0:00:02 > 0:00:06This programme contains scenes which some viewers may find upsetting.
0:00:06 > 0:00:08An amazing lump of blancmange that weighs about a kilo.
0:00:08 > 0:00:11The human brain has 100 billion neurons,
0:00:11 > 0:00:14which makes it the most powerful learning tool in the world.
0:00:14 > 0:00:21Your entire person is encapsulated in that little blob of blancmange.
0:00:22 > 0:00:26Jay Jayamohan is a senior paediatric neurosurgeon
0:00:26 > 0:00:29at the John Radcliffe Hospital in Oxford.
0:00:29 > 0:00:32He is part of an almost 100-strong team of consultants
0:00:32 > 0:00:36who deal with every conceivable problem of the brain.
0:00:36 > 0:00:38We are making life-and-death decisions.
0:00:38 > 0:00:43One split second decides everything.
0:00:45 > 0:00:49Each year, they perform almost 4,500 operations.
0:00:49 > 0:00:53You're concentrating constantly. Is it in the right place?
0:00:53 > 0:00:54Stop any bleeding.
0:00:54 > 0:00:57So you're already in that mindset of think, think, think, think, think.
0:00:57 > 0:01:01Cutting-edge procedures that carry high risk.
0:01:01 > 0:01:06It can be a bit like walking on a tightrope in very high winds.
0:01:06 > 0:01:08You could fall off and die.
0:01:08 > 0:01:12Their interventions can mean the difference between life and death.
0:01:14 > 0:01:15You've got to respect the organ.
0:01:15 > 0:01:18You've got to respect the fact that what you do to it
0:01:18 > 0:01:20can have huge implications for the patient.
0:01:32 > 0:01:33The John Radcliffe Hospital
0:01:33 > 0:01:37is Oxfordshire's main accident and emergency centre.
0:01:38 > 0:01:41PHONE RINGS
0:01:43 > 0:01:45Hello, neurosurgery?
0:01:45 > 0:01:47What's the story?
0:01:47 > 0:01:49- Do you want one?- No.
0:01:49 > 0:01:52All right, I'll come down. OK. Bye.
0:01:52 > 0:01:54I've got to go to A&E.
0:01:55 > 0:01:59Neuro registrar Tim Lawrence is on call.
0:01:59 > 0:02:01He's overseeing the wards and theatres
0:02:01 > 0:02:03in the neuroscience department.
0:02:03 > 0:02:07I usually walk through the door with a bit of trepidation,
0:02:07 > 0:02:09because you don't know what's happening.
0:02:09 > 0:02:11You know that things can go wrong very, very quickly,
0:02:11 > 0:02:14and if you haven't prepared yourself for the eventualities,
0:02:14 > 0:02:16then you'll come unstuck.
0:02:16 > 0:02:18So there has to be a small amount of fear.
0:02:18 > 0:02:20I think that's probably fairly healthy.
0:02:23 > 0:02:25Hello, Tim Lawrence, neurosurgery?
0:02:25 > 0:02:28I can't hold on. I can't hold on one moment, sorry.
0:02:28 > 0:02:31He also deals with A&E patients
0:02:31 > 0:02:33who come through the door with head injuries.
0:02:33 > 0:02:37Let's get blocks on. Alex, start doing primary survey, please, ASAP.
0:02:37 > 0:02:39So, head looks smashed...
0:02:39 > 0:02:43The patient, Tracey, has been unconscious for over an hour,
0:02:43 > 0:02:45and there's fear of extensive brain damage.
0:02:47 > 0:02:49Decompress the chest on the left-hand side.
0:02:49 > 0:02:51Was there anything out of that drain, guys?
0:02:51 > 0:02:53- No blood.- No blood at all?
0:02:53 > 0:02:56The patient's been involved in a bad car accident.
0:02:56 > 0:02:59Conscious level is very bad. We think it's a primary head injury.
0:02:59 > 0:03:02Watch your hands. Chest X-ray about to take place.
0:03:02 > 0:03:06Pelvis looks fine on chest X-ray. No long bone.
0:03:06 > 0:03:09Tracey, a midwife and a mum with two grown-up sons,
0:03:09 > 0:03:12was out with her husband when their car crashed.
0:03:12 > 0:03:14We need to know what's going on with her.
0:03:14 > 0:03:17- Yeah, yeah, let's get a head scan. - Let's just get her moving now.
0:03:17 > 0:03:18Let's just get her into CP. OK?
0:03:18 > 0:03:22A scan will help Tim decide on the best treatment.
0:03:23 > 0:03:25'You listen to what information you have,
0:03:25 > 0:03:28'scans you have to look at, make a decision
0:03:28 > 0:03:31'about how life-threatening the condition is
0:03:31 > 0:03:32'and in what sort of timescale
0:03:32 > 0:03:35'that condition is life-threatening for the patient.'
0:03:35 > 0:03:37Ready, steady, slide.
0:03:39 > 0:03:44'And sometimes you have a case where you have to drop everything else,
0:03:44 > 0:03:47'take that patient straight to theatre.'
0:03:49 > 0:03:52Kerry, it's Tim. Is Sister there?
0:03:52 > 0:03:55Well, I need to speak to her pretty urgently.
0:03:55 > 0:03:57I need to know if there's space in theatre now.
0:03:57 > 0:03:59I'm just with a patient in the scanner at the moment.
0:03:59 > 0:04:03If we could just hold Theatre 11 until I am absolutely clear
0:04:03 > 0:04:06I'm not bringing this patient, that would be great. Don't let...
0:04:06 > 0:04:09Fine. I'll let you know.
0:04:09 > 0:04:11The scan reveals a major bleed
0:04:11 > 0:04:14that's bruised and swollen Tracey's brain,
0:04:14 > 0:04:16cutting off the vital supply of oxygen.
0:04:16 > 0:04:19There's nothing Tim can do until the swelling abates.
0:04:21 > 0:04:23There's nothing on the scan that we're going to operate on.
0:04:23 > 0:04:25The question is how we manage her from here,
0:04:25 > 0:04:29and I suppose it's going to be ICP monitor and brain...
0:04:29 > 0:04:30Yeah, yeah.
0:04:32 > 0:04:35Yeah, in a convertible sports car that's been T-boned.
0:04:35 > 0:04:37I think I'm going to stick in a pressure monitor
0:04:37 > 0:04:39and I expect her pressures to be through the roof,
0:04:39 > 0:04:44and then talk to the family about brainstem testing.
0:04:47 > 0:04:49Nothing else for theatre at the moment, no.
0:04:49 > 0:04:51There's another trauma that came with this one,
0:04:51 > 0:04:53so the other passenger who's just come in,
0:04:53 > 0:04:58so we'll see what happens with that, but nothing else for theatre.
0:04:58 > 0:05:01Great. Thanks, Orlando. Cheers. Bye.
0:05:01 > 0:05:02Hello?
0:05:03 > 0:05:07Yeah, it's gone nuts, yeah. HE LAUGHS
0:05:07 > 0:05:12The neuroscience department looks after over 3,000 patients a year.
0:05:12 > 0:05:16Adult and paediatric wards function side by side,
0:05:16 > 0:05:19with theatres on standby 24/7.
0:05:21 > 0:05:25Jay Jayamohan is one of four paediatric neurosurgeons at the hospital.
0:05:25 > 0:05:28I keep saying that because I met her first, antenatally.
0:05:28 > 0:05:31He begins his day with the morning ward round.
0:05:32 > 0:05:35So you're going to pressure monitor to kick off.
0:05:35 > 0:05:38- And then you can do Jack.- You do the pressure monitor, then I'll do Jack.
0:05:38 > 0:05:41- Yeah.- Then your guy will be in, hopefully, by then.
0:05:41 > 0:05:44- And then Abbey after that? - Yeah.- OK.
0:05:44 > 0:05:46BABY CRIES
0:05:47 > 0:05:50- He's looking very well, isn't he? - He's had a good discussion with you.
0:05:50 > 0:05:52Yes.
0:05:54 > 0:05:58Across the way, at the neurointensive care unit,
0:05:58 > 0:06:00Tim's handing over to the day shift.
0:06:03 > 0:06:05That's a bit worrying, isn't it?
0:06:05 > 0:06:06Where's the patient?
0:06:10 > 0:06:14The NICU is where the most critical patients come
0:06:14 > 0:06:16for round-the-clock care.
0:06:18 > 0:06:23This week, it's the domain of neuroanaesthetic consultant Mhairi Speirs.
0:06:23 > 0:06:26Back to my favourite occupation of filing!
0:06:28 > 0:06:31- Yes, we've got to stay close, Mhairi.- Oh!
0:06:31 > 0:06:32SHE LAUGHS
0:06:32 > 0:06:35All my Christmases come at once!
0:06:35 > 0:06:37Good morning.
0:06:37 > 0:06:40This is the ward round. We're just going to talk about you, OK?
0:06:40 > 0:06:41Do you know where you are?
0:06:41 > 0:06:43No, you're in Oxford.
0:06:45 > 0:06:49Tracey has now been sedated and moved to neurointensive care.
0:06:50 > 0:06:51So, Tracey.
0:06:51 > 0:06:53Tracey Lake.
0:06:53 > 0:06:55GCS4 at the scene, fixed pupils at the scene.
0:06:55 > 0:06:58Her scan shows traumatic subarachnoid haemorrhage.
0:06:58 > 0:07:02She's got C2 lateral mass fracture and multiple left-sided rib fractures
0:07:02 > 0:07:04and some right-sided rib fractures.
0:07:04 > 0:07:07Left-sided lung contusions, bilateral chest drains.
0:07:07 > 0:07:11She'll probably survive, but it's a severe injury.
0:07:11 > 0:07:14We spoke to cardiac yesterday. Bianca spoke to them.
0:07:14 > 0:07:18They don't want to fix the ribs unless she can't wean,
0:07:18 > 0:07:21which we haven't tried yet, or she's got a lot of pain.
0:07:21 > 0:07:23But let's scan her, and then see what her head looks like,
0:07:23 > 0:07:25because that will determine her weaning.
0:07:25 > 0:07:29Tracey's level of consciousness must be assessed
0:07:29 > 0:07:32before she can be weaned off the ventilator.
0:07:32 > 0:07:35Now, can we ask James to attack a shunt...?
0:07:35 > 0:07:38Before going to theatre, Jay checks on his patient.
0:07:40 > 0:07:41Hello, hello. You all right?
0:07:41 > 0:07:44Very leopard-y, tiger-y...
0:07:44 > 0:07:4714-year-old Georgia has swelling
0:07:47 > 0:07:49where the brain and spinal cord meet.
0:07:49 > 0:07:53It's affecting her mobility and causing a lot of pain.
0:07:53 > 0:07:56So, about 45 minutes or so, OK?
0:07:58 > 0:08:00- See you later, guys. BOTH:- See you.
0:08:03 > 0:08:06It's what you do in Liverpool if you hear someone running behind you.
0:08:06 > 0:08:07You start jogging.
0:08:09 > 0:08:14Jay has spent 16 years becoming a senior paediatric neurosurgeon.
0:08:14 > 0:08:18He's done thousands of operations and countless procedures.
0:08:18 > 0:08:21Theatre is his second home.
0:08:21 > 0:08:23Ah, whose is this speaker?
0:08:23 > 0:08:25- It's mine.- Can I plug it in?
0:08:25 > 0:08:29And music keeps him going.
0:08:29 > 0:08:31It's shuffle.
0:08:32 > 0:08:34It's just random, man.
0:08:38 > 0:08:40They're both for the larger gentleman.
0:08:40 > 0:08:43Maybe I haven't been sticking to my diet as strictly as I should be.
0:08:43 > 0:08:45Been going to the gym a lot.
0:08:45 > 0:08:47And I did lose some weight.
0:08:47 > 0:08:50Then I went on holiday, and it all just piled back on again.
0:08:50 > 0:08:53I did end up after the gym, after my dinner,
0:08:53 > 0:08:58having home-made banana cake with Nutella on it. Mmm.
0:08:58 > 0:09:00But I don't think it helps me lose weight.
0:09:01 > 0:09:04J will open the back of Georgia's neck
0:09:04 > 0:09:06to make more space for the junction
0:09:06 > 0:09:09between the base of the brain and the spinal cord.
0:09:12 > 0:09:13That's her spinal cord.
0:09:13 > 0:09:16All those little blood vessels are feeding the spinal cord.
0:09:16 > 0:09:17We don't want to injure them.
0:09:17 > 0:09:22These big fat chubbers here, those are the cerebellar tonsils.
0:09:22 > 0:09:25OK, so we want to release the compression off of there.
0:09:25 > 0:09:28We want to shrink them down a little bit.
0:09:28 > 0:09:32They are quite big and pushing quite hard
0:09:32 > 0:09:35onto the junction of the spinal cord and brain.
0:09:35 > 0:09:38You can see these have gone pale. I've buzzed them.
0:09:38 > 0:09:41And as I buzz them with the coagulation,
0:09:41 > 0:09:43they actually shrink a little bit.
0:09:46 > 0:09:49Oh, yeah. So we've got a flow. See that red?
0:09:49 > 0:09:51It means that you've lifted the pressure off
0:09:51 > 0:09:53so that fluid can flow through.
0:09:53 > 0:09:55So I am happy. Lights on.
0:09:55 > 0:09:58Top lights, please? Scope can go.
0:09:59 > 0:10:01So, closure.
0:10:06 > 0:10:11The NICU team look after 1,500 patients a year.
0:10:12 > 0:10:15They can't do anything without an admission number.
0:10:17 > 0:10:20Three admissions in the last 20 minutes.
0:10:20 > 0:10:21One, two, three.
0:10:21 > 0:10:27With one consultant, a registrar and 25 specialist nurses
0:10:27 > 0:10:29caring for patients around the clock,
0:10:29 > 0:10:31bed space is at a premium.
0:10:31 > 0:10:34No, there's no bed. We've got no emergency bed.
0:10:34 > 0:10:36So the whole time, we're juggling somebody in
0:10:36 > 0:10:37and juggling somebody out,
0:10:37 > 0:10:40so we've got two patients that could go to the ward,
0:10:40 > 0:10:42but there's no ward beds and we've got four admissions coming in,
0:10:42 > 0:10:44so it's going to be a bit tight.
0:10:44 > 0:10:49We are like ducks. Very calm on top, but paddling like mad underneath.
0:10:52 > 0:10:54So, five admissions in one hour.
0:10:54 > 0:10:56That's taking a record.
0:11:03 > 0:11:07Martin is one of the latest admissions to the NICU.
0:11:08 > 0:11:11His condition began with flu-like symptoms
0:11:11 > 0:11:15that rapidly deteriorated into complete paralysis.
0:11:15 > 0:11:18Come on, babe. Can you squeeze my hand?
0:11:21 > 0:11:23Come on, babe, open your eyes.
0:11:23 > 0:11:24There you go.
0:11:24 > 0:11:27Hi. Marty.
0:11:27 > 0:11:28Hi.
0:11:28 > 0:11:30This rare disease of the brain
0:11:30 > 0:11:33affects just eight in a million people.
0:11:34 > 0:11:36Oh, just for a second.
0:11:39 > 0:11:40Oh, lovey.
0:11:43 > 0:11:46Martin and Lisa have been married for 10 years.
0:11:50 > 0:11:52It's been like a really bad dream.
0:11:52 > 0:11:56It did, it felt like we were grieving, almost,
0:11:56 > 0:11:59but now, you know, we've got some hope.
0:11:59 > 0:12:01His eyes seemed to move a little bit.
0:12:01 > 0:12:04Today they just opened ever so slightly
0:12:04 > 0:12:07when I first came in and he heard me.
0:12:07 > 0:12:11And that's what's helping me get through.
0:12:11 > 0:12:14It's the gradual, you know,
0:12:14 > 0:12:21the positive changes that he is going to recover.
0:12:21 > 0:12:22So...
0:12:25 > 0:12:27Yeah.
0:12:33 > 0:12:36MACHINE BLEEPS
0:12:38 > 0:12:42Tracey has now been in a deep coma for 48 hours.
0:12:42 > 0:12:43Everything will be all right.
0:12:46 > 0:12:48Trace? It's John.
0:12:48 > 0:12:49Can you hear me?
0:12:58 > 0:12:59You just keep fighting.
0:13:00 > 0:13:04Her husband John, a fireman for 25 years,
0:13:04 > 0:13:08was also involved in the crash, but escaped with minor injuries.
0:13:10 > 0:13:11And I promise...
0:13:11 > 0:13:13no more silly classical cars.
0:13:18 > 0:13:22- Mr Lake? I've got the scan up for you if you want to see it.- OK, yeah.
0:13:22 > 0:13:24Come on, I'll show you.
0:13:24 > 0:13:29John's friend Mike, a doctor, has come to give support.
0:13:29 > 0:13:31- We know that her head was shaken.- Yeah.
0:13:31 > 0:13:35We know that she took the impact on the left side.
0:13:35 > 0:13:37You know, that's where most of her injuries are.
0:13:37 > 0:13:39You can see that from her face alone.
0:13:39 > 0:13:42This here is not normal, so that's a bruise.
0:13:42 > 0:13:44OK.
0:13:45 > 0:13:49Although lots of people don't believe in contrecoup, that is...
0:13:49 > 0:13:51- Sorry, what's...? - Contrecoup, it means...
0:13:51 > 0:13:52So contrecoup is...
0:13:52 > 0:13:55You know in all these scans you see of boxers in slow motion,
0:13:55 > 0:13:58they go back? So it's not...
0:13:58 > 0:14:03the brain is in a hard box on a very small lollipop stick,
0:14:03 > 0:14:07- which is your spinal cord.- Mm-hm. - And it shakes about a lot.
0:14:07 > 0:14:10So you take the smack at the front, and the brain,
0:14:10 > 0:14:14the jelly inside it is still going bang, bang.
0:14:14 > 0:14:17So contrecoup means a hit on the other side. It's just French.
0:14:17 > 0:14:18- Right.- So...
0:14:18 > 0:14:19Ah, right.
0:14:19 > 0:14:22Yeah, contre, opposite, blow on the left side.
0:14:22 > 0:14:25We've taken the sedation right down, and the numbers are good,
0:14:25 > 0:14:29but they could be falsely good because we've got a CSF leak.
0:14:29 > 0:14:30Right, OK.
0:14:31 > 0:14:33But the numbers are good,
0:14:33 > 0:14:35- so we're going to keep the sedation off.- OK.
0:14:36 > 0:14:40- She's kind of moved her eye for me today.- Right.
0:14:40 > 0:14:43She kind of, when I was doing something mean to her.
0:14:43 > 0:14:47She doesn't really cough much when I put a suction cast in.
0:14:47 > 0:14:51- I've done a sample from her chest. She didn't cough much.- Right.
0:14:54 > 0:14:55Too early to say.
0:14:59 > 0:15:02We're not out of the woods yet. I'm sorry. We're not.
0:15:02 > 0:15:05OK. Thank you.
0:15:10 > 0:15:13Tracey had just qualified as a midwife,
0:15:13 > 0:15:18and I had just qualified as a fireman,
0:15:18 > 0:15:20and we met on a Christmas do.
0:15:20 > 0:15:22And it's so sort of cliched, you know,
0:15:22 > 0:15:26nurses and midwives on a night out and a load of firemen.
0:15:27 > 0:15:29That was 24 years ago.
0:15:30 > 0:15:33I love her to bits. We've got two sons.
0:15:35 > 0:15:36I don't think in all that time,
0:15:36 > 0:15:39we've never really had a cross word between us.
0:15:40 > 0:15:44Tracey always says that the night we met,
0:15:44 > 0:15:46she knew we were going to get married.
0:15:51 > 0:15:53We all make all these plans about, you know,
0:15:53 > 0:15:56what are you going to do for the weekend and next month
0:15:56 > 0:15:59and next year and next decade,
0:15:59 > 0:16:05but for hundreds, if not thousands of people up and down the country,
0:16:05 > 0:16:09those plans never really work out, because of just a random event.
0:16:13 > 0:16:18One split second decides everything.
0:16:18 > 0:16:20In one second...
0:16:22 > 0:16:23..that's it.
0:16:25 > 0:16:26Game over.
0:16:30 > 0:16:33I think we're more here to try and bring order
0:16:33 > 0:16:37to what is a completely disordered event that happens.
0:16:40 > 0:16:43- What noise?- A constant beep.
0:16:43 > 0:16:45I don't think she's going to wake up.
0:16:47 > 0:16:49I think she's going to be like this.
0:16:51 > 0:16:55There's nothing pharmacological keeping her asleep,
0:16:55 > 0:16:57but she was on a lot of sedation yesterday,
0:16:57 > 0:17:00but now she's on basically nothing,
0:17:00 > 0:17:05and she doesn't respond and her pupils are reacting,
0:17:05 > 0:17:07but she hasn't moved yet.
0:17:07 > 0:17:10Maybe I'm just being a bit premature. I hope I'm wrong.
0:17:15 > 0:17:18For those on the neurointensive care unit,
0:17:18 > 0:17:20life hangs in the balance.
0:17:20 > 0:17:23This morning, Mhairi's lost another patient.
0:17:24 > 0:17:27Hello. Dr De Souza's patient?
0:17:32 > 0:17:33Good morning, it's Mhairi Speirs.
0:17:33 > 0:17:36I am an ICU consultant at the West Wing of the John Radcliffe.
0:17:36 > 0:17:38May I discuss a death, please?
0:17:38 > 0:17:42Died at 3:33 this morning.
0:17:42 > 0:17:46Was on the normal post-op, in fact, the elective admission bed.
0:17:46 > 0:17:49Cardiac arrest. Call went out 15:53.
0:17:51 > 0:17:54Found unresponsive, gasping respiration.
0:17:54 > 0:17:57I saw him last week, actually, which makes it even worse.
0:17:57 > 0:18:01We did quite a lot to get him back, so...
0:18:04 > 0:18:07SHE SIGHS
0:18:09 > 0:18:10I don't know what you can say.
0:18:15 > 0:18:19For Mhairi and the staff of the NICU,
0:18:19 > 0:18:21death is an occupational hazard.
0:18:25 > 0:18:27But some days, it just gets to you
0:18:27 > 0:18:29when you've told five families in a row
0:18:29 > 0:18:31that their relative is not going to survive
0:18:31 > 0:18:34or you can't do anything else.
0:18:35 > 0:18:37I do go home and I'm quiet.
0:18:37 > 0:18:40I only live at the bottom of the road.
0:18:40 > 0:18:43So sometimes I will cycle home, and it's much better,
0:18:43 > 0:18:47but I sometimes drive here and you could probably do with
0:18:47 > 0:18:50a bit of extra time to forget everything as you go home.
0:18:51 > 0:18:53I mean, you can't....
0:18:57 > 0:18:59You know, some wee boy's just gone home,
0:18:59 > 0:19:01and his mum's not coming home tonight.
0:19:05 > 0:19:07Sharon?
0:19:07 > 0:19:08Sharon?
0:19:08 > 0:19:10Sharon?
0:19:10 > 0:19:11Come on, Sharon.
0:19:11 > 0:19:15Martin? Martin?
0:19:27 > 0:19:29Martin?
0:19:29 > 0:19:30I mean, we were fine this morning.
0:19:30 > 0:19:34We had so many beds, and now we don't have any beds.
0:19:34 > 0:19:39It just needs one really sick patient, bed 10,
0:19:39 > 0:19:41to concentrate us all day,
0:19:41 > 0:19:44and you worry about all the other patients, and then...
0:19:44 > 0:19:46How do you cope?
0:19:46 > 0:19:49How do you cope when you have so many things?
0:19:52 > 0:19:55You just have to, so that the relatives aren't upset.
0:19:59 > 0:20:01You just have to.
0:20:02 > 0:20:03Anyway.
0:20:06 > 0:20:07Time to go home.
0:20:07 > 0:20:10I'll just go and hand over to the night shift to make sure.
0:20:13 > 0:20:17It's been nearly a week since Tracey was in a head-on collision.
0:20:17 > 0:20:20There's growing concern that her lack of responses
0:20:20 > 0:20:24means she'll be in a coma for the long term.
0:20:33 > 0:20:36I carry the weight of every patient with me.
0:20:36 > 0:20:38And it's difficult.
0:20:41 > 0:20:44Because when it's good, like the kid this morning,
0:20:44 > 0:20:48it's fantastic, and you feel great
0:20:48 > 0:20:50and you feel like you've done something amazing.
0:20:50 > 0:20:52But when it's bad...
0:20:52 > 0:20:55you just feel horrendous.
0:21:00 > 0:21:01Yeah.
0:21:03 > 0:21:06It's a bit like being a manic depressive, I think.
0:21:06 > 0:21:09Neurosurgery is a bit like being mentally ill.
0:21:09 > 0:21:11HE LAUGHS
0:21:17 > 0:21:19Hello, stranger.
0:21:19 > 0:21:22All right? How is she?
0:21:22 > 0:21:27Tim sees one of Jay's regular patients, seven-year-old Charlie.
0:21:27 > 0:21:32If you hit me with that, who's going to do my operation?
0:21:32 > 0:21:38She's a frequent flyer, clocking up 22 procedures in seven years.
0:21:38 > 0:21:42Now she's back, suffering from acute headaches.
0:21:43 > 0:21:46So, am I not having an operation today?
0:21:46 > 0:21:47I don't think so, no.
0:21:47 > 0:21:51- So am I allowed something to eat? - Well, that's a very good question.
0:21:51 > 0:21:53Yeah, I think you can have something to eat.
0:21:53 > 0:21:54You've already had your dinner!
0:21:54 > 0:21:57Yeah, you've had your dinner > and everything.
0:21:58 > 0:22:01- Thank you. - CHARLIE LAUGHS
0:22:02 > 0:22:09- Just down the corridor, Jay visits Georgia in recovery.- Georgia?
0:22:09 > 0:22:11- Georgia?- My head hurts.
0:22:11 > 0:22:14Your head is sore, huh? It will get better, OK?
0:22:15 > 0:22:18Do you remember, we said it was going to be a bit sore for a bit?
0:22:18 > 0:22:20- Yes.- OK. Good girl, you're doing really good.
0:22:20 > 0:22:22Just wiggle your hands for me.
0:22:22 > 0:22:24And the other one. Yeah, good.
0:22:24 > 0:22:27And your toes. Oh, yeah. Good, good, good.
0:22:27 > 0:22:28Everything is done, all right?
0:22:28 > 0:22:30It will get better.
0:22:32 > 0:22:34It doesn't matter how much you explain it's going to be sore.
0:22:34 > 0:22:37Nobody really quite believes you until it happens.
0:22:37 > 0:22:40You have to get them as ready as you can.
0:22:40 > 0:22:43They're still always surprised by how sore it is.
0:22:44 > 0:22:47Which is a bit rubbish, but it will get better.
0:23:11 > 0:23:13Do you want beans?
0:23:13 > 0:23:16Or recycled vegetables?
0:23:16 > 0:23:17Er... Beans.
0:23:17 > 0:23:19Oh right, beans. Beans.
0:23:19 > 0:23:21Beans.
0:23:21 > 0:23:24Well, I normally cook on a Sunday night
0:23:24 > 0:23:27for a Monday night tea, because I'm normally on call on a Monday night.
0:23:27 > 0:23:29- Sit down. Have you washed your hands?- No.
0:23:29 > 0:23:31Could you wash your hands, please?
0:23:31 > 0:23:35So, yeah. No, I do like cooking. I like baking better.
0:23:35 > 0:23:37I like my time on a Sunday morning at the rugby club.
0:23:37 > 0:23:39Maybe it's just a chance to be bossy
0:23:39 > 0:23:41without the surgeons answering back to me.
0:23:41 > 0:23:43Right, pie.
0:23:43 > 0:23:46- Recycled pie. There you are. - Thank you.
0:23:46 > 0:23:48Not deep-fried.
0:23:48 > 0:23:49Not deep-fried?
0:23:51 > 0:23:54That's his genes. His genes. He's scorning his genes!
0:23:56 > 0:23:57I mean, my husband is a doctor,
0:23:57 > 0:23:59so I suppose we always talk to each other about it.
0:23:59 > 0:24:01In fact, you've got to remember you've got a 10-year-old.
0:24:01 > 0:24:04Sometimes you have completely inappropriate conversations
0:24:04 > 0:24:05over the dinner table, then...
0:24:05 > 0:24:08he dropped his knife and fork the other day and said,
0:24:08 > 0:24:09"I'd like to remind you I'm 10!"
0:24:09 > 0:24:11I don't need to be talking about penises.
0:24:11 > 0:24:13SHE LAUGHS
0:24:13 > 0:24:16Poor Duncan always has his tea on his own.
0:24:17 > 0:24:20Could always make him wear a hat and scrum.
0:24:20 > 0:24:23You know, the other day, he fell. He came, he tripped on the stairs
0:24:23 > 0:24:25coming out of the playroom and fell all the way across the ground.
0:24:25 > 0:24:29I said, "Oh, for goodness' sake, just get up," and he said,
0:24:29 > 0:24:32"If you were a proper mum, you would have been caring."
0:24:32 > 0:24:35But it's the same with any nurses' child.
0:24:35 > 0:24:36Unless their leg is hanging off,
0:24:36 > 0:24:38then you're not going to do anything about it.
0:24:38 > 0:24:41Like, I think he's got a broken finger just now,
0:24:41 > 0:24:43but we just strapped his fingers. He'll be fine.
0:24:43 > 0:24:45I mean, you have to just come in and keep going.
0:24:45 > 0:24:48I only live close to the hospital, so you haven't got time to unwind,
0:24:48 > 0:24:50so you've just got to come in and clean school shoes
0:24:50 > 0:24:54and put the dishwasher on and do the laundry and tidy up
0:24:54 > 0:24:58and get the schoolbag organised and all the things that mums do,
0:24:58 > 0:25:01whether they've just certified somebody dead or not.
0:25:09 > 0:25:12Shall we go in the treatment room?
0:25:12 > 0:25:13Yeah?
0:25:13 > 0:25:17Charlie's dwarfism affects every cell in her body.
0:25:17 > 0:25:19She has hydrocephalus.
0:25:19 > 0:25:22Fluid circulation in the brain has been disrupted,
0:25:22 > 0:25:25and the pressure in her head is rising.
0:25:25 > 0:25:28It's regulated by a drain called a shunt.
0:25:29 > 0:25:31You look all sleepy now.
0:25:31 > 0:25:32Did we wake you up?
0:25:34 > 0:25:35Did he wake you up?
0:25:39 > 0:25:41Please don't press too hard.
0:25:41 > 0:25:44OK. I'm not allowed to press too hard.
0:25:45 > 0:25:46Jay told me to.
0:25:47 > 0:25:49- No, he didn't.- He did!
0:25:49 > 0:25:51- He didn't!- Jay can do no wrong.
0:25:51 > 0:25:53Jay can do no wrong?
0:25:55 > 0:25:57- Ow.- Sorry, sorry, sorry.
0:25:57 > 0:26:01Can I hold this thing again?
0:26:01 > 0:26:03- You want to do it?- Yeah.- Yeah, OK.
0:26:03 > 0:26:06Tim is going to try to relieve Charlie's pain
0:26:06 > 0:26:10using a magnetic device to release the pressure in her shunt.
0:26:10 > 0:26:12Right, turn it that way. Keep going.
0:26:13 > 0:26:15- Good girl.- Keep going. A bit more.
0:26:16 > 0:26:19Brilliant. Now let it set.
0:26:24 > 0:26:25OK.
0:26:25 > 0:26:27Do you want to check it, feel it?
0:26:27 > 0:26:29- Does it feel all right?- Yeah.
0:26:29 > 0:26:30Excellent.
0:26:31 > 0:26:33All done, all done.
0:26:33 > 0:26:35Good girl.
0:26:35 > 0:26:37I said you could pull the scab off.
0:26:37 > 0:26:39- I didn't pull the scab off.- You did.
0:26:39 > 0:26:40No, I didn't! It's still there.
0:26:42 > 0:26:43See you.
0:26:48 > 0:26:52Tim's been a registrar for five years.
0:26:52 > 0:26:54It's a long apprenticeship before he can become
0:26:54 > 0:26:58a consultant neurosurgeon like Jay.
0:26:58 > 0:27:00You have to do your time.
0:27:00 > 0:27:04The general rules are, your boss has worked harder
0:27:04 > 0:27:08under worse conditions than you will ever do.
0:27:08 > 0:27:12And we work harder than the SHOs and the house officers
0:27:12 > 0:27:15and the medical students will ever work.
0:27:15 > 0:27:18So there's a very clear hierarchy.
0:27:18 > 0:27:22A registrar on call works long hours through the night,
0:27:22 > 0:27:25looking after all the wards and theatres.
0:27:26 > 0:27:29Tonight, Andy is the registrar on duty.
0:27:29 > 0:27:32The new Pirelli calendar, is that?
0:27:32 > 0:27:34I'm not joking.
0:27:34 > 0:27:36MACHINE BLEEPS
0:27:36 > 0:27:37- Hello.- Hiya.
0:27:37 > 0:27:40- Are you bed managing at the moment? - No, it's actually Kaya.
0:27:40 > 0:27:43- No, it's Binu. Binu. - Oh, it's Binu.
0:27:43 > 0:27:47Binu? Can I just quickly ask if you know what the bed state is?
0:27:47 > 0:27:49Have we got any space at the inn?
0:27:49 > 0:27:51Would you have any space on the ward
0:27:51 > 0:27:52if we had to admit anybody?
0:27:54 > 0:27:58- We can bring one emergency in. - We've got one bed.
0:27:58 > 0:28:01- That's empty, that bay, is it? - There's one patient in that bay.- OK.
0:28:01 > 0:28:03- Then we have a few beds.- OK. Is it staying open for the weekend?
0:28:03 > 0:28:05It is at the moment, yes.
0:28:05 > 0:28:07So it's always good when you're starting your shift,
0:28:07 > 0:28:09whether it's day, weekend or night shift,
0:28:09 > 0:28:11to know how many beds you've got to play with -
0:28:11 > 0:28:14ward beds, intensive care beds, paediatric beds,
0:28:14 > 0:28:17because even if something is an emergency,
0:28:17 > 0:28:19you may be tempted just to take them over
0:28:19 > 0:28:22and operate immediately and deal with the bed situation afterwards,
0:28:22 > 0:28:24but in a situation where it's not critical,
0:28:24 > 0:28:27you'll spend the next few hours on the phone trying to sell the patient
0:28:27 > 0:28:30to a different neurosurgical unit somewhere else in the British Isles.
0:28:30 > 0:28:32We have got staff to cover another...
0:28:32 > 0:28:36- One more acute admission. If the need arises.- Yes.
0:28:36 > 0:28:39- Yes, we have.- Great. Thank you.
0:28:45 > 0:28:47Don't know if you saw at the end of the ward,
0:28:47 > 0:28:49we had two resident police officers.
0:28:49 > 0:28:53It's not unusual to have members of our local constabulary on the ward.
0:28:53 > 0:28:56We do get a number of admissions with a forensic background.
0:28:56 > 0:28:59But it's relatively genteel in Oxford.
0:28:59 > 0:29:03We had, obviously, a lot of assaults in the London hospitals
0:29:03 > 0:29:05with firearms and knives,
0:29:05 > 0:29:10and Oxford is more of a Chinese burn type sort of place,
0:29:10 > 0:29:12or someone might accidentally misquote Shakespeare,
0:29:12 > 0:29:15but it tends not to be so heavy on shootings and stabbings.
0:29:21 > 0:29:23Our beds are at a tremendous premium,
0:29:23 > 0:29:27so when we have so few beds, we have to really be quite callous
0:29:27 > 0:29:31and have a think about who is going to benefit most
0:29:31 > 0:29:33from that degree of intervention.
0:29:33 > 0:29:35You know, she is unlikely to survive
0:29:35 > 0:29:39a period on an intensive care unit and neurosurgical procedure. OK.
0:29:39 > 0:29:42If the patient is unwell enough that they are going to deteriorate
0:29:42 > 0:29:46within the hour, then they are unlikely to do that well anyway.
0:29:46 > 0:29:49We are seen as the gatekeepers that always say no,
0:29:49 > 0:29:50so as a result, we're not liked,
0:29:50 > 0:29:52and I suspect if you looked up "hate" in the dictionary,
0:29:52 > 0:29:55you would either have a neurosurgeon or more specifically,
0:29:55 > 0:29:57perhaps, my picture next to it.
0:29:59 > 0:30:01There is one call that Andy can't refuse.
0:30:01 > 0:30:06A teenage boy admitted to his local A&E with amnesia.
0:30:08 > 0:30:11Was he confused before then, as well?
0:30:11 > 0:30:12What time was that?
0:30:14 > 0:30:17I thought you said he had been confused all morning, at school?
0:30:17 > 0:30:18Or...?
0:30:19 > 0:30:22By the way, could you ask your CT department if they could do
0:30:22 > 0:30:27coronal and surgical reconstructions on those images as well?
0:30:27 > 0:30:32If there was a great big tumour lying in the brainstem that's
0:30:32 > 0:30:35contributing to this, then I need to know that now.
0:30:35 > 0:30:36I do need to speak to Jay now.
0:30:36 > 0:30:39Would you mind putting me through to Mr Jayamohan?
0:30:39 > 0:30:40He's on call, isn't he?
0:30:40 > 0:30:43The number of times you're on call that you will need to ask
0:30:43 > 0:30:45one of the consultants who is on call with you,
0:30:45 > 0:30:48wake them up in the middle of the night and ask their advice.
0:30:48 > 0:30:50But if you reach a point where you need some
0:30:50 > 0:30:52senior input then so be it.
0:30:52 > 0:30:56Hi, it's Andy here. Is that Jay?
0:30:56 > 0:30:59I got a call just a few minutes ago from Horton A&E.
0:31:00 > 0:31:04They have got a 14-year-old boy, who went to school today,
0:31:04 > 0:31:07came back home after school and he has been confused.
0:31:07 > 0:31:10He can't remember what happened at school throughout the morning.
0:31:10 > 0:31:12There is a confounding story of him
0:31:12 > 0:31:15being hit in the head by a football at school.
0:31:15 > 0:31:17He has got gross hydrocephalus and it is clearly chronic.
0:31:17 > 0:31:19OK, thanks, Jay, cheers, bye.
0:31:21 > 0:31:25Adam's case is so serious that Jay has decided to come in
0:31:25 > 0:31:27and do the operation himself.
0:31:27 > 0:31:31That's the key for my locker, feel free to fish around in my pockets.
0:31:31 > 0:31:33- And you want your iPhone? - Yes, please.
0:31:33 > 0:31:34I will write you a good reference!
0:31:36 > 0:31:39Jay plans to pierce a hole far inside the brain,
0:31:39 > 0:31:42to release the build-up of fluid that is pressing
0:31:42 > 0:31:47dangerously on Adam's fornix, a crucial structure for memory.
0:31:47 > 0:31:50I need to be able to get the telescope into the right place,
0:31:50 > 0:31:53I then need to be able to see safely to be able to make the hole
0:31:53 > 0:31:56without damaging any of the other structures.
0:31:56 > 0:32:03- Finished yet, Jay?- She is trying to bring bloody Scottish malarkey.
0:32:03 > 0:32:07- Two albums, two albums. - That is brilliant.
0:32:07 > 0:32:10- These aren't Scottish! - They are all Scottish.
0:32:10 > 0:32:13That is why they are on there, the clue is in the title.
0:32:13 > 0:32:17- Wait, wait, wait. The Waterboys are Scottish?- Yeah, Scottish.- Are they?
0:32:17 > 0:32:19- Are the Proclaimers on there?- Yes.
0:32:19 > 0:32:23When I come back there had better be some better behaviour in here.
0:32:23 > 0:32:25D'you want a CD through, we have got one?
0:32:25 > 0:32:27No!
0:32:28 > 0:32:31Here is the thing with this operation.
0:32:31 > 0:32:34If it works, it is absolutely fantastic.
0:32:34 > 0:32:37It is great for the patient and, for us
0:32:37 > 0:32:39as surgical staff in particular, it is a really good
0:32:39 > 0:32:43view of anatomical parts of the brain that we do not normally see.
0:32:43 > 0:32:45So it is a very beautiful operation, if it works.
0:32:47 > 0:32:51If it doesn't, it's a real pig. But...it'll work.
0:32:53 > 0:32:55As Jay scrubs up for one operation,
0:32:55 > 0:32:57Andy admits another patient.
0:33:01 > 0:33:03A mother of two, Wai Fong,
0:33:03 > 0:33:06who collapsed suddenly with severe headaches.
0:33:08 > 0:33:13He consults the adult neurosurgeon on call about Wai's case.
0:33:13 > 0:33:14Fine. And she basically came into A&E
0:33:14 > 0:33:17because for the last couple of days she became diplopic
0:33:17 > 0:33:20on the back of a couple of weeks' vomiting, that was severe today.
0:33:20 > 0:33:23My feeling is that this is a massive high-grade glioma
0:33:23 > 0:33:25with lots of vasogenic oedema around it.
0:33:25 > 0:33:29Midline shift. It's in the left anterior frontal lobe.
0:33:29 > 0:33:31Wai has a massive tumour
0:33:31 > 0:33:35that has spread right across the two hemispheres of her brain.
0:33:35 > 0:33:38This is really bad news, this is a tumour
0:33:38 > 0:33:40that she is not going to get on top of.
0:33:40 > 0:33:43This is a rapid decline.
0:33:43 > 0:33:45The art, I think, is not in
0:33:45 > 0:33:48working out what is wrong with the patient
0:33:48 > 0:33:50but it's working out what to do.
0:33:50 > 0:33:53What is right for one person may not be right for the next one.
0:33:54 > 0:33:58I think I may have just stolen that line from Diff'rent Strokes!
0:33:58 > 0:33:59Oh, Dan!
0:34:01 > 0:34:04While you're here, mate, you couldn't unlock it
0:34:04 > 0:34:07and stick it on to my speaker so we could have a few tunes, could you?
0:34:08 > 0:34:12There is an on-switch and underneath there's a jack.
0:34:14 > 0:34:18The sense of achievement is overwhelming, actually, doing this.
0:34:18 > 0:34:21This is the neurosurgeon of the future.
0:34:21 > 0:34:23You can't plug it in.
0:34:23 > 0:34:25MUSIC PLAYS
0:34:25 > 0:34:27Addicted To Bass, that'd be all right, yeah.
0:34:27 > 0:34:28That'll wake us up a bit.
0:34:33 > 0:34:36I feel uncomfortable with that music.
0:34:36 > 0:34:38It's like walking into the supermarket
0:34:38 > 0:34:40and realising you have no pants on.
0:34:41 > 0:34:45You want the thing? Don't squash it. Don't squash it.
0:34:45 > 0:34:48Andy must warn Wai's husband
0:34:48 > 0:34:51and their friend of the dangers of operating.
0:34:51 > 0:34:53There is a chance that she might not wake up.
0:34:53 > 0:34:55And there is a chance, of course,
0:34:55 > 0:34:57that she might not get through the operation.
0:35:02 > 0:35:05I think he is just very, very upset about this.
0:35:07 > 0:35:10- Shall we put him in a bed? - He has collapsed.
0:35:10 > 0:35:16- It's all right, he has got a pulse. What's his name?- His name is Jimmy.
0:35:16 > 0:35:20Jimmy, Jimmy, you all right?
0:35:22 > 0:35:28God. Is it OK? This guy has collapsed. I need some help now, OK?
0:35:30 > 0:35:32Let's just get a monitor on him first.
0:35:39 > 0:35:41All right, I think he will be OK.
0:35:44 > 0:35:47Yeah, I think he just needs some oxygen and some fluids.
0:35:48 > 0:35:51He became very sweaty, but he's not really become
0:35:51 > 0:35:52particularly tachycardic either.
0:35:52 > 0:35:56He has had a decent pulse. What did you say his BM is?
0:35:56 > 0:35:58Right, OK.
0:35:58 > 0:36:00Yes, he has been responding.
0:36:03 > 0:36:07Wai and her husband now occupy two beds in adjoining rooms.
0:36:10 > 0:36:14Are you ready to take trochlear out? Take it out, thanks.
0:36:14 > 0:36:17To release the pressure in Adam's brain, Jay must pierce
0:36:17 > 0:36:22a hole in the ventricle where the cerebrospinal fluid is trapped.
0:36:22 > 0:36:23That is us now in the ventricles
0:36:23 > 0:36:26in the middle of the fluid spaces of the brain.
0:36:26 > 0:36:30Right between the red dot at the top and the red line at the bottom,
0:36:30 > 0:36:33is our landing pad.
0:36:37 > 0:36:38It's OK at the moment, thanks.
0:36:40 > 0:36:43We need to obviously be very careful about where we make our hole,
0:36:43 > 0:36:45we don't want to damage either the basilar artery
0:36:45 > 0:36:46or the pituitary gland.
0:36:50 > 0:36:55Just stretching... Now getting a little tiny dot of a hole.
0:36:55 > 0:36:59Just trying to make it open up by itself, so kind of passively
0:36:59 > 0:37:03trying to get it to open up rather than having to tear a hole.
0:37:03 > 0:37:06This is one of my favourite operations, I absolutely love them.
0:37:09 > 0:37:12Because this is real hallowed ground for neurosurgeons, this area.
0:37:12 > 0:37:18This is stuff which, 30 years ago operating in this region was
0:37:18 > 0:37:22one of the most dangerous operations a neurosurgeon would do.
0:37:23 > 0:37:26And now, I won't say we can do it with impunity
0:37:26 > 0:37:29because that would be madness, but it wasn't quite a death sentence
0:37:29 > 0:37:33but it was highly, highly dangerous for the patient.
0:37:34 > 0:37:37Jay is now precariously close to the fornix,
0:37:37 > 0:37:40where memories are made and stored.
0:37:40 > 0:37:43This is the most intricate part of the procedure.
0:37:43 > 0:37:45That is the fornix,
0:37:45 > 0:37:48that structure there which sort of makes the wall of that hole.
0:37:48 > 0:37:51We have got to watch that because if you damage that you can
0:37:51 > 0:37:55severely impair their ability to make new memories.
0:37:55 > 0:37:58Clearly, in a schoolkid... Well, it is important for anyone,
0:37:58 > 0:38:00but someone who wants to learn.
0:38:10 > 0:38:13Andy knows that because Wai's tumour is so huge,
0:38:13 > 0:38:16he will only be able to remove a third of it at best.
0:38:16 > 0:38:19And he will be taking healthy brain tissue with it.
0:38:22 > 0:38:23It's an enormous tumour,
0:38:23 > 0:38:26it's spread from the left to the right side of the brain.
0:38:26 > 0:38:28It has crossed the midline.
0:38:30 > 0:38:34Like Adam, the part of Wai's brain affected includes her fornix.
0:38:35 > 0:38:39But in Wai's case, it may have to be sacrificed to prolong her life.
0:38:42 > 0:38:46I would like to think that this procedure was enough to make
0:38:46 > 0:38:49her alert, more orientated
0:38:49 > 0:38:53and perhaps go home for a few weeks, maybe a few months.
0:38:58 > 0:39:00Until Wai comes round, it is
0:39:00 > 0:39:04impossible to know the extent of her memory loss.
0:39:04 > 0:39:09Even though her prognosis is pretty abysmal, I can't stand by
0:39:09 > 0:39:14and let her deteriorate because of something I can do something about.
0:39:27 > 0:39:28There are operations where you think,
0:39:28 > 0:39:31"Oh, my word", and there are operations where you think,
0:39:31 > 0:39:34"Yeah, that sounds like it's going to be good."
0:39:34 > 0:39:37The other good bit about this operation
0:39:37 > 0:39:41is it has a very good chance of fixing him for life.
0:39:44 > 0:39:49And whatever people tell you, you can't do any job that is
0:39:49 > 0:39:53constantly about being knocked down about disaster and death.
0:39:53 > 0:39:58You have got to have some successes and some nice outcomes.
0:39:58 > 0:40:00And these are the sort of operations
0:40:00 > 0:40:02where you can have a really good outcome
0:40:02 > 0:40:06in a short period of time and send people home, essentially cured.
0:40:12 > 0:40:14Thank you.
0:40:15 > 0:40:16See you later, guys.
0:40:16 > 0:40:18Are you running?
0:40:18 > 0:40:23Uh? I am done. I just do my operations and run, man.
0:40:23 > 0:40:25I'm the Scarlet Pimpernel.
0:40:27 > 0:40:33After five anxious hours, Adam's parents visit their son in recovery.
0:40:35 > 0:40:40How you doing? Eh, you all right?
0:40:40 > 0:40:43- Yeah.- All finished now.
0:40:45 > 0:40:47- You should be all better. - You all right?
0:40:47 > 0:40:49Yeah, he says he doesn't know whether he's got a headache or
0:40:49 > 0:40:52- if it's just the top of his head is sore.- Probably a bit of both.
0:40:52 > 0:40:54You have just had an operation on your brain.
0:40:54 > 0:40:56Anyway, I think we have fixed you now, OK?
0:40:56 > 0:40:59We're going to let you rest up and see how you go.
0:41:19 > 0:41:23Back on the NICU, Tracey has been in a deep coma for almost a week
0:41:23 > 0:41:25and is still not responding.
0:41:30 > 0:41:33We'll have been married 24 years this year.
0:41:35 > 0:41:38And I just think about all the good times we have had together and
0:41:38 > 0:41:43all the things that we have still got planned to do, and that we will do.
0:41:44 > 0:41:45You know, you just...
0:41:49 > 0:41:50Tracey's my soul mate.
0:41:53 > 0:41:55I just love her so much.
0:41:58 > 0:41:59Tracey will pull through this.
0:41:59 > 0:42:01And all the things that we have got planned to do,
0:42:01 > 0:42:04we will still be able to do.
0:42:04 > 0:42:07We may have to buy in for a bit, but nothing is going to change.
0:42:09 > 0:42:11Nothing is going to change.
0:42:23 > 0:42:25We can't undo brain damage.
0:42:25 > 0:42:29We can rewire, we can prevent a secondary injury
0:42:29 > 0:42:32but we can't undo what happened in the morning.
0:42:34 > 0:42:40And if she's left like this, worse than death,
0:42:40 > 0:42:42she is left like this for ever.
0:43:02 > 0:43:04It is the end of a long night on call,
0:43:04 > 0:43:07and Andy is finally going home.
0:43:10 > 0:43:13I have no idea what is going on with me.
0:43:13 > 0:43:17His patient, Wai, has woken up confused after her operation.
0:43:22 > 0:43:25Erm, I'm from China and my husband is from Hong Kong.
0:43:27 > 0:43:29We have two daughters, we met here.
0:43:29 > 0:43:37My two daughters, one is 12, one is ten.
0:43:38 > 0:43:40They both are in grammar school.
0:43:42 > 0:43:45I am quite proud of them.
0:43:49 > 0:43:55I don't know what is going on with myself, to be honest.
0:43:57 > 0:44:02When I wake up, all I noticed was I have got a scar on my head.
0:44:04 > 0:44:08I think probably I've got a tumour inside my head.
0:44:08 > 0:44:09Did I?
0:44:11 > 0:44:12- BEHIND CAMERA:- Yeah.
0:44:15 > 0:44:18Why I have a tumour inside my head?
0:44:20 > 0:44:24The operation has given Wai some precious extra time
0:44:24 > 0:44:27with her daughters and husband, who's now recovered.
0:44:32 > 0:44:35On the NICU, there's finally a breakthrough
0:44:35 > 0:44:38with one of Mhairi's coma patients.
0:44:38 > 0:44:40Hello, Mr Coates. How are you today?
0:44:40 > 0:44:42Martin? Hello, how are you?
0:44:42 > 0:44:45You're doing really well.
0:44:45 > 0:44:47Opened his eyes. Yeah. Hello!
0:44:47 > 0:44:49Great! OK.
0:44:49 > 0:44:53The immunoglobulins and the methylprednisolone
0:44:53 > 0:44:54is now starting to work.
0:44:54 > 0:44:57So he's six days since that was started.
0:44:57 > 0:44:59It finished two days ago, yeah.
0:44:59 > 0:45:01So it's starting to work, which is good.
0:45:01 > 0:45:04So the antibiotics were the right thing,
0:45:04 > 0:45:06and he's much more awake.
0:45:27 > 0:45:29- TV:- 'I was already a blood-sucking parasite.
0:45:29 > 0:45:33- 'All I needed was a briefcase! - Have a great afternoon!'
0:45:34 > 0:45:37CHARLIE GROANS
0:45:41 > 0:45:43CHARLIE GROANS
0:45:43 > 0:45:46Charlie's headaches are getting worse.
0:45:46 > 0:45:49A warning sign of a dangerous build-up of cerebrospinal fluid.
0:45:54 > 0:45:57Jay wants to operate as soon as possible.
0:45:58 > 0:46:00It'll be probably early afternoon.
0:46:00 > 0:46:02- That's fine.- She'll be on the list.
0:46:07 > 0:46:09Lisa's got some good news.
0:46:09 > 0:46:11Martin's medication is having an impact.
0:46:11 > 0:46:13Hi, lovey!
0:46:14 > 0:46:15Hi!
0:46:15 > 0:46:18Hello! Aw!
0:46:20 > 0:46:21Hi, darling!
0:46:25 > 0:46:26Can you feel my cold hands?
0:46:28 > 0:46:31Hey, can you squeeze me?
0:46:32 > 0:46:35Oh, that's lovely! Thank you!
0:46:35 > 0:46:37Can you look at me?
0:46:37 > 0:46:40Aw, hi! Can you see me?
0:46:41 > 0:46:45Give me a squeeze if you can see me. Oh!
0:46:46 > 0:46:49I did my hair and make-up today for you. Cos you're waking up.
0:46:51 > 0:46:53I didn't want to look scary.
0:46:54 > 0:46:56Oh, love, it's all right.
0:46:56 > 0:46:59The doctors expect you to recover.
0:46:59 > 0:47:02They expect you to get your movement back.
0:47:02 > 0:47:04It just might take some time.
0:47:05 > 0:47:07- Aw! - SHE KISSES HIS HAND
0:47:11 > 0:47:12I love you.
0:47:15 > 0:47:17Open your eyes, darling.
0:47:17 > 0:47:21It's me. It's John. Open your eyes.
0:47:21 > 0:47:24Open your eyes.
0:47:28 > 0:47:30The doctors here have done all they can
0:47:30 > 0:47:32to help Tracey recover,
0:47:32 > 0:47:34but her condition isn't improving.
0:47:34 > 0:47:37Open your eyes, darling. It's me.
0:47:37 > 0:47:40It's time to move her to a local hospital
0:47:40 > 0:47:42for less invasive therapy.
0:47:46 > 0:47:49Mhairi calls John in to break the news.
0:47:49 > 0:47:54She hasn't made as much neurological recovery
0:47:54 > 0:47:57as we might have expected.
0:47:57 > 0:47:59She opens her eyes.
0:47:59 > 0:48:02- I know yesterday, you thought she was trying to speak to you.- Yeah.
0:48:02 > 0:48:07Family members often see more than we actually see.
0:48:07 > 0:48:09I think it's wishful thinking, as well.
0:48:09 > 0:48:13You just hope that it's not as bad as you think.
0:48:13 > 0:48:16I've tried to stay as positive as I can,
0:48:16 > 0:48:18but I can tell that you would expect to see more.
0:48:21 > 0:48:24I hoped we would see more.
0:48:24 > 0:48:25But from the word go,
0:48:25 > 0:48:28and I can't ever take away your hope at the beginning,
0:48:28 > 0:48:30but what was worrying us at the beginning
0:48:30 > 0:48:34was that she was deeply unconscious at scene.
0:48:34 > 0:48:37Um, it's only two weeks.
0:48:37 > 0:48:39I know it seems like a lifetime for you,
0:48:39 > 0:48:42but it's too early for us to really see.
0:48:42 > 0:48:45I mean, the next step is going to be for her and you
0:48:45 > 0:48:47getting her closer to home.
0:48:47 > 0:48:49But this is the normal...
0:48:49 > 0:48:52what we would do when the patient doesn't need
0:48:52 > 0:48:54the specialist care that we give.
0:48:54 > 0:48:56Things move on and, you know,
0:48:56 > 0:49:01this is just sort of a moment in time and it's a long journey.
0:49:01 > 0:49:03And we're just at the start of it.
0:49:03 > 0:49:05And, you know, we'll get there.
0:49:12 > 0:49:15I think he knows. He's been really cheery from the word go.
0:49:15 > 0:49:17But, you know, if she's like this
0:49:17 > 0:49:19for the rest of her life, she's only 50.
0:49:21 > 0:49:23That's a...
0:49:23 > 0:49:26damning lifestyle for him as well as her.
0:49:26 > 0:49:29He's going to be visiting her for ever.
0:49:31 > 0:49:35Sometimes, you always just take the bad. Tell them the bad stuff.
0:49:37 > 0:49:40But if you tell them the bad stuff first, then...
0:49:41 > 0:49:44Then I want them to go home...
0:49:44 > 0:49:47Somebody said to Claire the other day,
0:49:47 > 0:49:49"That doctor was wrong. This patient is awake."
0:49:49 > 0:49:51Great. I want to be wrong.
0:49:53 > 0:49:56But if nobody ever told them just how bad it could be...
0:49:59 > 0:50:02And if I'm the person who tells them that and then they say,
0:50:02 > 0:50:04"Well, she didn't know..."
0:50:04 > 0:50:05There's sometimes I am right.
0:50:09 > 0:50:11And you can remember all the ones you've been right about.
0:50:11 > 0:50:12The ones that have died.
0:50:17 > 0:50:18I hope it's never me.
0:50:18 > 0:50:20I hope it's never my family member.
0:50:23 > 0:50:24But you don't know.
0:50:35 > 0:50:39Will I ever get my Tracey back? I don't know.
0:50:39 > 0:50:41I don't know what I'll do without her,
0:50:41 > 0:50:43but I need to be there for my sons.
0:50:43 > 0:50:46I need to be strong for Tracey. I need to be there for her.
0:50:49 > 0:50:51The future for Tracey is uncertain,
0:50:51 > 0:50:53but John lives in hope for her recovery.
0:51:08 > 0:51:09Yeah, this is the right size!
0:51:09 > 0:51:13- That's the perfect size, isn't it? - I'm a bigger baby.
0:51:13 > 0:51:16'I saw Charlie on Saturday. She said, "Ooh, I like your trainers!'
0:51:16 > 0:51:18"Where did you get your jeans from?"
0:51:18 > 0:51:20I said, "Oh, do you think I've lost weight?"
0:51:20 > 0:51:23She looked at me and she went, "Nah, not really."
0:51:25 > 0:51:27Very depressing when your child tells you that.
0:51:30 > 0:51:33Jay's been looking after Charlie since she was born.
0:51:37 > 0:51:41This will be her 23rd procedure.
0:51:41 > 0:51:42Down here somewhere.
0:51:42 > 0:51:45Here we go! Sprint finish!
0:51:45 > 0:51:49Oh, are you tired now, Charlie? All that running?
0:51:49 > 0:51:51Come on then, doodles.
0:51:51 > 0:51:52Good girl!
0:51:55 > 0:51:57Need some more scrub, please.
0:51:57 > 0:52:01You can give Andy the leftovers in that one. He can use that.
0:52:01 > 0:52:04Andy's assisting Jay with Charlie's operation.
0:52:04 > 0:52:08It's always a bit disheartening when you get the same people in.
0:52:08 > 0:52:11There's that kind of depression, isn't there?
0:52:11 > 0:52:14When you say, "Charlie's back in," and everyone goes, "Oh..."
0:52:14 > 0:52:15And the anaesthetist goes,
0:52:15 > 0:52:18"Oh, Charlie again? Why can't you fix her?"
0:52:19 > 0:52:23The shunt, a plastic pipe that drains the CSF fluid,
0:52:23 > 0:52:25is malfunctioning.
0:52:25 > 0:52:30Jay needs to work out what's gone wrong and try to repair it.
0:52:30 > 0:52:33So the end is full of brain and crud.
0:52:33 > 0:52:35Just watch your sucker.
0:52:35 > 0:52:37If it's touching my thing, you'll make a circuit.
0:52:37 > 0:52:42A lot of the time, it's actually just unexplainable bad luck,
0:52:42 > 0:52:44why these things go wrong.
0:52:44 > 0:52:47But shunts go wrong more than just about anything else we do.
0:52:49 > 0:52:52And, guaranteed, you're going to have shunt disasters.
0:52:52 > 0:52:56You're going to have people who get infected, people who get blocked.
0:52:56 > 0:53:00As Jay tries to remove the blocked shunt,
0:53:00 > 0:53:03he finds it's entwined with Charlie's blood vessels.
0:53:03 > 0:53:07I'm worried that it's going to poke a vessel.
0:53:07 > 0:53:10We've already got some bleeding there now.
0:53:10 > 0:53:12HE TUTS Shite!
0:53:16 > 0:53:18Finished yet, Jay?
0:53:18 > 0:53:21No, it's stuck right the way through the hole,
0:53:21 > 0:53:24so even though we're burning what's in the centre,
0:53:24 > 0:53:27through the actual thickness of the tubing,
0:53:27 > 0:53:29it's stuck in those bits.
0:53:29 > 0:53:31They're quite big vessels in there.
0:53:31 > 0:53:34There, you can see it's wrapped around it.
0:53:34 > 0:53:36Like a boa constrictor.
0:53:36 > 0:53:38Come on, you!
0:53:39 > 0:53:42With the mood I'm in,
0:53:42 > 0:53:44Rage Against the Shunt!
0:53:44 > 0:53:48I can bipolar it under direct vision now, cos it's so close.
0:53:48 > 0:53:50So I need a bipolar, please.
0:53:50 > 0:53:53Can we turn it down to two, but stand by to turn it up.
0:53:53 > 0:53:55I need the bipolar pedal. Is it back on?
0:53:55 > 0:53:57Am I still using the normal bipolar pedal?
0:53:57 > 0:53:59- Yes.- Thanks.
0:53:59 > 0:54:01Suction, please.
0:54:05 > 0:54:07OK, Andy, can you see what I'm doing there?
0:54:07 > 0:54:11- Yeah.- Bits stuck on the end there. - Yeah.
0:54:11 > 0:54:14- As it comes through, you will see it.- Up to six, please, bipolar.
0:54:20 > 0:54:22Hold it, hold it, hold it!
0:54:22 > 0:54:24Hold it really carefully there.
0:54:29 > 0:54:31Right, I need some normal scissors. Oh, got it.
0:54:34 > 0:54:37Finally, Jay removes the blocked shunt
0:54:37 > 0:54:40that's been giving Charlie so much trouble.
0:54:40 > 0:54:43Beautiful! Local, thank you.
0:54:43 > 0:54:46- I think we should probably do a little hair-wash.- Yeah.
0:54:47 > 0:54:50Right, thanks, super troops! I hopefully won't see you again.
0:54:50 > 0:54:52We'll see how she's doing.
0:54:52 > 0:54:55'Everyone who knows me says I'm a grumpy git,
0:54:55 > 0:54:59'but work makes me happy, because I feel like I've done something good.'
0:54:59 > 0:55:01Best job ever!
0:55:03 > 0:55:05Without doubt. There's nothing else that comes close.
0:55:05 > 0:55:07Great, OK.
0:55:07 > 0:55:10There should be no real problems.
0:55:10 > 0:55:13It's a bit...like that it's all right, yeah?
0:55:13 > 0:55:14Yeah, yeah. Absolutely fine. Good!
0:55:14 > 0:55:17- Hi, there! How are you? - I'm fine.
0:55:17 > 0:55:18Good, good.
0:55:19 > 0:55:21Where is he?
0:55:21 > 0:55:24It's a week since Martin first opened his eyes
0:55:24 > 0:55:27and started to react consciously.
0:55:30 > 0:55:32Can they...can they turn your voice..?
0:55:34 > 0:55:37- Shall we ask if they can turn Daddy's voice on?- Yeah.
0:55:37 > 0:55:40Would you like him to have some sound?
0:55:41 > 0:55:44Oh, this is a special trick, this is!
0:55:44 > 0:55:49- Dad is in his nightgown.- He is!
0:55:49 > 0:55:53I think that means they washed him and they changed his gown.
0:55:53 > 0:55:55- HE MOUTHS - Every day he gets washed,
0:55:55 > 0:55:58and they put a fresh gown on him
0:55:58 > 0:56:00so he looks handsome.
0:56:01 > 0:56:04It's his evening gown.
0:56:04 > 0:56:05Hospital fashion.
0:56:07 > 0:56:09- NURSE:- Try it?
0:56:09 > 0:56:10Hello!
0:56:10 > 0:56:13Martin Coates, BBC! THEY LAUGH
0:56:13 > 0:56:16SHE GIGGLES
0:56:16 > 0:56:18That's all right, eh?
0:56:18 > 0:56:25It is Thursday 21st June, 2012.
0:56:25 > 0:56:28Good night! SHE GIGGLES
0:56:31 > 0:56:33- Oh, I love you!- Love you too.
0:56:33 > 0:56:35Oh, it's good to hear you talking.
0:56:35 > 0:56:37I did really well.
0:56:37 > 0:56:40I sat up. I didn't fall over.
0:56:40 > 0:56:43I can hold myself up.
0:56:43 > 0:56:45I can feel myself working.
0:56:45 > 0:56:50It's going to be a lot of hard work, but once you get into rehab...
0:56:50 > 0:56:52Honey, don't pull on the wire.
0:56:52 > 0:56:54- Oh, sorry, Dad! - Do you know what I mean?
0:56:54 > 0:56:58- Yeah, well, logically... - I'm so close.- I know, I know.
0:56:58 > 0:57:01- While you were sedated, could you hear me?- Yeah.
0:57:01 > 0:57:03You could hear me when you were sedated?
0:57:03 > 0:57:05So all the time I was talking to you...
0:57:05 > 0:57:08Yeah, I remember you going, "Marty, it's Lisa.
0:57:08 > 0:57:11- "Can you hear me?"- Oh, my God!
0:57:11 > 0:57:12"Squeeze my..."
0:57:12 > 0:57:16Hand! I would say that every day!
0:57:17 > 0:57:20And I'd squeeze it.
0:57:20 > 0:57:21Or try to.
0:57:21 > 0:57:23- Aw!- I don't know if I did.
0:57:23 > 0:57:26You couldn't open your eyes, though, could you?
0:57:26 > 0:57:29You were awake, you couldn't open your eyes.
0:57:29 > 0:57:31I was just in a dream world.
0:57:31 > 0:57:34Look at you. Now you're awake. You're alive.
0:57:34 > 0:57:37- Yes.- And you're getting your movement back.
0:57:37 > 0:57:39And you're going to walk again.
0:57:39 > 0:57:41- MHAIRI:- 'It is brilliant when the patients come back.
0:57:41 > 0:57:44'When Martin woke up, that was great.'
0:57:44 > 0:57:46Every one of us is so cocooned in your own wee world,
0:57:46 > 0:57:51you don't think just how precious that world is.
0:57:51 > 0:57:52You think you're invincible.
0:57:54 > 0:57:57Charlie may be a frequent flyer,
0:57:57 > 0:57:59but for now, she's back to her old self.
0:58:01 > 0:58:02Helicopters!
0:58:05 > 0:58:09Six months on, Martin is well on the road to a full recovery.
0:58:12 > 0:58:14It's so lovely to see.
0:58:46 > 0:58:49Subtitles by Red Bee Media Ltd