Emergency Brain Doctors

This programme contains scenes which some viewers may find upsetting.

An amazing lump of blancmange that weighs about a kilo.

The human brain has 100 billion neurons,

which makes it the most powerful learning tool in the world.

Your entire person is encapsulated in that little blob of blancmange.

Jay Jayamohan is a senior paediatric neurosurgeon

at the John Radcliffe Hospital in Oxford.

He is part of an almost 100-strong team of consultants

who deal with every conceivable problem of the brain.

We are making life-and-death decisions.

One split second decides everything.

Each year, they perform almost 4,500 operations.

You're concentrating constantly. Is it in the right place?

Stop any bleeding.

So you're already in that mindset of think, think, think, think, think.

Cutting-edge procedures that carry high risk.

It can be a bit like walking on a tightrope in very high winds.

You could fall off and die.

Their interventions can mean the difference between life and death.

You've got to respect the organ.

You've got to respect the fact that what you do to it

can have huge implications for the patient.

The John Radcliffe Hospital

is Oxfordshire's main accident and emergency centre.

PHONE RINGS

Hello, neurosurgery?

What's the story?

-Do you want one?

-No.

All right, I'll come down. OK. Bye.

I've got to go to A&E.

Neuro registrar Tim Lawrence is on call.

He's overseeing the wards and theatres

in the neuroscience department.

I usually walk through the door with a bit of trepidation,

because you don't know what's happening.

You know that things can go wrong very, very quickly,

and if you haven't prepared yourself for the eventualities,

then you'll come unstuck.

So there has to be a small amount of fear.

I think that's probably fairly healthy.

Hello, Tim Lawrence, neurosurgery?

I can't hold on. I can't hold on one moment, sorry.

He also deals with A&E patients

who come through the door with head injuries.

Let's get blocks on. Alex, start doing primary survey, please, ASAP.

So, head looks smashed...

The patient, Tracey, has been unconscious for over an hour,

and there's fear of extensive brain damage.

Decompress the chest on the left-hand side.

Was there anything out of that drain, guys?

-No blood.

-No blood at all?

The patient's been involved in a bad car accident.

Conscious level is very bad. We think it's a primary head injury.

Watch your hands. Chest X-ray about to take place.

Pelvis looks fine on chest X-ray. No long bone.

Tracey, a midwife and a mum with two grown-up sons,

was out with her husband when their car crashed.

We need to know what's going on with her.

-Yeah, yeah, let's get a head scan.

-Let's just get her moving now.

Let's just get her into CP. OK?

A scan will help Tim decide on the best treatment.

'You listen to what information you have,

'scans you have to look at, make a decision

'about how life-threatening the condition is

'and in what sort of timescale

'that condition is life-threatening for the patient.'

Ready, steady, slide.

'And sometimes you have a case where you have to drop everything else,

'take that patient straight to theatre.'

Kerry, it's Tim. Is Sister there?

Well, I need to speak to her pretty urgently.

I need to know if there's space in theatre now.

I'm just with a patient in the scanner at the moment.

If we could just hold Theatre 11 until I am absolutely clear

I'm not bringing this patient, that would be great. Don't let...

Fine. I'll let you know.

The scan reveals a major bleed

that's bruised and swollen Tracey's brain,

cutting off the vital supply of oxygen.

There's nothing Tim can do until the swelling abates.

There's nothing on the scan that we're going to operate on.

The question is how we manage her from here,

and I suppose it's going to be ICP monitor and brain...

Yeah, yeah.

Yeah, in a convertible sports car that's been T-boned.

I think I'm going to stick in a pressure monitor

and I expect her pressures to be through the roof,

and then talk to the family about brainstem testing.

Nothing else for theatre at the moment, no.

There's another trauma that came with this one,

so the other passenger who's just come in,

so we'll see what happens with that, but nothing else for theatre.

Great. Thanks, Orlando. Cheers. Bye.

Hello?

Yeah, it's gone nuts, yeah. HE LAUGHS

The neuroscience department looks after over 3,000 patients a year.

Adult and paediatric wards function side by side,

with theatres on standby 24/7.

Jay Jayamohan is one of four paediatric neurosurgeons at the hospital.

I keep saying that because I met her first, antenatally.

He begins his day with the morning ward round.

So you're going to pressure monitor to kick off.

-And then you can do Jack.

-You do the pressure monitor, then I'll do Jack.

-Yeah.

-Then your guy will be in, hopefully, by then.

-And then Abbey after that?

-Yeah.

-OK.

BABY CRIES

-He's looking very well, isn't he?

-He's had a good discussion with you.

Yes.

Across the way, at the neurointensive care unit,

Tim's handing over to the day shift.

That's a bit worrying, isn't it?

Where's the patient?

The NICU is where the most critical patients come

for round-the-clock care.

This week, it's the domain of neuroanaesthetic consultant Mhairi Speirs.

Back to my favourite occupation of filing!

-Yes, we've got to stay close, Mhairi.

-Oh!

SHE LAUGHS

All my Christmases come at once!

Good morning.

This is the ward round. We're just going to talk about you, OK?

Do you know where you are?

No, you're in Oxford.

Tracey has now been sedated and moved to neurointensive care.

So, Tracey.

Tracey Lake.

GCS4 at the scene, fixed pupils at the scene.

Her scan shows traumatic subarachnoid haemorrhage.

She's got C2 lateral mass fracture and multiple left-sided rib fractures

and some right-sided rib fractures.

Left-sided lung contusions, bilateral chest drains.

She'll probably survive, but it's a severe injury.

We spoke to cardiac yesterday. Bianca spoke to them.

They don't want to fix the ribs unless she can't wean,

which we haven't tried yet, or she's got a lot of pain.

But let's scan her, and then see what her head looks like,

because that will determine her weaning.

Tracey's level of consciousness must be assessed

before she can be weaned off the ventilator.

Now, can we ask James to attack a shunt...?

Before going to theatre, Jay checks on his patient.

Hello, hello. You all right?

Very leopard-y, tiger-y...

14-year-old Georgia has swelling

where the brain and spinal cord meet.

It's affecting her mobility and causing a lot of pain.

So, about 45 minutes or so, OK?

-See you later, guys. BOTH:

-See you.

It's what you do in Liverpool if you hear someone running behind you.

You start jogging.

Jay has spent 16 years becoming a senior paediatric neurosurgeon.

He's done thousands of operations and countless procedures.

Theatre is his second home.

Ah, whose is this speaker?

-It's mine.

-Can I plug it in?

And music keeps him going.

It's shuffle.

It's just random, man.

They're both for the larger gentleman.

Maybe I haven't been sticking to my diet as strictly as I should be.

Been going to the gym a lot.

And I did lose some weight.

Then I went on holiday, and it all just piled back on again.

I did end up after the gym, after my dinner,

having home-made banana cake with Nutella on it. Mmm.

But I don't think it helps me lose weight.

J will open the back of Georgia's neck

to make more space for the junction

between the base of the brain and the spinal cord.

That's her spinal cord.

All those little blood vessels are feeding the spinal cord.

We don't want to injure them.

These big fat chubbers here, those are the cerebellar tonsils.

OK, so we want to release the compression off of there.

We want to shrink them down a little bit.

They are quite big and pushing quite hard

onto the junction of the spinal cord and brain.

You can see these have gone pale. I've buzzed them.

And as I buzz them with the coagulation,

they actually shrink a little bit.

Oh, yeah. So we've got a flow. See that red?

It means that you've lifted the pressure off

so that fluid can flow through.

So I am happy. Lights on.

Top lights, please? Scope can go.

So, closure.

The NICU team look after 1,500 patients a year.

They can't do anything without an admission number.

Three admissions in the last 20 minutes.

One, two, three.

With one consultant, a registrar and 25 specialist nurses

caring for patients around the clock,

bed space is at a premium.

No, there's no bed. We've got no emergency bed.

So the whole time, we're juggling somebody in

and juggling somebody out,

so we've got two patients that could go to the ward,

but there's no ward beds and we've got four admissions coming in,

so it's going to be a bit tight.

We are like ducks. Very calm on top, but paddling like mad underneath.

So, five admissions in one hour.

That's taking a record.

Martin is one of the latest admissions to the NICU.

His condition began with flu-like symptoms

that rapidly deteriorated into complete paralysis.

Come on, babe. Can you squeeze my hand?

Come on, babe, open your eyes.

There you go.

Hi. Marty.

Hi.

This rare disease of the brain

affects just eight in a million people.

Oh, just for a second.

Oh, lovey.

Martin and Lisa have been married for 10 years.

It's been like a really bad dream.

It did, it felt like we were grieving, almost,

but now, you know, we've got some hope.

His eyes seemed to move a little bit.

Today they just opened ever so slightly

when I first came in and he heard me.

And that's what's helping me get through.

It's the gradual, you know,

the positive changes that he is going to recover.

So...

Yeah.

MACHINE BLEEPS

Tracey has now been in a deep coma for 48 hours.

Everything will be all right.

Trace? It's John.

Can you hear me?

You just keep fighting.

Her husband John, a fireman for 25 years,

was also involved in the crash, but escaped with minor injuries.

And I promise...

no more silly classical cars.

-Mr Lake? I've got the scan up for you if you want to see it.

-OK, yeah.

Come on, I'll show you.

John's friend Mike, a doctor, has come to give support.

-We know that her head was shaken.

-Yeah.

We know that she took the impact on the left side.

You know, that's where most of her injuries are.

You can see that from her face alone.

This here is not normal, so that's a bruise.

OK.

Although lots of people don't believe in contrecoup, that is...

-Sorry, what's...?

-Contrecoup, it means...

So contrecoup is...

You know in all these scans you see of boxers in slow motion,

they go back? So it's not...

the brain is in a hard box on a very small lollipop stick,

-which is your spinal cord.

-Mm-hm.

-And it shakes about a lot.

So you take the smack at the front, and the brain,

the jelly inside it is still going bang, bang.

So contrecoup means a hit on the other side. It's just French.

-Right.

-So...

Ah, right.

Yeah, contre, opposite, blow on the left side.

We've taken the sedation right down, and the numbers are good,

but they could be falsely good because we've got a CSF leak.

Right, OK.

But the numbers are good,

-so we're going to keep the sedation off.

-OK.

-She's kind of moved her eye for me today.

-Right.

She kind of, when I was doing something mean to her.

She doesn't really cough much when I put a suction cast in.

-I've done a sample from her chest. She didn't cough much.

-Right.

Too early to say.

We're not out of the woods yet. I'm sorry. We're not.

OK. Thank you.

Tracey had just qualified as a midwife,

and I had just qualified as a fireman,

and we met on a Christmas do.

And it's so sort of cliched, you know,

nurses and midwives on a night out and a load of firemen.

That was 24 years ago.

I love her to bits. We've got two sons.

I don't think in all that time,

we've never really had a cross word between us.

Tracey always says that the night we met,

she knew we were going to get married.

We all make all these plans about, you know,

what are you going to do for the weekend and next month

and next year and next decade,

but for hundreds, if not thousands of people up and down the country,

those plans never really work out, because of just a random event.

One split second decides everything.

In one second...

..that's it.

Game over.

I think we're more here to try and bring order

to what is a completely disordered event that happens.

-What noise?

-A constant beep.

I don't think she's going to wake up.

I think she's going to be like this.

There's nothing pharmacological keeping her asleep,

but she was on a lot of sedation yesterday,

but now she's on basically nothing,

and she doesn't respond and her pupils are reacting,

but she hasn't moved yet.

Maybe I'm just being a bit premature. I hope I'm wrong.

For those on the neurointensive care unit,

life hangs in the balance.

This morning, Mhairi's lost another patient.

Hello. Dr De Souza's patient?

Good morning, it's Mhairi Speirs.

I am an ICU consultant at the West Wing of the John Radcliffe.

May I discuss a death, please?

Died at 3:33 this morning.

Was on the normal post-op, in fact, the elective admission bed.

Cardiac arrest. Call went out 15:53.

Found unresponsive, gasping respiration.

I saw him last week, actually, which makes it even worse.

We did quite a lot to get him back, so...

SHE SIGHS

I don't know what you can say.

For Mhairi and the staff of the NICU,

death is an occupational hazard.

But some days, it just gets to you

when you've told five families in a row

that their relative is not going to survive

or you can't do anything else.

I do go home and I'm quiet.

I only live at the bottom of the road.

So sometimes I will cycle home, and it's much better,

but I sometimes drive here and you could probably do with

a bit of extra time to forget everything as you go home.

I mean, you can't....

You know, some wee boy's just gone home,

and his mum's not coming home tonight.

Sharon?

Sharon?

Sharon?

Come on, Sharon.

Martin? Martin?

Martin?

I mean, we were fine this morning.

We had so many beds, and now we don't have any beds.

It just needs one really sick patient, bed 10,

to concentrate us all day,

and you worry about all the other patients, and then...

How do you cope?

How do you cope when you have so many things?

You just have to, so that the relatives aren't upset.

You just have to.

Anyway.

Time to go home.

I'll just go and hand over to the night shift to make sure.

It's been nearly a week since Tracey was in a head-on collision.

There's growing concern that her lack of responses

means she'll be in a coma for the long term.

I carry the weight of every patient with me.

And it's difficult.

Because when it's good, like the kid this morning,

it's fantastic, and you feel great

and you feel like you've done something amazing.

But when it's bad...

you just feel horrendous.

Yeah.

It's a bit like being a manic depressive, I think.

Neurosurgery is a bit like being mentally ill.

HE LAUGHS

Hello, stranger.

All right? How is she?

Tim sees one of Jay's regular patients, seven-year-old Charlie.

If you hit me with that, who's going to do my operation?

She's a frequent flyer, clocking up 22 procedures in seven years.

Now she's back, suffering from acute headaches.

So, am I not having an operation today?

I don't think so, no.

-So am I allowed something to eat?

-Well, that's a very good question.

Yeah, I think you can have something to eat.

You've already had your dinner!

Yeah, you've had your dinner > and everything.

-Thank you.

-CHARLIE LAUGHS

-Just down the corridor, Jay visits Georgia in recovery.

-Georgia?

-Georgia?

-My head hurts.

Your head is sore, huh? It will get better, OK?

Do you remember, we said it was going to be a bit sore for a bit?

-Yes.

-OK. Good girl, you're doing really good.

Just wiggle your hands for me.

And the other one. Yeah, good.

And your toes. Oh, yeah. Good, good, good.

Everything is done, all right?

It will get better.

It doesn't matter how much you explain it's going to be sore.

Nobody really quite believes you until it happens.

You have to get them as ready as you can.

They're still always surprised by how sore it is.

Which is a bit rubbish, but it will get better.

Do you want beans?

Or recycled vegetables?

Er... Beans.

Oh right, beans. Beans.

Beans.

Well, I normally cook on a Sunday night

for a Monday night tea, because I'm normally on call on a Monday night.

-Sit down. Have you washed your hands?

-No.

Could you wash your hands, please?

So, yeah. No, I do like cooking. I like baking better.

I like my time on a Sunday morning at the rugby club.

Maybe it's just a chance to be bossy

without the surgeons answering back to me.

Right, pie.

-Recycled pie. There you are.

-Thank you.

Not deep-fried.

Not deep-fried?

That's his genes. His genes. He's scorning his genes!

I mean, my husband is a doctor,

so I suppose we always talk to each other about it.

In fact, you've got to remember you've got a 10-year-old.

Sometimes you have completely inappropriate conversations

over the dinner table, then...

he dropped his knife and fork the other day and said,

"I'd like to remind you I'm 10!"

I don't need to be talking about penises.

SHE LAUGHS

Poor Duncan always has his tea on his own.

Could always make him wear a hat and scrum.

You know, the other day, he fell. He came, he tripped on the stairs

coming out of the playroom and fell all the way across the ground.

I said, "Oh, for goodness' sake, just get up," and he said,

"If you were a proper mum, you would have been caring."

But it's the same with any nurses' child.

Unless their leg is hanging off,

then you're not going to do anything about it.

Like, I think he's got a broken finger just now,

but we just strapped his fingers. He'll be fine.

I mean, you have to just come in and keep going.

I only live close to the hospital, so you haven't got time to unwind,

so you've just got to come in and clean school shoes

and put the dishwasher on and do the laundry and tidy up

and get the schoolbag organised and all the things that mums do,

whether they've just certified somebody dead or not.

Shall we go in the treatment room?

Yeah?

Charlie's dwarfism affects every cell in her body.

She has hydrocephalus.

Fluid circulation in the brain has been disrupted,

and the pressure in her head is rising.

It's regulated by a drain called a shunt.

You look all sleepy now.

Did we wake you up?

Did he wake you up?

Please don't press too hard.

OK. I'm not allowed to press too hard.

Jay told me to.

-No, he didn't.

-He did!

-He didn't!

-Jay can do no wrong.

Jay can do no wrong?

-Ow.

-Sorry, sorry, sorry.

Can I hold this thing again?

-You want to do it?

-Yeah.

-Yeah, OK.

Tim is going to try to relieve Charlie's pain

using a magnetic device to release the pressure in her shunt.

Right, turn it that way. Keep going.

-Good girl.

-Keep going. A bit more.

Brilliant. Now let it set.

OK.

Do you want to check it, feel it?

-Does it feel all right?

-Yeah.

Excellent.

All done, all done.

Good girl.

I said you could pull the scab off.

-I didn't pull the scab off.

-You did.

No, I didn't! It's still there.

See you.

Tim's been a registrar for five years.

It's a long apprenticeship before he can become

a consultant neurosurgeon like Jay.

You have to do your time.

The general rules are, your boss has worked harder

under worse conditions than you will ever do.

And we work harder than the SHOs and the house officers

and the medical students will ever work.

So there's a very clear hierarchy.

A registrar on call works long hours through the night,

looking after all the wards and theatres.

Tonight, Andy is the registrar on duty.

The new Pirelli calendar, is that?

I'm not joking.

MACHINE BLEEPS

-Hello.

-Hiya.

-Are you bed managing at the moment?

-No, it's actually Kaya.

-No, it's Binu. Binu.

-Oh, it's Binu.

Binu? Can I just quickly ask if you know what the bed state is?

Have we got any space at the inn?

Would you have any space on the ward

if we had to admit anybody?

-We can bring one emergency in.

-We've got one bed.

-That's empty, that bay, is it?

-There's one patient in that bay.

-OK.

-Then we have a few beds.

-OK. Is it staying open for the weekend?

It is at the moment, yes.

So it's always good when you're starting your shift,

whether it's day, weekend or night shift,

to know how many beds you've got to play with -

ward beds, intensive care beds, paediatric beds,

because even if something is an emergency,

you may be tempted just to take them over

and operate immediately and deal with the bed situation afterwards,

but in a situation where it's not critical,

you'll spend the next few hours on the phone trying to sell the patient

to a different neurosurgical unit somewhere else in the British Isles.

We have got staff to cover another...

-One more acute admission. If the need arises.

-Yes.

-Yes, we have.

-Great. Thank you.

Don't know if you saw at the end of the ward,

we had two resident police officers.

It's not unusual to have members of our local constabulary on the ward.

We do get a number of admissions with a forensic background.

But it's relatively genteel in Oxford.

We had, obviously, a lot of assaults in the London hospitals

with firearms and knives,

and Oxford is more of a Chinese burn type sort of place,

or someone might accidentally misquote Shakespeare,

but it tends not to be so heavy on shootings and stabbings.

Our beds are at a tremendous premium,

so when we have so few beds, we have to really be quite callous

and have a think about who is going to benefit most

from that degree of intervention.

You know, she is unlikely to survive

a period on an intensive care unit and neurosurgical procedure. OK.

If the patient is unwell enough that they are going to deteriorate

within the hour, then they are unlikely to do that well anyway.

We are seen as the gatekeepers that always say no,

so as a result, we're not liked,

and I suspect if you looked up "hate" in the dictionary,

you would either have a neurosurgeon or more specifically,

perhaps, my picture next to it.

There is one call that Andy can't refuse.

A teenage boy admitted to his local A&E with amnesia.

Was he confused before then, as well?

What time was that?

I thought you said he had been confused all morning, at school?

Or...?

By the way, could you ask your CT department if they could do

coronal and surgical reconstructions on those images as well?

If there was a great big tumour lying in the brainstem that's

contributing to this, then I need to know that now.

I do need to speak to Jay now.

Would you mind putting me through to Mr Jayamohan?

He's on call, isn't he?

The number of times you're on call that you will need to ask

one of the consultants who is on call with you,

wake them up in the middle of the night and ask their advice.

But if you reach a point where you need some

senior input then so be it.

Hi, it's Andy here. Is that Jay?

I got a call just a few minutes ago from Horton A&E.

They have got a 14-year-old boy, who went to school today,

came back home after school and he has been confused.

He can't remember what happened at school throughout the morning.

There is a confounding story of him

being hit in the head by a football at school.

He has got gross hydrocephalus and it is clearly chronic.

OK, thanks, Jay, cheers, bye.

Adam's case is so serious that Jay has decided to come in

and do the operation himself.

That's the key for my locker, feel free to fish around in my pockets.

-And you want your iPhone?

-Yes, please.

I will write you a good reference!

Jay plans to pierce a hole far inside the brain,

to release the build-up of fluid that is pressing

dangerously on Adam's fornix, a crucial structure for memory.

I need to be able to get the telescope into the right place,

I then need to be able to see safely to be able to make the hole

without damaging any of the other structures.

-Finished yet, Jay?

-She is trying to bring bloody Scottish malarkey.

-Two albums, two albums.

-That is brilliant.

-These aren't Scottish!

-They are all Scottish.

That is why they are on there, the clue is in the title.

-Wait, wait, wait. The Waterboys are Scottish?

-Yeah, Scottish.

-Are they?

-Are the Proclaimers on there?

-Yes.

When I come back there had better be some better behaviour in here.

D'you want a CD through, we have got one?

No!

Here is the thing with this operation.

If it works, it is absolutely fantastic.

It is great for the patient and, for us

as surgical staff in particular, it is a really good

view of anatomical parts of the brain that we do not normally see.

So it is a very beautiful operation, if it works.

If it doesn't, it's a real pig. But...it'll work.

As Jay scrubs up for one operation,

Andy admits another patient.

A mother of two, Wai Fong,

who collapsed suddenly with severe headaches.

He consults the adult neurosurgeon on call about Wai's case.

Fine. And she basically came into A&E

because for the last couple of days she became diplopic

on the back of a couple of weeks' vomiting, that was severe today.

My feeling is that this is a massive high-grade glioma

with lots of vasogenic oedema around it.

Midline shift. It's in the left anterior frontal lobe.

Wai has a massive tumour

that has spread right across the two hemispheres of her brain.

This is really bad news, this is a tumour

that she is not going to get on top of.

This is a rapid decline.

The art, I think, is not in

working out what is wrong with the patient

but it's working out what to do.

What is right for one person may not be right for the next one.

I think I may have just stolen that line from Diff'rent Strokes!

Oh, Dan!

While you're here, mate, you couldn't unlock it

and stick it on to my speaker so we could have a few tunes, could you?

There is an on-switch and underneath there's a jack.

The sense of achievement is overwhelming, actually, doing this.

This is the neurosurgeon of the future.

You can't plug it in.

MUSIC PLAYS

Addicted To Bass, that'd be all right, yeah.

That'll wake us up a bit.

I feel uncomfortable with that music.

It's like walking into the supermarket

and realising you have no pants on.

You want the thing? Don't squash it. Don't squash it.

Andy must warn Wai's husband

and their friend of the dangers of operating.

There is a chance that she might not wake up.

And there is a chance, of course,

that she might not get through the operation.

I think he is just very, very upset about this.

-Shall we put him in a bed?

-He has collapsed.

-It's all right, he has got a pulse. What's his name?

-His name is Jimmy.

Jimmy, Jimmy, you all right?

God. Is it OK? This guy has collapsed. I need some help now, OK?

Let's just get a monitor on him first.

All right, I think he will be OK.

Yeah, I think he just needs some oxygen and some fluids.

He became very sweaty, but he's not really become

particularly tachycardic either.

He has had a decent pulse. What did you say his BM is?

Right, OK.

Yes, he has been responding.

Wai and her husband now occupy two beds in adjoining rooms.

Are you ready to take trochlear out? Take it out, thanks.

To release the pressure in Adam's brain, Jay must pierce

a hole in the ventricle where the cerebrospinal fluid is trapped.

That is us now in the ventricles

in the middle of the fluid spaces of the brain.

Right between the red dot at the top and the red line at the bottom,

is our landing pad.

It's OK at the moment, thanks.

We need to obviously be very careful about where we make our hole,

we don't want to damage either the basilar artery

or the pituitary gland.

Just stretching... Now getting a little tiny dot of a hole.

Just trying to make it open up by itself, so kind of passively

trying to get it to open up rather than having to tear a hole.

This is one of my favourite operations, I absolutely love them.

Because this is real hallowed ground for neurosurgeons, this area.

This is stuff which, 30 years ago operating in this region was

one of the most dangerous operations a neurosurgeon would do.

And now, I won't say we can do it with impunity

because that would be madness, but it wasn't quite a death sentence

but it was highly, highly dangerous for the patient.

Jay is now precariously close to the fornix,

where memories are made and stored.

This is the most intricate part of the procedure.

That is the fornix,

that structure there which sort of makes the wall of that hole.

We have got to watch that because if you damage that you can

severely impair their ability to make new memories.

Clearly, in a schoolkid... Well, it is important for anyone,

but someone who wants to learn.

Andy knows that because Wai's tumour is so huge,

he will only be able to remove a third of it at best.

And he will be taking healthy brain tissue with it.

It's an enormous tumour,

it's spread from the left to the right side of the brain.

It has crossed the midline.

Like Adam, the part of Wai's brain affected includes her fornix.

But in Wai's case, it may have to be sacrificed to prolong her life.

I would like to think that this procedure was enough to make

her alert, more orientated

and perhaps go home for a few weeks, maybe a few months.

Until Wai comes round, it is

impossible to know the extent of her memory loss.

Even though her prognosis is pretty abysmal, I can't stand by

and let her deteriorate because of something I can do something about.

There are operations where you think,

"Oh, my word", and there are operations where you think,

"Yeah, that sounds like it's going to be good."

The other good bit about this operation

is it has a very good chance of fixing him for life.

And whatever people tell you, you can't do any job that is

constantly about being knocked down about disaster and death.

You have got to have some successes and some nice outcomes.

And these are the sort of operations

where you can have a really good outcome

in a short period of time and send people home, essentially cured.

Thank you.

See you later, guys.

Are you running?

Uh? I am done. I just do my operations and run, man.

I'm the Scarlet Pimpernel.

After five anxious hours, Adam's parents visit their son in recovery.

How you doing? Eh, you all right?

-Yeah.

-All finished now.

-You should be all better.

-You all right?

Yeah, he says he doesn't know whether he's got a headache or

-if it's just the top of his head is sore.

-Probably a bit of both.

You have just had an operation on your brain.

Anyway, I think we have fixed you now, OK?

We're going to let you rest up and see how you go.

Back on the NICU, Tracey has been in a deep coma for almost a week

and is still not responding.

We'll have been married 24 years this year.

And I just think about all the good times we have had together and

all the things that we have still got planned to do, and that we will do.

You know, you just...

Tracey's my soul mate.

I just love her so much.

Tracey will pull through this.

And all the things that we have got planned to do,

we will still be able to do.

We may have to buy in for a bit, but nothing is going to change.

Nothing is going to change.

We can't undo brain damage.

We can rewire, we can prevent a secondary injury

but we can't undo what happened in the morning.

And if she's left like this, worse than death,

she is left like this for ever.

It is the end of a long night on call,

and Andy is finally going home.

I have no idea what is going on with me.

His patient, Wai, has woken up confused after her operation.

Erm, I'm from China and my husband is from Hong Kong.

We have two daughters, we met here.

My two daughters, one is 12, one is ten.

They both are in grammar school.

I am quite proud of them.

I don't know what is going on with myself, to be honest.

When I wake up, all I noticed was I have got a scar on my head.

I think probably I've got a tumour inside my head.

Did I?

-BEHIND CAMERA:

-Yeah.

Why I have a tumour inside my head?

The operation has given Wai some precious extra time

with her daughters and husband, who's now recovered.

On the NICU, there's finally a breakthrough

with one of Mhairi's coma patients.

Hello, Mr Coates. How are you today?

Martin? Hello, how are you?

You're doing really well.

Opened his eyes. Yeah. Hello!

Great! OK.

The immunoglobulins and the methylprednisolone

is now starting to work.

So he's six days since that was started.

It finished two days ago, yeah.

So it's starting to work, which is good.

So the antibiotics were the right thing,

and he's much more awake.

-TV:

-'I was already a blood-sucking parasite.

-'All I needed was a briefcase!

-Have a great afternoon!'

CHARLIE GROANS

CHARLIE GROANS

Charlie's headaches are getting worse.

A warning sign of a dangerous build-up of cerebrospinal fluid.

Jay wants to operate as soon as possible.

It'll be probably early afternoon.

-That's fine.

-She'll be on the list.

Lisa's got some good news.

Martin's medication is having an impact.

Hi, lovey!

Hi!

Hello! Aw!

Hi, darling!

Can you feel my cold hands?

Hey, can you squeeze me?

Oh, that's lovely! Thank you!

Can you look at me?

Aw, hi! Can you see me?

Give me a squeeze if you can see me. Oh!

I did my hair and make-up today for you. Cos you're waking up.

I didn't want to look scary.

Oh, love, it's all right.

The doctors expect you to recover.

They expect you to get your movement back.

It just might take some time.

-Aw!

-SHE KISSES HIS HAND

I love you.

Open your eyes, darling.

It's me. It's John. Open your eyes.

Open your eyes.

The doctors here have done all they can

to help Tracey recover,

but her condition isn't improving.

Open your eyes, darling. It's me.

It's time to move her to a local hospital

for less invasive therapy.

Mhairi calls John in to break the news.

She hasn't made as much neurological recovery

as we might have expected.

She opens her eyes.

-I know yesterday, you thought she was trying to speak to you.

-Yeah.

Family members often see more than we actually see.

I think it's wishful thinking, as well.

You just hope that it's not as bad as you think.

I've tried to stay as positive as I can,

but I can tell that you would expect to see more.

I hoped we would see more.

But from the word go,

and I can't ever take away your hope at the beginning,

but what was worrying us at the beginning

was that she was deeply unconscious at scene.

Um, it's only two weeks.

I know it seems like a lifetime for you,

but it's too early for us to really see.

I mean, the next step is going to be for her and you

getting her closer to home.

But this is the normal...

what we would do when the patient doesn't need

the specialist care that we give.

Things move on and, you know,

this is just sort of a moment in time and it's a long journey.

And we're just at the start of it.

And, you know, we'll get there.

I think he knows. He's been really cheery from the word go.

But, you know, if she's like this

for the rest of her life, she's only 50.

That's a...

damning lifestyle for him as well as her.

He's going to be visiting her for ever.

Sometimes, you always just take the bad. Tell them the bad stuff.

But if you tell them the bad stuff first, then...

Then I want them to go home...

Somebody said to Claire the other day,

"That doctor was wrong. This patient is awake."

Great. I want to be wrong.

But if nobody ever told them just how bad it could be...

And if I'm the person who tells them that and then they say,

"Well, she didn't know..."

There's sometimes I am right.

And you can remember all the ones you've been right about.

The ones that have died.

I hope it's never me.

I hope it's never my family member.

But you don't know.

Will I ever get my Tracey back? I don't know.

I don't know what I'll do without her,

but I need to be there for my sons.

I need to be strong for Tracey. I need to be there for her.

The future for Tracey is uncertain,

but John lives in hope for her recovery.

Yeah, this is the right size!

-That's the perfect size, isn't it?

-I'm a bigger baby.

'I saw Charlie on Saturday. She said, "Ooh, I like your trainers!'

"Where did you get your jeans from?"

I said, "Oh, do you think I've lost weight?"

She looked at me and she went, "Nah, not really."

Very depressing when your child tells you that.

Jay's been looking after Charlie since she was born.

This will be her 23rd procedure.

Down here somewhere.

Here we go! Sprint finish!

Oh, are you tired now, Charlie? All that running?

Come on then, doodles.

Good girl!

Need some more scrub, please.

You can give Andy the leftovers in that one. He can use that.

Andy's assisting Jay with Charlie's operation.

It's always a bit disheartening when you get the same people in.

There's that kind of depression, isn't there?

When you say, "Charlie's back in," and everyone goes, "Oh..."

And the anaesthetist goes,

"Oh, Charlie again? Why can't you fix her?"

The shunt, a plastic pipe that drains the CSF fluid,

is malfunctioning.

Jay needs to work out what's gone wrong and try to repair it.

So the end is full of brain and crud.

Just watch your sucker.

If it's touching my thing, you'll make a circuit.

A lot of the time, it's actually just unexplainable bad luck,

why these things go wrong.

But shunts go wrong more than just about anything else we do.

And, guaranteed, you're going to have shunt disasters.

You're going to have people who get infected, people who get blocked.

As Jay tries to remove the blocked shunt,

he finds it's entwined with Charlie's blood vessels.

I'm worried that it's going to poke a vessel.

We've already got some bleeding there now.

HE TUTS Shite!

Finished yet, Jay?

No, it's stuck right the way through the hole,

so even though we're burning what's in the centre,

through the actual thickness of the tubing,

it's stuck in those bits.

They're quite big vessels in there.

There, you can see it's wrapped around it.

Like a boa constrictor.

Come on, you!

With the mood I'm in,

Rage Against the Shunt!

I can bipolar it under direct vision now, cos it's so close.

So I need a bipolar, please.

Can we turn it down to two, but stand by to turn it up.

I need the bipolar pedal. Is it back on?

Am I still using the normal bipolar pedal?

-Yes.

-Thanks.

Suction, please.

OK, Andy, can you see what I'm doing there?

-Yeah.

-Bits stuck on the end there.

-Yeah.

-As it comes through, you will see it.

-Up to six, please, bipolar.

Hold it, hold it, hold it!

Hold it really carefully there.

Right, I need some normal scissors. Oh, got it.

Finally, Jay removes the blocked shunt

that's been giving Charlie so much trouble.

Beautiful! Local, thank you.

-I think we should probably do a little hair-wash.

-Yeah.

Right, thanks, super troops! I hopefully won't see you again.

We'll see how she's doing.

'Everyone who knows me says I'm a grumpy git,

'but work makes me happy, because I feel like I've done something good.'

Best job ever!

Without doubt. There's nothing else that comes close.

Great, OK.

There should be no real problems.

It's a bit...like that it's all right, yeah?

Yeah, yeah. Absolutely fine. Good!

-Hi, there! How are you?

-I'm fine.

Good, good.

Where is he?

It's a week since Martin first opened his eyes

and started to react consciously.

Can they...can they turn your voice..?

-Shall we ask if they can turn Daddy's voice on?

-Yeah.

Would you like him to have some sound?

Oh, this is a special trick, this is!

-Dad is in his nightgown.

-He is!

I think that means they washed him and they changed his gown.

-HE MOUTHS

-Every day he gets washed,

and they put a fresh gown on him

so he looks handsome.

It's his evening gown.

Hospital fashion.

-NURSE:

-Try it?

Hello!

Martin Coates, BBC! THEY LAUGH

SHE GIGGLES

That's all right, eh?

It is Thursday 21st June, 2012.

Good night! SHE GIGGLES

-Oh, I love you!

-Love you too.

Oh, it's good to hear you talking.

I did really well.

I sat up. I didn't fall over.

I can hold myself up.

I can feel myself working.

It's going to be a lot of hard work, but once you get into rehab...

Honey, don't pull on the wire.

-Oh, sorry, Dad!

-Do you know what I mean?

-Yeah, well, logically...

-I'm so close.

-I know, I know.

-While you were sedated, could you hear me?

-Yeah.

You could hear me when you were sedated?

So all the time I was talking to you...

Yeah, I remember you going, "Marty, it's Lisa.

-"Can you hear me?"

-Oh, my God!

"Squeeze my..."

Hand! I would say that every day!

And I'd squeeze it.

Or try to.

-Aw!

-I don't know if I did.

You couldn't open your eyes, though, could you?

You were awake, you couldn't open your eyes.

I was just in a dream world.

Look at you. Now you're awake. You're alive.

-Yes.

-And you're getting your movement back.

And you're going to walk again.

-MHAIRI:

-'It is brilliant when the patients come back.

'When Martin woke up, that was great.'

Every one of us is so cocooned in your own wee world,

you don't think just how precious that world is.

You think you're invincible.

Charlie may be a frequent flyer,

but for now, she's back to her old self.

Helicopters!

Six months on, Martin is well on the road to a full recovery.

It's so lovely to see.

Subtitles by Red Bee Media Ltd