Episode 3 Keeping Britain Alive: The NHS in a Day

This programme contains scenes which some viewers may find upsetting.

18th of October 2012.

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

THROUGH MEGAPHONE: This change will be a disaster.

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

Three days ago you had a stroke.

1,500 of us will die.

2,000 will be born.

ALARM SOUNDS

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

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

Hello, we're going to help you.

-'We rely on it.'

-Be really brave.

-'Complain about it.'

-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.

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

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

I just love this drive to work in the mornings.

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

There's a deer.

Look, two, three. There they go.

They come right up to the road.

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

Chris Abell is a GP on a remote island

off the west coast of Scotland.

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

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

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

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

So any serious illnesses, accidents,

we will see, which is unusual for GPs.

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

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

At the UK's largest dedicated brain hospital,

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

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

called Darrell Gittings.

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

had a brain tumour diagnosed.

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

but unfortunately the tumour has come back.

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

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

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

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

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

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

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

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

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

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

and that's what goes off into the brain

and makes it difficult to treat.

When Darrell started developing new symptoms, his local health authority

in Wales supported a referral for specialist treatment in London.

So, this is Darrell's latest scan.

And you can see immediately that there is a huge

difference between this side and this side.

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

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

I think probably with a little cyst.

What has been put to Darrell and what is the truth

is that if we do nothing here

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

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

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

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

and improve his quality of life.

I want them to take...

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

because of the spidering off of the tumour.

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

That will be better than winning the Lottery to me,

better than anything else.

-Ha, ha, ha!

-Ha, ha, ha.

Just there?

SHE SIGHS

Morning in the mortuary. Love it.

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

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

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

You again?

-Yeah, it's me again!

-THEY LAUGH

Come down.

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

is...personal knowledge of patients.

'And...continuity.'

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

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

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

Although emergencies are rare, this small island has its own

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

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

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

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

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

Bizarre.

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

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

A patient who has been brought up possibly having swallowed

her bottom set of dentures.

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

-Can I come in?

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

But an X-ray proves inconclusive.

I actually think that it's probably a case of

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

gone down their throat.

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

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

The patient's carer is still worried.

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

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

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

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

Mr Stuart, please.

-Did you have a busy morning out there?

-Very busy.

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

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

-In you come.

-Cheers.

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

-Yeah, any minute.

For the trolley or whatever you want to call it.

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

Yeah, get on with it.

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

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

We tend not to see each other on the day

because we upset each other too much.

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

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

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

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

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

It's...

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

It's like your wedding day.

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

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

It's a high-risk procedure, this,

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

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

much worse than he goes on to the operating table.

To minimise the risk to Darrell's speech,

he'll need to be monitored during the operation.

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

and asked to talk while the surgery continues.

You make a decision.

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

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

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

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

And I love what I do in my life personally.

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

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

Open your eyes for me.

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

The reason for doing him awake

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

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

-OK, we're all ready.

-Ready? One, two, three.

There you go.

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

He-llo.

-Very busy, isn't it?

-Always is.

-Yep.

# BHBN Hospital Radio! #

-Would you like a song on the radio tonight?

-Hotel California.

-By?

-Eagles.

-Eagles, of course it is.

-The extended version.

-The extended version.

-Dedicated to my wife, Lisa Jones.

-Lisa.

-Thank you very much, thank you.

-Lisa Jones.

Get well soon, Lisa, from everybody at BHBN.

We're getting requests that are going to be broadcast

this evening on BHBN Hospital Radio.

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

-Hospital radio is important.

-I agree, totally. Well said.

Hello!

My name is Ciaran and this is Olly

and we're from BHBN Hospital Radio.

Would you like a song?

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

-Hmm.

-Get well soon from everybody at BHBN.

How many do you think we have?

-11?

-12.

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

That is absolutely perfect, that's really good.

AMBULANCE SIREN

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

INAUDIBLE MUTTERING

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

after she collapsed from a brain haemorrhage.

Her husband Pat has been by her bedside ever since.

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

and during the interview she lost feeling in her left leg

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

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

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

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

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

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

This morning, doctors will stop her sedatives

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

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

of a more general hit

her brain encountered during this haemorrhage.

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

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

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

One in five will die from their injuries.

The issue about brain injuries is that actually

it can strike at any time, anybody.

On the whole, brain injury is something that

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

They're just doing what they do every day

and suddenly their life and that of their family changes.

They've stopped all the drugs completely now

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

Laura likes to have a good sleep

so it'll probably take slightly longer for her.

Hello? Hello!

No answer. I'm on my own.

Help!

Help!

Is he breathing?

One,

two,

three.

Yes, he is definitely breathing.

If someone on Islay needs intensive care,

they have to be airlifted to the mainland.

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

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

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

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

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

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

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

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

OK, and about that speed.

-Help!

-Help! Go for it.

Help! Help!

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

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

In England, somebody has a heart attack, 999,

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

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

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

and in the winter that definitely happens,

it might be 10, 12 hours or more.

It is genuinely frightening.

OK?

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

I've got two pads...

MACHINE: Apply pads to patient's bare chest.

Put that on the chest that way. OK.

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

'Analysing heart rhythm.

'Do not touch the patient.

'Analysing heart rhythm.

'No shock advised.'

Dr Abell still has home visits to make.

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

What's happening?

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

-Which is?

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

..and they won't come out.

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

With an unusual case like this,

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

Hello?

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

I have a patient on the island of Islay.

She has swallowed her dentures,

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

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

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

I can't take them out here,

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

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

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

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

How serious do you think this is?

Well, it's not blue lights and ambulance serious

in the sense that the patient is fine,

she can breathe OK and she's not uncomfortable,

but potentially, erm, if she vomits

or if she starts inhaling...erm,

sputum and things, yeah, it can be serious.

This is obviously the brain here.

You can see the area where this tumour is starting

on the surface, it's all here.

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

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

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

You can wake him up, mate. Thank you.

Darrell? Darrell?

-Darrell?

-Darrell?

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

-Darrell?

-Darrell?

-Darrell, can you open your eyes for me?

-That's it.

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

He's holding a mug.

-But what's he doing?

-He's having a mug of coffee.

-OK, good.

Let's go to the next one.

Left-hand drive.

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

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

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

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

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

and it will disrupt the function

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

All right?

Good, just sing out when you want some more.

Here, is the sort of motor speechy areas.

-Language function is usually all down here.

-OK.

And here would be memory and verbal memory,

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

All those sort of functions are around here.

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

-I'm perfect!

That's what we want to hear, Darrell!

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

-Yep, I know.

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

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

How much do you think you can get out?

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

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

It's abnormal here.

This abnormal tissue, the tumour,

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

As long as Darrell is still speaking,

Andrew knows he can continue removing parts of the tumour.

The more he takes out,

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

Are you still awake, Darrell?

Yeah, just. I...oh.

I really want you awake, mate,

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

-OK.

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

We've got loads of it coming out.

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

It's a huge amount of tumour.

What's the dog doing?

It's holding something in its mouth.

Darrell is still talking brilliantly

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

It's gone a bit wishy-washy there.

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

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

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

-Are you all right?

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

-Yes, that was just me.

-What have you done then, Andrew?

-We've put a bit of water in there

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

-Oh, right.

You're doing great here.

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

Good.

How much have you got out, Andrew?

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

OK. OK.

A lot.

-What did you say you needed to look for?

-All right, Bob.

Just stay with us.

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

Not me being heavy-handed.

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

The mortuary is always pretty much well hidden.

Obviously people don't come to hospital to die.

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

earmark where we actually are,

hence the private kind of thing.

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

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

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

and us mortuary folk do exist.

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

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

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

lets us know which patients have come in overnight

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

either for post-mortem information or potential post-mortem

information, or even coffin size,

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

And to make sure they are the correct people.

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

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

So rather than keep them saturated in their own fluids,

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

This is our fridge room.

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

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

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

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

This is our one bariatric unit for the larger patients.

These here are our designated high-risk fridges,

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

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

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

There's not a law about it.

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

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

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

Tuck you back in, mate.

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

Some flower pictures?

You have to start breathing on your own soon.

They're needing an air cut.

-I'm Pat.

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

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

-Hi, Mirabelle, how are we doing?

-Erm...

Laura's sedatives have now worn off

and nurses are going to try and wake her up.

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

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

-I'm just waiting to see that.

-Hello, Laura. Open your eyes, Laura.

Hello? Laura, come on, open your eyes.

Laura, open your eyes.

Angel.

Start waking up now?

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

So you've just got to start coming up.

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

Laura, open your eyes, Laura.

Can you open your eyes for me?

-Please?

-Laura?

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

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

Come on.

So why isn't she waking up?

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

that you understand that the sedation has now worn off

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

So how she is at the moment is

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

-OK.

I suppose there are no clear sort of timeframes of saying

we've now got to the gloomy stage?

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

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

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

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

Right, OK. Thank you.

That's a lot to take in.

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

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

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

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

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

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

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

injury that patients do remain unconscious for some time.

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

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

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

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

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

but there would be some sort of response,

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

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

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

In fact it was worse than disappointing.

Ooh!

-Adele?

-Adele.

-Love Adele.

Do you know where this patient's gone?

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

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

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

Well done, boys.

Don't trip over on the way out.

Take it easy, gents.

Right, let's get you dry now.

As well as storing the bodies,

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

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

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

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

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

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

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

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

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

We have this kind of conflict with doctors sometimes.

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

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

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

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

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

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

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

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

or the patient - would normally reside.

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

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

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

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

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

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

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

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

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

You can often have fainters, kind of like hysteria.

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

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

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

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

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

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

I have to take some antidepressants the doctor gave me

because I had an overactive bladder, and it works.

-HE SNEEZES

-You're all right!

No, you're all right.

-You'll be all right.

-You'll be fine.

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

Around 80% of all surgery today will be carried out

on people over the age of 75.

-You're all right?

-Yes. Fine.

Well, get up and let me sit down!

John is 85.

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

OK?

Off we go.

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

Yeah, a cataract.

I'm virtually blind now, you know.

My right eye is the worst.

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

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

Everywhere's blurred.

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

-HE LAUGHS Didn't you?

-Yeah!

He thought it was the television that had gone.

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

We bought a bigger television. You know.

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

This is the latest.

Everything else has been done.

Do you know what the operation entails?

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

-whatever it is, and put the lens in.

-We watched it on the television.

-Didn't we?

-Yes.

-He likes watching things like that.

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

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

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

-Oh, no.

Put up with that.

Are you worried at all about the operation?

-No.

-Not worried?

-No.

No.

He's strong!

You know, and he never gives in for anything.

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

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

OK, put your chin on the chin rest there.

You OK like that?

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

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

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

-Definitely not!

Demand for cataract surgery has grown with an ageing population,

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

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

and watch the television, things like that.

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

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

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

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

-How long have you been married for?

-60 years.

-60 years married?

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

and many happy, er, anniversaries and things.

A lovely card. My daughter arranged that.

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

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

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

-That's very sweet.

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

I feel sorry for the Queen, actually!

Because I've had no trouble with my children.

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

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

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

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

-Barbara is 84 and has lung cancer.

-Can I sit here?

-Mm.

How are you doing?

-Not as well as I would like to do.

-Ah.

Barbara's situation is a situation that really touches me

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

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

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

and how much difficulty she has coping there.

Are you wanting to go home, Barbara?

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

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

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

-No.

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

-Yes.

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

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

of course we can bring you back in again.

-Oh, I will try, believe me.

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

No, I won't.

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

-will it?

-Worry rarely does, does it?

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

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

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

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

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

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

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

What Barbara needs is love and respect, really.

She doesn't need anything else.

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

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

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

It's, er...

..keep going without a pause, really.

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

and eat a sandwich is very good.

The role of the doctor I feel is less important,

less technological than I used to think of it as.

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

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

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

Sometimes it's just to help people cope

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

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

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

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

and psychological problems that they have.

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

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

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

Can I have a cup of tea?

And his speech is completely intact.

For me as the surgeon,

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

what we needed to do.

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

-Yes.

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

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

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

-How are you feeling?

-Better than expected.

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

-Are you OK?

-Yes.

-Everything works?

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

On the left hand as well.

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

Very good. That's good.

Er, now I want to see Jill.

And just...have a hug.

I'm alive.

I'm emotion, as we speak.

I'm breathing deep.

I survived because I love my family.

Oh, and he's awake.

-Hello!

-Hello!

-Oh!

-All right?

Are you going to get a cup of tea?

He said Andrew's taken a massive amount.

-Good.

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

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

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

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

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

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

the Eagles, to name but a few.

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

and, Scott, this is just for you.

Enjoy.

-I haven't got names.

-Pardon?

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

-Oh, who they're for!

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

Come on, quickly.

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

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

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

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

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

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

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

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

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

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

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

# Welcome to the Hotel California

# Such a lovely place

# Such a lovely place

# Such a lovely place... #

-Are you all right?

-Yeah.

-OK, give me a kiss.

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

-Just a bit.

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

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

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

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

Thank you very much!

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

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

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

which was a lot of money then.

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

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

to treat everything wrong with you.

Eyes, nose, everything.

I've never seen him look as happy!

I'll make him something nice for his tea.

Chips!

-RADIO:

-Welcome to drive time.

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

You've got to start waking up.

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

There's been no response.

Come on, darling. Start waking up.

Come on, babe. Eh?

Flicker your eyes. Flicker your eyes.

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

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

I just want her to be awake.

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

Try and open your eyes, love.

Just a little bit.

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

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

and I'm the doer.

You know, we make joint decisions

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

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

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

That's just there.

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

Yeah, that would be good.

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

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

-Will do.

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

-Oh, yes.

-OK.

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

-You are, OK,

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

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

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

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

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

Many patients and their families actually might not perceive

that death IS the worst outcome, that actually surviving with

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

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

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

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

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

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

..how it's going to turn out.

Erm...

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

I can't just go to somebody and say,

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

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

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

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

This doesn't happen to fit young women.

Er, but clearly it does.

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

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

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

just completely different?

So, it's, erm,

strange, difficult, all those things.

Scary. Very, very scary.

Darrell will be in hospital for several days.

In another part of the building,

pathologists are analysing a sample of his tumour.

They're doing preliminary checks

to see if the grade or the malignancy has increased.

The vessels are suspicious, and I think the cellularity

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

It probably is more likely to be a four.

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

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

After this operation, it will come back even earlier.

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

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

It's going to be devastating news for him

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

We can only do what we can to help people

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

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

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

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

I'm sure, a very aggressive chemotherapy,

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

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

and eventually, unfortunately, they succumb to their tumours.

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

AMBULANCE SIREN

Have you taken any tablets tonight?

No. No...

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

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

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

I have my own little tuck box.

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

the patient who swallowed her false teeth.

Hiya. Chris Abell speaking.

Oh, hiya.

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

OK. OK.

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

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

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

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

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

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

That's a bit better.

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

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

Something happens to them

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

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

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

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

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

you've done a wonderful thing.

Supper.

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

..fear death.

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

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

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