1
00:00:10,640 --> 00:00:12,320
What's the blood pressure?

2
00:00:13,520 --> 00:00:15,480
The pulse is very, very weak.

3
00:00:16,640 --> 00:00:19,560
We need to push his blood pressure
above 120, please.

4
00:00:19,640 --> 00:00:20,680
120?

5
00:00:20,760 --> 00:00:21,720
Yes, please.

6
00:00:24,440 --> 00:00:27,080
Otherwise, everything we've done now
is gonna block.

7
00:00:28,520 --> 00:00:31,480
Toby has got
significant damage to the foot

8
00:00:31,560 --> 00:00:33,920
from his motorbike accident.

9
00:00:34,000 --> 00:00:39,680
The survival of Toby's foot
depends on a good blood supply.

10
00:00:42,040 --> 00:00:43,800
The pressure is still low.

11
00:00:44,880 --> 00:00:46,200
We need to push it up.

12
00:00:46,280 --> 00:00:47,840
I just pushed it up.

13
00:00:49,000 --> 00:00:55,074



14
00:00:57,040 --> 00:00:58,360
Lovely.

15
00:01:02,200 --> 00:01:03,960
We're not far from finishing.

16
00:01:04,760 --> 00:01:06,360
Pull a little bit.

17
00:01:09,320 --> 00:01:10,400
Perfect.

18
00:01:11,720 --> 00:01:16,120
The vein has now been sewn to replace
the damaged section of the artery.

19
00:01:16,840 --> 00:01:20,080
So, in theory,
blood should flow into the foot.

20
00:01:20,920 --> 00:01:22,160
Doppler, please.

21
00:01:23,760 --> 00:01:26,600
The Doppler machine
gives an audible signal

22
00:01:26,680 --> 00:01:30,160
of the blood flow in the vessels.

23
00:01:30,240 --> 00:01:33,000
What I want to hear is a strong signal.

24
00:01:34,200 --> 00:01:36,520
What I don't want to hear is silence.

25
00:01:39,800 --> 00:01:41,280
This is the moment of truth.

26
00:02:00,600 --> 00:02:02,120
Is the Doppler on?

27
00:02:08,440 --> 00:02:10,880
Can you press it one more time, please?

28
00:02:14,240 --> 00:02:17,840
In surgery, it's well known
that the best chance of getting it right

29
00:02:17,920 --> 00:02:19,120
is the first chance.

30
00:02:19,640 --> 00:02:21,600
So there is always this extra pressure.

31
00:02:23,600 --> 00:02:25,200
You have time ticking.

32
00:02:26,360 --> 00:02:28,440
The foot is on the verge of dying.

33
00:02:30,000 --> 00:02:33,480
We need to hear a strong pulsatile signal.

34
00:02:44,720 --> 00:02:46,360
It sounds good.

35
00:02:46,440 --> 00:02:50,200
This is very good.
It's all now filling up nicely.

36
00:02:53,800 --> 00:02:57,920
The relationship between you
and the patient is a special relationship.

37
00:02:59,080 --> 00:03:00,480
In Toby's case,

38
00:03:00,560 --> 00:03:05,560
it's a promise between me and him
that I will try my best to save the foot.

39
00:03:06,720 --> 00:03:10,040
You do the surgery
with the hope that it will work,

40
00:03:10,840 --> 00:03:13,200
but you have to wait to see the effect.

41
00:03:15,960 --> 00:03:16,960
Perfect.

42
00:03:17,880 --> 00:03:18,880
I'm done.

43
00:03:19,960 --> 00:03:24,120
We managed to reconnect all the arteries
that were damaged to his foot.

44
00:03:24,200 --> 00:03:28,920
However, he does have a lot of damage
to the soft tissue and the fractures.

45
00:03:29,000 --> 00:03:31,320
So we will now be guided
by our colleagues.

46
00:03:31,920 --> 00:03:33,400
Thanks, mate.

47
00:03:34,720 --> 00:03:36,600
Toby has complex injuries.

48
00:03:36,680 --> 00:03:38,400
So it's what we call polytrauma,

49
00:03:38,480 --> 00:03:41,240
which is the worst
top-tier level of injury.

50
00:03:41,840 --> 00:03:45,560
It's got circulation now to his foot,
which is good news.

51
00:03:45,640 --> 00:03:47,720
But it's not a happy leg.

52
00:03:47,800 --> 00:03:50,600
We have to stabilize his femur still.

53
00:03:51,760 --> 00:03:55,560
The next part of the operation
is to try and salvage the limb.

54
00:03:56,080 --> 00:03:58,520
Big Langenbeck back, please. Lovely.

55
00:03:59,080 --> 00:04:03,040
He's lost a fair amount of blood.
Also, his nerve has been ruptured.

56
00:04:04,680 --> 00:04:05,960
Okay, go for it.

57
00:04:07,240 --> 00:04:09,080
It's a bad situation to be in.

58
00:04:09,160 --> 00:04:10,000
Thank you.

59
00:04:11,160 --> 00:04:14,760
Our long bones allow us
to move around, of course.

60
00:04:16,320 --> 00:04:19,040
But they also
are blood-producing factories.

61
00:04:20,120 --> 00:04:22,120
There's about a liter of blood in a femur,

62
00:04:22,200 --> 00:04:24,560
and we only have
about five liters of blood inside us.

63
00:04:24,640 --> 00:04:27,720
So, if you have
a smashed femur like he has,

64
00:04:27,800 --> 00:04:31,200
it's like having a conical flask
full of Ribena,

65
00:04:31,280 --> 00:04:34,200
and if you break it on the floor,
all the blood comes out.

66
00:04:34,720 --> 00:04:38,280
Losing blood is not a good thing,
so we need to stabilize his femur.

67
00:04:39,080 --> 00:04:42,840
We put some pins into the bone
above and below the fracture.

68
00:04:42,920 --> 00:04:45,240
Okay, let's have X-ray there, please.

69
00:04:45,920 --> 00:04:49,760
And then attach some rods,
which are a bit like scaffolding pipes,

70
00:04:49,840 --> 00:04:53,160
on the outside of the limb
to stabilize the bones and the fracture.

71
00:04:53,760 --> 00:04:54,840
X-ray again.

72
00:04:56,240 --> 00:04:58,160
Okay. Right, we'll go with that.

73
00:04:59,360 --> 00:05:02,040
Unfortunately, Toby has
a combination of injuries,

74
00:05:02,120 --> 00:05:03,640
not just bones,

75
00:05:03,720 --> 00:05:06,600
but also his blood vessels,
and particularly the arteries.

76
00:05:07,280 --> 00:05:11,040
Biggest problem he's got, given the nature
of the injury to his foot,

77
00:05:11,120 --> 00:05:14,840
is whether the tissue is going to survive.

78
00:05:15,920 --> 00:05:18,320
There's still a very high risk
of an amputation.

79
00:05:30,800 --> 00:05:32,640
New incident details received.

80
00:05:32,720 --> 00:05:34,560
Been reported as an RTC, car versus car.

81
00:05:35,520 --> 00:05:36,560
Okay, then.

82
00:05:36,640 --> 00:05:40,240
This is a HEMS activation.
ETA ten minutes to you.

83
00:05:40,800 --> 00:05:42,640
Okay, ready? Copy.

84
00:05:43,400 --> 00:05:45,200
We've got help coming now.

85
00:05:47,600 --> 00:05:49,240
Medic one, go ahead.

86
00:05:49,320 --> 00:05:51,040
It's a trauma in South London.

87
00:05:51,880 --> 00:05:54,280
What's the blood doing?
Is it trickling down his arm?

88
00:05:54,360 --> 00:05:56,080
Or is it spurting out?

89
00:05:56,160 --> 00:05:57,720
Oh my goodness.

90
00:05:58,880 --> 00:06:00,600
Lots of blood all over the floor.

91
00:06:00,680 --> 00:06:03,800
We're gonna get someone down
to help you very shortly, okay?

92
00:06:03,880 --> 00:06:05,800
Let's go to George's.

93
00:06:06,520 --> 00:06:08,080
ETA ten minutes.

94
00:06:08,920 --> 00:06:10,360
Nasty injury.

95
00:06:15,200 --> 00:06:16,560
Hello, St George's. Resus.

96
00:06:16,640 --> 00:06:18,960
It's an adult male, major trauma call,

97
00:06:19,040 --> 00:06:21,520
and he's got an ETA of ten minutes to you.

98
00:06:22,120 --> 00:06:24,760
Adult male trauma call. ETA ten minutes.

99
00:06:24,840 --> 00:06:29,600
We've got a 29-year-old male coming in
with a significant wound to his arm.

100
00:06:30,840 --> 00:06:32,480
Let's get stuff out for bloods.

101
00:06:32,560 --> 00:06:35,480
Grab some gray cannulas
from the next cubicle.

102
00:06:35,560 --> 00:06:37,120
They wouldn't give us a pre-alert

103
00:06:37,200 --> 00:06:39,960
unless they thought
there was a serious injury to the arm.

104
00:06:40,600 --> 00:06:42,160
Do we have a tray for bloods?

105
00:06:42,240 --> 00:06:45,080
So the most concerning thing
would be an injury to the artery.

106
00:06:46,960 --> 00:06:48,760
It can be very serious.

107
00:06:50,120 --> 00:06:52,240
You can bleed to death
from an artery injury.

108
00:06:55,280 --> 00:06:57,880
So, this is 29-year-old Mani,

109
00:06:57,960 --> 00:06:59,640
who was at a building site working

110
00:06:59,720 --> 00:07:04,040
when he was going up the stairs,
tripped, and fell into two panels

111
00:07:04,120 --> 00:07:05,480
of kinda thin glass.

112
00:07:05,560 --> 00:07:07,360
He's cut his elbow.

113
00:07:07,440 --> 00:07:11,400
When bent, you can see to the bone,
and a massive laceration to his wrist.

114
00:07:11,480 --> 00:07:15,080
His colleagues then applied a tourniquet,
and that's when I got there.

115
00:07:15,160 --> 00:07:17,520
He's got no other obvious injuries.

116
00:07:17,600 --> 00:07:21,160
However, on our way literally pulling up,
it started bleeding again.

117
00:07:21,240 --> 00:07:22,200
Quite bad, innit?

118
00:07:22,280 --> 00:07:23,880
A lot of blood on the scene?

119
00:07:23,960 --> 00:07:26,720
-Just under 500 mils of blood loss.
-Okay.

120
00:07:27,280 --> 00:07:29,320
-It was pissing out.
-Nice.

121
00:07:30,320 --> 00:07:31,840
Sorry, excuse the language.

122
00:07:31,920 --> 00:07:32,880
That's all right.

123
00:07:32,960 --> 00:07:34,680
We get it more when it's like that.

124
00:07:35,560 --> 00:07:36,800
That's Mani for you.

125
00:07:36,880 --> 00:07:40,880
Thank you. Can we transfer him
onto a monitor and get the primary survey?

126
00:07:40,960 --> 00:07:41,920
Hey, Mani.

127
00:07:42,000 --> 00:07:45,560
-We might need to cut this off.
-That's fine. All good. Yeah.

128
00:07:47,760 --> 00:07:49,680
Apologies for any smelly feet.

129
00:07:51,960 --> 00:07:55,480
-I'm gonna be overnight, ain't I?
-Yeah, you're not going home today.

130
00:07:56,240 --> 00:07:58,080
We won't celebrate our birthday tomorrow.

131
00:07:58,160 --> 00:08:00,080
It's your birthday tomorrow?

132
00:08:00,160 --> 00:08:01,520
Thirtieth birthday.

133
00:08:01,600 --> 00:08:02,960
-Thirtieth?
-Yeah.

134
00:08:03,040 --> 00:08:04,760
-Oh, right. Okay.
-Oh, mate!

135
00:08:04,840 --> 00:08:08,240
You're gonna have to redo that next year.
You can't be doing that.

136
00:08:08,320 --> 00:08:09,760
We'll all have a party.

137
00:08:13,640 --> 00:08:15,440
Can you move your fingers?

138
00:08:16,160 --> 00:08:18,080
-No.
-No?

139
00:08:20,440 --> 00:08:22,680
-Can you feel my touch here?
-No.

140
00:08:23,920 --> 00:08:24,760
No?

141
00:08:25,440 --> 00:08:28,120
My last two fingers, I can't move them.

142
00:08:28,200 --> 00:08:29,720
We're gonna have a look.

143
00:08:29,800 --> 00:08:31,440
We'll see what's going on. Okay?

144
00:08:32,440 --> 00:08:35,240
A glass injury is often
very similar to a knife wound.

145
00:08:35,320 --> 00:08:38,160
It can cut straight through
pretty much anything.

146
00:08:39,000 --> 00:08:41,880
One of the most crucial things
that we would check straight away

147
00:08:41,960 --> 00:08:43,080
is blood supply.

148
00:08:43,840 --> 00:08:45,720
And part of that is checking for a pulse.

149
00:08:47,920 --> 00:08:50,680
-What do you do for a living?
-Double glazing.

150
00:08:50,760 --> 00:08:52,880
You're not doing
a good advert for it either.

151
00:08:52,960 --> 00:08:54,080
I have to say this.

152
00:08:54,680 --> 00:08:58,000
I assume he normally puts it up
rather than puts himself through it.

153
00:08:58,080 --> 00:08:59,560
Yeah, 100%.

154
00:09:00,480 --> 00:09:02,000
Let's have a look.

155
00:09:02,880 --> 00:09:04,960
I'd look away
if you don't wanna have a look.

156
00:09:05,040 --> 00:09:06,040
I don't wanna…

157
00:09:06,560 --> 00:09:08,760
-If you don't wanna see.
-Hang on.

158
00:09:10,360 --> 00:09:12,120
-You're doing very well.
-Man.

159
00:09:12,640 --> 00:09:13,480
Okay.

160
00:09:13,560 --> 00:09:15,960
Fucking hell, that's a bad one, innit?

161
00:09:17,400 --> 00:09:20,040
Want more green stuff? You good?
We're checking your pulse.

162
00:09:20,120 --> 00:09:22,360
We don't wanna poke your wound too hard.

163
00:09:22,440 --> 00:09:23,520
I can't feel it anyways.

164
00:09:23,600 --> 00:09:24,840
I can't find anything.

165
00:09:27,160 --> 00:09:28,680
You can't feel anything?

166
00:09:30,080 --> 00:09:31,640
-No.
-Okay.

167
00:09:32,280 --> 00:09:35,200
If we can't feel a pulse,
then that's extremely worrying.

168
00:09:37,200 --> 00:09:39,440
If he's lost the main artery,

169
00:09:39,520 --> 00:09:42,680
then he could lose
the whole blood supply to that hand.

170
00:09:42,760 --> 00:09:44,640
It could be a life-changing injury.

171
00:09:45,160 --> 00:09:46,840
We'll need to get an X-ray.

172
00:09:46,920 --> 00:09:48,240
Your fingers are numb,

173
00:09:48,320 --> 00:09:51,480
which means you likely
have cut the nerve that's angled.

174
00:09:51,560 --> 00:09:54,560
So we can see there's some
tendon injuries there as well.

175
00:09:54,640 --> 00:09:58,400
And the fact that it was spurting suggests
you might have cut the artery too.

176
00:09:58,480 --> 00:10:00,840
So it's definitely
gonna need an operation.

177
00:10:01,400 --> 00:10:02,440
You're doing good.

178
00:10:05,600 --> 00:10:09,880
I'm Manraj's middle sister.
He has a big family.

179
00:10:10,400 --> 00:10:14,440
So, we are three sisters,
and he's our baby brother.

180
00:10:16,120 --> 00:10:20,800
I'd describe him as a giant gentleman.

181
00:10:21,400 --> 00:10:24,120
Lively, kind.

182
00:10:24,920 --> 00:10:29,120
-You're a good guy. You're a funny guy.
-Yeah. Favorite patient of the day.

183
00:10:31,400 --> 00:10:32,960
My father received a phone call.

184
00:10:33,040 --> 00:10:34,920
Let's just get this X-ray done.

185
00:10:35,000 --> 00:10:37,240
He's had a terrible accident.

186
00:10:37,320 --> 00:10:39,360
He's bleeding out heavily.

187
00:10:40,040 --> 00:10:41,800
An ambulance has been called.

188
00:10:43,120 --> 00:10:45,400
I just felt sick to the stomach.

189
00:10:46,000 --> 00:10:47,680
I think it's still oozing out blood.

190
00:10:47,760 --> 00:10:48,840
Don't worry about it.

191
00:10:52,120 --> 00:10:54,520
He's just started his own business.

192
00:10:55,320 --> 00:10:57,600
Oh! Fuck it. Oh man!

193
00:10:58,160 --> 00:10:59,520
Get it raised a bit.

194
00:11:00,320 --> 00:11:02,760
We don't know the extent of the damage.

195
00:11:04,680 --> 00:11:06,080
Difficult times ahead.

196
00:11:08,400 --> 00:11:09,960
Yeah, not nice.

197
00:11:11,680 --> 00:11:15,400
Mani has cut through his tendons,
his artery and his nerves.

198
00:11:16,800 --> 00:11:19,120
The longer you leave an injury like this,

199
00:11:19,200 --> 00:11:22,160
the more likely there's going to be
long-term consequences.

200
00:11:23,680 --> 00:11:26,400
The worst-case scenario is
that he could lose his hand.

201
00:11:27,600 --> 00:11:30,440
The plastics team
are the hand specialists.

202
00:11:30,520 --> 00:11:33,080
It's critical that they look at this
very urgently.

203
00:11:38,360 --> 00:11:40,920
Manraj presented with a foreign body glass

204
00:11:41,000 --> 00:11:43,240
penetrating injury bilateral hands, elbow.

205
00:11:43,320 --> 00:11:44,480
In terms of his fallout,

206
00:11:44,560 --> 00:11:47,560
he had immediate
on-the-nerve sensory deficit,

207
00:11:47,640 --> 00:11:49,520
and he's got motor deficit as well.

208
00:11:49,600 --> 00:11:52,000
You don't want to be doing that
on your own.

209
00:11:52,600 --> 00:11:54,560
I think you need two people for that case.

210
00:11:54,640 --> 00:11:55,480
Yeah.

211
00:11:59,160 --> 00:12:01,720
Whenever someone hears "plastic surgeon,"

212
00:12:01,800 --> 00:12:04,720
they would immediately think
cosmetic surgery.

213
00:12:04,800 --> 00:12:08,480
Breast implant work
or Botox or fillers of any kind.

214
00:12:08,560 --> 00:12:12,920
But often in major trauma,
the plastic surgeon gets involved

215
00:12:13,000 --> 00:12:15,960
to save someone's limb
or life, for that matter.

216
00:12:18,160 --> 00:12:23,080
Being a healthcare professional
has taken me to so many places.

217
00:12:24,240 --> 00:12:27,400
As a medical student,
I went to South Africa

218
00:12:27,480 --> 00:12:30,760
to work in essentially
what looked like a hut hospital.

219
00:12:31,360 --> 00:12:36,280
They had a security guard with a gun
and men bleeding with stab injuries,

220
00:12:36,360 --> 00:12:38,000
with gunshot wounds.

221
00:12:39,080 --> 00:12:44,600
Being a doctor, it's a very emotionally
exhausting occupation.

222
00:12:46,600 --> 00:12:50,000
But there are always
elements of surprises along the way.

223
00:12:52,520 --> 00:12:58,360
In 2021, I worked in New Zealand,
and very quickly, should luck have it,

224
00:12:58,440 --> 00:13:01,680
I met my boyfriend Mickey
when I was out there.

225
00:13:02,880 --> 00:13:07,320
We would spend many weekends
travelling and hiking,

226
00:13:07,400 --> 00:13:11,080
and it's really important
to have that safe space.

227
00:13:13,640 --> 00:13:14,960
Somebody to rely on.

228
00:13:17,960 --> 00:13:23,680
Because every day you realize
that trauma can happen in a split second.

229
00:13:24,480 --> 00:13:26,280
It does not discriminate.

230
00:13:28,800 --> 00:13:31,080
We are all vulnerable to it.

231
00:13:36,000 --> 00:13:38,320
How's it going, bud? Yeah, not too bad.

232
00:13:38,400 --> 00:13:41,800
What it is, though, I'm in hospital
waiting for some surgery.

233
00:13:41,880 --> 00:13:44,120
I'm gonna get one of the boys
to give you a call,

234
00:13:44,200 --> 00:13:47,080
and get my fitter down there
to get that window fitted for you.

235
00:13:47,680 --> 00:13:49,560
Thank you. Take care now.

236
00:13:52,040 --> 00:13:54,200
Day in the life of a window fitter.

237
00:13:54,280 --> 00:13:55,960
It doesn't stop with me laid up.

238
00:13:58,640 --> 00:14:01,080
I'll be in the window trade
ten years next year.

239
00:14:01,760 --> 00:14:03,160
Just me and my dad do it.

240
00:14:03,920 --> 00:14:05,520
Just the two of us, really.

241
00:14:06,320 --> 00:14:08,320
When it happened, I was on my own.

242
00:14:08,400 --> 00:14:10,880
I was going upstairs,
and I ended up tripping,

243
00:14:10,960 --> 00:14:13,040
putting my hand through the glass.

244
00:14:13,120 --> 00:14:14,360
Went through two panes.

245
00:14:14,960 --> 00:14:16,800
Builder that was there called 999.

246
00:14:17,760 --> 00:14:19,320
I'll tell you something.

247
00:14:19,400 --> 00:14:22,760
I actually did not want to work this week
'cause it was my birthday.

248
00:14:23,480 --> 00:14:26,160
But needs is a must, so I had to work.

249
00:14:28,720 --> 00:14:31,680
Had I stuck to my guns,
I don't think I'd be here right now.

250
00:14:33,560 --> 00:14:35,680
I'd be somewhere enjoying my 30th.

251
00:14:35,760 --> 00:14:38,240
But here we are over here,
enjoying it, innit?

252
00:14:39,520 --> 00:14:43,240
We'll be enjoying it a bit more
after the operation's done, to be honest.

253
00:14:47,120 --> 00:14:50,120
This operation is really crucial for Mani.

254
00:14:50,200 --> 00:14:53,160
His injury is
quite significant and severe.

255
00:14:54,200 --> 00:14:57,000
He has cut
through multiple soft tissue structures.

256
00:14:57,080 --> 00:15:00,120
But only in theater
will we definitively find out

257
00:15:00,200 --> 00:15:02,320
what structures are damaged.

258
00:15:05,200 --> 00:15:06,640
But as it stands,

259
00:15:07,200 --> 00:15:08,880
he's got no hand function.

260
00:15:15,000 --> 00:15:16,240
150, go ahead.

261
00:15:16,320 --> 00:15:19,280
1597, correct, over.
Has he been able to walk on that leg?

262
00:15:19,360 --> 00:15:21,160
I'm gonna get help down to you now.

263
00:15:23,440 --> 00:15:24,560
Copy, medic one, thank you.

264
00:15:26,600 --> 00:15:28,040
They're gonna go to King's.

265
00:15:39,360 --> 00:15:42,200
Toby's a young guy
who had a motorcycle accident.

266
00:15:43,680 --> 00:15:47,840
He injured both his arms and his legs,
to such a significant degree

267
00:15:47,920 --> 00:15:50,080
that the blood supply
was lost to his right leg.

268
00:15:52,080 --> 00:15:55,600
Despite all of the heroic attempts
by our surgeons

269
00:15:55,680 --> 00:15:57,960
to resupply the foot with blood,

270
00:15:59,080 --> 00:16:02,680
unfortunately
the vascular reconstruction failed.

271
00:16:03,600 --> 00:16:06,680
So, we had to make a decision
between life and limb.

272
00:16:07,520 --> 00:16:08,840
And we chose life.

273
00:16:14,120 --> 00:16:15,880
I just remember crying.

274
00:16:17,080 --> 00:16:18,160
I just looked down

275
00:16:18,240 --> 00:16:21,200
and just kept looking at it, really.

276
00:16:23,400 --> 00:16:24,680
Kept touching it,

277
00:16:25,320 --> 00:16:27,960
processing that my foot
is not there anymore.

278
00:16:29,680 --> 00:16:32,000
I just thought it could be fixed.

279
00:16:32,520 --> 00:16:35,440
It was going to be fine.
I got here in time.

280
00:16:36,040 --> 00:16:37,360
Unfortunately, not.

281
00:16:39,440 --> 00:16:42,640
I'm still trying to understand
how my life's gonna change.

282
00:16:53,040 --> 00:16:54,600
It's heartbreaking.

283
00:16:55,640 --> 00:17:01,560
There is absolutely nothing we can do
to make this situation better.

284
00:17:03,280 --> 00:17:07,680
He does understand what's happened,
but I'm not sure he's processed

285
00:17:07,760 --> 00:17:08,840
what that means.

286
00:17:09,640 --> 00:17:11,760
He's not gonna be able to go to the gym.

287
00:17:12,560 --> 00:17:14,480
He's not gonna be able
to work for a while.

288
00:17:15,960 --> 00:17:18,760
We don't know what can be done
to help him get back

289
00:17:18,840 --> 00:17:21,640
to some kind of normality.

290
00:17:26,520 --> 00:17:28,800
As a blind person myself,

291
00:17:29,560 --> 00:17:32,200
the world can be very difficult.

292
00:17:33,200 --> 00:17:38,320
Most people, I find, see the disability
before they see the person.

293
00:17:39,360 --> 00:17:42,440
And it's, "How can he get through that?"

294
00:17:43,680 --> 00:17:45,800
I think that is my biggest concern.

295
00:17:46,920 --> 00:17:49,520
It's so hard because your thought just…

296
00:17:50,720 --> 00:17:53,320
All your thoughts go out to him,
and you want to be there,

297
00:17:53,400 --> 00:17:54,840
and you want to support him.

298
00:18:02,400 --> 00:18:06,000
When a patient goes through
a catastrophic injury like Toby,

299
00:18:06,520 --> 00:18:08,280
it's a long road of recovery.

300
00:18:09,400 --> 00:18:13,280
As a doctor, you wanna get them back
to doing whatever they love, back to work,

301
00:18:13,360 --> 00:18:17,200
back with their families,
and in no pain, which is the key thing.

302
00:18:19,880 --> 00:18:22,480
I had a bit of a roundabout way
into medicine.

303
00:18:22,560 --> 00:18:24,280
I had no idea what I wanted to do.

304
00:18:24,360 --> 00:18:27,680
So, actually, I ended up going
and work for an investment bank.

305
00:18:27,760 --> 00:18:31,480
Work was really interesting.
The people were dreadful. Um…

306
00:18:31,560 --> 00:18:35,680
They would climb over the dead bodies
of their parents to make more money.

307
00:18:37,840 --> 00:18:40,440
I went out for dinner with my sister,
who's a doctor.

308
00:18:40,520 --> 00:18:43,440
And she told me
about a graduate degree in medicine.

309
00:18:43,520 --> 00:18:47,800
So I started medical school when I was 26.

310
00:18:47,880 --> 00:18:51,760
As a plastic surgeon, there's a bit of art
in making something look good.

311
00:18:51,840 --> 00:18:53,760
But ultimately, for me,

312
00:18:54,360 --> 00:18:57,600
it's about putting people
back together again after major trauma.

313
00:19:02,400 --> 00:19:04,520
Can you just show me the report of the CT?

314
00:19:06,600 --> 00:19:10,400
My orthopedic colleagues
have fixed Toby's femur fracture.

315
00:19:10,480 --> 00:19:14,560
And we performed a guillotine amputation,
which is a rapid amputation.

316
00:19:15,680 --> 00:19:20,520
So, he needs a plate, and we need
to finalize his stump and shorten it.

317
00:19:22,880 --> 00:19:25,240
Now we need to take stock,

318
00:19:25,320 --> 00:19:29,360
see how much of the soft tissue
is healthy, how much skin survives,

319
00:19:29,880 --> 00:19:33,720
and then carefully turn it
into a definitive amputation

320
00:19:33,800 --> 00:19:37,240
that is robust enough
to allow him to wear a prosthesis

321
00:19:37,320 --> 00:19:38,920
and hopefully walk again.

322
00:19:40,000 --> 00:19:42,360
Trauma, by the nature, there's big wounds,

323
00:19:42,440 --> 00:19:46,600
big injuries, big cuts,
and so rarely do you just break one thing.

324
00:19:47,720 --> 00:19:49,080
He's a polytrauma patient,

325
00:19:49,160 --> 00:19:52,080
so he's got a closed
right arm fracture as well.

326
00:19:52,600 --> 00:19:54,600
That arm's gonna take you what, an hour?

327
00:19:54,680 --> 00:19:58,080
-It's a big--
-The humerus? Yeah, sure. At least.

328
00:19:58,600 --> 00:20:01,360
Soft tissue and bones
will all break all at the same time,

329
00:20:01,440 --> 00:20:06,240
so the ability to get a plastic surgeon
and an orthopedic surgeon in the same room

330
00:20:06,320 --> 00:20:09,200
to do the operation at the same time
is unrivalled.

331
00:20:12,720 --> 00:20:18,800
My colleague, Ash, will focus on his arm,
whilst I'll focus on the soft tissue.

332
00:20:19,320 --> 00:20:21,640
-Do you have to do it lateral?
-No, supine.

333
00:20:21,720 --> 00:20:23,880
Okay, then I can do the leg
at the same time.

334
00:20:23,960 --> 00:20:25,320
Yeah, exactly.

335
00:20:25,400 --> 00:20:26,800
Ash is a unique individual.

336
00:20:26,880 --> 00:20:29,520
He lives and breathes trauma,
and he's passionate about it,

337
00:20:29,600 --> 00:20:31,480
and he's really good at it.

338
00:20:31,560 --> 00:20:36,600
I can look at a fracture fixed by Ash
and five other surgeons,

339
00:20:36,680 --> 00:20:38,680
and I'll know exactly which one he did.

340
00:20:40,080 --> 00:20:43,560
Working with a great team around me
is really a privilege.

341
00:20:44,800 --> 00:20:50,040
There was a solid year where Ed and I
did every single open fracture case.

342
00:20:50,120 --> 00:20:51,800
Ed I implicitly trust, you know.

343
00:20:51,880 --> 00:20:54,560
One of the few people
I'd let operate on any of my family,

344
00:20:54,640 --> 00:20:55,480
without question.

345
00:20:58,000 --> 00:21:01,320
-Is that your lunch?
-Yeah, I'm gonna mix it all together.

346
00:21:01,400 --> 00:21:03,480
So, when I was doing my fellowship,

347
00:21:03,560 --> 00:21:07,480
I had to find the cheapest food around
because I was fairly poor at that time.

348
00:21:07,560 --> 00:21:10,320
So this is my lunch then,
and I literally can't…

349
00:21:10,400 --> 00:21:12,480
I like it too much now to not eat it.

350
00:21:13,520 --> 00:21:16,720
Ed thinks it's boring,
but I still find it lovely.

351
00:21:17,320 --> 00:21:19,320
Just need to get some crisps now.

352
00:21:20,160 --> 00:21:23,120
He's very methodical. He's very precise.

353
00:21:24,000 --> 00:21:27,440
So yeah, it doesn't surprise me
he eats the same thing every day.

354
00:21:28,040 --> 00:21:31,520
Couscous, avocado,
falafel and crisps all mixed up.

355
00:21:31,600 --> 00:21:33,240
Same lunch for eight years.

356
00:21:34,080 --> 00:21:34,920
That's it.

357
00:21:48,520 --> 00:21:51,440
If we don't get a good
definitive amputation,

358
00:21:51,520 --> 00:21:55,600
then Toby could be left in a wheelchair
for the rest of his life.

359
00:21:57,200 --> 00:22:00,960
I just want something to put over there.
A dressing of some kind.

360
00:22:02,200 --> 00:22:07,200
It's a really important operation
that will define his future.

361
00:22:09,200 --> 00:22:11,680
This isn't a straightforward amputation.

362
00:22:14,000 --> 00:22:18,160
He's lost quite a lot of muscle,
which you would normally look to use.

363
00:22:18,240 --> 00:22:21,600
You gotta think on your feet,
work with what you've got.

364
00:22:25,560 --> 00:22:28,800
Plan A was, "Do it like this,"
and then you go, "That's not gonna work."

365
00:22:28,880 --> 00:22:32,600
So yeah, it can be quite challenging,
but that's the beauty of trauma.

366
00:22:32,680 --> 00:22:35,960
'Cause you never know
what you're gonna do until you get there.

367
00:22:39,240 --> 00:22:40,640
Still bits of road in here.

368
00:22:41,840 --> 00:22:42,680
Jesus.

369
00:22:43,200 --> 00:22:45,280
Can I get
a three-liter bag of saline, please?

370
00:22:46,840 --> 00:22:50,160
Major amputations are pretty bloody.

371
00:22:51,560 --> 00:22:53,240
It can be brutal at times.

372
00:22:53,840 --> 00:22:55,400
There's a bit of pus in here.

373
00:22:56,160 --> 00:22:58,360
Let's keep our stuff separate.

374
00:22:59,280 --> 00:23:03,360
If we see a lot of pus in a wound,
it can be a bit of a red flag.

375
00:23:03,440 --> 00:23:05,880
And infections can be life-threatening.

376
00:23:09,040 --> 00:23:11,640
It's all really mashed down here,
unfortunately.

377
00:23:13,040 --> 00:23:15,200
It's difficult to see
where his sural nerve is

378
00:23:15,280 --> 00:23:16,640
and his saphenous nerve.

379
00:23:18,800 --> 00:23:19,800
Tricky.

380
00:23:21,600 --> 00:23:26,360
All of the nerves are going to be damaged
below the level of the amputation.

381
00:23:27,960 --> 00:23:31,760
The nerves end up firing
these wrong signals,

382
00:23:31,840 --> 00:23:35,120
telling the brain the toes are curling
or the foot is burning.

383
00:23:35,200 --> 00:23:37,520
Electric shock-like sensations.

384
00:23:38,560 --> 00:23:40,120
To prevent phantom limb pain,

385
00:23:40,200 --> 00:23:41,800
we move the nerve endings

386
00:23:41,880 --> 00:23:44,720
into other nerves and muscles.

387
00:23:44,800 --> 00:23:48,640
And that gives that nerve
something to do and somewhere to go.

388
00:23:54,040 --> 00:23:55,480
We're hampered by the fact

389
00:23:55,560 --> 00:23:58,200
that his muscles
have been cut really quite short.

390
00:23:58,280 --> 00:24:01,760
So, unfortunately,
it doesn't quite follow the textbook.

391
00:24:03,680 --> 00:24:06,760
You have to kinda work out
what you've got, what you need,

392
00:24:07,360 --> 00:24:12,080
and how you can salvage the situation
with the structure you've got.

393
00:24:12,160 --> 00:24:14,080
That's trauma, really, isn't it?

394
00:24:15,080 --> 00:24:18,760
So, Ash is getting on and fixing his arm.

395
00:24:19,560 --> 00:24:23,400
If we can fix his arm in a timely manner,
along with his leg,

396
00:24:23,480 --> 00:24:26,720
then he's got a good arm
that he can use with crutches.

397
00:24:26,800 --> 00:24:29,360
And so he can start his physio
that much sooner.

398
00:24:30,240 --> 00:24:33,160
See some biceps there.
That deltoid is going slightly different,

399
00:24:33,240 --> 00:24:35,640
so your vein
would probably be around here.

400
00:24:36,960 --> 00:24:40,440
It's been a little while since his injury,
so his fracture is trying to heal.

401
00:24:40,520 --> 00:24:43,680
So we need to release it a bit
so we can make it a bit more mobile

402
00:24:43,760 --> 00:24:46,320
so we can then put the jigsaw
back together.

403
00:24:48,240 --> 00:24:49,080
Thank you.

404
00:24:53,400 --> 00:24:56,120
So, we've got the plate inside.
We're gonna centralize it

405
00:24:56,200 --> 00:24:58,480
just to make sure
it's sitting on the bone properly

406
00:24:58,560 --> 00:25:01,160
to help really hold it
in a very robust manner.

407
00:25:02,320 --> 00:25:04,960
Lots of length, as much as you can. More.

408
00:25:05,560 --> 00:25:06,400
Yeah. Nice.

409
00:25:10,320 --> 00:25:11,480
X-ray there.

410
00:25:15,200 --> 00:25:16,320
That's great. Okay.

411
00:25:16,400 --> 00:25:19,800
So, we're happy with everything.
So now we're just gonna close up.

412
00:25:21,440 --> 00:25:24,440
This is slowly coming back together.
It's quite tricky.

413
00:25:25,160 --> 00:25:27,960
Not enough muscle
to cover the end of the stump.

414
00:25:30,520 --> 00:25:32,600
I've reattached the muscles where I can.

415
00:25:33,120 --> 00:25:34,840
He's got flexion and extension.

416
00:25:35,360 --> 00:25:38,200
But I think I've managed to achieve
what we set out to do.

417
00:25:40,720 --> 00:25:43,920
At the end, you know
that every stitch that you put in,

418
00:25:44,600 --> 00:25:47,080
you're either gonna thank or regret.

419
00:25:47,160 --> 00:25:48,400
You have to get it right.

420
00:25:51,120 --> 00:25:54,760
Someone who's 19, 20,
whatever you end up doing,

421
00:25:54,840 --> 00:25:57,440
they're gonna live with for 60, 70 years.

422
00:25:57,520 --> 00:26:00,040
So you have to make sure
that whatever you do is robust

423
00:26:00,120 --> 00:26:01,360
and it's gonna last them.

424
00:26:04,560 --> 00:26:06,720
Yeah. Ugh. Um…

425
00:26:07,720 --> 00:26:08,840
Yeah, it's tricky.

426
00:26:09,560 --> 00:26:10,720
I… I… I think, um,

427
00:26:12,160 --> 00:26:15,560
the traumatic amputation
kinda doesn't leave you with much

428
00:26:16,080 --> 00:26:18,000
to move around.

429
00:26:18,080 --> 00:26:20,600
But I was able to find the key nerves,

430
00:26:20,680 --> 00:26:23,960
shorten the bone to a decent level,
cover the bone end with muscle.

431
00:26:24,680 --> 00:26:26,800
That gives it a decent amount of padding.

432
00:26:28,440 --> 00:26:32,600
We'll only really know
how well it's gone after he starts rehab.

433
00:26:33,160 --> 00:26:37,360
So, hopefully, we'll be able to get him
onto a prosthesis relatively quickly.

434
00:26:39,120 --> 00:26:41,120
You have to have maturity to be a doctor

435
00:26:41,200 --> 00:26:43,240
because you are
in a very privileged position.

436
00:26:43,320 --> 00:26:45,760
You're managing patients who are probably

437
00:26:45,840 --> 00:26:48,520
in their most vulnerable period
of their life.

438
00:26:49,200 --> 00:26:52,320
It's not about me.
It's not about how I feel.

439
00:26:52,400 --> 00:26:55,080
It's about knowing that what you've done

440
00:26:55,160 --> 00:26:58,720
will put your patient
in the best possible position

441
00:26:58,800 --> 00:27:00,320
to get back to normal.

442
00:27:08,080 --> 00:27:11,800
Twenty-year-old male,
tripped over, head injury, GCS3.

443
00:27:12,400 --> 00:27:14,520
AP60's en route, ETA of 20 minutes.

444
00:27:26,320 --> 00:27:29,960
My fascination with anatomy started early.

445
00:27:31,400 --> 00:27:33,760
I grew up in China in the '80s.

446
00:27:35,160 --> 00:27:36,600
And when I was six years old,

447
00:27:36,680 --> 00:27:39,040
my dad used to give me
a little plastic basket

448
00:27:39,120 --> 00:27:42,120
and some change,
and he used to send me to the fish market.

449
00:27:42,720 --> 00:27:44,960
The fishermen,
they thought it was hilarious

450
00:27:45,040 --> 00:27:47,360
seeing a little child with a little basket

451
00:27:48,160 --> 00:27:49,760
and some change.

452
00:27:49,840 --> 00:27:52,200
And so they were always very kind to me.

453
00:27:53,520 --> 00:27:56,880
When I brought the fish back,
my dad would take me to the kitchen

454
00:27:56,960 --> 00:27:59,360
and show me which bits of the fins to cut.

455
00:28:00,360 --> 00:28:02,560
And then he would use a pair of scissors,

456
00:28:02,640 --> 00:28:06,120
open up the fish's belly
and rip out the organs.

457
00:28:06,960 --> 00:28:10,280
And I used to be very eager and say,
"No, I want to do it."

458
00:28:10,360 --> 00:28:12,440
And so he would teach me how to do it.

459
00:28:14,280 --> 00:28:17,160
I found that whole process very visceral.

460
00:28:17,240 --> 00:28:18,080
I loved it.

461
00:28:20,640 --> 00:28:22,280
That was one of the key moments

462
00:28:22,360 --> 00:28:25,360
that led to me
becoming a plastic surgeon today.

463
00:28:30,800 --> 00:28:32,360
Have a nice sleep for your 30th.

464
00:28:33,000 --> 00:28:35,240
I'll have to celebrate
twice as hard next year.

465
00:28:35,320 --> 00:28:36,200
Yeah.

466
00:28:41,000 --> 00:28:44,120
Like many other surgeons,
I'm my own worst enemy

467
00:28:44,200 --> 00:28:46,320
because I just want everything
to be perfect.

468
00:28:47,120 --> 00:28:51,720
Okay. Surgical site's marked.
Imaging has been reviewed this morning.

469
00:28:51,800 --> 00:28:54,160
But to be a good plastic surgeon…

470
00:28:56,600 --> 00:28:58,320
you have to be a perfectionist.

471
00:28:59,040 --> 00:29:02,520
You can see here,
he's lost his normal cascade.

472
00:29:02,600 --> 00:29:06,720
Every finger should be held like that.
So you can see how these are straighter.

473
00:29:06,800 --> 00:29:10,160
Plastic surgery
is the most intricate of all specialties.

474
00:29:10,760 --> 00:29:14,840
We do microsurgery,
connecting tiny blood vessels and nerves

475
00:29:14,920 --> 00:29:17,920
that are less than one millimeter
in diameter.

476
00:29:19,080 --> 00:29:21,440
We wrote up on the board the structures.

477
00:29:21,520 --> 00:29:24,200
So you want to identify
what's broken, what needs fixing.

478
00:29:24,280 --> 00:29:28,840
P. FDS. Okey dokey.

479
00:29:29,760 --> 00:29:32,520
With Mani's job as a manual worker,

480
00:29:32,600 --> 00:29:36,600
knowing that patient's livelihood
is entirely destroyed

481
00:29:36,680 --> 00:29:38,440
if he cannot use the hand,

482
00:29:39,280 --> 00:29:40,920
that is a lot of pressure.

483
00:29:42,400 --> 00:29:43,480
All right.

484
00:29:43,560 --> 00:29:46,760
Pretty much everything
that we thought was gone is gone.

485
00:29:49,800 --> 00:29:52,120
Mani has a significant injury.

486
00:29:52,800 --> 00:29:54,880
He has cut through ten tendons.

487
00:29:56,640 --> 00:29:58,840
Tendons essentially are structures

488
00:29:58,920 --> 00:30:02,120
that join the muscle onto the bone.

489
00:30:02,200 --> 00:30:04,400
He's gone through
several layers of tendons

490
00:30:04,480 --> 00:30:08,360
that connect your forearm
and the joints of the fingers

491
00:30:08,440 --> 00:30:11,040
that allow you
to open and close your hand.

492
00:30:11,840 --> 00:30:15,920
And also he's cut through one artery
and one of the main nerves.

493
00:30:17,160 --> 00:30:21,400
If we don't repair every single thing,
he will be left without his hand.

494
00:30:22,760 --> 00:30:25,080
So spaghetti-like.

495
00:30:25,960 --> 00:30:28,720
Plastic surgery
is a bit like origami sometimes,

496
00:30:28,800 --> 00:30:32,960
figuring out what's damaged
and how to reorientate everything.

497
00:30:33,640 --> 00:30:36,000
He has shredded this at the worst place.

498
00:30:36,760 --> 00:30:39,040
He's cut it where tendon becomes muscle.

499
00:30:40,560 --> 00:30:44,040
When the tendon has been cut
very close to the muscle,

500
00:30:44,120 --> 00:30:45,680
the muscle will contract,

501
00:30:46,280 --> 00:30:50,080
so the tendon end is buried
within the muscle itself.

502
00:30:51,200 --> 00:30:53,440
It would have slipped back
if it helped me.

503
00:30:53,520 --> 00:30:55,640
Tendons, they're like elastic bands,

504
00:30:55,720 --> 00:31:00,440
and they do retract in your forearms
and become quite difficult to find.

505
00:31:00,520 --> 00:31:03,120
Take that arm out. Perfect.

506
00:31:03,640 --> 00:31:06,080
So we're having to extend the wound

507
00:31:06,160 --> 00:31:09,440
to find out
where the retracted tendons are.

508
00:31:20,040 --> 00:31:22,640
This one's really retracted.

509
00:31:23,760 --> 00:31:26,280
-And they have even to extend more.
-More.

510
00:31:26,360 --> 00:31:28,240
This is crazy.

511
00:31:29,600 --> 00:31:32,600
The more you cut off,
the more it will affect the function.

512
00:31:37,320 --> 00:31:40,080
In theater, it often is high pressure,

513
00:31:40,800 --> 00:31:43,160
but as soon as I'm wielding a knife,

514
00:31:43,240 --> 00:31:45,880
everything else completely zones out,

515
00:31:45,960 --> 00:31:48,560
and I'm absolutely focused on
what I'm doing.

516
00:31:49,080 --> 00:31:50,560
We can't make mistakes.

517
00:31:54,480 --> 00:31:56,600
There's something down there.

518
00:31:56,680 --> 00:32:00,040
-Part of a FDP ring, is it?
-It's definitely a FDP ring.

519
00:32:00,640 --> 00:32:02,360
Now we're starting to see them.

520
00:32:03,240 --> 00:32:04,400
-That is that.
-Yeah.

521
00:32:04,480 --> 00:32:06,720
-That is to that bit.
-Yeah.

522
00:32:06,800 --> 00:32:09,040
So I'm gonna repair that big one.

523
00:32:09,720 --> 00:32:10,680
Yeah. Nice.

524
00:32:15,000 --> 00:32:18,280
It's quite remarkable, really,
when you think about these little tendons.

525
00:32:18,360 --> 00:32:20,000
Tiny little structures that you see

526
00:32:20,080 --> 00:32:22,440
essentially can carry
your entire body weight.

527
00:32:23,400 --> 00:32:25,920
That is the index.
Now I'm gonna do the middle.

528
00:32:28,280 --> 00:32:31,720
There's a lot of misperception
of surgeons and our jobs,

529
00:32:31,800 --> 00:32:34,520
certainly our society in general.

530
00:32:35,080 --> 00:32:39,040
You know, people always think
that women do other things,

531
00:32:39,120 --> 00:32:42,280
but I would say
in plastic surgery specifically…

532
00:32:42,360 --> 00:32:43,560
We've got a few girls.

533
00:32:43,640 --> 00:32:46,080
There is a higher proportion
of female surgeons.

534
00:32:47,040 --> 00:32:48,760
Girl power.

535
00:32:50,080 --> 00:32:52,000
All right, so believe it or not,

536
00:32:52,080 --> 00:32:55,880
after all those knots,
we've just repaired the tendons.

537
00:32:57,200 --> 00:32:59,440
Dream team. Thanks so much.

538
00:33:01,120 --> 00:33:05,160
Teamwork makes a dream work,
and it's absolutely true in surgery.

539
00:33:06,240 --> 00:33:10,440
I liken it to Formula One cars
and having their wheels changed.

540
00:33:10,520 --> 00:33:11,800
Everybody has a role

541
00:33:11,880 --> 00:33:15,080
and everybody does
their specific role really well

542
00:33:15,680 --> 00:33:18,240
to get the best outcome for the patient.

543
00:33:20,240 --> 00:33:22,160
We're gonna repair the ulnar artery

544
00:33:22,240 --> 00:33:24,080
and the ulnar nerve under the microscope.

545
00:33:24,160 --> 00:33:27,680
Can I have a stay suture
and an artery clip?

546
00:33:30,120 --> 00:33:33,120
Just getting the two ends
of the vessel prepared.

547
00:33:35,080 --> 00:33:38,880
The ulnar artery
delivers blood to keep the hand alive.

548
00:33:39,920 --> 00:33:41,400
When we repair an artery,

549
00:33:41,480 --> 00:33:46,040
we want the tube to reconnect
so that blood can easily flow through it.

550
00:33:48,280 --> 00:33:50,880
I'm gonna do one more here,
and then loops.

551
00:33:57,600 --> 00:33:59,280
Right. Moment of truth.

552
00:34:00,080 --> 00:34:03,960
We do a test to check the blood's flowing
and not getting stopped somewhere.

553
00:34:08,840 --> 00:34:10,480
We've got a pulse again.

554
00:34:10,560 --> 00:34:13,480
We now move on to the nerve.

555
00:34:13,560 --> 00:34:16,720
The nerves are there
to supply sensation to the hand.

556
00:34:17,320 --> 00:34:19,560
This is why the patient
can't feel his fingers,

557
00:34:19,640 --> 00:34:20,960
because he's cut it in half.

558
00:34:21,680 --> 00:34:24,360
Nerve repair requires
using the right instrument

559
00:34:24,440 --> 00:34:27,480
to help to bring
the ends of the nerve together.

560
00:34:28,000 --> 00:34:30,320
We do sometimes also use glue.

561
00:34:31,400 --> 00:34:34,040
It's called Tisseel.
Basically, nerve glue.

562
00:34:34,640 --> 00:34:39,760
The glue is synthetic fibrin,
which we all make when we have a cut.

563
00:34:39,840 --> 00:34:43,120
The gunkiness of the wound
that forms very quickly,

564
00:34:43,880 --> 00:34:45,720
that essentially is fibrin.

565
00:34:54,960 --> 00:34:57,040
That nerve is intact.

566
00:34:57,560 --> 00:34:58,520
Job well done.

567
00:34:59,960 --> 00:35:01,280
We'll finish off here.

568
00:35:08,200 --> 00:35:12,080
When you know that you've done
the best possible job that you can,

569
00:35:12,160 --> 00:35:16,400
and that the patient hopefully
will get a good result, it's exhilarating.

570
00:35:17,360 --> 00:35:19,200
That's incredible for me.

571
00:35:21,200 --> 00:35:23,440
Okay. Thank you everyone.

572
00:35:25,720 --> 00:35:29,840
Trauma is a unique journey
to each person and their family.

573
00:35:33,880 --> 00:35:38,440
And I know the devastating effect
of a major trauma firsthand.

574
00:35:42,560 --> 00:35:44,120
Life was beautiful.

575
00:35:44,960 --> 00:35:48,880
Mickey and I,
we led a very hedonistic life

576
00:35:48,960 --> 00:35:51,040
just full of laughter and joy.

577
00:35:54,040 --> 00:35:55,280
We'd do crazy things

578
00:35:55,360 --> 00:35:58,600
like hiking at 3:00 in the morning
just to see a sunrise

579
00:35:59,120 --> 00:36:03,120
or hiking in the dark
just to see the stars. Um…

580
00:36:04,120 --> 00:36:06,680
He was… He was my best friend.

581
00:36:09,080 --> 00:36:11,840
On 18th March, um…

582
00:36:12,480 --> 00:36:16,120
I went to a clinic

583
00:36:17,120 --> 00:36:20,200
around two, three hours' drive
from where I was based.

584
00:36:20,720 --> 00:36:24,200
Mickey insisted
that he wanted to join me on that journey.

585
00:36:25,240 --> 00:36:27,920
I drove most of the time,

586
00:36:28,000 --> 00:36:32,640
but on this particular day,
I was feeling very tired.

587
00:36:33,240 --> 00:36:37,440
For the first time, I actually asked him,
"Do you mind driving us home?"

588
00:36:38,080 --> 00:36:39,360
And he did.

589
00:36:42,680 --> 00:36:44,880
Within ten minutes of that journey

590
00:36:46,680 --> 00:36:50,680
we were hit by an oil tanker
at high speed.

591
00:36:53,120 --> 00:36:56,040
I remember the car spinning,

592
00:36:56,640 --> 00:36:59,000
and I remember Mickey reaching out,

593
00:37:00,040 --> 00:37:01,560
grabbing my hand.

594
00:37:03,120 --> 00:37:08,200
And the last thing he said to me was,
"I love you, Shan Shan."

595
00:37:10,320 --> 00:37:11,440
And that was it.

596
00:37:14,680 --> 00:37:19,240
So I had multiple injuries
that kept me in ICU.

597
00:37:21,880 --> 00:37:25,240
I remember, days after the accident,

598
00:37:26,240 --> 00:37:27,080
this

599
00:37:28,000 --> 00:37:29,320
amazing nurse

600
00:37:30,360 --> 00:37:33,080
telling me that Mickey didn't make it.

601
00:37:36,280 --> 00:37:37,840
In that split second,

602
00:37:37,920 --> 00:37:41,280
it was as if a bomb had gone off

603
00:37:41,880 --> 00:37:44,880
that excavated everything that I had.

604
00:37:50,040 --> 00:37:51,800
I think I suffered from

605
00:37:52,680 --> 00:37:55,000
extreme survivor's guilt

606
00:37:56,440 --> 00:37:58,080
that I got to live.

607
00:38:01,440 --> 00:38:04,840
Trauma patients
often carry a psychological burden.

608
00:38:05,880 --> 00:38:07,840
People will feel

609
00:38:08,560 --> 00:38:09,560
disbelief…

610
00:38:12,360 --> 00:38:13,480
anger,

611
00:38:14,360 --> 00:38:15,920
and regret.

612
00:38:16,720 --> 00:38:19,240
But forgiveness is critical,

613
00:38:21,120 --> 00:38:23,240
because life is so precious,

614
00:38:24,960 --> 00:38:27,240
and there is light
at the end of the tunnel.

615
00:38:30,200 --> 00:38:31,640
We're happy to send you home.

616
00:38:32,400 --> 00:38:34,480
All right. I'll see you later. Bye.

617
00:38:36,240 --> 00:38:39,400
Being a major trauma patient myself

618
00:38:39,480 --> 00:38:42,600
has really made me appreciate

619
00:38:42,680 --> 00:38:46,920
the totality of what trauma
and trauma recovery is.

620
00:38:47,000 --> 00:38:49,080
And it's really helped me

621
00:38:49,640 --> 00:38:53,360
to better manage my patients
and their family.

622
00:39:05,120 --> 00:39:08,120
Okay. Postoperatives from yesterday.

623
00:39:08,200 --> 00:39:10,760
Let's go through them. This is Jared.

624
00:39:11,480 --> 00:39:13,040
He's a really nice guy.

625
00:39:14,360 --> 00:39:18,080
That butterfly fragment
was quite difficult to reduce.

626
00:39:18,160 --> 00:39:19,640
I… I think it's in a good…

627
00:39:19,720 --> 00:39:20,560
Looks good now.

628
00:39:20,640 --> 00:39:22,320
Yeah. It looks…

629
00:39:22,400 --> 00:39:25,680
And it was flipped as well.
So, now we've got it in the right place.

630
00:39:28,480 --> 00:39:29,320
Morning.

631
00:39:31,240 --> 00:39:33,160
-Hi, Jared.
-Hi there.

632
00:39:33,920 --> 00:39:35,080
Sorry for waking you up.

633
00:39:37,040 --> 00:39:38,960
Operation went really well yesterday.

634
00:39:39,040 --> 00:39:41,280
It went really well.
So I'm really pleased.

635
00:39:41,800 --> 00:39:44,680
We got the job done.
We put the nail down, the metal rod

636
00:39:44,760 --> 00:39:46,720
inside your canal, so…

637
00:39:47,240 --> 00:39:48,640
So really happy with that.

638
00:39:48,720 --> 00:39:52,800
You're gonna start getting you to dangle
your foot off the edge of the bed. Yeah?

639
00:39:53,360 --> 00:39:55,560
And then we'll slowly get you
up and about.

640
00:39:56,680 --> 00:39:59,840
So, from our side, Jared,
if dangling is good,

641
00:39:59,920 --> 00:40:03,880
just keep the leg down
as much as you want from day four or five.

642
00:40:04,560 --> 00:40:07,720
Okay? And from there on,
you can start doing physio and everything.

643
00:40:07,800 --> 00:40:09,840
We'll tell you the regimen. Don't worry.

644
00:40:10,840 --> 00:40:12,160
Yeah, look like you.

645
00:40:13,680 --> 00:40:15,760
Well, why don't you want to look like me?

646
00:40:18,320 --> 00:40:21,080
You're doing well,
so we're feeling positive.

647
00:40:21,160 --> 00:40:22,920
-Yeah. It's good.
-Thank you.

648
00:40:24,600 --> 00:40:26,600
Hopefully, you can get some rest.

649
00:40:29,080 --> 00:40:32,720
It's the most amazing feeling
to see someone who,

650
00:40:33,680 --> 00:40:38,400
in that moment of having an accident,
their whole life has stopped.

651
00:40:40,120 --> 00:40:45,040
And then you go in,
and your whole aim is to make them better.

652
00:40:46,200 --> 00:40:50,080
You then start to see them
in the recovery phase in clinic,

653
00:40:50,160 --> 00:40:52,520
and you watch them go through the cycle.

654
00:40:54,200 --> 00:40:56,880
To see that person
on the road to recovery,

655
00:40:58,240 --> 00:41:01,440
there's nothing
that can replace that feeling.

656
00:41:03,560 --> 00:41:07,400
I never knew I was gonna appreciate
the NHS to this magnitude.

657
00:41:08,760 --> 00:41:10,640
Until these things happen to you,

658
00:41:10,720 --> 00:41:16,240
you wouldn't know
how unappreciative or how much of a…

659
00:41:17,840 --> 00:41:19,320
I don't know how to say this.

660
00:41:20,160 --> 00:41:22,360
How much of an arse you are.

661
00:41:24,280 --> 00:41:27,360
This situation has given me
a little epiphany

662
00:41:27,440 --> 00:41:32,240
in terms of really living
certain moments, you know?

663
00:41:32,320 --> 00:41:35,800
'Cause you just don't know
when they're gonna be taken away.

664
00:41:36,320 --> 00:41:38,680
I've never felt this feeling before.

665
00:41:38,760 --> 00:41:40,960
I'm gonna live my happiest days now.

666
00:41:41,040 --> 00:41:41,920
You know?

667
00:41:42,720 --> 00:41:44,160
So, we shall see.

668
00:41:57,240 --> 00:41:59,240
Someone has beaten up my boyfriend.

669
00:41:59,320 --> 00:42:01,560
He's not breathing.
There's blood everywhere.

670
00:42:01,640 --> 00:42:04,720
There's blood everywhere.

671
00:42:04,800 --> 00:42:05,640
Please!

672
00:42:08,960 --> 00:42:10,080
50, go ahead. Yeah?

673
00:42:10,160 --> 00:42:13,800
Got a crew request for assault on a male.

674
00:42:13,880 --> 00:42:16,560
He's currently unconscious
following a head injury.

675
00:42:16,640 --> 00:42:18,000
Okay.

676
00:42:20,760 --> 00:42:24,160
People describe it as being
a bit like a coiled spring ready to go.

677
00:42:26,520 --> 00:42:27,960
We're drilled. We're trained.

678
00:42:28,040 --> 00:42:30,440
We know that somebody's got
a significant head injury.

679
00:42:31,360 --> 00:42:34,440
His name's Isaac. He's 23.

680
00:42:35,040 --> 00:42:37,560
Head injuries are very time-critical.

681
00:42:39,160 --> 00:42:40,280
And there's many things

682
00:42:40,360 --> 00:42:42,440
that could be going on
inside Isaac's skull.

683
00:42:42,520 --> 00:42:44,600
Some of which are life-threatening.

684
00:42:46,480 --> 00:42:48,720
He's laying on the floor.

685
00:42:49,800 --> 00:42:51,680
Isaac! Isaac!

686
00:42:53,600 --> 00:42:55,000
God, his eyes are just blank.

687
00:42:56,560 --> 00:42:59,160
He's not responding.
Is there an ambulance coming?

688
00:43:01,480 --> 00:43:04,400
Isaac had his head
stamped on a number of times.

689
00:43:04,480 --> 00:43:07,200
We assumed he had a critical brain bleed.

690
00:43:08,240 --> 00:43:10,640
He needs to go to a major trauma center

691
00:43:10,720 --> 00:43:13,080
with neurosurgeons on site
as quickly as possible.

692
00:43:13,160 --> 00:43:15,680
Adult male. Trauma call. ETA 15 minutes.

693
00:43:18,280 --> 00:43:19,880
Hi, it's Jim, A&E consultant.

694
00:43:19,960 --> 00:43:23,440
There's a young male who's been assaulted.
They're coming to us by land.

695
00:43:23,520 --> 00:43:25,160
He's got a significant head injury.

696
00:43:32,440 --> 00:43:33,440
This is Isaac.

697
00:43:33,520 --> 00:43:37,760
At about 21:00 hours, he was assaulted,
but we believe he's been stamped on.

698
00:43:37,840 --> 00:43:38,760
Injuries top to toe.

699
00:43:38,840 --> 00:43:41,760
He's probably got an intracranial bleed
'cause he was agitated.

700
00:43:41,840 --> 00:43:45,520
He had a sedation of 30 of ketamine
and then an RSI.

701
00:43:45,600 --> 00:43:48,200
He's got a bruising
over the top right side of his chest,

702
00:43:48,280 --> 00:43:49,960
so possible rib fractures.

703
00:43:50,040 --> 00:43:52,200
He's got a significant
left-sided facial injury.

704
00:43:52,280 --> 00:43:53,960
We're concerned about his eye.

705
00:43:54,480 --> 00:43:57,240
If we get him off the scoop
and get him onto our monitoring

706
00:43:57,320 --> 00:43:58,600
and onto our ventilator.

707
00:43:58,680 --> 00:43:59,800
Ready?

708
00:43:59,880 --> 00:44:01,480
One, two, three.

709
00:44:02,240 --> 00:44:05,240
Okay. And if we start
the primary survey, please.

710
00:44:05,320 --> 00:44:08,880
Trachea center,
bruise over the right side,

711
00:44:08,960 --> 00:44:11,080
no surgical emphysema.

712
00:44:13,760 --> 00:44:17,000
Isaac's eyes are not responding
to the torch shone in them.

713
00:44:17,080 --> 00:44:20,600
As swelling increases in the brain,
it will compress the cranial nerves

714
00:44:20,680 --> 00:44:23,280
and affect the nerves
that supply the pupil.

715
00:44:24,040 --> 00:44:25,720
Hi, it's Jim, A&E consultant.

716
00:44:25,800 --> 00:44:28,120
Could you protocol
a trauma scan for me, please?

717
00:44:28,920 --> 00:44:32,840
The priority with a big head injury
is to get a CT scan 'cause we wanna know

718
00:44:32,920 --> 00:44:36,200
if there's a time-critical injury
that needs a neurosurgeon immediately.

719
00:44:37,080 --> 00:44:39,320
He's intubated.
I just want to scan everything.

720
00:44:39,400 --> 00:44:40,280
Ready to roll?

721
00:44:41,200 --> 00:44:43,960
Your brain is contained
within a rigid box, the skull,

722
00:44:44,040 --> 00:44:47,600
and so if your brain swells up,
there's nowhere for that swelling to go,

723
00:44:47,680 --> 00:44:52,240
so that effectively squishes your brain,
and that can have profound consequences.

724
00:44:53,200 --> 00:44:54,360
We're most worried about,

725
00:44:54,440 --> 00:44:57,640
in the immediate stage,
that it's life-changing.

726
00:44:58,720 --> 00:45:00,720
Or that it's life-ending.

726
00:45:01,305 --> 00:46:01,738