0:00:04 > 0:00:09This programme contains scenes which some viewers may find upsetting.
0:00:12 > 0:00:1518th of October, 2012.
0:00:16 > 0:00:21Across Britain, 100 cameras are filming the NHS on a single day.
0:00:21 > 0:00:25This change will be a disaster. CHEERING
0:00:25 > 0:00:30On this day, more than 1.5 million of us will be treated.
0:00:31 > 0:00:34Three days ago, you had a stroke.
0:00:34 > 0:00:371,500 of us will die.
0:00:37 > 0:00:402,000 will be born.
0:00:43 > 0:00:47The NHS is the largest public healthcare system in the world.
0:00:49 > 0:00:52We want that to be in your voice all the time.
0:00:52 > 0:00:55- We're going to help you. - We rely on it,
0:00:55 > 0:00:59- complain about it. - In the bin. That's because of you.
0:00:59 > 0:01:02Often we take it for granted.
0:01:02 > 0:01:07- Lucas!- What we expect from the NHS is ever-increasing.
0:01:07 > 0:01:10The money to pay for it isn't.
0:01:12 > 0:01:17If we could see what this institution does in a single day,
0:01:17 > 0:01:20what would it make us think?
0:01:21 > 0:01:25This entire series tells the story of one day.
0:01:25 > 0:01:29- So why isn't she waking up? - 100 cameras
0:01:29 > 0:01:33capturing the NHS as you've never seen it before.
0:01:33 > 0:01:35Baby born at five to three.
0:01:45 > 0:01:48JAMES NAUGHTIE: 'Six o'clock on Thursday, 18th...
0:01:49 > 0:01:52'Plans by the government to...'
0:02:11 > 0:02:15'I have a whole world of possibilities ahead of me.
0:02:19 > 0:02:25'I feel anxious, but happy to be in the hands of such a good surgeon today.
0:02:28 > 0:02:31'It's one enormous step on the way'
0:02:31 > 0:02:37to where I'm going, so...it's going to be... momentous, really!
0:02:37 > 0:02:40I can't wait to see the outcome, actually.
0:02:42 > 0:02:45Um, yeah. It's going to be quite something.
0:02:54 > 0:02:57My age is 62.
0:03:06 > 0:03:08Morning, Boots.
0:03:08 > 0:03:10Hungry, girl? Here you are.
0:03:10 > 0:03:13No? All right. Maybe later.
0:03:13 > 0:03:20My daughter tells me off terribly for doing this. She says, "How can you put purple eyeliner on?!
0:03:20 > 0:03:25"It's atrocious." It's not the done thing at age 14.
0:03:25 > 0:03:29She knows a lot about makeup. I say, "I know nothing about makeup."
0:03:29 > 0:03:35When I first became a consultant, I had a makeover. An image consultant.
0:03:35 > 0:03:40We spent a lot of time doing supervised shopping and learning what to buy
0:03:40 > 0:03:46and how to do one's war paint. And she just taught me ONE method of doing it,
0:03:46 > 0:03:52which is probably completely wrong now because I've done it this way without supervision for too long.
0:03:59 > 0:04:01Tania is a plastic surgeon.
0:04:01 > 0:04:06She splits her time between working for the Army and the NHS.
0:04:08 > 0:04:10So just to remind me...
0:04:10 > 0:04:14My plan for today is to open up your previous scar.
0:04:14 > 0:04:19You've got the two bones inside the leg, the big bone and little bone.
0:04:19 > 0:04:25We're going to shorten back the little bones on both sides. They're causing the trouble.
0:04:25 > 0:04:30But leave the main bone the same length. That needs filing down.
0:04:30 > 0:04:34I can't be any shorter because my daughter's getting too tall!
0:04:34 > 0:04:40I've got this with one of my soldiers who used to be nearly 7 foot and had to lose two inches
0:04:40 > 0:04:46because the prosthetist couldn't make him balance at that height. He had to accept a shortening.
0:04:46 > 0:04:53Tania's first patient of the day is Claire, who lost her legs to bacterial meningitis aged 17.
0:04:53 > 0:04:59The bones in her stumps have continued to grow, making it too painful to walk on false legs.
0:04:59 > 0:05:03Tania will be operating on her so that she can walk again.
0:05:03 > 0:05:08Claire has two below the knee amputations and has to have a different set of legs
0:05:08 > 0:05:13depending on what she's wearing. She has a pair for flat shoes
0:05:13 > 0:05:16and a pair of legs for high heel shoes.
0:05:16 > 0:05:23The ankle position is different. If she wants to wear heels, she has to wear a different set of legs.
0:05:31 > 0:05:36Tell me about your heart. Can you tell me about your heart?
0:05:43 > 0:05:48Katie was involved in a road traffic collision yesterday evening.
0:05:48 > 0:05:52She was a passenger in the front seat, wearing a seatbelt.
0:05:52 > 0:05:55Last night, very shortly after she arrived,
0:05:55 > 0:05:59she went to theatre because she had lost a lot of blood from a ruptured liver and ruptured spleen.
0:05:59 > 0:06:04Our enduring hope is that her spinal cord has not yet been damaged,
0:06:04 > 0:06:07which potentially could result in paralysis.
0:06:07 > 0:06:11Her mum was driving and I'm sure very innocently,
0:06:11 > 0:06:17but her daughter has these distressing and potentially life-changing injuries.
0:06:17 > 0:06:21I've been doing this for donkeys' years and have children her age
0:06:21 > 0:06:25and I still have no idea what she feels like.
0:06:25 > 0:06:31As well as her mum, Katie's twin brother was also in the car when they collided with a van.
0:06:31 > 0:06:35Katie was the only one seriously injured.
0:06:35 > 0:06:40Doctors put her in a medically-induced coma to keep her safe
0:06:40 > 0:06:44while they investigate the damage to her spinal cord.
0:06:46 > 0:06:48You all right?
0:06:48 > 0:06:53'This is the last ward you want to be in. Nobody wants their family in here. Why would they?'
0:06:53 > 0:06:57They only get through the doors if they have a life-threatening problem.
0:06:57 > 0:07:03One thing we tend to say at the very beginning when parents arrive is that we will be brutally honest.
0:07:04 > 0:07:10We will also, quite shamelessly, worry people needlessly
0:07:10 > 0:07:15because things can change suddenly, but if you expect something is going to get bad,
0:07:15 > 0:07:20you're not doing anybody any favours by not telling them.
0:07:21 > 0:07:25Right, we're scanning her head, aren't we?
0:07:25 > 0:07:28Including neck. The whole spine.
0:07:29 > 0:07:36If the MRI scan reveals that Katie's spinal cord is damaged, she might never walk again.
0:07:36 > 0:07:40Is everyone ready? On roll. Ready, steady...roll.
0:07:40 > 0:07:42Ready, steady, roll.
0:07:43 > 0:07:49We're going to go on slide. Is everyone ready? Ready, steady, slide.
0:07:49 > 0:07:50Stop.
0:07:53 > 0:07:55- Can we tape her eyes?- Yeah.
0:07:55 > 0:07:57OK. zero. >
0:08:30 > 0:08:34- Just try the temperature of this on your head.- OK, that's good.
0:08:34 > 0:08:36- Is that all right?- Yeah.
0:08:38 > 0:08:43- Is that a nice feeling, Steven? - Having my hair washed? Oh, yeah.
0:08:43 > 0:08:49It's lovely. That's two advantages of being a tetraplegic.
0:08:49 > 0:08:53I never have to wash my hair again and I'll never have to shave again.
0:08:55 > 0:08:58Scratch the top of my head as well, please.
0:08:58 > 0:09:01Yeah, there. Oh, yeah.
0:09:01 > 0:09:06That must be the worst thing, having an itch and not being able to do anything about it.
0:09:06 > 0:09:149 months ago, Steven fell down the stairs and damaged his spinal cord. He's been in hospital ever since.
0:09:14 > 0:09:19He's paralysed from the neck down and fed through a tube in his stomach.
0:09:19 > 0:09:22I can swallow,
0:09:22 > 0:09:27but there's something deflecting what I swallow into my lungs.
0:09:27 > 0:09:32- Have you given up eating olives, then?- I've given up olives, yeah.
0:09:32 > 0:09:35We call it Olivegate.
0:09:35 > 0:09:41My mother was eating olives with garlic in them and I begged her for an olive.
0:09:41 > 0:09:45So she reluctantly gave me one and I ate it.
0:09:45 > 0:09:51It came up one day when they were doing some physio. He coughed it up and they kept it in a little tube.
0:09:51 > 0:09:56The smell just comes wafting over you and you're not in a good space.
0:09:56 > 0:10:02You think if you eat an olive it will change the way you feel for a couple of seconds.
0:10:02 > 0:10:04It's just that.
0:10:04 > 0:10:07Take a deep breath. One, two, three.
0:10:14 > 0:10:16OK, ready?
0:10:18 > 0:10:22- Time for a fag soon! - I'll pretend I didn't hear that!
0:10:25 > 0:10:27Ready? One, two, three.
0:10:27 > 0:10:32In a month, Steven will leave the spinal injuries unit and move to a new home
0:10:32 > 0:10:37with the 24-hour care he'll need for the rest of his life.
0:10:37 > 0:10:40- Now go to Skype.- Yeah, yeah.
0:10:40 > 0:10:44- OK.- OK.- Got it?- Yeah. - Double click that.
0:10:44 > 0:10:46Hello, baby! How are you?
0:10:46 > 0:10:51- I can't see you. Can you see me? - Yeah, I can see you.
0:10:51 > 0:10:56How's Johnny been? Johnny's the rabbit.
0:10:56 > 0:11:00- He's been good?- Yeah.- We're going out of the hospital today.
0:11:00 > 0:11:07Caroline's going to pick you up, and we'll do a bit of shopping. I'll see you about 11.30, 12 o'clock.
0:11:07 > 0:11:10OK? Is that a little heart you put for me, was it?
0:11:10 > 0:11:13- Yeah.- It's beating as well.
0:11:13 > 0:11:17Is it beating? I love you to pieces, baby.
0:11:17 > 0:11:20- Bye-bye, darling.- Close it?- Yeah.
0:11:39 > 0:11:41WHISTLES CALMLY
0:11:44 > 0:11:52Sally is one of more than 3,000 people in Britain who are in the process of changing their gender.
0:11:52 > 0:11:58The NHS spends around £2 million a year on gender reassignment surgery,
0:11:58 > 0:12:04but before an operation, patients must live as their preferred sex for two years, undergo assessment
0:12:04 > 0:12:09- and have hormone treatment. - I'm Iffy. Pleased to meet you. - I've heard all about you.
0:12:09 > 0:12:11Have you? It's all lies.
0:12:14 > 0:12:19- What are you currently taking? - Oestradiol valerate, Progynova.
0:12:19 > 0:12:24- Yeah.- And Decapeptyl.- OK. - Once every three months.- OK.
0:12:24 > 0:12:29And I don't take medicines. I'm from the pharmaceutical industry!
0:12:29 > 0:12:33- OK.- I avoid them if I can possibly...!
0:12:33 > 0:12:35OK, on a scale of 1-10,
0:12:35 > 0:12:401 being terrible, 10 fantastic, where are your energy levels at the moment?
0:12:40 > 0:12:44- I would say probably 3-4.- OK.
0:12:44 > 0:12:49And your sex drive, what's that like on a good day and a bad day?
0:12:49 > 0:12:54- I was going to say zero! - You can say zero if you like.
0:12:54 > 0:12:57- Between zero and 2.- OK.
0:12:59 > 0:13:03- Horrible question, but do you see any erections any more?- No.- OK.
0:13:03 > 0:13:08Now, from a surgical point of view, referral through, hopefully,
0:13:08 > 0:13:15- for the labiaplasty. Is that correct? For the cosmetic... - That's right.- Lovely.
0:13:15 > 0:13:21- So the next thing I'm going to do is put you on the weigh-in scales. OK?- Yes.
0:13:23 > 0:13:27- OK.- My blood pressure's fine. - I will be doing that as well.- Good.
0:13:27 > 0:13:29Yes, I will.
0:13:32 > 0:13:33Hello.
0:13:33 > 0:13:36I'm all right. How are you?
0:13:36 > 0:13:39I'm going to start at the beginning.
0:13:39 > 0:13:41Current medicines?
0:13:41 > 0:13:45'On my very first appointment here, something very funny happened.'
0:13:45 > 0:13:50There were a couple of trans women and a lady said, "Is this your first time here?"
0:13:50 > 0:13:54I was like, "Yes." I thought maybe I seem really nervous.
0:13:54 > 0:14:00She said, "I feel you could have made a bit more effort with your appearance."
0:14:00 > 0:14:04Was I dressed too casually or something like that?
0:14:04 > 0:14:11But then she added, "It's good to start looking more feminine at some point when you go outside."
0:14:11 > 0:14:18I realised that she thought I was born male and was trying to transition to be female.
0:14:18 > 0:14:23I politely pointed out that actually I was female transitioning to be male!
0:14:23 > 0:14:27I think I hide it well, but I have double D breasts.
0:14:27 > 0:14:32- How's your general health?- I'm just getting used to my face changing.
0:14:32 > 0:14:36I saw some photographs of myself a year ago, before the testosterone.
0:14:36 > 0:14:41I suddenly looked at a picture now and I was like, "Wow!"
0:14:41 > 0:14:48And now I'm getting body hair everywhere. I'm getting it on the face, my belly at the bottom.
0:14:48 > 0:14:52That's good news that you're getting it where you should be getting it.
0:14:52 > 0:14:58- It's nice to see it here, isn't it? - I like my little wolf patch that I sort of get here.
0:15:01 > 0:15:05Good morning, Sally. My name is Helena. Nice to meet you.
0:15:05 > 0:15:08I'll be helping your anaesthetist.
0:15:08 > 0:15:12- Can you just confirm your name and date of birth?- Sally Rivers.
0:15:12 > 0:15:14BIRTH DATE BLEEPED OUT
0:15:21 > 0:15:27And you are coming for cricothyroid approximation and thyroid chondroplasty?
0:15:27 > 0:15:31- You understand the operation? - I do.- Have you signed the consent?
0:15:31 > 0:15:35Today Sally is having an operation to change the pitch of her voice
0:15:35 > 0:15:39and reduce the size of her Adam's apple.
0:15:41 > 0:15:45Hello. Good morning. Can I come in?
0:15:45 > 0:15:49If I could just have a little peep at your neck.
0:15:49 > 0:15:53- There's a nice skin crease there so we'll use that.- OK.
0:15:53 > 0:15:57Afterwards, you're going to rest your voice completely.
0:15:57 > 0:16:01The odd word's not the end of the world, but rest your voice.
0:16:01 > 0:16:05- In two or three weeks, you'll meet with Speech Therapy?- Yes.- OK.
0:16:05 > 0:16:12'I was, in many respects, a normal child, but something started to happen.
0:16:12 > 0:16:18'I just began to relate more to what girls were doing than what boys were doing.
0:16:18 > 0:16:21'And it utterly horrified me.
0:16:21 > 0:16:24'You are a prisoner in your own body.
0:16:24 > 0:16:30'There are plenty of other people who have illnesses where they're trapped in their own body,
0:16:30 > 0:16:36'but it's almost like I'm giving myself permission now to lead a full and proper life as other women do
0:16:36 > 0:16:41'and rather than it being a dream, it's now becoming a reality.'
0:16:46 > 0:16:48All the way.
0:16:48 > 0:16:51I want big, slow breaths.
0:17:40 > 0:17:44We're just reducing the laryngeal prominence, the Adam's apple.
0:17:49 > 0:17:55We've exposed the larynx completely at the front and I'm going to do a little bit of a trim here.
0:17:55 > 0:17:5715 blade, thank you.
0:17:58 > 0:18:03Sally's vocal cord surgery costs around £2,000.
0:18:08 > 0:18:15I'm probably the third generation of surgeon doing this procedure. The pioneers were in the early '70s.
0:18:15 > 0:18:19We've been doing between 50 and 70 cases a year.
0:18:19 > 0:18:23It's probably the largest number I know of any unit in the world.
0:18:23 > 0:18:27But we're getting less referrals for this surgery through the NHS
0:18:27 > 0:18:32and that relates to the current economic environment we live in,
0:18:32 > 0:18:37but times change and I'm sure they'll rediscover its value.
0:18:41 > 0:18:45In a moment, we'll tighten the sutures
0:18:45 > 0:18:47and they should tension the cords.
0:18:47 > 0:18:53- The analogy of a guitar string. - My colleague's just said the analogy is a guitar string.
0:18:53 > 0:18:57If you tension a string, the pitch gets higher.
0:18:57 > 0:19:03This is probably the most crucial part of the whole operation. Get the mosquito.
0:19:03 > 0:19:07- Have we not got a mosquito rather than...?- No.
0:19:07 > 0:19:09OK, go ahead.
0:19:09 > 0:19:11- Got it?- Mm-hm.
0:19:11 > 0:19:13- OK?- Yeah.
0:19:16 > 0:19:21So basically the gap here was much, much larger a few minutes ago.
0:19:21 > 0:19:27What the effect of this is is that inside the larynx, it's tensioning the cords.
0:19:27 > 0:19:29I've got scissors here.
0:19:40 > 0:19:44Most of the patients with gender dysphoria are of a working age.
0:19:44 > 0:19:48Now if you are born the wrong sex,
0:19:49 > 0:19:55you're uncomfortable going out, you're uncomfortable socialising, being involved.
0:19:55 > 0:19:58'And some of these patients do not work.
0:19:58 > 0:20:05'The simple fact is that if you're not working and paying your taxes, that is money lost to everyone.'
0:20:05 > 0:20:11There are other ill health issues. Going to the doctor's with depression or they attempt suicide
0:20:11 > 0:20:14and end up being treated on the Intensive Care Unit.
0:20:14 > 0:20:18One day in there will cost far more than this whole procedure,
0:20:18 > 0:20:23so if you think about it like that, it does pay for itself.
0:20:28 > 0:20:32Let's get this. Follow that car, catch up with him.
0:20:32 > 0:20:37Foetus inside, so the students can get a feel for where the baby is.
0:20:56 > 0:21:00I'm not sure. I think it's here that's fractured.
0:21:00 > 0:21:06- On both sides. Is that right? - There is spinal trauma. The rest is C2, isn't it?- Yeah.
0:21:10 > 0:21:13- The cord looks fine.- That's good.
0:21:19 > 0:21:25Greatly relieved. The spinal cord isn't damaged and she's not paralysed.
0:21:25 > 0:21:31If you're going to break your neck, that's the way to do it - in a way that can be fixed in a safe manner
0:21:31 > 0:21:37and also is not going to impact too much on the way we look after the rest of her injuries.
0:21:46 > 0:21:50- I'll go and get Mum and Dad. - OK. Thanks.
0:21:50 > 0:21:56No, I'll get the nurse to go and get them or they'll think something terrible.
0:21:56 > 0:22:01Do you mind getting Mum and Dad round so the guys...?
0:22:01 > 0:22:05- I can come round as well. - Or we talk to them there.
0:22:16 > 0:22:21We had a discussion with the neurosurgeons.
0:22:21 > 0:22:27She's got a fracture which is colloquially called a hangman's fracture, which isn't very nice,
0:22:27 > 0:22:31but it's the one you get when basically her neck's done that.
0:22:31 > 0:22:35What is good is that the spinal cord has plenty of room, nice and free.
0:22:35 > 0:22:36So...
0:22:37 > 0:22:41she's unlikely to have any kind of neurological injury.
0:22:41 > 0:22:47We'd quite like to keep her asleep. It gives a little bit of time for the other injuries to settle down.
0:22:47 > 0:22:51At the moment, we're looking at about Monday to wake her up.
0:22:51 > 0:22:55I know you have a 16-year-old daughter with a broken neck,
0:22:55 > 0:22:59- but it's a bit better this afternoon than it was this morning.- OK.
0:22:59 > 0:23:01Thank you.
0:23:37 > 0:23:39Look...
0:23:39 > 0:23:42You might be having a heart attack.
0:23:45 > 0:23:49Before I had my surgery, I weighed 25 stone.
0:23:49 > 0:23:51I'm half the person I used to be!
0:23:59 > 0:24:04For three months, Steven's been having daily therapy to help him cope.
0:24:04 > 0:24:08This intensive therapy will end when he leaves the unit,
0:24:08 > 0:24:12but his care will still cost the NHS £80,000 a year.
0:24:15 > 0:24:17That sort it?
0:24:17 > 0:24:22That feels good. As it runs past wherever it does,
0:24:22 > 0:24:29- I'm more aware of... - Absolutely. It's about waking up all those senses, really.
0:24:29 > 0:24:35- Is it nice to taste something? - Lovely. This is the highlight of my day. Definitely the highlight.
0:24:35 > 0:24:39- Having a glass of orange. - Who'd have thought?- I know.
0:24:42 > 0:24:47- I've actually brought some yoghurt. - OK.- Which will come in handy.
0:24:47 > 0:24:52- Wow.- This is the big treat. - A big day today, eh?
0:24:52 > 0:24:54- Ready?- OK.
0:25:10 > 0:25:16- OK?- I felt good. - But that swallow is tiring. It's taking more effort to trigger.
0:25:16 > 0:25:20I think I'm going to stop, actually. Everything's getting really tired.
0:25:20 > 0:25:25- I'll just get you into trouble.- OK. - You won't thank me for that.- OK.
0:25:30 > 0:25:32Do you want some suction?
0:25:34 > 0:25:38- No, it's OK.- See? That's what I suspect is the yoghurt sliding down.
0:25:40 > 0:25:42No, it's all right. No.
0:25:42 > 0:25:45We'll get a SATs monitor on.
0:25:45 > 0:25:50I think it's fair to say he'll probably never eat a full meal again.
0:25:50 > 0:25:57For pleasure purposes, it would be really valuable to take a small amount so on any social occasion
0:25:57 > 0:26:01he may be able to sit down and have a drink with some friends or coffee.
0:26:01 > 0:26:05Eating, drinking is the glue of life, quite often.
0:26:05 > 0:26:10If he can have something, he can be a part of the party.
0:26:32 > 0:26:36- Hello. - Hello, Karma! Hello, baby.
0:26:37 > 0:26:42Am I going to have a kiss? Am I going to get a kiss?
0:26:42 > 0:26:46- Oh, I can't reach you.- Can't reach. - Come round here and see if you can.
0:26:49 > 0:26:53You must be able to. Stand on the bed, then.
0:26:54 > 0:26:57Oh...so close!
0:26:57 > 0:26:59Ah, thank you, darling.
0:26:59 > 0:27:03- Oh...- All right?- A bit chilly. - Do you want...?- No, it's OK.
0:27:03 > 0:27:06- Do you want a rug or something? - No, no, no.
0:27:06 > 0:27:11Looks uncool in a rug. It's bad enough being in a wheelchair.
0:27:12 > 0:27:18As part of his rehab, Steven is taken out to help him get used to life in a wheelchair.
0:27:20 > 0:27:24Steven's separated from his partner and sees his daughter once a week.
0:27:24 > 0:27:30Today's the first time he's left the hospital with her since the accident.
0:27:30 > 0:27:33I miss you.
0:27:34 > 0:27:38- I miss you, too. - I miss you very much, Karma.
0:27:38 > 0:27:40I miss you very much, too.
0:27:41 > 0:27:45I miss... going swimming with you.
0:27:45 > 0:27:52Do you know that? Probably that's the most... the most...the most missed anything.
0:27:52 > 0:27:54Going swimming.
0:27:54 > 0:27:57- Yeah?- Yeah.
0:27:57 > 0:27:59Yeah, me, too.
0:28:31 > 0:28:35What we see here, this is the right leg
0:28:35 > 0:28:39and you can see that the fibula and tibia are fairly similar in length.
0:28:39 > 0:28:45I would like to achieve 2cm difference between the fibula and the tibia.
0:28:48 > 0:28:54I think the NHS's role is about making you function.
0:28:54 > 0:28:59With the improvement in prostheses that we've seen over the last few decades, there are very few things
0:28:59 > 0:29:03that an amputee can't actually do.
0:29:03 > 0:29:08The only real thing you can't do is easily leap out of bed in the night to go to the loo
0:29:08 > 0:29:14because you've got to put your leg on, but other than that, with a well-fitted below-knee prosthesis,
0:29:14 > 0:29:20you can do an awful lot of the things that used to be considered to be impossible for amputees.
0:29:21 > 0:29:23She's twitching.
0:29:25 > 0:29:29It's not causing me concern. It was interesting that she was doing it.
0:29:29 > 0:29:32I wasn't sure it was significant or anything.
0:29:54 > 0:29:57Oh, that's why I wear a visor!
0:30:02 > 0:30:05- Shall I take it off? - If you like. I don't mind.
0:30:05 > 0:30:08- Will it be easier to clean that way? - Hmm.
0:30:08 > 0:30:10I'm just having a quick clean.
0:30:17 > 0:30:21And then we're going to need the saw in a minute.
0:30:26 > 0:30:29LOUD DRILLING
0:30:34 > 0:30:36OK, and the nail file.
0:30:36 > 0:30:38SCRAPING SOUND
0:30:42 > 0:30:46OK. The nice thing about having new instruments is they're all sharp.
0:30:46 > 0:30:51So that's now quite a lot shorter than the main bone here.
0:31:08 > 0:31:12We're just going to take a quick short cut.
0:31:17 > 0:31:23I think a lot of what we do is about the whole patient, rather than just this operation.
0:31:23 > 0:31:29I expect that I will need to do modifications to Claire for many, many years to come
0:31:29 > 0:31:33and there may be other treatments that are more cosmetic,
0:31:33 > 0:31:37but that's not cosmetic, i.e, making you look more like a film star.
0:31:37 > 0:31:42That's bringing you in line with what is normal for the population as a whole.
0:31:42 > 0:31:48My feeling is that what the NHS should be allowed to do is normalise people.
0:32:16 > 0:32:19- Aaagh!- Just there. Sorry. - It's all right.
0:32:20 > 0:32:24- How's that?- No, that's numb. That feels quite numb.
0:32:24 > 0:32:27You've just had a special birthday.
0:32:27 > 0:32:3040, plus VAT. That's what I was.
0:32:30 > 0:32:35- Where did you go?- Marbella. Me and the girls and it was absolutely fabulous.
0:32:35 > 0:32:39- God, you see the sights there! - Oh, yeah.
0:32:39 > 0:32:46- We've done the lap-dancing clubs and the poles.- What? Did you?- I struggled with that pole though, Ann.
0:32:46 > 0:32:49- You didn't, really? - I did, yeah, Puerto Banus.
0:32:49 > 0:32:53You've got to go to Puerto Banus when you're in Marbella.
0:32:53 > 0:32:55Oh, yeah, it's fabulous.
0:33:00 > 0:33:05For the past ten years, the NHS has been offering nipple tattoos
0:33:05 > 0:33:10to patients who have had breast reconstruction as a result of cancer.
0:33:10 > 0:33:16Today, over 300 hospitals across the country offer the service.
0:33:17 > 0:33:21Back in 1999, a long time ago now,
0:33:21 > 0:33:25I didn't have a lump or anything like that, just a bit of a hard boob.
0:33:25 > 0:33:28How old were you then and how old were you?
0:33:28 > 0:33:30Well, that was... I was 35.
0:33:30 > 0:33:33- I was 11. - That must have been hard.
0:33:33 > 0:33:40And just being on our own, a single parent, just me and Em, it was a bit...harrowing.
0:33:42 > 0:33:46So, anyway, I went to see my GP, he sat me down,
0:33:46 > 0:33:50stuck these X-rays, blah-blah-blah,
0:33:50 > 0:33:55on this machine and said, "Yes, well, you've got ductal carcinoma in situ."
0:33:56 > 0:33:59And I'm going, "Oh, that's good...
0:34:00 > 0:34:02"That's great news."
0:34:02 > 0:34:06"And you're going to have to have a mastectomy."
0:34:06 > 0:34:12And I can remember just breaking down, crying, and saying, "Am I going to die?"
0:34:12 > 0:34:15"Well," he said, "not if I can help it."
0:34:16 > 0:34:20I wasn't really worried about waking up with a boob gone because...
0:34:24 > 0:34:28..you don't worry about what you're going to look like.
0:34:29 > 0:34:34I can remember then waking up, being very sick,
0:34:34 > 0:34:39and, being the very vain person I am, looking for a mirror,
0:34:39 > 0:34:45because I said, "I've got to put my lippy on. I may not have a boob, but I'm going to put my lippy on."
0:34:45 > 0:34:49And looking in the mirror, I looked like I'd been knocked out.
0:34:49 > 0:34:55I was violently, violently sick and I remember thinking, "No, I do want to die."
0:34:55 > 0:34:59And I put that foam prosthesis in my bra, put my bra on,
0:34:59 > 0:35:04put on the same black shirt that I'd come into hospital in
0:35:04 > 0:35:08and I looked in that mirror and it was me.
0:35:08 > 0:35:12- It's true.- OK?- Can I have a look in the mirror?- Yeah.
0:35:12 > 0:35:16You've got to tread carefully with how much you do in terms of tattooing
0:35:16 > 0:35:19- because you do ooze a little bit. - Yeah.
0:35:19 > 0:35:25- If we get you back again to get the colour that you want to be... - No, that looks really good.
0:35:25 > 0:35:28- Yeah, chuffed. Chuffed. - It looks good.
0:35:28 > 0:35:30Debbie's nips.
0:35:30 > 0:35:32LAUGHTER
0:35:49 > 0:35:55Dr McAllister, there's just another gentleman beside him, Mr Nelson, James Nelson.
0:35:55 > 0:35:59I'll just let you pop your head in when you're here.
0:36:05 > 0:36:09I'm looking at his monitor there. Everything looks normal on that.
0:36:09 > 0:36:13I was tired after the operation, but I'm grand now.
0:36:30 > 0:36:37And you can rotate it round and choose which prostate you would like them to examine.
0:36:46 > 0:36:50So where are we going today... Start again.
0:36:50 > 0:36:52Right, where's Daddy going today?
0:36:52 > 0:36:55- "Hostipal".- "Hostital".- Why?
0:36:55 > 0:36:58- To get a new hand. - To get a new hand.
0:36:58 > 0:37:02- Are you guys excited about that?- Yes.
0:37:02 > 0:37:04How much are you excited? THEY SHOUT
0:37:12 > 0:37:15- If I can take that hand from you... - Mm-hm.
0:37:18 > 0:37:20Thank you.
0:37:22 > 0:37:25He's programming the hand now.
0:37:25 > 0:37:28On the trial hand I had various grip patterns.
0:37:28 > 0:37:32And so Bruce is now taking those patterns and putting them
0:37:32 > 0:37:36on to the new hand via Bluetooth, which is incredible.
0:37:36 > 0:37:38It's all wireless.
0:37:38 > 0:37:43- No beep when it changes, just the vibrate.- Just the vibrate.- They're all in the right order.- Fantastic.
0:37:55 > 0:37:58- This...- I like your knuckles. - A Chinese grip, yeah.
0:37:58 > 0:38:00If you're going to be a robot, you need that.
0:38:10 > 0:38:12- Ready?- I am.
0:38:14 > 0:38:16I think I look chubby.
0:38:17 > 0:38:22I know it's just my anorexia talking. I know that that's not real.
0:38:25 > 0:38:28"Chubby, chubster, whale..."
0:38:31 > 0:38:34- "Big bird?"- Oh, yeah, "big bird".
0:38:45 > 0:38:49- That's not a bad day's shopping, was it, Karma?- No.
0:38:49 > 0:38:51No? "Thanks, Dad."
0:38:52 > 0:38:56Did you say, "Thanks..."? Did you say, "Thanks, Dad"?
0:38:56 > 0:38:58Thanks, Dad.
0:38:58 > 0:39:01You're welcome, baby.
0:39:01 > 0:39:04You want a children's meal - chicken nuggets,
0:39:04 > 0:39:07- a double burger...- Yeah.
0:39:07 > 0:39:11- A wrap?- Yeah. - And a hot and cold chocolate?
0:39:11 > 0:39:13- Yeah, and chips.- And chips.
0:39:23 > 0:39:26You're not talking now.
0:39:27 > 0:39:30- Are you really hungry?- Yeah.
0:39:30 > 0:39:36- All right...- You're two minutes away now.- Let's get some food then.
0:39:37 > 0:39:39OK? Have we got everything?
0:39:39 > 0:39:42All right, don't drop those, Karma.
0:39:44 > 0:39:46I don't think she will.
0:39:46 > 0:39:48It smells delicious.
0:39:49 > 0:39:51OK, right, OK...
0:39:51 > 0:39:56- OK...- Can I take them out of your pocket now? - No, you can leave them in there.
0:39:58 > 0:40:01- Right, see you later, baby.- Bye!
0:40:01 > 0:40:03Take care.
0:40:03 > 0:40:05- Bye.- Bye-bye, darling.- Bye.
0:40:05 > 0:40:07Bye. I love you.
0:40:07 > 0:40:12- Karma...- Yeah?- Don't forget to Skype me. All right?
0:40:12 > 0:40:14Skype me tomorrow.
0:40:15 > 0:40:17See you later, darling.
0:40:17 > 0:40:20- Bye.- Bye.
0:40:20 > 0:40:23Karma was a bit distant from me today.
0:40:23 > 0:40:27Normally, she's all over me like a rash.
0:40:27 > 0:40:32We were really close. I mean, you can see it in that photograph there.
0:40:32 > 0:40:39She had a big grin on her face like that most of the day because we were doing such fun things.
0:40:40 > 0:40:42I'm not the dad I was.
0:40:42 > 0:40:45You know, I'm not the fun dad I was.
0:40:46 > 0:40:50You feel yourself isolated, stuck in a wheelchair now.
0:40:52 > 0:40:55And not even being able to put my arm around her,
0:40:55 > 0:40:58I find it quite upsetting, really.
0:40:59 > 0:41:04- What can I do with her? - You can help her do her homework.
0:41:04 > 0:41:09- There's loads of things you can do with her.- Yeah, I know. - Just not active things.- No.
0:41:27 > 0:41:32This is Roger's aeroplane that he had the accident in,
0:41:32 > 0:41:34obviously, before.
0:41:34 > 0:41:36It's not my favourite.
0:41:40 > 0:41:42And that was how it was.
0:41:42 > 0:41:48The front of the aeroplane is completely devastated by fire. Roger would have been sitting about here.
0:41:48 > 0:41:52Had I been a passenger, I would have been sitting there,
0:41:52 > 0:41:55so I may possibly have come off worse than Roger.
0:41:55 > 0:42:00Anybody in that front seat would have died. There's no question about that at all.
0:42:00 > 0:42:05- Do you remember anything about the crash?- Nothing. Nothing, I'm pleased to say.
0:42:05 > 0:42:10The last recollection I have is saying "cheerio" to Kim on Thursday
0:42:10 > 0:42:15and the next clear recollection I have of my own, other than from what people have told me,
0:42:15 > 0:42:21is about seven weeks afterwards when I woke up from an induced coma in the Burns Unit at Chelmsford.
0:42:25 > 0:42:28I see Roger as that man.
0:42:28 > 0:42:31He's my first love and he always will be.
0:42:31 > 0:42:35This is him at the nose wheel of an A300.
0:42:36 > 0:42:39Roger's plane crash was four years ago.
0:42:39 > 0:42:42He was trapped in the fire for half an hour.
0:42:42 > 0:42:48Since then, he has been going to hospital every two months for reconstructive surgery.
0:42:50 > 0:42:54This part of my arm here, as you can see, doesn't straighten.
0:42:54 > 0:42:58I've had three operations on it already, so hopefully, with luck,
0:42:58 > 0:43:04provided the tendons and muscles themselves haven't shortened, I should be able to straighten my arm.
0:43:04 > 0:43:07Do you get excited about operations?
0:43:07 > 0:43:09HE LAUGHS
0:43:09 > 0:43:12- I'm sorry. - Do you look forward to them?
0:43:12 > 0:43:14- No.- Not at all.
0:43:14 > 0:43:20Honestly, I've had so many of the bloody things and I just want to move forward.
0:43:26 > 0:43:30I'd very much sooner not look like an extra off a Hammer film,
0:43:30 > 0:43:33which I do at the moment, but it's not a big priority.
0:43:34 > 0:43:40The big goal is to fly again. I don't mean to fly as a passenger again, but as a pilot.
0:43:45 > 0:43:48I was never, ever concerned about how he'd look.
0:43:48 > 0:43:51That's never concerned me.
0:43:51 > 0:43:55It was...whether or not Roger would be the same person
0:43:55 > 0:43:58as he was before the accident.
0:43:58 > 0:44:03If...Roger had had any brain damage,
0:44:03 > 0:44:07I...I don't know how or what we'd have done.
0:44:07 > 0:44:11And I can honestly say that I have absolutely no idea.
0:44:11 > 0:44:17I think I'd be lying to say that there haven't been times that I wish I hadn't survived.
0:44:17 > 0:44:21I suppose one of the most difficult things to bear
0:44:21 > 0:44:26is losing, other than Kim, more or less everything that I enjoy doing,
0:44:26 > 0:44:30losing my profession and hobbies...
0:44:31 > 0:44:33..all of the things that are lost.
0:44:33 > 0:44:37A lot of them are functions and bits of my body that are no longer there.
0:44:42 > 0:44:48- How are you?- Pretty good, thanks. How are you?- Hi, Kim. How are things? - Not bad.- Had a busy morning?
0:44:48 > 0:44:54It was slightly more interesting than it might have been. I've changed my suit. I'm clean.
0:44:54 > 0:44:59The plan for today then... I'm going to do some releases on that elbow.
0:44:59 > 0:45:02So how is it looking after last time?
0:45:02 > 0:45:06So we've still got quite a lot of that. If we draw around that...
0:45:06 > 0:45:08- That part has survived.- Yeah.
0:45:08 > 0:45:10That part is good.
0:45:10 > 0:45:15- But we've lost a bit in the middle and that's contracted down a bit. - Yeah.
0:45:15 > 0:45:19We are optimistic that we'll be able to get that arm out a bit straighter.
0:45:19 > 0:45:25- I don't want to cut that biceps muscle because, obviously, you need that for power to flex.- OK.
0:45:25 > 0:45:31But if we can encourage it to release some of its strands, that'll give you more movement.
0:45:31 > 0:45:35- Good. You need to sign a consent form still, don't you?- I do. - Yeah. I shall get one.
0:45:35 > 0:45:37Here.
0:45:38 > 0:45:40- Oh, just there.- There somewhere.
0:45:41 > 0:45:45Roger has had 36 operations since his crash,
0:45:45 > 0:45:48around half of them carried out by Tania.
0:45:48 > 0:45:52I must go back and tell the boys and girls we're ready to go.
0:45:52 > 0:45:56- I'll get you down and I'll see you very soon.- Super.- All right?- Thanks.
0:45:56 > 0:46:02Currently, we're very lucky in Burn Care. There are no specific restrictions,
0:46:02 > 0:46:07so if I physically can provide an operation to improve the function,
0:46:07 > 0:46:13sometimes the appearance of a burns victim, we would be allowed to do that on the NHS
0:46:13 > 0:46:16and do so on a very regular basis.
0:46:17 > 0:46:19OK.
0:46:19 > 0:46:23Right, Roger. We're just going to give you a little bit of oxygen,
0:46:23 > 0:46:27so we make sure your lungs are full of oxygen before we begin.
0:46:27 > 0:46:29Can I just squeeze... Sorry.
0:46:29 > 0:46:33You need a kiss first? That's fine. We're allowing that today!
0:46:33 > 0:46:35See you later.
0:46:36 > 0:46:40- Stay there. You might get another one.- Oh, mightn't I?- If you're lucky.
0:46:40 > 0:46:42I'll definitely stay here then.
0:46:42 > 0:46:48It's not the full anaesthetic. It's just going to make you feel nice, relaxed, chilled, drunk, happy, high.
0:46:48 > 0:46:51Something like that. Most people quite like it.
0:46:51 > 0:46:57We want you just to concentrate on taking some nice, long, slow, deep breaths.
0:46:57 > 0:47:01The other thing is to think about something really nice to dream about.
0:47:01 > 0:47:05Some people have some cracking dreams on this stuff.
0:47:06 > 0:47:08Keep taking those nice, deep breaths.
0:47:08 > 0:47:12There's probably time for one more kiss. One more kiss.
0:47:12 > 0:47:16Before it starts going in, it can just be a little bit achy.
0:47:16 > 0:47:20- All right...- See you later. - A little bit more of that oxygen.
0:47:50 > 0:47:52So, all the time,
0:47:52 > 0:47:58- if you can start really pushing on that as hard as you can...- OK. Yeah.
0:47:58 > 0:48:04And sort of rocking backwards and forwards a little bit, so it's starting to release...
0:48:04 > 0:48:09I'm just stretching him out to see how much more extension we can get.
0:48:23 > 0:48:26The idea is clearly not to break Roger's arm.
0:48:28 > 0:48:31OK, your turn. Lean on there for a bit.
0:48:31 > 0:48:33Another knife, please.
0:48:35 > 0:48:38To ensure that Roger's arm heals properly,
0:48:38 > 0:48:41Tania uses a hi-tech, artificial skin.
0:48:42 > 0:48:46It's made from bovine beef collagen
0:48:46 > 0:48:48and shark glycosaminoglycans
0:48:48 > 0:48:51which gives it something
0:48:51 > 0:48:57that is rather like the human structure.
0:48:57 > 0:49:02Apparently, it needs shark in it to really become completely like the human structure.
0:49:02 > 0:49:05And the idea is that it produces a scaffolding
0:49:05 > 0:49:09that the blood vessels then grow into.
0:49:34 > 0:49:36Right, wash hands.
0:49:38 > 0:49:42All right, I'll be back fairly... Well, fairly soon. Soon-ish.
0:49:43 > 0:49:47She's still on the answerphone, so we'll go this way.
0:49:50 > 0:49:56- Can I ask you a few questions? - Yeah, if we walk and talk at the same time because I'm on a mission.
0:49:59 > 0:50:01Hello.
0:50:01 > 0:50:04Let's go through. OK...
0:50:18 > 0:50:21Yes, so it is becoming sort of second nature, so...
0:50:24 > 0:50:26- Here we go.- Perfect.
0:50:26 > 0:50:31- If you just make a big leap on to the scales... - Yeah, why not? Let's do it.
0:50:46 > 0:50:48INAUDIBLE
0:50:49 > 0:50:53Sally has been advised not to speak while her vocal cords recover.
0:50:53 > 0:50:57Once they do, she'll join a speech therapy group at the clinic
0:50:57 > 0:51:00to refine the sound of her voice.
0:51:07 > 0:51:11We hear the smile in someone's voice, don't we?
0:51:11 > 0:51:16We want that to be in your voice all the time, to have that smile in your voice,
0:51:16 > 0:51:18not kind of that..."euh",
0:51:18 > 0:51:21but that bright... "Morning!"
0:51:21 > 0:51:26"On either side of the river lie long fields of barley and of rye...
0:51:26 > 0:51:31"Willows whiten, aspens quiver, little breezes dusk and shiver.
0:51:31 > 0:51:37"And moving through a mirror clear that hangs before her all the year...
0:51:37 > 0:51:42"Sometimes a troop of damsels glad, an abbot on an ambling pad...
0:51:42 > 0:51:46"She knows not what the curse may be,
0:51:46 > 0:51:51"and so she weaveth steadily,
0:51:51 > 0:51:55"and little other care hath she,
0:51:55 > 0:51:57"the Lady of Shalott."
0:52:02 > 0:52:0461.
0:52:04 > 0:52:07And 113.
0:52:07 > 0:52:09Which is very good.
0:52:09 > 0:52:12You've got a small waist now.
0:52:17 > 0:52:21And that says... What have we there? 37.
0:52:37 > 0:52:42- Very good. Oh, look, she's well organised.- Well, I was.
0:52:48 > 0:52:50Hello!
0:52:58 > 0:53:01It's just nice to sit here
0:53:01 > 0:53:03and look at the fire.
0:53:06 > 0:53:09Home at last.
0:53:10 > 0:53:14What would you do if you could run the NHS?
0:53:14 > 0:53:16SHE LAUGHS LOUDLY
0:53:16 > 0:53:19If I could run the NHS?
0:53:21 > 0:53:23Hmm...
0:53:25 > 0:53:30I don't fancy running the NHS. I don't want to fly a desk. I quite like looking after patients.
0:53:30 > 0:53:36One of the nice things about my job is that I do actually still look after patients.
0:53:36 > 0:53:38That's what gives me a buzz.
0:53:38 > 0:53:40MOBILE PHONE JINGLE Oh...
0:53:44 > 0:53:47I wonder what that represents? It could be...
0:53:47 > 0:53:51It's all right. It's my husband. It's not the Burns Unit.
0:53:52 > 0:53:54Hello.
0:53:56 > 0:53:58I'm sitting in front of the log-burner,
0:53:58 > 0:54:03being filmed for the end... the end of the day shots.
0:54:12 > 0:54:16It's like a reflection that I do at the end of every day.
0:54:25 > 0:54:27I fancy a cigarette now.
0:54:27 > 0:54:30- You're not allowed one. - Stop it.- I do.
0:54:30 > 0:54:35- You caused trouble last time you had one.- Who gave it to you? I'll tell them off.- My aunt.
0:54:35 > 0:54:37I managed to blackmail her.
0:54:37 > 0:54:40How did you blackmail her? What did you say?
0:54:40 > 0:54:45I said, "All these people ever say to me is, 'No, you can't do this, you can't do that.'"
0:54:45 > 0:54:48- So I got...- You made her feel bad. - I did, yeah.
0:54:48 > 0:54:50- That's terrible.- I know it is, yeah.
0:54:50 > 0:54:52I know.
0:54:57 > 0:55:00- So did you miss me today?- Loads.
0:55:00 > 0:55:03- It's more like, "Didn't you miss us?"- I was too busy.
0:55:06 > 0:55:08OK, we're in.
0:55:15 > 0:55:20- I'm feeling pretty cold now.- OK. - We'll get you warm in a minute.
0:55:26 > 0:55:29- You're nearly there, darling. - There you go.
0:55:37 > 0:55:41Listen... Listen, did you finish all of that McDonald's that we got you?
0:55:41 > 0:55:44You finished every single bit of it?
0:55:46 > 0:55:48Where did you put it all?
0:55:51 > 0:55:53In your stomach? Right.
0:55:53 > 0:55:55'Have you had a nice day?'
0:55:55 > 0:56:00I have had a nice day, although I am quite tired now.
0:56:02 > 0:56:04All right? OK.
0:56:04 > 0:56:08Yes, I did. I've had a very nice day, especially seeing you.
0:56:08 > 0:56:11All right, are you going to bed soon?
0:56:13 > 0:56:16I'm going... Do you know what? I'm in bed already.
0:56:17 > 0:56:20All right, I miss you madly.
0:56:20 > 0:56:22Take care, darling.
0:56:22 > 0:56:24'I miss you more than you.'
0:56:24 > 0:56:28No, I miss you more than what you miss me.
0:56:28 > 0:56:31OK, take care of yourself, baby.
0:56:31 > 0:56:33And give me a call.
0:56:33 > 0:56:35All right?
0:56:35 > 0:56:37Will you give me a call?
0:56:39 > 0:56:42All right, take care. I love you.
0:56:42 > 0:56:45- Bye-bye, darling.- 'Bye!'- Bye-bye.
0:56:45 > 0:56:47Bye.
0:56:47 > 0:56:51Can you see my phone anywhere? Can you switch my phone off?
0:56:51 > 0:56:53Yeah, thanks.
0:56:55 > 0:56:59Just switch my phone... It's just the bottom...
0:57:23 > 0:57:27Carry on going up here, then we do a right at the next bit.
0:57:52 > 0:57:56To order your free copy of the Open University's booklet,
0:57:56 > 0:58:00Working To Save Lives, which accompanies this series, call:
0:58:03 > 0:58:07Or go to bbc.co.uk/keepingbritainalive
0:58:07 > 0:58:09and follow the links to the OU.
0:58:33 > 0:58:36Subtitles by Red Bee Media Ltd