Episode 1 Keeping Britain Alive: The NHS in a Day

This programme contains some strong language and scenes which some viewers may find upsetting

18th of October 2012.

Across Britain, a hundred cameras are filming the NHS on a single day.

'This change will be a disaster.'

On this day, more than one and a half million of us will be treated.

Three days ago you had a stroke.

1,500 of us will die.

2,000 will be born.

WHISTLE BLOWS

The NHS is the largest public healthcare system in the world.

We want that to be in your voice all the time.

Can I help you?

-We rely on it...

-Be really brave.

..complain about it...

And in the bin. That's because of you.

..often we take it for granted.

Lucas! Lucas!

What we expect from the NHS is ever-increasing.

But money to pay for it isn't.

If we could see what this institution does in

a single day...

..what would it make us think?

This entire series tells the story of one day...

So why isn't she waking up?

..100 cameras

capturing the NHS as you've never seen it before.

Baby born at five to three.

-RADIO:

-'Good morning, everyone.

'Thursday the 18th of October.'

That's it. And again.

WOMAN GROANS

-Not wanting to wait no longer.

-It's probably because they're busy.

-It's not my fault they're so busy.

-I appreciate that.

All I've come here for is cos you're walking down here with a gown on.

I just want to make sure you're all right to go home.

I'm fine. Yeah, but I'm not waiting that long.

-I've been waiting probably an hour.

-An hour?

-All you've been waiting is an hour?

-All? All?

Yeah, but it's an Accident and Emergency department.

-It takes a while to process people.

-It does indeed.

But it's more of an accident,

cos there's a lack of staff there that can help people.

OK, can you tell me your name?

-No.

-What's your name?

-Don't worry about me. Are you a police officer?

No, no. I just want to make sure you're aware enough to make the decision to discharge yourself.

-That's all.

-I'm fine.

-You're all right?

-Yeah.

OK, I can't stop you from leaving

-if you're well enough to take yourself.

-Good night.

-OK.

'My first priority was that he was safe to go home.

'If he's safe to go home and he's got capacity,

'I'm not going to persuade him to come back in,'

but it's interesting that he dialled an ambulance,

it's interesting that he came to A & E.

'He's waited an hour and he's left. That's completely unreasonable.'

One of my children does that when they are... How old was he? 19, 20?

If they do that, I will absolutely hang, draw and quarter them.

That's a waste of public resources an unacceptable way to behave,

and not how I've brought up my children.

Liz runs the Clinical Decision Unit, or CDU.

Most large hospitals now have one.

They help avoid unnecessary admissions and

take pressure off A & E departments.

It's almost like a big filter for the hospital.

You come in here, we will decide whether you actually need

a hospital bed or we'll filter you off home again to make sure that the

only people that are in hospital are people that really need to be here.

Well, I know she'll go home.

I looked at her yesterday in A & E and we'll sit her out this morning.

Is there anybody else that's obvious that we can sit out?

-Here.

-Oh, no.

Not again! She hasn't got the police with her today?

She has, but she's under 136.

So, what did you take last night?

Honestly, please, my love.

I'm going to get one of the consultants to see you.

-Is she on a section now?

-We haven't sectioned her.

-You haven't? Good.

OK. I'm going to get the doctors to come and see you

and you will be discharged this morning. All right?

So, it doesn't look like she's actually taken an overdose

of what she says she's taken. She's a very regular patient.

The issue is, for us, is that anyone who's says they've taken

an overdose, we have to take seriously.

We have to do everything as if they're completely genuine

and make sure she's safe.

-MAN:

-Does she just like to come into hospital?

-Yeah.

Liz's next patient is a 27-year-old who

woke in the night with severe pain and came straight to A & E.

Past two days I've had a pain underneath the chest.

You've come to us with some chest pain, is that right?

And kind of a bit of an irregular feeling,

like your heartbeat's irregular.

Everything's absolutely normal, but what we need to do is do this

blood test, which will rule out any damage to your heart.

We'll take you round the corner, but just bear with us.

All right? OK. Fabulous.

'It's incredibly unlikely that there is anything wrong with his heart.'

It does happen, but very rare.

Yeah, when you don't know what it is

and it's around your heart area, you need to come and see a doctor.

You can find anything on the internet.

I've regularly got a brain tumour if I look on the internet.

He kept me awake all night just to

talk to him, to keep him calm a bit.

-He was really scared.

-I was, yeah. I was. I was definitely scared.

He thought he was going to die and everything, he did.

I don't think they know what it is, to be honest.

LIZ: 'I don't think, as a society, we're very stoical any more.'

The minute you feel slightly unwell, you don't go see your GP, you don't

go and see your pharmacist, you come straight to the emergency department.

But you can't have an NHS that picks up everything,

otherwise it will cease to function.

SIREN BLARES

She definitely has got her teeth stuck in her throat.

So remember how that's still a lot better

-than before the first operation.

-Yes.

Come and sit down, Alice. Oh, right.

OK, so I'm going to start at the beginning as usual.

Your sex drive. What's that like?

SIREN BLARES

We've got a 20-year-old motorcyclist versus car.

Do you remember everything that's happened?

It's been a busy morning in Leeds A & E,

when a 64-year-old man who's collapsed at work is rushed in.

He's paralysed down one side and unable to speak.

-Brian? Hello, there.

-Hello.

My name's Robin, I'm one of the nurses.

It looks like he's probably had some kind of stroke or something

that's gone on in his head,

either a clot or some kind of bleed in his head.

Brian...

-Is it Brian?

-Graham.

Graham? I've been calling him Brian.

I thought you said Graham.

Can you lift this arm up for me?

Can you lift this arm up? Graham?

Can you lift your arm up in the air for me?

GRAHAM MUMBLES

He's unable to converse with us at this moment in time.

He's got a dense right-sided weakness.

He's confused and unable to actually physically tell us what's wrong.

I know it's really scary. We just need to take some blood from you, OK?

And then we're going to take you for a scan of your brain, OK?

The words that he's using are just not making any sense at all.

GRAHAM MUMBLES

Say that again, Graham.

Just ten minutes after arriving at hospital,

Graham's brain is scanned to find out what caused his collapse.

Oh, it's a big clot. Ooh.

Right-side weakness. Look at that.

You can see that is a high density. So that is a clot.

Can we get somebody to ring the GP, get the GP history out of him

and screen the results over.

What I'm going to do is, I'm going to go from his groin,

go up into his head on his left side, get into the vessel

and then first see what the problem is and see

whether I can take it out and then I'll go inside and I'll use

the special stent, which you can actually pull the clot.

So we're going to try and use those stents to pull the clot out.

It's like a plumbing job - the drain is not going to open,

so you have to suck it and take it out.

There's a term that we use - time is brain.

So the quicker we do stuff, the quicker we can get things done,

the more brain and the more of the person can survive.

OK. Now then, just look at my face. Look at me.

With millions of brain cells dying every minute,

Graham's given a clot-busting drug while the surgical team prepare.

-Can you see my hand moving?

-I've stopped all the other cases.

He's going to be the top priority now.

I've got an anaesthetist here with me now,

so what we're going to do, the main idea is to put him to sleep very quickly.

And then we're going to try and get this done.

Hello? We're just going to pop this blood pressure cuff back on, OK?

If we don't do it, basically the brain is starved of oxygen,

so you've got to take the block, so the blood flow gets back

and the oxygen gets back. That's what you're trying to do.

You're getting oxygen back into the brain.

You OK? I'm Dr Patankar, I'm the consultant, OK?

What we're planning to do is, you're in this room here

where we're going to try and remove the clot from your head.

Everybody's used to this, OK? All right?

You're in the right place at the right time

and we'll get you better, OK?

Right? See you soon, all right?

Graham is one of around 400 people who will suffer

a stroke in Britain today.

Try and keep your eyes open for as long as you can.

One in five will die.

Around half of them will be left disabled.

One, two, three.

-RADIO:

-'Now this morning,

'confusion about David Cameron's plan to make energy...'

'..cheaper fuel deals.'

BABY CRIES

-Hello. How are you?

-A bit nervous.

-Are you?

-Yeah.

This is Sarah, my oldest daughter.

She's had the gastric sleeve

and she's lost 11 stone since 2010.

Though it doesn't look like it.

Oh, it does. It does. It does.

All set.

48-year-old Lynn weighs 20 stone.

She's battled with her weight for years.

The start of my new life.

Later today, she'll become the third member of her family

to have weight loss surgery.

-How are you feeling?

-Nerves, bit anxious.

Just looking forward to the end result, really.

You know, waiting for it to be over.

I've had a comment on Facebook saying that people

who are overweight are lazy, they should get off their backsides

and lose weight normally and not cost the NHS money.

They should save up and pay for it themselves.

That upset me, actually, that comment, last night.

I see that. Hasn't affected you this morning, though, has it?

No, because it's something that I need for a better way of life.

I mean, I've got to find something different to do at the weekends now,

cos we used to go out for dinner.

Obviously, I will be able to do that, but smaller portions.

But for the while I won't be able to go to a restaurant.

At the end of the day, they don't understand what people go through.

Definitely not the easy option.

-RADIO:

-'Psychological counselling around their eating habits

'and nearly a fifth of patients were readmitted within six months...'

'some needing further operations. The report was carried out by

'the National Confidential Enquiry into Patient Outcome and Death.

'Ian Martin is...'

I quite like, basically, neck of femurs, in the older generation.

Attending to them. OK.

Purely because you're helping the older generation that don't normally call out for any sort of help.

-Oh, I better get rid of this.

-Yeah.

We get a call now, we've got to go and you've got to get rid of that.

That bin over there?

I'm sure this gets longer, Doctor.

Well, thank you for coming to the clinic today. How have you been?

Not so good.

I'm not sleeping at all, because the sleep apnoea's waking me up.

My back's got more worse.

Whereas I used to go out all the time,

I only go out for an hour of a morning.

You also went to see a cardiologist. What happened with that?

He gave me a letter, recommending the gastric band.

Your letter to them said I'd be on as much as £30,000 worth

of medication and treatment a year,

annually,

if they don't do the operation.

That's wasting a lot of money.

I'll save them money, have your tablets back

and give me the operation.

I need something done now.

The problem is, when we applied for it,

they felt that you do not qualify

what is called a comorbidity criteria.

Comorbidity means other conditions accompanying weight problems.

I've got everything they asked me to have except one.

That was the diabetes.

The problem that we have is where you are from, the West Midlands,

has got one of the highest levels of obesity in Europe.

So if they funded everybody who was eligible,

then the NHS in the West Midlands would be bankrupt.

So if I moved to Birmingham...

No, you wouldn't. It's the West Midlands.

-You have to move outside the West Midlands.

-It's not fair.

Lynn lives in the South East, Britain's slimmest region,

which funds more weight loss surgery than anywhere in the country.

How are you feeling?

Shaky?

In the NHS, the number of these weight loss operations has

quadrupled in the last six years.

The surgery costs £10,000.

Obesity in this country has doubled in the last 20 years.

That is an epidemic. You know, the messages are all very confused.

Shops are open 24 hours a day, seven days a week.

The Olympic Games was sponsored by McDonald's.

So society is now organised in such a way

that it's just making us all bigger.

Morning, ladies.

The cost of obesity to the NHS is about £4 billion a year.

The cost of diabetes is £10 billion a year

and that's related to obesity.

So whilst surgery itself isn't cheap, after two to three years,

we'll start saving money.

-Is this your daughter?

-My daughter. She had a gastric sleeve.

-Did you?

-I did.

-Wow.

No problems?

SARAH LAUGHS

Yeah.

I had a blood vessel to my stomach burst,

so I had to have emergency surgery.

-Oh, no.

-Yes. I very nearly died.

I was doing the crossword, I dropped my pen and I thought,

"I'm not going to call a nurse just to pick up a pen."

So I bent down, I felt a little pop,

"Oh, maybe it was just gas."

And yes, my stomach burst.

Gosh. That was traumatic.

I hope it will be nice and straightforward today.

It was that bad that they allowed my cousin

and my husband at the time to come up to the top floor to say

goodbye and they don't usually let family go up to the top floor.

-MAN:

-Is that one of the reasons that you're quite nervous?

Yeah, I think...

I mean, you hear stories about any operation, don't you,

but there's always a bad one to go with a good one.

-Bye.

-Bye, see you later.

-You've got pneumonia.

-Yes, so they told me.

-Good.

-You're getting better.

-Good, good.

-OK.

Because he knows that the doctor told me

if I didn't get better I'd die.

Well, that's...

And I thought, "Well, at 89, who cares?"

The October weather means Liz and the team in CDU

are busy juggling beds.

They've already seen 50 patients today, many of them elderly.

I know, but to get you home, we need a relative.

People are getting older

and treatments are getting more sophisticated and we can make

people live longer, but whether we should or not is another question.

People are aware of it, but they're just not aware of how much it

affects frontline services day in, day out, day in, day out.

-Hello, Mrs Evans.

-Hello.

-This is the team looking after you today.

-Over the last few weeks, have you felt more tired or breathless?

-Yes.

-Yes. Has that been gradually getting worse?

-Yes.

OK. I think you've had an operation

-and a number of tests on the colon before, haven't you?

-I'm not sure.

-I don't think so. Breast cancer.

-They had the breast cancer.

-Yes, that was done.

-Then there was the colon one as well.

Nobody said a word about that.

-Nobody said anything about that.

-No.

You have problems with your memory a little bit recently.

At the moment, I can't remember anything twice.

I think, because you got a bit anaemic, it might be worth us

giving you a couple of pints of blood to top you up.

Oh, not again.

The honest truth is I don't think there's an awful lot more that

I can do to slow it down.

-The only thing I don't like here is no daylight.

-No, I agree with you.

This is totally the wrong room for you

and we'll find you a room with some daylight.

-Oh, please.

-All right.

-Yes, thank you.

MAN: How long have you been poorly?

I don't really know.

Last Christmas it started, I think, or just before.

And I went in because I thought I'd broken my hip

and it was to do all this...

I don't know what it is.

I don't like it, anyway.

I don't think anybody likes to be poorly, do they?

No. Well, that's the pleasure of growing old.

You can't have both.

-That's Bernard, my husband.

-Oh, I've got to sit down.

-Yes, I know you have.

-Before I fall down.

Sorry to drag you out.

I'm not quite sure why I'm in here.

They're making a clinical decision about what's going to happen to you.

What is going to happen to me?

They're either going to put you in the ward, I suppose, or send you home.

She's got this bowel cancer

and we've got to face up to the fact that she is in a very bad

position and we make the best of it while we can, what's left to us.

When you get to my age,

you appreciate the fact that you haven't got much longer to go.

-What?

-That you haven't got much longer to go.

-You're going to pop your clogs sometime.

-Of course we are.

MONITORS BEEP

OK, forward.

She's trying to get an access into the groin,

so she's going to get into the artery.

And this is a little bit difficult, because he's big.

It's going to be a little bit tricky.

But she's good.

She's got access now and everything we're going to do is from the groin.

OK?

Two hours ago, 64-year-old Graham was rushed to A & E with

a clot in his brain.

It's going to be a problem.

The team need to remove the clot before Graham suffers

permanent brain damage.

OK, wire forward, please.

Dr Patankar will try and remove the clot using a procedure he's

only been performing for ten months.

He's going to access Graham's brain through an artery in his groin.

It's a risky operation that only a handful of hospitals perform.

So now I have to find my way. It's like driving a car.

You're trying to get your car parked in the vessel

in the left side of the neck.

So I'm going to try and see how his blood vessels are.

OK? Lovely. Happy with that?

The treatment has been there for a long time.

Retrieving clots in other parts of the body had been going on.

But for stroke, of late,

it has been promoted in the last year a lot more.

The main issue, what we've got to try and do is

get blood flow back to that part of the brain

that's not working,

so the left hemisphere,

which controls language and the power to the right side of the body.

The critical thing is to try and get the clot out of the middle

cerebral artery, which is providing bloods to that area of the brain.

So that's what's happening at the moment.

What's the success rate?

Don't ask now.

Life is full of surprises.

Everybody ready?

This is the clot here, huh, John?

I'm actually through the clot.

I can feel it, you know? It's not easy, because you can't see anything.

Everything is blind, everything is in my head.

Believe me, this is stressful.

Come on, guys.

OK. Oh, don't come back, baby.

Bingo.

-Ah! Succeeded. Lovely.

-Excellent.

-Brilliant.

What's happened is, his brain needed perfusion, right?

I have opened it now, so the perfusion is there

and now we can go back in and try and take the clot out.

Something has come. Let's clean that up.

The final challenge is to pull

the entire clot back through Graham's body.

If at any point the clot breaks up,

it could trigger another stroke.

Lovely.

There's clot everywhere. OK.

Lovely. Oh, look at that.

Brilliant, man.

I'm so pleased. John, happy?

-Yeah.

-Yeah? Nice, isn't it?

Yeah. It looks good.

God, that was so much clot, wasn't it? Everywhere.

The clot was just everywhere. Everything came out. Look at that.

Four hours and £16,000 later,

blood flow has been restored to Graham's brain.

Money is an issue. I mean, these are expensive.

How much money have I spent here? Quite a bit.

But I think it's still worth it,

for the man who has paid his taxes for his life.

I would want it, wouldn't you?

I pay taxes. I pay 50% tax.

And I need to have this treatment if I get a stroke.

No system is perfect,

but the ability to do this sort of thing would not be available in

other healthcare systems to anybody who just came in off the street.

I don't know this gentleman, I've never met him,

I don't know what his background is.

And that just doesn't matter.

We just get on and treat him.

But the success of this operation is still unknown.

It's not so much whether they survive these events or not,

but most people have got a real fear of being left with

severe neurological disability.

Although it's very good we've got blood coming

down the artery, what really matters is what's happened to the brain

and we will not know that until the anaesthetic has been reversed and

we actually wake him up

and actually see what the residual problems will be.

And just let it go. OK.

So you're doing this four times.

Slowly and gently, mindfully bringing your breath in...

..and then breathing out.

A breath in...

OK, let's cover her up.

Is there any next of kin on that phone yet?

I can't find anybody on his phone either, but I presume we've

looked on Portal, have we, to see if he's known anywhere?

Liz and her team in CDU have now seen 67 patients today.

So, what's your GP worried about?

Well, he reckons it could be some sort of

leakage in the valves in my heart.

OK. What I'm going to do is have a quick press on your tummy, if that's all right?

Yeah. She does have a murmur, Kate.

We need to get you to be seen by the cardiologist,

so the doctors who look after the heart.

Pure fat, I know. I'm too fat.

Is that why I've got this problem?

No, I don't think so.

Danny has been here for seven hours complaining of chest pain.

Daisy, who's the doctor, is going to come and see you.

She's just looking at the chest X-ray on the computer

and then she'll be with you, OK?

Do you know how long that's going to be?

As long as it takes to look at a chest X-ray.

So it shouldn't be too long.

-I want to go.

-That's awful.

How long does it take to look at an X-ray?

-Oh, there you go. It's done.

-Oh, right.

Should be done now, then.

LIZ: A lot of the health campaigns in the past have said,

"If you have chest pain, go to hospital."

What they didn't say was

if you have no risk factors and you're young,

the likelihood of you needing to go to hospital are small.

But that campaign was hugely successful

and it's stuck in people's minds.

The majority of them just need to go home and take a paracetamol

and see if it settles.

Hello. Right. Do you want to sit down for me?

So the good news is that all your blood tests are back

and they're absolutely fine.

-Your chest X-ray looked completely fine as well.

-So what is it, then?

-What's a chest X-ray?

-No, I mean what's this pain?

Can I have a quick look at you? Examine you?

-Would that be all right?

-Yeah.

If I press on there, is that painful?

-Slightly here.

-Slightly there. OK.

Sometimes people can get a little bit of inflammation down there,

which is something we call costochondritis,

which is just a fancy word for saying a little bit of

inflammation in the cartilage which joins the ribs to the breastbone.

So is it just something that's going to pass?

Yeah. Ibuprofen and paracetamol.

-Good.

-Thank you very much.

-No worries.

-Cheers.

-MAN: How are you feeling now?

-Relieved, mainly.

Have you any idea how much

that process that you've been through cost?

I wouldn't have a clue, no.

No idea how much it would cost for me to sit in the room, no.

No. The thought didn't cross my mind.

We take it for granted, don't we?

Of course we do. All of us.

We know they're here for us, no matter what.

We expect them to be here for us, no matter what.

And they are, which is really good.

Is the wound still bleeding freely?

-Ah-ah-ah.

-Super.

Hello, Lynne. You've brought all this in?

That's my daughter, she's with me.

-Yes.

-She's had her sleeve done.

-Yes.

She is due to have it done next year. And that's my youngest one.

Goodness me.

So, let's go through it all.

So this is the consent form for your operation.

Like all surgery, there are risks, this is no different.

The mortality risk with this operation is about one in 500.

The risk of a problem is one in 100.

They are all those risks, they are very low risks,

but obviously I have to tell you all that and then you just sign there.

-Signature to my new life.

-That's it.

Good for you. All right, we'll see you in a bit.

See you in a bit. Bye.

So, when did you have your operation?

I had mine in May 2010, but I had the sleeve,

-which is just one down from a bypass.

-You look great.

That's what I'm looking forward to - the confidence, you know?

Get a life.

'It's interesting, isn't it?'

All of her daughters have obesity, one's had an operation,

one's waiting for an operation. It does tend to cluster in families.

That's not genetic so much, it's more an environmental issue.

But there is still a huge amount of prejudice towards obesity

and it's grossly unfair.

If you see somebody who is obese, you just do not know what has led

that person to that point in their life.

And it's very unfair to judge people on those grounds.

I had a very nasty comment made yesterday that the money

should be spent on people that needed heart transplants.

They judge you before they even know you. They don't know your story.

Lucy hasn't got diabetes yet,

but if she doesn't have this then she will have it.

It wouldn't be just for diabetes, it would be numerous things,

and I would be going to the NHS to solve those problems.

And how much would that cost?

At the end of the day, we're going to have the last laugh. Definitely.

We'll have the last laugh. And we'll be happy.

-And that's the main thing.

-Yeah!

Do you want to just pop that on for me? It does up at the back.

And then we'll get you down to theatre shortly.

I'll make sure I've got all your notes together. There we go.

'Do you think this kind of operation is a waste of NHS resources?'

Definitely not. Definitely not.

Hi.

'You see them a year, two years later,'

they're not actually a drain on the NHS any more.

They become an active member of the community

and they're out there working and doing something with their lives.

It's just giving them their life back.

They're happy, and happy is the key word,

because a lot of my patients aren't happy when they come in.

-I'm getting really nervous now.

-I'm sure you are.

Now, you're going to start feeling

like you've had a bottle or so of wine.

-I know it's a bit early in the day.

-Feel it now?

We'll see you in a couple of hours.

Out with the old and in with the new!

I've done 600 of these before, and I'll hopefully do this one

exactly as I have done the last 600. We don't like surprises.

So you ate in the Park Tavern last night, did you?

Richie was there, was he, and Louisa? So, mainly our team.

And Joe, yeah, yeah.

-Where was my invitation?

-Eh?

-Where was my invitation?!

New surgical techniques over the last 10 years have reduced

the cost of operations like Lynne's and improved recovery time.

This is all done with keyhole surgery.

This is our telescope, so these are the eyes for the operation,

and it puts a picture up on the screen. We'll start off here.

So everything that you see that's yellow is fat, fat, fat.

Then we get onto muscle here, there is a muscle layer. Muscle layer.

Muscle layer. OK, and that is into the abdominal cavity now.

Here we go, so we are inside her abdomen.

She's not got a great liver, look. Lots of little bits and bobs on it.

Come down this side, Anna, if we could just take the port out,

take the camera out.

-Something weird.

-There's something there.

-Yep.

Go back a little bit. OK, she has got a mass.

What sort of mass is it?

I'm not sure I'm going to carry on with her,

-cos I think she's got a cancer.

-She's got a mass.

Look, she's got a big pelvic mass.

-I wondered what was going on in her liver.

-It did look like a mass.

-She has got a tumour of some sort. I think it's ovarian.

-Yeah.

I think she's got an ovarian tumour.

So I'm not going to do anything more for her.

It would be wrong for me to plough on with an operation

when there could be some other pathology that is significant.

She wouldn't have known about it, we wouldn't have known about it.

Very difficult to even feel it, to be honest with you.

But, you know, that is entirely unusual, so that is a shock to us

all, it will be a shock to her, poor love, when I tell her. It's tough.

We'll see what it is. Bit upset by that, to be honest.

Poor Lynne, you know? Anyway, let's find out what it is first.

We can't speculate just yet.

'That's the first time I've found what I think is a cancer'

whilst doing an operation. She's only 48.

Only 48.

'Makes you think, it makes you reflect.'

We are all subject to these problems. Let's wait and see.

If that's a cancer, then she's got a battle on her hands.

So I'm going to go speak to her daughter now.

-Have you not got any pennies with you?

-Have you got no money?

10 months ago, neurosurgeon Sasha Burn operated on three-year-old

Charlie to remove a tumour from his brain.

Today, at her weekly clinic, she will tell his family

if he's got the all clear.

When Charlie's mum comes into clinic,

all she's really going to want me to say is the scan looks fantastic

and there's no changes, but in all likelihood, she may

sense that there is some doubt in my voice or what have you,

and will know straight away that there might be an issue, and

so it's about me telling her openly and directly what we think, showing

her the scan so she can see for herself, and she has an idea in her

mind's eye as to what the problem is, and I'm not hiding anything from her.

You know, it will introduce an element of concern

and worry for her, but hopefully she'll be reassured that

we are keeping a very close eye on Charlie.

Look at that, is that aeroplane? How cool is that?

OK, now, from the point of view of the scan that was done last week,

-essentially, it looks very similar to the previous.

-OK.

But there is just a tiny subtle change in appearance.

This is the one that was done in June.

And this is the scan that is the one where it shows up more obviously.

If you just look at that and look at that, you can just

see that there is just, it looks just a little bit more substantial.

The area that it's potentially going into,

is that the motor neuron area, is it back into that a bit more?

Slightly. Let's just see.

If, on the next scan, it looks like there is a definite change

at this point, then I would say first off we would offer more surgery.

You would suggest surgery rather than chemo or anything?

Let's just see what it looks like.

The whole point is, we would want to be able to remove it without

causing any damage to Charlie.

That was the whole premise of the first surgery,

and we want to do the same thing.

It may be something, it may be nothing.

'Whilst acknowledging what has happened,

'for me it's been sort of a survival technique.'

You couldn't continue to work for 25-30 years as a consultant

in this job if you absorbed too deeply everything that goes on.

-Thank you very much.

-You're welcome. Take care now. Bye-bye.

The number of times that you miss

your child's first nativity play, or parents' evening,

or sports day, or that dinner date that you had in the diary for ages -

that is just life, and

these other events are competing with a sick child, and they will

never win, you will always stay with a sick child

before you would go home.

How are you, champion? Hiya, come in, take a seat.

-Hi, come in, have a seat.

-Come in, have a seat.

-Hi, Kevin.

-Welcome, welcome.

-You're looking well, anyway.

Are you feeling all right today?

-So, how have things been?

-Business as usual, really.

Hey, Ben, how are you? You all right?

Back in August, I saw you about the back pain, didn't I?

-Yes, and I hadn't heard anything since.

-Oh, dear!

We've ordered some blood for you.

Oh, no. Have I got to stay here?

Well, we're going to move you to one of our medical wards upstairs

-where there's a bit of natural light for you.

-Oh, yes.

-So that will be Ward 513.

-Oh, yes, I don't know that one.

-No, it's OK.

-Is it lively up there?

-Do you like a bit of lively?

Well, I mean, it's dreary in here.

It is, it's much more lively up there, and you've got natural

-daylight as well, which will be good for you.

-Thank you, thank you.

Good luck. You're welcome.

I don't like the sound of cancer at all.

-What, the word, or what?

-Anything about it, I just don't want to know.

-What's the prognosis, do you know?

-Well, I don't really ask.

I just say, well,

I'm not going to have... I don't want the operation.

It's very, very serious and I'm a bit old for that.

But there you are, it's no good complaining, is it?

I've got to a good old age.

-How old are you now?

-90. Don't mention it!

-Is it frightening?

-Frightening? Oh, yes, when I think about it.

Well, I don't know why, you've got to die sometime.

I don't particularly want to die a painful death -

just to go to bye-byes. If I can.

They're expecting you at one.

'My friends have all said, "If it was me, I wouldn't be as brave as

'"you," but I don't personally think it's about being brave.'

I think if it was you, you haven't got a choice.

What would you do otherwise?

I don't know. I couldn't kill myself.

You have to do it, it's not about being brave, I don't think.

10 people under the age of 24 will be diagnosed with cancer today.

-Do you not feel scared?

-No.

That's one thing I've never felt - scared.

I'm scared of being sick, that's one thing. No, I've never felt scared.

Yeah, that's weird, that is, isn't it? My mum is. God, speak to her.

Bloody hell.

Like many young people with cancer, Laura was misdiagnosed

several times before her brain tumour was discovered.

# Why, why, why, Delilah? #

A year ago, 17-year-old Dean was told his headaches were just

migraines.

# ..Take any mo-o-o-o-ore. #

All right, Dean?

Better late than never, hey? Dean is a little star.

-I love a bit of Tom Jones. Anything else?

-Culture Club.

-Oh!

-So, I'm just accessing Dean's line.

-My magic line.

-Your magic line, yeah.

-I've had this in 12 months now.

It's doing well for 12 months, this line, isn't it?

I'll be happy when it's over so I can start college.

-That's all I'm hoping to do.

-What are you doing at college?

-Performing arts.

-So, what does performing arts involve?

-Acting, singing, dance.

-Perfect for you, Dean!

I was hoping to start last year in September,

but I was diagnosed with the cancer

so I had to go for the treatment, hold it back for another year.

Was that a real blow?

Yeah, and I'm just stuck here all the time, I've got nothing to do.

It's quite isolating, being in on your own.

It was a brain tumour I was diagnosed with back in August,

and I had to undergo an operation that lasted 12 hours.

As you can see, my face is not even.

Half of my face went because of the operation.

I used to be able to smile.

But now if I smile...it's not the same as what it used to be.

So that kind of works out quite difficult.

But I always said I'd rather not be able to smile

and still be alive than if I could smile and I'd be dead.

And that's how I see it.

My auntie is downstairs. I'm going to go and tell her and my sister.

-Are you bringing them back up here?

-Yeah.

I'm going to tell them downstairs

and then I'm going to bring them up, so we can wait for Mum

and then we can all be there when they tell Mum what's going on.

-Do you want to bring them up here and tell them?

-Yeah.

-Do that then.

All right, thank you.

SHE SIGHS

Hello!

Hello!

-I'll take you up to where she is.

-All right.

-They're going to bring her up in a minute.

-Yeah.

-It didn't take long to get here, actually.

-Did it not?

-Couple of hours?

-It was quite quick from when I spoke to you.

-Yeah.

It takes two hours.

So...not too bad at all.

And there was no traffic, so...

Oh, that's all right, especially for that time of day.

-I know.

-So...

-Is she back up yet?

-No, they'll bring her up in a minute.

-Right.

How long was she in there for?

Um, not... About... Just over an hour.

Oh, right.

-In here?

-Yeah.

-Her own little room.

-Yeah. Want to sit down?

She didn't have the op.

Oh, no.

-HER VOICE BREAKS:

-When they opened her up...

..they found a tumour filling the whole of her pelvis.

SHE BREAKS DOWN SOBBING

She'll be all right!

What's the matter? What are you crying for?

What's the matter?

Have they done it?

They haven't done it, have they?

They will do it. They are going to do it.

Mr Pring is going to come up and he's going to tell you

you know, when they're going to be able to do it again, etc.

-How did you know they didn't do it?

-I had a feeling.

Right.

It's just not your day, pet. It's just not meant to be today.

Mr Pring is still in theatre.

He won't be able to speak to Lynn

until he's finished today's operating list.

Grahame's family is with him as he comes round after his surgery.

Only now will they know how successful it's been.

Can you lift your right arm up for me?

No, your right arm. Your arm.

You'd no movement in there at all.

And can you lift this right leg at all?

He couldn't move it at all earlier on. He couldn't move it at all, could he?

'Me husband goes out at morning...'

and you get a phone call saying he's collapsed

and been taken to hospital.

So you're just in a blur then. You just do what you have to do.

Terrible.

You don't think it's ever going to happen.

'Well, obviously I'm delighted.

'I'm interested in what happens to the patient.'

It's nice to see all the blood come back down the artery.

But in the end it's actually how the patient is.

And OK, his speech is a little bit slurred still.

That's to be expected.

But to get all that movement back from about six hours ago,

ten hours ago now in total, is really quite remarkable.

You know, we would hope to get him back to work.

It doesn't always go like that

and that's why it's been a great pleasure to be around today.

It makes it worth coming to work.

You sometimes just have to push the boundaries a little bit,

you know, and it's important that we're able to do that because

that's how you get advances in medical care.

-Hello! Hello, Mrs Evans.

-Hello.

Your bed's ready, so we'll get all your stuff packed up

-and then we'll get you escorted up there.

-Oh, good.

-Is that all right?

-Lovely.

-All right then.

In CDU, Jeanette is finally being moved upstairs to her room

with a view.

A few doors down, a hospital regular has just been readmitted -

58-year-old Ken.

What brought you into hospital?

Well, me mates phoned the ambulance cos I was throwing up blood

and everything.

-You mentioned that you take heroin. Is that right?

-Yeah, that's right.

Heroin and crack cocaine.

-And do you drink?

-Yeah.

OK, so that's the reason they referred you to us again,

so we can make sure you're on whatever it is you need to

be on to stay comfortable while you're here.

-Yeah.

-So how much would you do a day, Ken?

Er...about 50 quid a day. Depends on how much money we've got.

-OK, well...

-It's an expensive habit, but you just don't get a lot.

Yeah, OK.

And in terms of, like, alcohol, how much would you drink a day, Ken?

I'm on six cans of Skol Super a day.

-Which is 10%.

-Yes.

A three-litre bottle of White Lightning.

Plus waking up pouring meself a snakebite.

All right, well, let's get your meds sorted out for tonight and then

tomorrow we'll come back and review things, see how you are and

we'll try and get some kind of plan in place for when they send you home.

-OK.

-All right?

-Yeah, thank you.

-Thank you.

A friend of Ken's has turned up at reception

hoping to pay him a visit.

-Have you had a drink?

-Only one...

HIS SPEECH IS SLURRED

I'm sure. Yeah, that's fine. You can write him a little note.

That's fine, you can write him a little note

and I'll take it to him, but I won't allow you to see him at the moment.

He's not feeling very well and he just needs peace and quiet.

I'll just be outside.

-We'll try and get him out.

-Thank you.

Hello.

-Kenneth?

-Yeah.

-Is that your friend?

-Yeah.

-I've not let him in.

-I know...

-He's quite drunk.

-Yeah, yeah.

I got him to write you a little note though, cos he's worried about you.

-Yeah.

-I've told him that you're very well.

I'll go for a smoke, but I've got me coat anyway.

-You won't have a drink out there, will you?

-No, no.

It would be very dangerous to have some alcohol now.

Because we're giving you drugs that are supporting you being off the alcohol.

Hold on, hold on, cos you've got a line that's attached to you.

So you need to just wait a minute. Your friends can wait.

You just need to wait for the nursing staff to make sure they're all sorted and get this out, right?

Can you undo this...please?

-You will come back, won't ya?

-Yeah, course I will.

-See you in a bit, Kenneth.

-OK.

-Take care, walk slowly.

-I will.

-How common is that kind of thing?

-Very common.

I'd say about...I don't know, maybe 25%, maybe,

of our patients are similar.

I can't really judge, but...

It's hard when you get them in time and time again.

That's when it becomes hard, because you give them all the right care and

medication, treatment, yet they'll just go back out

and drink again and, but...

that's their way of life, in and out of hospital, I suppose.

They've been used to it for years.

It can be frustrating, Kenneth's lovely, so I don't mind.

MAN GROANS

Mr Pring has now finished his fourth weight-loss operation of the day

and has been able to speak to Lynn.

So I've just basically said, you know, that we need to do a scan.

There's something going on in the pelvis. It's probably a tumour.

We don't know what sort of tumour.

But everyone in theatre was stunned, so you just don't expect it.

So it leaves you with a bit of an empty feeling, I have to say.

-LYNN:

-'Some people go through life and it runs smoothly

'and they get what they want when they want how they want.'

Our family's always had to fight all the way for everything that we've had.

Another challenge to get over.

WOMAN: You can do it.

She's come in for one problem, we've uncovered another problem

and then tomorrow, another day in the NHS,

we'll set about sorting out her other problem.

And she'll get the scans and the tests and the expert opinion.

It's incredible that she's got this big care blanket around her

that's going to look after her.

-Mr Lawrence is outside with two intoxicated friends.

-Oh, dear. OK.

-Do you want me to bring him back in?

-No, he's fine.

He's assured me he's not going to have a drink,

but he's had Chlordiazepoxide, so it will be dangerous if he has a drink.

Now, where has he gone?

It's the end of Liz's shift, but she's concerned about Ken.

He's been missing since his visitor arrived.

Where has he gone?

I might get security to just have a little walk round,

because if he's not obviously out here...

I don't suppose anybody thinks

when they come into nursing that that's what they'll spend a portion

of their day doing, but it is the reality of what I spend my day doing.

Night!

NURSE: Thank you.

-I'll be about tomorrow, yeah?

-Right.

Kenneth?

Ken? Kenneth, back in now, mate.

OK.

They tried to get me off smoking, trying to get you off the heroin,

they're trying to get you off the drink...

If God meant them to have their way, you wouldn't do nothing, would ya?

If they want to spend their money on drugs, then fair enough.

It's their money, they're earning it. You know...

But what about when you end up in hospital and they have to try

and pick up the pieces?

Well, yeah, that is a point.

That is a very good point.

OK, that, I can quite understand that.

Ken, what's that in your pocket, mate?

-Which?

-Ken, what's that in your pocket?

I didn't know that was there! That's from yesterday, that is!

You can't have that in hospital, mate. I'll have to take that off you.

-Do you want a blanket round you, mate?

-No...

-Sure? Sit down for me, please.

Ken's chest problem needs monitoring

so a space has been found for him on a ward upstairs.

Freeing up a bed for another day in CDU.

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