Episode 2 Hospital

This programme contains strong language

Just move yourselves over to the side for a minute.

This winter, one of Britain's busiest NHS trusts

opened its doors...

We have to look after the patients,

whether they come from Buck Palace or the park bench.

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

We've got lots of patients

now competing for an unknown number of beds.

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

The pressure's just gone.

What?! Has it completely gone?

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

We just had our worst ten days on record.

There's nowhere in the hospital to move anybody.

At some point somebody will be telling us

whether we're allowed to do any work.

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

Tumour's out, job done.

Where lives are transformed.

This is saving his life. It has to work.

But they are operating at a time when the NHS

has never been under more pressure.

-Any beds?

-No.

-No beds for anyone?

-No.

-OK.

It does feel to me like the elastic's

a bit nearer to breaking now than it ever was.

Its very future under scrutiny.

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

real pressure in the Emergency Department.

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

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

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

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

..to the moment they leave.

It is all good news. The cancer has gone.

-You don't need any more treatment.

-Fantastic.

Thank you so much.

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

about who to care for next.

That patient is coming to me to be operated on,

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

They're going to die.

KEYPAD BEEPS

'Say your name and then press hash.'

BEEP

St Mary's.

St Mary's is the largest hospital in

London's Imperial College Healthcare NHS Trust,

where, every week, hundreds of life-saving operations

are performed.

Today, a team of expert surgeons is preparing for one

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

The team is led by consultant vascular surgeon Colin Bicknell.

Shall I load the scans up, then?

It's taken two months to coordinate

the diaries of the highly skilled surgical team.

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

four consultant vascular surgeons, one cardiac surgeon,

two expert perfusionists,

three anaesthetists,

one general surgeon and our expert nursing team.

That's purely in that theatre.

The patient is retired software engineer Peter Lai.

-I really want to have it done now.

-I know. Well, so do I.

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

-I want you to have it done.

-Yeah.

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

That's right, yeah.

Mr Lai, 60 years old, had a dissection,

type B aortic dissection, 15 or 20 years ago,

and he had a continued dilation of his false lumen.

It has been amazing,

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

And then, it was round about ten years ago,

he got a carotid, carotid,

carotid subclavian bypass,

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

But he's continued to dilate.

This will be his ninth operation.

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

all the clotted blood that's accumulated there

in all these years.

It should really fix his aneurysm for good.

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

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

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

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

-Well...

Anyhow, you're...

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

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

-Yeah.

-We just need the luck.

-Yeah. That's right.

-Yeah.

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

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

This is the left lung,

but it's filled up completely by this aneurysm.

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

in his chest quickly and he'll die.

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

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

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

He's had multiple operations,

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

He's lived with this condition for many years.

He knows the dangers that are there.

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

He's actually a remarkable human being.

I'm not sure whether I, personally,

would have taken all of this quite so well.

I have no choice, basically.

I just go along with whatever's required.

I just want to get it over and done with.

My wife is very worried,

but I don't worry.

I always believe there's nothing to worry

until there's something to worry.

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

but currently the hospital is experiencing very high demand

for its 301 adult beds.

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

a smattering of confirmed discharges, but nothing else.

We've got a number of patients needing placement,

and we're still awaiting a plan, yeah?

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

This is really bad.

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

but this is particularly bad.

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

What is the latest you can wait?

Well, all right.

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

Oh, my goodness.

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

to allocate beds for patients.

It's not going very well.

I mean, we're sort of getting there,

but for every bed we give,

we've got three other patients waiting.

Oh. Oh, thank you very much.

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

-OK, thank you.

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

-That's plenty, thank you.

-All right.

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

-OK.

There might be a bit of a wait.

We also need to take some more blood from you.

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

-OK.

-All right?

-See you later.

-Thank you.

I think everybody is acutely aware that this man

needs his surgery tomorrow.

If this was an ordinary case,

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

Because his is a particularly big case that

has required an awful lot of organisation

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

um...

it could be that senior managers in the hospital

manage to find him a bed somewhere.

As well as a bed on a ward tonight,

Peter will need a bed in Intensive Care tomorrow,

because of the seriousness of his operation.

Well, it is such an invasive procedure,

it's massively traumatic.

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

and then, of course,

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

Mr Lai?

-Hello.

-Hello.

Can I come and steal some blood from you?

Yeah. Where shall we... Here?

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

So, what's the situation now?

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

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

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

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

-It's been requested.

-Yeah.

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

-Hello.

-Hello.

-How are you?

I'm all right.

With the hospital full,

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

-Good morning, girls.

-Morning.

How are you?

OK, thank you.

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

-No.

-No.

-No?

-Sorry.

Well, I don't either, you see.

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

Asking the question, if someone can go home tomorrow,

why can't they go home today?

-Any of your team speak Polish?

-Polish?

-Polish.

She's not here at the moment.

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

most complex patients to discharge.

The pressure that's on the NHS,

you worry about it because you think,

well, the walls are not elastic.

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

One of her cases is a Polish man, Tadeusz.

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

Anybody here speak Polish?

-Pardon?

-No. Italia.

But getting him out of hospital has not been straightforward.

Any of you speak Polish?

He's homeless.

He's been working as a mechanic,

but sleeping in the cars that he repairs.

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

because he probably has neglected it a little bit.

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

Hello. How are you?

You understand a little English?

-A little English.

-A little?

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

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

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

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

You can. You can.

You literally can discharge a homeless person.

But my particular gentleman has health needs,

because his leg looks very vulnerable.

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

is not ideal.

Alice has applied for help from the local council homeless centre

so Tadeusz can continue to get support.

But until an appointment is available, he will remain

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

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

homeless, awaiting placement through a homeless persons' unit,

so any number of people on that spectrum who are delayed

not by us, as a hospital,

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

28 today.

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

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

-It's extraordinary.

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

clearing one of our main wards out completely

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

So that would be today's problems solved.

Louis, from the top.

Our gentleman that fell over whilst on a business trip -

doing very well from a medical perspective.

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

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

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

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

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

from a social perspective.

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

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

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

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

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

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

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

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

I've been here for nearly three weeks.

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

is one of the hospital's oldest patients.

I feel good in myself.

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

walk...you know,

the way I am.

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

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

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

Through... Closed or...

Through your nose and out through your mouth.

Are you happy to be here?

Yeah, I am, really,

because I'm getting the treatment I need.

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

for instance, I passed out this morning,

and, um...

They were all there to rally round, you know,

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

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

I really don't.

It might not be necessarily dangerous to someone

that's like me or you.

However, to someone at her age,

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

Dolly is waiting to be moved to a community hospital,

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

Dolly, are you in any pain right now?

No, love, I feel fine.

I feel... Honestly, really...

Sometimes patients stay here longer than they need to,

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

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

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

and they're just giving you tablets,

you're wasting a bed.

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

What does that feel like?

It feels awful.

I'm not supposed to be here.

Which I'm not.

In a way.

Because they want my bed.

So, what have I got to do?

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

-I brought you some shower gel.

-Just in case.

-Yeah.

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

-No.

Peter and his wife Diana are still waiting to see if

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

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

-Hmm.

-It is nice and bright here, and quieter.

-Yeah.

-It's not busy here, is it?

-No.

-It's just quiet.

We married in 1980, so 36 years.

How did you both meet?

At college. There was volleyball at lunchtime

and he was playing, so it was mixed teams,

and he, actually, was the only boy

who would pass the ball to women because...

He IS competitive, but he's fair.

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

And then got talking.

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

I love him as much today as I ever did.

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

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

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

Protect him.

And...

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

Because he's a very special person.

So...it has been difficult.

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

But, luckily, Peter is really, really positive,

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

And so, it's difficult.

We want a bed for him overnight tonight.

How is that looking?

SHE SIGHS

Not too good at the moment.

At the moment the ward is full.

There may be one discharge.

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

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

is fit for discharge.

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

When St Mary's is full,

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

For every discharge that we'd planned for,

we usually automatically allocate that bed to someone else.

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

Why is this bloke still here?

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

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

after an emergency operation to stop internal bleeding.

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

He has had massive blood transfusion,

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

What he really needs is an Intensive Care bed.

The operation finished over six hours ago,

but they're still waiting to transfer him,

because Intensive Care is full.

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

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

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

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

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

make room for people who need to come here.

Until an Intensive Care bed becomes available,

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

meaning that operations that were scheduled to take place in

theatre 7 cannot go ahead.

It just gets really frustrating when, actually,

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

rather than here in theatre.

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

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

with the best care that we can deliver.

As one of London's four major trauma centres,

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

Trauma team to A&E Resus, please.

Thank you.

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

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

who has fallen two floors at work.

-Fallen from height?

-From four metres.

-From four metres.

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

HARRY MOANS

HE VOMITS

All right?

HARRY GROANS

Well done. It is just some oxygen...

-Please stop that! Please!

-Harry...

You stop that shit! Fuck off!

All right, Harry, you're OK.

-It fucking hurts! Stop it!

-All right, sweetheart.

-Please...

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

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

OK, tube. Intubate.

-Yeah.

-Lovely.

He is anaesthetised and his breathing is supported

so the doctors can ascertain the extent of his injury.

It looks almost certain that he'll need

a bed on the Intensive Care Unit,

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

the Intensive Care Unit is completely full to the rafters.

-PHONE RINGS

-That might be them. Yes, it is.

Hiya.

Have you got anything you can kick out there?

Yeah. Yeah, I know.

I know.

I think we should probably prepare for it.

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

Is it always like this?

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

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

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

There are times when I start thinking, whoa!

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

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

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

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

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

Mum's on her way.

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

-Hello.

-Mrs Jackson, nice to see you again.

When we saw you earlier on this morning,

you were looking pretty unwell.

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

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

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

given that you had your collapse,

we should probably keep an eye on you here.

Yeah, I think I'd be better off.

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

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

the rehab hospital but, unfortunately,

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

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

-while we wait for it to come up again.

-OK.

-OK?

-Thank you.

Very nice to see you. Bye-bye.

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

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

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

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

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

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

DOLLY GROANS

Oh, I know, sometimes it happens.

But otherwise, you look good.

-Yeah.

-OK, then.

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

-OK.

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

-We take you from there.

-Thank you.

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

-Oh, yeah.

-That one.

-Yeah. Ain't that good?

Is that the one you want blown up?

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

Dolly's granddaughter Nicola has come to visit,

with Peter, Dolly's husband of 32 years.

Where did you guys meet?

We met in a pub.

She's definitely a fighter.

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

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

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

Went roller-skating and broke her ankle.

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

I always had good legs.

Nice legs, shame about the face!

THEY ALL LAUGH

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

I know she won't.

They did have a place for her, care home,

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

Have you had your boot on today?

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

I've had to stay in bed.

I had to have a bed pan and all.

No commode.

In case I fell off the commode again!

THEY ALL LAUGH

After receiving emergency life-saving surgery in the

early hours of the morning, the patient in theatre 7

is still waiting to be transferred to Intensive Care.

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

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

This is exactly what our problem is.

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

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

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

You're waiting for the dominoes to all line up

and all fall at the same time.

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

-Hello.

-Hello, Alice.

I've come to see my little man.

Alice's patient, Tadeusz,

has got an appointment at a council homeless centre.

Hello.

How are you?

Are you all right?

We're here again.

Yes.

I have got one of the chappies that work here

-to come and explain about your homelessness.

-Yeah. OK.

-So that you and I can have a chat.

-Yes. Thank you.

That's OK.

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

Rather than wait for the hospital's translation service,

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

This gentleman states he has no place to live.

What I do need to know from him is,

how does he live now that he is homeless,

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

TRANSLATION:

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

I mean, your family are not straightforward.

There are some challenging people in the family,

as well as everywhere else,

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

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

Does he have any friends?

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

-Nobody knows you?

-No.

-No friend at all?

-No.

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

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

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

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

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

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

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

if they can get him accommodation.

He says he agrees with that.

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

I am happy that he can be discharged.

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

Yeah.

Toe touch.

Our code of professional conduct states that we look after

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

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

Toe touch.

Toe touch!

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

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

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

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

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

It's just so frightening.

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

It is really frightening. Really frightening.

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

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

and which ward he will be admitted to.

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

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

We'll take the tube out.

Just keep taking some nice deep breaths.

We'll take the tube out.

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

he's classed as a level III patient,

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

and that is an intensive care unit.

Whereas, if he does the breathing for himself,

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

and he's looking moderately stable,

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

Harry.

Can you open your eyes wide?

Open your eyes wide.

We'll take the tube out.

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

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

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

and take the tube out.

-Oxygen.

-OK.

MACHINE BEEPS

Nice deep breath. Deep breath, in and out.

HIGHER-PITCHED BEEPING

Shall we just bring him up a bit?

You're just waking up, Harry.

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

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

Good. Excellent. Lunch.

Intensive Care has been full all day

but there's been a development.

-What's new?

-I discharged one patient.

-And that was a big relief?

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

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

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

After hours of waiting, the patient who had emergency surgery

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

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

Do you want to switch that ventilator off?

I do my job because I love it.

So, let's take that.

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

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

have anybody to hand over to.

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

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

More days that I leave work unsatisfied.

Not that I haven't done the best

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

because of the lack of resources.

Intensive Care is now full,

but patients continue to arrive at A&E.

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

we're running at 98-99% capacity.

Which is extraordinary.

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

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

It wouldn't be a problem

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

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

We can't change that.

SIREN BLARES

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

-Yeah.

-I'll text you.

-Yeah, text, or I can ring.

-Mmm.

-Not from today.

-No. Shall I leave that?

-No. I won't tell anyone.

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

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

-So, bye, darling.

-Might see you tomorrow.

-Yeah. See you then.

Aneurysm patient Peter has been waiting for nine hours

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

I'm on my own now.

I'm just waiting.

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

Yeah.

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

and just need a bit of luck.

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

And...we can start the recovery.

-I have some news.

-You got news?

-I've got some good news.

-Oh.

We have a bed.

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

Yeah?

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

-Tomorrow.

-We'll do our best for you.

-Yeah.

-Certainly.

-Thank you very much.

-I shall see you later on.

-I'm here for another couple of hours.

-OK.

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

and we'll walk you over.

-OK. Thank you very much.

-All right. See you later.

-Bye-bye.

Oh, so that's

good news. Got a bed tonight.

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

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

and we can get all of this,

it takes a tremendous amount of organising and planning.

It takes a huge amount of preoperative work up.

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

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

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

with him waiting.

Likelihood of an ITU bed?

Not very high at the moment.

The final hurdle, really,

will be tomorrow morning because you never...

Never say never.

You don't know what will happen overnight tonight.

It's the morning of Peter's operation.

While the team assembles in theatre,

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

But Intensive Care is already full.

So, what's the order of the day?

It's bed management.

For a couple of hours.

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

So, we should be briefing at 7.30.

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

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

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

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

How frustrating is this for you?

You should be in there doing the surgery.

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

trying to just find a bed.

Yeah.

Trying to find a bed for your patient is

a particular problem that we go through.

It's because it's an acute hospital.

It's because we have a major trauma centre

and we can't predict all of that.

At the morning ward round,

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

Hello. Good morning.

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

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

Her name is Dorothy Jackson.

There was a delay and you asked us to call today

to confirm what time she can come.

Everything is ready. Yes.

Yes.

-You look nice today.

-Ah, thank you.

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

OK. Yes. Thanks, love.

I want to see her get home

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

and enjoying her life, not stuck in hospital.

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

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

Definitely. She's on their list.

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

then they'll get a bed for her.

So, we're sure she will go today.

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

Yeah? They've got a space for me?

-Yes. We've spoken to them.

-Oh, right.

-They have a bed for you.

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

Yeah, that's good news.

OK. Do you want to sit up for me?

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

Harry, who came into hospital yesterday after a fall,

has spent the night under observation on

a high-dependency ward.

Very good.

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

'really hurting, really hurting today.'

And I'm waiting to see the doctor now

to see what's happening.

OK, so eyes wide open.

-Argh!

-That painful?

-That really hurt.

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

He wants to go home cos Paige is 21 tomorrow.

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

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

And now this has happened.

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

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

on this shoulder.

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

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

and celebrate.

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

One, two, three, go.

Excellent. Eyes open for me.

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

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

This is not a banal situation.

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

is, overall, quite reassuring.

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

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

I've only just recovered from breaking my ankle.

I've only just gone back to work.

-INTERVIEWER:

-You're joking?

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

I've only been back about three.

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

I fell down two levels.

Lucky I'm not dead, really.

-HE SCREAMS

-Ow, Mum! Mum!

What have I done?

Fucking pulled that!

Oh, I'm sorry.

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

That's it.

PHONE RINGS

Hello?

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

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

step-able down patients.

-Mr Peter?

-Yes?

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

-OK.

I'll just put my things...

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

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

We've got to have the full confirmation

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

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

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

the ITU ward rounds.

-INTERVIEWER:

-Are you pleased with that?

Yeah.

Very.

-Probably won't see you...?

-No.

-I won't see you again.

-Probably not.

-Thank you very much.

-I'm going down with you.

-Oh, are you? Oh, good.

Everyone's here, everyone's ready.

And...

..I think he might be lucky.

-See you after.

-OK.

Hello.

Your name?

PHONE RINGS

Hello, SAT Operations, Lesley speaking.

So, Peter, can you tell us your name?

-Peter Lai.

-Yeah, and your date of birth?

23rd August.

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

I'm going to have an operation.

Hello, how are you?

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

OK. What have you got at the moment?

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

-Yeah.

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

Oh, good.

-But quite...

-Great.

-..confident.

-See you later. Take care.

-Thank you very much.

-Bye.

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

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

All righty. Bye-bye.

Heads-up from them was -

we are not going to have an Intensive Care bed

for our planned elective patient,

as it stands at the moment.

-Does your wife know yet?

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

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

it's definitely going ahead.

This kidney will be up.

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

-That's the left side, yeah?

-Yeah.

OK, so from there...

-Gentlemen?

-Just in that corner.

-Gentlemen?

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

-There is no bed.

-What?!

What do you mean there's no bed?

No bed? No-one to transfer out?

And there is no...

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

The feedback is it's not available now.

-You remember me from last time?

-I remember you.

-I remember your name.

-Last three times. Yeah.

-Three times?

-Yeah. Two times.

-I know I've treated you before.

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

-I'm OK, thank you.

-Yeah?

-Good, thank you.

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

But that's a definite, is it?

That's all we need to know now.

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

..cancel?

All right.

Thank you, bye.

-Toast.

-Definitely not.

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

I'll come with you.

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

Hello.

Really sorry. There's no bed.

Really, really sorry.

Gutted. Of course we're gutted.

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

we were all ready for it.

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

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

-Really sorry.

-It's all right.

You tried your best.

It means organising the whole process again,

equipment-wise, personnel-wise.

It means all the people in the clinics that are coming

in a few weeks' time need to be cancelled.

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

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

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

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

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

as soon as possible.

I felt ready for it when I was down there.

OK, seeing everybody, say hello to everybody.

Yeah, I'm going for it.

And then... Oh.

It just deflates.

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

The last minute...

Yes, and then no.

Yeah.

I'm still waiting.

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

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

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

But now I've got to get there.

So...

Got another problem on our hands.

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

I might have to stay here all night again.

Like this!

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

SHE LAUGHS

It's a farce, really.

It could be made into a comedy.

If you work in acute hospital, you will have cancellations

from the High Dependency, from the Intensive Care,

from the theatre availability beds.

It's inevitable, isn't it?

I...

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

It always feels like it's...

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

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

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

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

-Young Dorothy.

-That's me, love.

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

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

-Thank you, love.

-All the best. Aww!

-And you, yeah?

-Bye!

I'm here again.

I'm ready for it.

But the only thing I hope is,

they won't cancel it again.

-Hello.

-How are you?

-I'm OK, thank you.

-Good.

-Back again.

-Back again, yes.

-In your favourite bed.

-Yeah.

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

is really bad and there were queues of people,

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

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

-Yeah, good.

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

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

-Yeah.

Well, I'm looking forward to the operation.

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

-doing this together.

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

and everything!

-See you soon.

-See you.

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

or on holiday.

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

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

if we can get away with this.

It's not my journey.

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

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

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

whenever I can.

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

-Thank you.

-Yeah.

-Take care, Peter.

-Thank you.

-I'll see you later.

-I'll see you later.

-Hello, Peter.

-Good morning.

You have good news. We're on.

We're on. Yes.

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

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

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

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

and then close the sac.

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

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

Good. Everyone happy?

So, apart from the seven or eight surgeons,

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

which is three people.

So it's about 14.

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

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

and try and get people like this sorted out,

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

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

-the move?

-Okey dokes.

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

Let's just open here.

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

-This is through the sac, clearly.

-Yeah, yeah, that's the sac.

Just don't look at it.

My God.

Just...

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

-All of this.

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

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

then lots of sucking.

Ready?

-OK.

-Lumbar sutures ready?

-The clamps ready?

-Yes.

OK, Mr Lai.

Oh, my gosh.

Another one.

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

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

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

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

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

If that...

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

and so is his family and so is his wife.

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

I hope that he'll do well.

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

nine times a day for the next two weeks.

-Hello, there.

-Hi.

Hello, darling.

Yeah. You OK, hon?

Yeah. Aww.

SIREN BLARES

The team assembles for a life and death operation

to remove a gigantic brain tumour.

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

I could die.

Thanks for the help.

But with waiting lists growing...

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

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

top brain surgeon.

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

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

And doctors attempt to cure a patient's tremor

with a futuristic deep brain operation.

The first time I actually saw non-invasive surgery,

interestingly, was on Star Trek 30 years ago,

performed by Dr Sulu.

What choices would you make when faced with

complex health care decisions?

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

Go to...

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