Episode 1 Hospital

This programme contains some strong language

and some scenes which some viewers may find upsetting.

Good afternoon, ladies and gentlemen.

We're here to review...

..vacancies and retention.

OK.

How many vacancies have we got at the moment?

699.

699, OK.

Throughout this year, we've run at anywhere between

12% and 14% vacancy rates.

OK. Draw our attention to the key points in the report.

-So, one of the... We've obviously plugged in at the moment...

-PHONE RINGS

..the 20-odd Band 4s that we have joining us in April,

-but it would be nice to see some of the hard-to-recruit people...

-ANOTHER PHONE RINGS

TEXT MESSAGE ALERT

We are on stand-by for a major incident at Westminster Bridge?

The Houses of Parliament?

Have you got any more details?

You on the news channel?

Who's ringing?

-BBC.

-BBC News.

-OK, we'd better adjourn.

Go to your major incident positions and we'll await further information.

We are on standby for a major incident.

There's been some stabbing or shooting at Westminster.

The Ambulance Service notified us

that we're on standby for an incident in Westminster.

So we've got a plan when this happens,

and that's what we're now putting in place.

So I'm going off to the site office,

which will be the place

where we will start to co-ordinate our response.

-Any more detail?

-So, 15 potential casualties.

Potential? Do we know how many there are at this time?

We've no idea. All we know is LAS have given us stand-by

-with 15 excepting.

-OK.

Well, you can see on the TV there what's going on.

-NEWSREADER:

-We know that one police officer has been stabbed

and that assailant has been shot.

There is a major police operation now underway.

Crikey.

St Mary's Hospital in Paddington is one of four major trauma centres

in London capable of dealing with mass casualties.

Sarah, how many casualties?

Three miles from Westminster,

it's the nearest to the scene of a suspected terror attack.

Everybody's phones are ringing like fury now as well.

Hello, Lesley Powls?

Lesley's taking Silver and Judy is taking Bronze.

All right?

During a major incident,

the hospital follows a 194-page set of protocols.

"Stand by" means prepare to receive casualties.

Hello, Gold, this is Silver.

The reason we have the command and control structure we do -

which is Gold, who is strategic, Silver, which is what I'm doing,

which runs the operational response,

and Bronze, who runs the pure operational side of things.

No, we can't give out any information.

The reason we do that is so that you keep people in their own role.

The word people are using at the moment

is that this is a terrorist incident,

so we need to be in a position to make sure that all of our

decision-making is absolutely crystal clear.

So anybody else who was elected for today who hasn't gone knife-to-skin,

they need to be sent home.

I'll tell them.

We need a collation of A&E receiving spaces,

trauma receiving spaces,

and then a running collation of beds available now.

What we'll do is we'll just go through each site quickly.

I just have specific questions for each site.

So, Hammersmith, have you got ICU beds?

Can you go back to ICU and see if they can make as a bed,

because we've been put on stand-by?

How many spare beds do you have at the moment?

ICU, they are full, is the simple answer.

Major trauma have two spaces.

So we're asking them to explore the capability -

if they need to, can they go into major trauma?

Or, by preference, are they going to go down to recovery?

Guys, can we all please just make sure I know we've signed in?

During a major incident, the entire resus area has to be cleared out.

Because we are going to be getting lots of sick, sick people.

It's 12 minutes since the hospital was put on standby.

Off-duty medical and nursing staff arrive to assist in A&E.

So each of the bays has got a team allocated

of surgeons, anaesthetists,

nursing staff, theatre staff.

The bleep goes off, your phone goes off, and you come in.

So we'll just make sure we're all organised.

They look like they're getting some stretchers into ambulances.

OK, so we need to make sure all your night shift

can get in for duty tonight,

because it looks like the whole of Westminster is shut.

The only, obviously for labs,

the big pressure will be we suddenly need a lot of blood.

We would need surgical nurses from upstairs to come down

and actually look after these patients as well.

They can stay here and we'll bring the patient, yeah?

The first ambulance is on the ramp.

SIRENS BLARE

Everybody, just be quiet in resus for the moment.

This is a gunshot wound.

The first person to arrive in A&E is the alleged attacker.

Non-open chest, we're going to transfer

to a long-side and a right-side location, please.

OK, so, right...

Quiet for a second.

The first casualty that's arrived has died,

so we're going to set up a mortuary, he will go there

and the police guard.

So people are jumping in the river to escape,

so this is what's come through from the antiterrorists.

Right, Judy, get switchboard to stand us up formally now,

put that call out.

We're declaring.

We're declaring a major incident at the St Mary's site only.

So, NHS England have just come through to say, so,

stood up or declared are ourselves, Chelsea and Westminster,

-King's, Guy's and St Thomas' and UCLH.

-Wow.

St Mary's is now formally declared

and the next phase of protocol can be implemented.

London Ambulance Service will only bring

critically-ill patients to A&E.

We're now deploying the full lockdown policy

and procedure for the St Mary's site.

We'll make the site as secure as we possibly can be.

'OK, that's very good, well done.'

Simon, are we all right upstairs?

We just need to start getting the beds actually liberated.

Simon Ashworth is Head of Intensive Care.

He needs to create capacity for casualties

who have yet to arrive from the scene.

This is the list of the people that we can move.

It's the ambulances that are my issue.

Our transport services are going to see if we can staff

any more transfer ambulances.

OK, right.

You always worry about the situations arising

when the system's already under strain.

We're trying to arrange transfers across to other hospitals,

but the problem is that

we don't know if we're going to be able to get ambulances

in the circumstances to be able to actually move them.

Let's find out how we're getting on.

We should be able to create up to 12.

-OK.

-But it's going to take time.

OK.

What we really don't want is a situation where the resus area

can't function because they can't move people out.

And that's what will cost people their lives.

-Right.

-Oh, my goodness, they're showing what happened.

A man thought to be armed with a knife was shot by armed police.

A number of others have been hurt,

including some with catastrophic injuries...

Our first casualty, who arrived to us as a code red,

is believed to be the perpetrator of the incident.

-'OK.'

-SIRENS BLARE

So we're getting a fair bit of ambulance activity

going on outside now, David, just to be aware.

Paramedics have been treating victims at the scene.

-NEWSREADER:

-Mowed down on Westminster Bridge.

Our colleague Nick Robinson saying a party of French schoolchildren

were among those involved...

Guys, this patient looks like they're arriving.

Right, guys, patient's here.

Over there, please. Thank you.

The first victim to arrive at St Mary's is a French schoolboy.

OK, on three, one, two, three.

Right, guys, we'd better get a handle on our patient. Fire away.

Today was the last day of a school trip to London.

Right, we've got to finish the primary survey.

We're going to get a collar on, we're going to log roll him,

get him off the scoop, get him covered up warm,

fast scan, set of bloods, then we're going to go to scanner, OK?

Chest wall tender on the right-hand side.

Victor, can you move your left leg for me?

Lift your left leg straight up.

Thank you. And your right leg?

IN FRENCH:

Sorry, he's 16. Does he know what's happening?

So, can you explain to him that he was hit by a car?

What's this one?

Victor's school friend arrives in A&E.

18-year-old Yann has lost a dangerous amount of blood

from a severe scalp wound.

We need quarters...

I've got people who need to move.

He's taken for immediate life-saving surgery.

Are you free?

As part of the major incident protocol,

all nonemergency surgery has been cancelled

and operating theatres cleared.

Is this the scalp laceration?

Theatre six, please.

We have got one, two, three, four theatres available.

OK, guys, resus, please, listen in.

Resus one is unstable and they need to go to CT immediately.

Resus two is going upstairs to the major trauma ward.

Resus three is coming back from CT

and resus four is just on their way to CT.

If you're in the trauma team, stick with your team,

if you're not in a red tabard I need more space in resus, please.

Move out of the way, please.

16-year-old Victor is being taken for a CT scan.

Right, we are all connected, let's go.

When people come in with major trauma

and they've got multiple injuries,

there may be stuff that we can't see,

so the CT scan should be done as quickly as possible

because given the amount of force, anything could be at risk here.

Guys, can we slide him up, guys?

-Are you all right translating for him as well?

-Oui.

The story is he's amnesic to events.

He's complaining of right-sided shoulder, queried chest pain.

So we're querying head, querying something in the torso as well.

-His elbow...

-Yeah, the elbow's dislocated, isn't it? Yeah.

Guys, can we get hands in to get him off the trolley

while we have a quick look at this?

-So, fractures posterior from ten to about six...

-Yeah.

The scan reveals a fractured dislocation of the right elbow,

multiple rib fractures and spinal damage.

But most concerning is a collapsed lung.

Guys, hang on, two seconds!

So, with a collapsed lung, it can be life-threatening

if it's what's called a tension pneumothorax,

and that needs to be treated straight away.

OK, resus two.

We need to put what's called a chest drain in to let this air come out

and let his lung re-inflate.

We need to put a tube, do you understand?

A tube on your chest.

A small tube.

-No fail-safe.

-No fail-safe, it's just a two pint.

So, he'll go into the invasive rib fracture...

What I need to find out is whether we've got any beds available

on the first floor.

So as soon as that drain's in he could potentially come out.

How are we doing, sedation-wise? What are we giving him?

40 of ketamine.

40 of ketamine, great.

It's 45 minutes since Victor arrived in A&E.

His condition is now stable and does not require immediate surgery.

OK? There we go.

There we go. OK?

IN FRENCH:

We'll get him upstairs.

-VICTOR: Natalie.

-Natalie?

-Anthony.

-Natalie, Anthony.

The poor boy is here on a school trip and he's brought into a place

where there was a lot going on.

So for him, he's only 16, it's quite nerve-racking.

So our main aim is to make sure the patients are treated properly,

treated in a timely manner,

hopefully comfortable up in the ward

and that, actually, they are kept safe.

Do you want to call his dad? We can get him to speak to his dad.

IN FRENCH:

You OK? Oui, ca va?

HE GASPS

This patient...

..he was bleeding so much in A&E, he has had some blood,

which has gone through.

Victor's school friend, 18-year-old Yann,

is undergoing surgery on his badly-lacerated scalp.

So there are several layers to the scalp

and he has gone through all of them right down to the skull.

But, luckily, he hasn't got a skull fracture.

The windscreen apparently had evidence of a bull's-eye hit

and he was lying adjacent to the car,

so we think perhaps the car hit him from behind,

hence he has got an injury to the back of the scalp.

Surgeons must sew each layer of Yann's scalp back together.

He's also got a spinal injury,

so we've had to be really careful about transferring him

so that we don't move those injuries,

so we're not making something that's stable at the moment

into something unstable.

Oh!

-From the scene?

-Yeah.

OK. Well, we can put them in one of the bays down here.

On an average day, St Mary's treats eight trauma patients.

In the last hour and a half, six have arrived from Westminster.

So, casualty update, then.

So, we have the one RIP.

Seven major trauma patients.

We've also had three blue calls unrelated to the incident.

So we are busy.

I don't have much in the way of current capacity.

It's all predicated on these moves happening.

You know, we need the ICU capacity.

It's still unclear how many patients will require intensive care beds.

He's got pretty terrible injuries.

I'm not very convinced he can go.

To create capacity, Simon has to identify patients

who can be transferred from St Mary's

to another intensive care unit in the trust.

One is nearing the end of an operation.

I'm just going to talk to the vascular surgeons about...

..what we do with their patient,

whose surgery started at eight o'clock this morning.

Obviously the major incident has intervened,

and we need to decide where we put them.

And what I don't want to do is put someone in an ambulance

and transfer them who is too sick to actually move.

How sick is he going to be at the end?

What is the right answer, Simon? How do I get a bed?

THEY CHUCKLE

I'm looking at needing to take seven patients today,

but I'm looking at who's the least risky people to transfer.

I don't like transferring hot vascular patients

because the things that go wrong will then...

He should definitely stay here.

OK.

Hi, there.

So, this lady...

It looks like a survivable injury, so...

She is certainly fit for transfer

and she's on the list to go.

Just to make you a bit more comfortable,

I'm going to lift your head up, OK?

They'll give you some more painkillers in the ambulance, all right?

The ambulances themselves don't really come with

all the gear you need.

Charing Cross, which is our sister hospital...

..has sent doctors with assistants and all the equipment

so that they can retrieve the patients to Charing Cross.

And it's an absolute life-saver for us, you know?

It's the reason we've capacity

to take all of the patients who we need to take today.

HE SIGHS

So...

This is where now we're sort of...

..more or less ready to actually cope with the influx of patients.

What about SIC?

-SIC is free.

-SIC is free,

however, we would prefer to cope with all the major incident patients

in main theatres.

Helgi is now gone to resus.

Are you happy to be the Bronze anaesthetist again?

Do you want to send the open tibia guy up to theatre two now?

40-year-old Stephen was on a day trip to London

when he was caught up in the Westminster attack.

He has multiple injuries that require surgery.

Obviously it's a terrorist attack on your home city.

For us, we have to push past that

and just focus on doing the job on hand,

which is patients come in that have injuries,

we work out what's going on with them,

we sort out a plan and we deal with it.

Blood loss anticipated.

Stephen's complex four-hour operation

-is led by Shehan Hettiaratchy...

-Blade, please.

..who served as a military surgeon in Afghanistan.

'He has got some quite serious injuries.

'He had quite a serious chest injury,

'quite a serious facial injury,

'he has got quite a serious lower leg injury.

'One of those injuries in isolation is not life-threatening

'but when you put them all together in one person,

'they have the potential to become life-threatening.'

Blade, please.

'The idea of a trauma centre is you get all the right experts

'to look after that one individual patient in one place.'

Can I get a curette?

No, a bone nibbler, actually, let's have a bone nibbler.

When you're ready.

'If you look at what the trauma system has done,

'you're twice as likely to survive major trauma now

'than you were ten years ago.

'This is a system that is saving lives.

'I spent time working in Afghanistan -

'you know, that was the most successful trauma system

'the world has ever seen.

'That happened because we were a single focused specialist

'dealing with one thing, trauma,

'and that's all we did and all we were there for,

'and it shows actually what can be achieved.'

Forceps.

Stephen's wife, Cara, was next to him on the bridge when he was hit.

She has sustained minor physical injuries.

We're quite private people.

We don't go out a lot.

This was a special occasion.

It's funny, because I don't like going on the Tube because I'm scared

of something that might happen,

and so we decided to get a taxi.

Obviously we were going to flag a taxi down.

What he looked like on the road...

And he was just covered in blood.

It was all over him.

Everyone goes through shit, you know,

but...not this.

Not being ploughed down.

SIRENS BLARE

Can you stand us down at St Mary's for the major incident, please?

Did you hear that? So, that is an LAS stand-down at 18.24 for us.

-'Have we had any more casualties come in?'

-No.

My suggestion is people reasonably have a think about

what they need to do for us to get into business as usual,

and just to check staffing tonight.

All right, I've got people coming from

all of the other hospitals to help.

That's better.

Stephen and two other victims of the attack remain in surgery.

Do you want to take it up any higher? Happy with that?

-What happened?

-A car mounted the pavement on Westminster Bridge.

-OK.

-Yeah. And then...

..whether it was the driver or somebody else,

they then got out with a big knife and stabbed a policeman,

who was then shot.

It does test your faith in humanity,

seeing how horrible people can be to each other.

But also, we see a lot of very uplifting things

that make you think, "You know, actually, humanity is all right."

On three, two...

Yann, the French teenager,

has had his scalp successfully repaired.

IN FRENCH:

Victor, the youngest one,

has been asking about him and was worried about him,

how he is doing.

And he was also worried about his friend.

We spoke to his family, his parents,

and they are coming a bit later.

I think a plane is being catered for the family in France

to come over to London.

Guys, let's stay focused, please.

Stephen has been in surgery for two hours.

It's quite a high-energy injury.

Quite a lot of contamination,

so we spent the last hour just getting that properly cleaned.

If you get infection here, it could be a disaster.

-Go for it.

-Yeah?

-Yeah.

Yeah, the challenge is he's lost his soft tissues,

where his broken bones are, and we've got to fix that,

we've got to cover that.

That's probably going to require quite a complex operation to do.

So we are going to have to replace that tissue there.

And the only way we can do that is to take tissue from somewhere else

in his body and connect it up, which we'll get done hopefully...

..next week, I guess.

Basically, before orthopaedic and plastic surgery

got to where it is now, this was an amputation-level injury.

So this is now, we can salvage the limb.

We hope.

I don't even know actually what happened.

It looks like it was a car that went onto the pavement.

-NEWSREADER:

-Four people are known to have died.

20 people have been injured.

-Four people have died?

-Mm.

HE SIGHS

Yes. A busy day. Busy day.

..there has been an attack on the seat of politics for the UK

but they have lost one of their own officers.

No, I doubt if we will either.

I can guarantee you the minute I get on the Tube,

the reality of this will start to hit home

in that what we've got here are individuals whose lives

have probably been massively altered by something totally unexpected.

So as much of a shock that this was to us...

..you can't even begin to imagine what it's like

for these poor patients and their families.

So, yeah, it will absolutely prey on my mind tonight.

I guarantee it.

I will look like a broken, sleepless woman tomorrow.

Right, OK.

OK, it was a challenging day, but actually, everything went to plan,

everything went smoothly,

we got all the work done.

It's as good as it could be.

It's actually, it's really easy when there's a little bit of heat on,

when things are a little bit uncomfortable, to fall apart.

So actually, I think what I was most pleased about today

was our team worked

and it worked well.

30 people were treated in five London hospitals

for injuries sustained during the Westminster attack.

Five remain at St Mary's.

OK. So, for this morning, then,

we're going to try and get back to normal.

You can feel it today. You can feel the atmosphere,

everybody is a bit jittery. "Did you sleep?"

Because people aren't quite sure how to process yesterday.

So actually, what we've got to do today is just reset everybody

to recognise that we're back into normal.

So we'll step the site... With the agreement of the Met

we're going to step off lockdown,

but we will keep a police presence on the ninth floor.

-Also, someone on the first floor.

-Two on the first floor.

Two on the first floor.

And we'll keep someone at reception for the moment.

Can I ask you, at least for the next 20 minutes,

to put some of the emotion and some of the other thoughts in our heads

around the incident to the back of your mind and let's focus on

the clinical problems of the patients?

Shall we start with the ITU ones?

Yeah.

Stephen has been intubated in ICU overnight.

Major injuries of concern are an open tib-fib fracture...

..which was operated on successfully.

-Stage one.

-Stage one.

So, the plan with him, he will need a tibial nail next week.

OK. The two French chaps on a tour from Brittany.

I'll just check your temperature, yeah? Just under your tongue.

OK. 18-year-old Yann?

He had a large laceration on his scalp

which was sutured by the plastic surgery service last night.

Of all the patients from yesterday,

he's probably the first one that can properly be discharged.

-OK.

-And ex-patted back to France.

And we'll work out follow-up if he's going back to France.

The second patient, Victor.

Victor is 16.

His main injuries are quite a number of right-sided rib fractures

with a traumatic pneumothorax,

which was treated with a chest drain insertion.

So, reality, he'll be with us over the weekend at least.

I think so, yeah.

Anything else we need to be aware of with him?

Everyone happy?

IN FRENCH:

Victor's parents arrived at the hospital just before midnight.

C'est bien.

HE IMITATES HER

Stephen has spent the night in intensive care.

He was celebrating his 40th birthday.

So, I guess that illustrates the sort of...

..the way these events just crash into people's lives.

-You're going to keep him sleeping, I heard, until tomorrow.

-Yeah.

I think we need to know what you're going to do

with the rib fractures.

I mean, it's a borderline flail.

I'm not really very convinced how well they do.

Stephen we would describe as critically ill,

in that he requires support on a breathing machine

with a tube down his throat

and he's requiring drugs to support his blood pressure.

Now, I'm reasonably confident that he should make a good recovery...

..but you can never be complacent about people in intensive care.

There is always the potential for things to go wrong.

Probably site a different epidural for the flap...

..because obviously, hopefully, the chest pain will have receded.

-We can minimise the risk.

-Yeah.

-We won't be able to eliminate it.

Stephen requires another major operation to save his damaged leg.

Until his condition stabilises, he is sedated and on life support.

It's really hard when you spend

so much time with somebody and then...

..they're taken away from you

and you're suddenly really, really alone.

Because you just want to grab hold of him and...

and just give him a cuddle and a squeeze and take care of him.

But then he's so fragile you can't...

..you just can't touch him.

It's two days since the Westminster attack.

The insurance company acting for Victor and Yann

wants to fly them home together.

PHONE RINGS

Hello!

Well, sure.

Our first patient, Yann, is certainly fit for discharge today.

The second patient, Victor...

Victor's injuries are more severe in that I don't think

he should be discharged or repatriated at the moment.

OK. I understand,

but it's not like we're signing off a mortgage contract here,

we're dealing with a person,

and as regards liability and responsibility,

you know, it goes both ways.

What's that? Monday or Tuesday, depending on how he looks.

OK. Thanks for calling.

OK. Bye.

So, you know, they want to take the patient today.

And I can understand emotionally it's probably the right thing to do

but you have to remember these teams are making...

are trying to make decisions with the best will in the world

and, you know, very genuine decisions based on

information over the phone, which isn't the same

as actually standing at the end of the bed and seeing the patient.

That's the real test of whether a patient looks

fit to go or shouldn't go and I think right now

the safest option - he's only 16 - is to wait.

I think this doesn't make sense from our perspective

but I don't know what you think, Morgan.

No, I don't understand what the rush is.

-And it's only to France.

-We did say that.

And we're still part of the EU!

At least for a little bit.

-Bonjour. Can you give me a cough?

-MORGAN COUGHS

-A big cough.

-HE COUGHS

-Encore.

-HE COUGHS

-A big breath.

-MORGAN GASPS

So, he has a lot of rib fractures.

And his lung collapsed.

And this drain treats that.

Now, there was some talk about discharge today.

Now, I know France is very close by but even so...

..I wouldn't be in favour of him being transferred

in a compressed aircraft because of the lung injury.

WOMAN TRANSLATES

I feel he should stay until after the weekend

and I think the best thing is whatever the safest option is.

WOMAN TRANSLATES

OK. D'accord. OK.

The boys have been in separate parts of the ward and haven't seen

each other since the night of the attack.

Great. Well done. Good.

And we're just going to come round this side.

OK. Well done.

Good job.

OK. Do you want some pain relief?

-Yes.

-I'll go ask the nurse for you to get some pain relief.

IN FRENCH:

You know, it's a horrible situation for Victor

because he wants to go home.

We always try and do what our patients would wish us to do

but there are times where we just can't do that.

We've got to wait until we're comfortable and confident

that he will be able to breathe without the chest drain in

before we can let him fly.

Stephen is no longer sedated and has been moved out of intensive care.

And were you just in London for the day?

-It was my birthday.

-Oh, was it your birthday

on the day? Oh, Stephen.

I remember making the decision, "Let's cross the bridge,

"get a taxi on the other side." That's pretty much it.

My wife was there as well.

-Oh, is she OK?

-She has minimal physical injuries.

I think she has a twisted ankle and a few bruises.

-Right.

-But...

she remembers it and I don't.

You don't remember it.

So, I've got the broken body, she's got the broken...

The broken mind, I know.

I'm really worried about her.

You know, it was horrendous.

Cara told me there was an image online of us

so I went looking for it.

This is it, really.

This is me laying in the road

and Cara is just on her knees crouched over me,

telling me to be OK and it's all right.

I just see love in it, really, cos all that chaos and hatred,

all I can just see is my wife looking after me.

But we're going to deal with it together.

So... That's what we've kind of...

HE SIGHS

That's our plan, you know, we'll both do it together.

And so, like I say,

we've got different experiences of the situation.

OK if we come in?

Do you remember me?

So, I was going to chat to you a little about the leg.

You know, getting the operation done

to fix both the bone and the soft tissue.

So, the whole aim of this is trying to get rid of

any chance of infection which could...

Do it once and do it well once and that's it.

That's exactly right.

OK, the other thing I always ask people is,

are you having any problems sleeping, flashbacks,

anything like that?

Erm...

-Let's get this sorted.

-Yeah.

Then we can cross that bridge when we come to it.

Just so you're aware, if you do start getting those kind of things,

it's completely normal.

I just want it over and done with.

If you want someone to talk to, we've always got people around.

Our aim is to get you back to where you were, OK?

'We've got to get it into his head that actually it's not going to be

'a smooth journey. He's going to have rough days, bad days,

'he's going to go up and down.

'He might be walking down the road in six months' time

'and hear a car revving and it may just somehow

'subconsciously flick him back into where he was

'on the day of the accident,

'and I think it's important to warn people that can happen.'

Every one of us has a limit to how much mental resilience we have

and you've just got to be conscious of that.

SPEECH INAUDIBLE

Bonjour.

Ca va?

-Can you give me a big cough?

-VICTOR COUGHS

-Big breath in.

-THEY INHALE

That was good. I think we can take that out.

We're going to remove the drain.

Whilst the lung re-inflates and expands,

it sticks to the inside of the chest wall.

And that keeps it up.

Just taking out a stitch.

OK, and again.

And blow hard.

THEY EXHALE

OK. Done.

Done. Breathe normal.

OK?

Tres bien?

Good. Do it again.

Non.

OK, we're going to take a quick picture of your chest, yeah?

Good. Get your shoulders very close for me.

OK. Big breath in for me, please.

And breathe normally.

IN FRENCH:

Yeah. His lung is nicely expanded,

his collapsed lung is nicely sealed, so he could be discharged today.

IN FRENCH:

-Bonjour.

-Bonjour.

Paramedics from the French insurance company

arrive to collect Victor.

IN FRENCH:

Victor, all the best, man. OK?

I walked across Westminster Bridge yesterday and it's just so mundane.

I know exactly where our patients were injured.

Sometimes, it's almost surreal to think that actually, a week ago,

it was a very different scene.

It's the day of Stephen's leg operation.

About six, eight months ago we got married.

And that's it.

We're just a happy little unit, really.

We live our lives like anybody else.

We go to work, go home, watch a bit of TV,

have a bit of dinner and go to bed.

This will change us.

We're going to appreciate each other more.

You know, and for both of us to survive....

You know, that's just...

You take it for granted, you step out of the door every morning

and on your merry way you go.

The operation is the start of his rehabilitation

and the start of his journey back towards getting to being

that person he was before he got hit.

If we can now say to you, "Right, Stephen, you're fixed..."

..your next focus is walking out of the hospital, that's a big deal.

-Are you ready, Stephen?

-I am.

I don't know if that's going to be the last of it.

I'm not expecting it to be the last of it.

I want him back home.

I want to have a Friday night

on the sofa with a pizza and a beer, you know?

I want that back.

Right. There we go.

This is our titanium nail that's going to stabilise the fracture.

The operation will last nine hours.

First, an orthopaedic team inserts a 390mm rod

into Stephen's shin to stabilise the fracture.

OK. X-ray, please.

Then, Shehan attempts to repair the large open wound.

'You see, the leg break itself's relatively straightforward.

'The problem for him is that it's happened in the context

'of losing lots of skin around the leg break.

'So we need to replace the skin that's been lost

'using tissue from his other leg.

'The way we do that is we take a block of tissue

'on its blood vessels.

'We then move it to where that skin is missing.

'So, slightly robbing Peter to pay Paul,

'but we're hoping the robbery's worth the outcome.

'And then we reconnect that blood vessel

'to blood vessels in his legs...

'..using microsurgery, so it's quite delicate stuff.

'If we can't get that connection to work...

'..then we've got a problem.'

Yes, that's all now hooked up.

So, you can see this tissue's now bleeding,

and ideally you want it bleeding exactly the same as it was

when it was in the thigh.

So hopefully, after today, he's going to be...

..on the road to recovery and walking

and getting back on with his life,

at least from the physical side.

I'm sure that other things take a bit longer.

-All right?

-Good.

-How are you?

-How are you?

-I'm all right.

It went really well.

Probably 12.

That's basically... That's as good as it could be.

Cara, hi, Shehan Hettiaratchy,

I'm the surgeon looking after Stephen.

He is awake, comfortable...

..and he wants to go dancing, so I think that's probably a good sign.

No, it's a pleasure. Take care. All right.

Bye-bye.

'Our job here within our trauma centre

'is to deal with victims of trauma no matter how they suffered that.'

It's important to reflect,

but it's also important to realise we all have jobs to do

and we have to move on from this and we have to keep going.

I want to do this as a log roll.

I'll come down.

Where are you? You're in resus? Yep, coming down.

-What's happening?

-I don't know,

but I know there's a bad stabbing down there.

Salut!

IN FRENCH:

I can't wait to have that first kind of beer in the garden.

I think, Cara, I feel like...

..I'm allowed to say we've won.

We survived and we're safe.

My heart...

..hopes that you only ever have one day like that.

My head tells me that I'll be putting on that tabard again.

And that sense of almost inevitability

is something that you just have to get used to.

So, let's move on to the income report.

With the NHS under mounting financial pressure...

We have a financial deficit of 41 million.

..the trust treats private patients to boost income.

It's better that we address our deficit that way

than that we have to cut back on NHS services.

And with patient demands for new, expensive cancer drugs rising...

We are in a golden era of more and more drugs available.

How do you cost life?

It is very, very difficult.

..an increasing number are self-funding

experimental treatments.

If it even gives Glenn something to live for now...

..it's serving a purpose.

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...

..and follow the links to the Open University.