Episode 7 Keeping Britain Alive: The NHS in a Day


Episode 7

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Transcript


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This programme contains scenes which some viewers may find upsetting.

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18th of October, 2012.

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

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This change will be a disaster.

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

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Three days ago you had a stroke.

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1,500 of us will die.

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2,000 will be born.

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WHISTLE SOUNDS

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

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

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Hello. We're going to help you.

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-'We rely on it...'

-Be really brave.

-'..complain about it.'

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In the bin. That's because of you!

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Often we take it for granted.

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What we expect from the NHS is ever-increasing.

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The money to pay for it, isn't.

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

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..what would it make us think?

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This entire series tells the story of one day.

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So why isn't she waking up?

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

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Baby born at 2:55am.

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RADIO: 10th of October. The main stories.

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The report finds alarming failures...

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Official estimates suggest the number of people being trafficked in and out...

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BABY CRIES

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The stabbing we will bring into two. Is that all right?

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Every night while we sleep, the NHS continues its work,

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looking after us 24 hours a day.

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RADIO TRANSMISSION: It's a 20-year-old female.

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She's requested no lights and siren.

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She is 15 weeks pregnant

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and has taken an overdose of mixed medication.

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Repeat that. BEEPING

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Yeah, that's all received and we're mobile on that.

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Paramedics Mel and Jay are halfway through their 12-hour night shift.

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We have a young lady.

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She's 15 weeks pregnant, apparently,

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and she's taken an overdose of painkillers.

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Overdoses are really common. Yeah. Really common.

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They're normally just for attention.

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There's normally no suicidal intent but we shall see.

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Mel thinks she recognises the name and the address.

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And last time she wanted a bit of company.

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But I'm not very good at company!

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-HORN SOUNDS

-Women drivers! It's always women!

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It also said that she's asked we don't use lights

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and sirens so we'll turn them off when we get up the street.

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Apparently 999 do requests now!

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The name really, really rings a bell.

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I think it's going to drive me mad till I get there!

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Have a sit-down. What's the problem tonight?

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Stupid. Don't be stupid!

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They've picked up the patient

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and Mel recognises her as a regular caller.

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It's all over now. Don't be ridiculous.

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-Sit yourself down.

-Sit down.

-Sit down!

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-What do you think's going to happen?

-Sit down!

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Do you think we're going to let you just jump out of the cab? Eh?

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-Seriously?

-Sit down.

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What do you think is going to happen?

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Sit on the seat!

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We're here to help you. Now sit on the seat.

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Where are you going to go? We'll get the police and you'll get arrested.

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You are not getting off the ambulance.

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-You called for our help, haven't you?

-I didn't call you.

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I called NHS Direct.

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Sit down. Don't be silly about it.

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-Just get the police in. She is not going to come.

-Fine.

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You're not getting off the ambulance.

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You're not, cos I've locked the doors now.

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INDISTINCT RADIO SPEECH

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Thank you. Can we get police, please?

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We've pulled up at the side of the road.

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-This patient is trying to jump off the ambulance.

-One, two, three. Yes.

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I'm not going to let you go to jump into the road in front of cars!

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It's not going to happen, is it?

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You keep asking but I'm a stubborn twat, so no.

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RADIO: Can we confirm that you're remaining where you are at the moment?

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You're not going to get out, are you?

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It's locked so you can't get out.

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We're going to be watching it all night. You'll be videoed up there.

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In the UK, one in three of us struggles with a sleep disorder.

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Basically, the reason I'm here is that I've been having very

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disturbed sleep and it's mainly my wife, actually,

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that's pointed it out to me, but I tend to kick in my sleep,

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I twitch in my sleep

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and I'm starting to give my wife a few bruises, I think.

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SIGHING

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-Shall we go through some CCTV today, Carlos?

-Can do, yeah.

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SIREN SOUNDS

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In west London, a young man has been stabbed

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and is on his way to the specialist trauma centre in St Mary's.

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This is Leon. 20-year-old male.

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Was standing at the gateway to a house, somebody ran past him

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-that he didn't see.

-Right.

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Consultant Mark Wilson leads the team as they assess

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the extent of Leon's injuries.

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Incised wound of the left scapula.

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-Not sucking or blowing.

-OK.

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-He's had five milligrams of morphine.

-OK, fine.

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All right. Thank you very much. OK, let's take it from the top. Hi, Leon.

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How are you? I'm one of the doctors. Are you all right? So airways clear.

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-Talking.

-Let's have a quick listen to your chest, OK?

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Deep breaths in and out.

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We've got a line in, we've got the bloods off.

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'Trauma is a big thing.'

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Trauma's the commonest cause of death in the under-40s, worldwide.

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We're going to put a couple of stitches in this as well, all right?

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Do you know what you were stabbed with, by any chance?

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'Usually, we have very little history as patients come through the doors'

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so you start with a blank canvas

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and you treat in priority things that are likely to kill you

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and you're assessing and treating as you go on.

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-Is this to set him up for the chest X-ray?

-Yeah.

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The only thing that's really of obvious concern, immediate,

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is his tachycardia, his fast heart rate.

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That can be a sign of blood loss, which can occur

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without you really knowing it in young, fit people

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cos they compensate very well.

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But he kind of looks too well for that.

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It's more likely to be something he's taken or something else going on

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that's giving him tachycardia.

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Or pain. Pain alone can cause a fast heart rate.

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-We'll take the dressing down.

-Leave that for the minute.

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-Let's get the scan and chest X-ray done first and we will do that in a minute.

-No blood at the meatus.

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No scrotal haematoma. OK. Good.

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Well, on the scan we think we've seen some blood within his thorax

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so that means he's probably bleeding internally, which would account for the high heart rate.

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So we want to do a CT scan now and just see exactly how much blood he has got in his chest.

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Nice, deep breaths.

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-And again.

-I'll come with you.

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If Leon has a lot of blood on his chest,

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the pressure could force his lungs to collapse.

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On three. One, two, three.

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-Are you all right?

-We will be as quick as we can.

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SIREN SOUNDS

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Because their patient tried to jump out of the ambulance,

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Mel and Jay now have a police escort to the hospital.

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Every single person that you deal with,

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it's constantly in the back of your mind that,

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you know, this could kick off, really.

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There was no reason to do what she's just tried to do.

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To be fair, I thought she was going to hit me.

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Once a completely unconscious patient just flipped.

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Pulled my crewmate over his chest, kicked me twice in the chest

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and flung me into a wall.

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And then once in the back of the ambulance,

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we spent an hour and a half with this girl, who was drunk,

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so that she was safe till her boyfriend came and picked her up.

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And just completely out of the blue,

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she dug her nails in me and drew a tiny bit of blood.

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Whoever the judge was when they dealt with her proper threw the book at her.

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And it's the way it should be. It should be zero tolerance.

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What are you doing? Just sit yourself down.

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-Do you want me to pull over?

-Just carry on.

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-I think we'll be all right.

-OK.

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Where's your seatbelt? Move.

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-Nearly there now, anyway.

-PATIENT: Help me! Get off!

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Don't spoil it.

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-I'm only going to

-BLEEP

-do it again anyway.

-Do what?

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Take the tablets again.

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See, this really annoys me because she's saying that she's only going to do it again.

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She's been sectioned three times in the last three days.

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How long is this going to carry on for?

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Going by her history she's had an ambulance out every single day.

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The same sort of thing.

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Throwing herself off ambulances, out of police cars.

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From all the different stations, we've all got our regular callers.

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You all right, mate?

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Right, just wondering if you've got any ongoing situations at the moment?

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I think an 18-year-old with his mum and dad

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so I don't think that... He's compliant at the moment.

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Right, OK. Is there any other ongoing situations?

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'We've had quite a lot of tussles.'

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I've been here nearly 16, 17 years.

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I don't want to frighten anyone but I've had two broken noses,

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I've been stabbed once, just slightly.

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It was just a small blade.

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That was about 1997, wasn't it? So, hence we've got these.

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Every day, the NHS coordinates the collection and distribution

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of organs, thousands of litres of blood and other vital fluids.

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In this neonatal unit in London,

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premature babies are given breast milk,

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donated by new mums across the country.

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Anna's baby was born 13 weeks premature.

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I didn't have milk first three days and this is normal

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because the body is not ready for feeding the baby.

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And then one of the nurses told me that, "Don't worry.

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"They would be given donor's milk."

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I was so grateful to women which were giving milk,

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for free, to somebody else

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and maybe one day to meet them and to tell thank you.

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It's really, really important.

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SIGHING

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SIREN SOUNDS

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We're going to a 31-year-old female that's pregnant.

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Don't know how far gone she is but it's just coming through as labour.

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She's having contractions every five minutes, apparently.

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You know, they've had nine months to prepare for a birth, really.

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And then as soon as they start getting contractions,

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they'll call us rather than phone a taxi or whatever.

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-Materna-taxi.

-Yeah, materna-taxi, we call it!

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Last year, more than 700,000 babies were born in Britain.

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Around 20,000 were born outside of an NHS hospital.

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I wonder if he's round the other side of the building.

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Nearly 40 of them were born in am ambulance.

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Hello.

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-When did the contractions start, then?

-Yesterday.

-OK.

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You've got no urge to push or anything like that, have you?

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All right.

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GROANING

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Oh, gosh!

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I don't want to patronise you and tell you to do all your breathing and stuff like that.

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All right.

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People just think we're an extension of the GP service

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so most jobs, they're not life-threatening.

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I've not been to somebody who's been mangled by a train yet.

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I've not been to a decapitation. I'd quite like to see that.

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I've not had a really bad burn, either.

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I've had burns but not really, really bad ones.

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There's still loads to see.

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-It's very small.

-Small and tiny,

-yeah.

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And this one, just because of the rip. Yes.

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Stab victim Leon's scan results are in.

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They show he has a significant amount of blood in his chest.

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The doctors need to release the pressure on his lungs immediately.

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What we're going to need to do is put a chest drain in,

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which is a tube that goes in around your lungs

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to try and reabsorb some of the air that is now trapped in there

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and also to drain the blood out and allow the lungs to re-expand.

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How long am I going to be here for?

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Probably around 24 hours. 48 hours, probably.

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-All right?

-OK.

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We'll crack on and do that.

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Unfortunately, it's a very common injury.

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Common across the whole of London. We probably see two or three a night.

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Two or three within 24 hours, here.

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Even in my relatively short career, over 15 years,

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I've seen the numbers go really quite high.

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They just become more and more common.

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Hurting, man!

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We just need to suture up your wound on your back, OK?

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-No, man! It's hurting!

-Give it a few minutes.

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We'll give you some more painkillers as well, OK.

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Just treat him with more analgesia.

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It hurts, man.

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-One-year-old.

-One-year-old.

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-One month old.

-Another trauma call is coming in.

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A baby has fallen face first onto concrete.

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Please make sure that's switched off.

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-Next stop is theatre.

-So, Vicky.

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Vicky.

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Mum, do you want to just come here?

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Actually, you can stand here for a minute.

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What we're going to do is we're going to transfer Max across to this other table.

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It's not clear whether baby Max lost consciousness after he fell.

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This is just a scan to make sure there is no bleeding on the tummy or the chest, OK.

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And we'll probably do a little X-ray after that, just to make sure there is no broken bones,

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which I'm sure there won't be.

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Did he cry when he, when you fell down the stairs?

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Yeah, he cried but a really strange cry, like...

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IMITATES WHINING CRY

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-Sure, sure.

-All right.

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Some bruising over the nose and the forehead.

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-Bruising on his forehead.

-Have a little sit-down.

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BABY CRIES

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-OK, little man.

-Roll him over.

-Ready, steady, roll.

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We couldn't get sats because he's so tiny.

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And rest about 60.

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I know. It happens so often. It really does. Honestly.

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In terms of Max, was it normal, well normal delivery?

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-40 weeks?

-Yeah.

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-Yeah. Two weeks early.

-38 weeks.

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'Managing a head injury properly'

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makes a massive difference in outcome.

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You can obviously save people's lives.

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That's not actually the big deal.

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For me, it's preventing brain injury that renders people

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needing 24-hour care or nursing care for the rest of their life.

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If I can prevent that, I find it rewarding.

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Shall we just, now we've done that, let's just lift him up

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and have a look down the back.

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BABY CRIES

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I'll just shine lights in your eyes, now.

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That's it.

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I've got a nine o'clock tutorial.

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The weirdest things we've seen.

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Went to a woman who had her womb stolen, she reckoned, didn't we?

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-That was a pretty strange one.

-Hi, Gordon.

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We're going to use your wheelchair to get you out to the ambulance.

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Is that all right? Because it's comfier than ours.

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Mel and Jay have been called out to 85-year-old Gordon.

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He may have suffered a stroke.

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So he says confusion is worse today than...

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It's much worse this evening. Yes.

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Paramedic Jay thinks he recognises the symptoms as something less serious.

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It sounds really crude but the smell when we lifted him up,

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it does smell very water infection-y.

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I have not smelled that before.

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It sounds really bad but that's the kind of whiff the UTI makes,

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which would explain the increased confusion

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cos it can really knock you off your feet.

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-It could be.

-Yeah. Definitely, yeah.

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The hospital quickly confirms that Gordon hasn't had a stroke.

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You'll be all right soon.

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'As soon as he's had antibiotics, he'll be fine.

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'That is a quite typical job, really.'

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We don't mind jobs like that, I don't think.

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When it's, it's genuine, you know.

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It's not a dire emergency but, you know,

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still needs sorting so he needs to get to hospital, so...

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The population's allegedly getting older. People die, don't they?

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Guaranteed. It's the only thing that is guaranteed.

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If I was in the state of some of our patients,

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I'd probably want to be dead before it got to that point.

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I've always said the first time I wet myself and it's not through alcohol, I want to be put down.

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BABY CRIES

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At St Mary's, Dr Wilson's team have found no serious injuries

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in four-week-old Max.

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-It's going to be fine. He's fine.

-Really?

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He's fine, don't worry. Really fine.

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-He's moving all four limbs very powerfully.

-Very good.

-Oh, yes.

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Let's wrap him up. Let's give him back to Victoria.

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Dr Wilson will keep Max under observation until the morning, to be safe.

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If at any point he's a bit drowsy or not quite right,

0:19:490:19:51

then we'll reassess him and do a scan. Is that OK?

0:19:510:19:55

I mean, is there anything like brain damage, in terms of that knock?

0:19:550:19:58

-That's...

-Honestly?

0:19:580:19:59

I've doctored loads of kids like this who are not right.

0:19:590:20:02

He's right. He's fine.

0:20:020:20:04

If there's something going on in his head, we'll know about it

0:20:040:20:07

and we'll do something about it.

0:20:070:20:09

-It's fine.

-OK!

-You must be really worried. Are you...

0:20:090:20:12

-Who is around?

-Husband's in Switzerland.

-Oh, right.

0:20:120:20:15

Great(!) Not helpful.

0:20:170:20:19

'Working nights isn't great.

0:20:200:20:23

'But unfortunately, trauma tends to occur in the evenings

0:20:240:20:27

'and night-time which is obviously why the emergency department is quite busy at that time.'

0:20:270:20:32

I have no life. I'm a doctor.

0:20:330:20:36

It's destroyed my life.

0:20:360:20:38

No. I do have a bit of a life outside. I've got some kids which I sort of see occasionally.

0:20:380:20:42

I lost my footing at the top of the concrete stairs

0:20:470:20:50

and I spun off down the stairs.

0:20:500:20:54

I grabbed hold of the banister but I held onto him as much as I could.

0:20:540:20:58

I went over and so did he.

0:20:580:21:02

And it's just incomprehensible to even think about right now.

0:21:020:21:05

They're just so fragile at this age.

0:21:070:21:10

RADIO: Radio Lancashire at 7:06am.

0:21:200:21:23

The weather, a mostly fine day with sunny spells.

0:21:230:21:25

A few scattered showers likely.

0:21:250:21:27

SMASHING CROCKERY

0:21:300:21:32

Morning!

0:21:380:21:41

I wasn't here yesterday because I'm working the weekend.

0:21:580:22:02

Sadly we had a lady that died yesterday, by the looks of it.

0:22:020:22:06

Looks like we got quite a few complex patients on today

0:22:060:22:09

so we need to get up and out, really, this morning.

0:22:090:22:12

Dot has been a district nurse for 26 years.

0:22:140:22:17

There are fewer district nurses than ever before

0:22:170:22:19

and Dot is the only full-time nurse covering the area.

0:22:190:22:23

Just give me a ring, girls, if you need me.

0:22:230:22:25

I'll be over the hill and far away!

0:22:250:22:27

'The demands of the job have increased.

0:22:310:22:33

'There's more complex patients that we see in community

0:22:330:22:36

'so it might not be that there is more patients to see'

0:22:360:22:39

but the time that we need to spend with these patients is longer.

0:22:390:22:44

Cos a lot of patients are elderly

0:22:440:22:47

and have quite a lot of long-term conditions.

0:22:470:22:52

And it's really important that we don't just support them

0:22:520:22:55

but we support the families as well.

0:22:550:22:57

And you see, that's quite a big aspect of our work.

0:22:570:23:00

We don't just go in and deal with the physical side of care,

0:23:030:23:06

we do deal with a lot of psychological

0:23:060:23:08

and social well-being needs of patients.

0:23:080:23:10

KNOCKING Hello!

0:23:150:23:19

We'll have a good chat about things.

0:23:190:23:21

-What we need to do is do your catheter today.

-OK.

0:23:210:23:24

And I've also brought you a flu jab, Hugh.

0:23:240:23:27

-Right.

-Are you feeling better?

0:23:270:23:29

-You weren't feeling very well last week, were you?

-I think so.

0:23:290:23:33

Can you not remember? THEY LAUGH

0:23:350:23:37

So that everything's to hand.

0:23:370:23:40

Thank you very much.

0:23:400:23:43

-How long have you been married?

-1948.

0:23:460:23:50

-So a long time. A long time.

-63.

0:23:500:23:55

Wonderful.

0:23:550:23:57

Morning! It's Dot!

0:24:000:24:02

A lot of these patients that we go to see

0:24:020:24:05

may not have family living nearby and often it's the case that

0:24:050:24:09

they might be, we might be the only people they see throughout that day.

0:24:090:24:13

KNOCKING

0:24:130:24:15

Hello!

0:24:150:24:17

-Shall we pop it in your leg? Are you all right with your...?

-Yes.

0:24:170:24:22

I think if we do it up here. OK.

0:24:220:24:24

This is the last one, then. Wonderful.

0:24:250:24:29

We get a lot more complex patients in the community.

0:24:290:24:33

Patients coming out of hospital

0:24:330:24:34

with chest drains and lines in

0:24:340:24:38

that need management and we wouldn't have seen those type of patients

0:24:380:24:42

in the community years ago.

0:24:420:24:44

They would have remained in hospital.

0:24:440:24:46

We got this house for less than £800.

0:24:460:24:50

-Wow! Golly, me!

-Yeah, yeah.

0:24:500:24:52

Haven't times changed? Yes. Can't believe it, can you, really now?

0:24:520:24:56

-And the rest is history, as they say!

-Yes. Yes.

0:24:580:25:02

-You've never looked back!

-No. No.

0:25:020:25:04

-Only when Jack died.

-Oh.

0:25:050:25:08

-That was the worst day of my life.

-I bet it was.

0:25:100:25:12

How many years ago was that, now?

0:25:120:25:15

That Jack died?

0:25:150:25:17

-Can you remember when he died?

-12.

-12, is it?

0:25:180:25:21

There we go, love.

0:25:210:25:23

The heart started beating, happily, which is a good sign.

0:25:260:25:29

RADIO: Flooding in Fife has closed some roads this morning...

0:25:310:25:34

She's got really little hands.

0:25:360:25:38

She has got very little hands, hasn't she?

0:25:380:25:42

Kiss on the cheek.

0:25:420:25:44

Hi, I'm Will.

0:25:440:25:46

I always feel a little bit strange as a 26-year-old guy,

0:25:460:25:51

surrounded by people having babies and various fertility problems.

0:25:510:25:56

So I tend to keep my head down a little bit.

0:25:580:26:00

The department is hidden away with just two little signs

0:26:000:26:04

to show you where you're going.

0:26:040:26:08

-So this is Cue.

-Do you want a glass of water?

0:26:090:26:13

No, I'm all right, thank you. All well hydrated.

0:26:130:26:16

There is the stigma attached to being a sperm donor.

0:26:170:26:21

My family were quite horrified to start with, actually.

0:26:210:26:24

Mum's reaction was one of complete terror.

0:26:240:26:28

Thinking that I was going to have a load of kids

0:26:280:26:31

running around my feet and something along those lines.

0:26:310:26:34

When you're finished, ring the doorbell two times

0:26:340:26:37

-and I will come here, OK?

-Fantastic.

0:26:370:26:39

-A pot and a pen.

-Thank you very much.

0:26:390:26:42

-Cheers, Will.

-All right, see you.

0:26:420:26:44

Will is one of a growing number of sperm donors in the UK.

0:26:440:26:47

With over 50,000 women having fertility treatment each year,

0:26:470:26:51

the demand for sperm has never been higher.

0:26:510:26:53

This is the room that we get.

0:26:530:26:56

The other one has a window in which has recently gained a curtain

0:26:560:27:00

because some people could see in once.

0:27:000:27:04

But basically, a couch, a sink and a toilet

0:27:040:27:08

and they provide you with some slightly dated material.

0:27:090:27:15

Something from back in the '80s, I think.

0:27:170:27:19

So I think most people tend to just ignore that

0:27:220:27:24

and bring some of their own stuff.

0:27:240:27:28

So, rather important, make sure the door is very much closed.

0:27:280:27:31

Cue always tells me that we're getting,

0:27:330:27:35

you got to stay in here for at least half an hour

0:27:350:27:38

because the longer you take, the better the sample you give is.

0:27:380:27:41

So I'm not allowed out this room for at least half an hour,

0:27:410:27:44

otherwise Cue gets angry with me.

0:27:440:27:47

So I will now turn this film off and see you in half an hour.

0:27:470:27:51

SIREN SOUNDS

0:27:510:27:53

Which way? Left or right?

0:27:560:27:58

Any other pains or aches?

0:27:580:28:01

Right. I'll get out the way for a second.

0:28:030:28:05

Yeah. How are you, are you OK?

0:28:050:28:07

In south London, a motorbike has collided with a van.

0:28:090:28:12

Gareth Davies is a doctor with London's Air Ambulance.

0:28:130:28:17

He's been called to the scene as the biker's injuries may be life-threatening.

0:28:170:28:22

If you can just, you may have to grit to teeth a little bit

0:28:250:28:28

while we do this, OK?

0:28:280:28:30

Just squeeze my hand. OK, so we just move it over.

0:28:300:28:33

Just bear with us, we're going to move it over now. Three, two, one.

0:28:330:28:38

Big breath.

0:28:380:28:40

The biker's femur has been snapped by the impact of the crash.

0:28:400:28:43

Gareth is worried there may be more internal damage.

0:28:430:28:46

You're shivering a bit, I know.

0:28:460:28:48

I think you may be in a bit of shock and a bit cold.

0:28:480:28:50

So your breathing's fine. Just let me see you move your feet again for me.

0:28:500:28:54

OK, that's brilliant.

0:28:540:28:56

So I'm just feeling for a pulse in his leg cos the major bone,

0:29:030:29:07

his thigh bone has been broken.

0:29:070:29:09

When it breaks, it can damage the blood supply if it goes into the leg.

0:29:090:29:12

And the way we check for that is looking at the colour of the foot and checking for pulse.

0:29:120:29:16

There was some question about whether there was a pulse there

0:29:160:29:19

and actually I'm quite happy that there is a pulse there.

0:29:190:29:22

It feels reasonably warm.

0:29:220:29:24

Do you want to give him a bit more, then?

0:29:240:29:27

-Cos he's a big bloke.

-Give him another 10 more?

-Yeah.

0:29:270:29:29

I'll give you some more morphine, OK?

0:29:290:29:32

The bone in his thigh is a massive bone.

0:29:320:29:34

It's one of the biggest,

0:29:340:29:36

strongest in the body and to snap it requires a huge amount of energy.

0:29:360:29:42

Huge!

0:29:420:29:44

And it's that event that fills you full of adrenaline

0:29:460:29:48

and puts you into shock.

0:29:480:29:51

When the city wakes up, people start moving and start injuring themselves.

0:29:540:29:58

That's the long and short of it.

0:29:580:30:01

There'll be a team in there of about seven or eight people.

0:30:060:30:09

They're going to fuss round you, take some X-rays and things.

0:30:090:30:11

-That's all normal, all right?

-Yep.

-You're going to be fine.

0:30:110:30:15

Can't guarantee that you might not need an operation on that leg

0:30:170:30:19

but we'll see. OK.

0:30:190:30:22

So, now the second stitch so we'll use two.

0:30:250:30:29

A request from Peter to nurse Sue. In fact, it's a dedication, Peter.

0:30:290:30:33

So make sure you're tuned in. I'm sure you will be by now.

0:30:330:30:35

Elvis Presley and some Jailhouse Rock!

0:30:350:30:38

OK, so that's all done.

0:30:380:30:40

I've taken a grand total of 28 minutes.

0:30:400:30:44

Produced my sample.

0:30:440:30:46

-There's our scientist in there.

-Pop that in there.

0:30:480:30:51

'I can't imagine what it must be like

0:30:510:30:53

'to discover that you can't have children.'

0:30:530:30:55

It is an opportunity to sort of give a gift, I suppose,

0:30:550:30:59

and you can't pass up that sort of opportunity.

0:30:590:31:03

So this is the expenses for time and getting here and so on.

0:31:030:31:07

-Thank you very much.

-OK. I'll walk you out.

0:31:070:31:10

'That's I think something like the 16th donation'

0:31:110:31:15

so now off to another hospital to actually go and learn something useful for a medical degree.

0:31:150:31:21

DOT: All right. Go steady. All right. Bye-bye, love. Bye-bye, now.

0:31:280:31:32

With more people being treated at home than ever before,

0:31:370:31:40

Dot and her team visit over 30 patients every day.

0:31:400:31:44

We have a number of complex patients, really, on our caseload.

0:31:460:31:50

And some of them are reaching the end stage of life.

0:31:500:31:54

And I always think it's very much like

0:31:540:31:57

when a midwife delivers a newborn baby.

0:31:570:32:00

It's such a fantastic experience

0:32:020:32:05

and one, probably, they will never forget

0:32:050:32:07

because every child delivers different but for us,

0:32:070:32:10

we're seeing the end stage of life

0:32:100:32:12

and it's really important for us that we get it right,

0:32:120:32:15

cos we've only got one chance to get it right.

0:32:150:32:17

Dot's next patient is Jill, who is looked after by her husband, Robert.

0:32:220:32:26

Jill, hello.

0:32:280:32:29

SHE MOANS

0:32:310:32:34

I sing to her quite a lot, but fairly badly.

0:32:340:32:38

Some of her favourite sort of nursery rhymes

0:32:390:32:42

which I know she likes from years ago and things that we used to,

0:32:420:32:46

sort of, have a joke about when she was well.

0:32:460:32:49

And I go over those over and over sometimes, you know.

0:32:490:32:53

It seems to really perk her up. Yeah.

0:32:530:32:56

Robert gave up his job as an engineer eight years ago

0:32:590:33:01

to become his wife's full-time carer.

0:33:010:33:04

Jill has a very complex long-term condition

0:33:050:33:08

and she's been nursed in bed for several years now.

0:33:080:33:12

Sadly, it has affected her very badly

0:33:130:33:17

and she is unable to talk now

0:33:170:33:19

and is totally reliant on Robert

0:33:190:33:23

and the carers that go in four times a day to provide care for her.

0:33:230:33:27

She understands everything, everything that you say.

0:33:270:33:32

But yeah, she's quick.

0:33:320:33:34

You used to not think so, by looking at her,

0:33:350:33:37

you wouldn't think she would be, but she is.

0:33:370:33:40

And with me talking to her all the time,

0:33:410:33:43

I know that she's there, you know.

0:33:430:33:46

The doctors don't know whether she can see properly or hear properly.

0:33:460:33:51

They haven't said she can

0:33:510:33:53

but they're not sure that she can or not.

0:33:530:33:55

But I know that she can.

0:33:550:33:58

Peter is due in this morning.

0:34:150:34:17

The hostel's, I suppose, support worker rang just to say

0:34:170:34:21

he's leaving now to get to work.

0:34:210:34:24

If he gets to work, he needs to see what state Peter's in to get him here.

0:34:240:34:27

So he's got to ring me close to 11:00am so I said...yeah.

0:34:270:34:30

Let's see what happens, eh?

0:34:320:34:34

You can tell as soon as they walk in.

0:34:340:34:36

I think it depends how fast the front door opens and you go,

0:34:360:34:39

"Oh, God. They nearly took the door off the hinges then.

0:34:390:34:42

"What mood are they in today?"

0:34:420:34:44

Dr Simon Abram's GP practice has opened its doors to what are known

0:34:460:34:51

as zero tolerance patients.

0:34:510:34:53

It's become the only place in Liverpool that takes patients

0:34:530:34:57

who have been banned from other surgeries for abusive or violent behaviour

0:34:570:35:00

and habitual drug use.

0:35:000:35:02

It's well known that general practice

0:35:020:35:04

has problems with access

0:35:040:35:05

and the people who succeed in getting through are those people

0:35:050:35:08

who are educated and sophisticated

0:35:080:35:10

and can work out how systems can be got through.

0:35:100:35:13

There is an appointment being made on there as well.

0:35:130:35:15

Patients come to their GP practice for healthcare

0:35:150:35:18

and any patient is coming for healthcare,

0:35:180:35:22

no matter what their behaviour is.

0:35:220:35:25

I've whacked doctors across Liverpool

0:35:250:35:27

for years and years, right? And I've got away with it.

0:35:270:35:30

-All right?

-Nice to see you.

0:35:300:35:32

I used to go into GPs surgeries using other people's names,

0:35:330:35:36

just to get tablets, nitrazepam, anything ending in "pam" I'll take.

0:35:360:35:42

Do you mind if I just have a quick look at the notes?

0:35:420:35:45

-No, go on, doctor. Help yourself.

-Some of them are hard work.

0:35:450:35:49

We had a man outside the other day and he was lying on the ramp

0:35:490:35:52

and wouldn't move and all the other patients were looking at him

0:35:520:35:56

and stuff but you can't help it, that's just the way he is.

0:35:560:35:59

-You've got your prescription?

-I've got that. That's done.

0:35:590:36:02

That's sorted. Thank you very much, yeah.

0:36:020:36:04

I'm on eight milligrams of diazepam now.

0:36:040:36:06

Next week is six milligrams

0:36:060:36:09

so six weeks from next Wednesday, doctor, I'll be off them.

0:36:090:36:12

-Thank you very much.

-Do you think you are going to manage that?

0:36:120:36:15

-Is that OK?

-Do you think I'll manage that? I think I will, yeah.

0:36:150:36:17

I'll struggle a little bit but I'll be all right.

0:36:170:36:20

-I'll get there, doctor.

-It's probably the last tablet that's going to be the hardest.

0:36:200:36:24

Yeah, it will. When I get on the last one, you can probably,

0:36:240:36:27

I'll see yourself or stick it on the notes or something,

0:36:270:36:30

give me some Zopiclone or something, just to help me sleep.

0:36:300:36:34

Hmm. That's out of the frying pan and into the fire.

0:36:340:36:36

I don't see much point in that. Yes.

0:36:360:36:38

What else can you help me with?

0:36:380:36:41

If you want, I mean, I suspect you can get down to one tablet like that.

0:36:410:36:45

But if you want to,

0:36:450:36:46

I'm reasonably happy to say let's go to half a tablet.

0:36:460:36:49

'It's put me on the right track, it has. It's definitely helped me.'

0:36:490:36:53

They could have just said no and washed their hands of me,

0:36:530:36:55

"We're not helping you, Stefan.

0:36:550:36:57

"Go away and come back in a fortnight's time for your inhaler for your asthma."

0:36:570:37:03

'Cos not all GPs are as nice as what you make out to be.

0:37:030:37:05

'You know, I've dealt with a lot of doctors in my experience.'

0:37:050:37:08

I know. You're old school you, doctor!

0:37:080:37:12

All of our patients can do what they like, can't they?

0:37:120:37:15

Cos we can't throw them off anyway. It doesn't matter.

0:37:150:37:18

They'll only boomerang back to us, won't they?

0:37:180:37:20

The ones that don't behave are here for good.

0:37:200:37:23

But the future of the surgery and its zero tolerance patients is now under threat.

0:37:250:37:30

A local regeneration project means the surgery has to move

0:37:320:37:36

and they are struggling to find new premises.

0:37:360:37:38

There is a risk that we won't have anywhere to go.

0:37:390:37:43

The sort of traditional thing that would happen is

0:37:430:37:46

the practice list would be dispersed to local practices

0:37:460:37:49

and the zero tolerance facility would be lost.

0:37:490:37:52

There are no guarantees at all

0:37:520:37:54

that the services we provide would be replicated.

0:37:540:37:57

I think it could be a disaster.

0:37:570:37:59

We got back from New York...

0:38:010:38:03

I was basically riding on a skateboard and...

0:38:030:38:06

I tried to stop.

0:38:070:38:10

My leg just completely twisted and it's dislocated.

0:38:100:38:15

Gareth is on his way back to the air ambulance

0:38:330:38:35

when another trauma call comes in.

0:38:350:38:37

A mother and child have fallen through a window.

0:38:370:38:40

SIREN SOUNDS

0:38:420:38:44

INDISTINCT SPEECH

0:38:440:38:46

A one-year-old has fallen out of a building and is not breathing

0:38:500:38:54

so we're just making our way back to the helicopter now,

0:38:540:38:57

as quick as we can, and make our way to that job.

0:38:570:39:02

No-one likes dealing with children that are ill or injured...

0:39:040:39:07

..and it always adds another layer of anxiety

0:39:110:39:13

that isn't there for adult jobs.

0:39:150:39:17

The baby is in a critical condition 15 miles away

0:39:230:39:26

but the helicopter should get Gareth there in a matter of minutes.

0:39:260:39:30

The golden hour is a term used to describe

0:39:310:39:34

a period after really serious injury

0:39:340:39:38

where it's absolutely vital to get things right.

0:39:380:39:42

And if you don't do things in a timely manner, it will result

0:39:460:39:49

in the patient's death, at worst, or leave them severely disabled.

0:39:490:39:55

So a lot of clinicians feel that the golden hour is part of the hospital environment but actually,

0:39:570:40:03

it belongs to the patient.

0:40:030:40:04

And most of that period is out at the site of the accident or on the way to hospital.

0:40:040:40:09

The baby's mother has already been taken to hospital.

0:40:110:40:14

He fell nine foot onto a hard surface.

0:40:150:40:18

Mother was holding him on our arrival. Respiratory arrest.

0:40:180:40:21

-Blood on his face.

-His airway was soiled.

0:40:210:40:24

Second dose of adrenaline at the moment.

0:40:240:40:27

Can we just stop and see where we are?

0:40:270:40:29

We're getting some kind of rhythm but very, very slow.

0:40:290:40:32

The baby's been in cardiac arrest for over 10 minutes,

0:40:330:40:36

in spite of the ambulance crew's attempts to resuscitate him.

0:40:360:40:40

Gareth manages to get a tube down into his lungs

0:40:450:40:47

to take over his breathing but there's no heartbeat.

0:40:470:40:51

So shall we just decompress his chest, as well?

0:40:570:40:59

So let's do some thoracostomies.

0:40:590:41:01

He pierces the side of the baby's chest in an effort to relieve

0:41:030:41:06

any pressure that might be stopping his lungs from working.

0:41:060:41:10

There is no air in there.

0:41:100:41:13

We're letting you know we're bringing you a one-year-old little boy

0:41:190:41:23

who is in traumatic cardiac arrest.

0:41:230:41:26

-We'll be with you in about one minute.

-Four minutes.

-Four minutes.

0:41:260:41:30

Gareth has done everything he can but the baby still has no pulse.

0:41:330:41:37

They continue chest compressions and head for the nearest hospital.

0:41:370:41:41

I mean, I'm not sure that blood is going to turn this around.

0:41:410:41:45

I think we have addressed everything that will be addressed.

0:41:470:41:52

'Today is an example of just how fragile things are.

0:41:520:41:56

'Just walking down some steps in your own home

0:41:560:41:58

'can result in absolute tragedy and it does make us as individuals

0:41:580:42:04

'appreciate every moment of life cos we know that tomorrow,

0:42:040:42:09

'we may not be here. It may be us. It may be our turn.'

0:42:090:42:14

SIREN SOUNDS

0:42:170:42:19

It's one of those you don't think about too much now and worry about it later.

0:42:350:42:39

These guys did a sterling job there, so...

0:42:410:42:43

A lot of unanswered questions

0:42:450:42:47

which we will find answers, as much as we can, when we get a chance.

0:42:470:42:52

So now the thing is to get ready for the next one.

0:42:540:42:57

Come on, then. Hospital corners all around.

0:43:040:43:07

Not so much now but I used to be known as the vampire.

0:43:280:43:32

-That's lovely.

-There we go.

0:43:320:43:34

For some people, it's maybe a cultural thing.

0:43:340:43:38

They don't want anybody else to have it.

0:43:390:43:42

I suppose, you know, you can't expect people to embrace it because you do.

0:43:460:43:50

You've got to find a way of engaging them and so at the beginning,

0:43:500:43:53

I used to bribe the midwives

0:43:530:43:55

and say I'd give a £20 Marks and Spencer's voucher

0:43:550:43:58

to the midwife who collects the most cords that month!

0:43:580:44:01

OK! Here we have it!

0:44:010:44:04

It took a bit longer than we thought but we got it.

0:44:040:44:07

It was a little bit tricky getting out

0:44:070:44:09

so we may have lost a little bit.

0:44:090:44:12

Pull the umbilical cord through.

0:44:130:44:16

We take the cannula.

0:44:160:44:19

Take the lid off. Get the nice, big juicy vein.

0:44:190:44:23

King's was one of the first hospitals in the UK

0:44:260:44:28

to collect umbilical cord blood for stem cell treatment

0:44:280:44:31

that can cure diseases such as leukaemia.

0:44:310:44:34

And what we try to do now is get as much blood out of the placenta

0:44:340:44:38

as we possibly can by massaging.

0:44:380:44:40

BABY CRIES

0:44:430:44:45

You get cords that are really short.

0:44:450:44:48

We've had cords where we've had to stand out here to reach the bottom!

0:44:480:44:52

Really, really long cords.

0:44:520:44:54

We had cords that have been really thick and kind of curly,

0:44:540:44:57

that look like, remind me of the grips that go around and hold curtains back.

0:44:570:45:01

That kind of twine.

0:45:010:45:03

We've had cords with knots in.

0:45:030:45:05

And you can see the cord is emptying.

0:45:050:45:08

You can see the last of the bits of blood going down.

0:45:080:45:11

So we will clamp it off.

0:45:110:45:13

I find that African women tend to have really big kind of fat cords

0:45:150:45:20

and Caucasian women often have quite slim chords.

0:45:200:45:24

See if you can guess the nationality by looking at the umbilical cord!

0:45:240:45:28

-See that white thing in the middle?

-Yeah.

0:45:300:45:32

-That's the tendon...

-OK.

-..that I've stitched up.

0:45:320:45:34

HUMMING

0:45:450:45:47

She used to like this before she was poorly.

0:45:470:45:50

Hair stroking.

0:45:500:45:52

-Do you love her in the same way, then?

-Oh, yeah.

0:45:550:45:58

Exactly the same. No difference at all.

0:45:580:46:01

That's for certain, is that.

0:46:010:46:03

I tell her that every day, as well. Every day.

0:46:030:46:06

So she knows.

0:46:070:46:09

It's in sickness and in health

0:46:110:46:12

and there's no chance of her ever going into a home,

0:46:120:46:15

not unless something happens to me.

0:46:150:46:18

As long as I'm here, stood straight up, then that's how it will be.

0:46:190:46:24

So at one point they wanted to stop...

0:46:250:46:27

..her food and sort of leave her to just fade away.

0:46:290:46:34

And so I sort of lost it a little bit, to be honest.

0:46:360:46:40

And told them what I thought.

0:46:400:46:43

And then one person actually said to me,

0:46:440:46:47

from the social services, at that point,

0:46:470:46:49

"Are you thinking of Jill or are you thinking of yourself?"

0:46:490:46:52

She actually said that in the meeting!

0:46:520:46:54

Well, I've been here about four years now.

0:46:570:47:00

We've come to sort of have a very good sort of relationship together.

0:47:000:47:04

I think he knows he can trust me and I've got his best interests at heart

0:47:040:47:06

at the end of the day and, obviously, Jill's as well.

0:47:060:47:09

It's important that they've got trust in you

0:47:090:47:12

and they know that you're there for them at the end of the day.

0:47:120:47:16

Robert himself has got problems of his own.

0:47:160:47:21

He's suffering with a long-term condition as well.

0:47:210:47:24

Nearly two years after his wife became ill,

0:47:240:47:27

Robert was diagnosed with Parkinson's disease.

0:47:270:47:30

We don't look after Robert and he goes under,

0:47:300:47:33

then Jill has to go in somewhere, so we sort of look at his needs,

0:47:330:47:37

from a respite point of view and make sure that he gets a regular rest

0:47:370:47:41

so that then he can carry on again when she comes home.

0:47:410:47:43

KNOCKING

0:47:430:47:45

Hello, Jill! All right, Jill? Hello.

0:47:450:47:49

Hello, darling.

0:47:510:47:53

Have you got a nice smile for us? Yes!

0:47:530:47:56

You're wide awake this afternoon, aren't you? Yeah.

0:47:590:48:02

It's a bit vocal this afternoon, Jill.

0:48:060:48:09

SHE LAUGHS

0:48:090:48:11

-The grandchildren are here.

-That might be the difference, then.

0:48:110:48:14

I think they've all just come back from school, Jill.

0:48:140:48:18

All be coming up to see you, won't they?

0:48:180:48:20

There we go.

0:48:210:48:23

It's not been all bad, you know.

0:48:230:48:25

You just make the best of what you've got

0:48:250:48:28

because you have no choice.

0:48:280:48:30

And that's what I think we've done

0:48:320:48:34

and she's seen her grandchildren grow up.

0:48:340:48:36

They come up here every day and talk to her.

0:48:360:48:39

She really beams when they come into the room.

0:48:390:48:43

So she's, although she's in bed,

0:48:430:48:45

she leads as good a life as she can, under the circumstances.

0:48:450:48:48

She has seen them a lot and has given them something back as well.

0:48:480:48:52

So it's not really wasted at all.

0:48:520:48:55

So how are you feeling, Robert, at the moment?

0:48:590:49:02

I'm feeling not too bad, considering.

0:49:020:49:05

Got used to the new pills. A bit stronger as well.

0:49:050:49:09

I'm getting a few aches at the moment,

0:49:090:49:11

which means I'm probably overdoing the job a little bit.

0:49:110:49:15

Just striking a balance, you know.

0:49:150:49:18

All right, take care, love. Bye for now. Bye.

0:49:180:49:20

It's so hard, I mean...

0:49:280:49:31

Do you ever think what sort of quality of life somebody has?

0:49:310:49:35

I think it depends how you measure quality of life,

0:49:380:49:41

doesn't it, at the end of the day?

0:49:410:49:43

Quality of life means lots of different things to people, really.

0:49:430:49:48

I think Jill's very happy.

0:49:480:49:50

She's very comfortable and Robert's around her all the time.

0:49:500:49:53

She's very much aware of that.

0:49:530:49:55

I know that you can't actually talk but she displays a lot of emotions

0:49:550:49:59

through her eyes and her facial expressions so from what we see,

0:49:590:50:04

she's got quality of life cos that is her life at the end of the day.

0:50:040:50:09

Just because somebody can't be independent

0:50:140:50:17

and lead a normal life... What's normal, at the end of the day?

0:50:170:50:23

So I think you've just got to accept everybody

0:50:230:50:26

for the life that they're living and just try and support that life.

0:50:260:50:30

My main focus is to keep my own illness at bay as much as I can

0:50:320:50:36

and not think about it and focus on Jill.

0:50:360:50:40

Because I wouldn't be able to do it if I didn't do that.

0:50:400:50:42

I'll never give in. Never.

0:50:420:50:45

It's just not me.

0:50:450:50:48

Everybody knows that who knows me. I'll never, never give in.

0:50:480:50:51

He's having to crack his knuckles about seven or eight times a day.

0:50:580:51:01

-It's worse than he's making out.

-CRACKING KNUCKLES

0:51:010:51:04

INDISTINCT CHATTER

0:51:120:51:14

How is he doing?

0:51:150:51:17

This gentleman will pass away in the next hour or so.

0:51:200:51:24

Right. Give me a shout when it happens.

0:51:260:51:29

A patient, Philip, has been brought into A&E.

0:51:310:51:35

He has a history of long-term ill-health

0:51:350:51:37

and has had a suspected heart attack.

0:51:370:51:40

You can ring back on 854515, it would be much appreciated.

0:51:400:51:44

The nurses are struggling to find next of kin.

0:51:440:51:47

Yep, can do.

0:51:470:51:49

Often, by now, we've had the care home on the phone,

0:51:510:51:55

asking how they're doing.

0:51:550:51:57

But we haven't had that so far, neither.

0:51:570:51:59

He doesn't have any family so what we'll do,

0:52:010:52:03

we'll have a nurse with him and she will stay with him and hold his hand

0:52:030:52:06

until he passes so at least, you know,

0:52:060:52:10

at least there's someone with him as he passes.

0:52:100:52:13

I wouldn't say it's something I enjoy

0:52:180:52:21

but I think it's a fundamental part of your job

0:52:210:52:24

and it's something that needs to be done well.

0:52:240:52:26

Still, you see, he's got a very good pulse

0:52:280:52:30

and he's actually making respiratory effort without any oxygen.

0:52:300:52:35

The patient's vital signs are still normal.

0:52:350:52:38

One of the nurses asked whether they should support him with fluids.

0:52:380:52:42

No, I wouldn't. No. Let's just leave him for an hour or something.

0:52:430:52:47

If we give him fluids, all we'll do is just kind of prolong it, really.

0:52:470:52:51

I would just give him just some very, very low flow oxygen.

0:52:520:52:56

'He's cardiac arrested twice'

0:52:560:52:57

and he's got a significant past amount of history

0:52:570:53:02

which would mean that if we did resuscitate him...

0:53:020:53:06

..it would prolong his agony so sometimes you got to make a decision

0:53:080:53:11

and sometimes a difficult decision to let someone pass away naturally

0:53:110:53:15

or to be more aggressive. And in his case,

0:53:150:53:18

it's in his best interests, really, just to let him pass away naturally.

0:53:180:53:21

And I'm sure that will happen probably within the next hour or so

0:53:210:53:25

but he's not in any pain and he's fairly settled.

0:53:250:53:28

An hour later, the patient's vital signs are still holding up

0:53:320:53:36

so he is taken to a side room and given fluids.

0:53:360:53:38

Within minutes of the move, the patient dies.

0:53:550:53:57

I was unable to go with him

0:54:000:54:02

so I've just been to find out now and the wards have asked

0:54:020:54:06

if I'd like to go around and help prepare him to go to the mortuary.

0:54:060:54:09

So that's nice of them and I feel like it's the last thing I can do for that patient.

0:54:090:54:14

It is sad.

0:54:140:54:16

You always just have a think about the funeral,

0:54:160:54:18

who is going to be there and sadly for some people who are alone,

0:54:180:54:23

that is how it ends.

0:54:230:54:26

So it is upsetting.

0:54:260:54:28

Where's this nurse, Mum? Where's the nurse?

0:54:380:54:40

-The fire brigade brought her in through there?

-I think so.

0:54:470:54:50

-Jesus.

-It's the end of Gareth's shift.

0:54:520:54:55

The baby he treated earlier died in hospital.

0:54:550:54:58

Since he's nearby, he has decided to return to the site of the accident

0:54:580:55:02

to try and draw a line under this tragedy.

0:55:020:55:04

HE SIGHS

0:55:040:55:05

Gareth does this whenever he can.

0:55:050:55:08

The glass was very, very thin. The wood was all rotten.

0:55:080:55:11

There's no banister at all.

0:55:110:55:13

And there is a disrupted plant pot with mud on it all down the stairs,

0:55:130:55:16

so I can only presume that she was walking down the stairs,

0:55:160:55:19

tripped on a plant pot and then with that,

0:55:190:55:22

she's then come through the glass.

0:55:220:55:24

You can see just behind that there's a smashed window there

0:55:240:55:27

and it looks as though Mum had the little fellow in her arms,

0:55:270:55:32

came down the stairs, slipped and went through the window

0:55:320:55:35

and then onto the porch and that's where he was injured.

0:55:350:55:40

And it's a miracle she hasn't been injured as well,

0:55:420:55:45

or more badly injured than that...

0:55:450:55:48

..nor that they didn't suffer injuries from the glass.

0:55:500:55:53

It's like many of these tragedies,

0:55:530:55:55

there are just a bizarre set of circumstances behind them.

0:55:550:55:58

I think it's just important for everyone to square things away,

0:56:020:56:05

not be left with unknowns and you know,

0:56:050:56:08

that's true for everybody, I think.

0:56:080:56:12

'And it's nice to have an understanding

0:56:120:56:15

'or an explanation of what happened.'

0:56:150:56:18

Home sweet home.

0:56:190:56:21

When you deal with cases that are very tragic,

0:56:310:56:34

it's hard to go away feeling high about what you've done,

0:56:340:56:40

but I think you can leave feeling we and society did absolutely

0:56:410:56:46

everything humanly possible to try and bring him back from the brink.

0:56:460:56:51

And, I don't know, I'll think about it on the way home,

0:56:550:56:58

try and turn it into a normal Thursday evening if I can.

0:56:580:57:01

My wife is a nurse and no doubt it will come up over tea

0:57:190:57:24

and just probably think how lucky we are.

0:57:240:57:27

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0:58:350:58:37

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0:58:370:58:42

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0:58:450:58:48

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0:58:480:58:51

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