Episode 9 Island Medics

Shetland - the most remote part of the UK.

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

And nearer Norway than you are to Edinburgh.

There are more puffins than people.

And more seals than supermarkets.

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

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

A&E, can I help you?

..from helicopter rescues and spinal injuries...

We're all here to make sure that you're OK.

..to serious medical mysteries...

Can we get assistance in, please?

Something's not right.

..Shetland's island medics have to be ready

for anything and everything.

-What happened?

-Got in a fight with a seagull.

-I suppose, sheep shears, was it?

-Yeah.

It means the tight-knit team of medics,

volunteers and emergency services have a special bond...

This might tickle, then!

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

Wee treat for night shift.

..so they're always ready for any island emergency.

Today, there's an extra special arrival

-for maternity receptionist Marie Jamieson...

-Oh!

Not gonna cry.

..nurse Gwen Angus attends to a lady with a nasty head injury...

It's quite a flap.

..And the Fetlar islanders receive a visit from a new locum GP.

-We've got to fix you.

-Yes.

Alongside the fishing, farming and oil industries,

the emergency and medical services are one of the biggest employers

-on Shetland...

-Deep breath.

..providing jobs for over 500 of the island's residents.

Living and serving in such a tight-knit community means

there's a special closeness,

unlike anywhere else in the UK.

Oh, my darling!

Staff of the Gilbert Bain Hospital

often end up treating relatives or people they know.

Every year on Shetland, around 250 babies are born into the world.

The maternity team are continually working together to help deliver

infants for both new and experienced parents.

And being such a small community means patients and staff

get to know each other rather well.

None more so than maternity receptionist Marie.

OK, that's...

There's a rather special familiar face on the ward today.

Her daughter Sonja is expecting

her third child and has been admitted to the labour ward.

Well, my daughter has come in in labour today,

so it is kind of exciting.

She's a few days' overdue.

But she was late with both her other bairns,

so we presumed she'd be later with this one.

I wasn't expecting the baby to come till the weekend.

So, it's kind of a strange feeling.

Dinnae ken whether to be here or go home.

Senior midwife Emma Courtier needs

to double check everything is prepared for the delivery

in the birthing pool.

Make sure that the pool's warm enough.

So I'll pop a bit more...

..water in it.

It helps relax the ladies.

It helps more with their mobility and positioning.

So, in the water, the water allows...

..easier for the weight-bearing so that they're not having...

On the bed, sometimes it's more difficult

to get into different positions.

Whilst the pool, it's warm water,

so kind of helps with the releasing of the endorphins.

And it's just good at relaxing the women.

So...

We find it's very popular here.

A lot of our ladies choose to use the pool at some stage

-during the labour.

-But, still on shift,

Sonja's mum Marie has to wait it out like everyone else.

I'm not a midwife, so I'm not in the know with what's happening.

And because of patient confidentiality,

the midwives can't actually tell me how she's doing.

Which is quite...

You dinnae ken...

I'm not sure whether to go home now or go home in five hours' time.

Or what the best thing is to do.

But they've all got smiley faces, so I think something's happening soon.

So what we're going to do is we're just going to walk from here

just across the labour room and we'll take you into the pool.

OK?

As this is Sonja's third pregnancy,

midwife Emma expects it to be a smooth and quick labour.

As Sonja's contractions have increased,

it's time to move through to the birthing pool

and to get as comfortable as possible for the birth.

There we are.

I did pop in to see her before she went into the labour ward

to give her a big hug. And just to say that...

..she can do it.

So I'll just leave Roseanne to get her actually into the pool.

She's doing really well so hopefully it'll not be long

and we'll have a little baby.

I've every faith in the staff here, as well.

So...I'm quite calm, considering.

On reception, Marie is hoping it won't be too long a wait.

In the meantime, she'll have to keep herself busy.

Despite Shetland's rugged coastline,

diverse wildlife and incredible people,

the islands have struggled to attract GPs

to some of its more remote posts.

Island beauty alone hasn't been enough to keep staff

in the furthest parts of Shetland.

One temporary solution has been to employ locum doctors to work in

far-flung surgeries and clinics.

Remote islands like Fair Isle, Unst, Foula and Fetlar

are ALL employing locum doctors and nurses to fill empty posts.

It's expensive, but vital for the rural communities.

It's 6.15 in the morning on the island of Yell.

And Dr Gerard Bulger has a ferry to catch.

Well, we're going round to the ferry terminal,

on to Fetlar, which is a small island.

I think it's a population of about 50 on there.

And there's a clinic every fortnight.

So... It's the first time for me to do it.

So, it's adventure for both of us.

Posted to Yell Health Centre one week ago,

Dr Bulger sees patients from Yell and Fetlar.

Being a locum doctor, it's his first visit to Shetland,

and a long way from his clinical roots in London.

Doctors that are here, anything about on-call nowadays,

they get terrified. Partly because I think what on-call they do,

they do from these very large centres,

where they might be looking after a population of, you know,

10, 20, 30, 40, 50 thousand. And there is pandemonium.

One of the reasons out-of-hours is pandemonium is because GPs...

Patients can't get to see the GP easily during the day.

Here, people are seen the same day.

Having worked in practices as diverse as Antarctica

and the Falkland Islands,

the problems that arise in a remote island community aren't

unfamiliar to Dr Bulger.

We've got an excellent nurse over there, full-time, called Becky.

We use the same clinical system,

so, messaging each other about patients.

I sent a patient in remotely the other day,

and I want to see how she's doing.

It's a three-hour round-trip to get on and off the island for Dr Bulger,

with his surgery starting nice and early at 8am.

Although it's Shetland,

so there's no guarantee it will all be plain sailing.

Want the right lane. Well, I'm booked.

And it's Fetlar.

Er, Fetlar, three and four, there we are, we've done it.

Navigating unfamiliar ferry lines comes with the territory.

But Dr Bulger's well aware of how crucial his expertise may be.

I mean, the car here is kitted out with full...

..advanced life support,

and defibs and everything,

because, you know, this is possible.

We're remote and we need to look after a patient

until help can get to us, which may be some hours.

And on a day like this, I think it would be very problematic,

even to fly someone out.

So, here we are. I think this is our boat coming in.

It's rather sweet, isn't it?

Hello.

I need a bit of paper, apparently.

I've no receipts, I'm afraid,

but I can give you a ticket.

Brilliant.

Pleasantly surprised how warm it is.

Even though it must look very bleak, it's actually quite warm.

And I understand it never gets quite that terribly cold here.

So, you know, it is an adventure.

It's an astonishing place.

And I can't understand why they can't find a GP

to do it full-time because it's just...

..a unique set of experiences.

A unique little practice.

GPs and nurses travel to Shetland's remote island communities,

but if any of the inhabitants require hospital care,

there's only one place to go -

the Gilbert Bain in Lerwick, on mainland Shetland.

William has travelled to A&E from the island of Burra,

to the south-west of Lerwick.

I was pulling up plasterboard.

Got a big splinter off it.

Bit of wood. I tried to cut it out but it just...

..snapped off.

It might appear trivial, but sometimes the smallest of injuries

are worthy of a trip to A&E.

Something senior A&E and surgical Dr Kushik Lalla is only too aware of.

The problem is, this guy got some

splinters into his finger and the finger began to swell.

And you've got little tendon sheets within your fingers,

tendon sheets are potential spaces.

So, their function is to lubricate the area and allow the tendon

to slide nice and easily within them.

But if you get an infection into the tendon sheet,

then it spreads very rapidly.

The tendon sheet is just a space,

so as soon as the infection gets into that space,

it just spreads very rapidly down it

and then it spreads into the entire hand and can spread up

the other fingers, as well.

You end up with a very bad hand infection

which you could end up losing your hand for.

Following the examination,

Dr Caitlin Brennan is going to prep him for surgery,

to make sure any remains of the splinter is removed.

So, what we'll do, we'll just put in some anaesthetic

either side of the finger. And it will feel a bit weird,

because you'll see us cutting and pulling, but you won't feel it.

So, essentially, in the finger,

you got digital nerves that run either side of the finger,

and if you anaesthetise those nerves,

it means that from there downwards is anaesthetised,

so it's a good block, because it means you can put in a small amount

of anaesthetic and numb a larger area,

whereas if you put in a local anaesthetic around the tissues,

you just anaesthetise the tissues.

It's good for fish hooks as well, which is a common presentation.

Dr Brennan is a junior doctor,

so she'll carry out the procedure supervised by Dr Lalla.

Right. OK, you're not allergic to anything, you said?

OK. What I'm going to do is just tie this round the base of your finger.

In nice, big hospitals, you have these lovely tourniquets.

Over here, we have to make our own.

OK.

The makeshift tourniquet suppresses the blood supply and keeps

the anaesthetic where the doctors want it.

You'll still feel pressure,

but there should be nothing sharp, no pain.

No? OK. That's good.

I would go more distal.

No, no. Distal. Yeah, yeah. From about there.

Just open it up. If you're finding anything sore, let us know.

Yeah? Carry on, carry on, carry on.

Use your swab now, and just using your swab,

squeeze any excess blood out.

Once you get rid of the excess blood,

then you get a nice bloodless field,

and then you can actually see what you're doing after that.

Is that a splinter fragment over there that we see?

No, I think that's a vein.

Yeah. Use your mosquito now.

And just get into the wound, and just try and open that up.

The finger's infected.

There is a query as to whether there is a foreign body.

So, whether he's got a piece of wood that's sitting in there...

..and that's what's resulted in the finger becoming swollen like this.

Doctor Brennan checks carefully for any foreign debris in William's infected finger...

..but can find nothing.

So, what we should do, then, is just leave the wound open.

-Yeah.

-Get the nurses to dress that.

And then you're going to stay in with us.

You need some antibiotics for just a couple...

..probably one or two days until we can get that under control

and then take it from there. All right?

We're going to leave that wound open,

because if there is a small bit of wood or something like that in it,

your body will just get rid of it and push it out.

OK, if we try and close that wound, it will all get stuck in again.

If things don't settle, William,

then we might take you to theatre and open this up again in theatre

on the other side as well.

OK?

Finger injuries can go from looking very trivial to very bad

very quickly,

and if you're not careful, it involves the entire palm,

and then you've really got problems.

So, we'll get him up to the ward just shortly.

With no debris found, and the wound needing to be left open,

William will enjoy the hospitality of the Gilbert Bain

for another couple of days.

In the UK, the most common place for accidents to happen is at home,

so while island life can produce unusual injuries,

there are plenty of domestic bumps and bruises too.

In A&E, 57-year-old Anne has travelled from Sandwick,

around 12 miles south of the Gilbert Bain, with a head injury.

Anne, are you wanting to come through and we'll get your details?

She's accompanied by her husband, Pete,

who's determined to stay by her side.

Are you coming in as well?

-Aye, yep.

-First to assess Anne is nurse Gwen Angus.

Now, I'm Gwen, one of the nurses here.

So, do you want to tell me what's happened?

I tripped up this morning in the kitchen.

I don't know what I'd tripped on,

but we're having a new kitchen fitted,

and there's four dogs there, so I could have tripped over a dog,

or just the fact there's stuff around, and I hit my head.

Originally from Essex, Anne's lived in Shetland for 29 years,

and has been referred to A&E by her GP,

who suspects she may need stitches.

I think it has stopped bleeding now.

But they just bandaged me up to make me look good.

Nurse Gwen must decide whether Anne needs to be sewn up.

But it's not going down well.

-OK...

-Oooh, even I saw that.

I'm not going to tell you.

I think we're definitely going to be needing some stitches.

Our doctor's busy just now, but we'll get her in,

and we'll need to patch you back up again.

Can you hit me on the back of the head and knock me out so I don't

feel the stitches? Yeah, I'm just more worried about the stitches.

Have you ever had stitches before?

I cracked my head open a few years ago and they glued it,

and I think that was pretty sore,

-so the stitches are maybe not any worse.

-OK.

Erm, it is quite... It is quite a flap,

and it's going down to the skull,

so she's had quite a knock,

so it is certainly going to be needing put together.

I'll get the doctor to come and have a look.

Who would have thought fitting a new kitchen would be so painful?

And it's up to Doctor Ashley Thomson to break some more bad news.

Anne, you're going to be left with a scar from this, unfortunately.

-That's all right. I'm not worried about that.

-We'll get it

as best we can together. Is it a new kitchen you're having done?

-Yeah. And I've waited 24 years. I wish I'd kept waiting.

-Bless you.

Aware Anne is nervous about the stitches,

Doctor Thomson administers a local anaesthetic

to help numb the affected area.

Now, this is going to be the stingy bit, OK?

Well done. You're doing really well.

When you get wounds to the head,

because there's lots of blood vessels,

it's very vascular, so it bleeds a lot.

Yeah, I noticed that when the dogs were trying

to lick it up off the floor!

It means that it heals very quickly,

but it does mean that there is quite a lot of bleeding.

-Yeah.

-Despite the news that she'll be left with a scar,

Anne's Essex banter still shines through.

Right, let's see how we go with that.

Now, we're going to start in the middle,

-and then we'll bring the sides together nicely, OK?

-OK.

-Ready for me to start?

-How many do you think there will be?

-Hmm...

-30?

-Shut your face!

Difficult to say. It could easily be about 12.

Blimey.

Yeah, we definitely couldn't have glued this one together.

Can you do embroidery stitches while you're there?

Put a fancy pattern or something.

I think this is where my sewing skills come in use from school.

Oh, cool.

I'm glad you're not a carpenter.

It's dressed up now.

Satisfied that Anne has been thoroughly checked over,

and happy with her neat needlework,

Doctor Thomson concludes her appointment

with a very grateful patient.

-That OK?

-Thank you, Doctor...

-No bother at all, no bother.

I hope that's all fine and you have no problems.

-Thank you.

-OK?

Erm, it didn't hardly hurt at all.

I was really nervous about getting stitches and that, but it was fine,

so, I don't know what else to say, except for thanks to the doctors.

If you're noticing anything concerning

-that's out of the ordinary...

-If I start frothing...

-I don't normally do that.

-..then you can obviously take her back,

-or give us a phone.

-Oh, yeah, that goes without saying.

-OK?

And that's you. I hope your kitchen's looking beautiful

-by the time you get there.

-Yes, so do I. It better be after all this.

-Thank you so much.

-No problems.

-Okey dokey, thank you.

-Thank you.

-Bye.

-Right, bye.

Thank you, bye.

In the maternity ward, receptionist Marie is awaiting news

on the birth of her third grandchild.

With her daughter in labour for the last hour and 20 minutes,

it's been an anxious wait.

Shortly before two o'clock,

her son-in-law David appears from the delivery room.

-It's a girl.

-What?!

-Yeah.

-I thought it was going to be a boy!

-I know.

-Oh, congratulations.

Yeah.

Baby Carina, born at 1.25pm, has weighed in at just shy of 8lbs.

It's tough work being a baby.

Mum and baby are both doing fine.

I'm not going to cry.

And after finally getting to see her new granddaughter,

it's into full-time granny mode,

looking after Carina's big sisters, Chloe and Ailidh.

Was she big?

Tiny.

Are you excited to change her nappy?

No.

With Sonja and baby Carina both doing well,

it's not long before they're allowed to head home.

They'll now be cared for by a team of midwives

who provide postnatal care to the new mums across Shetland.

Doctor Bulger is at the final stage

of his journey from Yell to the Fetlar surgery.

It's taken him an hour and a half to make the 19-mile journey,

but the 60 islanders on Fetlar rely on the fortnightly clinic.

Well, the clinic apparently starts bang on eight o'clock,

so I'm already late.

That's why she was calling.

That's it. We're here.

Well, that's pretty good, isn't it?

Look at that. Look at the view out there.

-Hi, Becky.

-Working as a locum means Doctor Bulger will probably only see

a patient for one short surgery.

I assume it was you ringing me.

It might be a remote clinic,

but it's kitted out like any other on Shetland.

It's a proper clinic, GP room.

Lots of equipment, so we can do stuff locally.

And such an essential thing - the sticky label printer.

-It doesn't work!

-Oh, doesn't it?

-Not at the moment, no.

-Oh, right.

We're now logging in. It always takes a couple of minutes to log in.

And we're going to start this clinic,

because we need to get back on that ferry at 10 past 11,

so we haven't got long here.

That's it, we've worked. It's logged in.

Fetlar resident Rose has been keen to see Doctor Bulger,

and she has some island medical history of her own.

Hello, Rose. I understand you used to be the nurse here?

I did. Many years ago.

-Right.

-Yes.

-So, when did you stop that?

Early 2000s.

-So, born here?

-Hm?

-Born here, or just got stuck here?

-No, I was born in Australia.

Really? I've been working in Australia for seven years.

-Oh, really?

-I was in Cairns.

Oh. High up.

Rose has an ongoing gastric condition

that's been causing her discomfort,

and has been waiting for test results

that might identify the cause.

I saw the specialist about pain in the stomach.

I've had trouble with it for ages,

and I've been treated for it once already,

so I had to send three specimens off,

and I've heard nothing since then.

Was the hospital sending it, or were you sending it?

No, it was the hospital.

It's gone to the consultant and he didn't write to us.

-Let me check.

-The thing is,

I'm booked to go to Australia in two weeks' time.

So, we've got to fix you.

-Huh?

-We've got to fix you.

-Yes.

-Quickly.

With a holiday to Australia planned in only a couple of weeks' time,

Rose hopes Doctor Bulger finds a fix for her problem.

Duncan, isn't it?

When I had a gastroscopy, I had seen her before.

They saw helicobacter, and she gave me some medication.

-So, you took antibiotics. How long ago was that now?

-No, but I...

I couldn't, because after two days, I just couldn't take any more,

because I thought it was going to kill me.

So, in other words, your last treatment wasn't successful

-because it wasn't full?

-No.

-Right.

-Have you lost weight? It says a kilogram.

-Yes.

Rose's extreme reaction to the previous treatment means

Dr Bulger finds an alternative

that will hopefully have her fit enough to travel.

-Amoxicillin 500.

-Yeah. And she takes two of those twice a day.

Take these. Same idea, twice a day.

-Yes.

-Right?

-Yes.

-That's one, twice a day.

This one's two, twice a day.

I'm here for another week and a bit,

so I can always sort something out in the meantime.

And those... Oh, those are your omeprazole.

-Yes, there's some in there.

-Yeah, yeah.

-That's fine.

-Excellent.

-Thank you.

-No trouble.

Thousands of patients visit the Gilbert Bain every year,

and the X-ray department is a vital service for many of them.

Today is no different.

Chin up high there, for me.

Now, if you could put your hands on your hips

and roll your elbows forward. That's it.

Ex-RAF officer Jason has come into A&E with chest pains

-and a low heart rate.

-Take a big breath in for me now.

Hold it there. And breathe away normally.

Yeah, I see you've got metalwork in there as well.

-Did you break your collarbone?

-Erm, yeah, in May.

Great, well, that's us all done.

You can take a seat back in your chair there.

Normally fit and healthy,

Jason has been struggling with a chest infection.

While visiting family on Unst with his wife and children,

his condition deteriorated.

Hi, Dad.

-Bye, Dad.

-Bye. See you later.

-See you later.

Why are you here?

-Causing trouble!

-Jason is already on antibiotics for the chest infection,

and there are some worrying signs for Doctor Kirsty Sneddon.

So, tell me the story as you know it.

You said you were feeling...

-I fall asleep an awful lot.

-So you're tired?

Yeah, all the time, yeah. I just constantly fall asleep.

What is terrible? What were you feeling?

Just, I want to sit down, I want to lie down.

My chest is really tight, really sore.

It's about the size of my fist, I guess, just there,

and that's where... it's just really tight.

I can't get a full breath in.

Where exactly is the pain?

There. Right there.

Right there. And anything make it better?

No. Sleep.

Just, if I go to sleep, I don't feel it.

Jason's heart rate is low, but as he is quite fit and healthy,

Doctor Sneddon's priority is to check his troublesome chest.

So, this patient has had about two weeks of chest infection

signs and symptoms. He had been investigated with it.

Your observations are looking OK.

I mean, I know that your heart runs slightly slower than everyone else,

being someone that is fairly fit and running around.

I'm just going to examine you now, OK?

-OK.

-That hurts when I'm doing that?

-Does it hurt...?

-I think it's because you're pushing that...

-That way?

-That goes against there, yeah.

The pain...

It doesn't quite seem muscle that's causing that pain.

It would hurt as I'm pushing in the muscle, so I think we do need

to keep you in to investigate a bit further

as to what's causing this discomfort.

Though, looking at the scan, I can't see anything particularly worrying,

there is still evidence of the effusion,

so I'm going to call the consultant for a second opinion.

It's quite normal for the nurses and doctors at the Gilbert Bain's A&E

to regularly see the same patients.

So, working in Shetland's really different

because you can treat someone here,

or treat their mum and dad,

and then, after you shift,

go down to Tesco and you bump into them.

So, it's the community aspect here that's massively different.

So, I'm used to working in Glasgow, which is an enormous hospital.

You know, you treat your patient, you probably never see them again

for the four or five months that you're there. You treat your patient here, you know,

you might see them three more times and get to know them pretty well.

So, there's that aspect.

Hi, how's it going?

Hi, Paula. Hello, how are you feeling?

Paula has travelled in from Scalloway,

six miles west of Lerwick.

She's recently been in and out of hospital

with ongoing health concerns complicated by her diabetes.

A familiar face, nurse Hannah Coutts is first to assess her.

What's been going on, Paula, can you tell me?

This past week, beginning of last week....

Phoned up to get a GP appointment...

..told them I was not feeling right.

And my blood sugars were starting to go up,

and I couldn't get them to come down to a reasonable level.

-OK.

-And then this pain...

When did this pain begin?

-Two days ago.

-Two days ago, OK.

And it's your upper right abdomen?

-Right here.

-OK.

Paula is a frequent visitor to the Gilbert Bain.

One of the first things nurse Hannah decides is that she'd like to take

some blood for testing.

We'll try and do that, and we'll need to get some access.

I'll see if the doctor is wanting a cannula.

Sometimes when a patient has had bloods taken regularly,

it becomes harder for the nurses to find a good vein.

But as a veteran in giving blood, Paula knows where best to take it.

I'll tell you the best spot.

It's usually about here.

Right.

I can't feel much.

Nurse Amanda Brown is drafted in to have a go.

I think it's more successful, well, I find it more...

It's better if you can feel them bouncing.

The aim is to take...

Yeah, it's to take bloods off,

but leave the cannula in so that we can have access to give Paula some

IV antibiotics.

No luck for Paula or Nurse Amanda.

So it's time to see if technology can help, with a vein finder.

Thread veins... I dinnae ken how it does with the deep ones.

I've never seen this before.

It's going to have to be left to Dr Cameron.

I did kind of cross my fingers, but...

No joy for Nurse Amanda,

so she's had to call on the medical doctor on shift, Dr Innis,

to take the bloods.

Well, we gave it a good shot.

30 minutes later, bloods are finally taken, and the cannula

is in Paula's arm.

Now, Dr Innis must check the all-important paperwork.

The sheets of the medications that I took earlier,

I've only got two and three pages...

Like, page two and page three.

-Page one is...

-If you turn page two over, you'll see page one.

Sorry.

That makes sense, I suppose.

If you turn page two over...

I'm just a typical man, really, I don't look under things.

Oh, God!

For Paula, it means intravenous antibiotics

are finally administered,

and for Nurse Amanda, it's good progress.

I'm going to get a cup of tea and then do some paperwork for Paula.

The consultant will see her tomorrow on the ward round.

Erm, she's just not feeling able to go home,

and it's right that we keep her,

and she might need an ultrasound scan on Monday,

and wait for blood results and things.

Clinical staff on Shetland often

travel to see patients in their homes.

The midwifery team are no different,

travelling to see new mums and babies

on any of the 15 inhabited islands.

On the outskirts of Lerwick,

midwife Hannah McCluskey is heading to see daughter

and newborn granddaughter of maternity receptionist Marie.

This is her third baby.

And she just went home yesterday afternoon.

And she's got a baby girl.

And she's doing really, really well.

I spoke to them earlier on this morning.

And I think they've had a sleepless night.

Sonja lives in Weisdale with husband David

and daughters Chloe and Ailidh.

Three days ago, Sonja gave birth to her third child, baby girl Carina.

Hello, how are you?

Not bad.

Midwife Hannah's here to check the health of baby and Mum.

OK, so it's day three today.

So, on Monday it will be...

..a visit for a blood spot test, and weight, to see how she's doing.

-OK.

-It was so nice that your mum was there the day you were...

-Was it good to have her about?

-Yeah.

I think she was a little bit worried at first,

on Wednesday, having contractions.

Because I came in in a wheelchair.

Because there was no way I was going to be able to walk up the stairs.

And I was crying, I was just so relieved to get to the hospital.

That gave her a bit of a shock.

But she was fine once she came and spoke to me.

She's such a brilliant feeder.

She's doing really good.

When she started feeding just now, I felt fine.

That's good. There's no point in persevering with a sore latch,

and it'll hurt you in the long run.

Try and count down from ten and if it's still sore after that,

-take her off, try again.

-OK.

Did you feed with the other two?

I fed them both for two weeks.

-I'm going to try a lot longer.

-Yes.

And if you need any support or anything like that,

you can phone the hospital switchboards -

every night between five and nine,

there is a breast-feeding supporter.

-OK.

-It's not one of us, it's one of the mums out in the community.

They can phone you or they will come and visit you if you need anything.

Nice to have a chat, cup of tea.

-Yeah, OK.

-As well as making sure Mum is coping,

midwife Hannah also monitors baby Carina's health and development...

Am I disturbing you?

..and how well Sonja's recuperating after the birth.

Blood pressure's fine.

I've got warm hands for once in my life.

Perfect. So, uterus is down here now, so it's good.

It's funny how it just goes.

When you've got a baby in there, it's all the way up here.

And now it's all the way back down there.

So, everything's going back down to normal, which is good.

I'm trying to get her to move her hand.

Does she like your glasses?

See you Monday. I think I'm on Wednesday and Friday community

as well, so I might see you then.

-But if you need anything, just give a shout.

-OK.

-See you later!

Bye!

With midwife Hannah content that Sonja and baby Karina

are well on their way to a good start in life,

Hannah can move on to her next appointment.

Doctor Sneddon is trying to get to the bottom

of a painful chest problem for ex-RAF officer Jason.

She's called on consultant Dr Ahmed to double check on his condition.

So, his resting heart rate is between 40 and 50 anyway.

There's slight dullness to percussion of the left lower zone

but breath sounds are normal throughout,

no added sounds are leaving.

Let's examine him, please. Then we'll take it from there.

He is in Resus.

Doctor Ahmed first checks Jason's heart...

-So far, sounds normal.

-..and listens for crackling in his chest.

No.

Deep breath.

So far, it's...

Diminished breath out...

Nothing much in terms of crackling.

No precardial rub.

-You can...

-That's all right, thank you.

I think it's just a lingering chest infection.

After that all-important second opinion,

Doctor Sneddon is assured of her assessment of Jason's chest.

From the investigations that we've done here,

he looks to have just residual chest infection.

There's nothing huge that we've found,

so we're happy for him to go home with some painkillers.

And proper bed rest.

Getting a second look at a patient like this is all the more critical

when they don't live on the island.

So, this gentleman currently lives in Cyprus with his wife

but is staying in Unst at the moment, on holiday.

Unst is quite far away.

Two ferries and about an hour's worth of driving

so we had to make sure he was stable before we sent him home.

What we would say is rest properly.

-No running.

-Oh, no, no.

No lifting. You know, just a couple of days of good rest.

-Yeah, OK.

-OK.

If it's muscular, it'll settle down.

If it's the infection,

it's maybe just going to take you a bit of time to get over it.

OK, good.

Under strict instructions for plenty of rest and relaxation,

Jason can be discharged and rejoin his family on Unst.

I'm fighting it.

And the antibiotics are all OK.

Just to keep taking them and just some few days of rest.

As much as I can, with three young children.

Before Doctor Bulger can jump back on the ferry to Yell,

he has one last patient to see.

He needs to travel a couple of miles down the road to make a house call

on a woman with breathing difficulties.

She's going for heart surgery in Aberdeen in a week's time,

but Doctor Bulger wants to check her condition hasn't worsened.

You're pretty fed up with your breathlessness.

And you haven't found it much better since going...

It's very debilitating.

I can't do what I want to do.

It's just breathlessness, breathlessness, breathlessness?

Yeah. That's the biggest problem.

Why's one side of the heart swollen?

Because the water...

The blood can't get past.

The blood is flushing back. You've got...

-Regurgitation.

-..regurgitation, and it just comes back in.

So, your heart is empty, probably,

because it just flushes back all the time.

And that's giving you back pressure on the lungs

and when you've got that pressure on the lungs, you get breathless.

It's actually a physical restriction of the lung which you can feel.

-Very much.

-And you've got a spectacular house here,

all spoilt by this health of yours.

Yeah.

Lots of things to do, I'm not able to do it.

By the way, you don't have any sheep out there?

No.

That's a start! Right, OK.

Hopefully, I'll be back.

I'm here another week down at the other...

So I'll know all about you.

But what you should have here

is a proper, permanent doctor you can have a relationship with.

-Right, were going to go now.

-Linda, I'm going to pop up later.

Right, no trouble.

With his scheduled visit complete,

Doctor Bulger heads back to the mainland on the ferry.

Well, that was an interesting little clinic.

It's not that extra risky living out here, you know.

It may be better for their health in many ways.

Clean air.

You have to think about the ways to manage patients

in this remote location which is slightly more pragmatic, I think.

I think they've gotten used to the fact that they are seeing

a different doctor each time which, in some ways,

is helpful because it puts them in charge of their own health,

which us doctors always want to try and do.

You know, they're the ones that need to know about themselves

because they are presenting themselves

to a different doctor every time. But it's not good.

So, it's such a shame they can't find doctors

that want to do this work permanently.

A young family here, the school's apparently the top of the league.

You could do your own Grand Design house here.

Easily. I think it's...

I think it would be absolutely great but, you know,

that would give such stability to management of the patients.

Doctor Bulger arrived just in time to catch his ferry back to Yell.

He'll be back in a week's time to take care of Fetlar's residents.

After spending a week on the ward,

Paula went home to Scalloway to recuperate.

Anne's nasty head wound healed nicely

and she finally got the kitchen she always wanted.

And, after working for two weeks on Shetland,

Doctor Bulger is planning to return in the near future.