Episode 8 Keeping Britain Alive: The NHS in a Day

MAN SCREAMS

18th October, 2012.

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

MAN VIA LOUDSPEAKER: This change will be a disaster.

CHEERING

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

Three days ago, you had a stroke.

1,500 of us will die.

2,000 will be born.

WHISTLE BLOWS

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

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

Hi, we're going to help you.

We rely on it...

-Be really brave.

-..complain about it...

In the bin. That's because of you.

..often, we take it for granted.

Lucas, Lucas!

What we expect from the NHS is ever-increasing.

The money to pay for it isn't.

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

..what would it make us think?

This entire series tells the story of one day.

So, why isn't she waking up?

100 cameras...

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

Baby born at 2.55.

RADIO: Good morning, everyone!

-RADIO:

-This day, 18th October. It's...

BABY CRIES

-Good morning.

-Morning.

-Morning, Collette. Any drama?

-RADIO:

-..West Yorkshire, overturned lorry at...

-Could you come and see a patient?

-Yeah, of course.

-PATIENT:

-Oh, the pain's getting worse, Doctor.

Dial 2222 for me, please. Is it...? What medication is he on?

All right, there's no...

PATIENT GROANS

What happened, Doctor?

Oh, what's going on?

Oh-h!

You've had a bit of a heart attack again, it looks like.

A bit of a what?

Manchester Royal Infirmary -

final-year medical students role-play heart attack scenarios.

Not another one! Oh-h!

The patient is Bob, a £33,000 dummy.

OK, guys, we'll stop there.

Thank you so much.

You saved my life!

Bob's alive.

Bob lives again! Right, marvellous. Let's go round the other side and...

Around 282 people will have heart attacks in Britain today.

200 will die.

Dr Ordoubadi is a heart specialist.

He's about to start one of his regular 24-hour shifts.

Hi, guys!

-Oh, hi!

-Yeah, you've got a heart attack case?

Just waiting for the ECG.

He's got previous bypass, extensive cardiac history.

AMBULANCE SIRENS BLARE

Dr Ordoubadi heads up the cardiac cath lab,

a specialist unit that deals with emergency heart problems

from across Greater Manchester.

A 77-year-old man has been rushed in by ambulance, after collapsing at home.

-Hello. You've had a bypass operation, when?

-1997.

-1997.

-Had you had previous heart attacks?

-Yes, the first one was in '92.

MACHINE BEEPS

-Sorry.

-It's all right, don't worry.

-We won't be able to...

I had a stent fitted and it was during the stent-fitting that I had a heart attack.

-Do you still have the chest pain?

-Yes.

-It looks as though you might be having a heart attack.

-Oh!

The cath lab aims to treat all patients within an hour

of their heart attack. The sooner Clifford gets treated,

the better the chances that doctors can prevent long-term damage.

If there's a blockage, we'll try to unblock it.

The longer that artery remains blocked,

the more muscle that actually dies,

so we need to unblock that as soon as possible, to save more heart muscle.

Are we ready?

That's why we want to get him in as soon as possible,

because the best way to unblock the artery is by putting

the wire down and doing angioplasty.

'And the sooner we get him on the table,

'the sooner we know where the blockage is and the sooner we can open it up.'

What a pain.

Damp, clammy...

Not very nice, no.

Access time now.

OK, all set.

OK, can I have the camera in, please?

Dr Ordoubadi guides a tiny catheter from Clifford's groin,

so the artery is feeding the heart, in an attempt to free the blockage.

It's, kind of, like fishing...

Fishing, fishing, fishing.

So, in a minute, you're going to get this hot flush. Ready?

Stop breathing, sir.

Make it start.

Clifford has had 20 years of heart problems,

but it's only in the last five that this technique has been available.

This artery is very degenerative.

It's, kind of, got massive amounts of clots in it.

It's just full of clots, full of clots.

Below it, haemorrhaging.

We found the problem.

Where they put the stent in, inside your chest,

-that's blocked off.

-Ah-ha.

-Mm.

Outside the operating room, the cath lab is starting to fill up.

As well as six patients booked in for pre-planned treatments,

there are more emergency cases coming in.

PHONE RINGS

Hello, primary PCI, Justine speaking.

OK, where is he coming from?

Just blue-light him straight over, don't worry.

-RADIO:

-Both directions between the M6...

-Put an arrow there, if that's all right?

-Yeah!

I'd love to go on Bake Off.

HENS CLUCK

GEESE SQUAWK

Morning, Basil.

Morning, Paddy.

Sit!

Morning, Mother.

25-year-old Ciaran has an extremely rare genetic disorder called Prader-Willi.

He just licked my ear!

The rabbit's just licked my ear.

Pardon!

Are you all right?

He's a bit irregular.

Mostly, that's what I hold, is the wee bunny rabbits.

That's all you do, put them towards your heart and hold them tightly,

but not too tight.

One of the main symptoms of the condition is an insatiable hunger,

for which there is no effective treatment beyond careful supervision around food.

GOOSE SQUAWKS

I am throwing this to Basil, the goose.

SQUAWKING CONTINUES

-My, he loves the tomatoes! Aye, doesn't he?

-Yeah.

-Yeah.

Since leaving home at 18, Ciaran,

who also suffers learning difficulties, has been

in and out of community placements and secure institutions.

For the last three weeks,

the NHS have been helping to fund a place in supported accommodation.

-DIRECTOR:

-So this is your palace, then?

-Yes, this is my palace.

My palace.

At Kilcreggan, Ciaran has his own house, but for his own safety,

his access to food is carefully controlled.

It's thought that as many as one in 35 people with Prader-Willi die as a result of overeating.

Does it frustrate you having the fridge locked and everything locked up?

It does, yeah. It doesn't feel like a normal person.

Like, yourself, your fridge is not locked.

If they didn't lock your fridges, would you eat the stuff in it?

No, I won't, but other Prader-Willis would eat themselves to death.

Overeat, overeat, you put on a lot of weight,

and then the wee heart stops and that will be the end of them - dead.

I'm still alive...

because I just watch what I eat, sometimes.

KNOCK ON DOOR

-Hi, Ciaran, how are you doing?

-Hello, Damian.

Damian is the manager of the home.

He knows that today, like every day, he'll need to watch Ciaran closely.

Ciaran is going to be a difficult proposition.

He feels hungry all the time.

That urge to quench that hunger is on him all the time,

irrespective of how much he eats.

To complicate it further, he has diabetes.

When you factor in his constant desire to have food

and how he can manage to manipulate situations

and get food in other ways that you are not aware of,

it makes it an extremely difficult condition to work with.

Can you sometimes be manipulative to get food?

Mmmm, if I was hungry, yes.

-Are we nearly ready to rock?

-Yes.

-Yes, you done?

'An hour delay on the train's northern route.'

Um, I was close to pigeons a few weeks ago.

-But not regularly close to pigeons?

-No.

-He is such a happy boy.

-What time are you taking him in?

-I'm not too sure.

-Has he not said yet?

-No.

Tell me about Kyran's heart operation today.

They are going to be opening him up from the chest

and then they are going to be fixing his aortic artery.

It's not a small operation.

There's nothing you can do about it though, is there? He has to have it.

Oh, dear.

Baby Kyran is six months old.

He was born with an abnormally small main artery to the heart

and, at ten-days-old, had his first open heart surgery.

Today is his second operation and, if all goes well,

it should be his last.

We need to stop the heart to go in and do this operation.

This is a complex procedure.

We need to put him on a heart-lung machine which takes

all of the blood, mixes with oxygen and pumps back into the body.

Getting into the chest a second time is always a difficult problem.

There's a bit of risk involved with this operation,

but I'm quite confident and optimistic that Kyran

-will do very well.

-Yes.

Parents Michael and Gemma separated before Kyran was born,

but attend all his medical appointments together.

What's that big smile, mate? Look at that big, lovely smile!

Here you go.

Is that better, eh, mate? It's cold on them corridors.

You don't have a clue, do you?

He's so happy.

-I know.

-It's the best way.

-I know.

Is that nice?

Hello, gorgeous. He's gorgeous, isn't he?

-Is he always this well behaved?

-Yeah.

BABY WHIMPERS

I'm sorry, sweetie. Oh, dear.

BABY CRIES

-Oh, sorry. Oh!

-OK, sh, sh, sh.

That's it now. Big kiss and we'll look after him for you, OK?

Did you see his eyes!

Bye now.

Did you see his eyes?

His eyes were just like, up like that.

I'm just a bit shocked because he...

He still had his eyes open as he was falling asleep,

so his eyes were like, going up.

The operation to repair Kyran's heart is expected to take 4.5 hours.

I'll try and get some sleep.

I wouldn't be able to go to sleep.

See the dots? Those dots are all clots.

It doesn't look that big,

but you only need that much to cause a complete blockage.

In the cath lab, Dr Ordoubadi has been working for over an hour

on Clifford's blocked arteries.

We have done a bit of fishing, we're going to do more fishing.

-What does the ECG doing?

-'It's on slow motion.'

-Thank you very much.

-What does that mean?

That means that what we were doing is working.

Simple as that.

Yes.

Yes.

Come in.

You can see the white bit is the clot,

we have actually managed to catch the clot.

Taking everything out...

This is the moment of truth. Let's get rid of this clot.

So this is it.

Open it up, that red bit at the bottom

is all of the clot that we captured.

That is what I found here.

OK, good. So, I think our job is done.

Clifford's procedure has been a success.

He'll be taken to recovery

while Dr Ordoubadi moves straight on to his next heart-attack patient.

You've got to treat her condition, so we just put it on, anyway.

The other one is already coming, isn't it?

It's coming from Hull, but I think that would be more suited to Bernard.

-Tell me what to do, I'll do it.

-Dance!

What would we do without the NHS, eh?

Hmm?

-What was the question?

-Show them what they get in a pack.

I could rip open the pack!

Are we allowed to rip it open?

There is a science behind what's in the pack.

Absolutely...

What we came across in the evidence is that,

if you quit for 28 days, you're actually five times more likely to quit

for good and so that is what we focused on with this campaign,

so it is a start to stopping, as it were.

At one point on Monday, 1 October when we launched,

we had 50 tweets a minute.

One, two, three, four, five. Yeah?

10, 11, 12, 13, 14, 15, 16.

So I would be lying to you if I said that I'm not nervous

or I'm not anxious or anything like that.

Most of the cases, when they are straightforward,

we don't think twice about it, but today's case, Kyran,

being a second operation, there is a certain element of risk.

-Testing the saw.

-Testing.

This is where things can go wrong while opening the breastbone

we can straight enter into the heart,

so we make sure that everybody's available in the theatre.

We have the perfusionist and the heart-lung machine ready

and set up, in case if we need to go on bypass.

Gently.

Are you OK?

Is everybody all right?

SAW WHIRRS

It's always in my mind, what they think they might be doing

and... I have visions in my head and...

I just don't think about it.

I don't know how you can do that. How can you not think about it?

It's mine now.

Hello, mate. What's been happening?

That's good news, Dad.

Look at the camera. Smile for the camera.

I know you haven't done your hair yet, but, hey!

You're still beautiful, you get me?

A true teenager.

Genieva was diagnosed with early stage kidney failure.

That's my girl.

Oh, it tastes nasty.

Yeah, but you know it's not about the taste,

it's about what it's going to do for your body.

All right there?

-Are you Genieva's sister?

-Yes.

Give her a kiss, then.

Do you love her?

Oh, cuddle time.

The Yorkshire air ambulance is one of 35 helicopters on stand-by

today across the UK.

'Ambulance, tell me exactly what's happened?'

'I've had a mechanic doing some work and I think he's had a heart attack.'

A call has come from a farm outside Ripon.

'OK, I'm organising help for you now.

'Stay on the line and I'll tell you how to do resuscitation.

-'Listen carefully.'

-Yes.

'Pump the chest hard and fast at least twice a second.

'We're going to do this 600 times or until help can take over.'

Paramedics have been dispatched by road.

The helicopter has been scrambled to get the 80-year-old mechanic

to hospital as fast as possible.

-'Is that the right pace?

-Yep. Keep going for me.'

'11, 12, 13, 14, 15...

'..55, 56, 57, 58, 59...

'..90, 91, 92, 93...

'96, 97, 98, 99...'

'Don't give up, this will keep him going

'until the ambulance gets there.'

'98, 99, 100. I think the ambulance is here.'

'OK, keep going for me until they're ready to take over.'

'I don't how long he was down. I literally...'

Paramedics are on the scene, trying to resuscitate the mechanic.

It's now 15 minutes since the 999 call was made.

Found collapsed, was blue, I got here CPR was in progress

when I got here. Arrest could have happened at any time.

He has got a bit of a cut on his head.

OK. Just stop.

Carry on. Tell me if you want to swap.

See if you can gather any information off the other guy,

-age and that type of thing.

-Yes, sure.

-Cheers.

Is it a relative or...?

No, he's a friend from the village. He does a bit of mechanicing.

He could be hypothermic. It's unlikely.

At the moment, he's not responding to anything we're doing.

-No, I didn't like the look of him when I found him.

-Yes.

Probably not going to be here.

He's not got any bruising where he's fallen or anything like that?

No. There is one cut here. He could've clouted it on the way.

He was saying to the chap it was a bit of a bugger as a job,

when he was doing this vehicle, so he could've got himself worked up.

Liz Shade.

-She's going to be absolutely mortified.

-Of course she is.

Why don't you hang fire a minute and let's see what happens.

Let's see if...

Yes, I don't want to hide it from her either, do you know what I mean?

I didn't know whether to call her first or the ambulance, but it was ambulance.

Yes, yes.

Pupils are fixed and dilated.

All right,

I think we're going to get to the point of calling this.

Is everybody happy that we call this?

All right, we've done ALS, we've done BLS.

-All his reversible causes.

-All his reversible causes.

Maintained asystole throughout.

-Right, stop here then, yes?

-Yes.

Tell this gentleman.

Yes, as we suspected, we've given him all the drugs we can

so far and, there's nothing.

I think Mark's just gone to...

I mean, great stuff for doing what you did.

I mean, certain cardiac events, certain things,

there's just no coming back from.

-Right, I better go up and see Liz then, hadn't I?

-OK.

Husband, father and grandfather

Jim Shade had no previous history of heart trouble.

We cut here. Press it and cut there.

Just leave it there.

Having reached baby Kyran's heart,

surgeon Ram is ready to cut into the artery.

Kyran's heart problems, this part of the aorta was quite small

when he was born, so, initial operation,

we made this bigger and now he came back with narrowing in here,

right in the root of this great vessel,

so we had to enlarge that wall,

make it bigger, as well as this part of the great artery.

To widen the valve, Ram has to painstakingly stitch

a six-millimetre skin graft into the artery,

but he can't operate with the heart beating.

-Are you happy?

-Yes.

-On bypass please.

-OK.

The bypass machine will take on the job of the heart.

So now, the heart-lung machine is taking over the circulation

and the heart will become empty now.

-We are about to stop the heart.

-We are about to stop the heart.

It has actually stopped.

If you see the ECG monitoring line there,

which has completely gone flat.

The white at the top and the heart rate is zero.

Gemma first found out there was a serious problem with Kyran's heart

during a routine pregnancy scan.

Doctors couldn't tell whether the defect was treatable

and weren't able to give a clear prognosis until he was born.

I was 32 weeks pregnant and they actually said to me

that I could actually terminate my pregnancy then.

For someone to say that you could terminate your baby at 32 weeks

is, it's very hard to take.

I couldn't.

I know they have to give you that opportunity

to have a termination but...

No, I couldn't.

Because of all the stress, me and Michael have split up.

Michael couldn't take it, so he went to live with his mum.

I think he just wanted to be on his own.

For Michael not being there, it was a lot harder to...

Because I was, I just got all of that information about Kyran

and all I wanted to do was just cuddle up to Michael,

you know, like you do, and he weren't there.

You're too busy worrying to think about each other. It's quite...

It very difficult.

He'll be all right.

Genieva, roll your window.

Thank you.

Where are you going, Genieva?

-Look in the camera, please. Where are you going?

-Hospital.

Which hospital?

Evelina.

Guys Children's Hospital.

-How do you feel about going there?

-OK.

You feel OK?

Cheese, Mum!

-Why do you have to go there?

-To have dialysis.

-Look into the camera, please.

-Cheese!

-To have dialysis.

-Three times a week.

-Yes.

Cheese!

'A very important date in the calendar of Welsh music today...'

My friend, Louisa, the blonde.

Very good. What lovely teeth.

Stigmatise the cigarette, rather than the smoker.

We want the smokers to feel we are on their side.

OK, let me show you again. This is our dominant image.

It's a cigarette with a fleshy, red, cancerous tumour.

Oh, I could never be a heroin addict!

'We are talking about the cost of celebrity gone wrong.

'Plebgate, it's not going away, you know.

'Gary Barlow is off on a solo tour. Would you pay to see him

'without the rest of the Take That lads?

Under the watchful eye of Kilcreggan care home staff,

Ciaran is making his favourite egg and onion sandwiches for lunch.

Ciaran does like onions,

absolutely no problem to him.

Eats them like apples. It's an acquired taste, that's for certain.

There is no medication to ease Ciaran's constant urge to eat.

All staff can do is make sure he maintains a healthy lifestyle

with exercise and strict meal rotas.

You go swimming today, yes?

No. Go on Sunday.

-It's under swimming.

-Zumba.

Zumba.

-Zumba.

-Zumba today.

-Yes.

-OK.

-I know what my days, I know my schedule, blah blah blah.

That's what I'm looking for.

You don't have soup today.

Yes, I have soup with my sandwich.

It's all right.

Go on, make a big fuss of it.

Go on! Make a big fuss of it! Go on!

-Make a big fucking fuss of it!

-I just want to...

Go on, make a big fuss of it, go on.

-I just want to talk to him.

-Go on, make a big fuss of it.

You see that there. I can crumple it up. I can put it in the bin.

-That's because of you.

-No, I just explained to you.

I've put it in the bin.

-You can read. Today...

-Fuck away off! Fuck away off!

Calm down, Ciaran.

I'm going to see him.

I'm not staying in this fucking Kilcreggan.

I'm telling you, I'm telling my mother.

Calm down, calm down.

Fuck away off. Fuck away off!

You are driving me in-fucking-sane, man.

He's over limit on his food budget,

because the soup is tomorrow's lunch.

Being in this place makes me so popping mad sometimes.

Ciaran, did you read this?

Get the saucepan out of his hands.

I'm sure you read that, Ciaran.

I always have a soup along with my sandwich.

So is the thing for you and me to do

-to have a conversation with Sandra later on?

-Yes.

OK, that's the thing we'll do then.

Mealtimes will, nine times out of ten, will be challenging.

What he was after, was he'd seen the cup-a-soups sitting there

and that's what he wanted.

That was part of his menu yesterday and part of his menu tomorrow

and he knows his menu, you can be absolutely sure of it,

but that was an opportunity that he'd seen to get something extra.

Anybody else, it's not a problem,

but, you know, he's limited to an amount of calories.

His metabolism burns off food a lot slower than we do

and that's where the real risk is.

It seems like such a simple thing to turn around and say,

"Yeah, go ahead and have that,"

and the next time, "Go ahead and have that."

Then you come back four weeks later and allow him to have all that

and you're looking at a stone weight on as fast as that.

And that continues to multiply

and that's where the real danger in his health comes to.

54 minutes, coming up to an hour now.

OK, now let me assess that other side once again to see...

No, stop.

He is given? OK, we will try and do our best to...

Ram has successfully sewn the tiny graft into baby Kyran's heart valve.

But in doing so, he has discovered another problem.

These are called the leaflets of the valve, they are supposed to be

very thin, but in Kyran's case they are a bit thicker now.

What looks like instead of having three leaflets out of three doors,

-surprisingly he has got only two doors.

-Did you know that?

Sometimes with the scans you can't exactly see,

but what we know is that it will cause problems to him

later on because it's not a normal valve.

The newly discovered defect means Kyran may well have to undergo

more open heart surgery.

What we need to do now is to expel all the air.

If air travels to the brain, it causes brain damage.

Is the vent sucking OK?

OK, clamp off, lungs off, please.

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

You can see the ECG has returned.

The heart is contracting,

so now we are ready to take Kyran off the heart-lung machine.

-Are you happy?

-Happy.

Are you ventilating a bit? Come off bypass, please. Go on.

-A little bit of volume, please.

-OK.

Ram can only be sure this operation has worked

when the heart is beating independently

and the scan shows the artery is working.

I am happy.

With the scan we have done

and with the result, we are sure that the operation is a success.

-Hello.

-Hello.

-Everything went fine.

-We did what we planned to do.

-Yes.

There were a couple of things that we hadn't been expecting.

Normally in every person the valves should contain three doors,

open and closed. Normal people.

So what Kyran has got is he has got only two doors

and the two doors are not equal.

So the problem now is that since his valve is not normal,

-it might require another operation later on.

-OK.

-He hopefully won't need another one after that.

-Hopefully not.

-Hopefully not.

-So...

-Everything went well.

We'll give him some more time

so that he'll settle and then wake up properly.

Yay!

-I'm going to cry. I am just so happy.

-Yes, he is fine.

-Good.

Thank you very much. Yes. I'm just so happy.

Everything were good, everything were successful, yes.

I'm just so happy. Yes.

At the cath lab,

73-year-old Noel has come in to have his arteries examined.

I seem to be, you know,

if I'm walking any distance, I seem to get breathless very easily.

And I get tired very, very easily.

So they just want to sort of check to see basically

what's causing this problem.

-What do you think it might be?

-Who knows?

Just have to wait and see.

Bit of pushing in the arm now, sir, a bit of pushing in the arm.

-Right, sir, we're done.

-Lovely.

We're going to take this tube out of your arm now,

if you just hold onto this, sir.

-We are done.

-Glad it's over.

-Right, so I'm just going to...

-Pretty boring just lying here.

All I'm thinking now is a nice cup of coffee.

And a cigarette. I shouldn't say that, should I?

Your arteries, although there are certain blockages here and there,

they're not severe enough to require any intervention,

be it stents or bypass surgery or anything like that.

The other thing to say is that the pumping function of your heart

is actually not bad.

So why does my body feel as if it's out of oxygen after about 100 metres?

-You know, remember you are a smoker, aren't you?

-Yes.

So it's not necessarily your heart that's to blame for all of this.

He does have clinical signs of smoking-related lung disease

and he's promised he's going to stop, gradually.

-Yes, the willpower is what you need now.

-Yes, I do.

Say to yourself, "Look, it's not too bad,

-"I've been given reasonably good news..."

-Right.

-"..let's consolidate that and build on it."

-Yes.

-OK?

-See you later on on the ward, then.

-Yes.

Smoking is a big part of his problem

and his main problem is breathlessness.

A proportion of his breathlessness will be down to his lungs

because when I did examine them, he does have wheezy lungs,

he's got expanded lungs and it's probably all smoking-related

so a lot of his breathlessness will be down to smoking.

Does it frustrate you that people carry on smoking after you see them?

It can be, but you know, you do your best to improve their health

and as frustrating as it may be, there is nothing I can do

to force him to stop. All we can do is just keep advising.

It's good news but I still haven't got sort of... How can I put it?

..something that I can do which actually can give me an improvement.

-If you understand me.

-They said if you cut down on smoking...

Yes, yes, yes. Well, I'm on ten.

Ten a day.

Instinctively I feel that that's not the problem.

Oh, well.

-How are you feeling?

-Anxious.

-Nervous?

-Yes.

-Excited?

-Excited, nervous.

-Can't wait?

-How old are you?

-Me, I'm 39 now,

I had a heart attack when I was 37.

And since I've had my bypass I've been back here 44 times

-with the same problem.

-That's crazy, isn't it?

-Yes.

I used to think it was down to being a little bit overweight,

but the time when I had my last heart attack,

there was a person in there who was on my ward, in my cubicle,

and by looking at him you could see that he was really fit,

he goes to the gym and everything and he had a bypass

so it could happen to anybody, really.

Right hand, quickly, quickly.

HE RETCHES

This is the hand that I used to use.

I had a stupid idea this, three months ago, I said,

for my 77th birthday, which was last week, to celebrate it...

..in Croatia. Dear! Did we?

Any heart problems prior to last week?

-I have had a heart attack when...

-July, 1996.

David and Josie have been married for 53 years.

On holiday in Croatia last week, David was rushed into hospital.

He spent three days on a coronary care ward in Dubrovnik

where he was diagnosed with a heart murmur.

He flew home, but today his symptoms have returned.

At least they all speak English, don't they?

David can communicate with people and you couldn't there,

and they were lovely, but it was very hard work, wasn't it?

Oh, yes, wonderful, wonderful doctor.

It was very traumatic for me in Dubrovnik.

They put him in a place like this,

"Well, we will keep him in. You go, we will keep him in."

I thought, "Oh, thanks."

So at twenty to four in the morning,

I was left in a very, very dark corridor with just little...

Nothing like these, nothing at all like that, just little lamps.

So how do you get out of there? You know?

"How do I get out of there?"

I thought "Well, I think I've done the easy bit,

"the easy bit is I've got David looked after,

"I could do with someone to look after me,"

because, you see, all the signs are in Croat. You just...

It's not something that I would recommend to anybody,

but we got through it.

Anyway, I found my way out with the help of a...gorgeous man.

Clogs and all. White clogs and everything on. You know?

We did want to come home, yes.

David more than me, because the food was, it was fed in steel bowls.

You know, like you give dogs.

It was, well, I don't know if it was soup or Ready Brek.

I don't know what it was. It was indescribable.

The food was terrible.

He said, "Look at my lunch!"

But he's not right, my David, you know, he's not right.

They'll get him right, hopefully.

Kyran is back from theatre and he is stable,

but since he's come onto the unit he has started bleeding

more and more.

We are on top of it, but his body is fighting us so we need to keep him...

There's been an unexpected complication.

Kyran's suddenly losing a lot of blood.

I can see his heart beating.

Yes, because it's beating so hard, so fast, the heart.

-He's not going into cardiac arrest or anything?

-No, as long as we...

Ram is going to reopen Kyran's chest to find out why he's bleeding so heavily.

If he is bleeding excessively...

When he initially came in here, it wasn't much,

he was extubated, everything was good, we thought.

But then he suddenly started bleeding.

We interfered with the clotting mechanism of the blood, so

we keep it very thin and sometimes it doesn't thicken very well.

It is always safer to have a look.

Hopefully we can fix it.

Will someone ring us?

Can I give him a quick kiss?

Ram needs to operate immediately and so closes the intensive care ward.

I thought that were it, I thought he were going to be fine and then...

Everything's changed.

I'm confident in everything what they're doing, but it's...

At the end of the day, it's still my baby and there's still,

something, you know, serious happening.

He's got an emergency on and there's one treat and return.

-And there's another one going in.

-There's another one after this one.

It looks like we going to be busy already, so...

I know, that's why I want to create as much capacity.

The cath lab is having a run of emergency cases.

When you say extensive, have you got a measurement?

OK, all done! Good news.

-One in, one out.

-One in, one out.

ETA, when, sorry?

Ten minutes, OK. Thank you very much.

There is a shortage of beds and procedure rooms.

Five minutes, thank you. All right, thanks, love. Bye. Five minutes.

With another emergency case about to arrive, the team have to make

a difficult decision about a female patient from another hospital,

who's been waiting for her planned operation.

She won't have a bed to go into because they're all male beds.

I'm not arguing who should be done, but there is still two to do.

Don't you agree with that, though?

Don't you think that's a wise decision?

If we can't do it, we can't do it.

-We're just moving, so there should be a bed.

-Right, lovely.

She's crying.

She's not happy.

It's quite sad really, because she's been waiting for a few days.

She's got a complex case and you want to do her procedure

but you can't right now, because we've got an emergency coming in.

If it's up to you, you'd stick around after five o'clock

and do it at six or seven, but it's not up to you

and we've got nowhere to put her after we do her procedure.

The latest emergency patient is 74-year-old Rita.

When did the chest pain start?

I've had an aching chest all week.

-Have you got chest pain now?

-Yes.

-ECG, please.

The ECG shows you're having a heart attack.

In that case we're going to take you straight to the lab

to unblock the artery to stop the heart attack.

-Is that OK?

-Yes.

-Let's go.

What's happened to the ECG?

INAUDIBLE SPEECH

Right, OK, so that means that we need to be acting more quickly.

-If you hear extensive ST changes...

-It sounds bad.

-It sounds bad, yeah.

I've just walked into the dialysis room.

This is the machine that Genieva's going to be plugged into.

My precious baby will not be on dialysis for ever,

because there's nothing God cannot do, amen.

Some saline.

When you found out I was sick, like, how did you feel?

When I found out you were sick I was heartbroken,

because...this was the last thing I expected to hear.

'See how it is out there on the water...'

THEY GIGGLE

-How are you feeling over there?

-All right.

-OK. Any chest pain?

-How is the chest pain?

-It's got a lot easier.

We can see why, because we managed to open the artery for you. It's open.

So you're getting blood back to your heart, which is good news.

That is the artery now.

That's what it was before. And here, the blood flow stops completely.

The edge of the heart is there,

so that portion of the heart is not getting any blood here.

And now, we put a stent here

and now we know that the blood flow is going back to where it should be.

Good.

-Are you a smoker?

-Yes.

One artery was fully blocked today.

The tablets that you're going to be on are very important to protect you,

but stopping smoking is absolutely vital here.

I only smoke about five a day.

My husband smokes three times as much.

Mind you, I hope he doesn't end up with the same thing.

-I never buy them. I won't buy them.

-You just smoke his?

I just smoke his!

Rita has no history of heart problems.

Well, we'd just had a cup of coffee and...

Rita said that she had pains here. She said, "It's like indigestion."

And it gradually got worse,

and I said, "This is more than indigestion."

And she was grey, her face was grey,

and her hands were clammy and then she started to vomit.

I said, "This is more than indigestion, this,

"let me get an ambulance."

She wouldn't let me get an ambulance at first.

-She wouldn't let you get one?

-No.

-Why not?

-Not at first.

Well, she doesn't like the fuss and things like that.

But she didn't tell me that she'd had this ache all week. Did you?

-No.

-Naughty girl.

Well, now I'm worried.

If I do have a smoke, it's not going to be in her vicinity.

-It's going to be outside. Away from her.

-Oh, no...

It will be, it will be. You watch.

I've always smoked, a good many years, you know.

-I enjoy a cigarette.

-Have you ever had any problems with your heart?

Touch wood, no.

HE COUGHS

Do you like smoking?

I do, yes.

Because I like working...

I like something working to do with my hands. I don't like...

I don't like my hands just lying flat.

Just the way I go.

That's what I do during the day - smoke.

During the night - smoke.

That's just one of my leisures.

Keeps you calm.

Does smoking take your mind off the food?

Erm, not really.

What happened, James?

Stabbed.

I'm looking to retire. I feel cheated at the moment

because the government's upped the retirement age,

so I've got to stay on an extra two years, so I feel very cheated.

'..Chelsea defender says he wanted to apologise to everyone...'

That's us leaving now after a long day at dialysis.

She's so tired and fed up.

Her room is damp, so we are all sleeping in one bedroom.

It's ridiculous, really.

But I love her courage, I love her strength.

If her dad was alive, I'm sure he'd be proud of her,

she's a beautiful daughter.

My beautiful Genieva.

-Hello.

-Hello.

-How's things?

-Not too bad.

-Hello, how are you?

-All right.

You're looking very smart.

So what's your plans the rest of the day, Ciaran?

Well, I don't know.

Since Ciaran moved in to the Kilcreggan Care Home

three weeks ago,

his mum, Angela, has been coming to check on him

as often as she can.

-We talk about it quite a lot, don't we, Ciaran?

-Yeah.

Yeah, just to make sure

you're on the same wavelength as everybody else, aren't we?

And that you've got the correct food and stuff,

that you're making the right choices to keep yourself alive, isn't it?

Because we wouldn't want anything less for you, would we? No.

We wouldn't. We wouldn't want anything less.

Have to be careful.

-What have you found?

-No, it's just sugar-free.

We were just checking to make sure it was the right stuff

that he should be drinking. But it is.

I'm not buying any stupid stuff.

No, I know you wouldn't buy stupid stuff, I'm just saying.

'If Ciaran wants food, he's going to get it anywhere.

At home we call Ciaran Houdini,

because he was able...

We were convinced he floated about the house,

because we never heard him.

You wouldn't know until the wrappers

or the bottles or whatever were sitting.

He was able to get tins of beans and things, even, out.

I lifted it out of his bedroom one time.

The food part of it is quite extreme with Ciaran.

This is my bathroom, my shower and that.

And my Home Changing Room sign.

'Independence to Ciaran is very much top of the agenda.

'We're hoping that this is the place for Ciaran,

'but, obviously, being out in the community,

'it's always at the back of your mind

'when you're going to get the phone call'

to say something's happened,

or he's gone into a diabetic coma, or...

Yeah, you're just waiting for that phone call, you know?

All Ciaran's previous attempts to live independently have failed.

The NHS found him a place at a residential college,

but it was only weeks before his behaviour deteriorated

and he was sectioned back to a secure hospital.

'Ciaran obviously was buying the wrong types of food,

'wasn't taking his insulin.'

He threatened a couple of the teachers down there

who were more than good to him.

The different bodies were all brought in, social services, doctor.

Ciaran was put in the back of the ambulance

and, for his own safety, Ciaran was then handcuffed,

because obviously he tried to jump out,

and he was taken up to a secure accommodation

on the outskirts of Belfast.

But, yeah, the worst day of our lives, that was. It was awful.

'We're obviously sceptical

'of what way things are going to go for Ciaran,

'but he's trying, and we're hoping that it'll be'

the place for him to stay and make a life for himself,

and hopefully live as long as he can, you know?

'I'm a 25-year-old man, I don't need to be treated like a two-year-old.'

I just want to get on with my normal life, before...

Like the rest of people do, like yourself. I just love independence.

'The freedom now that he's got out in the community is still worrying,

'because we know he can still

'do his wee Houdini tricks and get the food.'

We spend as much time as we can with him.

As much as he'll let us - because he's independent now!

-I was in that bar last weekend.

-Is it any good?

How the hell did you get home from that?

Doesn't take long to get up home.

You walked all the way up there on your own?

THEY LAUGH

Ram has managed to stem baby Kyran's bleeding

and he is now stable.

All went well.

We opened the chest

and then... There were tiny little holes, which were bleeding actually,

where we took the needles through the patch we used to repair.

What we did is, we reinforced all those tiny little holes

and then we put some material and stuff to help it seal up.

So, as you can see, there's not much coming out through the drains,

and earlier on there was blood all over, which is all gone now.

So hope that we're on top of things.

OK. Yeah. Good, yeah.

'Surgery today has saved my son's life.

'If it weren't for people like Ram, he wouldn't be here now.'

'We don't know what the future holds for Kyran.

'After a few months he might need another operation.

'It's going to be very stressful for all of us,

'but we are lucky, because Kyran did pull through today.

'That's a lot for a little baby to go through. So proud of him.'

-HE LAUGHS

-Part-timer!

Eight o'clock to eight o'clock in the evening. Still a part-timer.

Yeah, I'm in a hotel tonight

because I'm on call for the hospital patients.

It's 11 o'clock at night, we've just had a call.

Someone coming from one of our district hospitals.

He's having a heart attack now.

He should be with us any minute.

-It's a wonderful place.

-It is.

MUSIC: "Gimme Some Lovin'" By The Spencer Davis Group

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