0:00:02 > 0:00:07This programme contains scenes which some viewers may find upsetting.
0:00:13 > 0:00:1518th of October, 2012.
0:00:15 > 0:00:21Across Britain, 100 cameras are filming the NHS on a single day.
0:00:21 > 0:00:24This change will be a disaster.
0:00:26 > 0:00:29On 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 > 0:00:361,500 of us will die.
0:00:37 > 0:00:392,000 will be born.
0:00:41 > 0:00:43WHISTLE SOUNDS
0:00:43 > 0:00:46The NHS is the largest public healthcare system in the world.
0:00:48 > 0:00:51We want that to be in your voice all the time.
0:00:51 > 0:00:53Hello. We're going to help you.
0:00:53 > 0:00:57- 'We rely on it...'- Be really brave. - '..complain about it.'
0:00:57 > 0:00:59In the bin. That's because of you!
0:00:59 > 0:01:02Often we take it for granted.
0:01:04 > 0:01:07What we expect from the NHS is ever-increasing.
0:01:08 > 0:01:10The money to pay for it, isn't.
0:01:12 > 0:01:16If we could see what this institution does in a single day...
0:01:18 > 0:01:21..what would it make us think?
0:01:21 > 0:01:25This entire series tells the story of one day.
0:01:25 > 0:01:27So why isn't she waking up?
0:01:27 > 0:01:32100 cameras capturing the NHS as you've never seen it before.
0:01:33 > 0:01:35Baby born at 2:55am.
0:01:45 > 0:01:47RADIO: 10th of October. The main stories.
0:01:47 > 0:01:49The report finds alarming failures...
0:01:51 > 0:01:58Official estimates suggest the number of people being trafficked in and out...
0:01:58 > 0:02:00BABY CRIES
0:02:00 > 0:02:03The stabbing we will bring into two. Is that all right?
0:02:08 > 0:02:11Every night while we sleep, the NHS continues its work,
0:02:11 > 0:02:14looking after us 24 hours a day.
0:02:15 > 0:02:18RADIO TRANSMISSION: It's a 20-year-old female.
0:02:18 > 0:02:20She's requested no lights and siren.
0:02:20 > 0:02:22She is 15 weeks pregnant
0:02:22 > 0:02:25and has taken an overdose of mixed medication.
0:02:25 > 0:02:27Repeat that. BEEPING
0:02:27 > 0:02:30Yeah, that's all received and we're mobile on that.
0:02:30 > 0:02:34Paramedics Mel and Jay are halfway through their 12-hour night shift.
0:02:36 > 0:02:39We have a young lady.
0:02:39 > 0:02:41She's 15 weeks pregnant, apparently,
0:02:41 > 0:02:44and she's taken an overdose of painkillers.
0:02:46 > 0:02:49Overdoses are really common. Yeah. Really common.
0:02:49 > 0:02:51They're normally just for attention.
0:02:51 > 0:02:55There's normally no suicidal intent but we shall see.
0:02:55 > 0:02:57Mel thinks she recognises the name and the address.
0:02:57 > 0:03:01And last time she wanted a bit of company.
0:03:01 > 0:03:04But I'm not very good at company!
0:03:04 > 0:03:08- HORN SOUNDS - Women drivers! It's always women!
0:03:08 > 0:03:10It also said that she's asked we don't use lights
0:03:10 > 0:03:13and sirens so we'll turn them off when we get up the street.
0:03:13 > 0:03:16Apparently 999 do requests now!
0:03:18 > 0:03:20The name really, really rings a bell.
0:03:20 > 0:03:24I think it's going to drive me mad till I get there!
0:03:31 > 0:03:34Have a sit-down. What's the problem tonight?
0:03:38 > 0:03:39Stupid. Don't be stupid!
0:03:39 > 0:03:42They've picked up the patient
0:03:42 > 0:03:44and Mel recognises her as a regular caller.
0:03:46 > 0:03:48It's all over now. Don't be ridiculous.
0:03:48 > 0:03:51- Sit yourself down. - Sit down.- Sit down!
0:03:51 > 0:03:53- What do you think's going to happen?- Sit down!
0:03:53 > 0:03:56Do you think we're going to let you just jump out of the cab? Eh?
0:03:56 > 0:03:59- Seriously?- Sit down.
0:03:59 > 0:04:02What do you think is going to happen?
0:04:02 > 0:04:04Sit on the seat!
0:04:04 > 0:04:06We're here to help you. Now sit on the seat.
0:04:06 > 0:04:09Where are you going to go? We'll get the police and you'll get arrested.
0:04:09 > 0:04:11You are not getting off the ambulance.
0:04:11 > 0:04:13- You called for our help, haven't you?- I didn't call you.
0:04:13 > 0:04:15I called NHS Direct.
0:04:15 > 0:04:18Sit down. Don't be silly about it.
0:04:18 > 0:04:20- Just get the police in. She is not going to come.- Fine.
0:04:20 > 0:04:23You're not getting off the ambulance.
0:04:23 > 0:04:25You're not, cos I've locked the doors now.
0:04:25 > 0:04:27INDISTINCT RADIO SPEECH
0:04:27 > 0:04:29Thank you. Can we get police, please?
0:04:29 > 0:04:31We've pulled up at the side of the road.
0:04:31 > 0:04:34- This patient is trying to jump off the ambulance.- One, two, three. Yes.
0:04:34 > 0:04:37I'm not going to let you go to jump into the road in front of cars!
0:04:37 > 0:04:40It's not going to happen, is it?
0:04:40 > 0:04:43You keep asking but I'm a stubborn twat, so no.
0:04:43 > 0:04:47RADIO: Can we confirm that you're remaining where you are at the moment?
0:04:48 > 0:04:50You're not going to get out, are you?
0:04:50 > 0:04:53It's locked so you can't get out.
0:05:19 > 0:05:23We're going to be watching it all night. You'll be videoed up there.
0:05:26 > 0:05:30In the UK, one in three of us struggles with a sleep disorder.
0:05:30 > 0:05:33Basically, the reason I'm here is that I've been having very
0:05:33 > 0:05:37disturbed sleep and it's mainly my wife, actually,
0:05:37 > 0:05:40that's pointed it out to me, but I tend to kick in my sleep,
0:05:40 > 0:05:42I twitch in my sleep
0:05:42 > 0:05:45and I'm starting to give my wife a few bruises, I think.
0:06:08 > 0:06:10SIGHING
0:06:10 > 0:06:14- Shall we go through some CCTV today, Carlos?- Can do, yeah.
0:06:17 > 0:06:19SIREN SOUNDS
0:06:19 > 0:06:22In west London, a young man has been stabbed
0:06:22 > 0:06:25and is on his way to the specialist trauma centre in St Mary's.
0:06:25 > 0:06:28This is Leon. 20-year-old male.
0:06:28 > 0:06:31Was standing at the gateway to a house, somebody ran past him
0:06:31 > 0:06:33- that he didn't see.- Right.
0:06:33 > 0:06:36Consultant Mark Wilson leads the team as they assess
0:06:36 > 0:06:38the extent of Leon's injuries.
0:06:38 > 0:06:40Incised wound of the left scapula.
0:06:40 > 0:06:42- Not sucking or blowing.- OK.
0:06:42 > 0:06:45- He's had five milligrams of morphine.- OK, fine.
0:06:45 > 0:06:49All right. Thank you very much. OK, let's take it from the top. Hi, Leon.
0:06:49 > 0:06:52How are you? I'm one of the doctors. Are you all right? So airways clear.
0:06:52 > 0:06:55- Talking.- Let's have a quick listen to your chest, OK?
0:06:55 > 0:06:57Deep breaths in and out.
0:06:57 > 0:06:59We've got a line in, we've got the bloods off.
0:06:59 > 0:07:01'Trauma is a big thing.'
0:07:01 > 0:07:04Trauma's the commonest cause of death in the under-40s, worldwide.
0:07:04 > 0:07:07We're going to put a couple of stitches in this as well, all right?
0:07:07 > 0:07:09Do you know what you were stabbed with, by any chance?
0:07:09 > 0:07:13'Usually, we have very little history as patients come through the doors'
0:07:13 > 0:07:14so you start with a blank canvas
0:07:14 > 0:07:18and you treat in priority things that are likely to kill you
0:07:18 > 0:07:21and you're assessing and treating as you go on.
0:07:21 > 0:07:24- Is this to set him up for the chest X-ray?- Yeah.
0:07:24 > 0:07:27The only thing that's really of obvious concern, immediate,
0:07:27 > 0:07:31is his tachycardia, his fast heart rate.
0:07:31 > 0:07:35That can be a sign of blood loss, which can occur
0:07:35 > 0:07:37without you really knowing it in young, fit people
0:07:37 > 0:07:39cos they compensate very well.
0:07:39 > 0:07:41But he kind of looks too well for that.
0:07:41 > 0:07:44It's more likely to be something he's taken or something else going on
0:07:44 > 0:07:46that's giving him tachycardia.
0:07:46 > 0:07:49Or pain. Pain alone can cause a fast heart rate.
0:07:49 > 0:07:52- We'll take the dressing down. - Leave that for the minute.
0:07:52 > 0:07:57- Let's get the scan and chest X-ray done first and we will do that in a minute.- No blood at the meatus.
0:07:57 > 0:08:01No scrotal haematoma. OK. Good.
0:08:01 > 0:08:04Well, on the scan we think we've seen some blood within his thorax
0:08:04 > 0:08:08so that means he's probably bleeding internally, which would account for the high heart rate.
0:08:08 > 0:08:13So we want to do a CT scan now and just see exactly how much blood he has got in his chest.
0:08:13 > 0:08:15Nice, deep breaths.
0:08:17 > 0:08:20- And again.- I'll come with you.
0:08:20 > 0:08:23If Leon has a lot of blood on his chest,
0:08:23 > 0:08:26the pressure could force his lungs to collapse.
0:08:26 > 0:08:28On three. One, two, three.
0:08:30 > 0:08:32- Are you all right? - We will be as quick as we can.
0:08:49 > 0:08:51SIREN SOUNDS
0:08:54 > 0:08:56Because their patient tried to jump out of the ambulance,
0:08:56 > 0:09:00Mel and Jay now have a police escort to the hospital.
0:09:00 > 0:09:04Every single person that you deal with,
0:09:04 > 0:09:06it's constantly in the back of your mind that,
0:09:06 > 0:09:09you know, this could kick off, really.
0:09:10 > 0:09:14There was no reason to do what she's just tried to do.
0:09:15 > 0:09:17To be fair, I thought she was going to hit me.
0:09:17 > 0:09:21Once a completely unconscious patient just flipped.
0:09:21 > 0:09:24Pulled my crewmate over his chest, kicked me twice in the chest
0:09:24 > 0:09:26and flung me into a wall.
0:09:26 > 0:09:28And then once in the back of the ambulance,
0:09:28 > 0:09:32we spent an hour and a half with this girl, who was drunk,
0:09:32 > 0:09:35so that she was safe till her boyfriend came and picked her up.
0:09:35 > 0:09:38And just completely out of the blue,
0:09:38 > 0:09:41she dug her nails in me and drew a tiny bit of blood.
0:09:41 > 0:09:45Whoever the judge was when they dealt with her proper threw the book at her.
0:09:45 > 0:09:48And it's the way it should be. It should be zero tolerance.
0:09:48 > 0:09:51What are you doing? Just sit yourself down.
0:09:51 > 0:09:53- Do you want me to pull over? - Just carry on.
0:09:53 > 0:09:55- I think we'll be all right.- OK.
0:09:55 > 0:09:57Where's your seatbelt? Move.
0:09:57 > 0:09:59- Nearly there now, anyway. - PATIENT: Help me! Get off!
0:09:59 > 0:10:01Don't spoil it.
0:10:01 > 0:10:04- I'm only going to- BLEEP- do it again anyway.- Do what?
0:10:04 > 0:10:06Take the tablets again.
0:10:06 > 0:10:10See, this really annoys me because she's saying that she's only going to do it again.
0:10:10 > 0:10:15She's been sectioned three times in the last three days.
0:10:15 > 0:10:17How long is this going to carry on for?
0:10:18 > 0:10:21Going by her history she's had an ambulance out every single day.
0:10:21 > 0:10:23The same sort of thing.
0:10:23 > 0:10:27Throwing herself off ambulances, out of police cars.
0:10:27 > 0:10:31From all the different stations, we've all got our regular callers.
0:10:35 > 0:10:36You all right, mate?
0:10:36 > 0:10:41Right, just wondering if you've got any ongoing situations at the moment?
0:10:41 > 0:10:44I think an 18-year-old with his mum and dad
0:10:44 > 0:10:46so I don't think that... He's compliant at the moment.
0:10:46 > 0:10:49Right, OK. Is there any other ongoing situations?
0:10:49 > 0:10:52'We've had quite a lot of tussles.'
0:10:52 > 0:10:56I've been here nearly 16, 17 years.
0:10:56 > 0:10:59I don't want to frighten anyone but I've had two broken noses,
0:11:00 > 0:11:03I've been stabbed once, just slightly.
0:11:03 > 0:11:06It was just a small blade.
0:11:06 > 0:11:10That was about 1997, wasn't it? So, hence we've got these.
0:11:16 > 0:11:20Every day, the NHS coordinates the collection and distribution
0:11:20 > 0:11:24of organs, thousands of litres of blood and other vital fluids.
0:11:34 > 0:11:36In this neonatal unit in London,
0:11:36 > 0:11:39premature babies are given breast milk,
0:11:39 > 0:11:41donated by new mums across the country.
0:11:52 > 0:11:55Anna's baby was born 13 weeks premature.
0:11:55 > 0:11:59I didn't have milk first three days and this is normal
0:11:59 > 0:12:01because the body is not ready for feeding the baby.
0:12:03 > 0:12:06And then one of the nurses told me that, "Don't worry.
0:12:07 > 0:12:11"They would be given donor's milk."
0:12:13 > 0:12:18I was so grateful to women which were giving milk,
0:12:18 > 0:12:20for free, to somebody else
0:12:20 > 0:12:26and maybe one day to meet them and to tell thank you.
0:12:26 > 0:12:28It's really, really important.
0:12:38 > 0:12:40SIGHING
0:12:43 > 0:12:45SIREN SOUNDS
0:12:45 > 0:12:49We're going to a 31-year-old female that's pregnant.
0:12:49 > 0:12:53Don't know how far gone she is but it's just coming through as labour.
0:12:53 > 0:12:56She's having contractions every five minutes, apparently.
0:12:56 > 0:13:00You know, they've had nine months to prepare for a birth, really.
0:13:00 > 0:13:02And then as soon as they start getting contractions,
0:13:02 > 0:13:05they'll call us rather than phone a taxi or whatever.
0:13:07 > 0:13:10- Materna-taxi. - Yeah, materna-taxi, we call it!
0:13:13 > 0:13:17Last year, more than 700,000 babies were born in Britain.
0:13:17 > 0:13:21Around 20,000 were born outside of an NHS hospital.
0:13:21 > 0:13:23I wonder if he's round the other side of the building.
0:13:23 > 0:13:26Nearly 40 of them were born in am ambulance.
0:13:26 > 0:13:28Hello.
0:13:28 > 0:13:32- When did the contractions start, then?- Yesterday.- OK.
0:13:32 > 0:13:35You've got no urge to push or anything like that, have you?
0:13:35 > 0:13:36All right.
0:13:36 > 0:13:38GROANING
0:13:38 > 0:13:39Oh, gosh!
0:13:41 > 0:13:45I don't want to patronise you and tell you to do all your breathing and stuff like that.
0:13:45 > 0:13:47All right.
0:13:49 > 0:13:52People just think we're an extension of the GP service
0:13:52 > 0:13:54so most jobs, they're not life-threatening.
0:13:54 > 0:13:58I've not been to somebody who's been mangled by a train yet.
0:13:59 > 0:14:02I've not been to a decapitation. I'd quite like to see that.
0:14:02 > 0:14:05I've not had a really bad burn, either.
0:14:05 > 0:14:08I've had burns but not really, really bad ones.
0:14:10 > 0:14:12There's still loads to see.
0:14:12 > 0:14:15- It's very small. - Small and tiny,- yeah.
0:14:15 > 0:14:18And this one, just because of the rip. Yes.
0:14:18 > 0:14:21Stab victim Leon's scan results are in.
0:14:21 > 0:14:24They show he has a significant amount of blood in his chest.
0:14:24 > 0:14:28The doctors need to release the pressure on his lungs immediately.
0:14:28 > 0:14:30What we're going to need to do is put a chest drain in,
0:14:30 > 0:14:33which is a tube that goes in around your lungs
0:14:33 > 0:14:37to try and reabsorb some of the air that is now trapped in there
0:14:37 > 0:14:40and also to drain the blood out and allow the lungs to re-expand.
0:14:40 > 0:14:42How long am I going to be here for?
0:14:42 > 0:14:44Probably around 24 hours. 48 hours, probably.
0:14:44 > 0:14:46- All right?- OK.
0:14:46 > 0:14:49We'll crack on and do that.
0:14:53 > 0:14:56Unfortunately, it's a very common injury.
0:14:56 > 0:15:00Common across the whole of London. We probably see two or three a night.
0:15:00 > 0:15:03Two or three within 24 hours, here.
0:15:03 > 0:15:06Even in my relatively short career, over 15 years,
0:15:06 > 0:15:09I've seen the numbers go really quite high.
0:15:09 > 0:15:11They just become more and more common.
0:15:11 > 0:15:12Hurting, man!
0:15:12 > 0:15:15We just need to suture up your wound on your back, OK?
0:15:15 > 0:15:18- No, man! It's hurting! - Give it a few minutes.
0:15:18 > 0:15:21We'll give you some more painkillers as well, OK.
0:15:21 > 0:15:24Just treat him with more analgesia.
0:15:29 > 0:15:30It hurts, man.
0:15:33 > 0:15:35- One-year-old. - One-year-old.
0:15:35 > 0:15:38- One month old. - Another trauma call is coming in.
0:15:38 > 0:15:40A baby has fallen face first onto concrete.
0:15:40 > 0:15:42Please make sure that's switched off.
0:15:42 > 0:15:45- Next stop is theatre.- So, Vicky.
0:15:45 > 0:15:46Vicky.
0:15:46 > 0:15:49Mum, do you want to just come here?
0:15:49 > 0:15:51Actually, you can stand here for a minute.
0:15:51 > 0:15:55What we're going to do is we're going to transfer Max across to this other table.
0:15:55 > 0:15:59It's not clear whether baby Max lost consciousness after he fell.
0:15:59 > 0:16:03This is just a scan to make sure there is no bleeding on the tummy or the chest, OK.
0:16:03 > 0:16:06And we'll probably do a little X-ray after that, just to make sure there is no broken bones,
0:16:06 > 0:16:08which I'm sure there won't be.
0:16:08 > 0:16:11Did he cry when he, when you fell down the stairs?
0:16:11 > 0:16:14Yeah, he cried but a really strange cry, like...
0:16:14 > 0:16:16IMITATES WHINING CRY
0:16:16 > 0:16:19- Sure, sure.- All right.
0:16:20 > 0:16:23Some bruising over the nose and the forehead.
0:16:23 > 0:16:26- Bruising on his forehead. - Have a little sit-down.
0:16:26 > 0:16:27BABY CRIES
0:16:27 > 0:16:30- OK, little man. - Roll him over.- Ready, steady, roll.
0:16:35 > 0:16:37We couldn't get sats because he's so tiny.
0:16:37 > 0:16:41And rest about 60.
0:16:41 > 0:16:44I know. It happens so often. It really does. Honestly.
0:16:44 > 0:16:47In terms of Max, was it normal, well normal delivery?
0:16:47 > 0:16:49- 40 weeks?- Yeah.
0:16:49 > 0:16:52- Yeah. Two weeks early.- 38 weeks.
0:16:52 > 0:16:53'Managing a head injury properly'
0:16:53 > 0:16:56makes a massive difference in outcome.
0:16:56 > 0:16:58You can obviously save people's lives.
0:16:58 > 0:17:00That's not actually the big deal.
0:17:00 > 0:17:03For me, it's preventing brain injury that renders people
0:17:03 > 0:17:07needing 24-hour care or nursing care for the rest of their life.
0:17:07 > 0:17:10If I can prevent that, I find it rewarding.
0:17:10 > 0:17:12Shall we just, now we've done that, let's just lift him up
0:17:12 > 0:17:14and have a look down the back.
0:17:14 > 0:17:16BABY CRIES
0:17:21 > 0:17:24I'll just shine lights in your eyes, now.
0:17:26 > 0:17:28That's it.
0:17:30 > 0:17:33I've got a nine o'clock tutorial.
0:17:36 > 0:17:38The weirdest things we've seen.
0:17:38 > 0:17:42Went to a woman who had her womb stolen, she reckoned, didn't we?
0:17:44 > 0:17:47- That was a pretty strange one. - Hi, Gordon.
0:17:47 > 0:17:50We're going to use your wheelchair to get you out to the ambulance.
0:17:50 > 0:17:53Is that all right? Because it's comfier than ours.
0:17:55 > 0:17:58Mel and Jay have been called out to 85-year-old Gordon.
0:17:58 > 0:18:00He may have suffered a stroke.
0:18:00 > 0:18:02So he says confusion is worse today than...
0:18:02 > 0:18:04It's much worse this evening. Yes.
0:18:04 > 0:18:08Paramedic Jay thinks he recognises the symptoms as something less serious.
0:18:08 > 0:18:10It sounds really crude but the smell when we lifted him up,
0:18:10 > 0:18:13it does smell very water infection-y.
0:18:13 > 0:18:15I have not smelled that before.
0:18:15 > 0:18:19It sounds really bad but that's the kind of whiff the UTI makes,
0:18:19 > 0:18:21which would explain the increased confusion
0:18:21 > 0:18:24cos it can really knock you off your feet.
0:18:24 > 0:18:26- It could be.- Yeah. Definitely, yeah.
0:18:31 > 0:18:34The hospital quickly confirms that Gordon hasn't had a stroke.
0:18:34 > 0:18:36You'll be all right soon.
0:18:36 > 0:18:40'As soon as he's had antibiotics, he'll be fine.
0:18:40 > 0:18:43'That is a quite typical job, really.'
0:18:43 > 0:18:46We don't mind jobs like that, I don't think.
0:18:46 > 0:18:49When it's, it's genuine, you know.
0:18:49 > 0:18:52It's not a dire emergency but, you know,
0:18:52 > 0:18:55still needs sorting so he needs to get to hospital, so...
0:18:57 > 0:19:01The population's allegedly getting older. People die, don't they?
0:19:01 > 0:19:04Guaranteed. It's the only thing that is guaranteed.
0:19:04 > 0:19:07If I was in the state of some of our patients,
0:19:07 > 0:19:09I'd probably want to be dead before it got to that point.
0:19:09 > 0:19:14I've always said the first time I wet myself and it's not through alcohol, I want to be put down.
0:19:23 > 0:19:24BABY CRIES
0:19:24 > 0:19:28At St Mary's, Dr Wilson's team have found no serious injuries
0:19:28 > 0:19:31in four-week-old Max.
0:19:31 > 0:19:34- It's going to be fine. He's fine. - Really?
0:19:34 > 0:19:39He's fine, don't worry. Really fine.
0:19:39 > 0:19:42- He's moving all four limbs very powerfully.- Very good.- Oh, yes.
0:19:42 > 0:19:45Let's wrap him up. Let's give him back to Victoria.
0:19:45 > 0:19:49Dr Wilson will keep Max under observation until the morning, to be safe.
0:19:49 > 0:19:51If at any point he's a bit drowsy or not quite right,
0:19:51 > 0:19:55then we'll reassess him and do a scan. Is that OK?
0:19:55 > 0:19:58I mean, is there anything like brain damage, in terms of that knock?
0:19:58 > 0:19:59- That's...- Honestly?
0:19:59 > 0:20:02I've doctored loads of kids like this who are not right.
0:20:02 > 0:20:04He's right. He's fine.
0:20:04 > 0:20:07If there's something going on in his head, we'll know about it
0:20:07 > 0:20:09and we'll do something about it.
0:20:09 > 0:20:12- It's fine.- OK!- You must be really worried. Are you...
0:20:12 > 0:20:15- Who is around? - Husband's in Switzerland.- Oh, right.
0:20:17 > 0:20:19Great(!) Not helpful.
0:20:20 > 0:20:23'Working nights isn't great.
0:20:24 > 0:20:27'But unfortunately, trauma tends to occur in the evenings
0:20:27 > 0:20:32'and night-time which is obviously why the emergency department is quite busy at that time.'
0:20:33 > 0:20:36I have no life. I'm a doctor.
0:20:36 > 0:20:38It's destroyed my life.
0:20:38 > 0:20:42No. I do have a bit of a life outside. I've got some kids which I sort of see occasionally.
0:20:47 > 0:20:50I lost my footing at the top of the concrete stairs
0:20:50 > 0:20:54and I spun off down the stairs.
0:20:54 > 0:20:58I grabbed hold of the banister but I held onto him as much as I could.
0:20:58 > 0:21:02I went over and so did he.
0:21:02 > 0:21:05And it's just incomprehensible to even think about right now.
0:21:07 > 0:21:10They're just so fragile at this age.
0:21:20 > 0:21:23RADIO: Radio Lancashire at 7:06am.
0:21:23 > 0:21:25The weather, a mostly fine day with sunny spells.
0:21:25 > 0:21:27A few scattered showers likely.
0:21:30 > 0:21:32SMASHING CROCKERY
0:21:38 > 0:21:41Morning!
0:21:58 > 0:22:02I wasn't here yesterday because I'm working the weekend.
0:22:02 > 0:22:06Sadly we had a lady that died yesterday, by the looks of it.
0:22:06 > 0:22:09Looks like we got quite a few complex patients on today
0:22:09 > 0:22:12so we need to get up and out, really, this morning.
0:22:14 > 0:22:17Dot has been a district nurse for 26 years.
0:22:17 > 0:22:19There are fewer district nurses than ever before
0:22:19 > 0:22:23and Dot is the only full-time nurse covering the area.
0:22:23 > 0:22:25Just give me a ring, girls, if you need me.
0:22:25 > 0:22:27I'll be over the hill and far away!
0:22:31 > 0:22:33'The demands of the job have increased.
0:22:33 > 0:22:36'There's more complex patients that we see in community
0:22:36 > 0:22:39'so it might not be that there is more patients to see'
0:22:39 > 0:22:44but the time that we need to spend with these patients is longer.
0:22:44 > 0:22:47Cos a lot of patients are elderly
0:22:47 > 0:22:52and have quite a lot of long-term conditions.
0:22:52 > 0:22:55And it's really important that we don't just support them
0:22:55 > 0:22:57but we support the families as well.
0:22:57 > 0:23:00And you see, that's quite a big aspect of our work.
0:23:03 > 0:23:06We don't just go in and deal with the physical side of care,
0:23:06 > 0:23:08we do deal with a lot of psychological
0:23:08 > 0:23:10and social well-being needs of patients.
0:23:15 > 0:23:19KNOCKING Hello!
0:23:19 > 0:23:21We'll have a good chat about things.
0:23:21 > 0:23:24- What we need to do is do your catheter today.- OK.
0:23:24 > 0:23:27And I've also brought you a flu jab, Hugh.
0:23:27 > 0:23:29- Right.- Are you feeling better?
0:23:29 > 0:23:33- You weren't feeling very well last week, were you?- I think so.
0:23:35 > 0:23:37Can you not remember? THEY LAUGH
0:23:37 > 0:23:40So that everything's to hand.
0:23:40 > 0:23:43Thank you very much.
0:23:46 > 0:23:50- How long have you been married? - 1948.
0:23:50 > 0:23:55- So a long time. A long time.- 63.
0:23:55 > 0:23:57Wonderful.
0:24:00 > 0:24:02Morning! It's Dot!
0:24:02 > 0:24:05A lot of these patients that we go to see
0:24:05 > 0:24:09may not have family living nearby and often it's the case that
0:24:09 > 0:24:13they might be, we might be the only people they see throughout that day.
0:24:13 > 0:24:15KNOCKING
0:24:15 > 0:24:17Hello!
0:24:17 > 0:24:22- Shall we pop it in your leg? Are you all right with your...?- Yes.
0:24:22 > 0:24:24I think if we do it up here. OK.
0:24:25 > 0:24:29This is the last one, then. Wonderful.
0:24:29 > 0:24:33We get a lot more complex patients in the community.
0:24:33 > 0:24:34Patients coming out of hospital
0:24:34 > 0:24:38with chest drains and lines in
0:24:38 > 0:24:42that need management and we wouldn't have seen those type of patients
0:24:42 > 0:24:44in the community years ago.
0:24:44 > 0:24:46They would have remained in hospital.
0:24:46 > 0:24:50We got this house for less than £800.
0:24:50 > 0:24:52- Wow! Golly, me!- Yeah, yeah.
0:24:52 > 0:24:56Haven't times changed? Yes. Can't believe it, can you, really now?
0:24:58 > 0:25:02- And the rest is history, as they say! - Yes. Yes.
0:25:02 > 0:25:04- You've never looked back!- No. No.
0:25:05 > 0:25:08- Only when Jack died.- Oh.
0:25:10 > 0:25:12- That was the worst day of my life. - I bet it was.
0:25:12 > 0:25:15How many years ago was that, now?
0:25:15 > 0:25:17That Jack died?
0:25:18 > 0:25:21- Can you remember when he died? - 12.- 12, is it?
0:25:21 > 0:25:23There we go, love.
0:25:26 > 0:25:29The heart started beating, happily, which is a good sign.
0:25:31 > 0:25:34RADIO: Flooding in Fife has closed some roads this morning...
0:25:36 > 0:25:38She's got really little hands.
0:25:38 > 0:25:42She has got very little hands, hasn't she?
0:25:42 > 0:25:44Kiss on the cheek.
0:25:44 > 0:25:46Hi, I'm Will.
0:25:46 > 0:25:51I always feel a little bit strange as a 26-year-old guy,
0:25:51 > 0:25:56surrounded by people having babies and various fertility problems.
0:25:58 > 0:26:00So I tend to keep my head down a little bit.
0:26:00 > 0:26:04The department is hidden away with just two little signs
0:26:04 > 0:26:08to show you where you're going.
0:26:09 > 0:26:13- So this is Cue. - Do you want a glass of water?
0:26:13 > 0:26:16No, I'm all right, thank you. All well hydrated.
0:26:17 > 0:26:21There is the stigma attached to being a sperm donor.
0:26:21 > 0:26:24My family were quite horrified to start with, actually.
0:26:24 > 0:26:28Mum's reaction was one of complete terror.
0:26:28 > 0:26:31Thinking that I was going to have a load of kids
0:26:31 > 0:26:34running around my feet and something along those lines.
0:26:34 > 0:26:37When you're finished, ring the doorbell two times
0:26:37 > 0:26:39- and I will come here, OK? - Fantastic.
0:26:39 > 0:26:42- A pot and a pen. - Thank you very much.
0:26:42 > 0:26:44- Cheers, Will. - All right, see you.
0:26:44 > 0:26:47Will is one of a growing number of sperm donors in the UK.
0:26:47 > 0:26:51With over 50,000 women having fertility treatment each year,
0:26:51 > 0:26:53the demand for sperm has never been higher.
0:26:53 > 0:26:56This is the room that we get.
0:26:56 > 0:27:00The other one has a window in which has recently gained a curtain
0:27:00 > 0:27:04because some people could see in once.
0:27:04 > 0:27:08But basically, a couch, a sink and a toilet
0:27:09 > 0:27:15and they provide you with some slightly dated material.
0:27:17 > 0:27:19Something from back in the '80s, I think.
0:27:22 > 0:27:24So I think most people tend to just ignore that
0:27:24 > 0:27:28and bring some of their own stuff.
0:27:28 > 0:27:31So, rather important, make sure the door is very much closed.
0:27:33 > 0:27:35Cue always tells me that we're getting,
0:27:35 > 0:27:38you got to stay in here for at least half an hour
0:27:38 > 0:27:41because the longer you take, the better the sample you give is.
0:27:41 > 0:27:44So I'm not allowed out this room for at least half an hour,
0:27:44 > 0:27:47otherwise Cue gets angry with me.
0:27:47 > 0:27:51So I will now turn this film off and see you in half an hour.
0:27:51 > 0:27:53SIREN SOUNDS
0:27:56 > 0:27:58Which way? Left or right?
0:27:58 > 0:28:01Any other pains or aches?
0:28:03 > 0:28:05Right. I'll get out the way for a second.
0:28:05 > 0:28:07Yeah. How are you, are you OK?
0:28:09 > 0:28:12In south London, a motorbike has collided with a van.
0:28:13 > 0:28:17Gareth Davies is a doctor with London's Air Ambulance.
0:28:17 > 0:28:22He's been called to the scene as the biker's injuries may be life-threatening.
0:28:25 > 0:28:28If you can just, you may have to grit to teeth a little bit
0:28:28 > 0:28:30while we do this, OK?
0:28:30 > 0:28:33Just squeeze my hand. OK, so we just move it over.
0:28:33 > 0:28:38Just bear with us, we're going to move it over now. Three, two, one.
0:28:38 > 0:28:40Big breath.
0:28:40 > 0:28:43The biker's femur has been snapped by the impact of the crash.
0:28:43 > 0:28:46Gareth is worried there may be more internal damage.
0:28:46 > 0:28:48You're shivering a bit, I know.
0:28:48 > 0:28:50I think you may be in a bit of shock and a bit cold.
0:28:50 > 0:28:54So your breathing's fine. Just let me see you move your feet again for me.
0:28:54 > 0:28:56OK, that's brilliant.
0:29:03 > 0:29:07So I'm just feeling for a pulse in his leg cos the major bone,
0:29:07 > 0:29:09his thigh bone has been broken.
0:29:09 > 0:29:12When it breaks, it can damage the blood supply if it goes into the leg.
0:29:12 > 0:29:16And the way we check for that is looking at the colour of the foot and checking for pulse.
0:29:16 > 0:29:19There was some question about whether there was a pulse there
0:29:19 > 0:29:22and actually I'm quite happy that there is a pulse there.
0:29:22 > 0:29:24It feels reasonably warm.
0:29:24 > 0:29:27Do you want to give him a bit more, then?
0:29:27 > 0:29:29- Cos he's a big bloke. - Give him another 10 more?- Yeah.
0:29:29 > 0:29:32I'll give you some more morphine, OK?
0:29:32 > 0:29:34The bone in his thigh is a massive bone.
0:29:34 > 0:29:36It's one of the biggest,
0:29:36 > 0:29:42strongest in the body and to snap it requires a huge amount of energy.
0:29:42 > 0:29:44Huge!
0:29:46 > 0:29:48And it's that event that fills you full of adrenaline
0:29:48 > 0:29:51and puts you into shock.
0:29:54 > 0:29:58When the city wakes up, people start moving and start injuring themselves.
0:29:58 > 0:30:01That's the long and short of it.
0:30:06 > 0:30:09There'll be a team in there of about seven or eight people.
0:30:09 > 0:30:11They're going to fuss round you, take some X-rays and things.
0:30:11 > 0:30:15- That's all normal, all right? - Yep.- You're going to be fine.
0:30:17 > 0:30:19Can't guarantee that you might not need an operation on that leg
0:30:19 > 0:30:22but we'll see. OK.
0:30:25 > 0:30:29So, now the second stitch so we'll use two.
0:30:29 > 0:30:33A request from Peter to nurse Sue. In fact, it's a dedication, Peter.
0:30:33 > 0:30:35So make sure you're tuned in. I'm sure you will be by now.
0:30:35 > 0:30:38Elvis Presley and some Jailhouse Rock!
0:30:38 > 0:30:40OK, so that's all done.
0:30:40 > 0:30:44I've taken a grand total of 28 minutes.
0:30:44 > 0:30:46Produced my sample.
0:30:48 > 0:30:51- There's our scientist in there. - Pop that in there.
0:30:51 > 0:30:53'I can't imagine what it must be like
0:30:53 > 0:30:55'to discover that you can't have children.'
0:30:55 > 0:30:59It is an opportunity to sort of give a gift, I suppose,
0:30:59 > 0:31:03and you can't pass up that sort of opportunity.
0:31:03 > 0:31:07So this is the expenses for time and getting here and so on.
0:31:07 > 0:31:10- Thank you very much. - OK. I'll walk you out.
0:31:11 > 0:31:15'That's I think something like the 16th donation'
0:31:15 > 0:31:21so now off to another hospital to actually go and learn something useful for a medical degree.
0:31:28 > 0:31:32DOT: All right. Go steady. All right. Bye-bye, love. Bye-bye, now.
0:31:37 > 0:31:40With more people being treated at home than ever before,
0:31:40 > 0:31:44Dot and her team visit over 30 patients every day.
0:31:46 > 0:31:50We have a number of complex patients, really, on our caseload.
0:31:50 > 0:31:54And some of them are reaching the end stage of life.
0:31:54 > 0:31:57And I always think it's very much like
0:31:57 > 0:32:00when a midwife delivers a newborn baby.
0:32:02 > 0:32:05It's such a fantastic experience
0:32:05 > 0:32:07and one, probably, they will never forget
0:32:07 > 0:32:10because every child delivers different but for us,
0:32:10 > 0:32:12we're seeing the end stage of life
0:32:12 > 0:32:15and it's really important for us that we get it right,
0:32:15 > 0:32:17cos we've only got one chance to get it right.
0:32:22 > 0:32:26Dot's next patient is Jill, who is looked after by her husband, Robert.
0:32:28 > 0:32:29Jill, hello.
0:32:31 > 0:32:34SHE MOANS
0:32:34 > 0:32:38I sing to her quite a lot, but fairly badly.
0:32:39 > 0:32:42Some of her favourite sort of nursery rhymes
0:32:42 > 0:32:46which I know she likes from years ago and things that we used to,
0:32:46 > 0:32:49sort of, have a joke about when she was well.
0:32:49 > 0:32:53And I go over those over and over sometimes, you know.
0:32:53 > 0:32:56It seems to really perk her up. Yeah.
0:32:59 > 0:33:01Robert gave up his job as an engineer eight years ago
0:33:01 > 0:33:04to become his wife's full-time carer.
0:33:05 > 0:33:08Jill has a very complex long-term condition
0:33:08 > 0:33:12and she's been nursed in bed for several years now.
0:33:13 > 0:33:17Sadly, it has affected her very badly
0:33:17 > 0:33:19and she is unable to talk now
0:33:19 > 0:33:23and is totally reliant on Robert
0:33:23 > 0:33:27and the carers that go in four times a day to provide care for her.
0:33:27 > 0:33:32She understands everything, everything that you say.
0:33:32 > 0:33:34But yeah, she's quick.
0:33:35 > 0:33:37You used to not think so, by looking at her,
0:33:37 > 0:33:40you wouldn't think she would be, but she is.
0:33:41 > 0:33:43And with me talking to her all the time,
0:33:43 > 0:33:46I know that she's there, you know.
0:33:46 > 0:33:51The doctors don't know whether she can see properly or hear properly.
0:33:51 > 0:33:53They haven't said she can
0:33:53 > 0:33:55but they're not sure that she can or not.
0:33:55 > 0:33:58But I know that she can.
0:34:15 > 0:34:17Peter is due in this morning.
0:34:17 > 0:34:21The hostel's, I suppose, support worker rang just to say
0:34:21 > 0:34:24he's leaving now to get to work.
0:34:24 > 0:34:27If he gets to work, he needs to see what state Peter's in to get him here.
0:34:27 > 0:34:30So he's got to ring me close to 11:00am so I said...yeah.
0:34:32 > 0:34:34Let's see what happens, eh?
0:34:34 > 0:34:36You can tell as soon as they walk in.
0:34:36 > 0:34:39I think it depends how fast the front door opens and you go,
0:34:39 > 0:34:42"Oh, God. They nearly took the door off the hinges then.
0:34:42 > 0:34:44"What mood are they in today?"
0:34:46 > 0:34:51Dr Simon Abram's GP practice has opened its doors to what are known
0:34:51 > 0:34:53as zero tolerance patients.
0:34:53 > 0:34:57It's become the only place in Liverpool that takes patients
0:34:57 > 0:35:00who have been banned from other surgeries for abusive or violent behaviour
0:35:00 > 0:35:02and habitual drug use.
0:35:02 > 0:35:04It's well known that general practice
0:35:04 > 0:35:05has problems with access
0:35:05 > 0:35:08and the people who succeed in getting through are those people
0:35:08 > 0:35:10who are educated and sophisticated
0:35:10 > 0:35:13and can work out how systems can be got through.
0:35:13 > 0:35:15There is an appointment being made on there as well.
0:35:15 > 0:35:18Patients come to their GP practice for healthcare
0:35:18 > 0:35:22and any patient is coming for healthcare,
0:35:22 > 0:35:25no matter what their behaviour is.
0:35:25 > 0:35:27I've whacked doctors across Liverpool
0:35:27 > 0:35:30for years and years, right? And I've got away with it.
0:35:30 > 0:35:32- All right?- Nice to see you.
0:35:33 > 0:35:36I used to go into GPs surgeries using other people's names,
0:35:36 > 0:35:42just to get tablets, nitrazepam, anything ending in "pam" I'll take.
0:35:42 > 0:35:45Do you mind if I just have a quick look at the notes?
0:35:45 > 0:35:49- No, go on, doctor. Help yourself. - Some of them are hard work.
0:35:49 > 0:35:52We had a man outside the other day and he was lying on the ramp
0:35:52 > 0:35:56and wouldn't move and all the other patients were looking at him
0:35:56 > 0:35:59and stuff but you can't help it, that's just the way he is.
0:35:59 > 0:36:02- You've got your prescription? - I've got that. That's done.
0:36:02 > 0:36:04That's sorted. Thank you very much, yeah.
0:36:04 > 0:36:06I'm on eight milligrams of diazepam now.
0:36:06 > 0:36:09Next week is six milligrams
0:36:09 > 0:36:12so six weeks from next Wednesday, doctor, I'll be off them.
0:36:12 > 0:36:15- Thank you very much.- Do you think you are going to manage that?
0:36:15 > 0:36:17- Is that OK?- Do you think I'll manage that? I think I will, yeah.
0:36:17 > 0:36:20I'll struggle a little bit but I'll be all right.
0:36:20 > 0:36:24- I'll get there, doctor. - It's probably the last tablet that's going to be the hardest.
0:36:24 > 0:36:27Yeah, it will. When I get on the last one, you can probably,
0:36:27 > 0:36:30I'll see yourself or stick it on the notes or something,
0:36:30 > 0:36:34give me some Zopiclone or something, just to help me sleep.
0:36:34 > 0:36:36Hmm. That's out of the frying pan and into the fire.
0:36:36 > 0:36:38I don't see much point in that. Yes.
0:36:38 > 0:36:41What else can you help me with?
0:36:41 > 0:36:45If you want, I mean, I suspect you can get down to one tablet like that.
0:36:45 > 0:36:46But if you want to,
0:36:46 > 0:36:49I'm reasonably happy to say let's go to half a tablet.
0:36:49 > 0:36:53'It's put me on the right track, it has. It's definitely helped me.'
0:36:53 > 0:36:55They could have just said no and washed their hands of me,
0:36:55 > 0:36:57"We're not helping you, Stefan.
0:36:57 > 0:37:03"Go away and come back in a fortnight's time for your inhaler for your asthma."
0:37:03 > 0:37:05'Cos not all GPs are as nice as what you make out to be.
0:37:05 > 0:37:08'You know, I've dealt with a lot of doctors in my experience.'
0:37:08 > 0:37:12I know. You're old school you, doctor!
0:37:12 > 0:37:15All of our patients can do what they like, can't they?
0:37:15 > 0:37:18Cos we can't throw them off anyway. It doesn't matter.
0:37:18 > 0:37:20They'll only boomerang back to us, won't they?
0:37:20 > 0:37:23The ones that don't behave are here for good.
0:37:25 > 0:37:30But the future of the surgery and its zero tolerance patients is now under threat.
0:37:32 > 0:37:36A local regeneration project means the surgery has to move
0:37:36 > 0:37:38and they are struggling to find new premises.
0:37:39 > 0:37:43There is a risk that we won't have anywhere to go.
0:37:43 > 0:37:46The sort of traditional thing that would happen is
0:37:46 > 0:37:49the practice list would be dispersed to local practices
0:37:49 > 0:37:52and the zero tolerance facility would be lost.
0:37:52 > 0:37:54There are no guarantees at all
0:37:54 > 0:37:57that the services we provide would be replicated.
0:37:57 > 0:37:59I think it could be a disaster.
0:38:01 > 0:38:03We got back from New York...
0:38:03 > 0:38:06I was basically riding on a skateboard and...
0:38:07 > 0:38:10I tried to stop.
0:38:10 > 0:38:15My leg just completely twisted and it's dislocated.
0:38:33 > 0:38:35Gareth is on his way back to the air ambulance
0:38:35 > 0:38:37when another trauma call comes in.
0:38:37 > 0:38:40A mother and child have fallen through a window.
0:38:42 > 0:38:44SIREN SOUNDS
0:38:44 > 0:38:46INDISTINCT SPEECH
0:38:50 > 0:38:54A one-year-old has fallen out of a building and is not breathing
0:38:54 > 0:38:57so we're just making our way back to the helicopter now,
0:38:57 > 0:39:02as quick as we can, and make our way to that job.
0:39:04 > 0:39:07No-one likes dealing with children that are ill or injured...
0:39:11 > 0:39:13..and it always adds another layer of anxiety
0:39:15 > 0:39:17that isn't there for adult jobs.
0:39:23 > 0:39:26The baby is in a critical condition 15 miles away
0:39:26 > 0:39:30but the helicopter should get Gareth there in a matter of minutes.
0:39:31 > 0:39:34The golden hour is a term used to describe
0:39:34 > 0:39:38a period after really serious injury
0:39:38 > 0:39:42where it's absolutely vital to get things right.
0:39:46 > 0:39:49And if you don't do things in a timely manner, it will result
0:39:49 > 0:39:55in the patient's death, at worst, or leave them severely disabled.
0:39:57 > 0:40:03So a lot of clinicians feel that the golden hour is part of the hospital environment but actually,
0:40:03 > 0:40:04it belongs to the patient.
0:40:04 > 0:40:09And most of that period is out at the site of the accident or on the way to hospital.
0:40:11 > 0:40:14The baby's mother has already been taken to hospital.
0:40:15 > 0:40:18He fell nine foot onto a hard surface.
0:40:18 > 0:40:21Mother was holding him on our arrival. Respiratory arrest.
0:40:21 > 0:40:24- Blood on his face. - His airway was soiled.
0:40:24 > 0:40:27Second dose of adrenaline at the moment.
0:40:27 > 0:40:29Can we just stop and see where we are?
0:40:29 > 0:40:32We're getting some kind of rhythm but very, very slow.
0:40:33 > 0:40:36The baby's been in cardiac arrest for over 10 minutes,
0:40:36 > 0:40:40in spite of the ambulance crew's attempts to resuscitate him.
0:40:45 > 0:40:47Gareth manages to get a tube down into his lungs
0:40:47 > 0:40:51to take over his breathing but there's no heartbeat.
0:40:57 > 0:40:59So shall we just decompress his chest, as well?
0:40:59 > 0:41:01So let's do some thoracostomies.
0:41:03 > 0:41:06He pierces the side of the baby's chest in an effort to relieve
0:41:06 > 0:41:10any pressure that might be stopping his lungs from working.
0:41:10 > 0:41:13There is no air in there.
0:41:19 > 0:41:23We're letting you know we're bringing you a one-year-old little boy
0:41:23 > 0:41:26who is in traumatic cardiac arrest.
0:41:26 > 0:41:30- We'll be with you in about one minute.- Four minutes.- Four minutes.
0:41:33 > 0:41:37Gareth has done everything he can but the baby still has no pulse.
0:41:37 > 0:41:41They continue chest compressions and head for the nearest hospital.
0:41:41 > 0:41:45I mean, I'm not sure that blood is going to turn this around.
0:41:47 > 0:41:52I think we have addressed everything that will be addressed.
0:41:52 > 0:41:56'Today is an example of just how fragile things are.
0:41:56 > 0:41:58'Just walking down some steps in your own home
0:41:58 > 0:42:04'can result in absolute tragedy and it does make us as individuals
0:42:04 > 0:42:09'appreciate every moment of life cos we know that tomorrow,
0:42:09 > 0:42:14'we may not be here. It may be us. It may be our turn.'
0:42:17 > 0:42:19SIREN SOUNDS
0:42:35 > 0:42:39It's one of those you don't think about too much now and worry about it later.
0:42:41 > 0:42:43These guys did a sterling job there, so...
0:42:45 > 0:42:47A lot of unanswered questions
0:42:47 > 0:42:52which we will find answers, as much as we can, when we get a chance.
0:42:54 > 0:42:57So now the thing is to get ready for the next one.
0:43:04 > 0:43:07Come on, then. Hospital corners all around.
0:43:28 > 0:43:32Not so much now but I used to be known as the vampire.
0:43:32 > 0:43:34- That's lovely. - There we go.
0:43:34 > 0:43:38For some people, it's maybe a cultural thing.
0:43:39 > 0:43:42They don't want anybody else to have it.
0:43:46 > 0:43:50I suppose, you know, you can't expect people to embrace it because you do.
0:43:50 > 0:43:53You've got to find a way of engaging them and so at the beginning,
0:43:53 > 0:43:55I used to bribe the midwives
0:43:55 > 0:43:58and say I'd give a £20 Marks and Spencer's voucher
0:43:58 > 0:44:01to the midwife who collects the most cords that month!
0:44:01 > 0:44:04OK! Here we have it!
0:44:04 > 0:44:07It took a bit longer than we thought but we got it.
0:44:07 > 0:44:09It was a little bit tricky getting out
0:44:09 > 0:44:12so we may have lost a little bit.
0:44:13 > 0:44:16Pull the umbilical cord through.
0:44:16 > 0:44:19We take the cannula.
0:44:19 > 0:44:23Take the lid off. Get the nice, big juicy vein.
0:44:26 > 0:44:28King's was one of the first hospitals in the UK
0:44:28 > 0:44:31to collect umbilical cord blood for stem cell treatment
0:44:31 > 0:44:34that can cure diseases such as leukaemia.
0:44:34 > 0:44:38And what we try to do now is get as much blood out of the placenta
0:44:38 > 0:44:40as we possibly can by massaging.
0:44:43 > 0:44:45BABY CRIES
0:44:45 > 0:44:48You get cords that are really short.
0:44:48 > 0:44:52We've had cords where we've had to stand out here to reach the bottom!
0:44:52 > 0:44:54Really, really long cords.
0:44:54 > 0:44:57We had cords that have been really thick and kind of curly,
0:44:57 > 0:45:01that look like, remind me of the grips that go around and hold curtains back.
0:45:01 > 0:45:03That kind of twine.
0:45:03 > 0:45:05We've had cords with knots in.
0:45:05 > 0:45:08And you can see the cord is emptying.
0:45:08 > 0:45:11You can see the last of the bits of blood going down.
0:45:11 > 0:45:13So we will clamp it off.
0:45:15 > 0:45:20I find that African women tend to have really big kind of fat cords
0:45:20 > 0:45:24and Caucasian women often have quite slim chords.
0:45:24 > 0:45:28See if you can guess the nationality by looking at the umbilical cord!
0:45:30 > 0:45:32- See that white thing in the middle? - Yeah.
0:45:32 > 0:45:34- That's the tendon...- OK. - ..that I've stitched up.
0:45:45 > 0:45:47HUMMING
0:45:47 > 0:45:50She used to like this before she was poorly.
0:45:50 > 0:45:52Hair stroking.
0:45:55 > 0:45:58- Do you love her in the same way, then?- Oh, yeah.
0:45:58 > 0:46:01Exactly the same. No difference at all.
0:46:01 > 0:46:03That's for certain, is that.
0:46:03 > 0:46:06I tell her that every day, as well. Every day.
0:46:07 > 0:46:09So she knows.
0:46:11 > 0:46:12It's in sickness and in health
0:46:12 > 0:46:15and there's no chance of her ever going into a home,
0:46:15 > 0:46:18not unless something happens to me.
0:46:19 > 0:46:24As long as I'm here, stood straight up, then that's how it will be.
0:46:25 > 0:46:27So at one point they wanted to stop...
0:46:29 > 0:46:34..her food and sort of leave her to just fade away.
0:46:36 > 0:46:40And so I sort of lost it a little bit, to be honest.
0:46:40 > 0:46:43And told them what I thought.
0:46:44 > 0:46:47And then one person actually said to me,
0:46:47 > 0:46:49from the social services, at that point,
0:46:49 > 0:46:52"Are you thinking of Jill or are you thinking of yourself?"
0:46:52 > 0:46:54She actually said that in the meeting!
0:46:57 > 0:47:00Well, I've been here about four years now.
0:47:00 > 0:47:04We've come to sort of have a very good sort of relationship together.
0:47:04 > 0:47:06I think he knows he can trust me and I've got his best interests at heart
0:47:06 > 0:47:09at the end of the day and, obviously, Jill's as well.
0:47:09 > 0:47:12It's important that they've got trust in you
0:47:12 > 0:47:16and they know that you're there for them at the end of the day.
0:47:16 > 0:47:21Robert himself has got problems of his own.
0:47:21 > 0:47:24He's suffering with a long-term condition as well.
0:47:24 > 0:47:27Nearly two years after his wife became ill,
0:47:27 > 0:47:30Robert was diagnosed with Parkinson's disease.
0:47:30 > 0:47:33We don't look after Robert and he goes under,
0:47:33 > 0:47:37then Jill has to go in somewhere, so we sort of look at his needs,
0:47:37 > 0:47:41from a respite point of view and make sure that he gets a regular rest
0:47:41 > 0:47:43so that then he can carry on again when she comes home.
0:47:43 > 0:47:45KNOCKING
0:47:45 > 0:47:49Hello, Jill! All right, Jill? Hello.
0:47:51 > 0:47:53Hello, darling.
0:47:53 > 0:47:56Have you got a nice smile for us? Yes!
0:47:59 > 0:48:02You're wide awake this afternoon, aren't you? Yeah.
0:48:06 > 0:48:09It's a bit vocal this afternoon, Jill.
0:48:09 > 0:48:11SHE LAUGHS
0:48:11 > 0:48:14- The grandchildren are here. - That might be the difference, then.
0:48:14 > 0:48:18I think they've all just come back from school, Jill.
0:48:18 > 0:48:20All be coming up to see you, won't they?
0:48:21 > 0:48:23There we go.
0:48:23 > 0:48:25It's not been all bad, you know.
0:48:25 > 0:48:28You just make the best of what you've got
0:48:28 > 0:48:30because you have no choice.
0:48:32 > 0:48:34And that's what I think we've done
0:48:34 > 0:48:36and she's seen her grandchildren grow up.
0:48:36 > 0:48:39They come up here every day and talk to her.
0:48:39 > 0:48:43She really beams when they come into the room.
0:48:43 > 0:48:45So she's, although she's in bed,
0:48:45 > 0:48:48she leads as good a life as she can, under the circumstances.
0:48:48 > 0:48:52She has seen them a lot and has given them something back as well.
0:48:52 > 0:48:55So it's not really wasted at all.
0:48:59 > 0:49:02So how are you feeling, Robert, at the moment?
0:49:02 > 0:49:05I'm feeling not too bad, considering.
0:49:05 > 0:49:09Got used to the new pills. A bit stronger as well.
0:49:09 > 0:49:11I'm getting a few aches at the moment,
0:49:11 > 0:49:15which means I'm probably overdoing the job a little bit.
0:49:15 > 0:49:18Just striking a balance, you know.
0:49:18 > 0:49:20All right, take care, love. Bye for now. Bye.
0:49:28 > 0:49:31It's so hard, I mean...
0:49:31 > 0:49:35Do you ever think what sort of quality of life somebody has?
0:49:38 > 0:49:41I think it depends how you measure quality of life,
0:49:41 > 0:49:43doesn't it, at the end of the day?
0:49:43 > 0:49:48Quality of life means lots of different things to people, really.
0:49:48 > 0:49:50I think Jill's very happy.
0:49:50 > 0:49:53She's very comfortable and Robert's around her all the time.
0:49:53 > 0:49:55She's very much aware of that.
0:49:55 > 0:49:59I know that you can't actually talk but she displays a lot of emotions
0:49:59 > 0:50:04through her eyes and her facial expressions so from what we see,
0:50:04 > 0:50:09she's got quality of life cos that is her life at the end of the day.
0:50:14 > 0:50:17Just because somebody can't be independent
0:50:17 > 0:50:23and lead a normal life... What's normal, at the end of the day?
0:50:23 > 0:50:26So I think you've just got to accept everybody
0:50:26 > 0:50:30for the life that they're living and just try and support that life.
0:50:32 > 0:50:36My main focus is to keep my own illness at bay as much as I can
0:50:36 > 0:50:40and not think about it and focus on Jill.
0:50:40 > 0:50:42Because I wouldn't be able to do it if I didn't do that.
0:50:42 > 0:50:45I'll never give in. Never.
0:50:45 > 0:50:48It's just not me.
0:50:48 > 0:50:51Everybody knows that who knows me. I'll never, never give in.
0:50:58 > 0:51:01He's having to crack his knuckles about seven or eight times a day.
0:51:01 > 0:51:04- It's worse than he's making out. - CRACKING KNUCKLES
0:51:12 > 0:51:14INDISTINCT CHATTER
0:51:15 > 0:51:17How is he doing?
0:51:20 > 0:51:24This gentleman will pass away in the next hour or so.
0:51:26 > 0:51:29Right. Give me a shout when it happens.
0:51:31 > 0:51:35A patient, Philip, has been brought into A&E.
0:51:35 > 0:51:37He has a history of long-term ill-health
0:51:37 > 0:51:40and has had a suspected heart attack.
0:51:40 > 0:51:44You can ring back on 854515, it would be much appreciated.
0:51:44 > 0:51:47The nurses are struggling to find next of kin.
0:51:47 > 0:51:49Yep, can do.
0:51:51 > 0:51:55Often, by now, we've had the care home on the phone,
0:51:55 > 0:51:57asking how they're doing.
0:51:57 > 0:51:59But we haven't had that so far, neither.
0:52:01 > 0:52:03He doesn't have any family so what we'll do,
0:52:03 > 0:52:06we'll have a nurse with him and she will stay with him and hold his hand
0:52:06 > 0:52:10until he passes so at least, you know,
0:52:10 > 0:52:13at least there's someone with him as he passes.
0:52:18 > 0:52:21I wouldn't say it's something I enjoy
0:52:21 > 0:52:24but I think it's a fundamental part of your job
0:52:24 > 0:52:26and it's something that needs to be done well.
0:52:28 > 0:52:30Still, you see, he's got a very good pulse
0:52:30 > 0:52:35and he's actually making respiratory effort without any oxygen.
0:52:35 > 0:52:38The patient's vital signs are still normal.
0:52:38 > 0:52:42One of the nurses asked whether they should support him with fluids.
0:52:43 > 0:52:47No, I wouldn't. No. Let's just leave him for an hour or something.
0:52:47 > 0:52:51If we give him fluids, all we'll do is just kind of prolong it, really.
0:52:52 > 0:52:56I would just give him just some very, very low flow oxygen.
0:52:56 > 0:52:57'He's cardiac arrested twice'
0:52:57 > 0:53:02and he's got a significant past amount of history
0:53:02 > 0:53:06which would mean that if we did resuscitate him...
0:53:08 > 0:53:11..it would prolong his agony so sometimes you got to make a decision
0:53:11 > 0:53:15and sometimes a difficult decision to let someone pass away naturally
0:53:15 > 0:53:18or to be more aggressive. And in his case,
0:53:18 > 0:53:21it's in his best interests, really, just to let him pass away naturally.
0:53:21 > 0:53:25And I'm sure that will happen probably within the next hour or so
0:53:25 > 0:53:28but he's not in any pain and he's fairly settled.
0:53:32 > 0:53:36An hour later, the patient's vital signs are still holding up
0:53:36 > 0:53:38so he is taken to a side room and given fluids.
0:53:55 > 0:53:57Within minutes of the move, the patient dies.
0:54:00 > 0:54:02I was unable to go with him
0:54:02 > 0:54:06so I've just been to find out now and the wards have asked
0:54:06 > 0:54:09if I'd like to go around and help prepare him to go to the mortuary.
0:54:09 > 0:54:14So that's nice of them and I feel like it's the last thing I can do for that patient.
0:54:14 > 0:54:16It is sad.
0:54:16 > 0:54:18You always just have a think about the funeral,
0:54:18 > 0:54:23who is going to be there and sadly for some people who are alone,
0:54:23 > 0:54:26that is how it ends.
0:54:26 > 0:54:28So it is upsetting.
0:54:38 > 0:54:40Where's this nurse, Mum? Where's the nurse?
0:54:47 > 0:54:50- The fire brigade brought her in through there?- I think so.
0:54:52 > 0:54:55- Jesus. - It's the end of Gareth's shift.
0:54:55 > 0:54:58The baby he treated earlier died in hospital.
0:54:58 > 0:55:02Since he's nearby, he has decided to return to the site of the accident
0:55:02 > 0:55:04to try and draw a line under this tragedy.
0:55:04 > 0:55:05HE SIGHS
0:55:05 > 0:55:08Gareth does this whenever he can.
0:55:08 > 0:55:11The glass was very, very thin. The wood was all rotten.
0:55:11 > 0:55:13There's no banister at all.
0:55:13 > 0:55:16And there is a disrupted plant pot with mud on it all down the stairs,
0:55:16 > 0:55:19so I can only presume that she was walking down the stairs,
0:55:19 > 0:55:22tripped on a plant pot and then with that,
0:55:22 > 0:55:24she's then come through the glass.
0:55:24 > 0:55:27You can see just behind that there's a smashed window there
0:55:27 > 0:55:32and it looks as though Mum had the little fellow in her arms,
0:55:32 > 0:55:35came down the stairs, slipped and went through the window
0:55:35 > 0:55:40and then onto the porch and that's where he was injured.
0:55:42 > 0:55:45And it's a miracle she hasn't been injured as well,
0:55:45 > 0:55:48or more badly injured than that...
0:55:50 > 0:55:53..nor that they didn't suffer injuries from the glass.
0:55:53 > 0:55:55It's like many of these tragedies,
0:55:55 > 0:55:58there are just a bizarre set of circumstances behind them.
0:56:02 > 0:56:05I think it's just important for everyone to square things away,
0:56:05 > 0:56:08not be left with unknowns and you know,
0:56:08 > 0:56:12that's true for everybody, I think.
0:56:12 > 0:56:15'And it's nice to have an understanding
0:56:15 > 0:56:18'or an explanation of what happened.'
0:56:19 > 0:56:21Home sweet home.
0:56:31 > 0:56:34When you deal with cases that are very tragic,
0:56:34 > 0:56:40it's hard to go away feeling high about what you've done,
0:56:41 > 0:56:46but I think you can leave feeling we and society did absolutely
0:56:46 > 0:56:51everything humanly possible to try and bring him back from the brink.
0:56:55 > 0:56:58And, I don't know, I'll think about it on the way home,
0:56:58 > 0:57:01try and turn it into a normal Thursday evening if I can.
0:57:19 > 0:57:24My wife is a nurse and no doubt it will come up over tea
0:57:24 > 0:57:27and just probably think how lucky we are.
0:58:30 > 0:58:32Subtitles by Red Bee Media
0:58:35 > 0:58:37To order your free copy of the Open University's booklet
0:58:37 > 0:58:42Working To Save Lives, which accompanies this series, call:
0:58:45 > 0:58:48Or go to the website:
0:58:48 > 0:58:51and follow the links to the OU.