up to get a GP appointment...
0:30:18 > 0:30:20..told them I was not feeling right.
0:30:20 > 0:30:24And my blood sugars were starting to go up,
0:30:24 > 0:30:28and I couldn't get them to come down to a reasonable level.
0:30:28 > 0:30:32- OK.- And then this pain...
0:30:32 > 0:30:34When did this pain begin?
0:30:34 > 0:30:37- Two days ago.- Two days ago, OK.
0:30:38 > 0:30:41And it's your upper right abdomen?
0:30:41 > 0:30:43- Right here.- OK.
0:30:43 > 0:30:47Paula is a frequent visitor to the Gilbert Bain.
0:30:47 > 0:30:50One of the first things nurse Hannah decides is that she'd like to take
0:30:50 > 0:30:52some blood for testing.
0:30:52 > 0:30:54We'll try and do that, and we'll need to get some access.
0:30:54 > 0:30:57I'll see if the doctor is wanting a cannula.
0:30:57 > 0:30:59Sometimes when a patient has had bloods taken regularly,
0:30:59 > 0:31:03it becomes harder for the nurses to find a good vein.
0:31:03 > 0:31:08But as a veteran in giving blood, Paula knows where best to take it.
0:31:08 > 0:31:10I'll tell you the best spot.
0:31:11 > 0:31:13It's usually about here.
0:31:13 > 0:31:14Right.
0:31:16 > 0:31:18I can't feel much.
0:31:21 > 0:31:23Nurse Amanda Brown is drafted in to have a go.
0:31:25 > 0:31:28I think it's more successful, well, I find it more...
0:31:28 > 0:31:30It's better if you can feel them bouncing.
0:31:30 > 0:31:32The aim is to take...
0:31:32 > 0:31:33Yeah, it's to take bloods off,
0:31:33 > 0:31:39but leave the cannula in so that we can have access to give Paula some
0:31:39 > 0:31:42IV antibiotics.
0:31:42 > 0:31:44No luck for Paula or Nurse Amanda.
0:31:44 > 0:31:48So it's time to see if technology can help, with a vein finder.
0:31:48 > 0:31:52Thread veins... I dinnae ken how it does with the deep ones.
0:31:54 > 0:31:55I've never seen this before.
0:31:57 > 0:32:00It's going to have to be left to Dr Cameron.
0:32:00 > 0:32:05I did kind of cross my fingers, but...
0:32:07 > 0:32:09No joy for Nurse Amanda,
0:32:09 > 0:32:13so she's had to call on the medical doctor on shift, Dr Innis,
0:32:13 > 0:32:14to take the bloods.
0:32:16 > 0:32:18Well, we gave it a good shot.
0:32:18 > 0:32:2230 minutes later, bloods are finally taken, and the cannula
0:32:22 > 0:32:23is in Paula's arm.
0:32:23 > 0:32:26Now, Dr Innis must check the all-important paperwork.
0:32:26 > 0:32:29The sheets of the medications that I took earlier,
0:32:29 > 0:32:31I've only got two and three pages...
0:32:31 > 0:32:32Like, page two and page three.
0:32:32 > 0:32:37- Page one is...- If you turn page two over, you'll see page one.
0:32:38 > 0:32:40Sorry.
0:32:41 > 0:32:44That makes sense, I suppose.
0:32:44 > 0:32:47If you turn page two over...
0:32:47 > 0:32:50I'm just a typical man, really, I don't look under things.
0:32:50 > 0:32:51Oh, God!
0:32:54 > 0:32:57For Paula, it means intravenous antibiotics
0:32:57 > 0:32:58are finally administered,
0:32:58 > 0:33:01and for Nurse Amanda, it's good progress.
0:33:01 > 0:33:06I'm going to get a cup of tea and then do some paperwork for Paula.
0:33:06 > 0:33:09The consultant will see her tomorrow on the ward round.
0:33:11 > 0:33:14Erm, she's just not feeling able to go home,
0:33:14 > 0:33:16and it's right that we keep her,
0:33:16 > 0:33:19and she might need an ultrasound scan on Monday,
0:33:19 > 0:33:24and wait for blood results and things.
0:33:35 > 0:33:37Clinical staff on Shetland often
0:33:37 > 0:33:39travel to see patients in their homes.
0:33:40 > 0:33:42The midwifery team are no different,
0:33:42 > 0:33:45travelling to see new mums and babies
0:33:45 > 0:33:47on any of the 15 inhabited islands.
0:33:47 > 0:33:49On the outskirts of Lerwick,
0:33:49 > 0:33:52midwife Hannah McCluskey is heading to see daughter
0:33:52 > 0:33:56and newborn granddaughter of maternity receptionist Marie.
0:33:56 > 0:33:58This is her third baby.
0:33:58 > 0:34:02And she just went home yesterday afternoon.
0:34:02 > 0:34:06And she's got a baby girl.
0:34:06 > 0:34:08And she's doing really, really well.
0:34:08 > 0:34:11I spoke to them earlier on this morning.
0:34:11 > 0:34:13And I think they've had a sleepless night.
0:34:14 > 0:34:16Sonja lives in Weisdale with husband David
0:34:16 > 0:34:18and daughters Chloe and Ailidh.
0:34:21 > 0:34:25Three days ago, Sonja gave birth to her third child, baby girl Carina.
0:34:25 > 0:34:26Hello, how are you?
0:34:27 > 0:34:29Not bad.
0:34:29 > 0:34:32Midwife Hannah's here to check the health of baby and Mum.
0:34:32 > 0:34:35OK, so it's day three today.
0:34:35 > 0:34:37So, on Monday it will be...
0:34:39 > 0:34:43..a visit for a blood spot test, and weight, to see how she's doing.
0:34:43 > 0:34:48- OK.- It was so nice that your mum was there the day you were...
0:34:48 > 0:34:53- Was it good to have her about?- Yeah.
0:34:53 > 0:34:55I think she was a little bit worried at first,
0:34:55 > 0:34:58on Wednesday, having contractions.
0:34:58 > 0:35:00Because I came in in a wheelchair.
0:35:00 > 0:35:04Because there was no way I was going to be able to walk up the stairs.
0:35:05 > 0:35:08And I was crying, I was just so relieved to get to the hospital.
0:35:10 > 0:35:11That gave her a bit of a shock.
0:35:11 > 0:35:14But she was fine once she came and spoke to me.
0:35:18 > 0:35:20She's such a brilliant feeder.
0:35:21 > 0:35:23She's doing really good.
0:35:23 > 0:35:26When she started feeding just now, I felt fine.
0:35:26 > 0:35:30That's good. There's no point in persevering with a sore latch,
0:35:30 > 0:35:32and it'll hurt you in the long run.
0:35:32 > 0:35:37Try and count down from ten and if it's still sore after that,
0:35:37 > 0:35:39- take her off, try again. - OK.
0:35:39 > 0:35:42Did you feed with the other two?
0:35:42 > 0:35:44I fed them both for two weeks.
0:35:44 > 0:35:47- I'm going to try a lot longer.- Yes.
0:35:47 > 0:35:49And if you need any support or anything like that,
0:35:49 > 0:35:52you can phone the hospital switchboards -
0:35:52 > 0:35:55every night between five and nine,
0:35:55 > 0:35:57there is a breast-feeding supporter.
0:35:57 > 0:36:00- OK.- It's not one of us, it's one of the mums out in the community.
0:36:00 > 0:36:05They can phone you or they will come and visit you if you need anything.
0:36:05 > 0:36:08Nice to have a chat, cup of tea.
0:36:08 > 0:36:12- Yeah, OK.- As well as making sure Mum is coping,
0:36:12 > 0:36:16midwife Hannah also monitors baby Carina's health and development...
0:36:16 > 0:36:17Am I disturbing you?
0:36:20 > 0:36:22..and how well Sonja's recuperating after the birth.
0:36:27 > 0:36:28Blood pressure's fine.
0:36:31 > 0:36:33I've got warm hands for once in my life.
0:36:34 > 0:36:38Perfect. So, uterus is down here now, so it's good.
0:36:38 > 0:36:40It's funny how it just goes.
0:36:40 > 0:36:43When you've got a baby in there, it's all the way up here.
0:36:43 > 0:36:46And now it's all the way back down there.
0:36:46 > 0:36:49So, everything's going back down to normal, which is good.
0:36:49 > 0:36:52I'm trying to get her to move her hand.
0:36:52 > 0:36:54Does she like your glasses?
0:36:57 > 0:37:00See you Monday. I think I'm on Wednesday and Friday community
0:37:00 > 0:37:02as well, so I might see you then.
0:37:02 > 0:37:06- But if you need anything, just give a shout.- OK.- See you later!
0:37:07 > 0:37:08Bye!
0:37:10 > 0:37:12With midwife Hannah content that Sonja and baby Karina
0:37:12 > 0:37:15are well on their way to a good start in life,
0:37:15 > 0:37:17Hannah can move on to her next appointment.
0:37:28 > 0:37:31Doctor Sneddon is trying to get to the bottom
0:37:31 > 0:37:34of a painful chest problem for ex-RAF officer Jason.
0:37:34 > 0:37:39She's called on consultant Dr Ahmed to double check on his condition.
0:37:39 > 0:37:42So, his resting heart rate is between 40 and 50 anyway.
0:37:45 > 0:37:48There's slight dullness to percussion of the left lower zone
0:37:48 > 0:37:50but breath sounds are normal throughout,
0:37:50 > 0:37:53no added sounds are leaving.
0:37:53 > 0:37:56Let's examine him, please. Then we'll take it from there.
0:37:56 > 0:37:58He is in Resus.
0:37:58 > 0:38:00Doctor Ahmed first checks Jason's heart...
0:38:04 > 0:38:08- So far, sounds normal.- ..and listens for crackling in his chest.
0:38:08 > 0:38:09No.
0:38:11 > 0:38:12Deep breath.
0:38:14 > 0:38:16So far, it's...
0:38:16 > 0:38:19Diminished breath out...
0:38:19 > 0:38:20Nothing much in terms of crackling.
0:38:22 > 0:38:23No precardial rub.
0:38:25 > 0:38:27- You can...- That's all right, thank you.
0:38:29 > 0:38:33I think it's just a lingering chest infection.
0:38:33 > 0:38:36After that all-important second opinion,
0:38:36 > 0:38:39Doctor Sneddon is assured of her assessment of Jason's chest.
0:38:39 > 0:38:42From the investigations that we've done here,
0:38:42 > 0:38:46he looks to have just residual chest infection.
0:38:46 > 0:38:50There's nothing huge that we've found,
0:38:50 > 0:38:53so we're happy for him to go home with some painkillers.
0:38:53 > 0:38:55And proper bed rest.
0:38:55 > 0:38:58Getting a second look at a patient like this is all the more critical
0:38:58 > 0:39:00when they don't live on the island.
0:39:00 > 0:39:03So, this gentleman currently lives in Cyprus with his wife
0:39:03 > 0:39:06but is staying in Unst at the moment, on holiday.
0:39:06 > 0:39:08Unst is quite far away.
0:39:08 > 0:39:11Two ferries and about an hour's worth of driving
0:39:11 > 0:39:15so we had to make sure he was stable before we sent him home.
0:39:15 > 0:39:17What we would say is rest properly.
0:39:19 > 0:39:21- No running.- Oh, no, no.
0:39:21 > 0:39:26No lifting. You know, just a couple of days of good rest.
0:39:26 > 0:39:28- Yeah, OK.- OK.
0:39:28 > 0:39:30If it's muscular, it'll settle down.
0:39:33 > 0:39:34If it's the infection,
0:39:34 > 0:39:37it's maybe just going to take you a bit of time to get over it.
0:39:37 > 0:39:38OK, good.
0:39:39 > 0:39:43Under strict instructions for plenty of rest and relaxation,
0:39:43 > 0:39:46Jason can be discharged and rejoin his family on Unst.
0:39:47 > 0:39:49I'm fighting it.
0:39:49 > 0:39:51And the antibiotics are all OK.
0:39:53 > 0:39:57Just to keep taking them and just some few days of rest.
0:40:00 > 0:40:03As much as I can, with three young children.
0:40:11 > 0:40:14Before Doctor Bulger can jump back on the ferry to Yell,
0:40:14 > 0:40:15he has one last patient to see.
0:40:17 > 0:40:20He needs to travel a couple of miles down the road to make a house call
0:40:20 > 0:40:23on a woman with breathing difficulties.
0:40:23 > 0:40:26She's going for heart surgery in Aberdeen in a week's time,
0:40:26 > 0:40:30but Doctor Bulger wants to check her condition hasn't worsened.
0:40:31 > 0:40:33You're pretty fed up with your breathlessness.
0:40:35 > 0:40:37And you haven't found it much better since going...
0:40:37 > 0:40:39It's very debilitating.
0:40:39 > 0:40:41I can't do what I want to do.
0:40:43 > 0:40:46It's just breathlessness, breathlessness, breathlessness?
0:40:46 > 0:40:48Yeah. That's the biggest problem.
0:40:48 > 0:40:50Why's one side of the heart swollen?
0:40:52 > 0:40:54Because the water...
0:40:54 > 0:40:56The blood can't get past.
0:40:56 > 0:40:58The blood is flushing back. You've got...
0:40:58 > 0:41:02- Regurgitation.- ..regurgitation, and it just comes back in.
0:41:02 > 0:41:04So, your heart is empty, probably,
0:41:04 > 0:41:06because it just flushes back all the time.
0:41:06 > 0:41:08And that's giving you back pressure on the lungs
0:41:08 > 0:41:12and when you've got that pressure on the lungs, you get breathless.
0:41:12 > 0:41:15It's actually a physical restriction of the lung which you can feel.
0:41:15 > 0:41:20- Very much.- And you've got a spectacular house here,
0:41:20 > 0:41:24all spoilt by this health of yours.
0:41:24 > 0:41:25Yeah.
0:41:25 > 0:41:28Lots of things to do, I'm not able to do it.
0:41:28 > 0:41:31By the way, you don't have any sheep out there?
0:41:31 > 0:41:32No.
0:41:32 > 0:41:34That's a start! Right, OK.
0:41:36 > 0:41:37Hopefully, I'll be back.
0:41:37 > 0:41:39I'm here another week down at the other...
0:41:39 > 0:41:41So I'll know all about you.
0:41:41 > 0:41:42But what you should have here
0:41:42 > 0:41:45is a proper, permanent doctor you can have a relationship with.
0:41:45 > 0:41:49- Right, were going to go now. - Linda, I'm going to pop up later.
0:41:49 > 0:41:50Right, no trouble.
0:41:51 > 0:41:53With his scheduled visit complete,
0:41:53 > 0:41:56Doctor Bulger heads back to the mainland on the ferry.
0:41:58 > 0:42:00Well, that was an interesting little clinic.
0:42:00 > 0:42:03It's not that extra risky living out here, you know.
0:42:03 > 0:42:06It may be better for their health in many ways.
0:42:06 > 0:42:08Clean air.
0:42:08 > 0:42:11You have to think about the ways to manage patients
0:42:11 > 0:42:17in this remote location which is slightly more pragmatic, I think.
0:42:17 > 0:42:19I think they've gotten used to the fact that they are seeing
0:42:19 > 0:42:22a different doctor each time which, in some ways,
0:42:22 > 0:42:24is helpful because it puts them in charge of their own health,
0:42:24 > 0:42:26which us doctors always want to try and do.
0:42:26 > 0:42:29You know, they're the ones that need to know about themselves
0:42:29 > 0:42:31because they are presenting themselves
0:42:31 > 0:42:34to a different doctor every time. But it's not good.
0:42:34 > 0:42:37So, it's such a shame they can't find doctors
0:42:37 > 0:42:40that want to do this work permanently.
0:42:40 > 0:42:44A young family here, the school's apparently the top of the league.
0:42:45 > 0:42:48You could do your own Grand Design house here.
0:42:48 > 0:42:51Easily. I think it's...
0:42:51 > 0:42:54I think it would be absolutely great but, you know,
0:42:54 > 0:42:58that would give such stability to management of the patients.
0:43:01 > 0:43:07Doctor Bulger arrived just in time to catch his ferry back to Yell.
0:43:07 > 0:43:09He'll be back in a week's time to take care of Fetlar's residents.
0:43:18 > 0:43:20After spending a week on the ward,
0:43:20 > 0:43:22Paula went home to Scalloway to recuperate.
0:43:23 > 0:43:25Anne's nasty head wound healed nicely
0:43:25 > 0:43:28and she finally got the kitchen she always wanted.
0:43:30 > 0:43:32And, after working for two weeks on Shetland,
0:43:32 > 0:43:35Doctor Bulger is planning to return in the near future.