Episode 2 Hospital


Episode 2

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This programme contains strong language

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Just move yourselves over to the side for a minute.

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This winter, one of Britain's busiest NHS trusts

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opened its doors...

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We have to look after the patients,

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whether they come from Buck Palace or the park bench.

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..to show us what's really happening inside our hospitals.

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We've got lots of patients

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now competing for an unknown number of beds.

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Every week, more than 20,000 people are treated here...

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The pressure's just gone.

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What?! Has it completely gone?

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..and the numbers, as well as our expectations, are rising.

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We just had our worst ten days on record.

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There's nowhere in the hospital to move anybody.

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At some point somebody will be telling us

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whether we're allowed to do any work.

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This is a place with some of the best specialists in the world.

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Tumour's out, job done.

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Where lives are transformed.

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This is saving his life. It has to work.

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But they are operating at a time when the NHS

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has never been under more pressure.

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-Any beds?

-No.

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-No beds for anyone?

-No.

-OK.

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It does feel to me like the elastic's

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a bit nearer to breaking now than it ever was.

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Its very future under scrutiny.

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All right. I think we will go out on red because we're under

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real pressure in the Emergency Department.

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We're aware of the problems. Anybody got a solution?

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Following the patients from the moment they are admitted...

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Anything I've done up to this point means nothing compared to

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when you can literally give a bit of yourself to save someone else.

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..to the moment they leave.

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It is all good news. The cancer has gone.

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-You don't need any more treatment.

-Fantastic.

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Thank you so much.

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Week by week, we reveal the complex decisions the staff must make

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about who to care for next.

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That patient is coming to me to be operated on,

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and if I don't do it, then there's only one inevitable outcome.

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They're going to die.

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KEYPAD BEEPS

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'Say your name and then press hash.'

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BEEP

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St Mary's.

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St Mary's is the largest hospital in

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London's Imperial College Healthcare NHS Trust,

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where, every week, hundreds of life-saving operations

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are performed.

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Today, a team of expert surgeons is preparing for one

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of the most challenging operations they will carry out this year.

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The team is led by consultant vascular surgeon Colin Bicknell.

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Shall I load the scans up, then?

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It's taken two months to coordinate

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the diaries of the highly skilled surgical team.

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Just for this one operation, the people that we need -

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four consultant vascular surgeons, one cardiac surgeon,

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two expert perfusionists,

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three anaesthetists,

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one general surgeon and our expert nursing team.

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That's purely in that theatre.

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The patient is retired software engineer Peter Lai.

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-I really want to have it done now.

-I know. Well, so do I.

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Although I am frightened to death, but, at the same time,

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-I want you to have it done.

-Yeah.

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Otherwise they say you can have a rupture and drop dead in the street.

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That's right, yeah.

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Mr Lai, 60 years old, had a dissection,

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type B aortic dissection, 15 or 20 years ago,

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and he had a continued dilation of his false lumen.

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It has been amazing,

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the bringing together of all this expertise, just for Peter.

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And then, it was round about ten years ago,

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he got a carotid, carotid,

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carotid subclavian bypass,

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and a thoracic stent from the innominate down to the diaphragm.

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But he's continued to dilate.

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This will be his ninth operation.

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They're actually going to open his aneurysm up, they're going to take

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all the clotted blood that's accumulated there

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in all these years.

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It should really fix his aneurysm for good.

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So, we've got no choice and we said we would operate,

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and we've been through the risk lots and lots.

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Certain death if it ruptures, so we've got to do something.

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-Yeah, it's still very scary, isn't it?

-Well...

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Anyhow, you're...

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-That's good. I'm glad...

-You have to go through it. Hope for the best.

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-Yeah.

-We just need the luck.

-Yeah. That's right.

-Yeah.

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While Peter appears well, his scans tell a different story.

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This is the right lung, which is normal and healthy.

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This is the left lung,

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but it's filled up completely by this aneurysm.

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If it bursts, he'll lose a tremendous amount of blood

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in his chest quickly and he'll die.

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An aortic aneurysm is a ballooning of the main artery out of the heart.

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At 12cm, Peter's aneurysm is so large that St Mary's is

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one of the few places in the UK capable of repairing it.

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He's had multiple operations,

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and I've been involved in approximately half of them.

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He's lived with this condition for many years.

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He knows the dangers that are there.

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The only word for Mr Lai, in the face of this adversity, is calm.

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He's actually a remarkable human being.

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I'm not sure whether I, personally,

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would have taken all of this quite so well.

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I have no choice, basically.

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I just go along with whatever's required.

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I just want to get it over and done with.

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My wife is very worried,

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but I don't worry.

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I always believe there's nothing to worry

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until there's something to worry.

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Peter needs a bed on a ward ahead of his operation tomorrow,

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but currently the hospital is experiencing very high demand

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for its 301 adult beds.

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Empty beds wise, we have one bed at the moment on Grafton,

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a smattering of confirmed discharges, but nothing else.

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We've got a number of patients needing placement,

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and we're still awaiting a plan, yeah?

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Capacity wise, is this the worst you've ever seen?

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This is really bad.

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I mean, I'm sure it has been worse,

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but this is particularly bad.

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As soon as I get anything, I will give you a call.

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What is the latest you can wait?

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Well, all right.

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We'll see what we can do. All right. Bye, bye.

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Oh, my goodness.

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It's the responsibility of site director Lesley Powls and her team

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to allocate beds for patients.

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It's not going very well.

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I mean, we're sort of getting there,

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but for every bed we give,

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we've got three other patients waiting.

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Oh. Oh, thank you very much.

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-I've got the kettle on for your cup of tea, all right?

-OK, thank you.

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If that's not enough, let me know and I'll get you some more.

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-That's plenty, thank you.

-All right.

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-We're just trying to sort out a bed for you.

-OK.

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There might be a bit of a wait.

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We also need to take some more blood from you.

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-I'll wait until you've had your breakfast.

-OK.

-All right?

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-See you later.

-Thank you.

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I think everybody is acutely aware that this man

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needs his surgery tomorrow.

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If this was an ordinary case,

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I would say the chances of him having his surgery are very slim.

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Because his is a particularly big case that

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has required an awful lot of organisation

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to get all the various members of the operating team together,

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um...

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it could be that senior managers in the hospital

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manage to find him a bed somewhere.

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As well as a bed on a ward tonight,

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Peter will need a bed in Intensive Care tomorrow,

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because of the seriousness of his operation.

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Well, it is such an invasive procedure,

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it's massively traumatic.

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It's a long operation, a big area of dissection

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and then, of course,

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we may have to rewire all of the blood vessels in his body.

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Mr Lai?

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-Hello.

-Hello.

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Can I come and steal some blood from you?

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Yeah. Where shall we... Here?

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Yeah. If you wouldn't mind taking a seat.

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So, what's the situation now?

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We're hoping that one of our patients will be ready to go home

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later on today, and that would give us a bed for you.

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I am more concerned about the bed in ICU, because if that

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-is not available then the op can't go ahead.

-It's been requested.

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-Yeah.

-Whether it's available or not, I don't know. All right?

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-Hello.

-Hello.

-How are you?

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I'm all right.

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With the hospital full,

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patients can't be admitted until others are sent home.

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-Good morning, girls.

-Morning.

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How are you?

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OK, thank you.

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Yes. I just want to know, is there anybody here speaks Polish?

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-No.

-No.

-No?

-Sorry.

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Well, I don't either, you see.

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Proactive. "Brave" I think is sometimes the word we use.

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Asking the question, if someone can go home tomorrow,

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why can't they go home today?

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-Any of your team speak Polish?

-Polish?

-Polish.

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She's not here at the moment.

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Sister Alice Markey is one of a team of 14 that specialises in the

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most complex patients to discharge.

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The pressure that's on the NHS,

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you worry about it because you think,

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well, the walls are not elastic.

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There is no elastic in the walls, but the demand is high.

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One of her cases is a Polish man, Tadeusz.

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He's been medically fit to leave St Mary's for the past week.

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Anybody here speak Polish?

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-Pardon?

-No. Italia.

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But getting him out of hospital has not been straightforward.

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Any of you speak Polish?

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He's homeless.

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He's been working as a mechanic,

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but sleeping in the cars that he repairs.

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He got a sore on his ankle and obviously it has escalated,

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because he probably has neglected it a little bit.

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I just want him to understand the journey for him out now.

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Hello. How are you?

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You understand a little English?

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-A little English.

-A little?

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Little bit of English. And I will get an interpreter.

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Because, otherwise, you don't know what I'm saying,

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and I don't know what you're saying.

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Why is it that you can't just discharge a homeless person?

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You can. You can.

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You literally can discharge a homeless person.

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But my particular gentleman has health needs,

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because his leg looks very vulnerable.

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So, to go back to sleeping in the car at this precise moment

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is not ideal.

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Alice has applied for help from the local council homeless centre

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so Tadeusz can continue to get support.

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But until an appointment is available, he will remain

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on the ward classed as a DETOC, or a Delayed Transfer of Care.

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So that could be a patient who's waiting to go to a nursing home,

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homeless, awaiting placement through a homeless persons' unit,

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so any number of people on that spectrum who are delayed

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not by us, as a hospital,

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so they're ready to go and we're just waiting.

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28 today.

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Last week, I think it was 35 at one point.

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-That's quite a decent number of people that...

-It's extraordinary.

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That would be, in effect, me going upstairs now,

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clearing one of our main wards out completely

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and going, "There you go. 28 empty beds for you to admit into."

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So that would be today's problems solved.

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Louis, from the top.

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Our gentleman that fell over whilst on a business trip -

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doing very well from a medical perspective.

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I've seen him mobilising along the corridor on his own yesterday,

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so this man doesn't need to be in hospital.

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In one of the hospital's general wards, consultant David Shipway

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and his team are also trying to identify patients to discharge.

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There are a number of different barriers that we have to face

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from a social perspective.

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For example, we've got very frail elderly people,

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and they're falling over at home and having injuries,

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and then we have to make decisions about whether it's reasonable

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to get them home, or whether it's not.

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So, Dorothy. She's a fracture of the leg.

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We've made some more changes to her medication and, basically,

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we will see how she does over the next, say, 24, 48 hours.

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I'm here because I broke two bones in my ankle.

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I've been here for nearly three weeks.

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91-year-old Dorothy, or Dolly, as she's known,

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is one of the hospital's oldest patients.

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I feel good in myself.

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I do. I feel as though I could get up and walk...

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walk...you know,

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the way I am.

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But I can't, because I've got a broken ankle.

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Can you take a few deep breaths for me, please?

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Can you take a few deep breaths for me so I...

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Through... Closed or...

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Through your nose and out through your mouth.

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Are you happy to be here?

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Yeah, I am, really,

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because I'm getting the treatment I need.

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I mean, I don't know if you want to know but,

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for instance, I passed out this morning,

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and, um...

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They were all there to rally round, you know,

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to bring me round and see to me, whereas if I had have been at home

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on my own, I don't know what would've happened.

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I really don't.

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It might not be necessarily dangerous to someone

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that's like me or you.

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However, to someone at her age,

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her fantastic age, it's quite dangerous for her to be on her own.

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Dolly is waiting to be moved to a community hospital,

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where she will convalesce until she's well enough to go home.

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Dolly, are you in any pain right now?

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No, love, I feel fine.

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I feel... Honestly, really...

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Sometimes patients stay here longer than they need to,

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but we haven't got, necessarily, this middle ground right now,

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in between a hospital and a home, so that bed is being used.

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They are so short of beds that if you are just a patient

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and they're just giving you tablets,

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you're wasting a bed.

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But, then, I have to have somewhere to go where I'm going to be safe.

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What does that feel like?

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It feels awful.

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I'm not supposed to be here.

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Which I'm not.

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In a way.

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Because they want my bed.

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So, what have I got to do?

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I feel guilty because I've got nowhere else to go.

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-I brought you some shower gel.

-Just in case.

-Yeah.

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-I don't know where you're going to end up tonight.

-No.

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Peter and his wife Diana are still waiting to see if

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he'll get a bed on a ward before his operation tomorrow.

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-I'm quite happy sitting here, rather than sitting in the bed anyway.

-Hmm.

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-It is nice and bright here, and quieter.

-Yeah.

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-It's not busy here, is it?

-No.

-It's just quiet.

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We married in 1980, so 36 years.

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How did you both meet?

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At college. There was volleyball at lunchtime

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and he was playing, so it was mixed teams,

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and he, actually, was the only boy

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who would pass the ball to women because...

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He IS competitive, but he's fair.

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And he passed the ball, and I thought, "That's a nice trait."

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And then got talking.

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And then I actually asked him out, because he wasn't very forthcoming!

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I love him as much today as I ever did.

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I want to be there for him. I do my best for him.

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I wish I didn't cry all the time, but I do.

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But in every other way, I try and help him. Yeah.

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Protect him.

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And...

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Yeah, I've just found it very difficult, the whole journey.

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Because he's a very special person.

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So...it has been difficult.

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I just wish I was stronger, but I've tried to be strong. For him.

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But, luckily, Peter is really, really positive,

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and so I try my best to be, but he understands I'm not like him.

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And so, it's difficult.

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We want a bed for him overnight tonight.

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How is that looking?

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SHE SIGHS

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Not too good at the moment.

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At the moment the ward is full.

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There may be one discharge.

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It's a patient that's been looked after by a different team,

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so we're waiting to hear from that team whether this patient

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is fit for discharge.

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If that patient goes home, then we'll have a bed for Mr Lai.

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When St Mary's is full,

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the knock-on effects are felt across the whole hospital.

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For every discharge that we'd planned for,

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we usually automatically allocate that bed to someone else.

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So, if that goes wrong, our system starts to back up.

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Why is this bloke still here?

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We are waiting for a patient to be transferred off Intensive Care.

0:18:400:18:44

A 37-year-old man is being held in theatre

0:18:460:18:50

after an emergency operation to stop internal bleeding.

0:18:500:18:53

This patient had what we call a GI bleed, a gastrointestinal bleed.

0:18:560:19:00

He has had massive blood transfusion,

0:19:000:19:02

he has had lots of blood products that help the blood clot.

0:19:020:19:05

What he really needs is an Intensive Care bed.

0:19:050:19:09

The operation finished over six hours ago,

0:19:090:19:11

but they're still waiting to transfer him,

0:19:110:19:14

because Intensive Care is full.

0:19:140:19:17

We're trying to discharge some patients at the moment,

0:19:170:19:20

but we're not entirely sure where they're going to go,

0:19:200:19:23

so it's a lot of bed reorganisation, trying to

0:19:230:19:25

figure out where we can put people and where it's safe to put people.

0:19:250:19:28

At the moment, we're not entirely sure how we're going to

0:19:280:19:31

make room for people who need to come here.

0:19:310:19:33

Until an Intensive Care bed becomes available,

0:19:330:19:36

the patient will be kept on life support in the operating theatre,

0:19:360:19:39

meaning that operations that were scheduled to take place in

0:19:390:19:42

theatre 7 cannot go ahead.

0:19:420:19:44

It just gets really frustrating when, actually,

0:19:440:19:48

all I'm doing is better done by the Intensive Care Unit team,

0:19:480:19:54

rather than here in theatre.

0:19:540:19:56

We just don't have anywhere to put our patients and we have to

0:19:560:19:59

do the best we can for them in the best position we can,

0:19:590:20:02

with the best care that we can deliver.

0:20:020:20:04

As one of London's four major trauma centres,

0:20:060:20:09

St Mary's is facing increasing demand on its Emergency Department.

0:20:090:20:13

Trauma team to A&E Resus, please.

0:20:140:20:17

Thank you.

0:20:170:20:18

Sorry, they're going to come in...

0:20:190:20:22

The latest patient to arrive in A&E is 21-year-old carpenter Harry,

0:20:240:20:28

who has fallen two floors at work.

0:20:280:20:30

-Fallen from height?

-From four metres.

-From four metres.

0:20:320:20:36

You're not worried he's got a head injury?

0:20:360:20:39

HARRY MOANS

0:20:390:20:41

HE VOMITS

0:20:440:20:46

All right?

0:20:460:20:47

HARRY GROANS

0:20:470:20:49

Well done. It is just some oxygen...

0:20:490:20:50

-Please stop that! Please!

-Harry...

0:20:500:20:53

You stop that shit! Fuck off!

0:20:530:20:55

All right, Harry, you're OK.

0:20:550:20:57

-It fucking hurts! Stop it!

-All right, sweetheart.

-Please...

0:20:570:21:00

You're doing really, really well. I know it's horrible.

0:21:000:21:04

Harry's agitated behaviour suggests he may have a brain injury.

0:21:040:21:08

OK, tube. Intubate.

0:21:080:21:10

-Yeah.

-Lovely.

0:21:100:21:12

He is anaesthetised and his breathing is supported

0:21:140:21:16

so the doctors can ascertain the extent of his injury.

0:21:160:21:20

It looks almost certain that he'll need

0:21:240:21:26

a bed on the Intensive Care Unit,

0:21:260:21:28

which is not the easiest thing, seeing we know already that

0:21:280:21:34

the Intensive Care Unit is completely full to the rafters.

0:21:340:21:37

-PHONE RINGS

-That might be them. Yes, it is.

0:21:370:21:40

Hiya.

0:21:400:21:42

Have you got anything you can kick out there?

0:21:450:21:48

Yeah. Yeah, I know.

0:21:480:21:50

I know.

0:21:500:21:51

I think we should probably prepare for it.

0:21:510:21:54

Yeah. Absolutely. OK. Talk to you later. Bye.

0:21:550:21:58

Is it always like this?

0:22:090:22:11

We've always had times when it's been like this.

0:22:110:22:14

The emergency service has peaks and troughs in demand, like that,

0:22:140:22:18

and the peaks and troughs are going up and up and up.

0:22:180:22:21

There are times when I start thinking, whoa!

0:22:210:22:24

OK, if another thing happened now, the system would break.

0:22:240:22:29

And we'd be in really, really serious trouble.

0:22:290:22:32

Scans will help to determine how serious Harry's injury is,

0:22:340:22:37

and whether he needs one of the sought-after Intensive Care beds.

0:22:370:22:42

Debbie. OK, Debbie, we'll expect to see you soon. Thank you. Bye-bye.

0:22:420:22:48

Mum's on her way.

0:22:500:22:52

91-year-old Dolly is waiting to find out if she can be discharged today.

0:23:000:23:04

-Hello.

-Mrs Jackson, nice to see you again.

0:23:040:23:08

When we saw you earlier on this morning,

0:23:080:23:11

you were looking pretty unwell.

0:23:110:23:12

Now, as you know, we'd hoped to get you home later...

0:23:120:23:15

Well, not home, but to Willesden Community Hospital this morning,

0:23:150:23:18

for a bit of rehabilitation and some convalescence, but I think,

0:23:180:23:21

given that you had your collapse,

0:23:210:23:22

we should probably keep an eye on you here.

0:23:220:23:24

Yeah, I think I'd be better off.

0:23:240:23:26

So, I think what we're going to do is hang on to you for at least

0:23:260:23:29

another 24 hours, and then we'll send the referral again to

0:23:290:23:31

the rehab hospital but, unfortunately,

0:23:310:23:33

because they've given the bed up to another patient this morning,

0:23:330:23:36

we might end up having to keep you in here for a few more days

0:23:360:23:39

-while we wait for it to come up again.

-OK.

-OK?

-Thank you.

0:23:390:23:42

Very nice to see you. Bye-bye.

0:23:420:23:44

The problems that we face can only be solved, really,

0:23:440:23:47

by social services creating spaces for people in accommodation, be that

0:23:470:23:52

for homeless, drug users or people waiting rehousing for nursing homes.

0:23:520:23:56

There's a big disconnect between the NHS and social services,

0:23:560:23:58

and the NHS gets blamed quite a lot for problems in the community, which

0:23:580:24:03

are really slightly outside of our remit and outside of our control.

0:24:030:24:08

DOLLY GROANS

0:24:080:24:10

Oh, I know, sometimes it happens.

0:24:100:24:12

But otherwise, you look good.

0:24:120:24:14

-Yeah.

-OK, then.

0:24:140:24:16

-All right, I'll see you later, then.

-OK.

0:24:160:24:18

It's good, at least you are with us. No problem.

0:24:180:24:21

-We take you from there.

-Thank you.

0:24:230:24:25

You like the one I got yesterday of William and Harry, didn't you?

0:24:280:24:32

-Oh, yeah.

-That one.

-Yeah. Ain't that good?

0:24:320:24:35

Is that the one you want blown up?

0:24:350:24:37

To see you can just take their photo, just like that.

0:24:370:24:41

Dolly's granddaughter Nicola has come to visit,

0:24:410:24:44

with Peter, Dolly's husband of 32 years.

0:24:440:24:47

Where did you guys meet?

0:24:470:24:50

We met in a pub.

0:24:510:24:53

She's definitely a fighter.

0:24:530:24:55

She's had a lot of accidents, a lot of falls.

0:24:550:24:58

It's not the first time she's broke her ankle.

0:24:580:25:00

She went to Spain once with her friends. What did she do?

0:25:000:25:04

Went roller-skating and broke her ankle.

0:25:040:25:07

That's Dolly. She's got quite nice legs, when they're not like that.

0:25:070:25:10

I always had good legs.

0:25:100:25:12

Nice legs, shame about the face!

0:25:120:25:15

THEY ALL LAUGH

0:25:150:25:17

No good her coming home, because she won't cope at home.

0:25:180:25:22

I know she won't.

0:25:220:25:23

They did have a place for her, care home,

0:25:230:25:26

but whether she's lost that place for good, I don't know.

0:25:260:25:31

Have you had your boot on today?

0:25:310:25:34

No, I ain't been out of bed since I had that turn.

0:25:340:25:37

I've had to stay in bed.

0:25:370:25:39

I had to have a bed pan and all.

0:25:390:25:41

No commode.

0:25:410:25:43

In case I fell off the commode again!

0:25:430:25:45

THEY ALL LAUGH

0:25:450:25:48

After receiving emergency life-saving surgery in the

0:25:510:25:54

early hours of the morning, the patient in theatre 7

0:25:540:25:57

is still waiting to be transferred to Intensive Care.

0:25:570:26:00

So, the promise of a bed at half past two...

0:26:000:26:05

So, we've just called ITU, it may be another hour-and-a-half?

0:26:060:26:12

This is exactly what our problem is.

0:26:130:26:16

So, we're promised a bed at half past two, on Intensive Care,

0:26:160:26:22

but unless Intensive Care can move the patient that's in that

0:26:220:26:26

bed space onto the ward, we don't get anywhere.

0:26:260:26:30

You're waiting for the dominoes to all line up

0:26:300:26:33

and all fall at the same time.

0:26:330:26:35

And it takes hours in the NHS for that to happen.

0:26:350:26:39

-Hello.

-Hello, Alice.

0:26:390:26:41

I've come to see my little man.

0:26:410:26:44

Alice's patient, Tadeusz,

0:26:440:26:46

has got an appointment at a council homeless centre.

0:26:460:26:49

Hello.

0:26:530:26:55

How are you?

0:26:550:26:56

Are you all right?

0:26:560:26:59

We're here again.

0:26:590:27:01

Yes.

0:27:010:27:02

I have got one of the chappies that work here

0:27:020:27:07

-to come and explain about your homelessness.

-Yeah. OK.

0:27:070:27:14

-So that you and I can have a chat.

-Yes. Thank you.

0:27:140:27:17

That's OK.

0:27:170:27:19

I just want him to know exactly what we're doing for him.

0:27:190:27:24

Rather than wait for the hospital's translation service,

0:27:240:27:27

Alice asks a Polish colleague from the Transport Department to help.

0:27:270:27:32

This gentleman states he has no place to live.

0:27:320:27:34

What I do need to know from him is,

0:27:340:27:37

how does he live now that he is homeless,

0:27:370:27:40

who supports him, does he have money? So, ask him that.

0:27:400:27:43

TRANSLATION:

0:27:430:27:46

You look after your patients as if they're your family.

0:27:530:27:56

I mean, your family are not straightforward.

0:27:560:27:59

There are some challenging people in the family,

0:27:590:28:01

as well as everywhere else,

0:28:010:28:03

but, hey, you would deal with this, and I think that's how it should be.

0:28:030:28:07

It is difficult because he doesn't have any place to go.

0:28:080:28:12

Does he have any friends?

0:28:120:28:14

Oh, it is difficult. He doesn't have anyone.

0:28:140:28:17

-Nobody knows you?

-No.

0:28:170:28:19

-No friend at all?

-No.

0:28:190:28:21

He doesn't know really what he has to do and where he has to go,

0:28:210:28:25

and he doesn't have any place to go now.

0:28:250:28:29

We try to do the best we can but, unfortunately, when patients

0:28:290:28:35

come into hospital, they think hospital will sort it all out.

0:28:350:28:38

You know? That's why I say I don't go round with a block of flats

0:28:380:28:42

or a bungalow in my pocket. I wish I did, but I don't.

0:28:420:28:45

We would have to refer him to the homeless persons' unit, to see

0:28:450:28:50

if they can get him accommodation.

0:28:500:28:52

He says he agrees with that.

0:28:520:28:54

And now that I know he understands what we have to do for him,

0:28:540:28:58

I am happy that he can be discharged.

0:28:580:29:01

A week after he was medically fit to leave, Tadeusz is now on his way.

0:29:030:29:07

Yeah.

0:29:070:29:09

Toe touch.

0:29:090:29:11

Our code of professional conduct states that we look after

0:29:120:29:16

the patients in our care. Whether they come from Buck Palace

0:29:160:29:19

or the park bench, we give them all the same care.

0:29:190:29:22

Toe touch.

0:29:240:29:26

Toe touch!

0:29:260:29:27

Harry's girlfriend Paige and mum Debbie arrive at A&E.

0:29:370:29:42

I said to the nurse, "He's not going to die, is he?"

0:29:470:29:50

And she said, "I don't know. We can't tell at the moment."

0:29:500:29:53

And I thought I was going to die, right there on the spot.

0:29:530:29:57

He is 21 years of age. He's got a little baby.

0:29:570:30:00

It's just so frightening.

0:30:010:30:04

And, now, I know he's in the best place but...

0:30:060:30:10

It is really frightening. Really frightening.

0:30:110:30:14

The scans show Harry's brain injury is not as serious as first thought.

0:30:140:30:18

But it's still unclear how much medical support he needs

0:30:190:30:23

and which ward he will be admitted to.

0:30:230:30:25

We're going to wake him up and, fingers crossed, it'll be OK.

0:30:250:30:31

Harry. Can you open your eyes, Harry? Open your eyes wide.

0:30:310:30:35

We'll take the tube out.

0:30:350:30:37

Just keep taking some nice deep breaths.

0:30:370:30:40

We'll take the tube out.

0:30:400:30:42

If the breathing tube stays in and he stays on the ventilator,

0:30:420:30:45

he's classed as a level III patient,

0:30:450:30:47

which means that he needs the maximum support that we can give him

0:30:470:30:51

and that is an intensive care unit.

0:30:510:30:54

Whereas, if he does the breathing for himself,

0:30:540:30:56

and we're not having to support his blood pressure terribly much

0:30:560:31:00

and he's looking moderately stable,

0:31:000:31:01

he is a level II patient and he goes to a high dependency unit.

0:31:010:31:05

Harry.

0:31:050:31:07

Can you open your eyes wide?

0:31:070:31:09

Open your eyes wide.

0:31:090:31:11

We'll take the tube out.

0:31:110:31:14

I think there's more space in the High Dependency Unit than

0:31:140:31:16

there is on the Intensive Care Unit, at the moment,

0:31:160:31:18

so I'm secretly hoping that we'll be able to wake him up

0:31:180:31:22

and take the tube out.

0:31:220:31:23

-Oxygen.

-OK.

0:31:240:31:27

MACHINE BEEPS

0:31:270:31:29

Nice deep breath. Deep breath, in and out.

0:31:320:31:36

HIGHER-PITCHED BEEPING

0:31:360:31:39

Shall we just bring him up a bit?

0:31:410:31:43

You're just waking up, Harry.

0:31:430:31:45

You're in the hospital. You're in St Mary's Hospital.

0:31:450:31:48

You had a fall. Just keep taking nice big breaths.

0:31:480:31:51

Good. Excellent. Lunch.

0:31:530:31:55

Intensive Care has been full all day

0:32:030:32:05

but there's been a development.

0:32:050:32:07

-What's new?

-I discharged one patient.

-And that was a big relief?

0:32:090:32:14

Yeah. But we're preparing for the next admission to come in.

0:32:140:32:18

Ah, yes. So, the bed space is 90% ready.

0:32:260:32:29

I'm just going to bleep 1650, you told me.

0:32:290:32:32

After hours of waiting, the patient who had emergency surgery

0:32:340:32:37

can be transferred and the theatre can be used for other patients.

0:32:370:32:41

So, anything that doesn't need to go, doesn't need to go, guys.

0:32:410:32:45

Do you want to switch that ventilator off?

0:32:450:32:47

I do my job because I love it.

0:32:470:32:49

So, let's take that.

0:32:490:32:51

Things have definitely changed. The last decade has got a lot worse.

0:32:510:32:55

Personally, that means that I work longer hours because I don't

0:32:550:32:59

have anybody to hand over to.

0:32:590:33:02

Right. Everybody happy? OK. Let's go.

0:33:020:33:05

There are more days that frustrate me. More days that upset me.

0:33:050:33:09

More days that I leave work unsatisfied.

0:33:090:33:14

Not that I haven't done the best

0:33:140:33:16

I can but that I wasn't able to give the best to my patient

0:33:160:33:21

because of the lack of resources.

0:33:210:33:23

Intensive Care is now full,

0:33:270:33:29

but patients continue to arrive at A&E.

0:33:290:33:32

A lot of times, our capacity at St Mary's,

0:33:330:33:36

we're running at 98-99% capacity.

0:33:360:33:39

Which is extraordinary.

0:33:390:33:42

What that means, in essence, is we are always running

0:33:420:33:45

with one or two empty beds, which isn't nearly enough.

0:33:450:33:49

It wouldn't be a problem

0:33:530:33:54

if we never admitted more than one patient a day but we do.

0:33:540:33:58

It is what it is. People get sick. They come to hospital.

0:33:580:34:01

We can't change that.

0:34:010:34:03

SIREN BLARES

0:34:060:34:08

-All right, darling. I'll wait to hear from you, tomorrow, any news. Whenever.

-Yeah.

0:34:320:34:37

-I'll text you.

-Yeah, text, or I can ring.

-Mmm.

0:34:370:34:42

-Not from today.

-No. Shall I leave that?

-No. I won't tell anyone.

0:34:420:34:49

I'm not kissing him either. Because I don't want to give him anything.

0:34:490:34:52

Just in case. I want to keep him in tiptop condition.

0:34:520:34:55

-So, bye, darling.

-Might see you tomorrow.

-Yeah. See you then.

0:34:550:34:59

Aneurysm patient Peter has been waiting for nine hours

0:34:590:35:02

for a bed on a ward, ahead of his life-saving surgery tomorrow.

0:35:020:35:06

I'm on my own now.

0:35:070:35:09

I'm just waiting.

0:35:090:35:11

No-one... When the night comes in, it brings the sadness.

0:35:120:35:16

Yeah.

0:35:160:35:18

Still, hopefully, tomorrow, I'm going for the op

0:35:210:35:24

and just need a bit of luck.

0:35:240:35:26

It'll be good to go ahead. Get it over and done with.

0:35:260:35:31

And...we can start the recovery.

0:35:310:35:34

-I have some news.

-You got news?

-I've got some good news.

-Oh.

0:35:340:35:39

We have a bed.

0:35:390:35:41

Not in this ward, but we'll have a bed for you in about an hour.

0:35:410:35:45

Yeah?

0:35:450:35:46

-And we won't find out about an ITU bed until tomorrow.

-Tomorrow.

0:35:460:35:49

-We'll do our best for you.

-Yeah.

-Certainly.

0:35:490:35:51

-Thank you very much.

-I shall see you later on.

0:35:510:35:53

-I'm here for another couple of hours.

-OK.

0:35:530:35:55

So, as soon as a bed's available, we'll come and let you know

0:35:550:35:58

and we'll walk you over.

0:35:580:36:01

-OK. Thank you very much.

-All right. See you later.

-Bye-bye.

0:36:010:36:04

Oh, so that's

0:36:070:36:09

good news. Got a bed tonight.

0:36:090:36:12

And so, tomorrow, just need one more good news tomorrow.

0:36:130:36:16

To find a date when everyone is in hospital, free,

0:36:230:36:27

and we can get all of this,

0:36:270:36:29

it takes a tremendous amount of organising and planning.

0:36:290:36:32

It takes a huge amount of preoperative work up.

0:36:330:36:40

He has gone round and seen each one and every one of us.

0:36:400:36:44

He's been checked out from the heart, lungs, kidneys point of view.

0:36:440:36:48

So, all in all, six to eight weeks and we're here

0:36:480:36:52

with him waiting.

0:36:520:36:54

Likelihood of an ITU bed?

0:36:540:36:56

Not very high at the moment.

0:36:570:36:59

The final hurdle, really,

0:37:030:37:05

will be tomorrow morning because you never...

0:37:050:37:07

Never say never.

0:37:070:37:09

You don't know what will happen overnight tonight.

0:37:090:37:12

It's the morning of Peter's operation.

0:37:250:37:28

While the team assembles in theatre,

0:37:290:37:32

Colin Bicknell is on the hunt for a bed for Peter.

0:37:320:37:35

But Intensive Care is already full.

0:37:360:37:39

So, what's the order of the day?

0:37:400:37:42

It's bed management.

0:37:420:37:44

For a couple of hours.

0:37:440:37:46

And, then, we'll concentrate on the operation, I hope.

0:37:460:37:50

So, we should be briefing at 7.30.

0:37:520:37:55

And all will come down to the ICU bed. Everything else is ready to go.

0:37:550:37:58

What we need from ITU is an assurance that we'll have a bed.

0:38:030:38:08

We don't know until they've done the ward round

0:38:080:38:11

and they have understood how well the patients have done overnight.

0:38:110:38:15

How frustrating is this for you?

0:38:150:38:16

You should be in there doing the surgery.

0:38:160:38:18

And you're running around, up and down lifts,

0:38:180:38:20

trying to just find a bed.

0:38:200:38:22

Yeah.

0:38:220:38:23

Trying to find a bed for your patient is

0:38:250:38:28

a particular problem that we go through.

0:38:280:38:31

It's because it's an acute hospital.

0:38:310:38:34

It's because we have a major trauma centre

0:38:340:38:37

and we can't predict all of that.

0:38:370:38:39

At the morning ward round,

0:38:400:38:42

doctors assess patients to see if they can free up beds.

0:38:420:38:45

Hello. Good morning.

0:38:520:38:54

My name is Magdalen. I'm a sister in St Mary's Hospital.

0:38:540:38:59

We have a lady who is supposed to come to you yesterday.

0:38:590:39:03

Her name is Dorothy Jackson.

0:39:030:39:05

There was a delay and you asked us to call today

0:39:050:39:08

to confirm what time she can come.

0:39:080:39:11

Everything is ready. Yes.

0:39:110:39:13

Yes.

0:39:130:39:14

-You look nice today.

-Ah, thank you.

0:39:150:39:18

I do try. Thank you very much. I'll be back in a little bit.

0:39:180:39:22

OK. Yes. Thanks, love.

0:39:220:39:23

I want to see her get home

0:39:250:39:26

and I want to see her in her own clothes and doing her own things

0:39:260:39:29

and enjoying her life, not stuck in hospital.

0:39:290:39:31

It's not nice to stay in hospital for this long.

0:39:310:39:34

All right, then. Take care. Thanks, bye.

0:39:340:39:36

Definitely. She's on their list.

0:39:380:39:41

So, if everything is fine with the doctor and she's stable here,

0:39:410:39:45

then they'll get a bed for her.

0:39:450:39:47

So, we're sure she will go today.

0:39:470:39:49

I've come with good news for you. You're to go to Willesden today.

0:39:520:39:56

Yeah? They've got a space for me?

0:39:560:39:58

-Yes. We've spoken to them.

-Oh, right.

-They have a bed for you.

0:39:580:40:04

Well, that's it, then, isn't it? I'm off your books.

0:40:040:40:08

Yeah, that's good news.

0:40:080:40:09

OK. Do you want to sit up for me?

0:40:140:40:16

Just sit... If you can sit on the side of the bed and face me.

0:40:160:40:19

Harry, who came into hospital yesterday after a fall,

0:40:200:40:23

has spent the night under observation on

0:40:230:40:25

a high-dependency ward.

0:40:250:40:27

Very good.

0:40:270:40:28

'He's not very well today. He's crying. Said his head was

0:40:280:40:31

'really hurting, really hurting today.'

0:40:310:40:34

And I'm waiting to see the doctor now

0:40:340:40:37

to see what's happening.

0:40:370:40:38

OK, so eyes wide open.

0:40:380:40:40

-Argh!

-That painful?

-That really hurt.

0:40:410:40:44

He wants to go home, that's what he keeps saying.

0:40:440:40:46

He wants to go home cos Paige is 21 tomorrow.

0:40:460:40:50

Paige is Harry's girlfriend, so he was cooking her a nice meal,

0:40:500:40:53

and she told him all what she wanted - chicken...

0:40:530:40:57

And now this has happened.

0:40:580:41:00

So, if you turn your head to the left and keep it like that.

0:41:000:41:03

I'm going to count to three, I'm going to tip you quickly

0:41:030:41:06

on this shoulder.

0:41:060:41:07

We're now going to say that her birthday's next month

0:41:070:41:10

and hopefully Harry will be all better. We can all go out

0:41:100:41:13

and celebrate.

0:41:130:41:15

OK, so we'll do it together. On three.

0:41:150:41:17

One, two, three, go.

0:41:170:41:19

Excellent. Eyes open for me.

0:41:190:41:21

Superficially, it looks like he's got a serious problem.

0:41:210:41:25

And, yes, he's had a head injury.

0:41:250:41:27

This is not a banal situation.

0:41:270:41:29

It needs to be taken seriously. However, the clinical assessment

0:41:300:41:35

is, overall, quite reassuring.

0:41:350:41:37

And he should make good recovery from this with the right treatment.

0:41:380:41:43

Harry is expected to stay in hospital for the next few days.

0:41:430:41:47

I've only just recovered from breaking my ankle.

0:41:470:41:49

I've only just gone back to work.

0:41:490:41:51

-INTERVIEWER:

-You're joking?

0:41:510:41:53

I was off work for six weeks, I broke my ankle.

0:41:530:41:57

I've only been back about three.

0:41:570:41:59

Now I'm going to be off for another eight.

0:41:590:42:01

I fell down two levels.

0:42:030:42:04

Lucky I'm not dead, really.

0:42:060:42:07

-HE SCREAMS

-Ow, Mum! Mum!

0:42:120:42:16

What have I done?

0:42:160:42:17

Fucking pulled that!

0:42:170:42:18

Oh, I'm sorry.

0:42:180:42:20

When he starts swearing a bit, we know he's still there.

0:42:200:42:24

That's it.

0:42:270:42:28

PHONE RINGS

0:42:360:42:38

Hello?

0:42:380:42:40

I'm all right. I'm waiting on ITU.

0:42:400:42:43

There is a rumour... There is a rumour that they have

0:42:460:42:50

step-able down patients.

0:42:500:42:52

-Mr Peter?

-Yes?

-Yes, sorry, we're going to theatre now, sir, yeah?

-OK.

0:43:000:43:05

I'll just put my things...

0:43:050:43:07

It looks as if there is a possibility of an ITU bed today

0:43:090:43:12

because there's a patient who can step down from ITU.

0:43:120:43:15

We've got to have the full confirmation

0:43:150:43:17

when they've started the rounds, but it's enough for us to send

0:43:170:43:19

for the patient and start, which will save some time,

0:43:190:43:23

and then we'll get full confirmation when they've finished

0:43:230:43:26

the ITU ward rounds.

0:43:260:43:28

-INTERVIEWER:

-Are you pleased with that?

0:43:300:43:32

Yeah.

0:43:320:43:33

Very.

0:43:330:43:34

-Probably won't see you...?

-No.

0:43:370:43:40

-I won't see you again.

-Probably not.

-Thank you very much.

0:43:400:43:43

-I'm going down with you.

-Oh, are you? Oh, good.

0:43:430:43:46

Everyone's here, everyone's ready.

0:43:530:43:56

And...

0:43:560:43:57

..I think he might be lucky.

0:43:590:44:00

-See you after.

-OK.

0:44:030:44:04

Hello.

0:44:050:44:07

Your name?

0:44:080:44:09

PHONE RINGS

0:44:160:44:18

Hello, SAT Operations, Lesley speaking.

0:44:200:44:23

So, Peter, can you tell us your name?

0:44:250:44:27

-Peter Lai.

-Yeah, and your date of birth?

0:44:270:44:29

23rd August.

0:44:290:44:32

And can you tell us exactly what we're going to do today?

0:44:330:44:36

I'm going to have an operation.

0:44:360:44:38

Hello, how are you?

0:44:390:44:41

I'm all right, thank you. You're busy?

0:44:410:44:45

OK. What have you got at the moment?

0:44:450:44:47

-So, as you know, we're waiting for the confirmation of the ITU.

-Yeah.

0:44:490:44:53

It looks very good, so we're just waiting for the last green light.

0:44:530:44:57

Oh, good.

0:44:570:44:58

-But quite...

-Great.

-..confident.

0:44:580:45:01

-See you later. Take care.

-Thank you very much.

-Bye.

0:45:020:45:06

You know that you've got a booked patient, don't you?

0:45:060:45:10

OK, all right. All right, thanks, we'll speak tomorrow.

0:45:130:45:17

All righty. Bye-bye.

0:45:170:45:18

Heads-up from them was -

0:45:200:45:22

we are not going to have an Intensive Care bed

0:45:220:45:25

for our planned elective patient,

0:45:250:45:28

as it stands at the moment.

0:45:280:45:30

-Does your wife know yet?

-She doesn't know if we're going ahead or not.

0:45:320:45:36

So, I guess there's no way I can tell her

0:45:360:45:39

it's definitely going ahead.

0:45:390:45:42

This kidney will be up.

0:45:450:45:48

I mean, if we're on... We're miles away from these graphs.

0:45:480:45:51

-That's the left side, yeah?

-Yeah.

0:45:530:45:55

OK, so from there...

0:45:580:45:59

-Gentlemen?

-Just in that corner.

-Gentlemen?

0:46:010:46:03

We've got... Matt's just been talking to Marylebone.

0:46:040:46:07

-There is no bed.

-What?!

0:46:100:46:11

What do you mean there's no bed?

0:46:130:46:15

No bed? No-one to transfer out?

0:46:160:46:19

And there is no...

0:46:200:46:21

That's a no-no, rather than, "No, give us some time"?

0:46:230:46:27

The feedback is it's not available now.

0:46:270:46:30

-You remember me from last time?

-I remember you.

0:46:300:46:32

-I remember your name.

-Last three times. Yeah.

0:46:320:46:34

-Three times?

-Yeah. Two times.

-I know I've treated you before.

0:46:340:46:38

It's a shame to see you back, but how are you?

0:46:380:46:41

-I'm OK, thank you.

-Yeah?

-Good, thank you.

0:46:410:46:43

No, no, I know, it's not your fault.

0:46:480:46:50

But that's a definite, is it?

0:46:500:46:51

That's all we need to know now.

0:46:510:46:53

And it won't change later, and there's no-one who is going to...

0:46:530:46:56

..cancel?

0:46:580:47:00

All right.

0:47:040:47:05

Thank you, bye.

0:47:050:47:06

-Toast.

-Definitely not.

0:47:080:47:10

I'll just go and tell him it's off.

0:47:100:47:12

I'll come with you.

0:47:120:47:13

We can get you connected up to everything, so it's going to be...

0:47:310:47:35

Hello.

0:47:370:47:38

Really sorry. There's no bed.

0:47:380:47:40

Really, really sorry.

0:47:420:47:43

Gutted. Of course we're gutted.

0:47:450:47:48

It's disappointing because you build yourself up, you prepare for it,

0:47:480:47:51

we were all ready for it.

0:47:510:47:53

It's disappointing for the patient, to let them down.

0:47:530:47:56

He's going to be going home now. Can you imagine how he feels?

0:47:560:48:00

-Really sorry.

-It's all right.

0:48:000:48:03

You tried your best.

0:48:030:48:04

It means organising the whole process again,

0:48:110:48:16

equipment-wise, personnel-wise.

0:48:160:48:18

It means all the people in the clinics that are coming

0:48:180:48:21

in a few weeks' time need to be cancelled.

0:48:210:48:24

All the people that were going to be operated in a few weeks' time

0:48:240:48:27

need to be shifted around. The whole thing is like a moving...

0:48:270:48:30

A moving jigsaw and they all get pushed a bit further along,

0:48:310:48:34

but we have to do this man. Because of his large aneurysm

0:48:340:48:37

there's a risk of it rupturing, so we've got to get him in

0:48:370:48:40

as soon as possible.

0:48:400:48:41

I felt ready for it when I was down there.

0:48:440:48:47

OK, seeing everybody, say hello to everybody.

0:48:470:48:50

Yeah, I'm going for it.

0:48:500:48:52

And then... Oh.

0:48:520:48:53

It just deflates.

0:48:530:48:55

It's a bit unreal, isn't it? It's a bit unreal.

0:48:550:48:58

The last minute...

0:48:580:49:01

Yes, and then no.

0:49:010:49:02

Yeah.

0:49:040:49:05

I'm still waiting.

0:49:160:49:18

She got everything ready and she's been told she's going,

0:49:200:49:24

everybody knows she's going and now we're waiting for transport.

0:49:240:49:28

So the problem with getting a place in the care home has been solved.

0:49:280:49:34

But now I've got to get there.

0:49:350:49:37

So...

0:49:370:49:38

Got another problem on our hands.

0:49:390:49:42

You don't know whether you're coming or going.

0:49:420:49:45

I might have to stay here all night again.

0:49:450:49:49

Like this!

0:49:490:49:50

It's Dolly stuck in her bed with her big boot on.

0:49:520:49:55

SHE LAUGHS

0:49:550:49:57

It's a farce, really.

0:49:570:50:00

It could be made into a comedy.

0:50:000:50:02

If you work in acute hospital, you will have cancellations

0:50:280:50:31

from the High Dependency, from the Intensive Care,

0:50:310:50:35

from the theatre availability beds.

0:50:350:50:37

It's inevitable, isn't it?

0:50:370:50:39

I...

0:50:390:50:40

Is it more frequent? I don't know. It feels real every time.

0:50:400:50:44

It always feels like it's...

0:50:440:50:46

It's the worst thing in the world and it always feels like

0:50:460:50:49

it's happening to you, but we get a lot of work done here

0:50:490:50:53

and we're very proud of the work we get done here.

0:50:530:50:55

You've seen the very worst of it, I think.

0:50:550:50:57

-Young Dorothy.

-That's me, love.

0:50:590:51:02

I'm Dave, this is Graham. We're coming to take you out.

0:51:020:51:05

I don't know if you'll have room for my boot, will you?!

0:51:050:51:10

-Thank you, love.

-All the best. Aww!

0:51:100:51:12

-And you, yeah?

-Bye!

0:51:140:51:15

I'm here again.

0:51:310:51:32

I'm ready for it.

0:51:340:51:36

But the only thing I hope is,

0:51:360:51:39

they won't cancel it again.

0:51:390:51:43

-Hello.

-How are you?

-I'm OK, thank you.

-Good.

0:51:520:51:55

-Back again.

-Back again, yes.

-In your favourite bed.

-Yeah.

0:51:550:51:59

Whereas last time I was telling you that the ITU bed situation

0:51:590:52:05

is really bad and there were queues of people,

0:52:050:52:09

this time, there are queues of people waiting to come OUT

0:52:090:52:13

-of the ITU. So I'm rather hoping we are on.

-Yeah, good.

0:52:130:52:20

We still won't know the answer until you're down in theatre,

0:52:200:52:22

-but we'll all be down there with you.

-Yeah.

0:52:220:52:24

Well, I'm looking forward to the operation.

0:52:240:52:27

It means, you know, after eight years, I feel I'm part of the team,

0:52:270:52:31

-doing this together.

-You are. We're thinking of renaming the bed

0:52:310:52:34

and everything!

0:52:340:52:36

-See you soon.

-See you.

0:52:360:52:38

He will stand no chance if it ruptures when he's at home

0:52:380:52:42

or on holiday.

0:52:420:52:44

And, so this is... He's got to have it done if he wants to live

0:52:440:52:48

a long and happy life. There's no reason why he shouldn't do

0:52:480:52:51

if we can get away with this.

0:52:510:52:52

It's not my journey.

0:52:550:52:57

It's me and my wife's journey together.

0:52:570:53:00

I can't say not to worry and don't worry about it.

0:53:010:53:06

I can't do that. But what I can do is to comfort her

0:53:060:53:09

whenever I can.

0:53:090:53:11

-Let's get the brake on before you hop on.

-Thank you.

0:53:130:53:16

-Yeah.

-Take care, Peter.

-Thank you.

0:53:160:53:18

-I'll see you later.

-I'll see you later.

0:53:180:53:20

-Hello, Peter.

-Good morning.

0:53:260:53:28

You have good news. We're on.

0:53:280:53:30

We're on. Yes.

0:53:300:53:32

It's brilliant news. I mean, it's great cos we can

0:53:320:53:35

get going early as well, which is a real advantage.

0:53:350:53:38

We're going to open up the sac, where there will be some bleeding,

0:53:410:53:45

and then we know plan A is to sew off the lumbars

0:53:450:53:47

and then close the sac.

0:53:470:53:48

Plan B is, if it's bleeding, we'll put some stitches around the top.

0:53:480:53:51

Plan C is clamp the top and the bottom and replace the middle bit.

0:53:510:53:56

Good. Everyone happy?

0:53:560:53:58

So, apart from the seven or eight surgeons,

0:54:050:54:09

we've got three anaesthetists, a perfusionist and a scrub team,

0:54:090:54:13

which is three people.

0:54:130:54:16

So it's about 14.

0:54:160:54:17

The cost of this, just the financial cost, is enormous.

0:54:190:54:23

And I think it's a really optimistic thing that we push on

0:54:230:54:27

and try and get people like this sorted out,

0:54:270:54:29

no matter how big the team and how expensive the day is.

0:54:290:54:33

OK, can we have hands on deck? And, Colin, do you want to orchestrate

0:54:330:54:36

-the move?

-Okey dokes.

0:54:360:54:39

I was rather tempted to take this off and then we'll...

0:54:390:54:42

Let's just open here.

0:54:420:54:44

Can you feel it there? So we've got a little way to go.

0:54:450:54:47

-This is through the sac, clearly.

-Yeah, yeah, that's the sac.

0:54:470:54:50

Just don't look at it.

0:54:500:54:51

My God.

0:54:530:54:54

Just...

0:54:540:54:55

That is all aneurysm, which is rising up out of the chest.

0:54:550:54:58

-All of this.

-And that point there looks like it's about to blow.

0:54:580:55:02

So, you've got ready the knife to open up the sac,

0:55:020:55:05

then lots of sucking.

0:55:050:55:07

Ready?

0:55:070:55:09

-OK.

-Lumbar sutures ready?

0:55:090:55:10

-The clamps ready?

-Yes.

0:55:110:55:13

OK, Mr Lai.

0:55:150:55:16

Oh, my gosh.

0:55:190:55:20

Another one.

0:55:200:55:21

You can't predict how these things are going to go,

0:55:280:55:31

they're all one-offs, but that went very well.

0:55:310:55:33

It went as well as you can expect it to go.

0:55:360:55:40

But, of course, these people are on a journey through

0:55:400:55:43

the hospital and it's only 50%, the operation.

0:55:430:55:48

If that...

0:55:480:55:49

He's young though, and he's fit, and he is determined

0:55:510:55:56

and so is his family and so is his wife.

0:55:560:55:58

We've got everything crossed for him and, touch wood,

0:55:580:56:01

I hope that he'll do well.

0:56:010:56:02

I've known him for so long now that I'll been checking on him

0:56:050:56:08

nine times a day for the next two weeks.

0:56:080:56:10

-Hello, there.

-Hi.

0:56:440:56:46

Hello, darling.

0:56:470:56:49

Yeah. You OK, hon?

0:56:490:56:50

Yeah. Aww.

0:56:500:56:51

SIREN BLARES

0:57:270:57:29

The team assembles for a life and death operation

0:57:330:57:35

to remove a gigantic brain tumour.

0:57:350:57:38

We need to do this today. He's becoming paralysed.

0:57:380:57:41

I could die.

0:57:410:57:42

Thanks for the help.

0:57:420:57:44

But with waiting lists growing...

0:57:440:57:45

It's the fourth time I've been here.

0:57:450:57:47

..it's taking months for some patients to see the trust's

0:57:470:57:50

top brain surgeon.

0:57:500:57:51

It is what it is, isn't it? What can you do?

0:57:510:57:53

Nature of the beast, really, isn't it?

0:57:530:57:54

And doctors attempt to cure a patient's tremor

0:57:540:57:56

with a futuristic deep brain operation.

0:57:560:57:59

The first time I actually saw non-invasive surgery,

0:57:590:58:02

interestingly, was on Star Trek 30 years ago,

0:58:020:58:06

performed by Dr Sulu.

0:58:060:58:07

What choices would you make when faced with

0:58:150:58:17

complex health care decisions?

0:58:170:58:18

Visit our interactive pages to find out how you would respond.

0:58:180:58:22

Go to...

0:58:220:58:23

..and follow the links to the Open University.

0:58:250:58:28

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