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  • 2 days ago
999 The Critical List S01E02
Transcript
00:00Hi, are you bleeping emergency bleep?
00:04The patient from ED is coming in here now.
00:08Behind the scenes of every major hospital in the UK,
00:12there is an emergency list that few of us have ever heard of.
00:16The emergency list is a list of the sickest patients in the hospital,
00:20the patients who need emergency surgery.
00:24He's a sick patient who needs expediting. This critical list evolves
00:28by the hour as patients are added
00:32and prioritised.
00:34They've just booked this one also as a cat one.
00:36We weigh things up. This list is about order of priority of the sickest patients first.
00:41We follow the critical list at a time when the NHS is facing unprecedented pressure.
00:47The list is full.
00:49We see more and more people come through the door.
00:51It's the toughest time for the emergency list that I have ever known.
00:54But with patients hours away from being critically ill,
00:57staff are forced to make impossible decisions.
01:01Why is she taking priority over him?
01:03Of who goes next.
01:05Because the reality is hitting me.
01:07And who must wait.
01:09I cannot stay indefinitely in hospital.
01:12Never think that we don't think you're important to us as you are.
01:15Oh, thank you.
01:18You're all right.
01:19Oh!
01:20Without the emergency list, these patients, they would deteriorate.
01:25They would be taking hospital beds up for days.
01:28They would be in critical care.
01:30These patients would probably die.
01:32Just make sure I wake up.
01:34Just make sure I wake up.
01:45What's surname, love?
01:47Ali?
01:48Can we have a skin marker, please?
01:54The Royal Blackburn Hospital in Lancashire has 11 operating theatres.
02:01But only one is dedicated to unplanned emergency surgery.
02:05Theatre 6.
02:06That's the one.
02:07That's the one.
02:08It's fully expanded now, isn't it?
02:09It's fully expanded.
02:10Each day, patients needing urgent surgery are added to an emergency list
02:16and prioritised by the consultant on duty.
02:19Try and work out where the hell to start, if I'm perfectly honest.
02:22On call this week is Mr Nick Haywood.
02:25Has this been getting worse?
02:26Uh, yes, it has.
02:28I think when you look at the workload that we have as an emergency consultant,
02:32you can see that it's just unmanageable.
02:34Hello.
02:35Good morning.
02:36How are you feeling today?
02:37Because if you've got 30 patients and that's going to take just five minutes per patient,
02:45you're looking at a few hours' work just to get round those patients.
02:49That's better than yesterday.
02:50And then we've got to be in theatre operating on those patients.
02:54Because he's got no symptoms.
02:56You'd say we're at a broken point.
02:58Sometimes we feel that the system's broken and we're trying to fix it whilst trying to continue working.
03:03Just give him some fluids.
03:05Make sure he's on some antibiotics.
03:06He'll be all right to go with.
03:07It's just a day-on-day challenge every single day that everyone comes in to work.
03:11And you can see it across the rest of the staff.
03:14The ends are cold.
03:15Oh, I'm sorry.
03:17We're coping, essentially.
03:19We've got a camera in the tummy.
03:21Have a look at the appendix.
03:22Yeah.
03:23And take your appendix out if it's your appendix.
03:25Is that OK?
03:26OK.
03:27There are currently seven patients on the list.
03:30Where possible, children are prioritised for surgery.
03:34So eight-year-old Lola will be first in theatre six.
03:38Morning, Vanessa.
03:40Before he goes to operate, Mr. Hayward has time to visit one more patient.
03:45Not right?
03:46OK.
03:47I don't feel where we are, actually.
03:50OK.
03:51Can we get her an ECG some point later?
03:53Mum of six, Vanessa, was admitted to hospital two days ago, with what doctors suspect is an incarcerated hernia.
04:00Can I have a look at your tummy again?
04:02Yes.
04:03It's a potentially life-threatening condition that can cause the bowel to die.
04:08Vanessa's CT scan suggested that she needed a laparotomy, which is essentially where we cut the abdomen open and we go in.
04:17The consequence of that can be quite severe on somebody's body physiologically.
04:23And in the case of Vanessa, she's adamant she didn't want to take any risk that would make her quality of life worse.
04:29I'll come back and talk to you a bit later, because I've probably got a few complicated discussions to have with you about where we go from here.
04:37Is that OK?
04:38Yeah, that's fine.
04:3961-year-old Vanessa must decide whether or not to go ahead with major surgery.
04:48What are you thinking at the moment, Vanessa?
04:50Thinking.
04:51All sorts.
04:53It's hard.
04:55Cos I know my health's not that good.
04:59If I went through surgery, I could be in intensive care for months.
05:05If I don't go through with it, I'll just die anyway.
05:12So, what's the point in putting myself through all that?
05:20It is a big decision to make.
05:22Are you ready?
05:23Ready.
05:24Very strong.
05:25In theatre six, registrar Oladelli will operate on Lola alongside Mr. Haywood.
05:39I'm just trying to ring the consultant, let him know the patient is on table and we are good to go.
05:44We have a lot of patients today and we have to crack and see how many we can sort out before the day runs out.
05:52You never sleep.
05:53There's never a boring day.
05:54There's never a time to chill.
05:56And the patient will always keep coming.
05:58There's no end.
06:02I'm just in constant pain.
06:04It's agony.
06:0559-year-old Julie has a perianal abscess and has been waiting for surgery for three days.
06:11I struggle to sit.
06:13I struggle to stand because I'm so tired, because it's keeping me awake at night.
06:18I'm taking so many painkillers, I don't know which planet I'm on.
06:24Left untreated, an abscess can burst and cause sepsis, potentially fatal blood poisoning.
06:30Have you been in hospital for anything like this before?
06:33No.
06:34I have ulcerative colitis, so I've had my large intestine out and I have a ileostomy, so a bag, basically.
06:42It remains sort of there.
06:46I mean, I do have a reasonably active life.
06:49I've got three dogs.
06:50Yeah, I did have four, but I lost one just before Christmas with my little monsters.
06:55Yeah, my horse is a Welsh cob, so I do a lot of competing with my horse and my dogs.
07:03That's my life.
07:05So, I'm on the list. Hopefully I'll get done.
07:08It does obviously depend on if they get any emergencies coming in.
07:12I could get knocked off the list, but I'm just hoping that that doesn't happen.
07:17PHONE RINGS
07:22Hi, are you bleeping emergency bleep?
07:24In charge of managing the growing number of patients on the list...
07:27Oh, what is it for?
07:29..is theatre six coordinator, Nicky Tingle.
07:33I think he had a hernia repair.
07:35So, this patient, Graham, was operated on the emergency list last Monday.
07:42And he's out of the lead, so they need to do an evacuation of haematoma.
07:45It's Nicky's job to keep the list moving.
07:48We are on a battle every day to get all the patients in beds,
07:51all the patients out of recovery, keep all the lists running.
07:55So, this is Graham. It's a return to theatre, so we'll need an IR1.
07:59They don't know if it's starred yet. They're going to let the tutor know.
08:0261-year-old Graham requires surgery on a haematoma,
08:06a leaking blood vessel, and has just been added to today's list.
08:10So, any major health problems apart from this that we need to worry about?
08:13No, it just keeps sending shooting pains.
08:16Any further delay in treatment carries with it a risk of internal bleeding.
08:21Had my hernia done, so I went home,
08:24and then the day after, it just started hurting a little bit.
08:27So, the doctor said, you'd better come back to hospital,
08:29it looks infected.
08:31I mean, I've been in pain for four days.
08:34So, hopefully, it'll get sorted today.
08:35PHONE RINGS
08:43PHONE RINGS
08:45Hi, are you bleeping emergency bleep?
08:48OK, right, who is it?
08:50Yeah, cat one.
08:52OK.
08:54Down in the emergency department, a 27-year-old man is critically ill
08:59with a suspected bowel obstruction.
09:01I think it's got adhesions.
09:03They may have had some surgery in the past.
09:06As you're healing, some tissues can stick your bowel together
09:09in different places, and it can cause an obstruction.
09:12So, he's going to look in with the camera first,
09:14see what he can see, and then maybe do a laparotomy.
09:16But they want him to go now.
09:21As a category one case,
09:24this patient becomes the most urgent
09:26and moves to the top of the list.
09:28So, you've got a cat one, laparoscopy,
09:32plus or minus per C.
09:33They think it's adhesions.
09:35Why is he a cat one?
09:37His bowel could perforate,
09:39and then it'd be peritonitis septic,
09:41and he could die.
09:43But over in critical care,
09:44another category one patient needs to be added to the list.
09:4830-year-old Emma has been ill in hospital for two weeks,
09:52but her condition has deteriorated.
09:57Doctors are concerned she, too,
09:59has a potentially fatal issue with her bowel.
10:02I don't think he's shot.
10:04She's so special to us.
10:06Do you know where the family are?
10:09With two critically ill patients,
10:11both in need of surgery,
10:14Mr. Hayward has to decide who goes first.
10:17I think the most difficult thing to have to deal with
10:20is when you're bombarded with two or three things
10:23that need sorting at the same time,
10:25and you're having to make a decision immediately.
10:27There's a huge sense of responsibility as a consultant surgeon,
10:31knowing that, realistically, the buck stops with you.
10:33PHONE RINGS
10:52I'm just going to go into the screening.
10:54Are you OK?
10:55Yeah.
10:56At the Royal Blackburn Hospital two patients with life-threatening conditions require urgent surgery
11:03Who's the ICU one? We haven't got an ICU one booked.
11:07Oh very good. I'm just briefed for an ICU one.
11:09We haven't got it even booked.
11:10They need to sort their shit out today.
11:13Just briefed for it in here.
11:14This patient's not even been booked.
11:17Right, so just tell me why is she taking priority over him?
11:23Because she's systemically unwell and ICU needing inotropes.
11:28In an ideal world we'd do them both together.
11:31So at the moment we've got two patients that need to go to theatre for a laparotomy.
11:36One of them is a young girl who's got gas within the blood vessels in the liver
11:42that's probably come from somewhere in part of the bowel.
11:44And then we've got a patient who's got an obstruction from his bowel.
11:48His bowel's twisted. He needs an operation as well.
11:51But she's a bit more unwell so she needs to go first.
11:54And then the plan is to get him done afterwards as well as trying to manage the rest of the list.
11:59With Emma bumped to the top of the list, the other patients will have to wait.
12:04It's a big shock.
12:08You've just thrown everything all at once.
12:10It's a big shock. I mean it's a lot to take in really.
12:13Graham and Michelle's daughter Emma has Rett syndrome, a rare genetic disorder that impairs speech and motor skills.
12:21This is a picture of her.
12:23When she's happy.
12:24When she's happy.
12:25She has such a good quality of life, even though she needs 24-hour care.
12:29But she's so loved.
12:34We've been told the outcome might not be what we want, but we have to go through with it.
12:39So they've said they'll look after her and we put our trust in them.
12:44What else can you do?
12:46We so want her to recover.
12:50Life without her just...
12:53It's unbearable to think that we won't have her.
12:58We need her to recover.
13:00My love is so awful.
13:17It's chaos this week already.
13:19How far into the week?
13:21Monday.
13:22I don't even think it's three o'clock, is it?
13:25I've already aged 20 years today.
13:28Eight patients remain on the emergency list.
13:32But the immediate priority for coordinators Nicky and Becky is the CAT1 bowel obstruction.
13:39I'll let them know that patients arrived.
13:43They've found a short gap in operations in Theatre 5.
13:47But major abdominal surgery needs a specialist consultant.
13:51I've just spoken to Remy Ahmad.
13:53He's actually not on duty as such.
13:55We need to find another surgeon.
13:57He's just been here.
13:58Has he found another surgeon?
14:00No.
14:01Trying to locate surgeons at times can be really difficult.
14:05Before starting Emma's surgery in Theatre 6, Mr Haywood needs to give an update to Julie.
14:11I'm hoping to do this this evening.
14:13Still hoping?
14:14Yes.
14:15I'd like to do it myself because I'll probably look after you going forward.
14:19So I want to know what it's looking like to be able to sort it out long term.
14:23So it's going to happen?
14:25Providing nobody comes in through ED.
14:28Lock the doors, lock the doors.
14:30No, I'll let you know if it's any different but the plan is still.
14:33I'll stay and do it, okay?
14:35How are you feeling, Julie?
14:36Just tired and headache.
14:38I'm a bit fed up because I'm thinking, is this going to get cancelled again?
14:46What's your gut saying?
14:48I'm not listening to it.
14:51Hiya, are you okay?
14:54Are you at Blackburn?
14:56Becky has managed to arrange a surgeon to come from nearby Burnley Hospital.
15:01Mr Alumin's free.
15:03So Dan's going to ring him and get him to come down.
15:07So we've got anything to do now, right?
15:09We've got everything.
15:10With a new team now in place...
15:12We need you.
15:14We need you.
15:15The emergency bowel operation can proceed in Theatre V, led by Mr Alumin.
15:21I was in Burnley, but because there are so many cases in the emergency theatre,
15:27I got called in to help out.
15:30The two category one cases are now in theatre and off the list.
15:34So Julie, Graham and four other patients are a step closer to receiving their treatment.
15:44I'm here now.
15:45Hello?
15:46Where are you?
15:47I'm here now.
15:48Right.
15:49Is that your husband?
15:50Yes.
15:51How long have you been married?
15:52Right here.
15:53All together.
15:54Long time.
15:55Like a prison sentence.
15:5661-year-old Vanessa has been considering whether or not to go ahead with major surgery.
15:58How did you meet her?
15:59Hello?
16:00Hello?
16:01Where are you?
16:02Where are you?
16:03I'm here now.
16:04Right.
16:05Is that your husband?
16:06Yes.
16:07How long have you been married?
16:0830 years.
16:09All together.
16:10Long time.
16:11Like a prison sentence.
16:1461-year-old Vanessa has been considering whether or not to go ahead with major surgery.
16:24How did you meet?
16:25Yeah.
16:26I met him at train station at Accurton.
16:29Can we come in?
16:34Any other way?
16:35Yeah.
16:36Any other way?
16:37Yeah.
16:38I'm in the decision.
16:39I'm not going down for a knot.
16:40And I could die on table anyway.
16:41But she told me how I could come through, but being in 10 to take care of a month on edge. No, I'm not doing that. As long as you can keep me comfortable and that can really.
16:54I'm happy with that.
16:55So how are you going to get better?
16:56Eh?
16:57So you want to die?
16:58Eh?
16:59So you want to die?
17:00I'm not bothered.
17:01Well, I am.
17:02I think it's my decision.
17:03It's one of the hardest decisions I'll have to make, but I'm not bothered. I'm doing what's right. I think it's right.
17:09Vanessa's been struggling with her health recently and I don't think she's got the fight in her, really, at the moment.
17:38So she's still going to be looked after. She's still going to be in the hospital. She may change her mind.
17:51That's collapsed, yeah.
17:53The emergency list is currently running in two theatres.
17:58At least the main one, if you want, then go back to the other.
18:00In theatre five, Mr Allermann, who was rushed over from Burnley Hospital, is operating on a bowel obstruction.
18:07If there's a blockage and you leave it, it's like someone squeezing on the bowel. First of all, the stool can't get through. Secondly, it can lead to ischemic bowel, which is the blood supply gets cut off. That could be life threatening.
18:19While in theatre six...
18:20OK, gas on, please. Low flow to start.
18:23Mr Haywood is operating on Emma.
18:25In an ideal world, we'd be able to just get them all done when we can.
18:29But we already know that cases during the rest of the week are starting to mount up.
18:33That if we don't do this, it'll have a knock-on effect for the rest of the week.
18:43Hi, bleep and emergency bleep.
18:45A third category one laparotomy case has come into the emergency department.
18:50It's a mental ball in here. Mental.
18:52They must operate immediately.
18:54And the case has been rushed to the top of the list.
18:57Just when you think that the shit couldn't hit the fan anymore.
19:00But don't worry.
19:01Things couldn't get any worse.
19:04So Nicky must find another theatre and a third surgical team.
19:08They've just booked this one also as a cat one.
19:10Who's doing that one in five then?
19:12Alumin.
19:13So yeah, if you want us to do another one.
19:15We're good in four.
19:16Who's the surgeon in there who's going to do Darren?
19:18Darren, yeah.
19:19Has Darren agreed to it?
19:20Yeah.
19:21In order to treat the new emergency,
19:23two other patients with planned procedures will now have their surgeries cancelled.
19:28Nicole, are you alright with this?
19:30We'd love to know what's going on.
19:31Theatre eight, they're cancelling the two lap callers they've got left
19:35and just doing that one laparotomy.
19:37The emergency patients really do need to take the priority
19:41and that sometimes then affects what we can do
19:44with our elective patients coming in.
19:46The thing is, the emergencies are emergencies aren't they?
19:48You're going to have to, you're going to have to do them.
19:50Sometimes we have to cancel elective work
19:52because we have to provide the most optimal care
19:55for the most life-threatening conditions first.
20:05Right, photograph please.
20:06In theatre six, Mr Haywood is yet to locate the suspected hole in Emma's bowel.
20:13What I'm doing at the moment is something called a diagnostic laparoscopy.
20:17So, we're able to put a camera through a small cut into the abdomen
20:21and then we're able to look around at all the bits of the bowel.
20:25Well, the bowel's not unhealthy, is it?
20:29You know, it's not unhealthy at all.
20:32I'm having a good look around, there's nothing to suggest
20:35there's a hole in any of the gut anywhere, which is reassuring.
20:40Emma's rare genetic condition means she's been unable
20:43to communicate her symptoms to doctors.
20:46With surgery, when you operate on someone,
20:48you generally have an idea of what's going on
20:50based on speaking to a patient to elicit their history.
20:54In patients who can't communicate that history to us
20:57or maybe can't tell us that they've got pain or where it is,
21:01we're reliant on the imaging that we get, the scans,
21:05the blood tests, and put all that together.
21:09OK, so that's fine, so the colon's fine.
21:11Let's go all the way back round here, Deli.
21:13And sometimes you may have a scan that shows one thing,
21:16and when you get in to have a look in with a camera, for instance,
21:20into the abdomen, you find something that's a bit different.
21:24So that's completely normal.
21:25She's got what looks like a bit of fluid kind of in the tissues.
21:32Working diagnosis at the moment is whatever we're seeing
21:34in the bowel or in the abdomen is secondary
21:36to some other condition that's going on
21:38that's causing the changes, which you can see sometimes.
21:43Emma and the two other bowel procedures are having a major impact
21:46on the ever-growing emergency list,
21:49and it's become unlikely some patients
21:51will receive their treatments tonight.
21:5415 minutes before, it came up,
21:56and as soon as they were walking round that corner,
21:58they sent a messenger by to cancel it.
22:02Apparently, they've got three emergencies.
22:05But we've all heard that adage before.
22:08They say, oh, we've got an emergency.
22:10Well, that's what they say to try and justify it.
22:12So I'm a little bit upset.
22:15You feel as if they just shove you in bed and just leave you.
22:19So that's what it feels happening to me.
22:21PHONE RINGS
22:23Hi, bleeping emergency bleep.
22:27What is it for?
22:29I'm feeling a bit stressed out this list now today.
22:34We've got a lot to do.
22:36It makes me feel like I'm not doing my job very well.
22:40But it's totally out of my control.
22:46It's the toughest time for the emergency list that I have ever known.
22:49We're transferring patients to the next day, sometimes the following day.
22:54We've got so many patients on, so many demands on emergency services at the moment.
23:00We are sinking.
23:02The NHS is, I don't know how we're going to get out of it.
23:05PHONE RINGS
23:08Ideally, Julie's going to get done.
23:11I really do want her to be done.
23:13She's been waiting a long time.
23:15So far, Julie has been waiting at the hospital for three days.
23:19I've just been sent across by Mr Haywood.
23:22It's going a bit crazy, you know, you know that.
23:24It's an abnormal situation.
23:27Normally it doesn't happen to, we barely open a second theatre.
23:31It's now open the third theatre.
23:33There are patients who are really unwell, who need urgent treatment and operation.
23:38So if you want to stay around another two to three hours, probably we'll be able to get you done today.
23:45And I think it's worth waiting.
23:46If anything changes, we personally will come and speak to you.
23:51Thank you for bearing with us.
23:52I know it's quite a bit of an ask.
23:55OK.
23:56OK.
24:07It's just the let down again.
24:11I've had months and months of pain and not being able to function, not being able to sleep.
24:17And I just want it finished.
24:19We've got a laparoscopy in five, a laparotomy in eight, we've got the other one in theatre six.
24:29It's early evening at Blackburn Royal Hospital and with three theatres open and seven patients still waiting for treatment, the emergency list is running beyond capacity.
24:43What have we got left to do?
24:44Kevin.
24:45Stephen.
24:46He's not start until 7pm.
24:47There is Julie.
24:48Still waiting.
24:49Vanessa has refused the surgery but he won't let us take her off the list.
24:52Usman, lap appendix.
24:53Graham.
24:54Got a haematoma.
24:55Six.
24:56And it is now quarter past four.
24:57It's impossible.
24:58Right.
24:59I will go and do a walkthrough.
25:00In theatre six.
25:11I'm ready for another photograph.
25:14And it is now quarter past four, it's impossible.
25:18Right, I will go and do a walkthrough.
25:23In theatre six.
25:24Ready for another photograph.
25:26Mr Hayward is investigating whether or not
25:29to remove a part of Emma's bowel,
25:31suspected of having perforated.
25:34So the question is whether she has a problem with her bowel
25:37that needs surgery to rectify her illness,
25:40or whether there's an underlying condition
25:43that is giving us the findings that we see on the CT scan,
25:46it doesn't need anything further.
25:48So the operation we're doing now,
25:50called the diagnostic laparoscopy,
25:52allows us to look at the quality of the bowel
25:54that the CT scan hasn't been able to clarify for us.
25:58But at the moment I can't, I will do more harm than good
26:02by trying to remove something that doesn't require removal.
26:06So we'll have to explore other reasons for her being unwell
26:10on the ITU when she goes back.
26:13When we're managing patients who are non-verbal,
26:18who can't communicate with us in the standard ways,
26:22you never really can understand that patient's wishes.
26:25You know, you hope you're doing the right thing for them,
26:28but sometimes you just never know.
26:35Hello. Hello.
26:37Good news in a way. I'm not able to do anything.
26:39Oh, right.
26:40There's no significant problem with the blood supply to the bowel.
26:43The bowel looks all OK.
26:44And I've left a little drain, a plastic tube that goes in.
26:47There was a bit of fluid in there.
26:48So she's unwell from something.
26:50Right.
26:51But it's not being driven by anything that I can see.
26:54I can't explain some of the other findings on the scan.
26:56The best thing to do is keep her on antibiotics
26:58and bring her back here and see what happens,
27:01see where she goes.
27:02That's a nice shot.
27:03OK.
27:04Yeah, yeah, thanks.
27:05OK.
27:06No, you're welcome.
27:07Yeah.
27:08You'll be exhausted, so you get some rest.
27:10Yeah, yeah.
27:11OK.
27:12Yeah.
27:13Right, yeah, great.
27:14Thank you from the factory.
27:15All right.
27:16All right.
27:18All right.
27:19Oh, my God.
27:22Oh, God.
27:23Oh, God.
27:28Hello, you OK?
27:30Yeah, not too bad.
27:31Crazy chaos, as always.
27:33As two more cases are added to the emergency list,
27:36down in recovery, there is another problem.
27:39Look how many patients you've got in here as well.
27:42Yeah, none of them have got any beds.
27:43Nobody's moving.
27:45There are no spare beds up on the wards
27:47for recovery patients to go to.
27:49One space left.
27:51Yeah.
27:52That's got no monitor or CERNA abilities.
27:57There's just nobody moving.
27:59Whilst it's at capacity,
28:01Nikki is unable to keep the list moving,
28:04adding to the delays.
28:06If there's no beds on the wards,
28:08our patients can't leave recovery.
28:10If they can't leave recovery,
28:12patients can't go into surgery and have their operation.
28:15It's not ideal.
28:16Far from ideal.
28:18We have a finite number of resources,
28:19a finite number of staff,
28:20more and more patients coming into the hospital
28:22within a system that is essentially so much under strain.
28:26I think we do very well with what we have.
28:29Exactly.
28:30Dom's wrong, they want to run another emergency
28:33till midnight.
28:35Tonight?
28:36Which consultant will come and work till midnight?
28:38The effort and the goodwill from the staff
28:40is why it keeps going.
28:41Most of the team that are on long days
28:43have been here since seven o'clock this morning
28:45or eight o'clock.
28:46They're working till six.
28:47They won't stay till midnight.
28:48The more busy we get,
28:50the more strain it has on that goodwill.
28:56So you and Aaron are on the limit as well?
28:59Who else? And you?
29:00You're on till six?
29:01Yeah.
29:02Seven, doing all right?
29:03Mm.
29:04Hi, Nick. It's Nicola. Are you OK?
29:07In order to balance staff welfare,
29:10treat the most urgent patients
29:12and keep spare capacity available
29:14for any overnight life or limb emergencies...
29:17All right.
29:18Nicky and Mr Haywood
29:19need to reduce the numbers on tonight's list.
29:22All right, okey-doke.
29:23OK, bye!
29:25So, everything else on the list...
29:28Carboshed?
29:30Yeah.
29:31The four most urgent cases
29:33will be done by the evening shift.
29:35The remaining five cases,
29:37including Vanessa, Graham and Julie,
29:39will be delayed until tomorrow.
29:42He said Julie's too complex for the reg,
29:45which we worked out.
29:47Julie has been waiting for treatment
29:49on her perianal abscess for four days.
29:52I'm just here to appeal
29:54and explain to you what is going on.
29:56I really want to apologise for not being able
29:58to get to you today.
29:59As I speak with you, I have another patient
30:01who's got a life-threatening emergency
30:03that is still going to try and find a way
30:04to get him to theatre tonight.
30:06What we plan to do is to get you to the world
30:08and let's try again tomorrow.
30:10I really want to apologise.
30:12This could go on forever.
30:13You're always going to get emergencies coming in.
30:15It's never stopped.
30:16This could go on for six months.
30:17I cannot stay indefinitely in hospital.
30:20I just physically can't do it.
30:22I have responsibilities.
30:24I know.
30:25When do we get to the point
30:26where I am prioritised?
30:27You are...
30:28I'm never ever going to be a priority.
30:29No, you're always important.
30:30That's...
30:31But I'm not prioritised.
30:32Whether I'm important or not is...
30:33But the thing is, though,
30:34today we have to open two theatres,
30:35which is not normal.
30:36We have to get surgeons outside
30:38to help us with the patients
30:40because there was no way
30:42I'm going to cover almost 14 patients.
30:44There's no way.
30:45So that's how much we have to go today.
30:47I so wish I'd close my shift by eight,
30:49but I said I'm not going anywhere
30:51until I see everybody.
30:52I have them.
30:53So that's how much we have to go today.
30:54I wish I'd close my shift by eight,
30:55but I said I'm not going anywhere
30:56until I see everybody.
30:57I haven't touched today
30:59and speak to them one-on-one.
31:01We understand.
31:03We apologise.
31:04But we've been on our feet all day.
31:07We're stretched out to the thinness.
31:10But never think that we don't think
31:12you're important to us.
31:13You are.
31:14You are a partner.
31:15The reason why we come to work every day.
31:16And we have to sort you out.
31:18OK?
31:19OK.
31:20Don't worry.
31:25Nicky's shift is over for the day.
31:28How are you feeling about tomorrow?
31:31We've got Julie.
31:32We've got the right hemicolectomy.
31:34We've got Vanessa.
31:36We've got Usman.
31:37And we've also got Graham.
31:39Tomorrow is off to a busy start.
31:41But we've got a plan.
31:43We're hoping it works.
31:46Everybody knows that the emergency list is busy.
31:50She actually said she would stay till midnight.
31:53Are you up for staying?
31:55If it's going on, yeah.
31:56The people who tend to work in there
31:58are the people who are interested in a crazy day.
32:01Emma, we've just had another appendix box.
32:04Oh, brilliant.
32:05But we just manage it.
32:07We love it.
32:08Keep calm.
32:09And carry on.
32:10There are the odd times when it's absolute carnage
32:13and you can't see how you're going to get out of this.
32:16But we always do.
32:18See you next Tuesday.
32:20Get out, North girl.
32:22We work well together.
32:23The staff work well together.
32:25Everyone's got each other's backs.
32:27And I'm going.
32:28It's been a pleasure.
32:29Thank you for your help today.
32:30No problem at all.
32:32People keep going because they know these patients need looking after.
32:36So someone always comes up with a plan.
32:38And calm is restored.
32:40You've actually come through to the main reception of the hospital.
33:03I don't know if that's what you need.
33:05You naughty boy.
33:09Oh, shit.
33:11Calm down.
33:12Right, let's look at the list.
33:14Good morning.
33:15Except for the first patient, which is Julie, for her EUA rectum.
33:20Thank goodness for that.
33:22Where am I?
33:24Where am I?
33:25Oh, my God.
33:26I'm one step closer.
33:30Hello.
33:31Julie, I'm Nicola.
33:32One of the nurses.
33:33Are you OK?
33:34I am, yeah.
33:35Good.
33:36I think we've been in a state of shock.
33:37We are too.
33:38We've been waiting.
33:39We have been trying.
33:40We've been saying, Julie, Julie, Julie.
33:41We'll see you now.
33:42Yeah.
33:43It's been annoying.
33:44But I don't understand.
33:45Biscuits and a bag of crisps.
33:46That's it.
33:47These last few days, yeah, they've just been so busy with emergencies.
33:49And, you know, you could be selfish and stamp your feet and jump up and down.
34:04What's the point?
34:06At the end of the day, although I'm in a lot of pain, it's not life or death.
34:10And there's been people, it has been life or death.
34:13So, just got to get on with it.
34:15I don't think I'll be 100% convinced till I'm on that table with a needle in my arm going to sleep.
34:30If I went down for the yard, I don't think I'd pull through.
34:33With all my medical problems.
34:36Despite still being on the list, Vanessa hasn't changed her mind about surgery.
34:42Can you tell me what have your family said about your decision, though?
34:45They want me to have it done.
34:47My older son, if you don't have it done, I'm not going to speak to you.
34:51I said, you can't be like that.
34:53I said, it's my choice at the end of the day.
34:56Would you want to keep going through pain and pain and pain?
35:00I said, cos I don't.
35:05Hello, Vanessa.
35:06Hey.
35:07Can I have a look at your tummy? Is that OK?
35:10A second review of her scan suggests the swelling could be due to a hole in the bowel,
35:15allowing faecal matter to leak outwards, creating an abscess.
35:21Right.
35:22I've been having to think about what we should do.
35:24Yeah.
35:25The bowel, it's really close to the skin.
35:28I think, obviously, you don't want to have any major surgery.
35:30Yeah.
35:31Is that still the...?
35:32Yeah.
35:33Still the same thing.
35:34What I'm thinking we could do is make a little hole there with some local anaesthetic,
35:39and then allow it just to drain out.
35:41It may help with the pain that you have.
35:43And then we deal with the consequences afterwards.
35:45Yeah.
35:46How do you feel about it?
35:48Yeah.
35:49And then we'll swell in again.
35:50Yeah.
35:52Yeah, yeah.
35:53I think if we're going to do it, we'll do it in theatre.
35:55In theatre?
35:56Yeah, we'll take you down.
35:57You won't be asleep, but it's just at a better area to be able to do things
36:00than just on the ward down here.
36:02I know you don't want anything major, but it's also trying to do something
36:06that may help you along to get better to potentially get you home.
36:10Yeah.
36:13Lovely.
36:14OK.
36:15See you a bit later.
36:17He doesn't feel better, that doctor.
36:19What's he called?
36:21Nick Heerwood.
36:22Mr Heerwood.
36:23Mr Heerwood.
36:24He explains everything.
36:27That's why I like him.
36:35Can we give Mr Nick a call?
36:37Tell him that I've started and I need him to come here now.
36:40Yeah.
36:41In theatre six, surgery on Julie's perianal abscess
36:45is proving difficult for registrar Oladelli.
36:48Thanks, mate.
36:49It's a bit tricky.
36:51Our patient would have got a previous inflammatory bowel disease.
36:56So she's got multiple surgeries.
36:58MRI shows she's got a small abscess within the thin layers of the muscle.
37:04So we can't strain that easily.
37:06You know, the problem's causing her pain at the moment is this abscess.
37:11If you feel that around that nine o'clock position, yeah, I could feel it there.
37:16I put it in a needle.
37:17I couldn't get it.
37:19These complications of people that have had inflammatory bowel disease
37:23are often a lot more tricky to solve.
37:26Julie's abscess is located within a section of her bowel that has become sealed off.
37:33Yeah.
37:34Symptoms.
37:35Not great.
37:36Clinical director, Mr Vittoni, is called to assist.
37:39Can't get in.
37:40Is it strict?
37:41I think it's just strict.
37:42Do you think your stenosis is strict?
37:44No.
37:45It's quite difficult to get to where the abscess is.
37:48So we're trying to probe a bit further.
37:51It costs minimal damage while trying to relieve the pressure.
37:54So it's not straightforward.
38:08Well, we need to drain the abscess.
38:10That's within the two rings of sphincter muscle.
38:14So she's got an abscess between the internal and external sphincter.
38:19In theatre six, consultant surgeon, Mr Haywood, and clinical director, Mr Vittoni,
38:25need to drain Julie's perianal abscess.
38:28It's taller than five rows.
38:31I was just going to go in here and open that up.
38:34I think so.
38:35But due to the effects of multiple previous surgeries,
38:38they're unable to get to it.
38:40Just in terms of the abscess, you see, it might be better to do it transversal.
38:44We expose the sphincter and just allow it to drain.
38:48Mr Haywood will cut into the sphincter muscle to drain the abscess.
38:53Yeah, it's the pressure that's within it that's causing the discomfort.
38:57And by releasing that pressure, the pain should improve.
39:01She's got a chronic cavity.
39:03She also has a fistula, which is an abnormal track
39:06that runs between the anal canal, which is probably feeding this cavity.
39:10If we allow this to just heal up, she'll end up with the same problem again.
39:14So what we do is we put a little thread through and tie it so that hangs out
39:19and that keeps the track open to allow it to drain.
39:23Is it nice to finally get patients sorted?
39:25Yes, it's nice to find a patient sorted.
39:27It's my job. It's what I'm paid to do.
39:30And a relief that, OK, I've got one sorted.
39:33And you get a call that you've got three more new ones.
39:36It never ends.
39:41She's got a really quite complex case,
39:43and this is the start of quite a long road
39:45to try and sort her ongoing problems out.
39:49So we'll look after her here as a team.
39:52There's going to be a combination of surgery and painkillers and things
39:56that will hopefully enable her to get on with the life that she wants to live.
40:06PHONE RINGS
40:11PHONE RINGS
40:13Oh, my call's first in the queue. I didn't know I did that.
40:18Nicky and the team are trying to reach Mr Haywood.
40:21I bet if I'm in the hospital they can put me through.
40:23To find out which of yesterday's patients to call for next.
40:27If you get three before me, I'll be fuming.
40:32PHONE RINGS
40:36Is that Nick?
40:37Nicky, it's Matt or EP in theatres.
40:39No!
40:40Are you joking?
40:41Nicky's trying to get hold of you.
40:42We're just wondering which case you want to do next in six.
40:44We've got Vanessa and we've also got Graham.
40:48OK, nice.
40:49We're here to take you down, Vanessa.
40:5461-year-old Vanessa will be next in theatre six.
40:58I'm going to bring you down to theatre reception.
41:00We'll get you checked in and get the ball rolling, all right?
41:02Yeah, I'm scared.
41:03You'll be fine, don't worry. We've got good teams down there.
41:07Vanessa has been in hospital for four days.
41:10As she is too frightened for major surgery,
41:13Mr Haywood has persuaded her to have a small procedure
41:16under local anaesthetic.
41:18One, two, three.
41:20Ooh, that's horrible.
41:21She's really quite anxious.
41:23She has been quite a lot all week.
41:25We'll have to put some sterile drapes around you.
41:28We won't cover you up.
41:30And there'll always be someone at this end that you can talk to at this...
41:33Lift your head up again for me, sweetheart.
41:35In order to fix this definitively,
41:37she's likely to need major surgery.
41:39But we're hoping that by just draining this out,
41:43it'll help with the pain
41:45and it'll also provide some relief and prevent some ongoing infection.
41:50I'm just going to put a bit of local anaesthetic in
41:53so you might feel a sharp scratch.
41:56Oh, my God.
41:58I think one of the reasons the list is getting a lot busier
42:03is that the patients that we're seeing coming through the door
42:06are more elderly.
42:07They're more frail.
42:08They have more medical problems.
42:10Are you feeling so, nurse?
42:12Oh, cold.
42:14They're having longer recoveries.
42:16They're spending longer time in hospital.
42:18That puts a huge amount of pressure on the trust.
42:22But every patient deserves a chance
42:25and that's what we're trying to do.
42:27We're trying to provide a chance for people to get better
42:29and, in many ways, trying to save their life the best way we can.
42:33You can see the air that was in the cavity has made it drop down.
42:37How are you feeling there?
42:40A bit all right?
42:43I don't think we're going to be too much longer.
42:46No, we're nearly done.
42:47OK.
42:50We will see what happens.
42:52I mean, we'll know over the next few days
42:54whether there's any bowel content going to come out of it or not.
42:57But we're hoping that, actually, whatever's gone on
43:00will just heal itself up on its own
43:03and avoid that need for any major surgery.
43:06Great. All done.
43:09So we'll take the drapes down
43:11and then you've got a little bag over it now, like I said.
43:14So we'll see what comes out of it.
43:16All right, thank you.
43:17OK?
43:18Get you back into your bed.
43:19Get you back up to the ward.
43:20Back upstairs for mid-morning biscuit.
43:23A little?
43:24Yeah.
43:25All right.
43:26Come on, Miley.
43:27Lovely.
43:28With Vanessa out of theatre...
43:30Bye, Vanessa!
43:31Bye.
43:33Bye.
43:34Graeme's three-day wait for surgery on his haematoma is finally over.
43:38Hello.
43:39Yeah, you wanting me?
43:40I'm going to take theatre.
43:41You're all right.
43:42I've pushed in a little bit like me.
43:43Absolutely.
43:44I've pushed bigger than you.
43:45I'm fine.
43:46You'll be fine.
43:47You'll be fine.
43:48OK, for you.
43:49As I've been fairness, sir.
43:51You've done good.
43:54You've done good.
43:56Whilst Mr Hayward still doesn't know the underlying cause of Emma's infection,
44:01she is slowly recovering.
44:03At the minute, we're on a ward, which is fantastic.
44:07And she looks tons better.
44:09But we need to establish a drinking and eating pattern,
44:14cause she's totally lost that at the minute.
44:16And until we can do that, we can't move forward.
44:20Come on.
44:21Keep trying.
44:23We'll just need to sit it out and Emma will hopefully do it in her own time
44:27and we'll get her back to where she needs to be.
44:32After a night's recovery, Julie is ready to be discharged.
44:36How does it feel that you've finally gone home?
44:39Oh, relieved.
44:40Yeah, I want to get back to my dogs.
44:44I have got to have more stuff the surgeon has found,
44:47but he just wants me to get over this first.
44:50So it would be nice just to have a break from it all.
44:54I'll keep in touch.
44:55Yeah.
44:56I will.
44:57You're not picking kids up?
44:58No.
44:59Is that my fish pie?
45:13I've been looking forward to this all day.
45:18Is there any salt on that tree?
45:20Yeah, it's here.
45:21Oh, I've got some of my salt, I'm terrible.
45:24Is that enough?
45:25Or do you want another?
45:26Another.
45:27Another one of them?
45:28Ooh, it'll cost you.
45:29Ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha.
45:30The emergency list is an ever-moving situation.
45:31So the effort that goes into managing that list is phenomenal.
45:33Sometimes I wonder how it's achieved.
45:34Sometimes I wonder how it's achieved.
45:35I don't know anyone that I work with that is shy from work.
45:36Everyone's working incredibly hard.
45:37Everyone's working incredibly hard, working through their brain.
45:38It gives me inspiration.
45:39It gives me inspiration and the will to live now.
45:43There's light at the end of the tunnel now.
45:47The emergency list is an ever-moving situation.
45:54So the effort that goes into managing that list is phenomenal.
45:58Sometimes I wonder how it's achieved.
46:01I don't know anyone that I work with that is shy from work.
46:04Everyone's working incredibly hard, working through their breaks.
46:07You see that across the board with every member of staff.
46:11Surgeons coming in to operate.
46:13Anaesthetists putting people to sleep.
46:15The operation department team readying the theatre.
46:19The coordinators that are running up and down the corridor day or night.
46:23Everyone I work with is completely dedicated to what we do.
46:26And that's the nature of everyone that I come across who works in the NHS.
46:37It's planned for you to talk to us to be here.
46:46But the不graduate諸cussions as well.
46:53Certainly you were able to help me understand.
46:56Better don't worry about energy and all this kind of work.
47:00I'm happy to have a nice engine.