0:00:02 > 0:00:07This programme contains scenes which some viewers may find upsetting
0:00:11 > 0:00:14If you suffer a life-threatening injury,
0:00:14 > 0:00:16your chances of survival are changing.
0:00:16 > 0:00:20There's a revolution going on right now across the United Kingdom
0:00:20 > 0:00:22in the way that we treat patients with major trauma.
0:00:22 > 0:00:25We've got a head-on collision, with people still trapped in cars.
0:00:25 > 0:00:27There's not a lot left of that vehicle.
0:00:27 > 0:00:30In the past, hundreds of patients have died
0:00:30 > 0:00:31who might otherwise have survived
0:00:31 > 0:00:33had there been a more effective chain of survival.
0:00:33 > 0:00:36- PHONE RINGS - Addenbrooke's Major Trauma Centre.
0:00:36 > 0:00:40We think she's Triage Tool Positive under the pelvic fracture.
0:00:40 > 0:00:43OK, has she had pain relief?
0:00:43 > 0:00:46Now, across the country, a new coordinated system
0:00:46 > 0:00:49is triggered by the most critical injuries.
0:00:49 > 0:00:51She's going straight down. Kate is your team leader.
0:00:51 > 0:00:53OK. Quiet!
0:00:53 > 0:00:57Medics with advanced life-saving skills rush to the scene.
0:00:57 > 0:00:59Can we take over the leadership?
0:00:59 > 0:01:02A well-drilled emergency department prepares.
0:01:02 > 0:01:05MACHINE BEEPS Pupils are not reactive.
0:01:05 > 0:01:06The latest technology is waiting.
0:01:06 > 0:01:09I want this patient through the scanner as quickly as possible.
0:01:09 > 0:01:13And leading consultants stand by.
0:01:13 > 0:01:15We have every specialty under one roof, so we can deal with
0:01:15 > 0:01:18any type of injury coming through the front door.
0:01:18 > 0:01:20The clock is ticking.
0:01:24 > 0:01:28The BBC has followed the first regional Major Trauma Network
0:01:28 > 0:01:33to be fully operational, based at Addenbrooke's Hospital in Cambridge.
0:01:34 > 0:01:37This is the frontline of emergency medicine.
0:01:37 > 0:01:39Just don't keep anything from me.
0:01:39 > 0:01:42We have people who arrive at the very limits of life.
0:01:42 > 0:01:43SIREN WAILS
0:01:43 > 0:01:46And I just thought she'd gone at that point.
0:01:46 > 0:01:48OK. Stand clear, everyone. Shocking.
0:01:48 > 0:01:51If you suffer a critical injury,
0:01:51 > 0:01:56these are the men and women with the best chance of saving your life.
0:02:07 > 0:02:10It's 5pm on a Monday evening.
0:02:10 > 0:02:13Critical care paramedic Dan Cody
0:02:13 > 0:02:17is on call with the East of England Ambulance Trust.
0:02:17 > 0:02:20'Just off the junction of the A1301 before the roundabout.'
0:02:22 > 0:02:24'There are two vehicles on scene, over.'
0:02:24 > 0:02:28Yeah. Roger that. Thank you.
0:02:28 > 0:02:31Going to an RTC, involving a motorcycle and a car.
0:02:31 > 0:02:33I don't know much more than that.
0:02:35 > 0:02:38At Addenbrooke's Hospital, the emergency department
0:02:38 > 0:02:41is treating a steady flow of illness and minor injury.
0:02:41 > 0:02:45Any difficulty breathing?
0:02:47 > 0:02:51Consultant Catherine Hayhurst and Dr Adam Chesters
0:02:51 > 0:02:53are just coming on shift.
0:02:53 > 0:02:56- If we get on top of that. - Yeah, as soon as possible.- Cool.
0:03:00 > 0:03:05If it's the big bones - the thigh bone, the femur - that's a big bone.
0:03:05 > 0:03:09If there's enough force gone in to break that bone,
0:03:09 > 0:03:12there's always the risk of other injuries to go with it.
0:03:12 > 0:03:17Emergency medical teams effectively take the emergency department to the roadside
0:03:17 > 0:03:20and they actually start the process of treating major trauma
0:03:20 > 0:03:22before the patient even gets to the ED.
0:03:26 > 0:03:28Two ambulance crews and the police
0:03:28 > 0:03:30are already at the scene of the collision,
0:03:30 > 0:03:34but they need Dan's expertise and drugs
0:03:34 > 0:03:37before they can move the patient.
0:03:37 > 0:03:40- What have you got?- 17-year-old lady. She's normally fit and well.
0:03:40 > 0:03:42No allergy, no meds. She's come off her bike.
0:03:42 > 0:03:46Tenderness around pelvis and right femur, nothing else.
0:03:46 > 0:03:49OK. You keep doing that.
0:03:51 > 0:03:55- What's your name?- Molly. - Molly, I'm Dan. How we doing?
0:03:57 > 0:03:59Molly was riding her moped back from college
0:03:59 > 0:04:01when a car hit her from the side.
0:04:04 > 0:04:09- You got access? Happy with her chest? Happy she's GCS 15?- Yeah, yeah.
0:04:09 > 0:04:12Just pop that on the other finger for me.
0:04:12 > 0:04:15Molly's parents were called by the paramedics,
0:04:15 > 0:04:18and they rushed from home just a couple of miles away.
0:04:18 > 0:04:20Big, deep breath for me.
0:04:20 > 0:04:23- Any pain in your chest at all? - Not really, no.
0:04:23 > 0:04:28- Any pain there at all?- No. - It's mainly her hip.- On your hip?
0:04:28 > 0:04:31- Yeah. It's very tender.- OK.
0:04:31 > 0:04:36She's come off a motorbike. She's got quite serious injuries, probably to her pelvis and her right leg.
0:04:36 > 0:04:40She's completely awake at the moment, she's got no breathing problems -
0:04:40 > 0:04:44however, her blood pressure is very low. The bleeding, it appears that there is some.
0:04:44 > 0:04:47She's actually potentially quite sick.
0:04:47 > 0:04:51So our plan is just to finish off doing a couple of bits there,
0:04:51 > 0:04:55give her some fluid to bring her blood pressure up a bit, but not too much,
0:04:55 > 0:04:57and then sedate her with some ketamine,
0:04:57 > 0:04:59which is a strong painkiller,
0:04:59 > 0:05:02which will allow us to pull her leg out to length
0:05:02 > 0:05:04and stop hopefully some of that bleeding and splint it properly.
0:05:04 > 0:05:08- Molly, I'm going to give you some ketamine. It's a strong painkiller. - Is it...
0:05:08 > 0:05:10- Sorry? It's going to go through this tube in your arm.- Fine.
0:05:10 > 0:05:14When we do that, you're not really going to be aware what is going on.
0:05:14 > 0:05:15We're going to work on 60 kilos,
0:05:15 > 0:05:17so we're going to give her 30 mg to start with.
0:05:17 > 0:05:19She's going to go completely out of it.
0:05:19 > 0:05:22The ketamine will numb Molly's pain,
0:05:22 > 0:05:26giving Dan enough time to put her broken bones back into position.
0:05:26 > 0:05:30Ketamine's there going on, just hold on to her hip.
0:05:30 > 0:05:33We're going to get the pelvic splint on, then I'll get the traction splint on.
0:05:33 > 0:05:36Then we'll log roll her, get the bubble wrap underneath her
0:05:36 > 0:05:40with the scoop, package her up and on our way.
0:05:40 > 0:05:42Dan hopes that strapping Molly's leg and hips in place
0:05:42 > 0:05:45will stop the sharp pieces of broken bone
0:05:45 > 0:05:48cutting her blood vessels and causing more bleeding.
0:05:48 > 0:05:51Just give John a bit of countertraction.
0:05:57 > 0:05:59OK. Back down when you're ready, mate.
0:05:59 > 0:06:03Dan gives the Addenbrooke's Emergency Department early warning.
0:06:03 > 0:06:06Got a 17-year-old female. A motorcyclist. An RTC.
0:06:06 > 0:06:09Pelvic and femur fractures.
0:06:09 > 0:06:12Initially hypotensive, but now stable.
0:06:12 > 0:06:15OK, and what was the speed of the RTC?
0:06:15 > 0:06:19Liz Hamilton is the sister in charge of the resuscitation room.
0:06:19 > 0:06:21Was it bike V car?
0:06:21 > 0:06:23Car versus motorbike. Lovely.
0:06:23 > 0:06:27We're going to be going into Addenbrooke's...
0:06:29 > 0:06:31Liz gathers a six-person trauma team,
0:06:31 > 0:06:35ready to assess and stabilise the patient.
0:06:47 > 0:06:52The biggest risk to her is if she has damaged her pelvis, then the potential damage that has done.
0:06:52 > 0:06:55Inside the pelvis, there's lots of big blood vessels that can bleed.
0:06:55 > 0:06:58You can hide bleeding in the pelvis for quite some time
0:06:58 > 0:07:01before you actually start to have any physiological response to it.
0:07:01 > 0:07:04So, although she may look stable, she may deteriorate quite quickly.
0:07:04 > 0:07:08- Can you just tell me the initial BP, please?- It was 80 systolic.
0:07:08 > 0:07:11She's had some ketamine and some morphine without complication.
0:07:11 > 0:07:14We'll be with you in about 10 to 15 minutes.
0:07:14 > 0:07:1910/15 minutes. So I make it 1805 now, so about 18:15?
0:07:19 > 0:07:21Yes, about that.
0:07:21 > 0:07:23We'll make resus bay one available for you when you get here,
0:07:23 > 0:07:27- so if you want to come straight through to that.- OK.- Thanks. Bye.
0:07:27 > 0:07:30Adult trauma call, A&E resus.
0:07:30 > 0:07:33We've been told they suspect pelvic and long bone fractures,
0:07:33 > 0:07:37which is always worrying because you can lose a lot of blood from them.
0:07:37 > 0:07:40And the fact that she's quite tachiacardic and her blood pressure's a bit low
0:07:40 > 0:07:42suggests that that might be what's happened.
0:07:44 > 0:07:47- She's starting to come round now, isn't she?- Yeah, just ever so slightly.
0:07:47 > 0:07:49- Hello, Molly.- Hello.- How are you?
0:07:49 > 0:07:53I've just given her a bit of morphine. By the time that's working, she'll be coming out, I think.
0:07:53 > 0:07:56Trauma documentation.
0:07:56 > 0:07:59Ketamine and morphine.
0:07:59 > 0:08:01Expected at 6:15pm, which is three minutes or so.
0:08:19 > 0:08:23We're here. Just into bay 1, please.
0:08:23 > 0:08:25So this is Molly. Molly's a 17-year-old.
0:08:25 > 0:08:28At approximately 5pm, she was involved in an RTC.
0:08:28 > 0:08:31She was a motorcyclist, hit by a car
0:08:31 > 0:08:33on a reasonably fast stretch of road.
0:08:33 > 0:08:36Injuries suspected are query pelvis
0:08:36 > 0:08:39and obvious angulated mid-shaft right femur.
0:08:41 > 0:08:44Molly's mum joins her,
0:08:44 > 0:08:47as the trauma team check if she's stable enough for a CT scan.
0:08:51 > 0:08:54How is she? Have you spoken to her?
0:08:54 > 0:08:58- Very ketamined, but otherwise she's OK. She's responding to me.- Right.
0:08:58 > 0:09:01MOLLY GASPS
0:09:01 > 0:09:05- Well done.- It's all done. She's got the blood, so just relax.
0:09:05 > 0:09:06Fantastic.
0:09:06 > 0:09:09Catherine gives the go-ahead for the scan.
0:09:09 > 0:09:12The priority is to do a top to toe, so we know what injuries there are.
0:09:12 > 0:09:15Chest looks good, but we'll have to check that, as well.
0:09:15 > 0:09:20She's had a high-impact injury with very little protection if she's on a motorbike.
0:09:34 > 0:09:38The team's worried that Molly's still losing blood internally,
0:09:38 > 0:09:41and connect her to a blood infuser.
0:09:41 > 0:09:44It's really important that we can give blood wherever we need it.
0:09:44 > 0:09:48And if that's on route to different scanners then so be it.
0:09:48 > 0:09:50Moving into the scanner now.
0:09:50 > 0:09:53The CT is a rotating X-ray machine
0:09:53 > 0:09:57that produces detailed internal images from head to toe.
0:09:57 > 0:09:59It's a crucial tool in the Major Trauma System.
0:10:02 > 0:10:06She's got a mid-femoral fracture on the right, and she's got
0:10:06 > 0:10:11a nasty-looking pelvis fracture, so those are her major injuries.
0:10:11 > 0:10:14If you look at the socket here where it should actually be just there,
0:10:14 > 0:10:18it's broken off there. That's where the socket of the femur should be.
0:10:18 > 0:10:23If the broken bones have damaged surrounding arteries,
0:10:23 > 0:10:25it could put Molly's life in danger.
0:10:25 > 0:10:28The radiographer injects dye into an artery
0:10:28 > 0:10:30to help the scanner pick up any bleeding.
0:10:30 > 0:10:34You can see this bulge here in the back of the vein,
0:10:34 > 0:10:37which is the vein running up from the groin up into the abdomen.
0:10:37 > 0:10:41And this is the abnormal pouching in the back of the vein here.
0:10:41 > 0:10:44What's probably happened is this complex pelvic fracture,
0:10:44 > 0:10:47there's a sharp spike of bone that's hit the vein
0:10:47 > 0:10:48and made a hole in the vein.
0:10:48 > 0:10:50It's not actively bleeding at the moment,
0:10:50 > 0:10:52but it's bled and it's at risk of further bleeding.
0:10:52 > 0:10:55So when they manipulate - put this pelvic fracture back together -
0:10:55 > 0:10:58they might poke another hole in it and make it bleed again.
0:10:58 > 0:11:03So, just to be clear, we're going to scoop her off the bubble wrap,
0:11:03 > 0:11:06get the board out and then we'll do the traction.
0:11:06 > 0:11:09Adam Chesters has joined the team to help move Molly,
0:11:09 > 0:11:12so they can replace the temporary splints on her leg and pelvis.
0:11:12 > 0:11:16If the bones move too much and it punctures that blood vessel,
0:11:16 > 0:11:18we could have a serious bleeding problem on our hands,
0:11:18 > 0:11:21so we've got to be really, really careful.
0:11:21 > 0:11:24Treat it like a glass bowl - any slight movement could crack it
0:11:24 > 0:11:26and cause a catastrophic problem for us.
0:11:29 > 0:11:33She's been in a splint both on her pelvis and on her femur
0:11:33 > 0:11:36for the last couple of hours since she's been in here and that's stopped the bones moving.
0:11:36 > 0:11:40Now we've taken that splint off and we're moving the bones around,
0:11:40 > 0:11:41it's going to be excruciating
0:11:41 > 0:11:43if those two bones are allowed to grate together.
0:11:43 > 0:11:48On scale of 1 to 10 in terms of pain it's probably up there at 9 or 10.
0:11:48 > 0:11:51So, I'm giving her some very strong pain relief to essentially
0:11:51 > 0:11:54make her unconscious while we're doing this.
0:11:54 > 0:11:58The orthopaedic team can now put Molly's legs under tension.
0:11:58 > 0:12:02This procedure will hold the sharp, broken ends of her bones apart
0:12:02 > 0:12:04and prevent further internal damage.
0:12:04 > 0:12:07The bands are wrapped around the legs.
0:12:07 > 0:12:11And rope then go over the pulley system down to the weights that hang near the floor.
0:12:11 > 0:12:14And that just applies some gentle traction
0:12:14 > 0:12:16and pulls the legs out to length.
0:12:21 > 0:12:25Didn't even flinch. Very strong painkillers, ketamine.
0:12:25 > 0:12:28It's actually one of the common drugs of abuse.
0:12:28 > 0:12:31People take it to have a good time in town at parties -
0:12:31 > 0:12:33certainly not something we'd recommend.
0:12:33 > 0:12:37This is a medicinal dose, and it still does weird things to you.
0:12:37 > 0:12:39How was your dream on ketamine this time?
0:12:39 > 0:12:43- Weird.- Weird?
0:12:43 > 0:12:46You going to do some art work on it?
0:12:46 > 0:12:50Being an artist, you could do some fairly interesting pieces.
0:12:50 > 0:12:51You really could.
0:12:51 > 0:12:54It's anything from a really, really good dream
0:12:54 > 0:12:56to a horrendously scary dream.
0:12:56 > 0:12:58But actually this has been a very smooth reaction.
0:12:58 > 0:13:04I just saw an image of Asha with an extra set of eyes on her cheeks.
0:13:04 > 0:13:05Weird.
0:13:07 > 0:13:09Really weird.
0:13:15 > 0:13:17I arrived to cars
0:13:17 > 0:13:20and two ambulances and flashing lights
0:13:20 > 0:13:23and just seeing her lying with her leg at a weird angle.
0:13:23 > 0:13:26And keeping her very still, thinking...
0:13:26 > 0:13:30Well, all the worst things that go through your head.
0:13:30 > 0:13:33You know she's alive, but has she got spinal injury?
0:13:33 > 0:13:36Is she going to be paralysed? Is she going to be in a wheelchair
0:13:36 > 0:13:38for the rest of her life? What, what, what, how?
0:13:38 > 0:13:41The specialists have had a chance to have a look at all of her images
0:13:41 > 0:13:43from the CT scans and they're quite comfortable
0:13:43 > 0:13:46that there's nothing serious that needs to be fixed tonight.
0:13:46 > 0:13:50So she's going to have quite extensive operations
0:13:50 > 0:13:53to reconstruct her pelvis, to fix the long bones in her thigh.
0:13:53 > 0:13:57And actually that's best done in the cold light of day
0:13:57 > 0:13:58when there's a whole team there,
0:13:58 > 0:14:02as opposed to being done at midnight when it's just the on-call team
0:14:02 > 0:14:04who've got other emergencies to deal with.
0:14:16 > 0:14:19It's just before 6am on a Friday morning.
0:14:19 > 0:14:23Adam Chesters is back on shift, and, after a quiet night,
0:14:23 > 0:14:26he's just had early warning that a serious case is coming in.
0:14:26 > 0:14:30As part of the trauma network, we've got a transfer of a patient
0:14:30 > 0:14:33from one of the trauma units at King's Lynn.
0:14:33 > 0:14:36It's a 37-year-old who's been assaulted this evening.
0:14:36 > 0:14:41He came in with a head injury and deteriorated in their department.
0:14:42 > 0:14:45The stakes are high with these head-injured patients,
0:14:45 > 0:14:48because head injury is the biggest killer of people under the age of 40 in the UK,
0:14:48 > 0:14:51and we have to act fast and get the patient to the right place
0:14:51 > 0:14:53to have the right treatment.
0:14:53 > 0:14:58As soon as King's Lynn Hospital saw the patient was getting worse,
0:14:58 > 0:15:01they triggered the Major Trauma Network
0:15:01 > 0:15:04to rush him to the head injury specialists at Addenbrooke's.
0:15:06 > 0:15:09Adam needs to check the patient's stable
0:15:09 > 0:15:11and get him to the CT scanner within 20 minutes.
0:15:11 > 0:15:14Theoretically, we shouldn't have to do anything, other than
0:15:14 > 0:15:17put him across, check the tube and then go to CT.
0:15:17 > 0:15:19The quicker the specialists have an up-to-date scan,
0:15:19 > 0:15:23the sooner they can try to stop any damage getting worse still.
0:15:23 > 0:15:25Hi, chaps.
0:15:25 > 0:15:29We're going to need our scoop and we'll scoop him off.
0:15:29 > 0:15:34The police called to the assault say the patient's name is David,
0:15:34 > 0:15:37but they're not sure exactly what happened.
0:15:37 > 0:15:39Somehow attacked with a hammer,
0:15:39 > 0:15:42and he had blows to his head and the side of his face.
0:15:42 > 0:15:46So, guys, we'll do a log roll on to the scoop.
0:15:46 > 0:15:49Scoop him off their trolley and straight onto ours.
0:15:49 > 0:15:53This is always the bit that takes time.
0:15:53 > 0:15:55We're four minutes in, we're doing well.
0:15:55 > 0:15:59- Bring your end out a little bit more.- OK. Nice and quick.
0:15:59 > 0:16:01- 1, 2, 3.- Very good.
0:16:01 > 0:16:06OK, what I'd like to happen now is to go on to our ventilator, OK?
0:16:06 > 0:16:08We've found that the patient's remained
0:16:08 > 0:16:12as he was when he left King's Lynn, so we've got nothing to do in ED,
0:16:12 > 0:16:16other than just get him to CT and really characterise what injuries he has.
0:16:16 > 0:16:19So, team, we've got to pick up the pace a little bit.
0:16:19 > 0:16:22Can we get the bridge on and get ready for transfer as soon as you can?
0:16:22 > 0:16:26Just coming up to 19.5 minutes for our target 20.
0:16:26 > 0:16:29- Have we got the transfer bag? - Yeah.
0:16:29 > 0:16:31OK, let's do it.
0:16:31 > 0:16:34Very good. 20 minutes and 30 seconds.
0:16:34 > 0:16:37This has been a serious assault. It's fairly uncommon
0:16:37 > 0:16:40for someone to end up on a life support machine like this.
0:16:40 > 0:16:42This has been quite a beating.
0:16:42 > 0:16:47We're treating this like a brand-new trauma patient
0:16:47 > 0:16:49and we're just going to scan from top to toe.
0:16:49 > 0:16:53What we've found so far is that there's quite a lot of blood in the fluid that surrounds the brain,
0:16:53 > 0:16:58what we call a subarachnoid haemorrhage. That's causing a blockage to the outflow of fluid.
0:16:58 > 0:17:00If the pressure inside the skull spikes,
0:17:00 > 0:17:03then actually that could be fatal, that could kill him.
0:17:03 > 0:17:06So that's actually an emergency that may well need
0:17:06 > 0:17:09an immediate operation to reduce the pressure in the brain.
0:17:11 > 0:17:15Adam takes David straight to the Neuro-critical Care Unit,
0:17:15 > 0:17:19one of the UK's leading departments for severe head and spinal injuries.
0:17:19 > 0:17:22He's 37. He's been hit by a hammer.
0:17:22 > 0:17:26- That's it.- OK. That's all the information?- That's all I've got.
0:17:29 > 0:17:33The specialist on duty is Mark Kotter.
0:17:33 > 0:17:37These are his ventricles, the fluid-filled chambers of the brain.
0:17:37 > 0:17:40And if you look at the third ventricle,
0:17:40 > 0:17:42you can see there's a blood clot.
0:17:42 > 0:17:48This prevents fluid from draining from these lateral ventricles
0:17:48 > 0:17:50through into this chamber.
0:17:50 > 0:17:54And the lack of space around the brain suggests that there's quite some pressure in the brain.
0:17:59 > 0:18:03The clot plugging the fluid is too small to be removed by surgery,
0:18:03 > 0:18:07so instead Mark prepares to make a hole in his skull
0:18:07 > 0:18:09to release the pressure.
0:18:09 > 0:18:13The idea's really just to put in a drain from the outside
0:18:13 > 0:18:17into the ventricle in order to drain the fluid.
0:18:28 > 0:18:30Over the next three days,
0:18:30 > 0:18:35the pressure in David's skull drops as the excess fluid drains away,
0:18:35 > 0:18:38and he's taken off the breathing machine.
0:18:40 > 0:18:42He's regained consciousness
0:18:42 > 0:18:45and his mum, dad and sister Emma are here to see him.
0:18:47 > 0:18:51- Do you know who it is? Who is it? - Mummy.
0:18:51 > 0:18:54- I'm Mummy!- Well done, David, well done.- And who's this here?
0:18:54 > 0:18:58- All right, David?- Your sister.
0:19:00 > 0:19:02Mummy!
0:19:02 > 0:19:05Don't think he's ever called you Mummy, has he?
0:19:05 > 0:19:07Only when he wanted something.
0:19:07 > 0:19:12- Are you feeling a bit cooler? - Better than yesterday.
0:19:12 > 0:19:16- Better than yesterday? Oh, that's good.- That's good.
0:19:16 > 0:19:21- You remember yesterday then, do you? Hmm?- Don't remember all of it.
0:19:21 > 0:19:25Don't remember all of it. No, no.
0:19:25 > 0:19:28David had gone to Norfolk to see his girlfriend, it was her birthday.
0:19:28 > 0:19:32My brother had said that night that he'd felt a bit nervous
0:19:32 > 0:19:34and he thought something might happen,
0:19:34 > 0:19:37but they carried on celebrating her birthday.
0:19:37 > 0:19:41And her ex-partner smashed the window of the back door,
0:19:41 > 0:19:44ran in to the house, chased after David
0:19:44 > 0:19:48who then had to unlock the front door and run.
0:19:48 > 0:19:51And I think then he had a hammer,
0:19:51 > 0:19:54and hit him three times over the head with a hammer.
0:19:54 > 0:19:57Well, we got the phone call at home, Friday morning,
0:19:57 > 0:19:59to say that he was here.
0:19:59 > 0:20:04Just those first words, "This is the police," you know, just those first words and you think, "Oh, my God."
0:20:04 > 0:20:08He's doing absolutely fine because he's obeying commands,
0:20:08 > 0:20:10- and he's moving his legs.- Good. Yes.
0:20:10 > 0:20:15- When he's awake, he's fighting. That's what you're meant to do.- Yes.
0:20:15 > 0:20:17Yeah, he is a bit of a fighter.
0:20:17 > 0:20:21Just keep telling him where he is because he won't know where he is.
0:20:21 > 0:20:24And he's safe, where he is and what day it is,
0:20:24 > 0:20:25and keep everything simple.
0:20:25 > 0:20:28We're just waiting for the drain from his brain
0:20:28 > 0:20:31to start running a bit clearer,
0:20:31 > 0:20:33and then hopefully things will improve a bit.
0:20:33 > 0:20:36HE MUMBLES
0:20:36 > 0:20:37What?
0:20:37 > 0:20:39HE MUMBLES
0:20:39 > 0:20:43You're in hospital in Cambridge. All right?
0:20:43 > 0:20:46Nobody's going to hurt you. You're safe.
0:20:54 > 0:20:58It's six days since Molly was knocked off her moped.
0:20:58 > 0:21:00She's had her first operation,
0:21:00 > 0:21:03pinning her right thigh bone together.
0:21:04 > 0:21:08My art class made me a card.
0:21:08 > 0:21:13They've drawn themselves inside, which is the sweetest thing.
0:21:13 > 0:21:16And signed it all, which made me laugh a lot.
0:21:16 > 0:21:20Art is my everything - it's what I want to do for the rest of my life.
0:21:20 > 0:21:24And it's tough to be put in a situation
0:21:24 > 0:21:27where I can't be working towards my portfolio.
0:21:27 > 0:21:29(Oh, sweetie.)
0:21:36 > 0:21:39Thank you. I can do that. I can do that.
0:21:43 > 0:21:48Pelvic specialist Julian Owen has discovered her left thigh bone
0:21:48 > 0:21:50has shattered her hip joint.
0:21:50 > 0:21:54You can tell from this injury, with multiple fragments, that this
0:21:54 > 0:21:59was a very high energy fracture. And the high energy will have used
0:21:59 > 0:22:03the femoral head as a battering ram to smash the socket.
0:22:03 > 0:22:06So, you've got something hitting her from the side - femoral head - bam!
0:22:06 > 0:22:07It explodes.
0:22:07 > 0:22:10Molly's injury is right at the extreme
0:22:10 > 0:22:12of what I would attempt to reconstruct.
0:22:12 > 0:22:15But at her age, you have to try.
0:22:15 > 0:22:17They leave it a year
0:22:17 > 0:22:22and then they'll replace it with a metal hip and ball.
0:22:22 > 0:22:24And hopefully that will last her 20 years
0:22:24 > 0:22:27before she has to have another one.
0:22:27 > 0:22:31But it's quite a big deal for her to take in, aged 17.
0:22:31 > 0:22:33Originally they thought it just had a crack in it,
0:22:33 > 0:22:36and then they came and told us it was completely smashed.
0:22:36 > 0:22:42Originally I thought I was just going to be here for, like, a month...
0:22:42 > 0:22:45and now feels like it's a lot longer, and they're considering
0:22:45 > 0:22:49how much it's going to affect my college work.
0:22:49 > 0:22:52She's eaten something for the first time today.
0:22:52 > 0:22:54- Oh, brilliant. - She had some breakfast.
0:22:54 > 0:22:58Two of Molly's best mates have come to see her.
0:22:58 > 0:23:01Her first visit from outside the family.
0:23:01 > 0:23:05Normally she's so bouncy and happy and springy.
0:23:05 > 0:23:08It's going to be a bit strange seeing her.
0:23:08 > 0:23:11Love me! SHE LAUGHS
0:23:11 > 0:23:14- Oh, my God. Look at you. - It's so good to see you.
0:23:14 > 0:23:19I've missed you. Please don't cry, because I'm going to cry.
0:23:19 > 0:23:22- How's college? - Really boring without you.
0:23:22 > 0:23:27I've sat through hours of Spanish without you, just not being able to talk to anyone.
0:23:27 > 0:23:30I don't know anyone's names, it turns out, in my class.
0:23:30 > 0:23:33It's just not the same, Mol.
0:23:33 > 0:23:35She's really frightened.
0:23:35 > 0:23:38She's really scared and she's tired and she's hurting
0:23:38 > 0:23:40and she's full of drugs which are giving her bad dreams.
0:23:40 > 0:23:43- This is morphine!- Really?
0:23:43 > 0:23:48Ketamine... When they put me under to take me in the ambulance,
0:23:48 > 0:23:50they put me on ketamine.
0:23:50 > 0:23:52Your mum said you were tripping so bad.
0:23:52 > 0:23:55I was. You don't want to lift that blanket.
0:23:55 > 0:23:56It's hideous down there.
0:23:56 > 0:24:00There's a pin going through one of my knees, so they can pull it down.
0:24:00 > 0:24:02This is in pieces, this pelvis.
0:24:02 > 0:24:04It's just fractures of bone floating around.
0:24:04 > 0:24:07- I'll see you really, really soon. - Goodbye.
0:24:07 > 0:24:11The reconstruction of Molly's hip is planned for two days' time.
0:24:11 > 0:24:14It's a difficult and dangerous operation.
0:24:16 > 0:24:20It will be good to have it over and done with, to be honest,
0:24:20 > 0:24:24cos it's hanging over us a bit, this one. And it's - there's more
0:24:24 > 0:24:30risk all the time, because there could be floating fragments
0:24:30 > 0:24:34that are dangerous because there's lots of arteries and veins in there.
0:24:34 > 0:24:36So need to get it sorted.
0:24:38 > 0:24:42I need to keep telling myself that it could be a lot worse.
0:24:42 > 0:24:45That's what I tell myself - that actually,
0:24:45 > 0:24:48there are people who... At least there's no head injury.
0:24:55 > 0:24:59It's just before 9pm on a Wednesday evening.
0:25:00 > 0:25:03'Ambulance service, what's the address of the emergency?'
0:25:03 > 0:25:06'I'm at the scene of a road traffic accident.'
0:25:06 > 0:25:07'How many people are injured?'
0:25:07 > 0:25:10'Two people injured - one person that has been fitting
0:25:10 > 0:25:11'and has now stopped.
0:25:11 > 0:25:15'He's breathing OK. And one person unconscious who's still breathing.'
0:25:15 > 0:25:18The Major Trauma Network's been triggered again.
0:25:18 > 0:25:20Any change in the patient's condition?
0:25:20 > 0:25:23James French is the consultant on duty
0:25:23 > 0:25:25in the Addenbrooke's Emergency Department.
0:25:25 > 0:25:30Ten to 15 minutes. OK. So I'll be waiting at the front door, and basically I'll have
0:25:30 > 0:25:33some emergency drugs ready, more anaesthetic drugs,
0:25:33 > 0:25:38and a transfer bag, and we'll just go straight to theatre with him, essentially. See you in a bit.
0:25:38 > 0:25:41Unfortunately, a very young man was
0:25:41 > 0:25:44involved in a high-speed road traffic collision.
0:25:44 > 0:25:46Although he was walking around at scene,
0:25:46 > 0:25:49he has become critically ill at Peterborough Hospital.
0:25:49 > 0:25:52We've done a CT scan in Peterborough which shows he's got a large
0:25:52 > 0:25:54bleed around the outside of his brain
0:25:54 > 0:25:58and that bleed is expanding and that's absolutely life-threatening.
0:25:58 > 0:26:02The network's swung into action to bring the patient to
0:26:02 > 0:26:04Addenbrooke's, where there's a neurosurgical
0:26:04 > 0:26:07specialist on standby 24 hours a day.
0:26:07 > 0:26:10If a patient's coming from a network hospital to us,
0:26:10 > 0:26:13they'll send the scans through so we can start planning the surgery
0:26:13 > 0:26:14and getting the team ready.
0:26:14 > 0:26:19Damian Omato's on duty and assesses the scans sent from Peterborough.
0:26:19 > 0:26:22This is the clot making a sort of crescent shape, indenting
0:26:22 > 0:26:25the brain, and he's got a couple of little bruises in his brain, as well.
0:26:25 > 0:26:29You need to take the side of his head off and then get the clot out.
0:26:29 > 0:26:33And that is a simple concept, but obviously quite difficult to do because you're
0:26:33 > 0:26:35operating on someone's brain - it's brains surgery.
0:26:35 > 0:26:38We can do quite a lot for major trauma in terms of surgery.
0:26:38 > 0:26:42The results from the neck down are quite predictable,
0:26:42 > 0:26:45but it's a different story from the neck up.
0:26:50 > 0:26:53Is this the head injury?
0:26:53 > 0:26:56It's 4.5 hours since the patient's collision.
0:26:56 > 0:27:01His name is Sam - he's 19 years old.
0:27:01 > 0:27:03So, Katie, you're still managing his critical care,
0:27:03 > 0:27:06I'm just making sure he gets to the right place.
0:27:08 > 0:27:11It looks like the A pillar, which is the front pillar of the car,
0:27:11 > 0:27:13I think probably hit the side of his head.
0:27:13 > 0:27:15So he's been hit from the side,
0:27:15 > 0:27:18and that's actually one of the worst ways to be hit in a car.
0:27:23 > 0:27:27A craniotomy on the left side - his scan shows the left side...
0:27:27 > 0:27:29Good, OK?
0:27:29 > 0:27:33So that's a big safety thing.
0:27:33 > 0:27:36They do a time out before the operation, when they say,
0:27:36 > 0:27:40"Have we got the right patient, are we doing the right procedure on the right side?"
0:27:40 > 0:27:43Because stressed, people can make simple mistakes,
0:27:43 > 0:27:45and obviously this guy doesn't need a simple mistake.
0:27:56 > 0:27:59Damian first makes a cut in Sam's scalp.
0:27:59 > 0:28:03He then cuts an 8cm-wide hole in the skull,
0:28:03 > 0:28:07directly over the blood clot that's on the outside of the brain.
0:28:07 > 0:28:10It is a big clot,
0:28:10 > 0:28:13and the important thing about the clot in a younger person,
0:28:13 > 0:28:16is that his brain is well-developed, it hasn't degenerated over time
0:28:16 > 0:28:19that happens with age - so there's not a lot of space in his head.
0:28:19 > 0:28:22So it's really important to get it out straight away.
0:28:22 > 0:28:27With the bone cut away, Damian can reach in and remove the clot.
0:28:32 > 0:28:35We'll reconstruct the bone and put the bone back in,
0:28:35 > 0:28:36and close his scalp.
0:28:38 > 0:28:40So that's the fracture, right over the clot.
0:28:40 > 0:28:43That's the burn hole I've made just there,
0:28:43 > 0:28:46and then we come round and cut out a craniotomy there.
0:28:46 > 0:28:49So what we'll do is put some plates on there to hold that back
0:28:49 > 0:28:52together, and then we'll plate it back in.
0:28:52 > 0:28:55So we'll take him back down, have another scan after surgery,
0:28:55 > 0:28:57see what that looks like...
0:28:57 > 0:28:58and then try and wake him up.
0:29:00 > 0:29:03After Sam's been given a follow-up scan,
0:29:03 > 0:29:07he's taken to the Neurocritical Care Unit.
0:29:07 > 0:29:09Sam, wakey-wakey. It's one of the doctors.
0:29:09 > 0:29:13Open your eyes for me. Try and open your eyes.
0:29:15 > 0:29:16Good boy.
0:29:16 > 0:29:19Sam... Get that tube out of your mouth, hold on.
0:29:19 > 0:29:21Nice and still.
0:29:21 > 0:29:22Well done, well done.
0:29:22 > 0:29:26Open, open, that's it, good, well done.
0:29:26 > 0:29:31He's got good power in all of his limbs, so that's a good sign.
0:29:35 > 0:29:38Damian checks the latest scans to make sure there's no further
0:29:38 > 0:29:42damage developing in Sam's brain.
0:29:42 > 0:29:46This is my craniotomy here, that's the bone plate that we took out
0:29:46 > 0:29:50and beneath it was a clot that went like this before.
0:29:50 > 0:29:52So that's all gone now and he did have some
0:29:52 > 0:29:56bruising in the brain below that, and I can see that there.
0:29:56 > 0:29:59It's a bit bigger than it was pre-operatively,
0:29:59 > 0:30:01so we'll just have to see how he goes with that.
0:30:15 > 0:30:19David is still on the Neurocritical Care Unit,
0:30:19 > 0:30:22nearly two weeks after being attacked with a hammer.
0:30:22 > 0:30:25His condition has deteriorated
0:30:25 > 0:30:28and he's been put back on a breathing machine.
0:30:28 > 0:30:30Can you wiggle your toes?
0:30:30 > 0:30:32See if you can wiggle your toes for me.
0:30:33 > 0:30:36No, too tired are you?
0:30:38 > 0:30:40Too tired.
0:30:42 > 0:30:45You just have to take every day at a time, don't you?
0:30:47 > 0:30:49There's still hope.
0:30:49 > 0:30:51Yep.
0:30:52 > 0:30:56Consultant Neurosurgeon Peter Hutchinson has just received
0:30:56 > 0:30:58the latest scan of his brain.
0:30:58 > 0:31:02There's no doubt that his condition is worse now than it was
0:31:02 > 0:31:05a few days ago. You can see a different signal intensity
0:31:05 > 0:31:09on the left side of the brain compared to the right side.
0:31:09 > 0:31:12So this would fit with the stroke-like syndrome,
0:31:12 > 0:31:15where he's not moving the right side of his body.
0:31:15 > 0:31:18You know, there is going to be an element of disability as a result
0:31:18 > 0:31:23of this injury. The question is how severe that's going to be.
0:31:23 > 0:31:26Hi, have you met?
0:31:26 > 0:31:28Hi, yeah, I've seen you.
0:31:28 > 0:31:31Peter has arranged to give David's family an update.
0:31:31 > 0:31:36So we know this has been a very nasty injury that's been inflicted.
0:31:36 > 0:31:40The problem is when there's a lot of blood in the spaces around the brain, the vessels
0:31:40 > 0:31:45can go into spasm and that restricts the blood flow to the brain.
0:31:45 > 0:31:47I think that's what happened, that there
0:31:47 > 0:31:50have been parts of the brain that have not had enough blood supply
0:31:50 > 0:31:53and I think that's why he's deteriorated.
0:31:53 > 0:31:56So can that improve? Will things improve?
0:31:56 > 0:32:00Yes, he wasn't in a devastating condition immediately afterwards
0:32:00 > 0:32:05and he's been better than he is now and his age, are the positive features.
0:32:05 > 0:32:10- I think the concerns are the MRI scan is a concern.- Hmm.
0:32:10 > 0:32:13We are very concerned about his condition,
0:32:13 > 0:32:16but in terms of the way forward at the moment, I'm sure the right
0:32:16 > 0:32:21thing is to very actively treat him down on the Intensive Care Unit.
0:32:21 > 0:32:25The plan over the next few days is to get him breathing better
0:32:25 > 0:32:28so we can try and get him breathing by himself
0:32:28 > 0:32:31so he's not dependant on the ventilator to do the breathing.
0:32:31 > 0:32:35So you think there's, I know you can't say definitely,
0:32:35 > 0:32:37but a chance of recovery, some recovery?
0:32:37 > 0:32:40Yeah, I'm sure this is the right course, to do the tracheostomy
0:32:40 > 0:32:44and treat him actively and try to focus on that, rather than...
0:32:44 > 0:32:48in terms of prognosis in the future, you're looking at months.
0:32:48 > 0:32:51So is that months that he's going to wake up,
0:32:51 > 0:32:55or months that...he's talking?
0:32:55 > 0:32:57He needs to start breathing on his own...
0:32:57 > 0:33:01So I think the first step within this process is to get him
0:33:01 > 0:33:04breathing and get him off the ventilator.
0:33:04 > 0:33:06So I don't think there's any difficult decisions to make.
0:33:06 > 0:33:08No, no.
0:33:08 > 0:33:12I think it's clear what the right thing to do is at the moment
0:33:12 > 0:33:14and we're going down that route.
0:33:14 > 0:33:16Thanks very much.
0:33:34 > 0:33:39Molly's being taken for surgery that will piece her shattered hip joint back together.
0:33:39 > 0:33:42It's a highly complicated operation that will determine how well
0:33:42 > 0:33:44she'll be able to walk.
0:33:44 > 0:33:47She actually has a lot of pieces for someone of her age.
0:33:49 > 0:33:53Julian Owen and his colleague Peter Hull both spent
0:33:53 > 0:33:55a year in the US learning this operation
0:33:55 > 0:33:58and will work together to combine their experience.
0:33:58 > 0:34:01It's a very nasty fracture at a very young age
0:34:01 > 0:34:03and you can't rebuild them all.
0:34:03 > 0:34:06You can see it on the CT 3-D reconstructions here.
0:34:06 > 0:34:12The main injury runs across the hip socket, which would be through here,
0:34:12 > 0:34:16but there's more fragmentation of the front part of the hip socket.
0:34:16 > 0:34:19And then if we look from behind, that is this fragment here,
0:34:19 > 0:34:21which has most of the joint surface on it.
0:34:21 > 0:34:24This is where everything could either go right or go wrong.
0:34:24 > 0:34:30It's going to go right, cos we've got the top people on the job.
0:34:30 > 0:34:33Always, you're struggling to get to the hip socket, which is
0:34:33 > 0:34:36a very deep structure and there isn't an easy way of exposing
0:34:36 > 0:34:41the whole thing to get a perfect fracture realignment.
0:34:41 > 0:34:46Nearly there, OK? You'll be asleep very soon.
0:34:46 > 0:34:50The other issue here, of course, is the vein.
0:34:50 > 0:34:53Especially after an injury like this with the vein damaged so much.
0:34:53 > 0:34:56I have seen patients in my time, die of embolism before I've
0:34:56 > 0:34:59even had a chance to get to their fractures.
0:35:01 > 0:35:05So it's a very, very scary injury. It has to be taken very seriously.
0:35:12 > 0:35:15- Have you had your breakfast, boys? - Yes.
0:35:15 > 0:35:19I think it'll be all day.
0:35:19 > 0:35:22The risk of operating next to Molly's damaged vein
0:35:22 > 0:35:25means Julian and Peter will be joined by a third surgeon.
0:35:25 > 0:35:28How many surgeons to fix a bone?
0:35:28 > 0:35:30We've got Mr Boyle, the vascular consultant,
0:35:30 > 0:35:33because we'll be working very close to the artery and the vein.
0:35:33 > 0:35:37So the concern was, early on in the exposure, whether that suddenly might bleed, which is why he's here.
0:35:37 > 0:35:41- Well, I thought we might start, is that all right with you?- Yeah.
0:35:42 > 0:35:46Peter and Julian's first job is to create an opening to work on the hip.
0:35:48 > 0:35:50The fracture is there, isn't it?
0:35:50 > 0:35:54The first view of the hip socket confirms the scans.
0:35:54 > 0:35:58It's smashed, isn't it? What have we got here?
0:35:58 > 0:36:00It's just totally smashed up.
0:36:01 > 0:36:04- I think you're getting quite close to the big vessels there, aren't you?- I am.
0:36:04 > 0:36:06I think we are very close.
0:36:06 > 0:36:09So what happens if I hit the vein and then it starts bleeding?
0:36:09 > 0:36:12- Then I'll dissect it out...- But you'd happily do it in that order?
0:36:12 > 0:36:14Well...
0:36:14 > 0:36:17it's not the easiest bit of the vein to fix where it is.
0:36:18 > 0:36:22A fresh tear in the vein would need all of Jon Boyle's skill
0:36:22 > 0:36:23to stop the bleeding.
0:36:25 > 0:36:27Let's take a long...
0:36:32 > 0:36:34Now we're up to fracture.
0:36:34 > 0:36:36It's toast, isn't it?
0:36:36 > 0:36:39- The roof has gone, poof. - I can't get at it.
0:36:41 > 0:36:44So far we've got the fracture exposed,
0:36:44 > 0:36:48but we're starting to work out exactly how to get the reduction manoeuvres to hold it reduced.
0:36:48 > 0:36:51If we can't get the jigsaw puzzle back together perfectly,
0:36:51 > 0:36:54it increases her chances of arthritis, which are very high.
0:36:54 > 0:36:56Can you get a screw in that, at any direction,
0:36:56 > 0:36:59- without it going into joint? - A very short one.
0:36:59 > 0:37:02Just to hold it before you put the plate on?
0:37:06 > 0:37:09Julian and Peter put a screw into the top of the thigh bone,
0:37:09 > 0:37:13hoping to pull it into a more normal position in the socket.
0:37:13 > 0:37:15That's the closest you get to getting the head
0:37:15 > 0:37:18in the right place so far, isn't it, when that's there?
0:37:18 > 0:37:23- It's a good start, it's not perfect yet, but at least... - No, that's grand.
0:37:23 > 0:37:26Just have a look here at this column here, through this window,
0:37:26 > 0:37:30- that's now quite good. Oh, hello! - That's good.
0:37:30 > 0:37:32I think that's a good reduction.
0:37:34 > 0:37:38Pulling on the thigh bone has also brought the hip fragments into the right place.
0:37:38 > 0:37:41They can now be fixed using plates and screws.
0:37:43 > 0:37:46And another ball pusher, please.
0:37:47 > 0:37:51The more accurately Julian and Peter can re-piece the jigsaw, the
0:37:51 > 0:37:56better Molly's chance of avoiding a hip replacement in a year's time.
0:37:56 > 0:37:58The best screwdriver on the set, please.
0:38:01 > 0:38:03X-ray there...
0:38:06 > 0:38:08So this one's beautiful.
0:38:08 > 0:38:12That one, you've got the dome tilted back, I'm much happier.
0:38:14 > 0:38:17Julian and Peter just need to slot the last fragment
0:38:17 > 0:38:19of Molly's hip into place.
0:38:19 > 0:38:23They've managed to avoid her damaged vein throughout
0:38:23 > 0:38:24the six hours of surgery.
0:38:26 > 0:38:29- So that fragment's tilted right back.- It has, yeah.
0:38:29 > 0:38:31I'm really pleased with that.
0:38:46 > 0:38:49It's three weeks since David's head was seriously injured
0:38:49 > 0:38:51in an attack with a hammer.
0:38:53 > 0:38:56His parents and sister visit him every day
0:38:56 > 0:38:58on the Neuro Critical Care Unit.
0:38:59 > 0:39:03I'm playing him the Match Of The Day theme tune on YouTube.
0:39:03 > 0:39:07Because the other night on Wednesday it was the England and Sweden game.
0:39:07 > 0:39:11And he woke up as soon as the theme tune came on
0:39:11 > 0:39:13and opened his eyes for the whole football game
0:39:13 > 0:39:15and moved his arm a bit.
0:39:15 > 0:39:16He's a Liverpool supporter,
0:39:16 > 0:39:20so we've been playing him You'll Never Walk Alone, as well.
0:39:21 > 0:39:24David's chest has improved so much,
0:39:24 > 0:39:26he hardly needs the breathing machine,
0:39:26 > 0:39:28but he's still not responding.
0:39:31 > 0:39:34We just want somebody to say...
0:39:34 > 0:39:36you know, when he's going to wake up.
0:39:37 > 0:39:38But they can't, really.
0:39:41 > 0:39:46Peter Hutchinson has been asked for his opinion and calls a meeting.
0:39:46 > 0:39:49- I mean, really, he's not changed at all.- No, completely static.
0:39:49 > 0:39:50No, OK.
0:39:50 > 0:39:54The police have been in touch with me this morning about a statement.
0:39:54 > 0:39:58So there has been somebody who has been arrested and charged
0:39:58 > 0:40:01- and has pleaded guilty.- Pleaded guilty, is what they said to me.
0:40:01 > 0:40:05And is awaiting sentencing. So they want a statement and prognosis.
0:40:05 > 0:40:07In terms of the next few months, it's difficult to be sure,
0:40:07 > 0:40:11but I don't think this is looking very hopeful.
0:40:11 > 0:40:14Deeply comatose, I think it's very bleak.
0:40:14 > 0:40:17I can't see the next few months changing.
0:40:17 > 0:40:20There's nothing that we can do to make him more awake
0:40:20 > 0:40:24- and there's nothing we can do to not support him.- Yeah.
0:40:24 > 0:40:26I mean, I think I've had that conversation with them.
0:40:26 > 0:40:29There isn't a major treatment decision in terms
0:40:29 > 0:40:31of withdrawal of therapy.
0:40:38 > 0:40:41Peter's arranged to update David's family.
0:40:41 > 0:40:43We last spoke on...
0:40:44 > 0:40:47- Last Friday.- Friday, it was a week ago, wasn't it?
0:40:47 > 0:40:51How do you think he's been over the last week?
0:40:52 > 0:40:54- No response, really.- No.- No.
0:40:56 > 0:40:57I mean, he hasn't really changed.
0:40:57 > 0:41:01We would have hoped to have seen more of a response by now.
0:41:01 > 0:41:03He has the one eye open, the left one,
0:41:03 > 0:41:06but there's no recognition there.
0:41:06 > 0:41:10He doesn't even follow you, you know, doesn't even follow you.
0:41:10 > 0:41:13I think we should get another scan and I think we should try and get him
0:41:13 > 0:41:16- off the ventilator.- Mmm. - Then take things from there.
0:41:16 > 0:41:19So I don't think there's any big decision to make.
0:41:19 > 0:41:22- You know, I think we know what needs to be done.- Mmm.
0:41:22 > 0:41:25But we are very concerned.
0:41:33 > 0:41:34Oh, dear.
0:41:38 > 0:41:42- Mmm.- Having said that, we're still relatively early in...- Mmm?
0:41:42 > 0:41:46- You know, from the injury. - Yeah, yeah.
0:41:46 > 0:41:50I don't think we should give up, or lose hope.
0:41:51 > 0:41:54Have you got anything you want to ask?
0:41:54 > 0:41:58Do you want to say anything, Nicole? Have you got anything, you know?
0:42:05 > 0:42:09- We'll make sure that we're keeping you updated.- OK.
0:42:11 > 0:42:14- OK.- Do you want to stay in here for a bit?- Yeah.
0:42:14 > 0:42:16- Yeah, OK.- OK.
0:42:36 > 0:42:39Does there come a time when they just decide to stop?
0:42:39 > 0:42:41Sorry, Sam.
0:42:41 > 0:42:44No, that isn't something that we're even thinking about.
0:42:46 > 0:42:48- We can only give it a bit of time. - Yeah.
0:42:48 > 0:42:50- Unfortunately, it's time...- Mmm.
0:42:50 > 0:42:53- ..to just even out and see where we are.- Yeah, yeah.
0:43:04 > 0:43:07Sam's on the rehabilitation ward,
0:43:07 > 0:43:10three weeks after hitting his head in a collision.
0:43:10 > 0:43:13Since the operation to remove the blood clot,
0:43:13 > 0:43:17he's had more surgery to take away a section of his skull.
0:43:17 > 0:43:21We were concerned after Sam's operation that he was not waking up properly,
0:43:21 > 0:43:23and therefore he underwent a further scan.
0:43:23 > 0:43:26There was bleeding within the brain itself,
0:43:26 > 0:43:27causing pressure on the brain.
0:43:27 > 0:43:30So we undertook a second operation to remove the bone
0:43:30 > 0:43:33and that has enabled the brain to expand under the scalp
0:43:33 > 0:43:36to protect the rest of the brain.
0:43:39 > 0:43:42Sam's family are visiting.
0:43:42 > 0:43:44That's when you arrived in hospital.
0:43:44 > 0:43:45- Yeah.- Swearing.
0:43:45 > 0:43:49- I didn't swear.- You did. - Oh, OK.
0:43:49 > 0:43:54It was just a shock that, you know, it turned out to be so serious.
0:43:55 > 0:44:00Erm, obviously upset and, you know, he was on...
0:44:03 > 0:44:05..such a high that day, before...
0:44:05 > 0:44:07Sorry...
0:44:10 > 0:44:13That's straight after the operation.
0:44:13 > 0:44:14Oh, no.
0:44:14 > 0:44:17- Is that the first operation? - And boxing gloves.
0:44:17 > 0:44:20That's his first operation, I didn't see him after the second one.
0:44:20 > 0:44:23Two days later, we had to have surgery again.
0:44:24 > 0:44:28Deeper into the brain, because more bruising.
0:44:28 > 0:44:30Erm...
0:44:30 > 0:44:33and then I was really scared, very scared.
0:44:33 > 0:44:36There's a feeling inside that you can't describe.
0:44:38 > 0:44:41I don't remember anything like that,
0:44:41 > 0:44:44but, erm, pretty cool, to be honest.
0:44:44 > 0:44:46- It looks pretty cool now.- Yeah.
0:44:46 > 0:44:51- But it didn't then.- Yeah, I see. - And you couldn't move an inch.
0:44:51 > 0:44:54Yeah, I can't really remember, apart from the crash.
0:44:54 > 0:44:58That's about it, to be honest, I can't remember.
0:44:58 > 0:45:01- Where was you going, do you know? - No.
0:45:01 > 0:45:05- Right, because we thought you were perhaps going to visit your brother. - Maybe.
0:45:05 > 0:45:09A long recovery for you, I think. Lots of things to sort out.
0:45:09 > 0:45:13- I'll be all right. - You're not going to be all right yet.
0:45:13 > 0:45:17I don't think you really know how bad it is...
0:45:17 > 0:45:19or was. I just...
0:45:19 > 0:45:21You're in a bit of a dream.
0:45:21 > 0:45:24When you get home, you aren't going to do what you think you're going to do.
0:45:24 > 0:45:27- Yeah, I'm going to go out... - You're not, I'll chain you in.
0:45:27 > 0:45:32- It isn't going to be like it was for a while.- Yeah, I suppose.
0:45:32 > 0:45:35- Well, no, it just isn't.- Yeah.
0:45:35 > 0:45:37You've got half your head missing.
0:45:37 > 0:45:40- You're going to keep moving forward, aren't you?- Yes.
0:45:42 > 0:45:44How are you doing, Sam?
0:45:44 > 0:45:46Speech and language therapist, Lisa Robson,
0:45:46 > 0:45:49is one of the rehab team helping Sam with his recovery.
0:45:49 > 0:45:51How are you feeling today?
0:45:51 > 0:45:53- All right, I suppose.- You suppose.
0:45:54 > 0:45:57How are you finding your speaking?
0:45:57 > 0:46:02Erm, quite difficult to...say.
0:46:02 > 0:46:04I don't know, I don't know.
0:46:04 > 0:46:08Is it difficult thinking of the words, or stringing them into a sentence?
0:46:08 > 0:46:11- What kind of...- It wasn't difficult thinking of the word,
0:46:11 > 0:46:16but I can't string them, like... to a sentence
0:46:16 > 0:46:20- like I usually can.- OK.
0:46:20 > 0:46:23He's totally different. He just seems more polite to people.
0:46:23 > 0:46:26He's certainly talking to people a lot more.
0:46:26 > 0:46:29Whether that's due to being in here or an operation,
0:46:29 > 0:46:31or a change of personality, I don't know.
0:46:31 > 0:46:35I think what's going on with your language at the moment
0:46:35 > 0:46:37is something they call Aphasia.
0:46:37 > 0:46:41Aphasia is a language difficulty.
0:46:41 > 0:46:43So we normally store our language about here in your brain
0:46:43 > 0:46:46- on your left side.- Oh, right.
0:46:46 > 0:46:50So obviously you've had quite an injury to that bit of your brain.
0:46:50 > 0:46:52You're doing really well, from our point of view,
0:46:52 > 0:46:56- considering what has happened.- Yeah.
0:46:59 > 0:47:01- RADIO:- Cambridge 105...
0:47:01 > 0:47:04'I think it's time for some more shout-outs.
0:47:04 > 0:47:07'First of all, I think we should give a massive shout-out to Molly,
0:47:07 > 0:47:10'who's one of our most dedicated listeners.
0:47:10 > 0:47:13'Always there.'
0:47:13 > 0:47:18It's nearly a month since Molly's hip operation and she's regaining strength on the trauma rehab ward.
0:47:18 > 0:47:21- 'Yeah, she's in hospital at the moment, which is pretty sad.' - 'Yeah, it's awful.'
0:47:21 > 0:47:24'But, apparently, she's getting better, which is wicked!'
0:47:24 > 0:47:27'Yeah, so get better as soon as you can, Molly.'
0:47:27 > 0:47:28I will.
0:47:28 > 0:47:30'We're rooting for you.'
0:47:35 > 0:47:37That was so sweet.
0:47:37 > 0:47:39I feel all warm inside.
0:47:41 > 0:47:45You have this big input of surgical intervention
0:47:45 > 0:47:47and then there's a waiting game while the fracture heals,
0:47:47 > 0:47:51and it's a frustration for everyone because the patient starts to feel more comfortable,
0:47:51 > 0:47:56the wounds are healed, the clips holding the wound together have been removed, so there's just a scar
0:47:56 > 0:47:59and the feeling is, "Why can't I get up and start walking on it?"
0:48:01 > 0:48:03- Are you recording? - I am recording.
0:48:03 > 0:48:06Erm, so...
0:48:06 > 0:48:11The case manager came today and he says that he can ring
0:48:11 > 0:48:17the transport and fix a set time for me to come home tomorrow.
0:48:17 > 0:48:19So it's all a bit overwhelming
0:48:19 > 0:48:20and I'm hoping to go home...
0:48:22 > 0:48:26..first thing tomorrow, which is amazing,
0:48:26 > 0:48:29because I didn't think I'd be home for Christmas.
0:48:33 > 0:48:35MUSIC AND LAUGHTER
0:48:36 > 0:48:39MOLLY HUMS TO MUSIC
0:48:44 > 0:48:47FRIENDS JOIN IN HUMMING
0:48:47 > 0:48:49We should do a three-part harmony.
0:48:50 > 0:48:52She's going home!
0:48:54 > 0:48:55She's going home.
0:48:55 > 0:48:57Who's going to take the high one?
0:49:04 > 0:49:07It is hard to convince a patient that it's really important
0:49:07 > 0:49:09not to stress that fracture fixation.
0:49:09 > 0:49:13The problem is a waiting game to not flex the hip
0:49:13 > 0:49:16and not weight bear, and that means a reclining wheelchair
0:49:16 > 0:49:19and to convince the patient not to try and cheat.
0:49:38 > 0:49:42David shows no sign of regaining consciousness.
0:49:43 > 0:49:46To make his care easier in the longer term,
0:49:46 > 0:49:49Peter wants to do an operation.
0:49:49 > 0:49:52One of the problems that David has had is that the ventricles,
0:49:52 > 0:49:55the fluid spaces inside the brain that contain brain fluid,
0:49:55 > 0:49:58have become enlarged following the injury.
0:49:58 > 0:50:00And it's important that we treat that
0:50:00 > 0:50:04and the way we do that is through the shunt operation.
0:50:04 > 0:50:08This drain in here is draining the fluid outside into a bag,
0:50:08 > 0:50:10so in effect we're going to convert that so the fluid will drain
0:50:10 > 0:50:14through from the ventricles through a valve and down a piece of tubing
0:50:14 > 0:50:17that we're going to put into his abdomen, where it will get absorbed.
0:50:17 > 0:50:21He'll have this shunt in for the rest of his life.
0:50:21 > 0:50:24There's nothing we can do about the original injury,
0:50:24 > 0:50:26the treatment is there to try and give him
0:50:26 > 0:50:29the best possible chance of making the recovery.
0:50:29 > 0:50:31But, you know, we're very concerned and we don't know
0:50:31 > 0:50:34whether he will ever actually be able to take that opportunity.
0:50:38 > 0:50:42This is the tubing that we're going to pass under the skin.
0:50:45 > 0:50:48And this is a special sort of valve, in that we can vary
0:50:48 > 0:50:50the pressure using a magnet on the outside of the head.
0:50:53 > 0:50:58Medical intervention has made major advances
0:50:58 > 0:51:02and I think that people are now surviving who used to die.
0:51:02 > 0:51:05What I think we need to be really, really conscious of is
0:51:05 > 0:51:09the quality of the survival for these patients.
0:51:10 > 0:51:12For medical intervention to save life,
0:51:12 > 0:51:16but produce a cohort of patients who are in vegetative states
0:51:16 > 0:51:20or states of very severe disability is not a good outcome.
0:51:24 > 0:51:27You can actually see the fluid is then coming up the brain catheter,
0:51:27 > 0:51:30through the valve, and we can see the fluid dropping
0:51:30 > 0:51:32out of the bottom end of the abdominal catheter.
0:51:38 > 0:51:40The day of the court case was Friday.
0:51:40 > 0:51:43We were all a bit stressed that day.
0:51:43 > 0:51:47He got sentenced to nine years four months, which is
0:51:47 > 0:51:52one of the highest sentences you can get for that offence.
0:51:52 > 0:51:56So we are pleased with that outcome
0:51:56 > 0:52:01and, yeah, you just have to... That's gone now
0:52:01 > 0:52:06and now we just need to concentrate on getting David better.
0:52:06 > 0:52:07Fingers crossed he will.
0:52:16 > 0:52:19Hi...
0:52:19 > 0:52:21- How are you?- Not too bad.
0:52:21 > 0:52:26- In fact, I'm great.- Good, we need to get you out of here, don't we? - Yeah, please.
0:52:26 > 0:52:30- I would get out of here before somebody stops you going.- Yeah, OK.
0:52:30 > 0:52:31- All right?- Yeah.
0:52:31 > 0:52:35It's interesting if you compare David,
0:52:35 > 0:52:38who we know he's very, very unwell at the moment.
0:52:38 > 0:52:42He's dependant on nursing staff, he's really still in a coma.
0:52:42 > 0:52:47Sam is slightly different in that he has actually done well, we think.
0:52:47 > 0:52:49You know, he's been though two operations,
0:52:49 > 0:52:52he's made a good recovery, he's discharged and everybody's happy.
0:52:52 > 0:52:56So you know, from the outside he appears to have done really, really well,
0:52:56 > 0:53:01but, you know, there were potential issues in terms of perhaps more subtle things...
0:53:01 > 0:53:03Thanks. Thanks, Rodger.
0:53:03 > 0:53:06..in terms of his personality, memory and concentration,
0:53:06 > 0:53:08and it will be absolutely fascinating to see him
0:53:08 > 0:53:10in a couple of months' time.
0:53:12 > 0:53:15I can't believe that I made it.
0:53:25 > 0:53:28Two months later, Sam's back for his follow-up.
0:53:28 > 0:53:30Sam, why don't you come and sit here?
0:53:30 > 0:53:32Right side's my best side.
0:53:32 > 0:53:34Good man. It's nice to see you.
0:53:34 > 0:53:37How have you been getting on?
0:53:37 > 0:53:40Erm, good, apart from the seizures.
0:53:40 > 0:53:43- Apart from?- The seizures. - Seizures, OK.
0:53:43 > 0:53:45My face went droopy... kind of thing,
0:53:45 > 0:53:46I thought I was having a stroke.
0:53:46 > 0:53:51- Yeah.- And then my whole right-hand side body went.
0:53:51 > 0:53:55- You know, these are to prevent the seizures that you described?- Yeah.
0:53:55 > 0:53:58So, I think what we should do is just build this up, gradually...
0:54:00 > 0:54:05..until, you know, we're sure that you've got enough to stop you having these seizures.
0:54:05 > 0:54:07How are things otherwise?
0:54:07 > 0:54:09- Awesome.- Awesome, good.
0:54:09 > 0:54:11- Sense of smell?- Yeah.
0:54:11 > 0:54:12It's OK.
0:54:12 > 0:54:15Hearing? Speech?
0:54:15 > 0:54:19Well, my speech is a bit like this.
0:54:19 > 0:54:22And what about things like your memory?
0:54:22 > 0:54:24Probably not as good as it was, but it's all right.
0:54:26 > 0:54:29- Is that my brain?- That's your brain and you can see how swollen it was
0:54:29 > 0:54:32and, in fact, where we removed the bone it's swollen through that defect.
0:54:32 > 0:54:35- That's why we took the bone out. - Yeah.
0:54:35 > 0:54:38What we're going to have to do is plan putting the skull back together.
0:54:38 > 0:54:40Good.
0:54:40 > 0:54:44- We'll get the titanium back in instead.- That'll be cool.
0:54:44 > 0:54:47- Metal head.- Metal head, yeah.
0:54:47 > 0:54:48Do I get to keep my skull?
0:54:48 > 0:54:53- If you'd like it, yeah. - Yeah, I want it. It'll be awesome.
0:54:53 > 0:54:55At the end of the day, you've done fantastically well.
0:54:55 > 0:54:59We'll get on top of this and it's very, very good.
0:54:59 > 0:55:01- I'll be all right? - Yeah, you'll be fine.
0:55:04 > 0:55:08- Thanks for saving my life. - No, it's...
0:55:08 > 0:55:11As I said, we're really pleased with how everything's going. It's great.
0:55:11 > 0:55:12Yeah, cool.
0:55:12 > 0:55:16- Thank you.- We'll see you soon, hopefully for the plate.
0:55:16 > 0:55:19- Bye, take care, you know where we are if you need us.- Yes, thank you.
0:55:19 > 0:55:21Safe trip back.
0:55:21 > 0:55:25The outcome from head injury is a huge spectrum.
0:55:25 > 0:55:28We have many patients who don't survive,
0:55:28 > 0:55:32we have patients that make a fantastic, really good recovery
0:55:32 > 0:55:36and Sam, seeing Sam, who's at the better end of the spectrum
0:55:36 > 0:55:39in terms of the nature of his injury,
0:55:39 > 0:55:41is very satisfying for us.
0:55:41 > 0:55:44From the people who saw him at the scene,
0:55:44 > 0:55:46people in the emergency department, through intensive care,
0:55:46 > 0:55:50the operating theatre, the neurosurgical ward, the rehabilitation,
0:55:50 > 0:55:53doctors, nurses all the therapists and everybody that's been involved,
0:55:53 > 0:55:56I think it's sometimes a pity that everybody doesn't see Sam.
0:55:56 > 0:56:00It would be nice if we could get more of the nurses to see him like this.
0:56:00 > 0:56:03You know, see the impact of their work in terms of his recovery.
0:56:03 > 0:56:06So putting it all together, I think, it's good.
0:56:13 > 0:56:16It's nearly four months since Molly's accident.
0:56:16 > 0:56:19She's on her feet and back at school.
0:56:19 > 0:56:21By the end of the surgery, I was feeling an awful lot better
0:56:21 > 0:56:25that we'd certainly avoided a hip replacement for a while.
0:56:25 > 0:56:28And even if Molly's fracture deteriorates,
0:56:28 > 0:56:31she gets arthritis, there's still a solution.
0:56:31 > 0:56:34The hip replacement is now established and works
0:56:34 > 0:56:38and we will keep her walking, but hopefully, that won't be necessary.
0:56:41 > 0:56:43Erm, this goes at the front so...
0:56:43 > 0:56:46Everyone who visited me in the hospital said,
0:56:46 > 0:56:49"Oh, you're going to have to use this for your artwork,
0:56:49 > 0:56:52"this is a real major life experience."
0:56:52 > 0:56:57So I looked at Dirk Skreber because he looks at car crashes.
0:56:57 > 0:56:59So, yeah, I want to do something similar.
0:56:59 > 0:57:03It's something that is super personal to me and so the truth
0:57:03 > 0:57:07of that will, hopefully, come across in my work and get me a good mark.
0:57:07 > 0:57:11I can't tell whether the red... the red is actually blood, or not.
0:57:11 > 0:57:12Are these tendons or something?
0:57:12 > 0:57:15- No, these are arteries. - Oh, my gosh, really?
0:57:15 > 0:57:17And that was like, severed.
0:57:17 > 0:57:19This is what's in there now, though.
0:57:19 > 0:57:20THEY GIGGLE
0:57:20 > 0:57:23There was a mixed blessing in this, in that, you know,
0:57:23 > 0:57:24Molly and I got very close again
0:57:24 > 0:57:28and she had to allow me to care for her.
0:57:28 > 0:57:30I did, sort of, say a huge thank you.
0:57:30 > 0:57:33I don't think it will ever quite be enough.
0:57:33 > 0:57:36Now she's back up in her room, she's back on Twitter,
0:57:36 > 0:57:39she's back on Facebook, but there's just a difference, you know.
0:57:39 > 0:57:42I think Moll and I will always have a link now,
0:57:42 > 0:57:45which maybe we wouldn't have had if this hadn't happened.
0:57:50 > 0:57:52Shall I hold this so you can see it?
0:57:52 > 0:57:54It's so complicated looking at my X-rays
0:57:54 > 0:57:57and thinking, where would you even begin?
0:57:57 > 0:57:59I'm lucky that the people who looked after me
0:57:59 > 0:58:02were the best at what they do.
0:58:02 > 0:58:05Molly, actually, is a good example of an awful lot of specialties
0:58:05 > 0:58:07coming together and working together,
0:58:07 > 0:58:11and that is a product of the major trauma system.
0:58:11 > 0:58:15I keep on using the word "machine", because that's what it feels like, but it's a machine that works.
0:58:17 > 0:58:19All in all, I'm a very lucky girl.
0:58:43 > 0:58:46Subtitles by Red Bee Media Ltd