Episode 3 Keeping Britain Alive: The NHS in a Day


Episode 3

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Transcript


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This programme contains scenes which some viewers may find upsetting.

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18th of October 2012.

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Across Britain, 100 cameras are filming the NHS on a single day.

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THROUGH MEGAPHONE: This change will be a disaster.

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On this day, more than 1.5 million of us will be treated.

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Three days ago you had a stroke.

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1,500 of us will die.

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2,000 will be born.

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ALARM SOUNDS

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

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We want that to be in your voice... WITH LIGHTER PITCH: ..all the time.

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Hello, we're going to help you.

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-'We rely on it.'

-Be really brave.

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-'Complain about it.'

-In the bin. That's because of you.

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-'Often we take it for granted.'

-Lucas. Lucas!

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What we expect from the NHS is ever increasing.

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The money to pay for it isn't.

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If we could see what this institution does in a single day,

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what would it make us think?

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This entire series tells the story of one day.

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So why isn't she waking up?

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100 cameras,

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

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Baby born at five to three.

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RADIO: Eight o'clock, Thursday the 18th of October...

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..to allow my hand to go inside your tummy.

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I just love this drive to work in the mornings.

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And you never quite know what you're going to see.

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There's a deer.

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Look, two, three. There they go.

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They come right up to the road.

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There's another one, look, big deer, straight ahead.

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Chris Abell is a GP on a remote island

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off the west coast of Scotland.

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He's one of three doctors responsible for 3,500 islanders.

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Here on Islay it's slightly different from other places as a GP,

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because we're the only doctors here and the nearest hospital is...

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nearest big hospital is Glasgow. Which is a plane flight away.

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So any serious illnesses, accidents,

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we will see, which is unusual for GPs.

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It's one of the things that makes me slightly anxious

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when I'm going into work, thinking about what might happen.

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At the UK's largest dedicated brain hospital,

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lead surgeon Andrew McEvoy has just one patient on his list this morning.

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So, the operation that we're doing today is on a patient of ours

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called Darrell Gittings.

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He's a man probably in his mid-40s who unfortunately in 2008

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had a brain tumour diagnosed.

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Erm, an operation was done to remove some of the volume of that tumour

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but unfortunately the tumour has come back.

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For Darrell this is going to be one of the most important days of his life.

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Nine o'clock, and by God, would I love a cup of tea right now.

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Gagging for a cuppa, but I'm not allowed.

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Yeah, good roast pork dinner. And a pint of real ale.

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Previous operations elsewhere, one of which cost Darrell his leg after

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a post-operative blood clot, have reduced but not removed the tumour.

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So, to simplify it for people who aren't educated to tumours,

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mine is known as an astrocytoma, so if I was to give somebody

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a really easy lesson, think of astro, the star.

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So think of a round tumour, but then add, like, spider legs to it,

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and that's what goes off into the brain

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and makes it difficult to treat.

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When Darrell started developing new symptoms, his local health authority

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in Wales supported a referral for specialist treatment in London.

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So, this is Darrell's latest scan.

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And you can see immediately that there is a huge

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difference between this side and this side.

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And this is the area where he'd normally speak from,

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and you can see that there is a huge big solid mass of tumour,

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I think probably with a little cyst.

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What has been put to Darrell and what is the truth

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is that if we do nothing here

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that this tumour is going to result in him losing his speech.

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Darrell's fully aware this is not a curable situation, erm,

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that at some point in his life this tumour is going to get him.

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And what we're trying to do is give him more time

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and improve his quality of life.

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I want them to take...

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I'd like them to take 100% of the tumour but they can't

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because of the spidering off of the tumour.

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But if they can remove 80% to 90%, that will be wonderful.

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That will be better than winning the Lottery to me,

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better than anything else.

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-Ha, ha, ha!

-Ha, ha, ha.

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Just there?

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SHE SIGHS

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Morning in the mortuary. Love it.

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If you'd just...just relax for me.

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I'm just going to press on your rib cage, all right?

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On Islay, Dr Abell has a much smaller list of patients than most GPs.

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You again?

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-Yeah, it's me again!

-THEY LAUGH

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Come down.

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'One of the things that I think is just terribly important in general practice'

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is...personal knowledge of patients.

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'And...continuity.'

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There's a sort of an element of, "Oh, how nice, it's somebody I know."

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And it just makes the whole process more personal and...better.

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Mrs McPhee, was I meant to be doing a flu jab?

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Although emergencies are rare, this small island has its own

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ten-bed hospital with a fully equipped A&E department.

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Today, Dr Abell is the only doctor on call for emergencies.

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It's not that it's always dreadfully busy. Sometimes it's not busy at all.

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But sometimes it is. But it's still... You have to be there.

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You have to be ready and you have to be available.

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Bizarre.

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An hour into his morning surgery, an emergency case comes in.

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Oh, I've just had to go down to A&E.

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A patient who has been brought up possibly having swallowed

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her bottom set of dentures.

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A carer has brought in one of her more vulnerable patients...

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-Can I come in?

-..'convinced she's swallowed her false teeth.'

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But an X-ray proves inconclusive.

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I actually think that it's probably a case of

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what they're meant to have swallowed has actually been lost rather than

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gone down their throat.

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But it's extremely difficult to tell, and it's one of those odd things

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that comes up when you're covering A&E as well as doing your surgery.

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The patient's carer is still worried.

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It's just, where are the teeth? She never takes them out once they're in.

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I think it would be really helpful if you could have a good look for them.

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I will. That's the first thing I'm doing now.

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Dr Abell promises to re-examine the patient at home in a few hours.

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Mr Stuart, please.

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-Did you have a busy morning out there?

-Very busy.

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I'm sorry I'm late, I've just had to be sorting somebody out in A&E.

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-No, that's all right, that's grand.

-In you come.

-Cheers.

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-So are you going to be called any minute now?

-Yeah, any minute.

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For the trolley or whatever you want to call it.

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The chair, trolley, whatever. Running a bit late, and, er...

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Yeah, get on with it.

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Darrell's three sons are waiting at home in Wales.

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But his wife is spending the day in a hotel nearby.

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We tend not to see each other on the day

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because we upset each other too much.

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And I want him to be going into surgery with a positive outlook

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and not with just me... blubbering before he goes in.

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He needs to be positive and knowing that I'm being positive as well.

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But if we saw each other this morning then, you know,

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he'd only get upset and I get upset and...

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It's...

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To us, it feels unlucky. To be seen... You know, to see each other.

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It's like your wedding day.

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That you don't see each other first thing before you get married.

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I don't want to see him until he's out of that theatre and that he's awake and he's well.

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It's a high-risk procedure, this,

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you know, and we're obviously very concerned about the damage that we could cause here.

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My biggest fear here is that he comes off the operating table

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much worse than he goes on to the operating table.

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To minimise the risk to Darrell's speech,

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he'll need to be monitored during the operation.

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Unfortunately for Darrell, this means he'll be woken up

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and asked to talk while the surgery continues.

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You make a decision.

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You lie down and die or you stand up and fight, and you fight like hell.

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Well, I've chosen to fight. I can't stop fighting.

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I fight because I love my family, let alone I love myself

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because I'm vain! And that's true!

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And I love what I do in my life personally.

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It's what I love to do with my family and I want to see them develop.

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Darrell will be anaesthetised to allow surgeons to open up his skull.

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Open your eyes for me.

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Once his brain is exposed, he'll be woken.

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The reason for doing him awake

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is that when we start taking out the brain tumour, we'll test him

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throughout so that we can make sure we're not damaging as we go.

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-OK, we're all ready.

-Ready? One, two, three.

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There you go.

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I think it's going to end up being a struggle.

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He-llo.

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-Very busy, isn't it?

-Always is.

-Yep.

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# BHBN Hospital Radio! #

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-Would you like a song on the radio tonight?

-Hotel California.

-By?

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-Eagles.

-Eagles, of course it is.

-The extended version.

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-The extended version.

-Dedicated to my wife, Lisa Jones.

-Lisa.

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-Thank you very much, thank you.

-Lisa Jones.

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Get well soon, Lisa, from everybody at BHBN.

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We're getting requests that are going to be broadcast

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this evening on BHBN Hospital Radio.

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It's a vital part of being in a hospital.

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-Hospital radio is important.

-I agree, totally. Well said.

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Hello!

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My name is Ciaran and this is Olly

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and we're from BHBN Hospital Radio.

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Would you like a song?

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Or would you like us to choose you one? Bob Marley?

0:12:380:12:42

-Hmm.

-Get well soon from everybody at BHBN.

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How many do you think we have?

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-11?

-12.

-That's perfect. That's absolutely perfect.

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That is absolutely perfect, that's really good.

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AMBULANCE SIREN

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This guy. Yeah, oh yeah, she's a post-op.

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INAUDIBLE MUTTERING

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58-year-old Laura was admitted to intensive care three days ago

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after she collapsed from a brain haemorrhage.

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Her husband Pat has been by her bedside ever since.

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Laura was being interviewed for a... for a job,

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and during the interview she lost feeling in her left leg

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and they phoned first-aiders and they came and recommended an ambulance.

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And they assessed her very quickly, and sent her down here for surgery.

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And so they, erm, they operated to relieve the pressure on the brain

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and remove the blood, and, erm, she's been...

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she's been recovering ever since. So, to now.

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Since her operation, Laura has been in an induced coma.

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This morning, doctors will stop her sedatives

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to see if she'll wake up of her own accord.

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We have no concept at this moment in time how much of a...

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of a more general hit

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her brain encountered during this haemorrhage.

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For example we've no idea what she will be like from a cognitive

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point of view, erm, or...or even to what degree she'll wake up.

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Around half of people with a haemorrhage like this will suffer brain damage.

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One in five will die from their injuries.

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The issue about brain injuries is that actually

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it can strike at any time, anybody.

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On the whole, brain injury is something that

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comes up to anybody when they're probably least expecting it.

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They're just doing what they do every day

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and suddenly their life and that of their family changes.

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They've stopped all the drugs completely now

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so it's just a question of waiting for her to eventually come round.

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Laura likes to have a good sleep

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so it'll probably take slightly longer for her.

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Hello? Hello!

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No answer. I'm on my own.

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Help!

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Help!

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Is he breathing?

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One,

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two,

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three.

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Yes, he is definitely breathing.

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If someone on Islay needs intensive care,

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they have to be airlifted to the mainland.

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Unconscious people, just check whether they're breathing or not.

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So Dr Abell wants the islanders to be as self-sufficient as possible.

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What we're doing is we're... This is Portnahaven

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right at the very end of the island, a long way from any medical care.

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We've got a defibrillator and it's kept down in the village.

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I've taken this opportunity to come down and just go through

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some basic life support and use of the defibrillator with the group.

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# Ah, ah, ah, ah, stayin' alive, stayin' alive... #

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OK, and about that speed.

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-Help!

-Help! Go for it.

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Help! Help!

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Hello? OK, yes, the ambulance is on the way.

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Use your weight. That's very good. Excellent.

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In England, somebody has a heart attack, 999,

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be in the hospital within a very short space of time.

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Here, somebody has a heart attack, it's going to be three, four, five, six hours.

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And if it's really bad weather and the plane can't fly,

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and in the winter that definitely happens,

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it might be 10, 12 hours or more.

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It is genuinely frightening.

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OK?

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He's really hairy. Do you just want to hold that, Maureen?

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I've got two pads...

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MACHINE: Apply pads to patient's bare chest.

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Put that on the chest that way. OK.

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MACHINE: 'Plug in pad connector next to flashing light.'

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'Analysing heart rhythm.

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'Do not touch the patient.

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'Analysing heart rhythm.

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'No shock advised.'

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Dr Abell still has home visits to make.

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He's going to re-examine the woman with the missing false teeth.

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What's happening?

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Well, it's not solved the problem but at least I'm sure of the diagnosis now.

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-Which is?

-She definitely has got her teeth stuck in her throat...

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..and they won't come out.

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So, I think it's so obvious that she's got to have something done about it.

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With an unusual case like this,

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Dr Abell has to refer the patient to a specialist on the mainland.

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Hello?

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Hello, I'm Dr Abell. Who am I speaking to, please?

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I have a patient on the island of Islay.

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She has swallowed her dentures,

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and I've actually gently slid my finger into her throat,

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and she definitely has got her dentures stuck right at the back.

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No, it's a full, full set of plastic lower dentures.

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I can't take them out here,

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so she'll have to be sent to Glasgow to have that done.

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A fleet of four air ambulances covers the whole of Scotland.

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The planes cost £1,500 an hour to run and operate a strict priority system.

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Until the plane arrives, Dr Abell will keep the patient in hospital.

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How serious do you think this is?

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Well, it's not blue lights and ambulance serious

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in the sense that the patient is fine,

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she can breathe OK and she's not uncomfortable,

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but potentially, erm, if she vomits

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or if she starts inhaling...erm,

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sputum and things, yeah, it can be serious.

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This is obviously the brain here.

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You can see the area where this tumour is starting

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on the surface, it's all here.

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I think almost certainly that's going to end up being part of the tumour there.

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You see here where it's come out through the membrane of the brain.

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What we're going to do now is we're going to start doing the operation.

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You can wake him up, mate. Thank you.

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Darrell? Darrell?

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-Darrell?

-Darrell?

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Darrell, hello. Can you open your eyes for us?

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-Darrell?

-Darrell?

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-Darrell, can you open your eyes for me?

-That's it.

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You're going to do some tests for us. So, what's the man doing?

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He's holding a mug.

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-But what's he doing?

-He's having a mug of coffee.

-OK, good.

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Let's go to the next one.

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Left-hand drive.

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Although local anaesthetic means that Darrell can't feel any pain,

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he is now fully conscious and the team are monitoring his speech.

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What's the lion doing? Try to describe it to me.

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He's hiding, he's just sitting in the hole.

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I've got this little electrode and we're going to place this onto the surface of the brain

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and it will disrupt the function

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so what we don't want to see is that he stops speaking when we touch the brain.

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All right?

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Good, just sing out when you want some more.

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Here, is the sort of motor speechy areas.

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-Language function is usually all down here.

-OK.

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And here would be memory and verbal memory,

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things like your memory of words, of names, written information.

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All those sort of functions are around here.

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-At least you're talking at the moment, and that's good.

-I'm perfect!

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That's what we want to hear, Darrell!

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-100%, as if I've never had surgery.

-Yep, I know.

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I can't say it, I really have been glad to be here.

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Pity that I'm here because of the tumour, but there you go.

0:22:080:22:12

How much do you think you can get out?

0:22:140:22:16

I don't know, we'll just have to see. We're doing a really good job

0:22:160:22:19

but I've still got a big lump of tumour here that I'd like to remove.

0:22:190:22:22

It's abnormal here.

0:22:220:22:24

This abnormal tissue, the tumour,

0:22:240:22:26

and that's what I'm going to take out now.

0:22:260:22:30

As long as Darrell is still speaking,

0:22:300:22:32

Andrew knows he can continue removing parts of the tumour.

0:22:320:22:36

The more he takes out,

0:22:360:22:37

the closer he gets to the healthy parts of Darrell's brain.

0:22:370:22:40

Are you still awake, Darrell?

0:22:400:22:42

Yeah, just. I...oh.

0:22:420:22:44

I really want you awake, mate,

0:22:440:22:46

because I'm doing the really tricky bit at the moment so you keep going.

0:22:460:22:49

-OK.

-We're doing a fantastic job here. You just keep going, yeah?

0:22:490:22:54

We've got loads of it coming out.

0:22:540:22:56

You can see an enormous amount of tumour that we've removed here already.

0:22:560:23:01

It's a huge amount of tumour.

0:23:010:23:02

What's the dog doing?

0:23:020:23:04

It's holding something in its mouth.

0:23:040:23:06

Darrell is still talking brilliantly

0:23:060:23:08

so as long as he's still talking, I'm going to take more and more out.

0:23:080:23:11

It's gone a bit wishy-washy there.

0:23:110:23:14

Yeah, I've gone funny all of a sudden.

0:23:140:23:16

That's me pouring some water in, mate, you're just feeling it.

0:23:160:23:19

-Oh, it makes me...I'm all over the shop now.

-Are you all right?

0:23:190:23:23

-Yeah, I'm just wondering, my head is spinning.

-Yes, that was just me.

0:23:230:23:26

-What have you done then, Andrew?

-We've put a bit of water in there

0:23:260:23:29

-and it made you feel a bit funny because it stimulated it.

-Oh, right.

0:23:290:23:32

You're doing great here.

0:23:320:23:34

I think I'm doing all right, better than I expected.

0:23:340:23:38

Good.

0:23:380:23:39

How much have you got out, Andrew?

0:23:390:23:40

Oh, I think, I don't know, mate, but a lot. 70, 80% at least.

0:23:400:23:45

OK. OK.

0:23:450:23:48

A lot.

0:23:480:23:49

-What did you say you needed to look for?

-All right, Bob.

0:23:550:23:57

Just stay with us.

0:23:570:23:58

It's getting worse. The pain is getting worse, doctor.

0:23:580:24:02

Not me being heavy-handed.

0:24:040:24:05

We're always in the bowels of any hospital. We're always tucked away.

0:24:150:24:18

The mortuary is always pretty much well hidden.

0:24:180:24:20

Obviously people don't come to hospital to die.

0:24:200:24:23

Essentially they come here to get better, so they don't like to

0:24:230:24:26

earmark where we actually are,

0:24:260:24:27

hence the private kind of thing.

0:24:270:24:29

It causes a lot of problems when people are trying to find us,

0:24:290:24:32

but yeah, just the fundamental reason that mortuaries shouldn't

0:24:320:24:35

really exist, but obviously they do because sadly people do pass away

0:24:350:24:38

and us mortuary folk do exist.

0:24:380:24:41

Over 50% of all deaths in Britain take place in an NHS hospital.

0:24:410:24:46

At St Thomas's mortuary, they get around five new arrivals a day.

0:24:460:24:51

Erm, we get left with various removal forms of various descriptions,

0:24:510:24:54

lets us know which patients have come in overnight

0:24:540:24:57

and the kind of routine is to check them, weigh them, measure them,

0:24:570:25:01

either for post-mortem information or potential post-mortem

0:25:010:25:04

information, or even coffin size,

0:25:040:25:06

which we might get a call from the funeral directors eventually for.

0:25:060:25:09

And to make sure they are the correct people.

0:25:090:25:11

Erm, she just had a bit of, erm, a bit of fluid on her face, just where

0:25:140:25:19

possibly she's obviously laying down and it poured out of her mouth a bit.

0:25:190:25:23

So rather than keep them saturated in their own fluids,

0:25:230:25:26

we like to keep them nice and clean and give them a wipe.

0:25:260:25:29

This is our fridge room.

0:25:290:25:31

So we have designated fridge areas for all of our different patients.

0:25:310:25:35

For everything from a gestational foetus that might come from gynaecology or A&E

0:25:350:25:39

or the hospital birth centre, right up to your kind of 110-year-old,

0:25:390:25:43

and also high-risk patients, ie. those carrying an infection.

0:25:430:25:47

This is our one bariatric unit for the larger patients.

0:25:470:25:52

These here are our designated high-risk fridges,

0:25:520:25:55

and also we've kind of designated these as our decomp fridges as well

0:25:550:25:59

so we like to keep the maggots all kind of isolated away.

0:25:590:26:01

A lot of people think, why would you have to keep everyone isolated?

0:26:010:26:06

There's not a law about it.

0:26:060:26:07

It's maybe a recommendation, but there's no actual legislation

0:26:070:26:10

to say that a baby can't be in the same fridge as an adult

0:26:100:26:13

by any means, but it's just a kind of ethos that we've got here at Tommy's.

0:26:130:26:16

Tuck you back in, mate.

0:26:160:26:18

Are you going to draw us some pictures to put on our wall?

0:26:290:26:32

Some flower pictures?

0:26:320:26:33

You have to start breathing on your own soon.

0:26:380:26:41

They're needing an air cut.

0:26:410:26:43

-I'm Pat.

-Hi, I'm Mirabelle, I'm looking after your wife.

0:26:430:26:48

OK, yes, that's my wife, that's right.

0:26:480:26:51

-Hi, Mirabelle, how are we doing?

-Erm...

0:26:510:26:54

Laura's sedatives have now worn off

0:26:540:26:56

and nurses are going to try and wake her up.

0:26:560:27:00

I'm just staring at eyes and the first thing I expect to see,

0:27:000:27:03

do you know when people are asleep and they do the rapid eye movement thing?

0:27:030:27:06

-I'm just waiting to see that.

-Hello, Laura. Open your eyes, Laura.

0:27:060:27:11

Hello? Laura, come on, open your eyes.

0:27:110:27:14

Laura, open your eyes.

0:27:160:27:18

Angel.

0:27:210:27:22

Start waking up now?

0:27:230:27:24

They've stopped all the drugs so it's just you and the machine.

0:27:240:27:30

So you've just got to start coming up.

0:27:320:27:34

We're just waiting for you to open your eyes. Come on, open your eyes.

0:27:370:27:42

Laura, open your eyes, Laura.

0:27:420:27:44

Can you open your eyes for me?

0:27:440:27:47

-Please?

-Laura?

0:27:470:27:50

Can you hear me? Can you wiggle your toes for me? Or move your fingers?

0:27:500:27:53

Try and move your toes, love. Just wiggle them a little bit.

0:27:580:28:02

Come on.

0:28:070:28:09

So why isn't she waking up?

0:28:210:28:23

So, so what I wanted to talk to you about today is just to check

0:28:280:28:32

that you understand that the sedation has now worn off

0:28:320:28:37

so, so, how you see Laura is how she is.

0:28:370:28:41

So how she is at the moment is

0:28:410:28:44

-because of the brain haemorrhage, not because of any drugs, yes?

-OK.

0:28:440:28:50

I suppose there are no clear sort of timeframes of saying

0:28:500:28:55

we've now got to the gloomy stage?

0:28:550:28:59

No, I think that depends entirely on what progress she makes.

0:28:590:29:05

I mean this is very early days yet, but it means that, you know,

0:29:050:29:10

we can't give you any firm idea at the moment about

0:29:100:29:15

how she's going to progress over the next few days and where she might end up.

0:29:150:29:20

Right, OK. Thank you.

0:29:200:29:22

That's a lot to take in.

0:29:220:29:24

Is there anything you want to ask me or anything that's not clear?

0:29:240:29:27

No, I have taken in so much over the last three days, and, and...

0:29:270:29:33

and people have given me lots of information, which I'm

0:29:330:29:36

grateful for because just not knowing what's going on just makes it worse.

0:29:360:29:42

The information they want - that is will she be back to normal,

0:29:470:29:52

and when - is information we can't give them at this time,

0:29:520:29:56

but it's very common in the early phases after an acute brain

0:29:560:29:59

injury that patients do remain unconscious for some time.

0:29:590:30:04

That doesn't mean to say that that will be the ultimate outcome.

0:30:040:30:09

My expectation today, you know, and probably very silly,

0:30:110:30:16

but I was expecting to come in and, erm, and, er,

0:30:160:30:21

and for them to start stimulating her and that she'd wake up.

0:30:210:30:27

And I knew she wouldn't wake up with, you know, eyes wide open

0:30:270:30:30

but there would be some sort of response,

0:30:300:30:33

and that she would maybe understand that we were there and react to that.

0:30:330:30:38

So that was... That was kind of disappointing.

0:30:400:30:44

I'm not sure that's the right word but it was disappointing that that didn't happen.

0:30:440:30:48

In fact it was worse than disappointing.

0:30:480:30:50

Ooh!

0:30:540:30:55

-Adele?

-Adele.

-Love Adele.

0:30:550:30:57

Do you know where this patient's gone?

0:30:580:31:00

Imagine what it would be like if you had funeral directors turning up on a ward!

0:31:040:31:08

With obviously a trolley for deceased people and in their regalia,

0:31:080:31:13

it wouldn't be very nice for the patients who were still alive.

0:31:130:31:16

Well done, boys.

0:31:160:31:19

Don't trip over on the way out.

0:31:190:31:21

Take it easy, gents.

0:31:240:31:26

Right, let's get you dry now.

0:31:280:31:29

As well as storing the bodies,

0:31:310:31:33

the mortuary assistants also prepare them for the relatives' room.

0:31:330:31:36

We try and clean them up as best we can, no matter what state they're in.

0:31:360:31:39

Again, people who, say, jump off buildings from a great height

0:31:390:31:42

or people who get squished by lorries or cars and stuff like that,

0:31:420:31:44

they might come in in bits, or people who jump in front of trains.

0:31:440:31:47

If they're reconstructable, we'll reconstruct them.

0:31:470:31:50

It might take us five hours but we'll do it, just because, I mean,

0:31:500:31:53

it would bother us. I don't think any of us would sleep well

0:31:530:31:56

if we knew that we'd just left the person in bits in the fridge.

0:31:560:31:58

We have this kind of conflict with doctors sometimes.

0:32:030:32:05

They come in, ringing on the door and kind of go, "Hello, I'm a doctor."

0:32:050:32:08

"That's lovely, what do you want?" "I've come to see a body." I'm like, "Will mine do?"

0:32:080:32:12

What do you mean by that? Oh, do you mean you've come to see a patient?

0:32:120:32:16

They go, "They're not patients, they're dead." I'm like,

0:32:160:32:18

"No, until they leave this hospital, they're deceased patients."

0:32:180:32:21

They might be a different classification but they're our patients

0:32:210:32:24

and that's how we see them and that's how we look after them.

0:32:240:32:26

So, but yeah, I can take you through now to where the body -

0:32:260:32:29

or the patient - would normally reside.

0:32:290:32:32

Obviously this is the only area that the families would come into.

0:32:320:32:35

As you can see, it's quite a nice kind of calming environment.

0:32:350:32:38

If we get a viewing, the patient will be taken out of the fridge by us, the APTs.

0:32:380:32:43

Get put on the trolley, have a nice duvet put over them

0:32:430:32:45

so they look like they're tucked up in bed asleep.

0:32:450:32:47

Obviously we've cleaned them up and they're looking presentable.

0:32:470:32:50

Any tubes or lines, we'll cut those off at the level where they are

0:32:500:32:53

and poke those down so it's not quite as they looked in intensive care

0:32:530:32:56

and stuff like that, but it can get extremely, extremely emotional in here.

0:32:560:33:00

You can often have fainters, kind of like hysteria.

0:33:000:33:02

Sometimes they want to have a party. I've had it before with different cultures,

0:33:020:33:06

especially with our catchment area where we are, certain cultures demand

0:33:060:33:10

that you have to have a drink so we've had schnapps offered to us in here before.

0:33:100:33:13

We're like, "We really, really can't. We're kind of on duty."

0:33:130:33:16

"You must, you'll insult us if you don't!" So you get the boss on the phone.

0:33:160:33:19

"Can I have a shot of schnapps?" "No, you can't." "OK then, sorry!"

0:33:190:33:23

I have to take some antidepressants the doctor gave me

0:33:290:33:31

because I had an overactive bladder, and it works.

0:33:310:33:34

-HE SNEEZES

-You're all right!

0:33:340:33:36

No, you're all right.

0:33:390:33:40

-You'll be all right.

-You'll be fine.

0:33:570:34:00

I've told you, if you don't have yours done, I'll have mine done!

0:34:000:34:04

Around 80% of all surgery today will be carried out

0:34:040:34:07

on people over the age of 75.

0:34:070:34:10

-You're all right?

-Yes. Fine.

0:34:100:34:14

Well, get up and let me sit down!

0:34:140:34:16

John is 85.

0:34:160:34:18

Today he's having one of the most common operations performed on the NHS.

0:34:180:34:22

OK?

0:34:220:34:24

Off we go.

0:34:240:34:26

My name's Lindsay. Do you know why you're here today?

0:34:280:34:32

Yeah, a cataract.

0:34:320:34:34

I'm virtually blind now, you know.

0:34:340:34:37

My right eye is the worst.

0:34:370:34:39

Gradually, over the last 12 months, his eyes have just...

0:34:410:34:45

His right eye and his other one, well, both of them, they've just gone.

0:34:450:34:49

Everywhere's blurred.

0:34:490:34:52

He thought at first it was the television that was, er...

0:34:520:34:54

-HE LAUGHS Didn't you?

-Yeah!

0:34:540:34:57

He thought it was the television that had gone.

0:34:570:34:59

The television's going blurred, we'll have to do something about it.

0:34:590:35:02

We bought a bigger television. You know.

0:35:020:35:06

Always something going wrong, especially with me, you know.

0:35:060:35:09

This is the latest.

0:35:110:35:13

Everything else has been done.

0:35:130:35:16

Do you know what the operation entails?

0:35:160:35:18

Yes, they just slit the eye and take the sac out,

0:35:180:35:22

-whatever it is, and put the lens in.

-We watched it on the television.

0:35:220:35:28

-Didn't we?

-Yes.

-He likes watching things like that.

0:35:280:35:32

Nearly every operation I've had, I've been in some pain after it,

0:35:320:35:36

you know, but I believe this one is pretty painless.

0:35:360:35:40

-It doesn't matter if you're going to get your sight back, does it?

-Oh, no.

0:35:410:35:46

Put up with that.

0:35:460:35:47

Are you worried at all about the operation?

0:36:000:36:03

-No.

-Not worried?

-No.

0:36:030:36:06

No.

0:36:060:36:07

He's strong!

0:36:110:36:13

You know, and he never gives in for anything.

0:36:130:36:16

So, er, I don't worry. I mean what's the point?

0:36:170:36:21

You die if you worry, you die if you don't, so why worry at all?

0:36:220:36:27

OK, put your chin on the chin rest there.

0:36:290:36:32

You OK like that?

0:36:320:36:33

Do you want me to explain to you what the procedure involves

0:36:350:36:38

and go through it or are you happy with...

0:36:380:36:40

-As long as you're not going to chop my head off.

-Definitely not!

0:36:400:36:45

Demand for cataract surgery has grown with an ageing population,

0:36:470:36:51

but with NHS cuts, many hospitals have reduced the number they carry out.

0:36:510:36:56

They don't have to be perfect, but as long as he can read

0:36:560:37:00

and watch the television, things like that.

0:37:000:37:04

You know, because he loves to watch the television. All the quizzes.

0:37:040:37:10

Because you see, when you can't see very well,

0:37:100:37:12

those sort of things where you've got to think, keep your brain working.

0:37:120:37:17

I think we've done enough, but we've gone up to about what...

0:37:310:37:35

-How long have you been married for?

-60 years.

-60 years married?

0:37:370:37:41

We got a card off the Queen, er, with a photograph

0:37:410:37:46

and many happy, er, anniversaries and things.

0:37:460:37:49

A lovely card. My daughter arranged that.

0:37:500:37:53

She got on the Internet and straight through to the Palace.

0:37:540:37:58

You don't deal with the Queen, I don't think, but she signs the thing.

0:37:580:38:03

You know, printed sign, but it's a lovely card which we'll keep.

0:38:030:38:08

-That's very sweet.

-I keep a lot of things from royalty. I like royalty.

0:38:080:38:13

I feel sorry for the Queen, actually!

0:38:130:38:16

Because I've had no trouble with my children.

0:38:160:38:19

Dr Abell has the hospital in Glasgow on standby to treat the patient

0:38:250:38:29

who swallowed her false teeth, but there's no sign of a plane yet.

0:38:290:38:34

I really want to wait for this phone call to come through.

0:38:340:38:37

There's another patient in the hospital, who Dr Abell is keeping an eye on today.

0:38:410:38:45

-Barbara is 84 and has lung cancer.

-Can I sit here?

-Mm.

0:38:480:38:51

How are you doing?

0:38:540:38:56

-Not as well as I would like to do.

-Ah.

0:38:560:39:00

Barbara's situation is a situation that really touches me

0:39:000:39:06

personally because she is in the last few months of her life.

0:39:060:39:11

Er, she lives alone in quite a remote place, where she'd like to be,

0:39:110:39:18

but you can see just by looking at her how breathless she is

0:39:180:39:22

and how much difficulty she has coping there.

0:39:220:39:25

Are you wanting to go home, Barbara?

0:39:250:39:29

I don't know, really. And it's no use me...erm...

0:39:290:39:33

..kidding myself that I'm going to walk in to my front door.

0:39:360:39:41

-"Hello, I'm here." I'm not.

-No.

0:39:410:39:45

-I'm not. So I will need help.

-Yes.

0:39:450:39:50

If you are not well enough to go home, you don't have to go,

0:39:500:39:55

and if you go home and you can't manage,

0:39:550:39:59

of course we can bring you back in again.

0:39:590:40:01

-Oh, I will try, believe me.

-But if it doesn't go well, don't worry.

0:40:010:40:06

No, I won't.

0:40:090:40:11

And I'm not in a position to worry because it will achieve nothing,

0:40:110:40:17

-will it?

-Worry rarely does, does it?

0:40:170:40:21

No, it's a hiding to nowhere and nothing, you know.

0:40:210:40:26

And I'm shut up in here, and I'm happy, I'm not resentful, not angry.

0:40:260:40:32

I'm not...nothing. I've become like an amoeba.

0:40:320:40:38

Yes, of course we're treating her but it depends what you mean

0:40:400:40:43

by treating her. She'll get, here, really personal attention.

0:40:430:40:50

We will look after her, we will not be sending her away

0:40:500:40:55

to some remote hospital, where strangers will look after her.

0:40:550:41:00

What Barbara needs is love and respect, really.

0:41:000:41:05

She doesn't need anything else.

0:41:050:41:06

Yes, one of the things about being a doctor is you...

0:41:140:41:17

You're always running up against death, one way or another.

0:41:170:41:21

Well, it's just been a very busy day today.

0:41:260:41:29

It's, er...

0:41:290:41:30

..keep going without a pause, really.

0:41:320:41:35

And the opportunity just to sit down here for a minute or two

0:41:410:41:45

and eat a sandwich is very good.

0:41:450:41:48

The role of the doctor I feel is less important,

0:41:510:41:54

less technological than I used to think of it as.

0:41:540:41:57

Now I think that my role is actually more helping people,

0:41:570:42:01

and sometimes that help is about absolutely spotting the right diagnosis,

0:42:010:42:06

absolutely doing the right thing, absolutely getting the technology right.

0:42:060:42:11

Sometimes it's just to help people cope

0:42:110:42:14

with the vicissitudes of their life. There's nothing you can do...

0:42:140:42:18

There's nothing you can do to stop people suffering...

0:42:180:42:21

..degenerative problems, there's nothing you can do to stop people getting old,

0:42:240:42:27

there's nothing you can do to stop people having the social

0:42:270:42:30

and psychological problems that they have.

0:42:300:42:32

I'm never going to be able to cure those things,

0:42:320:42:35

but there are some things that I can do just to be helpful.

0:42:350:42:40

After six hours on the operating table, Darrell's surgery is over.

0:42:510:42:55

Can I have a cup of tea?

0:42:550:42:57

And his speech is completely intact.

0:42:570:43:00

For me as the surgeon,

0:43:000:43:02

I'm just very happy that we've managed to achieve

0:43:020:43:05

what we needed to do.

0:43:050:43:06

-Will I get any painkillers for the head at all?

-Yes.

0:43:060:43:10

He's got a very serious condition that he didn't want, and no-one would

0:43:100:43:15

wish on him, but I do think that we've been able to give him a better

0:43:150:43:20

outcome than he might otherwise have had in many other places.

0:43:200:43:24

-How are you feeling?

-Better than expected.

0:43:240:43:28

Yeah, I'm happy. Very, very happy.

0:43:280:43:33

-Are you OK?

-Yes.

-Everything works?

0:43:330:43:35

Can you wiggle your fingers for me? Wiggle your toes.

0:43:350:43:38

On the left hand as well.

0:43:380:43:41

I'm in London, it's the 18th of October, I've had full surgery with Andrew.

0:43:410:43:47

Very good. That's good.

0:43:470:43:50

Er, now I want to see Jill.

0:43:510:43:53

And just...have a hug.

0:43:560:44:00

I'm alive.

0:44:030:44:04

I'm emotion, as we speak.

0:44:090:44:11

I'm breathing deep.

0:44:140:44:18

I survived because I love my family.

0:44:180:44:21

Oh, and he's awake.

0:44:270:44:30

-Hello!

-Hello!

-Oh!

-All right?

0:44:300:44:34

Are you going to get a cup of tea?

0:44:350:44:38

He said Andrew's taken a massive amount.

0:44:380:44:42

-Good.

-Which is great stuff. And I mean a lot.

0:44:420:44:47

It's good that I got what I wanted, it's waking up.

0:44:470:44:50

# By your bedside all day every day, BHBN hospital radio! #

0:44:510:44:58

It's Olly and Ciaran for the next hour and it's our pleasure

0:44:590:45:03

and even a delight to play you the songs you guys have chosen.

0:45:030:45:07

This evening we've got requests for Stevie Wonder, Neil Diamond,

0:45:070:45:10

the Eagles, to name but a few.

0:45:100:45:12

This evening we're going to start with Eagles, Hotel California,

0:45:120:45:15

and, Scott, this is just for you.

0:45:150:45:17

Enjoy.

0:45:170:45:18

-I haven't got names.

-Pardon?

0:45:260:45:28

-I haven't got names on there, who they're for.

-Oh, who they're for!

0:45:280:45:31

Yeah. Have you got them on here? Quickly, quickly.

0:45:310:45:34

Come on, quickly.

0:45:340:45:36

When you're in hospital, you don't know when you're going to be home.

0:45:400:45:43

You don't know, there may be complications, God willing there isn't,

0:45:430:45:47

but you just don't know, and I think that's a lot of the thing.

0:45:470:45:49

People just, when they're in hospital, they just want to know

0:45:490:45:52

when they're going home, so it's a lonely place.

0:45:520:45:55

Even with people around you, it can be a very lonely place

0:45:550:45:57

and I think this brings a bit of warmth to people.

0:45:570:46:00

We spoke earlier about, you know, music being a healer, I believe that,

0:46:000:46:03

and I think that's part of what it does.

0:46:030:46:05

It's something to distract people when they are ill.

0:46:050:46:08

When they get their requests and their name read out, I think it's massively important.

0:46:080:46:12

# Welcome to the Hotel California

0:46:130:46:16

# Such a lovely place

0:46:190:46:21

# Such a lovely place

0:46:210:46:22

# Such a lovely place... #

0:46:220:46:24

-Are you all right?

-Yeah.

-OK, give me a kiss.

0:46:360:46:41

-You were worried just a little bit, weren't you?

-Just a bit.

0:46:430:46:47

I don't like to show it, though. You see, you know.

0:46:470:46:51

It's all right. You just stand there, I've got to take your hat off.

0:46:510:46:55

He's been a very, very good patient. It's gone very well

0:46:590:47:02

so hopefully you'll find tomorrow that there's a big difference.

0:47:020:47:06

Thank you very much!

0:47:060:47:07

The NHS, I think it's marvellous. We saw it start.

0:47:100:47:16

Prior to that, there used to be the doctor man came round

0:47:160:47:20

on a Friday night, and most people paid sixpence a week,

0:47:200:47:24

which was a lot of money then.

0:47:240:47:26

But today there isn't anywhere in the world where you could get the treatment.

0:47:260:47:31

I mean, think about it, in Manchester we've got every hospital you can think of

0:47:310:47:35

to treat everything wrong with you.

0:47:350:47:38

Eyes, nose, everything.

0:47:380:47:41

I've never seen him look as happy!

0:47:410:47:43

I'll make him something nice for his tea.

0:47:430:47:47

Chips!

0:47:470:47:49

-RADIO:

-Welcome to drive time.

0:47:490:47:51

Good, I'm just going to quickly check...

0:47:560:47:58

You've got to start waking up.

0:48:170:48:19

It's been six hours since nurses started trying to wake up Laura.

0:48:190:48:23

There's been no response.

0:48:230:48:25

Come on, darling. Start waking up.

0:48:250:48:27

Come on, babe. Eh?

0:48:290:48:32

Flicker your eyes. Flicker your eyes.

0:48:340:48:37

Anything, any sort of movement will do me for now.

0:48:430:48:47

I just want it, I just want it to happen quickly. I just want it to...

0:48:490:48:52

I just want her to be awake.

0:48:550:48:56

Just so we can know what's going on and...and get on with it.

0:48:560:49:01

Try and open your eyes, love.

0:49:070:49:10

Just a little bit.

0:49:100:49:12

Just to let me know, even just for a second.

0:49:130:49:16

We've been married 34 years, and she's the brains of the outfit

0:49:190:49:24

and I'm the doer.

0:49:240:49:25

You know, we make joint decisions

0:49:270:49:30

but it's, you know, whatever she decides basically is fine by me

0:49:300:49:34

because she's always, she always kinds of gets it right, you know?

0:49:340:49:38

That's what I carry around with me. Not that I need to, but...

0:49:410:49:45

That's just there.

0:49:470:49:49

Maybe tomorrow you'll see something a little bit different.

0:49:510:49:54

Yeah, that would be good.

0:49:540:49:55

You're having long days, but she's going to need you much more

0:49:550:49:59

when she's a bit more awake so think of yourself in all of this.

0:49:590:50:03

-Will do.

-You're going to go home tonight, aren't you?

0:50:030:50:05

-Oh, yes.

-OK.

-I'm used to long days, so...

-You are, OK,

0:50:050:50:08

but just sort of think of yourself because it's exhausting and

0:50:080:50:12

although we're here to look after her, we need to look after you as well.

0:50:120:50:16

After a brain injury, there's a whole spectrum of outcome

0:50:160:50:19

from getting back pretty much to how you were before at one end of the spectrum.

0:50:190:50:26

The other end of the spectrum is always considered to be death.

0:50:260:50:30

Many patients and their families actually might not perceive

0:50:300:50:35

that death IS the worst outcome, that actually surviving with

0:50:350:50:39

a terrible neurological injury, in a coma for the rest of one's

0:50:390:50:43

life, is in some people's minds potentially worse than dying.

0:50:430:50:47

It costs £1,600 a day to look after a patient in neuro intensive care.

0:50:500:50:56

Laura will remain here for as long as it takes for her to improve.

0:50:560:50:59

For her husband, Pat, there's nothing he can do but wait.

0:50:590:51:03

I suppose the worst is not knowing, erm...

0:51:050:51:09

..how it's going to turn out.

0:51:110:51:13

Erm...

0:51:160:51:17

And, and, and...knowing that there are no easy answers.

0:51:190:51:25

I can't just go to somebody and say,

0:51:250:51:27

"How long is this going to take to fix?"

0:51:270:51:29

But I suppose it'll take time for, for...

0:51:290:51:34

the real reality to kick in and, er, and for me to accept it.

0:51:340:51:41

I mean I accept it at one level, but this doesn't happen to Laura.

0:51:420:51:47

This doesn't happen to fit young women.

0:51:470:51:49

Er, but clearly it does.

0:51:520:51:54

And what will the future be? You know, that's the other big thing.

0:51:540:51:58

What's the future going to be? What's it going to be like?

0:51:580:52:00

Are we all going to go back to normal, or, you know,

0:52:000:52:04

just completely different?

0:52:040:52:07

So, it's, erm,

0:52:070:52:09

strange, difficult, all those things.

0:52:090:52:13

Scary. Very, very scary.

0:52:150:52:17

Darrell will be in hospital for several days.

0:52:370:52:40

In another part of the building,

0:52:410:52:43

pathologists are analysing a sample of his tumour.

0:52:430:52:47

They're doing preliminary checks

0:52:470:52:49

to see if the grade or the malignancy has increased.

0:52:490:52:52

The vessels are suspicious, and I think the cellularity

0:52:550:52:59

is very high and it's possible that we're having at least a grade three.

0:52:590:53:02

It probably is more likely to be a four.

0:53:040:53:06

For the patient that means first of all the tumour has become more malignant as it recurred,

0:53:070:53:12

and it also will unfortunately indicate or mean that the tumour, er, comes...

0:53:120:53:19

After this operation, it will come back even earlier.

0:53:190:53:23

So the majority of the people that have a grade four of this diagnosis

0:53:230:53:27

have a life expectancy of several months rather than several years.

0:53:270:53:32

It's going to be devastating news for him

0:53:360:53:38

and his family but I think you have to appreciate your place in the disease.

0:53:380:53:43

We can only do what we can to help people

0:53:430:53:45

and that's what we've tried to do today, but we can't play God.

0:53:450:53:50

We can't cure this tumour, he knows that.

0:53:500:53:53

He knew even when it was a low-grade tumour that it couldn't be cured.

0:53:530:53:57

There will be treatments that will be offered, and he'll be given,

0:53:570:54:00

I'm sure, a very aggressive chemotherapy,

0:54:000:54:03

but at the end of the day we know that for the vast majority of people,

0:54:030:54:06

they don't respond fully to the chemotherapy for high-grade brain tumours

0:54:060:54:09

and eventually, unfortunately, they succumb to their tumours.

0:54:090:54:12

Doctors will verify the test results before sharing the news with Darrell in a few days' time.

0:54:140:54:19

AMBULANCE SIREN

0:54:230:54:26

Have you taken any tablets tonight?

0:54:260:54:29

No. No...

0:54:290:54:32

There's no toilet on here, OK? If you're that desperate to go, go.

0:54:360:54:41

Because we're on call, I've got my own pillow.

0:54:480:54:51

When he's on duty, Dr Abell stays overnight in the hospital.

0:54:510:54:55

I have my own little tuck box.

0:55:030:55:06

But he won't go to bed until the plane has picked up

0:55:060:55:08

the patient who swallowed her false teeth.

0:55:080:55:11

Hiya. Chris Abell speaking.

0:55:110:55:12

Oh, hiya.

0:55:150:55:16

Have you got any ideas at all about when it might be?

0:55:190:55:23

OK. OK.

0:55:230:55:25

OK, good, so the aircraft in about two hours, hopefully.

0:55:270:55:31

His other patient, Barbara, is finding it difficult to sleep.

0:55:350:55:39

She knows that no more treatment can be given, she's had radiotherapy.

0:55:420:55:46

She knows that things are going to get worse and I'm absolutely sure

0:55:460:55:49

that she knows what is happening, but we don't have to discuss it.

0:55:490:55:53

If I switch the light off, do you think you might just have a bit of a doze?

0:55:530:55:57

That's a bit better.

0:56:020:56:04

One of the things that's changed is that ever so many people end up

0:56:100:56:16

falling into sort of the clutches of technology at the end of their lives.

0:56:160:56:21

Something happens to them

0:56:210:56:23

and the emergency response is admit them to hospital because, you know,

0:56:230:56:26

the traditional view is that doctors are in a fight against death,

0:56:260:56:30

that you have to sort of ward off the evil death with everything you can.

0:56:300:56:35

But, when death is coming, when it's inevitable,

0:56:350:56:39

if you can actually help a person and a family achieve a good death,

0:56:390:56:45

you've done a wonderful thing.

0:56:450:56:46

Supper.

0:56:460:56:48

I think that there's... a lot of people...

0:56:510:56:55

..fear death.

0:56:590:57:01

I don't fear death at all. I, I just don't.

0:57:030:57:07

The idea for me of death is, "Good, I can go to sleep."

0:57:070:57:12

Subtitles by Red Bee Media Ltd

0:57:570:57:59

To order your free copy of the Open University's booklet,

0:58:090:58:12

"working to save lives", which accompanies this series, call:

0:58:120:58:16

Or go to...

0:58:190:58:22

..and follow the links to the OU.

0:58:220:58:24

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