0:00:02 > 0:00:07This programme contains strong language
0:00:07 > 0:00:09Just move yourselves over to the side for a minute.
0:00:09 > 0:00:12This winter, one of Britain's busiest NHS trusts
0:00:12 > 0:00:14opened its doors...
0:00:14 > 0:00:15We have to look after the patients,
0:00:15 > 0:00:19whether they come from Buck Palace or the park bench.
0:00:19 > 0:00:22..to show us what's really happening inside our hospitals.
0:00:22 > 0:00:23We've got lots of patients
0:00:23 > 0:00:26now competing for an unknown number of beds.
0:00:26 > 0:00:30Every week, more than 20,000 people are treated here...
0:00:30 > 0:00:32The pressure's just gone.
0:00:32 > 0:00:34What?! Has it completely gone?
0:00:34 > 0:00:39..and the numbers, as well as our expectations, are rising.
0:00:39 > 0:00:42We just had our worst ten days on record.
0:00:42 > 0:00:45There's nowhere in the hospital to move anybody.
0:00:45 > 0:00:47At some point somebody will be telling us
0:00:47 > 0:00:49whether we're allowed to do any work.
0:00:49 > 0:00:52This is a place with some of the best specialists in the world.
0:00:52 > 0:00:53Tumour's out, job done.
0:00:53 > 0:00:56Where lives are transformed.
0:00:56 > 0:00:58This is saving his life. It has to work.
0:00:58 > 0:01:01But they are operating at a time when the NHS
0:01:01 > 0:01:03has never been under more pressure.
0:01:03 > 0:01:04- Any beds?- No.
0:01:04 > 0:01:06- No beds for anyone?- No.- OK.
0:01:06 > 0:01:10It does feel to me like the elastic's
0:01:10 > 0:01:13a bit nearer to breaking now than it ever was.
0:01:13 > 0:01:17Its very future under scrutiny.
0:01:17 > 0:01:20All right. I think we will go out on red because we're under
0:01:20 > 0:01:22real pressure in the Emergency Department.
0:01:22 > 0:01:25We're aware of the problems. Anybody got a solution?
0:01:25 > 0:01:28Following the patients from the moment they are admitted...
0:01:28 > 0:01:32Anything I've done up to this point means nothing compared to
0:01:32 > 0:01:35when you can literally give a bit of yourself to save someone else.
0:01:35 > 0:01:38..to the moment they leave.
0:01:38 > 0:01:40It is all good news. The cancer has gone.
0:01:40 > 0:01:43- You don't need any more treatment. - Fantastic.
0:01:43 > 0:01:45Thank you so much.
0:01:45 > 0:01:50Week by week, we reveal the complex decisions the staff must make
0:01:50 > 0:01:53about who to care for next.
0:01:53 > 0:01:56That patient is coming to me to be operated on,
0:01:56 > 0:02:00and if I don't do it, then there's only one inevitable outcome.
0:02:00 > 0:02:02They're going to die.
0:02:12 > 0:02:14KEYPAD BEEPS
0:02:14 > 0:02:16'Say your name and then press hash.'
0:02:16 > 0:02:18BEEP
0:02:18 > 0:02:19St Mary's.
0:02:24 > 0:02:26St Mary's is the largest hospital in
0:02:26 > 0:02:29London's Imperial College Healthcare NHS Trust,
0:02:29 > 0:02:33where, every week, hundreds of life-saving operations
0:02:33 > 0:02:35are performed.
0:02:35 > 0:02:39Today, a team of expert surgeons is preparing for one
0:02:39 > 0:02:42of the most challenging operations they will carry out this year.
0:02:42 > 0:02:47The team is led by consultant vascular surgeon Colin Bicknell.
0:02:49 > 0:02:51Shall I load the scans up, then?
0:02:52 > 0:02:54It's taken two months to coordinate
0:02:54 > 0:02:57the diaries of the highly skilled surgical team.
0:02:57 > 0:03:01Just for this one operation, the people that we need -
0:03:01 > 0:03:03four consultant vascular surgeons, one cardiac surgeon,
0:03:03 > 0:03:05two expert perfusionists,
0:03:05 > 0:03:07three anaesthetists,
0:03:07 > 0:03:11one general surgeon and our expert nursing team.
0:03:11 > 0:03:13That's purely in that theatre.
0:03:16 > 0:03:20The patient is retired software engineer Peter Lai.
0:03:20 > 0:03:23- I really want to have it done now. - I know. Well, so do I.
0:03:23 > 0:03:26Although I am frightened to death, but, at the same time,
0:03:26 > 0:03:28- I want you to have it done.- Yeah.
0:03:28 > 0:03:33Otherwise they say you can have a rupture and drop dead in the street.
0:03:33 > 0:03:35That's right, yeah.
0:03:35 > 0:03:39Mr Lai, 60 years old, had a dissection,
0:03:39 > 0:03:41type B aortic dissection, 15 or 20 years ago,
0:03:41 > 0:03:45and he had a continued dilation of his false lumen.
0:03:45 > 0:03:47It has been amazing,
0:03:47 > 0:03:51the bringing together of all this expertise, just for Peter.
0:03:51 > 0:03:54And then, it was round about ten years ago,
0:03:54 > 0:03:56he got a carotid, carotid,
0:03:56 > 0:03:59carotid subclavian bypass,
0:03:59 > 0:04:03and a thoracic stent from the innominate down to the diaphragm.
0:04:03 > 0:04:05But he's continued to dilate.
0:04:05 > 0:04:08This will be his ninth operation.
0:04:08 > 0:04:11They're actually going to open his aneurysm up, they're going to take
0:04:11 > 0:04:14all the clotted blood that's accumulated there
0:04:14 > 0:04:16in all these years.
0:04:16 > 0:04:19It should really fix his aneurysm for good.
0:04:19 > 0:04:22So, we've got no choice and we said we would operate,
0:04:22 > 0:04:25and we've been through the risk lots and lots.
0:04:25 > 0:04:29Certain death if it ruptures, so we've got to do something.
0:04:29 > 0:04:32- Yeah, it's still very scary, isn't it?- Well...
0:04:32 > 0:04:34Anyhow, you're...
0:04:34 > 0:04:40- That's good. I'm glad...- You have to go through it. Hope for the best.
0:04:40 > 0:04:44- Yeah.- We just need the luck.- Yeah. That's right.- Yeah.
0:04:47 > 0:04:52While Peter appears well, his scans tell a different story.
0:04:52 > 0:04:56This is the right lung, which is normal and healthy.
0:04:56 > 0:04:58This is the left lung,
0:04:58 > 0:05:01but it's filled up completely by this aneurysm.
0:05:01 > 0:05:04If it bursts, he'll lose a tremendous amount of blood
0:05:04 > 0:05:06in his chest quickly and he'll die.
0:05:06 > 0:05:11An aortic aneurysm is a ballooning of the main artery out of the heart.
0:05:11 > 0:05:16At 12cm, Peter's aneurysm is so large that St Mary's is
0:05:16 > 0:05:20one of the few places in the UK capable of repairing it.
0:05:21 > 0:05:24He's had multiple operations,
0:05:24 > 0:05:27and I've been involved in approximately half of them.
0:05:27 > 0:05:31He's lived with this condition for many years.
0:05:31 > 0:05:34He knows the dangers that are there.
0:05:34 > 0:05:39The only word for Mr Lai, in the face of this adversity, is calm.
0:05:39 > 0:05:43He's actually a remarkable human being.
0:05:43 > 0:05:45I'm not sure whether I, personally,
0:05:45 > 0:05:48would have taken all of this quite so well.
0:05:50 > 0:05:52I have no choice, basically.
0:05:52 > 0:05:54I just go along with whatever's required.
0:05:56 > 0:05:59I just want to get it over and done with.
0:05:59 > 0:06:01My wife is very worried,
0:06:01 > 0:06:04but I don't worry.
0:06:04 > 0:06:07I always believe there's nothing to worry
0:06:07 > 0:06:09until there's something to worry.
0:06:11 > 0:06:15Peter needs a bed on a ward ahead of his operation tomorrow,
0:06:15 > 0:06:19but currently the hospital is experiencing very high demand
0:06:19 > 0:06:21for its 301 adult beds.
0:06:21 > 0:06:26Empty beds wise, we have one bed at the moment on Grafton,
0:06:26 > 0:06:28a smattering of confirmed discharges, but nothing else.
0:06:28 > 0:06:31We've got a number of patients needing placement,
0:06:31 > 0:06:34and we're still awaiting a plan, yeah?
0:06:34 > 0:06:37Capacity wise, is this the worst you've ever seen?
0:06:37 > 0:06:39This is really bad.
0:06:39 > 0:06:41I mean, I'm sure it has been worse,
0:06:41 > 0:06:44but this is particularly bad.
0:06:45 > 0:06:48As soon as I get anything, I will give you a call.
0:06:48 > 0:06:51What is the latest you can wait?
0:06:51 > 0:06:52Well, all right.
0:06:52 > 0:06:55We'll see what we can do. All right. Bye, bye.
0:06:55 > 0:06:58Oh, my goodness.
0:06:58 > 0:07:02It's the responsibility of site director Lesley Powls and her team
0:07:02 > 0:07:04to allocate beds for patients.
0:07:04 > 0:07:06It's not going very well.
0:07:06 > 0:07:09I mean, we're sort of getting there,
0:07:09 > 0:07:11but for every bed we give,
0:07:11 > 0:07:13we've got three other patients waiting.
0:07:17 > 0:07:18Oh. Oh, thank you very much.
0:07:18 > 0:07:22- I've got the kettle on for your cup of tea, all right?- OK, thank you.
0:07:22 > 0:07:24If that's not enough, let me know and I'll get you some more.
0:07:24 > 0:07:26- That's plenty, thank you.- All right.
0:07:26 > 0:07:29- We're just trying to sort out a bed for you.- OK.
0:07:29 > 0:07:30There might be a bit of a wait.
0:07:30 > 0:07:32We also need to take some more blood from you.
0:07:32 > 0:07:35- I'll wait until you've had your breakfast.- OK.- All right?
0:07:35 > 0:07:37- See you later.- Thank you.
0:07:37 > 0:07:40I think everybody is acutely aware that this man
0:07:40 > 0:07:42needs his surgery tomorrow.
0:07:42 > 0:07:44If this was an ordinary case,
0:07:44 > 0:07:48I would say the chances of him having his surgery are very slim.
0:07:48 > 0:07:52Because his is a particularly big case that
0:07:52 > 0:07:55has required an awful lot of organisation
0:07:55 > 0:08:01to get all the various members of the operating team together,
0:08:01 > 0:08:03um...
0:08:03 > 0:08:08it could be that senior managers in the hospital
0:08:08 > 0:08:10manage to find him a bed somewhere.
0:08:13 > 0:08:15As well as a bed on a ward tonight,
0:08:15 > 0:08:18Peter will need a bed in Intensive Care tomorrow,
0:08:18 > 0:08:21because of the seriousness of his operation.
0:08:21 > 0:08:24Well, it is such an invasive procedure,
0:08:24 > 0:08:26it's massively traumatic.
0:08:26 > 0:08:30It's a long operation, a big area of dissection
0:08:30 > 0:08:31and then, of course,
0:08:31 > 0:08:35we may have to rewire all of the blood vessels in his body.
0:08:38 > 0:08:39Mr Lai?
0:08:39 > 0:08:41- Hello.- Hello.
0:08:41 > 0:08:43Can I come and steal some blood from you?
0:08:43 > 0:08:45Yeah. Where shall we... Here?
0:08:45 > 0:08:48Yeah. If you wouldn't mind taking a seat.
0:08:48 > 0:08:51So, what's the situation now?
0:08:53 > 0:08:56We're hoping that one of our patients will be ready to go home
0:08:56 > 0:08:59later on today, and that would give us a bed for you.
0:08:59 > 0:09:03I am more concerned about the bed in ICU, because if that
0:09:03 > 0:09:07- is not available then the op can't go ahead.- It's been requested.
0:09:07 > 0:09:12- Yeah.- Whether it's available or not, I don't know. All right?
0:09:18 > 0:09:21- Hello.- Hello.- How are you?
0:09:21 > 0:09:23I'm all right.
0:09:23 > 0:09:25With the hospital full,
0:09:25 > 0:09:28patients can't be admitted until others are sent home.
0:09:29 > 0:09:31- Good morning, girls.- Morning.
0:09:31 > 0:09:32How are you?
0:09:32 > 0:09:34OK, thank you.
0:09:34 > 0:09:38Yes. I just want to know, is there anybody here speaks Polish?
0:09:38 > 0:09:41- No.- No.- No?- Sorry.
0:09:41 > 0:09:43Well, I don't either, you see.
0:09:45 > 0:09:49Proactive. "Brave" I think is sometimes the word we use.
0:09:49 > 0:09:51Asking the question, if someone can go home tomorrow,
0:09:51 > 0:09:53why can't they go home today?
0:09:53 > 0:09:56- Any of your team speak Polish? - Polish?- Polish.
0:09:56 > 0:09:58She's not here at the moment.
0:09:58 > 0:10:02Sister Alice Markey is one of a team of 14 that specialises in the
0:10:02 > 0:10:05most complex patients to discharge.
0:10:05 > 0:10:07The pressure that's on the NHS,
0:10:07 > 0:10:10you worry about it because you think,
0:10:10 > 0:10:13well, the walls are not elastic.
0:10:13 > 0:10:17There is no elastic in the walls, but the demand is high.
0:10:17 > 0:10:20One of her cases is a Polish man, Tadeusz.
0:10:20 > 0:10:24He's been medically fit to leave St Mary's for the past week.
0:10:24 > 0:10:27Anybody here speak Polish?
0:10:27 > 0:10:29- Pardon?- No. Italia.
0:10:29 > 0:10:33But getting him out of hospital has not been straightforward.
0:10:33 > 0:10:35Any of you speak Polish?
0:10:35 > 0:10:37He's homeless.
0:10:37 > 0:10:39He's been working as a mechanic,
0:10:39 > 0:10:42but sleeping in the cars that he repairs.
0:10:42 > 0:10:47He got a sore on his ankle and obviously it has escalated,
0:10:47 > 0:10:50because he probably has neglected it a little bit.
0:10:50 > 0:10:56I just want him to understand the journey for him out now.
0:10:58 > 0:11:01Hello. How are you?
0:11:01 > 0:11:03You understand a little English?
0:11:03 > 0:11:05- A little English.- A little?
0:11:05 > 0:11:09Little bit of English. And I will get an interpreter.
0:11:09 > 0:11:13Because, otherwise, you don't know what I'm saying,
0:11:13 > 0:11:15and I don't know what you're saying.
0:11:19 > 0:11:23Why is it that you can't just discharge a homeless person?
0:11:23 > 0:11:26You can. You can.
0:11:26 > 0:11:29You literally can discharge a homeless person.
0:11:29 > 0:11:33But my particular gentleman has health needs,
0:11:33 > 0:11:35because his leg looks very vulnerable.
0:11:35 > 0:11:39So, to go back to sleeping in the car at this precise moment
0:11:39 > 0:11:41is not ideal.
0:11:41 > 0:11:45Alice has applied for help from the local council homeless centre
0:11:45 > 0:11:47so Tadeusz can continue to get support.
0:11:49 > 0:11:52But until an appointment is available, he will remain
0:11:52 > 0:11:57on the ward classed as a DETOC, or a Delayed Transfer of Care.
0:11:57 > 0:12:01So that could be a patient who's waiting to go to a nursing home,
0:12:01 > 0:12:05homeless, awaiting placement through a homeless persons' unit,
0:12:05 > 0:12:10so any number of people on that spectrum who are delayed
0:12:10 > 0:12:12not by us, as a hospital,
0:12:12 > 0:12:15so they're ready to go and we're just waiting.
0:12:15 > 0:12:1728 today.
0:12:17 > 0:12:21Last week, I think it was 35 at one point.
0:12:21 > 0:12:24- That's quite a decent number of people that...- It's extraordinary.
0:12:24 > 0:12:27That would be, in effect, me going upstairs now,
0:12:27 > 0:12:30clearing one of our main wards out completely
0:12:30 > 0:12:33and going, "There you go. 28 empty beds for you to admit into."
0:12:33 > 0:12:37So that would be today's problems solved.
0:12:42 > 0:12:43Louis, from the top.
0:12:43 > 0:12:47Our gentleman that fell over whilst on a business trip -
0:12:47 > 0:12:50doing very well from a medical perspective.
0:12:50 > 0:12:54I've seen him mobilising along the corridor on his own yesterday,
0:12:54 > 0:12:58so this man doesn't need to be in hospital.
0:12:58 > 0:13:01In one of the hospital's general wards, consultant David Shipway
0:13:01 > 0:13:05and his team are also trying to identify patients to discharge.
0:13:06 > 0:13:09There are a number of different barriers that we have to face
0:13:09 > 0:13:11from a social perspective.
0:13:11 > 0:13:14For example, we've got very frail elderly people,
0:13:14 > 0:13:17and they're falling over at home and having injuries,
0:13:17 > 0:13:20and then we have to make decisions about whether it's reasonable
0:13:20 > 0:13:23to get them home, or whether it's not.
0:13:23 > 0:13:25So, Dorothy. She's a fracture of the leg.
0:13:25 > 0:13:29We've made some more changes to her medication and, basically,
0:13:29 > 0:13:34we will see how she does over the next, say, 24, 48 hours.
0:13:34 > 0:13:39I'm here because I broke two bones in my ankle.
0:13:39 > 0:13:42I've been here for nearly three weeks.
0:13:43 > 0:13:4691-year-old Dorothy, or Dolly, as she's known,
0:13:46 > 0:13:49is one of the hospital's oldest patients.
0:13:49 > 0:13:51I feel good in myself.
0:13:51 > 0:13:55I do. I feel as though I could get up and walk...
0:13:55 > 0:13:57walk...you know,
0:13:57 > 0:13:59the way I am.
0:13:59 > 0:14:02But I can't, because I've got a broken ankle.
0:14:02 > 0:14:06Can you take a few deep breaths for me, please?
0:14:06 > 0:14:09Can you take a few deep breaths for me so I...
0:14:09 > 0:14:10Through... Closed or...
0:14:10 > 0:14:13Through your nose and out through your mouth.
0:14:13 > 0:14:16Are you happy to be here?
0:14:16 > 0:14:17Yeah, I am, really,
0:14:17 > 0:14:21because I'm getting the treatment I need.
0:14:22 > 0:14:25I mean, I don't know if you want to know but,
0:14:25 > 0:14:27for instance, I passed out this morning,
0:14:27 > 0:14:29and, um...
0:14:31 > 0:14:33They were all there to rally round, you know,
0:14:33 > 0:14:37to bring me round and see to me, whereas if I had have been at home
0:14:37 > 0:14:42on my own, I don't know what would've happened.
0:14:42 > 0:14:44I really don't.
0:14:45 > 0:14:49It might not be necessarily dangerous to someone
0:14:49 > 0:14:51that's like me or you.
0:14:51 > 0:14:52However, to someone at her age,
0:14:52 > 0:14:56her fantastic age, it's quite dangerous for her to be on her own.
0:14:56 > 0:15:00Dolly is waiting to be moved to a community hospital,
0:15:00 > 0:15:03where she will convalesce until she's well enough to go home.
0:15:03 > 0:15:06Dolly, are you in any pain right now?
0:15:06 > 0:15:08No, love, I feel fine.
0:15:09 > 0:15:11I feel... Honestly, really...
0:15:11 > 0:15:15Sometimes patients stay here longer than they need to,
0:15:15 > 0:15:18but we haven't got, necessarily, this middle ground right now,
0:15:18 > 0:15:23in between a hospital and a home, so that bed is being used.
0:15:23 > 0:15:28They are so short of beds that if you are just a patient
0:15:28 > 0:15:31and they're just giving you tablets,
0:15:31 > 0:15:33you're wasting a bed.
0:15:33 > 0:15:39But, then, I have to have somewhere to go where I'm going to be safe.
0:15:39 > 0:15:41What does that feel like?
0:15:41 > 0:15:44It feels awful.
0:15:44 > 0:15:46I'm not supposed to be here.
0:15:46 > 0:15:47Which I'm not.
0:15:47 > 0:15:49In a way.
0:15:49 > 0:15:51Because they want my bed.
0:15:51 > 0:15:54So, what have I got to do?
0:15:54 > 0:15:57I feel guilty because I've got nowhere else to go.
0:15:58 > 0:16:01- I brought you some shower gel. - Just in case.- Yeah.
0:16:01 > 0:16:04- I don't know where you're going to end up tonight.- No.
0:16:04 > 0:16:07Peter and his wife Diana are still waiting to see if
0:16:07 > 0:16:11he'll get a bed on a ward before his operation tomorrow.
0:16:11 > 0:16:15- I'm quite happy sitting here, rather than sitting in the bed anyway.- Hmm.
0:16:15 > 0:16:18- It is nice and bright here, and quieter.- Yeah.
0:16:18 > 0:16:22- It's not busy here, is it? - No.- It's just quiet.
0:16:23 > 0:16:27We married in 1980, so 36 years.
0:16:27 > 0:16:29How did you both meet?
0:16:29 > 0:16:32At college. There was volleyball at lunchtime
0:16:32 > 0:16:37and he was playing, so it was mixed teams,
0:16:37 > 0:16:40and he, actually, was the only boy
0:16:40 > 0:16:43who would pass the ball to women because...
0:16:43 > 0:16:46He IS competitive, but he's fair.
0:16:46 > 0:16:48And he passed the ball, and I thought, "That's a nice trait."
0:16:48 > 0:16:50And then got talking.
0:16:50 > 0:16:55And then I actually asked him out, because he wasn't very forthcoming!
0:16:59 > 0:17:02I love him as much today as I ever did.
0:17:02 > 0:17:05I want to be there for him. I do my best for him.
0:17:05 > 0:17:08I wish I didn't cry all the time, but I do.
0:17:08 > 0:17:12But in every other way, I try and help him. Yeah.
0:17:12 > 0:17:13Protect him.
0:17:13 > 0:17:15And...
0:17:15 > 0:17:19Yeah, I've just found it very difficult, the whole journey.
0:17:20 > 0:17:23Because he's a very special person.
0:17:24 > 0:17:26So...it has been difficult.
0:17:26 > 0:17:31I just wish I was stronger, but I've tried to be strong. For him.
0:17:31 > 0:17:34But, luckily, Peter is really, really positive,
0:17:34 > 0:17:39and so I try my best to be, but he understands I'm not like him.
0:17:39 > 0:17:41And so, it's difficult.
0:17:44 > 0:17:47We want a bed for him overnight tonight.
0:17:47 > 0:17:49How is that looking?
0:17:49 > 0:17:52SHE SIGHS
0:17:52 > 0:17:54Not too good at the moment.
0:17:54 > 0:17:56At the moment the ward is full.
0:17:56 > 0:17:58There may be one discharge.
0:17:58 > 0:18:03It's a patient that's been looked after by a different team,
0:18:03 > 0:18:06so we're waiting to hear from that team whether this patient
0:18:06 > 0:18:07is fit for discharge.
0:18:07 > 0:18:11If that patient goes home, then we'll have a bed for Mr Lai.
0:18:17 > 0:18:19When St Mary's is full,
0:18:19 > 0:18:22the knock-on effects are felt across the whole hospital.
0:18:24 > 0:18:27For every discharge that we'd planned for,
0:18:27 > 0:18:30we usually automatically allocate that bed to someone else.
0:18:30 > 0:18:34So, if that goes wrong, our system starts to back up.
0:18:38 > 0:18:40Why is this bloke still here?
0:18:40 > 0:18:44We are waiting for a patient to be transferred off Intensive Care.
0:18:46 > 0:18:50A 37-year-old man is being held in theatre
0:18:50 > 0:18:53after an emergency operation to stop internal bleeding.
0:18:56 > 0:19:00This patient had what we call a GI bleed, a gastrointestinal bleed.
0:19:00 > 0:19:02He has had massive blood transfusion,
0:19:02 > 0:19:05he has had lots of blood products that help the blood clot.
0:19:05 > 0:19:09What he really needs is an Intensive Care bed.
0:19:09 > 0:19:11The operation finished over six hours ago,
0:19:11 > 0:19:14but they're still waiting to transfer him,
0:19:14 > 0:19:17because Intensive Care is full.
0:19:17 > 0:19:20We're trying to discharge some patients at the moment,
0:19:20 > 0:19:23but we're not entirely sure where they're going to go,
0:19:23 > 0:19:25so it's a lot of bed reorganisation, trying to
0:19:25 > 0:19:28figure out where we can put people and where it's safe to put people.
0:19:28 > 0:19:31At the moment, we're not entirely sure how we're going to
0:19:31 > 0:19:33make room for people who need to come here.
0:19:33 > 0:19:36Until an Intensive Care bed becomes available,
0:19:36 > 0:19:39the patient will be kept on life support in the operating theatre,
0:19:39 > 0:19:42meaning that operations that were scheduled to take place in
0:19:42 > 0:19:44theatre 7 cannot go ahead.
0:19:44 > 0:19:48It just gets really frustrating when, actually,
0:19:48 > 0:19:54all I'm doing is better done by the Intensive Care Unit team,
0:19:54 > 0:19:56rather than here in theatre.
0:19:56 > 0:19:59We just don't have anywhere to put our patients and we have to
0:19:59 > 0:20:02do the best we can for them in the best position we can,
0:20:02 > 0:20:04with the best care that we can deliver.
0:20:06 > 0:20:09As one of London's four major trauma centres,
0:20:09 > 0:20:13St Mary's is facing increasing demand on its Emergency Department.
0:20:14 > 0:20:17Trauma team to A&E Resus, please.
0:20:17 > 0:20:18Thank you.
0:20:19 > 0:20:22Sorry, they're going to come in...
0:20:24 > 0:20:28The latest patient to arrive in A&E is 21-year-old carpenter Harry,
0:20:28 > 0:20:30who has fallen two floors at work.
0:20:32 > 0:20:36- Fallen from height?- From four metres.- From four metres.
0:20:36 > 0:20:39You're not worried he's got a head injury?
0:20:39 > 0:20:41HARRY MOANS
0:20:44 > 0:20:46HE VOMITS
0:20:46 > 0:20:47All right?
0:20:47 > 0:20:49HARRY GROANS
0:20:49 > 0:20:50Well done. It is just some oxygen...
0:20:50 > 0:20:53- Please stop that! Please!- Harry...
0:20:53 > 0:20:55You stop that shit! Fuck off!
0:20:55 > 0:20:57All right, Harry, you're OK.
0:20:57 > 0:21:00- It fucking hurts! Stop it! - All right, sweetheart.- Please...
0:21:00 > 0:21:04You're doing really, really well. I know it's horrible.
0:21:04 > 0:21:08Harry's agitated behaviour suggests he may have a brain injury.
0:21:08 > 0:21:10OK, tube. Intubate.
0:21:10 > 0:21:12- Yeah.- Lovely.
0:21:14 > 0:21:16He is anaesthetised and his breathing is supported
0:21:16 > 0:21:20so the doctors can ascertain the extent of his injury.
0:21:24 > 0:21:26It looks almost certain that he'll need
0:21:26 > 0:21:28a bed on the Intensive Care Unit,
0:21:28 > 0:21:34which is not the easiest thing, seeing we know already that
0:21:34 > 0:21:37the Intensive Care Unit is completely full to the rafters.
0:21:37 > 0:21:40- PHONE RINGS - That might be them. Yes, it is.
0:21:40 > 0:21:42Hiya.
0:21:45 > 0:21:48Have you got anything you can kick out there?
0:21:48 > 0:21:50Yeah. Yeah, I know.
0:21:50 > 0:21:51I know.
0:21:51 > 0:21:54I think we should probably prepare for it.
0:21:55 > 0:21:58Yeah. Absolutely. OK. Talk to you later. Bye.
0:22:09 > 0:22:11Is it always like this?
0:22:11 > 0:22:14We've always had times when it's been like this.
0:22:14 > 0:22:18The emergency service has peaks and troughs in demand, like that,
0:22:18 > 0:22:21and the peaks and troughs are going up and up and up.
0:22:21 > 0:22:24There are times when I start thinking, whoa!
0:22:24 > 0:22:29OK, if another thing happened now, the system would break.
0:22:29 > 0:22:32And we'd be in really, really serious trouble.
0:22:34 > 0:22:37Scans will help to determine how serious Harry's injury is,
0:22:37 > 0:22:42and whether he needs one of the sought-after Intensive Care beds.
0:22:42 > 0:22:48Debbie. OK, Debbie, we'll expect to see you soon. Thank you. Bye-bye.
0:22:50 > 0:22:52Mum's on her way.
0:23:00 > 0:23:0491-year-old Dolly is waiting to find out if she can be discharged today.
0:23:04 > 0:23:08- Hello.- Mrs Jackson, nice to see you again.
0:23:08 > 0:23:11When we saw you earlier on this morning,
0:23:11 > 0:23:12you were looking pretty unwell.
0:23:12 > 0:23:15Now, as you know, we'd hoped to get you home later...
0:23:15 > 0:23:18Well, not home, but to Willesden Community Hospital this morning,
0:23:18 > 0:23:21for a bit of rehabilitation and some convalescence, but I think,
0:23:21 > 0:23:22given that you had your collapse,
0:23:22 > 0:23:24we should probably keep an eye on you here.
0:23:24 > 0:23:26Yeah, I think I'd be better off.
0:23:26 > 0:23:29So, I think what we're going to do is hang on to you for at least
0:23:29 > 0:23:31another 24 hours, and then we'll send the referral again to
0:23:31 > 0:23:33the rehab hospital but, unfortunately,
0:23:33 > 0:23:36because they've given the bed up to another patient this morning,
0:23:36 > 0:23:39we might end up having to keep you in here for a few more days
0:23:39 > 0:23:42- while we wait for it to come up again.- OK.- OK?- Thank you.
0:23:42 > 0:23:44Very nice to see you. Bye-bye.
0:23:44 > 0:23:47The problems that we face can only be solved, really,
0:23:47 > 0:23:52by social services creating spaces for people in accommodation, be that
0:23:52 > 0:23:56for homeless, drug users or people waiting rehousing for nursing homes.
0:23:56 > 0:23:58There's a big disconnect between the NHS and social services,
0:23:58 > 0:24:03and the NHS gets blamed quite a lot for problems in the community, which
0:24:03 > 0:24:08are really slightly outside of our remit and outside of our control.
0:24:08 > 0:24:10DOLLY GROANS
0:24:10 > 0:24:12Oh, I know, sometimes it happens.
0:24:12 > 0:24:14But otherwise, you look good.
0:24:14 > 0:24:16- Yeah.- OK, then.
0:24:16 > 0:24:18- All right, I'll see you later, then.- OK.
0:24:18 > 0:24:21It's good, at least you are with us. No problem.
0:24:23 > 0:24:25- We take you from there.- Thank you.
0:24:28 > 0:24:32You like the one I got yesterday of William and Harry, didn't you?
0:24:32 > 0:24:35- Oh, yeah.- That one.- Yeah. Ain't that good?
0:24:35 > 0:24:37Is that the one you want blown up?
0:24:37 > 0:24:41To see you can just take their photo, just like that.
0:24:41 > 0:24:44Dolly's granddaughter Nicola has come to visit,
0:24:44 > 0:24:47with Peter, Dolly's husband of 32 years.
0:24:47 > 0:24:50Where did you guys meet?
0:24:51 > 0:24:53We met in a pub.
0:24:53 > 0:24:55She's definitely a fighter.
0:24:55 > 0:24:58She's had a lot of accidents, a lot of falls.
0:24:58 > 0:25:00It's not the first time she's broke her ankle.
0:25:00 > 0:25:04She went to Spain once with her friends. What did she do?
0:25:04 > 0:25:07Went roller-skating and broke her ankle.
0:25:07 > 0:25:10That's Dolly. She's got quite nice legs, when they're not like that.
0:25:10 > 0:25:12I always had good legs.
0:25:12 > 0:25:15Nice legs, shame about the face!
0:25:15 > 0:25:17THEY ALL LAUGH
0:25:18 > 0:25:22No good her coming home, because she won't cope at home.
0:25:22 > 0:25:23I know she won't.
0:25:23 > 0:25:26They did have a place for her, care home,
0:25:26 > 0:25:31but whether she's lost that place for good, I don't know.
0:25:31 > 0:25:34Have you had your boot on today?
0:25:34 > 0:25:37No, I ain't been out of bed since I had that turn.
0:25:37 > 0:25:39I've had to stay in bed.
0:25:39 > 0:25:41I had to have a bed pan and all.
0:25:41 > 0:25:43No commode.
0:25:43 > 0:25:45In case I fell off the commode again!
0:25:45 > 0:25:48THEY ALL LAUGH
0:25:51 > 0:25:54After receiving emergency life-saving surgery in the
0:25:54 > 0:25:57early hours of the morning, the patient in theatre 7
0:25:57 > 0:26:00is still waiting to be transferred to Intensive Care.
0:26:00 > 0:26:05So, the promise of a bed at half past two...
0:26:06 > 0:26:12So, we've just called ITU, it may be another hour-and-a-half?
0:26:13 > 0:26:16This is exactly what our problem is.
0:26:16 > 0:26:22So, we're promised a bed at half past two, on Intensive Care,
0:26:22 > 0:26:26but unless Intensive Care can move the patient that's in that
0:26:26 > 0:26:30bed space onto the ward, we don't get anywhere.
0:26:30 > 0:26:33You're waiting for the dominoes to all line up
0:26:33 > 0:26:35and all fall at the same time.
0:26:35 > 0:26:39And it takes hours in the NHS for that to happen.
0:26:39 > 0:26:41- Hello.- Hello, Alice.
0:26:41 > 0:26:44I've come to see my little man.
0:26:44 > 0:26:46Alice's patient, Tadeusz,
0:26:46 > 0:26:49has got an appointment at a council homeless centre.
0:26:53 > 0:26:55Hello.
0:26:55 > 0:26:56How are you?
0:26:56 > 0:26:59Are you all right?
0:26:59 > 0:27:01We're here again.
0:27:01 > 0:27:02Yes.
0:27:02 > 0:27:07I have got one of the chappies that work here
0:27:07 > 0:27:14- to come and explain about your homelessness.- Yeah. OK.
0:27:14 > 0:27:17- So that you and I can have a chat. - Yes. Thank you.
0:27:17 > 0:27:19That's OK.
0:27:19 > 0:27:24I just want him to know exactly what we're doing for him.
0:27:24 > 0:27:27Rather than wait for the hospital's translation service,
0:27:27 > 0:27:32Alice asks a Polish colleague from the Transport Department to help.
0:27:32 > 0:27:34This gentleman states he has no place to live.
0:27:34 > 0:27:37What I do need to know from him is,
0:27:37 > 0:27:40how does he live now that he is homeless,
0:27:40 > 0:27:43who supports him, does he have money? So, ask him that.
0:27:43 > 0:27:46TRANSLATION:
0:27:53 > 0:27:56You look after your patients as if they're your family.
0:27:56 > 0:27:59I mean, your family are not straightforward.
0:27:59 > 0:28:01There are some challenging people in the family,
0:28:01 > 0:28:03as well as everywhere else,
0:28:03 > 0:28:07but, hey, you would deal with this, and I think that's how it should be.
0:28:08 > 0:28:12It is difficult because he doesn't have any place to go.
0:28:12 > 0:28:14Does he have any friends?
0:28:14 > 0:28:17Oh, it is difficult. He doesn't have anyone.
0:28:17 > 0:28:19- Nobody knows you?- No.
0:28:19 > 0:28:21- No friend at all?- No.
0:28:21 > 0:28:25He doesn't know really what he has to do and where he has to go,
0:28:25 > 0:28:29and he doesn't have any place to go now.
0:28:29 > 0:28:35We try to do the best we can but, unfortunately, when patients
0:28:35 > 0:28:38come into hospital, they think hospital will sort it all out.
0:28:38 > 0:28:42You know? That's why I say I don't go round with a block of flats
0:28:42 > 0:28:45or a bungalow in my pocket. I wish I did, but I don't.
0:28:45 > 0:28:50We would have to refer him to the homeless persons' unit, to see
0:28:50 > 0:28:52if they can get him accommodation.
0:28:52 > 0:28:54He says he agrees with that.
0:28:54 > 0:28:58And now that I know he understands what we have to do for him,
0:28:58 > 0:29:01I am happy that he can be discharged.
0:29:03 > 0:29:07A week after he was medically fit to leave, Tadeusz is now on his way.
0:29:07 > 0:29:09Yeah.
0:29:09 > 0:29:11Toe touch.
0:29:12 > 0:29:16Our code of professional conduct states that we look after
0:29:16 > 0:29:19the patients in our care. Whether they come from Buck Palace
0:29:19 > 0:29:22or the park bench, we give them all the same care.
0:29:24 > 0:29:26Toe touch.
0:29:26 > 0:29:27Toe touch!
0:29:37 > 0:29:42Harry's girlfriend Paige and mum Debbie arrive at A&E.
0:29:47 > 0:29:50I said to the nurse, "He's not going to die, is he?"
0:29:50 > 0:29:53And she said, "I don't know. We can't tell at the moment."
0:29:53 > 0:29:57And I thought I was going to die, right there on the spot.
0:29:57 > 0:30:00He is 21 years of age. He's got a little baby.
0:30:01 > 0:30:04It's just so frightening.
0:30:06 > 0:30:10And, now, I know he's in the best place but...
0:30:11 > 0:30:14It is really frightening. Really frightening.
0:30:14 > 0:30:18The scans show Harry's brain injury is not as serious as first thought.
0:30:19 > 0:30:23But it's still unclear how much medical support he needs
0:30:23 > 0:30:25and which ward he will be admitted to.
0:30:25 > 0:30:31We're going to wake him up and, fingers crossed, it'll be OK.
0:30:31 > 0:30:35Harry. Can you open your eyes, Harry? Open your eyes wide.
0:30:35 > 0:30:37We'll take the tube out.
0:30:37 > 0:30:40Just keep taking some nice deep breaths.
0:30:40 > 0:30:42We'll take the tube out.
0:30:42 > 0:30:45If the breathing tube stays in and he stays on the ventilator,
0:30:45 > 0:30:47he's classed as a level III patient,
0:30:47 > 0:30:51which means that he needs the maximum support that we can give him
0:30:51 > 0:30:54and that is an intensive care unit.
0:30:54 > 0:30:56Whereas, if he does the breathing for himself,
0:30:56 > 0:31:00and we're not having to support his blood pressure terribly much
0:31:00 > 0:31:01and he's looking moderately stable,
0:31:01 > 0:31:05he is a level II patient and he goes to a high dependency unit.
0:31:05 > 0:31:07Harry.
0:31:07 > 0:31:09Can you open your eyes wide?
0:31:09 > 0:31:11Open your eyes wide.
0:31:11 > 0:31:14We'll take the tube out.
0:31:14 > 0:31:16I think there's more space in the High Dependency Unit than
0:31:16 > 0:31:18there is on the Intensive Care Unit, at the moment,
0:31:18 > 0:31:22so I'm secretly hoping that we'll be able to wake him up
0:31:22 > 0:31:23and take the tube out.
0:31:24 > 0:31:27- Oxygen.- OK.
0:31:27 > 0:31:29MACHINE BEEPS
0:31:32 > 0:31:36Nice deep breath. Deep breath, in and out.
0:31:36 > 0:31:39HIGHER-PITCHED BEEPING
0:31:41 > 0:31:43Shall we just bring him up a bit?
0:31:43 > 0:31:45You're just waking up, Harry.
0:31:45 > 0:31:48You're in the hospital. You're in St Mary's Hospital.
0:31:48 > 0:31:51You had a fall. Just keep taking nice big breaths.
0:31:53 > 0:31:55Good. Excellent. Lunch.
0:32:03 > 0:32:05Intensive Care has been full all day
0:32:05 > 0:32:07but there's been a development.
0:32:09 > 0:32:14- What's new?- I discharged one patient.- And that was a big relief?
0:32:14 > 0:32:18Yeah. But we're preparing for the next admission to come in.
0:32:26 > 0:32:29Ah, yes. So, the bed space is 90% ready.
0:32:29 > 0:32:32I'm just going to bleep 1650, you told me.
0:32:34 > 0:32:37After hours of waiting, the patient who had emergency surgery
0:32:37 > 0:32:41can be transferred and the theatre can be used for other patients.
0:32:41 > 0:32:45So, anything that doesn't need to go, doesn't need to go, guys.
0:32:45 > 0:32:47Do you want to switch that ventilator off?
0:32:47 > 0:32:49I do my job because I love it.
0:32:49 > 0:32:51So, let's take that.
0:32:51 > 0:32:55Things have definitely changed. The last decade has got a lot worse.
0:32:55 > 0:32:59Personally, that means that I work longer hours because I don't
0:32:59 > 0:33:02have anybody to hand over to.
0:33:02 > 0:33:05Right. Everybody happy? OK. Let's go.
0:33:05 > 0:33:09There are more days that frustrate me. More days that upset me.
0:33:09 > 0:33:14More days that I leave work unsatisfied.
0:33:14 > 0:33:16Not that I haven't done the best
0:33:16 > 0:33:21I can but that I wasn't able to give the best to my patient
0:33:21 > 0:33:23because of the lack of resources.
0:33:27 > 0:33:29Intensive Care is now full,
0:33:29 > 0:33:32but patients continue to arrive at A&E.
0:33:33 > 0:33:36A lot of times, our capacity at St Mary's,
0:33:36 > 0:33:39we're running at 98-99% capacity.
0:33:39 > 0:33:42Which is extraordinary.
0:33:42 > 0:33:45What that means, in essence, is we are always running
0:33:45 > 0:33:49with one or two empty beds, which isn't nearly enough.
0:33:53 > 0:33:54It wouldn't be a problem
0:33:54 > 0:33:58if we never admitted more than one patient a day but we do.
0:33:58 > 0:34:01It is what it is. People get sick. They come to hospital.
0:34:01 > 0:34:03We can't change that.
0:34:06 > 0:34:08SIREN BLARES
0:34:32 > 0:34:37- All right, darling. I'll wait to hear from you, tomorrow, any news. Whenever.- Yeah.
0:34:37 > 0:34:42- I'll text you.- Yeah, text, or I can ring.- Mmm.
0:34:42 > 0:34:49- Not from today.- No. Shall I leave that?- No. I won't tell anyone.
0:34:49 > 0:34:52I'm not kissing him either. Because I don't want to give him anything.
0:34:52 > 0:34:55Just in case. I want to keep him in tiptop condition.
0:34:55 > 0:34:59- So, bye, darling.- Might see you tomorrow.- Yeah. See you then.
0:34:59 > 0:35:02Aneurysm patient Peter has been waiting for nine hours
0:35:02 > 0:35:06for a bed on a ward, ahead of his life-saving surgery tomorrow.
0:35:07 > 0:35:09I'm on my own now.
0:35:09 > 0:35:11I'm just waiting.
0:35:12 > 0:35:16No-one... When the night comes in, it brings the sadness.
0:35:16 > 0:35:18Yeah.
0:35:21 > 0:35:24Still, hopefully, tomorrow, I'm going for the op
0:35:24 > 0:35:26and just need a bit of luck.
0:35:26 > 0:35:31It'll be good to go ahead. Get it over and done with.
0:35:31 > 0:35:34And...we can start the recovery.
0:35:34 > 0:35:39- I have some news.- You got news? - I've got some good news.- Oh.
0:35:39 > 0:35:41We have a bed.
0:35:41 > 0:35:45Not in this ward, but we'll have a bed for you in about an hour.
0:35:45 > 0:35:46Yeah?
0:35:46 > 0:35:49- And we won't find out about an ITU bed until tomorrow.- Tomorrow.
0:35:49 > 0:35:51- We'll do our best for you. - Yeah.- Certainly.
0:35:51 > 0:35:53- Thank you very much. - I shall see you later on.
0:35:53 > 0:35:55- I'm here for another couple of hours.- OK.
0:35:55 > 0:35:58So, as soon as a bed's available, we'll come and let you know
0:35:58 > 0:36:01and we'll walk you over.
0:36:01 > 0:36:04- OK. Thank you very much.- All right. See you later.- Bye-bye.
0:36:07 > 0:36:09Oh, so that's
0:36:09 > 0:36:12good news. Got a bed tonight.
0:36:13 > 0:36:16And so, tomorrow, just need one more good news tomorrow.
0:36:23 > 0:36:27To find a date when everyone is in hospital, free,
0:36:27 > 0:36:29and we can get all of this,
0:36:29 > 0:36:32it takes a tremendous amount of organising and planning.
0:36:33 > 0:36:40It takes a huge amount of preoperative work up.
0:36:40 > 0:36:44He has gone round and seen each one and every one of us.
0:36:44 > 0:36:48He's been checked out from the heart, lungs, kidneys point of view.
0:36:48 > 0:36:52So, all in all, six to eight weeks and we're here
0:36:52 > 0:36:54with him waiting.
0:36:54 > 0:36:56Likelihood of an ITU bed?
0:36:57 > 0:36:59Not very high at the moment.
0:37:03 > 0:37:05The final hurdle, really,
0:37:05 > 0:37:07will be tomorrow morning because you never...
0:37:07 > 0:37:09Never say never.
0:37:09 > 0:37:12You don't know what will happen overnight tonight.
0:37:25 > 0:37:28It's the morning of Peter's operation.
0:37:29 > 0:37:32While the team assembles in theatre,
0:37:32 > 0:37:35Colin Bicknell is on the hunt for a bed for Peter.
0:37:36 > 0:37:39But Intensive Care is already full.
0:37:40 > 0:37:42So, what's the order of the day?
0:37:42 > 0:37:44It's bed management.
0:37:44 > 0:37:46For a couple of hours.
0:37:46 > 0:37:50And, then, we'll concentrate on the operation, I hope.
0:37:52 > 0:37:55So, we should be briefing at 7.30.
0:37:55 > 0:37:58And all will come down to the ICU bed. Everything else is ready to go.
0:38:03 > 0:38:08What we need from ITU is an assurance that we'll have a bed.
0:38:08 > 0:38:11We don't know until they've done the ward round
0:38:11 > 0:38:15and they have understood how well the patients have done overnight.
0:38:15 > 0:38:16How frustrating is this for you?
0:38:16 > 0:38:18You should be in there doing the surgery.
0:38:18 > 0:38:20And you're running around, up and down lifts,
0:38:20 > 0:38:22trying to just find a bed.
0:38:22 > 0:38:23Yeah.
0:38:25 > 0:38:28Trying to find a bed for your patient is
0:38:28 > 0:38:31a particular problem that we go through.
0:38:31 > 0:38:34It's because it's an acute hospital.
0:38:34 > 0:38:37It's because we have a major trauma centre
0:38:37 > 0:38:39and we can't predict all of that.
0:38:40 > 0:38:42At the morning ward round,
0:38:42 > 0:38:45doctors assess patients to see if they can free up beds.
0:38:52 > 0:38:54Hello. Good morning.
0:38:54 > 0:38:59My name is Magdalen. I'm a sister in St Mary's Hospital.
0:38:59 > 0:39:03We have a lady who is supposed to come to you yesterday.
0:39:03 > 0:39:05Her name is Dorothy Jackson.
0:39:05 > 0:39:08There was a delay and you asked us to call today
0:39:08 > 0:39:11to confirm what time she can come.
0:39:11 > 0:39:13Everything is ready. Yes.
0:39:13 > 0:39:14Yes.
0:39:15 > 0:39:18- You look nice today.- Ah, thank you.
0:39:18 > 0:39:22I do try. Thank you very much. I'll be back in a little bit.
0:39:22 > 0:39:23OK. Yes. Thanks, love.
0:39:25 > 0:39:26I want to see her get home
0:39:26 > 0:39:29and I want to see her in her own clothes and doing her own things
0:39:29 > 0:39:31and enjoying her life, not stuck in hospital.
0:39:31 > 0:39:34It's not nice to stay in hospital for this long.
0:39:34 > 0:39:36All right, then. Take care. Thanks, bye.
0:39:38 > 0:39:41Definitely. She's on their list.
0:39:41 > 0:39:45So, if everything is fine with the doctor and she's stable here,
0:39:45 > 0:39:47then they'll get a bed for her.
0:39:47 > 0:39:49So, we're sure she will go today.
0:39:52 > 0:39:56I've come with good news for you. You're to go to Willesden today.
0:39:56 > 0:39:58Yeah? They've got a space for me?
0:39:58 > 0:40:04- Yes. We've spoken to them.- Oh, right.- They have a bed for you.
0:40:04 > 0:40:08Well, that's it, then, isn't it? I'm off your books.
0:40:08 > 0:40:09Yeah, that's good news.
0:40:14 > 0:40:16OK. Do you want to sit up for me?
0:40:16 > 0:40:19Just sit... If you can sit on the side of the bed and face me.
0:40:20 > 0:40:23Harry, who came into hospital yesterday after a fall,
0:40:23 > 0:40:25has spent the night under observation on
0:40:25 > 0:40:27a high-dependency ward.
0:40:27 > 0:40:28Very good.
0:40:28 > 0:40:31'He's not very well today. He's crying. Said his head was
0:40:31 > 0:40:34'really hurting, really hurting today.'
0:40:34 > 0:40:37And I'm waiting to see the doctor now
0:40:37 > 0:40:38to see what's happening.
0:40:38 > 0:40:40OK, so eyes wide open.
0:40:41 > 0:40:44- Argh!- That painful? - That really hurt.
0:40:44 > 0:40:46He wants to go home, that's what he keeps saying.
0:40:46 > 0:40:50He wants to go home cos Paige is 21 tomorrow.
0:40:50 > 0:40:53Paige is Harry's girlfriend, so he was cooking her a nice meal,
0:40:53 > 0:40:57and she told him all what she wanted - chicken...
0:40:58 > 0:41:00And now this has happened.
0:41:00 > 0:41:03So, if you turn your head to the left and keep it like that.
0:41:03 > 0:41:06I'm going to count to three, I'm going to tip you quickly
0:41:06 > 0:41:07on this shoulder.
0:41:07 > 0:41:10We're now going to say that her birthday's next month
0:41:10 > 0:41:13and hopefully Harry will be all better. We can all go out
0:41:13 > 0:41:15and celebrate.
0:41:15 > 0:41:17OK, so we'll do it together. On three.
0:41:17 > 0:41:19One, two, three, go.
0:41:19 > 0:41:21Excellent. Eyes open for me.
0:41:21 > 0:41:25Superficially, it looks like he's got a serious problem.
0:41:25 > 0:41:27And, yes, he's had a head injury.
0:41:27 > 0:41:29This is not a banal situation.
0:41:30 > 0:41:35It needs to be taken seriously. However, the clinical assessment
0:41:35 > 0:41:37is, overall, quite reassuring.
0:41:38 > 0:41:43And he should make good recovery from this with the right treatment.
0:41:43 > 0:41:47Harry is expected to stay in hospital for the next few days.
0:41:47 > 0:41:49I've only just recovered from breaking my ankle.
0:41:49 > 0:41:51I've only just gone back to work.
0:41:51 > 0:41:53- INTERVIEWER:- You're joking?
0:41:53 > 0:41:57I was off work for six weeks, I broke my ankle.
0:41:57 > 0:41:59I've only been back about three.
0:41:59 > 0:42:01Now I'm going to be off for another eight.
0:42:03 > 0:42:04I fell down two levels.
0:42:06 > 0:42:07Lucky I'm not dead, really.
0:42:12 > 0:42:16- HE SCREAMS - Ow, Mum! Mum!
0:42:16 > 0:42:17What have I done?
0:42:17 > 0:42:18Fucking pulled that!
0:42:18 > 0:42:20Oh, I'm sorry.
0:42:20 > 0:42:24When he starts swearing a bit, we know he's still there.
0:42:27 > 0:42:28That's it.
0:42:36 > 0:42:38PHONE RINGS
0:42:38 > 0:42:40Hello?
0:42:40 > 0:42:43I'm all right. I'm waiting on ITU.
0:42:46 > 0:42:50There is a rumour... There is a rumour that they have
0:42:50 > 0:42:52step-able down patients.
0:43:00 > 0:43:05- Mr Peter?- Yes?- Yes, sorry, we're going to theatre now, sir, yeah?- OK.
0:43:05 > 0:43:07I'll just put my things...
0:43:09 > 0:43:12It looks as if there is a possibility of an ITU bed today
0:43:12 > 0:43:15because there's a patient who can step down from ITU.
0:43:15 > 0:43:17We've got to have the full confirmation
0:43:17 > 0:43:19when they've started the rounds, but it's enough for us to send
0:43:19 > 0:43:23for the patient and start, which will save some time,
0:43:23 > 0:43:26and then we'll get full confirmation when they've finished
0:43:26 > 0:43:28the ITU ward rounds.
0:43:30 > 0:43:32- INTERVIEWER:- Are you pleased with that?
0:43:32 > 0:43:33Yeah.
0:43:33 > 0:43:34Very.
0:43:37 > 0:43:40- Probably won't see you...?- No.
0:43:40 > 0:43:43- I won't see you again.- Probably not. - Thank you very much.
0:43:43 > 0:43:46- I'm going down with you. - Oh, are you? Oh, good.
0:43:53 > 0:43:56Everyone's here, everyone's ready.
0:43:56 > 0:43:57And...
0:43:59 > 0:44:00..I think he might be lucky.
0:44:03 > 0:44:04- See you after.- OK.
0:44:05 > 0:44:07Hello.
0:44:08 > 0:44:09Your name?
0:44:16 > 0:44:18PHONE RINGS
0:44:20 > 0:44:23Hello, SAT Operations, Lesley speaking.
0:44:25 > 0:44:27So, Peter, can you tell us your name?
0:44:27 > 0:44:29- Peter Lai.- Yeah, and your date of birth?
0:44:29 > 0:44:3223rd August.
0:44:33 > 0:44:36And can you tell us exactly what we're going to do today?
0:44:36 > 0:44:38I'm going to have an operation.
0:44:39 > 0:44:41Hello, how are you?
0:44:41 > 0:44:45I'm all right, thank you. You're busy?
0:44:45 > 0:44:47OK. What have you got at the moment?
0:44:49 > 0:44:53- So, as you know, we're waiting for the confirmation of the ITU.- Yeah.
0:44:53 > 0:44:57It looks very good, so we're just waiting for the last green light.
0:44:57 > 0:44:58Oh, good.
0:44:58 > 0:45:01- But quite...- Great.- ..confident.
0:45:02 > 0:45:06- See you later. Take care. - Thank you very much.- Bye.
0:45:06 > 0:45:10You know that you've got a booked patient, don't you?
0:45:13 > 0:45:17OK, all right. All right, thanks, we'll speak tomorrow.
0:45:17 > 0:45:18All righty. Bye-bye.
0:45:20 > 0:45:22Heads-up from them was -
0:45:22 > 0:45:25we are not going to have an Intensive Care bed
0:45:25 > 0:45:28for our planned elective patient,
0:45:28 > 0:45:30as it stands at the moment.
0:45:32 > 0:45:36- Does your wife know yet?- She doesn't know if we're going ahead or not.
0:45:36 > 0:45:39So, I guess there's no way I can tell her
0:45:39 > 0:45:42it's definitely going ahead.
0:45:45 > 0:45:48This kidney will be up.
0:45:48 > 0:45:51I mean, if we're on... We're miles away from these graphs.
0:45:53 > 0:45:55- That's the left side, yeah?- Yeah.
0:45:58 > 0:45:59OK, so from there...
0:46:01 > 0:46:03- Gentlemen?- Just in that corner. - Gentlemen?
0:46:04 > 0:46:07We've got... Matt's just been talking to Marylebone.
0:46:10 > 0:46:11- There is no bed.- What?!
0:46:13 > 0:46:15What do you mean there's no bed?
0:46:16 > 0:46:19No bed? No-one to transfer out?
0:46:20 > 0:46:21And there is no...
0:46:23 > 0:46:27That's a no-no, rather than, "No, give us some time"?
0:46:27 > 0:46:30The feedback is it's not available now.
0:46:30 > 0:46:32- You remember me from last time? - I remember you.
0:46:32 > 0:46:34- I remember your name. - Last three times. Yeah.
0:46:34 > 0:46:38- Three times?- Yeah. Two times. - I know I've treated you before.
0:46:38 > 0:46:41It's a shame to see you back, but how are you?
0:46:41 > 0:46:43- I'm OK, thank you.- Yeah? - Good, thank you.
0:46:48 > 0:46:50No, no, I know, it's not your fault.
0:46:50 > 0:46:51But that's a definite, is it?
0:46:51 > 0:46:53That's all we need to know now.
0:46:53 > 0:46:56And it won't change later, and there's no-one who is going to...
0:46:58 > 0:47:00..cancel?
0:47:04 > 0:47:05All right.
0:47:05 > 0:47:06Thank you, bye.
0:47:08 > 0:47:10- Toast.- Definitely not.
0:47:10 > 0:47:12I'll just go and tell him it's off.
0:47:12 > 0:47:13I'll come with you.
0:47:31 > 0:47:35We can get you connected up to everything, so it's going to be...
0:47:37 > 0:47:38Hello.
0:47:38 > 0:47:40Really sorry. There's no bed.
0:47:42 > 0:47:43Really, really sorry.
0:47:45 > 0:47:48Gutted. Of course we're gutted.
0:47:48 > 0:47:51It's disappointing because you build yourself up, you prepare for it,
0:47:51 > 0:47:53we were all ready for it.
0:47:53 > 0:47:56It's disappointing for the patient, to let them down.
0:47:56 > 0:48:00He's going to be going home now. Can you imagine how he feels?
0:48:00 > 0:48:03- Really sorry.- It's all right.
0:48:03 > 0:48:04You tried your best.
0:48:11 > 0:48:16It means organising the whole process again,
0:48:16 > 0:48:18equipment-wise, personnel-wise.
0:48:18 > 0:48:21It means all the people in the clinics that are coming
0:48:21 > 0:48:24in a few weeks' time need to be cancelled.
0:48:24 > 0:48:27All the people that were going to be operated in a few weeks' time
0:48:27 > 0:48:30need to be shifted around. The whole thing is like a moving...
0:48:31 > 0:48:34A moving jigsaw and they all get pushed a bit further along,
0:48:34 > 0:48:37but we have to do this man. Because of his large aneurysm
0:48:37 > 0:48:40there's a risk of it rupturing, so we've got to get him in
0:48:40 > 0:48:41as soon as possible.
0:48:44 > 0:48:47I felt ready for it when I was down there.
0:48:47 > 0:48:50OK, seeing everybody, say hello to everybody.
0:48:50 > 0:48:52Yeah, I'm going for it.
0:48:52 > 0:48:53And then... Oh.
0:48:53 > 0:48:55It just deflates.
0:48:55 > 0:48:58It's a bit unreal, isn't it? It's a bit unreal.
0:48:58 > 0:49:01The last minute...
0:49:01 > 0:49:02Yes, and then no.
0:49:04 > 0:49:05Yeah.
0:49:16 > 0:49:18I'm still waiting.
0:49:20 > 0:49:24She got everything ready and she's been told she's going,
0:49:24 > 0:49:28everybody knows she's going and now we're waiting for transport.
0:49:28 > 0:49:34So the problem with getting a place in the care home has been solved.
0:49:35 > 0:49:37But now I've got to get there.
0:49:37 > 0:49:38So...
0:49:39 > 0:49:42Got another problem on our hands.
0:49:42 > 0:49:45You don't know whether you're coming or going.
0:49:45 > 0:49:49I might have to stay here all night again.
0:49:49 > 0:49:50Like this!
0:49:52 > 0:49:55It's Dolly stuck in her bed with her big boot on.
0:49:55 > 0:49:57SHE LAUGHS
0:49:57 > 0:50:00It's a farce, really.
0:50:00 > 0:50:02It could be made into a comedy.
0:50:28 > 0:50:31If you work in acute hospital, you will have cancellations
0:50:31 > 0:50:35from the High Dependency, from the Intensive Care,
0:50:35 > 0:50:37from the theatre availability beds.
0:50:37 > 0:50:39It's inevitable, isn't it?
0:50:39 > 0:50:40I...
0:50:40 > 0:50:44Is it more frequent? I don't know. It feels real every time.
0:50:44 > 0:50:46It always feels like it's...
0:50:46 > 0:50:49It's the worst thing in the world and it always feels like
0:50:49 > 0:50:53it's happening to you, but we get a lot of work done here
0:50:53 > 0:50:55and we're very proud of the work we get done here.
0:50:55 > 0:50:57You've seen the very worst of it, I think.
0:50:59 > 0:51:02- Young Dorothy.- That's me, love.
0:51:02 > 0:51:05I'm Dave, this is Graham. We're coming to take you out.
0:51:05 > 0:51:10I don't know if you'll have room for my boot, will you?!
0:51:10 > 0:51:12- Thank you, love.- All the best. Aww!
0:51:14 > 0:51:15- And you, yeah?- Bye!
0:51:31 > 0:51:32I'm here again.
0:51:34 > 0:51:36I'm ready for it.
0:51:36 > 0:51:39But the only thing I hope is,
0:51:39 > 0:51:43they won't cancel it again.
0:51:52 > 0:51:55- Hello.- How are you? - I'm OK, thank you.- Good.
0:51:55 > 0:51:59- Back again.- Back again, yes. - In your favourite bed.- Yeah.
0:51:59 > 0:52:05Whereas last time I was telling you that the ITU bed situation
0:52:05 > 0:52:09is really bad and there were queues of people,
0:52:09 > 0:52:13this time, there are queues of people waiting to come OUT
0:52:13 > 0:52:20- of the ITU. So I'm rather hoping we are on.- Yeah, good.
0:52:20 > 0:52:22We still won't know the answer until you're down in theatre,
0:52:22 > 0:52:24- but we'll all be down there with you.- Yeah.
0:52:24 > 0:52:27Well, I'm looking forward to the operation.
0:52:27 > 0:52:31It means, you know, after eight years, I feel I'm part of the team,
0:52:31 > 0:52:34- doing this together.- You are. We're thinking of renaming the bed
0:52:34 > 0:52:36and everything!
0:52:36 > 0:52:38- See you soon.- See you.
0:52:38 > 0:52:42He will stand no chance if it ruptures when he's at home
0:52:42 > 0:52:44or on holiday.
0:52:44 > 0:52:48And, so this is... He's got to have it done if he wants to live
0:52:48 > 0:52:51a long and happy life. There's no reason why he shouldn't do
0:52:51 > 0:52:52if we can get away with this.
0:52:55 > 0:52:57It's not my journey.
0:52:57 > 0:53:00It's me and my wife's journey together.
0:53:01 > 0:53:06I can't say not to worry and don't worry about it.
0:53:06 > 0:53:09I can't do that. But what I can do is to comfort her
0:53:09 > 0:53:11whenever I can.
0:53:13 > 0:53:16- Let's get the brake on before you hop on.- Thank you.
0:53:16 > 0:53:18- Yeah.- Take care, Peter.- Thank you.
0:53:18 > 0:53:20- I'll see you later. - I'll see you later.
0:53:26 > 0:53:28- Hello, Peter.- Good morning.
0:53:28 > 0:53:30You have good news. We're on.
0:53:30 > 0:53:32We're on. Yes.
0:53:32 > 0:53:35It's brilliant news. I mean, it's great cos we can
0:53:35 > 0:53:38get going early as well, which is a real advantage.
0:53:41 > 0:53:45We're going to open up the sac, where there will be some bleeding,
0:53:45 > 0:53:47and then we know plan A is to sew off the lumbars
0:53:47 > 0:53:48and then close the sac.
0:53:48 > 0:53:51Plan B is, if it's bleeding, we'll put some stitches around the top.
0:53:51 > 0:53:56Plan C is clamp the top and the bottom and replace the middle bit.
0:53:56 > 0:53:58Good. Everyone happy?
0:54:05 > 0:54:09So, apart from the seven or eight surgeons,
0:54:09 > 0:54:13we've got three anaesthetists, a perfusionist and a scrub team,
0:54:13 > 0:54:16which is three people.
0:54:16 > 0:54:17So it's about 14.
0:54:19 > 0:54:23The cost of this, just the financial cost, is enormous.
0:54:23 > 0:54:27And I think it's a really optimistic thing that we push on
0:54:27 > 0:54:29and try and get people like this sorted out,
0:54:29 > 0:54:33no matter how big the team and how expensive the day is.
0:54:33 > 0:54:36OK, can we have hands on deck? And, Colin, do you want to orchestrate
0:54:36 > 0:54:39- the move?- Okey dokes.
0:54:39 > 0:54:42I was rather tempted to take this off and then we'll...
0:54:42 > 0:54:44Let's just open here.
0:54:45 > 0:54:47Can you feel it there? So we've got a little way to go.
0:54:47 > 0:54:50- This is through the sac, clearly. - Yeah, yeah, that's the sac.
0:54:50 > 0:54:51Just don't look at it.
0:54:53 > 0:54:54My God.
0:54:54 > 0:54:55Just...
0:54:55 > 0:54:58That is all aneurysm, which is rising up out of the chest.
0:54:58 > 0:55:02- All of this.- And that point there looks like it's about to blow.
0:55:02 > 0:55:05So, you've got ready the knife to open up the sac,
0:55:05 > 0:55:07then lots of sucking.
0:55:07 > 0:55:09Ready?
0:55:09 > 0:55:10- OK.- Lumbar sutures ready?
0:55:11 > 0:55:13- The clamps ready?- Yes.
0:55:15 > 0:55:16OK, Mr Lai.
0:55:19 > 0:55:20Oh, my gosh.
0:55:20 > 0:55:21Another one.
0:55:28 > 0:55:31You can't predict how these things are going to go,
0:55:31 > 0:55:33they're all one-offs, but that went very well.
0:55:36 > 0:55:40It went as well as you can expect it to go.
0:55:40 > 0:55:43But, of course, these people are on a journey through
0:55:43 > 0:55:48the hospital and it's only 50%, the operation.
0:55:48 > 0:55:49If that...
0:55:51 > 0:55:56He's young though, and he's fit, and he is determined
0:55:56 > 0:55:58and so is his family and so is his wife.
0:55:58 > 0:56:01We've got everything crossed for him and, touch wood,
0:56:01 > 0:56:02I hope that he'll do well.
0:56:05 > 0:56:08I've known him for so long now that I'll been checking on him
0:56:08 > 0:56:10nine times a day for the next two weeks.
0:56:44 > 0:56:46- Hello, there.- Hi.
0:56:47 > 0:56:49Hello, darling.
0:56:49 > 0:56:50Yeah. You OK, hon?
0:56:50 > 0:56:51Yeah. Aww.
0:57:27 > 0:57:29SIREN BLARES
0:57:33 > 0:57:35The team assembles for a life and death operation
0:57:35 > 0:57:38to remove a gigantic brain tumour.
0:57:38 > 0:57:41We need to do this today. He's becoming paralysed.
0:57:41 > 0:57:42I could die.
0:57:42 > 0:57:44Thanks for the help.
0:57:44 > 0:57:45But with waiting lists growing...
0:57:45 > 0:57:47It's the fourth time I've been here.
0:57:47 > 0:57:50..it's taking months for some patients to see the trust's
0:57:50 > 0:57:51top brain surgeon.
0:57:51 > 0:57:53It is what it is, isn't it? What can you do?
0:57:53 > 0:57:54Nature of the beast, really, isn't it?
0:57:54 > 0:57:56And doctors attempt to cure a patient's tremor
0:57:56 > 0:57:59with a futuristic deep brain operation.
0:57:59 > 0:58:02The first time I actually saw non-invasive surgery,
0:58:02 > 0:58:06interestingly, was on Star Trek 30 years ago,
0:58:06 > 0:58:07performed by Dr Sulu.
0:58:15 > 0:58:17What choices would you make when faced with
0:58:17 > 0:58:18complex health care decisions?
0:58:18 > 0:58:22Visit our interactive pages to find out how you would respond.
0:58:22 > 0:58:23Go to...
0:58:25 > 0:58:28..and follow the links to the Open University.