1
00:00:07,120 --> 00:00:09,880
What have we got by way of bone fragments?

2
00:00:11,080 --> 00:00:13,760
We need to find big bits, okay?

3
00:00:13,840 --> 00:00:15,240
Chunky bits.

4
00:00:18,360 --> 00:00:19,840
Is there bone there?

5
00:00:20,800 --> 00:00:23,280
Well, I'm winging it, if you want to know.

6
00:00:25,000 --> 00:00:26,960
It's so smashed.

7
00:00:27,040 --> 00:00:29,400
The planes are quite difficult
to find at the moment.

8
00:00:35,720 --> 00:00:39,200
With Jack, the scan doesn't really show

9
00:00:39,280 --> 00:00:42,360
the extreme devastation
that I'm seeing face-to-face.

10
00:00:43,960 --> 00:00:47,200
His surgery is immensely complicated.

11
00:00:47,280 --> 00:00:48,280
Can you see bone?

12
00:00:48,800 --> 00:00:50,400
One of the big fears I have

13
00:00:50,480 --> 00:00:53,600
is not being able to complete
what I'd started.

14
00:00:53,680 --> 00:00:54,920
What's that?

15
00:00:56,120 --> 00:00:58,960
-That's rim, isn't it?
-That's your biggest.

16
00:00:59,040 --> 00:01:00,600
Mm. Interesting.

17
00:01:01,720 --> 00:01:03,920
I always say that facial appearance

18
00:01:04,000 --> 00:01:06,360
and how you see yourself
is really important.

19
00:01:08,720 --> 00:01:12,280
So, the responsibility
to get this right is heavy.

20
00:01:14,000 --> 00:01:20,074
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21
00:01:27,440 --> 00:01:28,800
There's a bit here.

22
00:01:31,160 --> 00:01:33,280
I mean, that's probably not bad, is it?

23
00:01:34,440 --> 00:01:36,320
This is like gold, all right?

24
00:01:37,040 --> 00:01:40,040
It's coming out of your pocket money
if you lose it.

25
00:01:42,440 --> 00:01:44,520
Have we got enough bone now to press on?

26
00:01:44,600 --> 00:01:46,240
-Yes.
-Yes.

27
00:01:46,320 --> 00:01:50,080
Okay. So we're gonna make Jack
a new forehead and eye socket.

28
00:01:51,160 --> 00:01:53,680
Jack was very brutally attacked
with an iron bar,

29
00:01:53,760 --> 00:01:56,400
and he had multiple blows
to his face and his head.

30
00:01:57,640 --> 00:02:00,640
We need to peel his face back
to get at the fractured bone,

31
00:02:02,480 --> 00:02:06,320
and then put it all back together again
using the bone fragments

32
00:02:06,400 --> 00:02:07,520
that we've found.

33
00:02:08,200 --> 00:02:11,400
Also, titanium mesh will be screwed
into place above his eye socket

34
00:02:11,480 --> 00:02:14,000
to seal the hole in the skull.

35
00:02:15,360 --> 00:02:18,000
Okay, well,
let's have the bone now, please.

36
00:02:19,280 --> 00:02:20,720
Can you put that in there?

37
00:02:23,480 --> 00:02:27,200
You can feel that nice crunch
as you lift the bone into the right place.

38
00:02:29,040 --> 00:02:30,400
It's visceral.

39
00:02:32,240 --> 00:02:35,000
Okay, so that's about right,
isn't it? Yeah?

40
00:02:36,600 --> 00:02:40,680
With the bridge in place,
we can now build the metal around that.

41
00:02:42,280 --> 00:02:44,800
-We know that it's got to be curved.
-Yeah.

42
00:02:45,440 --> 00:02:47,960
Something like that, maybe.

43
00:02:50,480 --> 00:02:53,480
I try and be Steady Eddie and measured,
all the way through.

44
00:02:55,360 --> 00:03:00,440
But getting the metal in the right place
without damaging any of the nerves…

45
00:03:01,280 --> 00:03:05,120
That attention to detail
is the most stressful.

46
00:03:08,400 --> 00:03:09,880
Five-mil screw, yeah?

47
00:03:09,960 --> 00:03:12,080
Okay. Is it tight? Yeah.

48
00:03:12,160 --> 00:03:13,840
Take it slow, so don't push it.

49
00:03:16,760 --> 00:03:19,760
If you trap the nerves,
there's a definite risk

50
00:03:19,840 --> 00:03:24,200
you render that patient unable to have
normal facial coordination.

51
00:03:26,120 --> 00:03:27,040
We have to be careful

52
00:03:27,120 --> 00:03:29,200
because we don't want
to make it even worse.

53
00:03:31,040 --> 00:03:34,040
One mistake could alter
the way the eyes move,

54
00:03:35,000 --> 00:03:37,600
or it could mean
your smile becomes lopsided.

55
00:03:39,000 --> 00:03:41,720
So there's an awful lot
that could go wrong.

56
00:03:43,280 --> 00:03:45,480
-I would take that edge off.
-Yeah.

57
00:03:45,560 --> 00:03:47,880
-We got the piezo saw handy?
-Yeah.

58
00:03:53,360 --> 00:03:55,160
-Have you got it?
-I've got it.

59
00:03:55,240 --> 00:03:57,960
That looks good to meezy. Okay.

60
00:03:58,960 --> 00:04:02,840
We just need to make him
a metal sheet for the forehead.

61
00:04:06,240 --> 00:04:09,720
This is gonna take the place
of the bone that has been lost.

62
00:04:13,600 --> 00:04:15,440
If we don't get it right,

63
00:04:17,160 --> 00:04:21,040
there is a very real concern
that he's going to be deformed.

64
00:04:24,120 --> 00:04:25,400
It's a long operation,

65
00:04:25,480 --> 00:04:29,360
and you absolutely know
that things can go wrong.

66
00:04:29,960 --> 00:04:32,800
I'm feeling nervous.

67
00:04:32,880 --> 00:04:37,000
But we haven't heard any bad news,
so we have to…

68
00:04:37,800 --> 00:04:41,040
We have to… Well,Ihave to tell myself
it's gonna be good news.

69
00:04:41,120 --> 00:04:44,040
You have to hold on to that positivity.

70
00:04:46,680 --> 00:04:49,920
Jack's my son,
and he means a great deal to us.

71
00:04:50,560 --> 00:04:51,400
Jack!

72
00:04:54,760 --> 00:04:58,440
His life and his future
is in the hands of experts

73
00:04:58,520 --> 00:05:02,520
who are helping shape
the rest of his life, frankly.

74
00:05:04,080 --> 00:05:05,840
This is the last bit to do.

75
00:05:07,240 --> 00:05:08,080
Screw, please.

76
00:05:15,520 --> 00:05:18,880
Okay, now, when the brain pulsates,

77
00:05:20,200 --> 00:05:21,480
the eye won't move.

78
00:05:23,600 --> 00:05:26,360
We've got the artificial forehead
in place.

79
00:05:26,440 --> 00:05:28,080
Shall we see what it looks like?

80
00:05:38,760 --> 00:05:42,320
He actually has a brow. Perfect.

81
00:05:44,600 --> 00:05:46,360
Let's make him beautiful now.

82
00:05:48,200 --> 00:05:49,600
To me?

83
00:05:49,680 --> 00:05:50,840
To you.

84
00:05:54,240 --> 00:05:56,600
Everything can look aesthetically right,

85
00:05:57,880 --> 00:06:01,320
but until you see
the patient talking to you the next day,

86
00:06:01,400 --> 00:06:04,800
seeing normally,
then you don't really fully relax.

87
00:06:06,320 --> 00:06:08,560
He was quite smashed around his temple,

88
00:06:08,640 --> 00:06:11,880
which is where the facial nerve is,
so that's a worry for me.

89
00:06:11,960 --> 00:06:13,520
So we'll see how it goes.

90
00:06:14,600 --> 00:06:17,760
You're just in the recovery room.

91
00:06:17,840 --> 00:06:20,520
All right. Good man.
You're doing really well.

92
00:06:22,520 --> 00:06:26,840
After my parents' car crash,
my mum had terrible facial scarring,

93
00:06:27,360 --> 00:06:30,120
and so in a lot of the patients,
inevitably, I see Mum.

94
00:06:31,920 --> 00:06:33,960
And I think because of that,

95
00:06:34,040 --> 00:06:37,280
I want to give the patients
the chance she never had.

96
00:06:38,640 --> 00:06:42,160
The best chance
to go out and be yourself again.

97
00:06:44,640 --> 00:06:45,680
You good?

98
00:06:47,520 --> 00:06:50,520
Yeah, hi, Fiona.
It's Simon here. Good news.

99
00:06:50,600 --> 00:06:52,560
Just to say the operation's done.

100
00:06:53,160 --> 00:06:58,280
We found enough bone to rebuild him
with a bit of metal mesh as well.

101
00:06:59,200 --> 00:07:01,920
So he's got a titanium mesh in his head.

102
00:07:02,000 --> 00:07:04,520
It won't set metal detectors off,
fortunately.

103
00:07:06,520 --> 00:07:09,840
Thank you for everyone
that's done so much today.

104
00:07:10,440 --> 00:07:13,240
-Yeah, thank you very much. Thank you.
-See you soon. Bye.

105
00:07:23,720 --> 00:07:26,120
You got something
you can press against the wound?

106
00:07:26,200 --> 00:07:30,240
So, the injuries are to the face?
Any difficulty in breathing?

107
00:07:30,320 --> 00:07:32,720
Climbed over a spiked fence, fell.

108
00:07:33,760 --> 00:07:35,040
Incisions at ribs.

109
00:07:36,080 --> 00:07:38,200
They'll need a full extraction.

110
00:07:38,280 --> 00:07:41,240
He tripped over,
and a steel beam's fallen across his back.

111
00:07:41,320 --> 00:07:42,520
He's in agony.

112
00:07:46,240 --> 00:07:48,320
Morning. You all right, mate?

113
00:07:48,400 --> 00:07:50,600
-How are you doing?
-Yeah, very good.

114
00:07:52,800 --> 00:07:54,040
I'm trying to lose weight.

115
00:07:54,120 --> 00:07:57,120
I'm going on a beach holiday.
I need a beach bod.

116
00:07:58,200 --> 00:08:00,640
So, I've got this calorie counter, yeah?

117
00:08:00,720 --> 00:08:03,800
And it's the one
where you take photos of everything.

118
00:08:03,880 --> 00:08:05,160
And you set a target.

119
00:08:05,240 --> 00:08:06,760
Hey, man. How are you?

120
00:08:06,840 --> 00:08:09,320
My calorie counter lies. It's a lying ca…

121
00:08:09,400 --> 00:08:11,800
It shows that I'm always in a deficit,

122
00:08:12,320 --> 00:08:15,000
but I don't lose weight. So…

123
00:08:15,080 --> 00:08:20,200
So, it's clear that there are
missing items from my calorie counter.

124
00:08:21,760 --> 00:08:22,720
I love to cook.

125
00:08:23,360 --> 00:08:25,560
A lot of my cooking came from my mum.

126
00:08:26,160 --> 00:08:27,360
She was a teacher,

127
00:08:27,440 --> 00:08:31,920
so she'd wake up super early,
like, at like 4:00 a.m. or 5:00 a.m.

128
00:08:32,000 --> 00:08:36,000
She'd cook for us for dinner,
and then she'd go off to go to work.

129
00:08:36,520 --> 00:08:38,960
And so I'd wake up,
smelling all these amazing dishes.

130
00:08:39,040 --> 00:08:40,760
You know? That would be my breakfast.

131
00:08:40,840 --> 00:08:42,800
She never knew, but anyway…

132
00:08:44,720 --> 00:08:47,160
Team… Sam, shall we go?

133
00:08:47,240 --> 00:08:50,400
Can you come with me quickly?
Let's go to the ward together.

134
00:08:50,480 --> 00:08:54,360
My mother, she…
she was very protective of us.

135
00:08:54,440 --> 00:08:57,600
You know, I grew up in a…
I grew up in an estate, you know?

136
00:08:57,680 --> 00:09:00,960
I grew up in an environment
which wasn't sort of perhaps

137
00:09:01,040 --> 00:09:04,920
the most conducive
to achieving a lot in life.

138
00:09:05,000 --> 00:09:08,360
But my mum, she pushed me on.
She had faith in me.

139
00:09:08,440 --> 00:09:12,080
A lot of my success
in life is down to her,

140
00:09:12,800 --> 00:09:14,520
because she directed me, you know?

141
00:09:15,040 --> 00:09:18,240
I think the happiest moment for me
was when she came to my graduation.

142
00:09:19,760 --> 00:09:21,240
She was very proud, yeah.

143
00:09:23,160 --> 00:09:25,120
Sharp scratch, my dear friend.

144
00:09:25,920 --> 00:09:29,920
So, Jared's a 26-year-old male,
motorcyclist versus van,

145
00:09:30,000 --> 00:09:33,240
sustaining a significant injury
to his leg.

146
00:09:33,320 --> 00:09:35,200
He has an open fracture.

147
00:09:36,760 --> 00:09:39,280
He should be in theater very shortly.

148
00:09:40,080 --> 00:09:42,400
-We'll go say hello, yeah?
-Brilliant.

149
00:09:42,920 --> 00:09:44,160
Hey, Jared.

150
00:09:45,040 --> 00:09:46,080
Hey, how are you?

151
00:09:46,160 --> 00:09:51,080
So we're gonna operate on you today.
We're gonna fix your broken bone.

152
00:09:51,160 --> 00:09:54,560
We're gonna put a nail,
it's a metal rod, basically,

153
00:09:54,640 --> 00:09:57,320
inside the canal of your bone.

154
00:09:57,400 --> 00:10:01,200
Then the plastic surgeon will do a flap.
And it will cover the defect,

155
00:10:01,280 --> 00:10:04,520
allowing you to get on with…
with the healing process.

156
00:10:06,080 --> 00:10:08,720
And, uh, I really want
to appreciate you guys

157
00:10:08,800 --> 00:10:12,560
in a whole different light
after this as well, I can't lie.

158
00:10:12,640 --> 00:10:15,080
We'll look after you.
We'll be taking you down soon.

159
00:10:15,160 --> 00:10:16,160
See you later.

160
00:10:17,360 --> 00:10:19,240
-He's a really nice guy.
-Yeah.

161
00:10:25,240 --> 00:10:28,800
How do you think
things will be after the operation?

162
00:10:29,800 --> 00:10:33,920
Hopefully, after this operation,
it goes all well.

163
00:10:34,000 --> 00:10:38,520
If it does, I want to be
the most positive aspect of myself.

164
00:10:38,600 --> 00:10:40,320
I've always been self-centered.

165
00:10:40,400 --> 00:10:41,960
-Do you know what I mean?
-Yeah.

166
00:10:42,040 --> 00:10:44,040
Like, I'm really grateful.

167
00:10:46,240 --> 00:10:48,080
Yeah.

168
00:10:48,160 --> 00:10:50,680
Also, this is making me really think about

169
00:10:51,640 --> 00:10:53,800
things I need to accomplish now.

170
00:10:54,840 --> 00:10:57,360
'Cause I never had
any accomplishments really,

171
00:10:57,440 --> 00:11:00,960
apart from, "I… I… I got a new bike."

172
00:11:01,040 --> 00:11:02,960
-Yeah.
-"I got this." You know what I mean?

173
00:11:03,040 --> 00:11:07,200
I need to, like, look out for people
as much as they look out for me.

174
00:11:08,320 --> 00:11:11,680
I really feel vulnerable, and I can't…

175
00:11:11,760 --> 00:11:14,720
Honestly, I've not seen you cry ever.

176
00:11:14,800 --> 00:11:19,000
-I know.
-It's weird to see you this squidgy…

177
00:11:20,040 --> 00:11:22,240
…and soft, but it's also nice.

178
00:11:25,480 --> 00:11:26,360
So yeah.

179
00:11:26,440 --> 00:11:28,640
-Hello.
-Oh, hi!

180
00:11:31,080 --> 00:11:33,200
-You all right, gorgeous?
-Hello, Mama.

181
00:11:33,280 --> 00:11:35,880
Yeah, just been down and everything.

182
00:11:35,960 --> 00:11:36,920
Oh no.

183
00:11:38,000 --> 00:11:41,040
When something really profound
happens to you in your life, yeah?

184
00:11:42,320 --> 00:11:47,600
And then you have strangers
who kind of come to your helping hand,

185
00:11:47,680 --> 00:11:49,640
you get quite affected by it.

186
00:11:51,760 --> 00:11:53,360
You can feel their empathy.

187
00:11:54,400 --> 00:11:56,240
And I think that's what he's just felt.

188
00:11:56,320 --> 00:12:00,640
You know, he's sat there,
and he's felt that same genuine empathy.

189
00:12:03,440 --> 00:12:06,480
My mother, 12 years,
she had breast cancer.

190
00:12:06,560 --> 00:12:10,200
She passed away in 2009.

191
00:12:11,280 --> 00:12:14,320
But I think the care that she received
was phenomenal.

192
00:12:14,400 --> 00:12:17,120
And I saw it firsthand,
what they did for her,

193
00:12:17,200 --> 00:12:18,920
and it really touched me.

194
00:12:21,240 --> 00:12:23,760
So, every patient I treat,

195
00:12:24,280 --> 00:12:26,880
I treat them as if they're my mum.

196
00:12:34,960 --> 00:12:37,720
The stakes are very high
in this operation.

197
00:12:39,720 --> 00:12:42,320
So, this is the tibia, and as you can see,

198
00:12:42,400 --> 00:12:46,000
there's this big fragment of bone
called a butterfly fragment.

199
00:12:46,080 --> 00:12:50,680
The bone's effectively exploded,
and it's spat out this wedge.

200
00:12:51,480 --> 00:12:53,800
It resembles the wing of a butterfly.

201
00:12:55,280 --> 00:12:56,400
It's huge.

202
00:12:57,080 --> 00:12:59,960
15% to 20% of the length
of his entire tibia.

203
00:13:01,400 --> 00:13:03,040
If we don't fix this,

204
00:13:03,120 --> 00:13:05,760
the worst-case scenario is
he loses his leg.

205
00:13:07,160 --> 00:13:09,960
This moment will dictate
the rest of his life.

206
00:13:11,800 --> 00:13:15,080
So today, we're gonna do
a fix and flap operation.

207
00:13:16,000 --> 00:13:19,160
This is one of the most complex operations
we do.

208
00:13:19,240 --> 00:13:22,840
It's a combined operation
that involves both orthopedic surgeons

209
00:13:23,440 --> 00:13:25,400
and plastic surgeons.

210
00:13:25,480 --> 00:13:27,520
That is your oblique.

211
00:13:27,600 --> 00:13:29,000
It's teamwork.

212
00:13:29,080 --> 00:13:31,840
It is like the Avengers coming together.

213
00:13:32,800 --> 00:13:34,720
We're like a combination of Hulk

214
00:13:35,560 --> 00:13:37,360
and Thor with the mallet.

215
00:13:39,400 --> 00:13:42,840
And the plastic surgeons,
they're more like Doctor Strange,

216
00:13:42,920 --> 00:13:44,880
a bit more fine and soft.

217
00:13:44,960 --> 00:13:49,320
Everyone knows their skills,
and we all have the same target.

218
00:13:49,920 --> 00:13:51,960
To sort out this problem.

219
00:13:53,360 --> 00:13:56,080
There's four consultants here.
It's brilliant.

220
00:13:56,160 --> 00:13:59,760
This is how we roll in here.
This team is the A-team.

221
00:13:59,840 --> 00:14:02,960
-I'll step in when it all goes wrong.
-When it all goes…

222
00:14:04,320 --> 00:14:06,840
Myself and Asmat are the consultants

223
00:14:06,920 --> 00:14:08,760
who look after the skin side of things.

224
00:14:08,840 --> 00:14:10,680
If we're going for a smallish flap,

225
00:14:10,760 --> 00:14:12,400
that's as much as we can close.

226
00:14:13,160 --> 00:14:16,200
Ibraheim and the orthopedic team
will look after the bone side.

227
00:14:16,280 --> 00:14:18,640
Let's get the drill ready, please.

228
00:14:18,720 --> 00:14:19,760
Let's go for it.

229
00:14:20,520 --> 00:14:23,360
-Before I address the butterfly fragment…
-Go on.

230
00:14:23,880 --> 00:14:26,360
…I need to fix the break in Jared's tibia.

231
00:14:27,680 --> 00:14:29,920
Okay, stop there. Come out of it.

232
00:14:30,000 --> 00:14:32,280
To do this,
I'm gonna pass a large metal nail

233
00:14:32,360 --> 00:14:34,880
down through the middle
of Jared's tibial bone.

234
00:14:35,760 --> 00:14:38,560
This will connect his knee to his ankle

235
00:14:38,640 --> 00:14:41,920
and enable the lower leg to be solid
so he can weight-bear again.

236
00:14:43,320 --> 00:14:45,520
If I don't get the alignment perfect,

237
00:14:46,040 --> 00:14:48,600
there could be
major consequences for Jared,

238
00:14:49,120 --> 00:14:50,480
like shattered bone

239
00:14:51,280 --> 00:14:52,720
or torn muscle.

240
00:14:54,040 --> 00:14:55,800
This could affect his life forever.

241
00:14:57,880 --> 00:15:01,000
The biggest challenge is to ensure

242
00:15:01,080 --> 00:15:05,840
that you get the rotation
and alignment perfect.

243
00:15:07,240 --> 00:15:10,320
Have we got the Bactiguard nail set open?
Are we happy?

244
00:15:13,640 --> 00:15:18,120
So this nail is coated with gold,
silver, and palladium.

245
00:15:18,880 --> 00:15:20,360
Can I have a mallet, please?

246
00:15:24,640 --> 00:15:27,720
And so it creates
an electrical environment

247
00:15:28,320 --> 00:15:32,240
which stops bacteria
from forming in this area.

248
00:15:34,360 --> 00:15:36,160
-X-ray. Shot there.
-Mind your hands.

249
00:15:37,360 --> 00:15:39,640
-You're almost there.
-Looks good.

250
00:15:39,720 --> 00:15:42,040
Every millimeter counts,

251
00:15:42,120 --> 00:15:45,160
so a millimeter of space
can lead to disaster.

252
00:15:45,680 --> 00:15:50,240
If the fracture gap is too great,

253
00:15:50,320 --> 00:15:54,480
that will impact
the ability for Jared to walk.

254
00:15:55,160 --> 00:15:57,280
Keep going. Stop.

255
00:15:58,840 --> 00:15:59,680
Shot there.

256
00:16:05,760 --> 00:16:08,360
You're in. Yeah. Good, man. Nice, nice.

257
00:16:10,320 --> 00:16:13,480
The nail is down.
Everything looks in a good place.

258
00:16:15,080 --> 00:16:17,320
Now we need to move on
to the butterfly fragment.

259
00:16:17,920 --> 00:16:19,640
This is really important, this is.

260
00:16:23,400 --> 00:16:27,080
This is a significant chunk of bone.

261
00:16:28,040 --> 00:16:28,880
Shot there.

262
00:16:30,120 --> 00:16:31,640
You're gonna have to push in.

263
00:16:32,280 --> 00:16:36,920
It's flipped 180 degrees,
so it's facing the wrong way.

264
00:16:38,120 --> 00:16:41,480
If that fragment
is not put back where it belongs,

265
00:16:43,160 --> 00:16:45,000
he may never walk ever again.

266
00:17:06,320 --> 00:17:08,760
London Ambulance Service. It's an RTC.

267
00:17:08,840 --> 00:17:10,240
LAS, who's been dispatched?

268
00:17:11,200 --> 00:17:13,680
We're screening
all of the 999 calls that come in,

269
00:17:13,760 --> 00:17:16,000
looking for people
with major trauma injuries.

270
00:17:16,080 --> 00:17:19,080
Blood all over the place.
Caller is screaming.

271
00:17:19,160 --> 00:17:23,520
We work out how bad the injury is,
what interventions they might require,

272
00:17:23,600 --> 00:17:26,400
and therefore whether we send
an advanced paramedic

273
00:17:26,920 --> 00:17:28,720
or an air ambulance team.

274
00:17:30,200 --> 00:17:34,320
Kent Surrey Sussex Air Ambulance
covers the South East region,

275
00:17:34,400 --> 00:17:35,760
outside of the capital.

276
00:17:46,960 --> 00:17:47,960
The day I wake up

277
00:17:48,040 --> 00:17:50,360
and that red phone goes
and I don't feel a flutter

278
00:17:50,960 --> 00:17:52,840
will be the day I'll stop doing this job.

279
00:17:55,560 --> 00:17:58,520
Adult male motorcyclist.
Needs a HEMS team rapidly.

280
00:17:59,720 --> 00:18:01,120
As an air ambulance charity,

281
00:18:01,200 --> 00:18:04,320
we only go
to the most critically injured patients.

282
00:18:08,640 --> 00:18:11,320
And some of the things we see,
no human should ever see.

283
00:18:18,800 --> 00:18:21,720
It was just me and my friend Toby
out on the bike.

284
00:18:22,560 --> 00:18:25,920
We love the acceleration, the speed.
Gets your adrenaline going.

285
00:18:26,000 --> 00:18:27,960
It makes you feel alive.

286
00:18:30,920 --> 00:18:32,640
We were fresh out of the gym.

287
00:18:35,840 --> 00:18:37,760
I was riding in front of Toby,

288
00:18:37,840 --> 00:18:40,120
and I saw a car coming down the road.

289
00:18:40,200 --> 00:18:43,960
As it goes past me,
I heard some sort of like big, loud bang.

290
00:18:45,560 --> 00:18:47,880
I've never heard
anyone scream like that before.

291
00:18:47,960 --> 00:18:49,480
Bloodcurdling sort of scream.

292
00:18:49,560 --> 00:18:52,000
"Am I gonna make it out of this?"
sort of scream.

293
00:18:53,600 --> 00:18:55,200
Toby means the world to me,

294
00:18:55,760 --> 00:18:58,120
and I knew this wasn't gonna be good.

295
00:18:58,760 --> 00:19:01,360
I saw them carry Toby into the helicopter.

296
00:19:04,400 --> 00:19:07,560
It's really important we get Toby
to hospital as quickly as possible.

297
00:19:07,640 --> 00:19:08,880
Minutes matter.

298
00:19:10,120 --> 00:19:13,280
But not any hospital,
a major trauma center.

299
00:19:14,360 --> 00:19:16,760
That means taking him
into King's College London.

300
00:19:19,680 --> 00:19:22,600
-We'll be there in two minutes.
-Yeah, thank you.

301
00:19:25,600 --> 00:19:26,840
A motorbike.

302
00:19:27,720 --> 00:19:30,320
-Is that another trauma coming in?
-Yeah.

303
00:19:30,880 --> 00:19:32,480
Adult's on his way in.

304
00:19:32,560 --> 00:19:34,160
Please activate the helipad.

305
00:19:38,280 --> 00:19:40,240
Toby has injuries that may kill him.

306
00:19:42,000 --> 00:19:44,160
He needs to be
inside a major trauma center

307
00:19:44,240 --> 00:19:46,040
where all of the specialties

308
00:19:46,120 --> 00:19:51,640
are ready to fight for people's lives
and their limbs 24-7.

309
00:19:52,760 --> 00:19:54,640
I can hear the heli. It's on the pad.

310
00:19:54,720 --> 00:19:55,720
Let's do this.

311
00:19:56,240 --> 00:19:59,280
As trauma team leader,
there is apprehension.

312
00:19:59,800 --> 00:20:03,960
'Cause if someone is coming to us,
the injuries are going to be bad.

313
00:20:04,560 --> 00:20:06,000
So we need to be ready for it.

314
00:20:13,000 --> 00:20:15,440
These people are incredibly vulnerable.

315
00:20:16,480 --> 00:20:18,280
They're scared. They're in pain.

316
00:20:18,360 --> 00:20:19,680
Ready, brace, lift.

317
00:20:21,840 --> 00:20:24,160
They have no idea what's going on.

318
00:20:24,680 --> 00:20:28,200
I'm constantly talking to him,
constantly making sure that he's okay,

319
00:20:28,280 --> 00:20:29,680
so he feels less scared.

320
00:20:30,280 --> 00:20:31,760
Okay, Toby, we're going into the lift.

321
00:20:31,840 --> 00:20:32,680
All right.

322
00:20:32,760 --> 00:20:33,600
Okay?

323
00:20:36,800 --> 00:20:40,520
Sometimes you can feel
the patient's raw emotions.

324
00:20:43,880 --> 00:20:45,480
On three. One, two…

325
00:20:47,880 --> 00:20:49,480
Okay, listen up, guys.

326
00:20:49,560 --> 00:20:50,800
Guys, this is Toby.

327
00:20:50,880 --> 00:20:54,080
Toby is 20 years old,
and approximately 90 minutes ago,

328
00:20:54,160 --> 00:20:58,600
he was involved in a motorcycle RTC
on a fast 60 mile-an-hour road.

329
00:20:58,680 --> 00:21:01,160
He's got some abrasions
to his right upper chest.

330
00:21:01,240 --> 00:21:04,040
He's got an obvious
closed right humeral fracture.

331
00:21:04,120 --> 00:21:05,680
He's got a right mid-femur.

332
00:21:05,760 --> 00:21:08,240
He's got a laceration
through his knee joint

333
00:21:08,320 --> 00:21:10,320
on the right side down to his patella.

334
00:21:10,400 --> 00:21:15,480
And his right ankle has an open tib fib
and a mid-foot dislocation I've reduced,

335
00:21:15,560 --> 00:21:18,360
because his right foot was white
with no blood flow to it.

336
00:21:18,440 --> 00:21:19,840
-Okay.
-Any questions?

337
00:21:20,680 --> 00:21:22,640
-No. That's it.
-Thank you very much.

338
00:21:22,720 --> 00:21:25,200
Thank you.
All right, we'll start with our primary.

339
00:21:25,280 --> 00:21:28,200
Chest expanding without obvious trauma.

340
00:21:28,800 --> 00:21:30,560
Abdomen soft and non-tender.

341
00:21:31,440 --> 00:21:34,080
Why don't we
just have a quick look at this?

342
00:21:37,840 --> 00:21:38,960
Where am I? London?

343
00:21:39,040 --> 00:21:40,760
You're at King's College Hospital.

344
00:21:40,840 --> 00:21:42,480
There's a huge wound there.

345
00:21:42,560 --> 00:21:43,760
Yeah, there we go.

346
00:21:43,840 --> 00:21:48,960
I was going home from the gym,
and then all of a sudden I was hit.

347
00:21:49,040 --> 00:21:54,560
And I was like sliding on top of my bike,
and then I got chucked off into the bush.

348
00:21:56,440 --> 00:21:59,160
He's just gonna move your toes
one by one, yeah?

349
00:22:00,520 --> 00:22:03,480
He's got quite significant
limb injuries to his lower leg.

350
00:22:04,360 --> 00:22:07,960
Multiple fractures which are open,
i.e. there's exposed wound.

351
00:22:09,720 --> 00:22:12,800
Your dad's on his way.
I'll go and tell him you got here safely.

352
00:22:12,880 --> 00:22:14,520
All right, mate? Nice to meet you.

353
00:22:14,600 --> 00:22:16,840
-I wish you all the best.
-Thank you.

354
00:22:16,920 --> 00:22:20,880
We're going to get him to a scanner
to make sure we're not missing any injury.

355
00:22:21,840 --> 00:22:23,840
Right, they're ready. Let's go.

356
00:22:31,400 --> 00:22:32,760
When we've handed over,

357
00:22:32,840 --> 00:22:35,240
and we're in the aircraft,
and we're flying home,

358
00:22:35,760 --> 00:22:37,240
that's the time we decompress.

359
00:22:39,000 --> 00:22:42,680
That's the time that we think about
what we've just witnessed.

360
00:22:43,240 --> 00:22:46,040
And that's when you really start
to reflect on the people,

361
00:22:46,120 --> 00:22:48,400
and the families,
and the loved ones involved.

362
00:22:52,680 --> 00:22:54,680
We were together in the kitchen.

363
00:22:56,000 --> 00:23:01,160
Toby's friend Ollie called me
and said there'd been a bad accident.

364
00:23:01,240 --> 00:23:03,320
Could one of us go to him?

365
00:23:05,480 --> 00:23:08,600
I'm totally blind, so I can't drive.

366
00:23:10,880 --> 00:23:14,440
So my husband needed to go
to the scene of the accident.

367
00:23:16,440 --> 00:23:19,280
He was clearly
in quite a large amount of pain.

368
00:23:20,160 --> 00:23:22,560
I was just trying to let him know
I was there.

369
00:23:23,760 --> 00:23:26,600
I think that's the hardest moment
for any parent,

370
00:23:26,680 --> 00:23:28,680
is when your child's in pain.

371
00:23:29,480 --> 00:23:31,480
And there's nothing you can do about it.

372
00:23:33,760 --> 00:23:36,040
Toby is our first child.

373
00:23:36,120 --> 00:23:36,960
Sorry.

374
00:23:37,040 --> 00:23:40,920
To see him like that, it's heartbreaking.

375
00:23:42,040 --> 00:23:47,280
You're just like,
"Where, how, what do we do now?"

376
00:23:55,160 --> 00:23:58,400
He's got a fracture in his arm,
sort of mid-shaft here.

377
00:23:59,720 --> 00:24:02,640
He has complex fractures in his knee,

378
00:24:03,720 --> 00:24:06,960
and then a nasty fracture of his femur.

379
00:24:07,040 --> 00:24:09,720
So, that bone needs straightening
and correction.

380
00:24:10,480 --> 00:24:14,560
But I think the biggest concern for him
is that foot is quite mangled.

381
00:24:15,880 --> 00:24:16,720
Okay.

382
00:24:18,880 --> 00:24:21,720
I cannot feel the pulse.
No, I can't feel anything.

383
00:24:21,800 --> 00:24:22,960
-Let me see again?
-Okay.

384
00:24:23,600 --> 00:24:28,520
We are worried that there might not
be adequate blood supply to his foot.

385
00:24:29,120 --> 00:24:32,080
We need to get an ultrasound
to assess the blood flow.

386
00:24:32,160 --> 00:24:34,160
The toes are looking even more dusky.

387
00:24:35,080 --> 00:24:36,880
And I can't see the arteries.

388
00:24:36,960 --> 00:24:38,040
You can't?

389
00:24:39,520 --> 00:24:40,760
Should be here.

390
00:24:41,520 --> 00:24:43,080
You can't see anything?

391
00:24:45,560 --> 00:24:49,120
I'm really hot,
and my right leg is dying right now.

392
00:24:49,200 --> 00:24:51,800
It's not getting better,
and it really hurts.

393
00:24:54,520 --> 00:24:59,040
It looks slightly worse
than initially thought.

394
00:25:01,200 --> 00:25:04,840
My concern is that given the significance

395
00:25:04,920 --> 00:25:07,280
of the types of broken bones that he has

396
00:25:07,360 --> 00:25:08,320
and where they are

397
00:25:08,920 --> 00:25:11,160
and the potential vascular compromise,

398
00:25:11,680 --> 00:25:15,680
this is a potentially
limb-threatening injury.

399
00:25:18,360 --> 00:25:21,680
We're just gonna remove the debris
in your skin.

400
00:25:24,480 --> 00:25:28,720
It can be very difficult when you
have severely injured trauma patients.

401
00:25:31,280 --> 00:25:35,000
This is why for my trauma shifts,
I tend to wear this hat.

402
00:25:36,360 --> 00:25:37,920
I'm a fan of Harry Potter.

403
00:25:40,280 --> 00:25:43,240
The kind of work
that we do in trauma is all very real.

404
00:25:43,320 --> 00:25:48,000
And sometimes you just need to be
in a different world and just escape.

405
00:25:50,320 --> 00:25:54,160
Somewhere where things can be
wished away with a bit of magic.

406
00:25:54,240 --> 00:25:56,200
And everything's all better.

407
00:25:58,000 --> 00:26:02,240
You want to restore people back
to what they were before they came to us.

408
00:26:03,440 --> 00:26:08,560
But the reality is
that sometimes it might not be possible.

409
00:26:32,440 --> 00:26:34,760
-Can I have a hook?
-A hook.

410
00:26:37,880 --> 00:26:39,240
It's critical for Jared

411
00:26:39,320 --> 00:26:43,200
we get the butterfly fragment
put back exactly where it belongs

412
00:26:43,280 --> 00:26:45,080
to ensure the leg can survive.

413
00:26:45,160 --> 00:26:46,800
Very soft hands, yeah?

414
00:26:53,240 --> 00:26:56,760
My children
are my most precious gifts. That's it.

415
00:26:56,840 --> 00:27:01,840
And… and so you look after them
as best as you possibly can.

416
00:27:04,080 --> 00:27:06,320
Jared doesn't often get shaken,

417
00:27:06,400 --> 00:27:09,360
but it will allow him to

418
00:27:10,720 --> 00:27:12,200
sit and breathe

419
00:27:13,640 --> 00:27:16,080
and decide where he wants his life to go.

420
00:27:17,920 --> 00:27:19,400
He got a bigger bike

421
00:27:19,480 --> 00:27:24,040
because he wanted to do
the blood and transplants delivery.

422
00:27:25,120 --> 00:27:29,400
I think a meaningful purpose
is what sits well with him.

423
00:27:30,960 --> 00:27:33,720
We want this leg to work again.

424
00:27:41,120 --> 00:27:42,800
Yeah, shot there.

425
00:27:42,880 --> 00:27:45,360
In order to put
the butterfly fragment back,

426
00:27:45,440 --> 00:27:47,640
there is some force required.

427
00:27:48,760 --> 00:27:51,560
But too much force,
you can make the problem worse.

428
00:27:51,640 --> 00:27:52,480
Too little force,

429
00:27:52,560 --> 00:27:55,360
you may not be able to put it back
where it belongs.

430
00:27:56,400 --> 00:27:59,000
It's at least 15 centimeters long.

431
00:27:59,840 --> 00:28:01,840
And it's got muscle
between it and the bone.

432
00:28:01,920 --> 00:28:02,760
Give us a shot.

433
00:28:03,840 --> 00:28:06,280
So, you can see it right there
on the X-ray.

434
00:28:07,120 --> 00:28:10,960
Around the tibia,
the muscle is quite bulky.

435
00:28:11,040 --> 00:28:12,520
It can get in the way,

436
00:28:13,040 --> 00:28:16,920
and it can make it very challenging
to put that fragment back

437
00:28:17,600 --> 00:28:21,280
without forcefully ripping
the remaining blood supply from it.

438
00:28:22,760 --> 00:28:26,000
And that's not good,
because that means it may not heal.

439
00:28:26,080 --> 00:28:28,920
So now I'm trying
to bring it back to where it belongs.

440
00:28:29,000 --> 00:28:31,240
We don't want to make
any more holes in his leg.

441
00:28:31,320 --> 00:28:33,760
So we'll try and tickle it,
bring it back in.

442
00:28:36,160 --> 00:28:40,360
Sometimes your fingers and your hands
are the best tool that you've got.

443
00:28:41,080 --> 00:28:43,960
It's all to do with
how you manipulate that fragment.

444
00:28:44,040 --> 00:28:44,880
Shot there.

445
00:28:46,840 --> 00:28:50,640
It's all about the feel. You push it in
gently, and then I usually tap it in.

446
00:28:51,240 --> 00:28:52,920
Can I have a ball spike pusher?

447
00:28:55,440 --> 00:28:57,600
This is a tricky bit of the operation.

448
00:28:58,320 --> 00:29:01,880
There's a lot of feedback from the bone.

449
00:29:01,960 --> 00:29:04,600
It's almost like the bone speaks to you.

450
00:29:04,680 --> 00:29:05,880
Shot there.

451
00:29:06,560 --> 00:29:08,360
That fragment is saying to me…

452
00:29:08,440 --> 00:29:09,480
Shot there.

453
00:29:09,560 --> 00:29:10,880
"Gently bring me round…"

454
00:29:10,960 --> 00:29:11,800
Shot there.

455
00:29:11,880 --> 00:29:14,080
"…and I'll slot back where I belong."

456
00:29:16,200 --> 00:29:17,920
That's beautiful. Look at that.

457
00:29:19,640 --> 00:29:23,920
We managed to get it in almost within
millimeters from where it should be.

458
00:29:24,440 --> 00:29:26,160
This is what we call cortical contact.

459
00:29:26,240 --> 00:29:29,600
So, how much bone and bone
is touching each other.

460
00:29:29,680 --> 00:29:31,800
When they touch each other,
they start to heal.

461
00:29:32,840 --> 00:29:37,160
So, that butterfly fragment
is as close as it could possibly be

462
00:29:37,240 --> 00:29:40,080
without having to put any metalwork in.

463
00:29:41,120 --> 00:29:44,600
It's the most amazing feeling
when an operation goes well.

464
00:29:45,520 --> 00:29:48,240
You feel like
this huge weight has been lifted.

465
00:29:48,840 --> 00:29:51,320
Dude, we're going well. It's all good.

466
00:29:51,400 --> 00:29:53,080
Half the operation's gone well.

467
00:29:53,160 --> 00:29:56,040
-Now it's your half.
-Half the operation's yet to go.

468
00:29:56,120 --> 00:29:56,960
I'm done.

469
00:29:59,680 --> 00:30:02,040
Orthopedic surgery is demanding.

470
00:30:02,120 --> 00:30:03,720
Mentally, you're laser-focused.

471
00:30:03,800 --> 00:30:06,000
Your brain is working
at a million miles an hour

472
00:30:06,080 --> 00:30:07,160
to solve problems.

473
00:30:08,000 --> 00:30:09,920
But also physically demanding.

474
00:30:10,000 --> 00:30:12,680
You're malleting, you're hammering,
you're screwdriving.

475
00:30:12,760 --> 00:30:16,040
It's fascinating
how much impact it has on your body.

476
00:30:16,120 --> 00:30:19,080
And you see it
when you take off your gown,

477
00:30:19,160 --> 00:30:21,240
and you're drenched in sweat.

478
00:30:21,320 --> 00:30:23,920
Sometimes you get blood on your face
when you operate.

479
00:30:24,000 --> 00:30:26,400
So it's quite a horrid look coming out.

480
00:30:26,480 --> 00:30:28,800
And they see blood
all splattered on your face.

481
00:30:28,880 --> 00:30:32,040
They think, "Oh gosh,
you've just come out of the butcher's."

482
00:30:33,480 --> 00:30:36,240
No, I'm really pleased.
This went really well.

483
00:30:36,320 --> 00:30:38,840
Now it's over to my plastic colleagues,

484
00:30:38,920 --> 00:30:41,040
who are gonna do their magic.

485
00:30:42,800 --> 00:30:43,640
Thanks, guys.

486
00:30:48,960 --> 00:30:52,240
We're now plumbing
the artery to artery and two veins.

487
00:30:52,320 --> 00:30:55,360
So, this new bit of skin's going to have
its own blood supply.

488
00:31:03,280 --> 00:31:04,440
Beautiful.

489
00:31:05,320 --> 00:31:08,600
Just need to now check
the blood supply is strong enough.

490
00:31:12,720 --> 00:31:13,600
There you go.

491
00:31:13,680 --> 00:31:15,880
-Is it going somewhere?
-Yeah. There you go.

492
00:31:15,960 --> 00:31:18,480
-That looks nice.
-Yeah. Wonderful.

493
00:31:20,120 --> 00:31:22,560
So, that gives us confidence
that the blood supply,

494
00:31:22,640 --> 00:31:25,920
the pressure going down into our new bit
of transplanted skin and fat,

495
00:31:26,000 --> 00:31:26,960
is good enough.

496
00:31:27,640 --> 00:31:29,200
Let's stitch this. Let's go.

497
00:31:31,920 --> 00:31:33,000
Perfect.

498
00:31:33,840 --> 00:31:35,240
Can I get a…

499
00:31:35,320 --> 00:31:36,360
A croissant?

500
00:31:37,080 --> 00:31:39,360
Can I have a croissant? No, I'm joking.

501
00:31:41,640 --> 00:31:42,640
It's gone well.

502
00:31:42,720 --> 00:31:45,360
We were able to transplant skin
and fat from the thigh

503
00:31:45,440 --> 00:31:48,280
down onto the lower leg
to close that defect.

504
00:31:49,720 --> 00:31:52,840
Which gives the environment
in which the bone to heal.

505
00:31:54,560 --> 00:31:56,520
The bone is fixed, the skin is fixed.

506
00:31:57,040 --> 00:31:59,200
It looks beautiful.
It looks beautiful.

507
00:31:59,280 --> 00:32:00,160
C'est fini.

508
00:32:05,680 --> 00:32:08,680
Theater is an environment
that I love to be in.

509
00:32:11,400 --> 00:32:15,160
I think every surgeon
takes the patient home with them.

510
00:32:15,840 --> 00:32:18,440
You're doing your level best,
you're doing your utmost,

511
00:32:18,520 --> 00:32:21,400
you know, to help that person
and look after that person.

512
00:32:22,680 --> 00:32:26,720
But you're constantly thinking,
"Did I do the right thing?" You know?

513
00:32:27,480 --> 00:32:32,240
Because whatever you do
impacts that patient's quality of life.

514
00:32:40,840 --> 00:32:42,880
We're seeing young Jack today,

515
00:32:42,960 --> 00:32:45,840
which is the first time I've seen him
after his discharge.

516
00:32:46,360 --> 00:32:48,640
I'm really keen to see how he's doing.

517
00:32:48,720 --> 00:32:51,680
This is a massive thing
for a young man to go through,

518
00:32:51,760 --> 00:32:54,880
have something happen to him
that he never thought would happen,

519
00:32:54,960 --> 00:32:57,720
and the consequences
could be so far-reaching.

520
00:33:01,520 --> 00:33:04,920
This is Jack's scan
that we took after his operation.

521
00:33:05,920 --> 00:33:09,280
Here we see
the mesh repair of his forehead.

522
00:33:09,360 --> 00:33:13,800
So, you can see how the eye itself
is supported by the bones that we remade.

523
00:33:15,560 --> 00:33:17,920
We spent a lot of time
trying to get this right.

524
00:33:18,440 --> 00:33:20,280
So you don't really fully relax

525
00:33:20,360 --> 00:33:22,800
until you see the patient
for the first time.

526
00:33:22,880 --> 00:33:25,800
-So… How you doing? Okay?
-Hi.

527
00:33:28,640 --> 00:33:31,960
If we haven't got this
aesthetically right,

528
00:33:32,040 --> 00:33:34,400
he will always be
that man who was beaten up.

529
00:33:36,200 --> 00:33:37,880
I was out quicker than I expected.

530
00:33:37,960 --> 00:33:41,400
And it was only four or five days ago
I had the operation, so…

531
00:33:41,480 --> 00:33:44,080
Made the bed for the first time
in three weeks yesterday.

532
00:33:44,160 --> 00:33:47,400
Today was the first time
I've tied shoelaces in three weeks.

533
00:33:48,520 --> 00:33:51,280
-Yeah. Yeah, it's about recovery.
-Yeah.

534
00:33:54,240 --> 00:33:58,000
I am still very tired, and I'm normally
having a sleep during the day.

535
00:33:58,080 --> 00:34:02,240
But the main psychological impact
seems to be when I'm asleep at night.

536
00:34:04,520 --> 00:34:06,320
-How are you, Jack? All right?
-Good.

537
00:34:06,400 --> 00:34:08,360
-How are you?
-Not too bad, thank you.

538
00:34:08,440 --> 00:34:10,920
How are you in yourself? How's your mood?

539
00:34:11,520 --> 00:34:13,760
After coming out of the hospital,

540
00:34:13,840 --> 00:34:16,200
I had really vivid dreams

541
00:34:16,280 --> 00:34:18,880
about being attacked
and not being able to escape.

542
00:34:18,960 --> 00:34:22,360
For instance, I've woken up
yesterday drenched in sweat,

543
00:34:22,440 --> 00:34:25,240
which has made me not look forward
to going to sleep too much,

544
00:34:25,320 --> 00:34:26,760
if I'm being honest.

545
00:34:26,840 --> 00:34:30,120
What we need to aim for is
that you actually don't have those dreams.

546
00:34:30,200 --> 00:34:34,320
-Yeah.
-And that you start to enjoy life again.

547
00:34:34,400 --> 00:34:35,400
Yeah.

548
00:34:36,520 --> 00:34:38,280
Okay, rest your head back for me.

549
00:34:38,840 --> 00:34:40,600
Just have a gentle look at the eye.

550
00:34:41,600 --> 00:34:44,200
Okay. Raise your eyebrows for me.

551
00:34:48,880 --> 00:34:51,000
The face is a road map of your life.

552
00:34:52,680 --> 00:34:56,400
When I see my mum,
the first thing I see are her scars.

553
00:34:57,840 --> 00:34:59,640
The hardest thing for me is

554
00:34:59,720 --> 00:35:02,560
that she was unable to have
the sort of surgery I perform.

555
00:35:07,680 --> 00:35:10,320
That's really good.
The eye's moving really nicely.

556
00:35:12,240 --> 00:35:15,720
When I look from above,
the contour's really perfect.

557
00:35:16,520 --> 00:35:17,360
Yeah.

558
00:35:18,280 --> 00:35:20,000
Considering how bad you were.

559
00:35:20,080 --> 00:35:22,440
I mean, he's just transformed, I mean…

560
00:35:25,360 --> 00:35:27,720
Yeah, thank you so much for everything.

561
00:35:28,960 --> 00:35:33,120
You come through all this,
your life can take a dichotomy, two roads.

562
00:35:33,200 --> 00:35:36,000
You can either relive the injury
and it'd be terrible,

563
00:35:36,080 --> 00:35:38,600
or you realize
how precious and wonderful life is.

564
00:35:39,640 --> 00:35:41,360
Wanna take a picture of you?

565
00:35:41,960 --> 00:35:44,480
-That would be good. All three of us.
-Yeah, of course.

566
00:35:44,560 --> 00:35:46,320
Come on. Okay.

567
00:35:46,400 --> 00:35:48,240
Okay. Three, two, one.

568
00:35:51,200 --> 00:35:55,320
I say to patients, "I didn't do
all this work for you to stay at home."

569
00:35:56,360 --> 00:35:57,520
Because I recognize

570
00:35:57,600 --> 00:36:01,320
that you've got to put that hand out
to help them out of the hole.

571
00:36:01,400 --> 00:36:05,160
Pull them up,
reassuring them that they are okay.

572
00:36:06,560 --> 00:36:09,000
-Thank you for taking care of my son.
-No problem.

573
00:36:09,680 --> 00:36:11,880
-All right. You know where I am, yeah?
-Yeah.

574
00:36:13,240 --> 00:36:17,240
I thank our lucky stars
for the trauma service we have now.

575
00:36:17,760 --> 00:36:21,120
Because we've seen patients
that historically didn't survive

576
00:36:21,640 --> 00:36:23,600
go on to have a normal life.

577
00:36:30,920 --> 00:36:34,320
What kind of injury is it?
Has he been able to walk on that leg?

578
00:36:34,400 --> 00:36:36,600
And is there any obvious deformity?

579
00:36:39,520 --> 00:36:40,520
Roger. Received.

580
00:36:40,600 --> 00:36:43,400
I'm gonna get an advanced paramedic
along to you as well.

581
00:36:45,360 --> 00:36:49,920
Somebody's jumped out of a window
and is lying unconscious on the floor.

582
00:36:58,080 --> 00:37:00,040
The leg hurts really bad.

583
00:37:00,920 --> 00:37:02,000
Can I get some painkillers?

584
00:37:02,080 --> 00:37:02,920
Yeah.

585
00:37:03,960 --> 00:37:05,680
I'm just in disbelief.

586
00:37:07,680 --> 00:37:09,640
This will affect me massively.

587
00:37:12,960 --> 00:37:15,800
The first time I met Toby,
I was eight years old.

588
00:37:16,880 --> 00:37:18,400
It was more than a friendship.

589
00:37:18,480 --> 00:37:20,920
It's almost like a sibling sort of bond.

590
00:37:22,320 --> 00:37:25,400
We also worked together
installing solar panels.

591
00:37:26,560 --> 00:37:29,120
We install them,
do the internals, the electrical bits.

592
00:37:29,200 --> 00:37:31,560
I work with him, go to the gym with him.

593
00:37:31,640 --> 00:37:33,680
I've spent every day of my life with him.

594
00:37:37,680 --> 00:37:40,920
Toby always loves pushing everything
to the max, especially in the gym.

595
00:37:41,000 --> 00:37:42,400
That's Toby's whole persona.

596
00:37:42,480 --> 00:37:43,480
Get it!

597
00:37:45,160 --> 00:37:46,400
This video here,

598
00:37:46,480 --> 00:37:50,680
I think this is within literally
half an hour before the actual crash.

599
00:37:53,440 --> 00:37:56,160
The plan was
to just go straight back to my house.

600
00:37:56,240 --> 00:37:58,320
But it was a lovely day.

601
00:37:59,120 --> 00:38:02,400
So I thought, "Let's go to a big hill,
watch the sunset."

602
00:38:03,680 --> 00:38:05,880
That's why we took that long route back.

603
00:38:07,560 --> 00:38:10,080
So a part of me feels
that it was my fault.

604
00:38:11,320 --> 00:38:13,520
Because I made the decision
to go on that ride.

605
00:38:15,360 --> 00:38:19,360
I was still hearing the screams
in my sleep, almost haunting me.

606
00:38:20,160 --> 00:38:21,160
Yeah.

607
00:38:29,440 --> 00:38:30,480
All right.

608
00:38:31,160 --> 00:38:35,480
So, the next case is
the 20-years-old chap called Toby.

609
00:38:35,560 --> 00:38:38,360
He was on his motorbike, was hit by a car.

610
00:38:38,440 --> 00:38:40,880
Is there a picture,
a clinical picture of the wound?

611
00:38:41,480 --> 00:38:42,920
Yeah. There.

612
00:38:43,480 --> 00:38:45,840
He sustained multiple injuries.

613
00:38:45,920 --> 00:38:48,560
He also has an anterior foot wound,

614
00:38:48,640 --> 00:38:51,040
where the tendon kind of
is just coming out.

615
00:38:53,160 --> 00:38:56,760
The amount of force to rip a tendon
through that hole is gonna be

616
00:38:56,840 --> 00:38:59,240
fairly massive, so…

617
00:38:59,320 --> 00:39:03,160
His sensation in his foot
is completely lacking, below the ankle.

618
00:39:05,200 --> 00:39:08,320
At some point,
we'll fix the humerus, fix the femur.

619
00:39:09,160 --> 00:39:11,920
But the time-critical thing
is trying to get some blood

620
00:39:12,000 --> 00:39:13,200
into his foot again.

621
00:39:14,800 --> 00:39:17,280
He's clearly got a vascular situation.

622
00:39:17,880 --> 00:39:19,760
So that's the pressing concern.

623
00:39:22,680 --> 00:39:26,840
Vascular is about looking
at the blood supply

624
00:39:26,920 --> 00:39:28,520
to all aspect of your body,

625
00:39:28,600 --> 00:39:31,160
all the way from the brain to the toes.

626
00:39:31,680 --> 00:39:35,240
We are like the plumbers
of the human anatomy and the human body.

627
00:39:37,520 --> 00:39:42,600
In Toby's case, if we follow
these arteries all the way down,

628
00:39:42,680 --> 00:39:45,240
suddenly we lose track of them,

629
00:39:45,840 --> 00:39:47,200
just at the ankle level.

630
00:39:47,720 --> 00:39:51,080
These vessels might have easily been
either severed or damaged,

631
00:39:51,160 --> 00:39:55,360
or simply snapped as a result
of the sheer force of the injury itself,

632
00:39:56,920 --> 00:40:01,560
leaving the tissue, muscles,
bones, and nerves susceptible to dying.

633
00:40:01,640 --> 00:40:02,560
And dying fast.

634
00:40:04,080 --> 00:40:07,720
It's always difficult
to explain to someone

635
00:40:07,800 --> 00:40:10,720
that he needs to have
an immediate surgery.

636
00:40:15,560 --> 00:40:16,840
-Hi, Toby.
-Hi.

637
00:40:17,920 --> 00:40:21,040
Normally, you should have three arteries

638
00:40:21,120 --> 00:40:23,440
that continue
to give blood supply to the foot.

639
00:40:23,520 --> 00:40:24,600
Yeah.

640
00:40:24,680 --> 00:40:27,920
The two that cross the ankle
are the most important.

641
00:40:28,000 --> 00:40:28,840
Okay.

642
00:40:28,920 --> 00:40:33,880
On the scan you had, both of them
seem to have completely been disrupted

643
00:40:33,960 --> 00:40:34,960
at the ankle level.

644
00:40:35,040 --> 00:40:35,880
Right.

645
00:40:35,960 --> 00:40:39,720
The problem here,
unless we improve the blood supply,

646
00:40:39,800 --> 00:40:43,640
there is a very high chance
you will not be able to keep the foot.

647
00:40:45,400 --> 00:40:49,880
The most crucial element now
is to try to reconnect the blood supply

648
00:40:49,960 --> 00:40:53,960
to give it every single little hope
and chance for it to survive.

649
00:40:54,040 --> 00:40:54,880
Okay.

650
00:40:55,400 --> 00:40:56,240
All right.

651
00:40:58,160 --> 00:41:01,080
Don't eat and drink anything.
I'm trying to rush you to theater.

652
00:41:03,120 --> 00:41:05,760
The job relies on me having two feet.

653
00:41:06,840 --> 00:41:10,800
On a busy day, I do about 30,000 steps.

654
00:41:11,400 --> 00:41:13,320
This is gonna take a toll on me.

655
00:41:15,920 --> 00:41:18,240
Toby, we'll be taking you in now, yeah?

656
00:41:21,960 --> 00:41:24,800
If we don't restore
the blood supply to the foot,

657
00:41:25,680 --> 00:41:27,600
the foot is going to die.

658
00:41:30,840 --> 00:41:32,320
Toby is still very young.

659
00:41:33,200 --> 00:41:36,280
It's my job and duty
to give him the best chance.

660
00:41:41,280 --> 00:41:43,920
It is like a huge burden
on your shoulders.

661
00:41:44,560 --> 00:41:48,120
And a huge trust
between you and the patient,

662
00:41:48,640 --> 00:41:51,320
and between you and the family.

663
00:41:51,400 --> 00:41:54,760
It's trust that they have put in you
that you are gonna try your best.

664
00:41:58,360 --> 00:42:00,760
You always want to be there
to support your children,

665
00:42:00,840 --> 00:42:04,040
but when it's something
you can do nothing about, it's…

666
00:42:05,080 --> 00:42:06,080
It's very scary.

667
00:42:07,480 --> 00:42:08,640
You feel helpless.

668
00:42:12,400 --> 00:42:13,920
He's in theater now,

669
00:42:14,000 --> 00:42:16,400
so we're going to start
with the blood supply issue.

670
00:42:17,880 --> 00:42:22,160
I don't want to scare you,
but even with our huge experience,

671
00:42:22,240 --> 00:42:24,480
we can't guarantee it's going to work.

672
00:42:27,160 --> 00:42:28,920
We'll try everything we can.

673
00:42:32,160 --> 00:42:36,760
We can't even think about
the potential impact on his life.

674
00:42:37,760 --> 00:42:41,120
You just have to hope
everything will be as okay as possible,

675
00:42:41,200 --> 00:42:44,560
because otherwise
your mind will spiral out of control.

676
00:42:45,480 --> 00:42:49,640
We have to rely on
these people to do the best they can.

677
00:42:50,520 --> 00:42:53,000
We just have to put so much trust in them.

678
00:43:00,360 --> 00:43:02,120
Fantastic. Let's start.

679
00:43:03,080 --> 00:43:05,520
Okay. Smaller swabs.

680
00:43:05,600 --> 00:43:07,120
Let's have a look.

681
00:43:08,560 --> 00:43:10,640
Until you go inside the foot,

682
00:43:10,720 --> 00:43:13,200
you never know exactly
what you are dealing with.

683
00:43:14,560 --> 00:43:17,240
This is all
the trauma-perforate fractures.

684
00:43:17,920 --> 00:43:21,160
All these are macerated, damaged muscles.

685
00:43:21,240 --> 00:43:25,720
That artery here
has been completely pulled apart.

686
00:43:27,600 --> 00:43:29,240
All this mess.

687
00:43:31,400 --> 00:43:35,880
I'm going to repair the first artery
by reconnecting the two ends.

688
00:43:37,640 --> 00:43:40,080
But this might not be enough
to save the foot.

689
00:43:41,200 --> 00:43:44,040
We have to find
the other damaged artery as well.

690
00:43:44,600 --> 00:43:47,560
However, they can be hard to locate

691
00:43:47,640 --> 00:43:50,600
because they retract
inside the damaged tissue.

692
00:43:54,000 --> 00:43:57,160
Let's try to see whether we can find
the anterior tibial artery.

693
00:43:59,920 --> 00:44:04,080
It's all been damaged fully inside,
and it's completely cut here.

694
00:44:05,160 --> 00:44:09,040
The force of the accident
has torn it apart completely.

695
00:44:10,800 --> 00:44:12,640
This is absolutely gone.

696
00:44:14,800 --> 00:44:18,360
The artery has been totally severed.

697
00:44:20,040 --> 00:44:22,200
This was the worst of my fears.

698
00:44:22,880 --> 00:44:24,320
It's not looking good.

699
00:44:26,240 --> 00:44:28,280
Don't waste your time to repair it.

700
00:44:28,360 --> 00:44:30,640
It's not gonna work. Replace it.

701
00:44:33,720 --> 00:44:36,320
The artery has been so badly damaged,

702
00:44:36,840 --> 00:44:41,000
I will have to cut out a section
of the vein from his other leg

703
00:44:41,080 --> 00:44:44,160
and use it to replace
the damaged artery altogether.

704
00:44:45,600 --> 00:44:46,480
Hold this one.

705
00:44:48,440 --> 00:44:49,280
Scissors.

706
00:44:52,440 --> 00:44:55,120
Arteries and veins
are incredibly delicate,

707
00:44:55,200 --> 00:44:57,400
and their walls are paper-thin.

708
00:44:57,920 --> 00:44:58,920
Excellent.

709
00:45:00,880 --> 00:45:04,880
You need absolute full focus
because this is the most important part.

710
00:45:07,120 --> 00:45:08,120
Lift up.

711
00:45:11,400 --> 00:45:13,200
Can I have the green needle?

712
00:45:15,120 --> 00:45:17,920
The needle must be
in the perfect position,

713
00:45:18,000 --> 00:45:19,400
in the perfect angle,

714
00:45:19,480 --> 00:45:22,200
and I'm talking about
a fraction of a millimeter.

715
00:45:24,680 --> 00:45:27,600
And I have
one opportunity to get it right.

716
00:45:31,680 --> 00:45:33,360
No. Stay there. Stay there.

717
00:45:34,280 --> 00:45:35,120
It's crucial.

718
00:45:35,760 --> 00:45:40,400
If we are not able to do this,
he will lose his foot.

719
00:45:40,920 --> 00:45:42,360
Relax.

720
00:45:43,160 --> 00:45:45,160
It can be like defusing a bomb.

720
00:45:46,305 --> 00:46:46,271
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