Episode 4 Keeping Britain Alive: The NHS in a Day


Episode 4

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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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This change will be a disaster. CHEERING

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

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

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-We're going to help you.

-We rely on it,

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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.

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-Lucas!

-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?

-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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JAMES NAUGHTIE: 'Six o'clock on Thursday, 18th...

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'Plans by the government to...'

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'I have a whole world of possibilities ahead of me.

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'I feel anxious, but happy to be in the hands of such a good surgeon today.

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'It's one enormous step on the way'

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to where I'm going, so...it's going to be... momentous, really!

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I can't wait to see the outcome, actually.

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Um, yeah. It's going to be quite something.

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My age is 62.

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Morning, Boots.

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Hungry, girl? Here you are.

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No? All right. Maybe later.

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My daughter tells me off terribly for doing this. She says, "How can you put purple eyeliner on?!

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"It's atrocious." It's not the done thing at age 14.

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She knows a lot about makeup. I say, "I know nothing about makeup."

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When I first became a consultant, I had a makeover. An image consultant.

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We spent a lot of time doing supervised shopping and learning what to buy

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and how to do one's war paint. And she just taught me ONE method of doing it,

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which is probably completely wrong now because I've done it this way without supervision for too long.

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Tania is a plastic surgeon.

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She splits her time between working for the Army and the NHS.

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So just to remind me...

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My plan for today is to open up your previous scar.

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You've got the two bones inside the leg, the big bone and little bone.

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We're going to shorten back the little bones on both sides. They're causing the trouble.

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But leave the main bone the same length. That needs filing down.

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I can't be any shorter because my daughter's getting too tall!

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I've got this with one of my soldiers who used to be nearly 7 foot and had to lose two inches

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because the prosthetist couldn't make him balance at that height. He had to accept a shortening.

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Tania's first patient of the day is Claire, who lost her legs to bacterial meningitis aged 17.

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The bones in her stumps have continued to grow, making it too painful to walk on false legs.

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Tania will be operating on her so that she can walk again.

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Claire has two below the knee amputations and has to have a different set of legs

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depending on what she's wearing. She has a pair for flat shoes

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and a pair of legs for high heel shoes.

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The ankle position is different. If she wants to wear heels, she has to wear a different set of legs.

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Tell me about your heart. Can you tell me about your heart?

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Katie was involved in a road traffic collision yesterday evening.

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She was a passenger in the front seat, wearing a seatbelt.

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Last night, very shortly after she arrived,

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she went to theatre because she had lost a lot of blood from a ruptured liver and ruptured spleen.

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Our enduring hope is that her spinal cord has not yet been damaged,

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which potentially could result in paralysis.

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Her mum was driving and I'm sure very innocently,

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but her daughter has these distressing and potentially life-changing injuries.

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I've been doing this for donkeys' years and have children her age

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and I still have no idea what she feels like.

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As well as her mum, Katie's twin brother was also in the car when they collided with a van.

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Katie was the only one seriously injured.

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Doctors put her in a medically-induced coma to keep her safe

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while they investigate the damage to her spinal cord.

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You all right?

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'This is the last ward you want to be in. Nobody wants their family in here. Why would they?'

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They only get through the doors if they have a life-threatening problem.

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One thing we tend to say at the very beginning when parents arrive is that we will be brutally honest.

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We will also, quite shamelessly, worry people needlessly

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because things can change suddenly, but if you expect something is going to get bad,

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you're not doing anybody any favours by not telling them.

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Right, we're scanning her head, aren't we?

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Including neck. The whole spine.

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If the MRI scan reveals that Katie's spinal cord is damaged, she might never walk again.

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Is everyone ready? On roll. Ready, steady...roll.

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Ready, steady, roll.

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We're going to go on slide. Is everyone ready? Ready, steady, slide.

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Stop.

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-Can we tape her eyes?

-Yeah.

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OK. zero. >

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-Just try the temperature of this on your head.

-OK, that's good.

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-Is that all right?

-Yeah.

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-Is that a nice feeling, Steven?

-Having my hair washed? Oh, yeah.

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It's lovely. That's two advantages of being a tetraplegic.

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I never have to wash my hair again and I'll never have to shave again.

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Scratch the top of my head as well, please.

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Yeah, there. Oh, yeah.

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That must be the worst thing, having an itch and not being able to do anything about it.

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9 months ago, Steven fell down the stairs and damaged his spinal cord. He's been in hospital ever since.

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He's paralysed from the neck down and fed through a tube in his stomach.

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I can swallow,

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but there's something deflecting what I swallow into my lungs.

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-Have you given up eating olives, then?

-I've given up olives, yeah.

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We call it Olivegate.

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My mother was eating olives with garlic in them and I begged her for an olive.

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So she reluctantly gave me one and I ate it.

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It came up one day when they were doing some physio. He coughed it up and they kept it in a little tube.

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The smell just comes wafting over you and you're not in a good space.

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You think if you eat an olive it will change the way you feel for a couple of seconds.

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It's just that.

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Take a deep breath. One, two, three.

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OK, ready?

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-Time for a fag soon!

-I'll pretend I didn't hear that!

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Ready? One, two, three.

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In a month, Steven will leave the spinal injuries unit and move to a new home

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with the 24-hour care he'll need for the rest of his life.

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-Now go to Skype.

-Yeah, yeah.

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-OK.

-OK.

-Got it?

-Yeah.

-Double click that.

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Hello, baby! How are you?

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-I can't see you. Can you see me?

-Yeah, I can see you.

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How's Johnny been? Johnny's the rabbit.

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-He's been good?

-Yeah.

-We're going out of the hospital today.

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Caroline's going to pick you up, and we'll do a bit of shopping. I'll see you about 11.30, 12 o'clock.

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OK? Is that a little heart you put for me, was it?

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-Yeah.

-It's beating as well.

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Is it beating? I love you to pieces, baby.

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-Bye-bye, darling.

-Close it?

-Yeah.

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WHISTLES CALMLY

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Sally is one of more than 3,000 people in Britain who are in the process of changing their gender.

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The NHS spends around £2 million a year on gender reassignment surgery,

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but before an operation, patients must live as their preferred sex for two years, undergo assessment

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-and have hormone treatment.

-I'm Iffy. Pleased to meet you.

-I've heard all about you.

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Have you? It's all lies.

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-What are you currently taking?

-Oestradiol valerate, Progynova.

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-Yeah.

-And Decapeptyl.

-OK.

-Once every three months.

-OK.

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And I don't take medicines. I'm from the pharmaceutical industry!

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-OK.

-I avoid them if I can possibly...!

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OK, on a scale of 1-10,

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1 being terrible, 10 fantastic, where are your energy levels at the moment?

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-I would say probably 3-4.

-OK.

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And your sex drive, what's that like on a good day and a bad day?

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-I was going to say zero!

-You can say zero if you like.

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-Between zero and 2.

-OK.

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-Horrible question, but do you see any erections any more?

-No.

-OK.

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Now, from a surgical point of view, referral through, hopefully,

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-for the labiaplasty. Is that correct? For the cosmetic...

-That's right.

-Lovely.

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-So the next thing I'm going to do is put you on the weigh-in scales. OK?

-Yes.

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-OK.

-My blood pressure's fine.

-I will be doing that as well.

-Good.

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Yes, I will.

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Hello.

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I'm all right. How are you?

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I'm going to start at the beginning.

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Current medicines?

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'On my very first appointment here, something very funny happened.'

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There were a couple of trans women and a lady said, "Is this your first time here?"

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I was like, "Yes." I thought maybe I seem really nervous.

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She said, "I feel you could have made a bit more effort with your appearance."

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Was I dressed too casually or something like that?

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But then she added, "It's good to start looking more feminine at some point when you go outside."

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I realised that she thought I was born male and was trying to transition to be female.

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I politely pointed out that actually I was female transitioning to be male!

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I think I hide it well, but I have double D breasts.

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-How's your general health?

-I'm just getting used to my face changing.

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I saw some photographs of myself a year ago, before the testosterone.

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I suddenly looked at a picture now and I was like, "Wow!"

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And now I'm getting body hair everywhere. I'm getting it on the face, my belly at the bottom.

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That's good news that you're getting it where you should be getting it.

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-It's nice to see it here, isn't it?

-I like my little wolf patch that I sort of get here.

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Good morning, Sally. My name is Helena. Nice to meet you.

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I'll be helping your anaesthetist.

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-Can you just confirm your name and date of birth?

-Sally Rivers.

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BIRTH DATE BLEEPED OUT

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And you are coming for cricothyroid approximation and thyroid chondroplasty?

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-You understand the operation?

-I do.

-Have you signed the consent?

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Today Sally is having an operation to change the pitch of her voice

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and reduce the size of her Adam's apple.

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Hello. Good morning. Can I come in?

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If I could just have a little peep at your neck.

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-There's a nice skin crease there so we'll use that.

-OK.

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Afterwards, you're going to rest your voice completely.

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The odd word's not the end of the world, but rest your voice.

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-In two or three weeks, you'll meet with Speech Therapy?

-Yes.

-OK.

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'I was, in many respects, a normal child, but something started to happen.

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'I just began to relate more to what girls were doing than what boys were doing.

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'And it utterly horrified me.

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'You are a prisoner in your own body.

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'There are plenty of other people who have illnesses where they're trapped in their own body,

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'but it's almost like I'm giving myself permission now to lead a full and proper life as other women do

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'and rather than it being a dream, it's now becoming a reality.'

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All the way.

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I want big, slow breaths.

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We're just reducing the laryngeal prominence, the Adam's apple.

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We've exposed the larynx completely at the front and I'm going to do a little bit of a trim here.

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15 blade, thank you.

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Sally's vocal cord surgery costs around £2,000.

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I'm probably the third generation of surgeon doing this procedure. The pioneers were in the early '70s.

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We've been doing between 50 and 70 cases a year.

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It's probably the largest number I know of any unit in the world.

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But we're getting less referrals for this surgery through the NHS

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and that relates to the current economic environment we live in,

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but times change and I'm sure they'll rediscover its value.

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In a moment, we'll tighten the sutures

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and they should tension the cords.

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-The analogy of a guitar string.

-My colleague's just said the analogy is a guitar string.

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If you tension a string, the pitch gets higher.

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This is probably the most crucial part of the whole operation. Get the mosquito.

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-Have we not got a mosquito rather than...?

-No.

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OK, go ahead.

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-Got it?

-Mm-hm.

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-OK?

-Yeah.

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So basically the gap here was much, much larger a few minutes ago.

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What the effect of this is is that inside the larynx, it's tensioning the cords.

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I've got scissors here.

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Most of the patients with gender dysphoria are of a working age.

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Now if you are born the wrong sex,

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you're uncomfortable going out, you're uncomfortable socialising, being involved.

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'And some of these patients do not work.

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'The simple fact is that if you're not working and paying your taxes, that is money lost to everyone.'

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There are other ill health issues. Going to the doctor's with depression or they attempt suicide

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and end up being treated on the Intensive Care Unit.

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One day in there will cost far more than this whole procedure,

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so if you think about it like that, it does pay for itself.

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Let's get this. Follow that car, catch up with him.

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Foetus inside, so the students can get a feel for where the baby is.

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I'm not sure. I think it's here that's fractured.

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-On both sides. Is that right?

-There is spinal trauma. The rest is C2, isn't it?

-Yeah.

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-The cord looks fine.

-That's good.

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Greatly relieved. The spinal cord isn't damaged and she's not paralysed.

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If 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

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and also is not going to impact too much on the way we look after the rest of her injuries.

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-I'll go and get Mum and Dad.

-OK. Thanks.

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No, I'll get the nurse to go and get them or they'll think something terrible.

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Do you mind getting Mum and Dad round so the guys...?

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-I can come round as well.

-Or we talk to them there.

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We had a discussion with the neurosurgeons.

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She's got a fracture which is colloquially called a hangman's fracture, which isn't very nice,

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but it's the one you get when basically her neck's done that.

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What is good is that the spinal cord has plenty of room, nice and free.

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So...

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she's unlikely to have any kind of neurological injury.

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We'd quite like to keep her asleep. It gives a little bit of time for the other injuries to settle down.

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At the moment, we're looking at about Monday to wake her up.

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I know you have a 16-year-old daughter with a broken neck,

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-but it's a bit better this afternoon than it was this morning.

-OK.

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Thank you.

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Look...

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You might be having a heart attack.

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Before I had my surgery, I weighed 25 stone.

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I'm half the person I used to be!

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For three months, Steven's been having daily therapy to help him cope.

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This intensive therapy will end when he leaves the unit,

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but his care will still cost the NHS £80,000 a year.

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That sort it?

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That feels good. As it runs past wherever it does,

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-I'm more aware of...

-Absolutely. It's about waking up all those senses, really.

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-Is it nice to taste something?

-Lovely. This is the highlight of my day. Definitely the highlight.

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-Having a glass of orange.

-Who'd have thought?

-I know.

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-I've actually brought some yoghurt.

-OK.

-Which will come in handy.

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-Wow.

-This is the big treat.

-A big day today, eh?

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-Ready?

-OK.

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-OK?

-I felt good.

-But that swallow is tiring. It's taking more effort to trigger.

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I think I'm going to stop, actually. Everything's getting really tired.

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-I'll just get you into trouble.

-OK.

-You won't thank me for that.

-OK.

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Do you want some suction?

0:25:300:25:32

-No, it's OK.

-See? That's what I suspect is the yoghurt sliding down.

0:25:340:25:38

No, it's all right. No.

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We'll get a SATs monitor on.

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I think it's fair to say he'll probably never eat a full meal again.

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For pleasure purposes, it would be really valuable to take a small amount so on any social occasion

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he may be able to sit down and have a drink with some friends or coffee.

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Eating, drinking is the glue of life, quite often.

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If he can have something, he can be a part of the party.

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-Hello.

-Hello, Karma! Hello, baby.

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Am I going to have a kiss? Am I going to get a kiss?

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-Oh, I can't reach you.

-Can't reach.

-Come round here and see if you can.

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You must be able to. Stand on the bed, then.

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Oh...so close!

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Ah, thank you, darling.

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-Oh...

-All right?

-A bit chilly.

-Do you want...?

-No, it's OK.

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-Do you want a rug or something?

-No, no, no.

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Looks uncool in a rug. It's bad enough being in a wheelchair.

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As part of his rehab, Steven is taken out to help him get used to life in a wheelchair.

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Steven's separated from his partner and sees his daughter once a week.

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Today's the first time he's left the hospital with her since the accident.

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I miss you.

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-I miss you, too.

-I miss you very much, Karma.

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I miss you very much, too.

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I miss... going swimming with you.

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Do you know that? Probably that's the most... the most...the most missed anything.

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Going swimming.

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-Yeah?

-Yeah.

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Yeah, me, too.

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What we see here, this is the right leg

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and you can see that the fibula and tibia are fairly similar in length.

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I would like to achieve 2cm difference between the fibula and the tibia.

0:28:390:28:45

I think the NHS's role is about making you function.

0:28:480:28:54

With the improvement in prostheses that we've seen over the last few decades, there are very few things

0:28:540:28:59

that an amputee can't actually do.

0:28:590:29:03

The only real thing you can't do is easily leap out of bed in the night to go to the loo

0:29:030:29:08

because you've got to put your leg on, but other than that, with a well-fitted below-knee prosthesis,

0:29:080:29:14

you can do an awful lot of the things that used to be considered to be impossible for amputees.

0:29:140:29:20

She's twitching.

0:29:210:29:23

It's not causing me concern. It was interesting that she was doing it.

0:29:250:29:29

I wasn't sure it was significant or anything.

0:29:290:29:32

Oh, that's why I wear a visor!

0:29:540:29:57

-Shall I take it off?

-If you like. I don't mind.

0:30:020:30:05

-Will it be easier to clean that way?

-Hmm.

0:30:050:30:08

I'm just having a quick clean.

0:30:080:30:10

And then we're going to need the saw in a minute.

0:30:170:30:21

LOUD DRILLING

0:30:260:30:29

OK, and the nail file.

0:30:340:30:36

SCRAPING SOUND

0:30:360:30:38

OK. The nice thing about having new instruments is they're all sharp.

0:30:420:30:46

So that's now quite a lot shorter than the main bone here.

0:30:460:30:51

We're just going to take a quick short cut.

0:31:080:31:12

I think a lot of what we do is about the whole patient, rather than just this operation.

0:31:170:31:23

I expect that I will need to do modifications to Claire for many, many years to come

0:31:230:31:29

and there may be other treatments that are more cosmetic,

0:31:290:31:33

but that's not cosmetic, i.e, making you look more like a film star.

0:31:330:31:37

That's bringing you in line with what is normal for the population as a whole.

0:31:370:31:42

My feeling is that what the NHS should be allowed to do is normalise people.

0:31:420:31:48

-Aaagh!

-Just there. Sorry.

-It's all right.

0:32:160:32:19

-How's that?

-No, that's numb. That feels quite numb.

0:32:200:32:24

You've just had a special birthday.

0:32:240:32:27

40, plus VAT. That's what I was.

0:32:270:32:30

-Where did you go?

-Marbella. Me and the girls and it was absolutely fabulous.

0:32:300:32:35

-God, you see the sights there!

-Oh, yeah.

0:32:350:32:39

-We've done the lap-dancing clubs and the poles.

-What? Did you?

-I struggled with that pole though, Ann.

0:32:390:32:46

-You didn't, really?

-I did, yeah, Puerto Banus.

0:32:460:32:49

You've got to go to Puerto Banus when you're in Marbella.

0:32:490:32:53

Oh, yeah, it's fabulous.

0:32:530:32:55

For the past ten years, the NHS has been offering nipple tattoos

0:33:000:33:05

to patients who have had breast reconstruction as a result of cancer.

0:33:050:33:10

Today, over 300 hospitals across the country offer the service.

0:33:100:33:16

Back in 1999, a long time ago now,

0:33:170:33:21

I didn't have a lump or anything like that, just a bit of a hard boob.

0:33:210:33:25

How old were you then and how old were you?

0:33:250:33:28

Well, that was... I was 35.

0:33:280:33:30

-I was 11.

-That must have been hard.

0:33:300:33:33

And just being on our own, a single parent, just me and Em, it was a bit...harrowing.

0:33:330:33:40

So, anyway, I went to see my GP, he sat me down,

0:33:420:33:46

stuck these X-rays, blah-blah-blah,

0:33:460:33:50

on this machine and said, "Yes, well, you've got ductal carcinoma in situ."

0:33:500:33:55

And I'm going, "Oh, that's good...

0:33:560:33:59

"That's great news."

0:34:000:34:02

"And you're going to have to have a mastectomy."

0:34:020:34:06

And I can remember just breaking down, crying, and saying, "Am I going to die?"

0:34:060:34:12

"Well," he said, "not if I can help it."

0:34:120:34:15

I wasn't really worried about waking up with a boob gone because...

0:34:160:34:20

..you don't worry about what you're going to look like.

0:34:240:34:28

I can remember then waking up, being very sick,

0:34:290:34:34

and, being the very vain person I am, looking for a mirror,

0:34:340:34:39

because 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."

0:34:390:34:45

And looking in the mirror, I looked like I'd been knocked out.

0:34:450:34:49

I was violently, violently sick and I remember thinking, "No, I do want to die."

0:34:490:34:55

And I put that foam prosthesis in my bra, put my bra on,

0:34:550:34:59

put on the same black shirt that I'd come into hospital in

0:34:590:35:04

and I looked in that mirror and it was me.

0:35:040:35:08

-It's true.

-OK?

-Can I have a look in the mirror?

-Yeah.

0:35:080:35:12

You've got to tread carefully with how much you do in terms of tattooing

0:35:120:35:16

-because you do ooze a little bit.

-Yeah.

0:35:160:35:19

-If we get you back again to get the colour that you want to be...

-No, that looks really good.

0:35:190:35:25

- Yeah, chuffed. Chuffed. - It looks good.

0:35:250:35:28

Debbie's nips.

0:35:280:35:30

LAUGHTER

0:35:300:35:32

Dr McAllister, there's just another gentleman beside him, Mr Nelson, James Nelson.

0:35:490:35:55

I'll just let you pop your head in when you're here.

0:35:550:35:59

I'm looking at his monitor there. Everything looks normal on that.

0:36:050:36:09

I was tired after the operation, but I'm grand now.

0:36:090:36:13

And you can rotate it round and choose which prostate you would like them to examine.

0:36:300:36:37

So where are we going today... Start again.

0:36:460:36:50

Right, where's Daddy going today?

0:36:500:36:52

-"Hostipal".

-"Hostital".

-Why?

0:36:520:36:55

-To get a new hand.

-To get a new hand.

0:36:550:36:58

-Are you guys excited about that?

-Yes.

0:36:580:37:02

How much are you excited? THEY SHOUT

0:37:020:37:04

-If I can take that hand from you...

-Mm-hm.

0:37:120:37:15

Thank you.

0:37:180:37:20

He's programming the hand now.

0:37:220:37:25

On the trial hand I had various grip patterns.

0:37:250:37:28

And so Bruce is now taking those patterns and putting them

0:37:280:37:32

on to the new hand via Bluetooth, which is incredible.

0:37:320:37:36

It's all wireless.

0:37:360:37:38

-No beep when it changes, just the vibrate.

-Just the vibrate.

-They're all in the right order.

-Fantastic.

0:37:380:37:43

-This...

-I like your knuckles.

-A Chinese grip, yeah.

0:37:550:37:58

If you're going to be a robot, you need that.

0:37:580:38:00

-Ready?

-I am.

0:38:100:38:12

I think I look chubby.

0:38:140:38:16

I know it's just my anorexia talking. I know that that's not real.

0:38:170:38:22

"Chubby, chubster, whale..."

0:38:250:38:28

-"Big bird?"

-Oh, yeah, "big bird".

0:38:310:38:34

-That's not a bad day's shopping, was it, Karma?

-No.

0:38:450:38:49

No? "Thanks, Dad."

0:38:490:38:51

Did you say, "Thanks..."? Did you say, "Thanks, Dad"?

0:38:520:38:56

Thanks, Dad.

0:38:560:38:58

You're welcome, baby.

0:38:580:39:01

You want a children's meal - chicken nuggets,

0:39:010:39:04

-a double burger...

-Yeah.

0:39:040:39:07

-A wrap?

-Yeah.

-And a hot and cold chocolate?

0:39:070:39:11

-Yeah, and chips.

-And chips.

0:39:110:39:13

You're not talking now.

0:39:230:39:26

-Are you really hungry?

-Yeah.

0:39:270:39:30

-All right...

-You're two minutes away now.

-Let's get some food then.

0:39:300:39:36

OK? Have we got everything?

0:39:370:39:39

All right, don't drop those, Karma.

0:39:390:39:42

I don't think she will.

0:39:440:39:46

It smells delicious.

0:39:460:39:48

OK, right, OK...

0:39:490:39:51

-OK...

-Can I take them out of your pocket now?

-No, you can leave them in there.

0:39:510:39:56

-Right, see you later, baby.

-Bye!

0:39:580:40:01

Take care.

0:40:010:40:03

-Bye.

-Bye-bye, darling.

-Bye.

0:40:030:40:05

Bye. I love you.

0:40:050:40:07

-Karma...

-Yeah?

-Don't forget to Skype me. All right?

0:40:070:40:12

Skype me tomorrow.

0:40:120:40:14

See you later, darling.

0:40:150:40:17

-Bye.

-Bye.

0:40:170:40:20

Karma was a bit distant from me today.

0:40:200:40:23

Normally, she's all over me like a rash.

0:40:230:40:27

We were really close. I mean, you can see it in that photograph there.

0:40:270:40:32

She had a big grin on her face like that most of the day because we were doing such fun things.

0:40:320:40:39

I'm not the dad I was.

0:40:400:40:42

You know, I'm not the fun dad I was.

0:40:420:40:45

You feel yourself isolated, stuck in a wheelchair now.

0:40:460:40:50

And not even being able to put my arm around her,

0:40:520:40:55

I find it quite upsetting, really.

0:40:550:40:58

-What can I do with her?

-You can help her do her homework.

0:40:590:41:04

-There's loads of things you can do with her.

-Yeah, I know.

-Just not active things.

-No.

0:41:040:41:09

This is Roger's aeroplane that he had the accident in,

0:41:270:41:32

obviously, before.

0:41:320:41:34

It's not my favourite.

0:41:340:41:36

And that was how it was.

0:41:400:41:42

The front of the aeroplane is completely devastated by fire. Roger would have been sitting about here.

0:41:420:41:48

Had I been a passenger, I would have been sitting there,

0:41:480:41:52

so I may possibly have come off worse than Roger.

0:41:520:41:55

Anybody in that front seat would have died. There's no question about that at all.

0:41:550:42:00

-Do you remember anything about the crash?

-Nothing. Nothing, I'm pleased to say.

0:42:000:42:05

The last recollection I have is saying "cheerio" to Kim on Thursday

0:42:050:42:10

and the next clear recollection I have of my own, other than from what people have told me,

0:42:100:42:15

is about seven weeks afterwards when I woke up from an induced coma in the Burns Unit at Chelmsford.

0:42:150:42:21

I see Roger as that man.

0:42:250:42:28

He's my first love and he always will be.

0:42:280:42:31

This is him at the nose wheel of an A300.

0:42:310:42:35

Roger's plane crash was four years ago.

0:42:360:42:39

He was trapped in the fire for half an hour.

0:42:390:42:42

Since then, he has been going to hospital every two months for reconstructive surgery.

0:42:420:42:48

This part of my arm here, as you can see, doesn't straighten.

0:42:500:42:54

I've had three operations on it already, so hopefully, with luck,

0:42:540:42:58

provided the tendons and muscles themselves haven't shortened, I should be able to straighten my arm.

0:42:580:43:04

Do you get excited about operations?

0:43:040:43:07

HE LAUGHS

0:43:070:43:09

-I'm sorry.

-Do you look forward to them?

0:43:090:43:12

-No.

-Not at all.

0:43:120:43:14

Honestly, I've had so many of the bloody things and I just want to move forward.

0:43:140:43:20

I'd very much sooner not look like an extra off a Hammer film,

0:43:260:43:30

which I do at the moment, but it's not a big priority.

0:43:300:43:33

The big goal is to fly again. I don't mean to fly as a passenger again, but as a pilot.

0:43:340:43:40

I was never, ever concerned about how he'd look.

0:43:450:43:48

That's never concerned me.

0:43:480:43:51

It was...whether or not Roger would be the same person

0:43:510:43:55

as he was before the accident.

0:43:550:43:58

If...Roger had had any brain damage,

0:43:580:44:03

I...I don't know how or what we'd have done.

0:44:030:44:07

And I can honestly say that I have absolutely no idea.

0:44:070:44:11

I think I'd be lying to say that there haven't been times that I wish I hadn't survived.

0:44:110:44:17

I suppose one of the most difficult things to bear

0:44:170:44:21

is losing, other than Kim, more or less everything that I enjoy doing,

0:44:210:44:26

losing my profession and hobbies...

0:44:260:44:30

..all of the things that are lost.

0:44:310:44:33

A lot of them are functions and bits of my body that are no longer there.

0:44:330:44:37

-How are you?

-Pretty good, thanks. How are you?

-Hi, Kim. How are things?

-Not bad.

-Had a busy morning?

0:44:420:44:48

It was slightly more interesting than it might have been. I've changed my suit. I'm clean.

0:44:480:44:54

The plan for today then... I'm going to do some releases on that elbow.

0:44:540:44:59

So how is it looking after last time?

0:44:590:45:02

So we've still got quite a lot of that. If we draw around that...

0:45:020:45:06

-That part has survived.

-Yeah.

0:45:060:45:08

That part is good.

0:45:080:45:10

-But we've lost a bit in the middle and that's contracted down a bit.

-Yeah.

0:45:100:45:15

We are optimistic that we'll be able to get that arm out a bit straighter.

0:45:150:45:19

-I don't want to cut that biceps muscle because, obviously, you need that for power to flex.

-OK.

0:45:190:45:25

But if we can encourage it to release some of its strands, that'll give you more movement.

0:45:250:45:31

-Good. You need to sign a consent form still, don't you?

-I do.

-Yeah. I shall get one.

0:45:310:45:35

Here.

0:45:350:45:37

-Oh, just there.

-There somewhere.

0:45:380:45:40

Roger has had 36 operations since his crash,

0:45:410:45:45

around half of them carried out by Tania.

0:45:450:45:48

I must go back and tell the boys and girls we're ready to go.

0:45:480:45:52

-I'll get you down and I'll see you very soon.

-Super.

-All right?

-Thanks.

0:45:520:45:56

Currently, we're very lucky in Burn Care. There are no specific restrictions,

0:45:560:46:02

so if I physically can provide an operation to improve the function,

0:46:020:46:07

sometimes the appearance of a burns victim, we would be allowed to do that on the NHS

0:46:070:46:13

and do so on a very regular basis.

0:46:130:46:16

OK.

0:46:170:46:19

Right, Roger. We're just going to give you a little bit of oxygen,

0:46:190:46:23

so we make sure your lungs are full of oxygen before we begin.

0:46:230:46:27

Can I just squeeze... Sorry.

0:46:270:46:29

You need a kiss first? That's fine. We're allowing that today!

0:46:290:46:33

See you later.

0:46:330:46:35

-Stay there. You might get another one.

-Oh, mightn't I?

-If you're lucky.

0:46:360:46:40

I'll definitely stay here then.

0:46:400:46:42

It's not the full anaesthetic. It's just going to make you feel nice, relaxed, chilled, drunk, happy, high.

0:46:420:46:48

Something like that. Most people quite like it.

0:46:480:46:51

We want you just to concentrate on taking some nice, long, slow, deep breaths.

0:46:510:46:57

The other thing is to think about something really nice to dream about.

0:46:570:47:01

Some people have some cracking dreams on this stuff.

0:47:010:47:05

Keep taking those nice, deep breaths.

0:47:060:47:08

There's probably time for one more kiss. One more kiss.

0:47:080:47:12

Before it starts going in, it can just be a little bit achy.

0:47:120:47:16

-All right...

-See you later.

-A little bit more of that oxygen.

0:47:160:47:20

So, all the time,

0:47:500:47:52

-if you can start really pushing on that as hard as you can...

-OK. Yeah.

0:47:520:47:58

And sort of rocking backwards and forwards a little bit, so it's starting to release...

0:47:580:48:04

I'm just stretching him out to see how much more extension we can get.

0:48:040:48:09

The idea is clearly not to break Roger's arm.

0:48:230:48:26

OK, your turn. Lean on there for a bit.

0:48:280:48:31

Another knife, please.

0:48:310:48:33

To ensure that Roger's arm heals properly,

0:48:350:48:38

Tania uses a hi-tech, artificial skin.

0:48:380:48:41

It's made from bovine beef collagen

0:48:420:48:46

and shark glycosaminoglycans

0:48:460:48:48

which gives it something

0:48:480:48:51

that is rather like the human structure.

0:48:510:48:57

Apparently, it needs shark in it to really become completely like the human structure.

0:48:570:49:02

And the idea is that it produces a scaffolding

0:49:020:49:05

that the blood vessels then grow into.

0:49:050:49:09

Right, wash hands.

0:49:340:49:36

All right, I'll be back fairly... Well, fairly soon. Soon-ish.

0:49:380:49:42

She's still on the answerphone, so we'll go this way.

0:49:430:49:47

-Can I ask you a few questions?

-Yeah, if we walk and talk at the same time because I'm on a mission.

0:49:500:49:56

Hello.

0:49:590:50:01

Let's go through. OK...

0:50:010:50:04

Yes, so it is becoming sort of second nature, so...

0:50:180:50:21

-Here we go.

-Perfect.

0:50:240:50:26

-If you just make a big leap on to the scales...

-Yeah, why not? Let's do it.

0:50:260:50:31

INAUDIBLE

0:50:460:50:48

Sally has been advised not to speak while her vocal cords recover.

0:50:490:50:53

Once they do, she'll join a speech therapy group at the clinic

0:50:530:50:57

to refine the sound of her voice.

0:50:570:51:00

We hear the smile in someone's voice, don't we?

0:51:070:51:11

We want that to be in your voice all the time, to have that smile in your voice,

0:51:110:51:16

not kind of that..."euh",

0:51:160:51:18

but that bright... "Morning!"

0:51:180:51:21

"On either side of the river lie long fields of barley and of rye...

0:51:210:51:26

"Willows whiten, aspens quiver, little breezes dusk and shiver.

0:51:260:51:31

"And moving through a mirror clear that hangs before her all the year...

0:51:310:51:37

"Sometimes a troop of damsels glad, an abbot on an ambling pad...

0:51:370:51:42

"She knows not what the curse may be,

0:51:420:51:46

"and so she weaveth steadily,

0:51:460:51:51

"and little other care hath she,

0:51:510:51:55

"the Lady of Shalott."

0:51:550:51:57

61.

0:52:020:52:04

And 113.

0:52:040:52:07

Which is very good.

0:52:070:52:09

You've got a small waist now.

0:52:090:52:12

And that says... What have we there? 37.

0:52:170:52:21

-Very good. Oh, look, she's well organised.

-Well, I was.

0:52:370:52:42

Hello!

0:52:480:52:50

It's just nice to sit here

0:52:580:53:01

and look at the fire.

0:53:010:53:03

Home at last.

0:53:060:53:09

What would you do if you could run the NHS?

0:53:100:53:14

SHE LAUGHS LOUDLY

0:53:140:53:16

If I could run the NHS?

0:53:160:53:19

Hmm...

0:53:210:53:23

I don't fancy running the NHS. I don't want to fly a desk. I quite like looking after patients.

0:53:250:53:30

One of the nice things about my job is that I do actually still look after patients.

0:53:300:53:36

That's what gives me a buzz.

0:53:360:53:38

MOBILE PHONE JINGLE Oh...

0:53:380:53:40

I wonder what that represents? It could be...

0:53:440:53:47

It's all right. It's my husband. It's not the Burns Unit.

0:53:470:53:51

Hello.

0:53:520:53:54

I'm sitting in front of the log-burner,

0:53:560:53:58

being filmed for the end... the end of the day shots.

0:53:580:54:03

It's like a reflection that I do at the end of every day.

0:54:120:54:16

I fancy a cigarette now.

0:54:250:54:27

-You're not allowed one.

-Stop it.

-I do.

0:54:270:54:30

-You caused trouble last time you had one.

-Who gave it to you? I'll tell them off.

-My aunt.

0:54:300:54:35

I managed to blackmail her.

0:54:350:54:37

How did you blackmail her? What did you say?

0:54:370:54:40

I said, "All these people ever say to me is, 'No, you can't do this, you can't do that.'"

0:54:400:54:45

-So I got...

-You made her feel bad.

-I did, yeah.

0:54:450:54:48

-That's terrible.

-I know it is, yeah.

0:54:480:54:50

I know.

0:54:500:54:52

-So did you miss me today?

-Loads.

0:54:570:55:00

-It's more like, "Didn't you miss us?"

-I was too busy.

0:55:000:55:03

OK, we're in.

0:55:060:55:08

-I'm feeling pretty cold now.

-OK.

-We'll get you warm in a minute.

0:55:150:55:20

-You're nearly there, darling.

-There you go.

0:55:260:55:29

Listen... Listen, did you finish all of that McDonald's that we got you?

0:55:370:55:41

You finished every single bit of it?

0:55:410:55:44

Where did you put it all?

0:55:460:55:48

In your stomach? Right.

0:55:510:55:53

'Have you had a nice day?'

0:55:530:55:55

I have had a nice day, although I am quite tired now.

0:55:550:56:00

All right? OK.

0:56:020:56:04

Yes, I did. I've had a very nice day, especially seeing you.

0:56:040:56:08

All right, are you going to bed soon?

0:56:080:56:11

I'm going... Do you know what? I'm in bed already.

0:56:130:56:16

All right, I miss you madly.

0:56:170:56:20

Take care, darling.

0:56:200:56:22

'I miss you more than you.'

0:56:220:56:24

No, I miss you more than what you miss me.

0:56:240:56:28

OK, take care of yourself, baby.

0:56:280:56:31

And give me a call.

0:56:310:56:33

All right?

0:56:330:56:35

Will you give me a call?

0:56:350:56:37

All right, take care. I love you.

0:56:390:56:42

-Bye-bye, darling.

-'Bye!'

-Bye-bye.

0:56:420:56:45

Bye.

0:56:450:56:47

Can you see my phone anywhere? Can you switch my phone off?

0:56:470:56:51

Yeah, thanks.

0:56:510:56:53

Just switch my phone... It's just the bottom...

0:56:550:56:59

Carry on going up here, then we do a right at the next bit.

0:57:230:57:27

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

0:57:520:57:56

Working To Save Lives, which accompanies this series, call:

0:57:560:58:00

Or go to bbc.co.uk/keepingbritainalive

0:58:030:58:07

and follow the links to the OU.

0:58:070:58:09

Subtitles by Red Bee Media Ltd

0:58:330:58:36

Download Subtitles

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