"Critical: Between Life and Death" Episode #1.6

1 00:00:06,000 --> 00:00:08,400 -[phone dialing] -[emotional music playing] 2 00:00:10,160 --> 00:00:11,680 [line ringing] 3 00:00:14,560 --> 00:00:15,520 [Karen] Hello? 4 00:00:15,600 --> 00:00:18,600 Hi, it's Tom Jackson, one of the pelvic surgeons. 5 00:00:18,680 --> 00:00:21,640 There's been a development with Grace. 6 00:00:23,960 --> 00:00:25,680 Her heart rate has risen, 7 00:00:25,760 --> 00:00:28,720 and her responsiveness overnight has dropped. 8 00:00:30,400 --> 00:00:32,840 We think that we should hold off going for surgery 9 00:00:32,920 --> 00:00:35,800 until we've done another CT scan of her brain. 10 00:00:39,120 --> 00:00:40,720 Okay. 65 seconds. 11 00:00:41,720 --> 00:00:44,800 [Tom] Try not to worry too much, and I'll speak to you later. 12 00:00:44,880 --> 00:00:47,120 [automated voice] Breathe in and hold your breath. 13 00:00:48,280 --> 00:00:50,320 [Karen] It's just devastating. 14 00:00:51,360 --> 00:00:54,200 You can't believe she's gone backwards. 15 00:00:58,440 --> 00:01:01,240 [man] The neurosurgeons are keen to look at her head. 16 00:01:01,320 --> 00:01:03,200 She's in an unstable condition. 17 00:01:03,280 --> 00:01:06,400 If there is anything that we feel concerned about, 18 00:01:06,480 --> 00:01:09,040 we would try and flag that to one of the doctors. 19 00:01:10,800 --> 00:01:13,400 In the emergency scan, we have to ensure 20 00:01:13,480 --> 00:01:16,120 that there's not an evolving situation in her brain. 21 00:01:16,200 --> 00:01:18,440 There could be bleeding inside the brain, 22 00:01:18,520 --> 00:01:21,800 which may require an emergency intervention. 23 00:01:21,880 --> 00:01:23,160 We don't want that to evolve 24 00:01:23,240 --> 00:01:25,840 when I'm halfway through fixing her pelvis. 25 00:01:28,160 --> 00:01:30,080 The hardest part is not knowing. 26 00:01:30,720 --> 00:01:33,560 You can't help but go to the darkest of places. 27 00:01:34,600 --> 00:01:36,680 -[heart beating] -[faint sirens blaring] 28 00:01:41,920 --> 00:01:43,760 [Karen] Grace is our firstborn. 29 00:01:44,960 --> 00:01:47,120 The only girl out of four kids. 30 00:01:49,400 --> 00:01:51,800 She's a really lovely sister. 31 00:01:53,200 --> 00:01:58,800 She's funny, and incredibly caring, and will help anyone if they need help. 32 00:01:59,960 --> 00:02:02,160 You know, everyone just seems to love Grace. 33 00:02:05,400 --> 00:02:07,440 Grace started Level 2 Beauty at college. 34 00:02:08,040 --> 00:02:11,880 And she was just thriving doing something that she enjoyed so much. 35 00:02:11,960 --> 00:02:13,360 [eerie music playing] 36 00:02:13,880 --> 00:02:18,160 She had finished the course herself the Friday before the accident. 37 00:02:19,080 --> 00:02:21,960 But Grace agreed to model for one of her friends for makeup 38 00:02:22,040 --> 00:02:24,120 so she could complete the course herself. 39 00:02:24,640 --> 00:02:27,120 And she was coming home from doing that 40 00:02:27,200 --> 00:02:30,360 when she was hit on the zebra crossing by the car. 41 00:02:33,680 --> 00:02:36,240 You do just think, "Why Grace?" 42 00:02:37,520 --> 00:02:39,200 [tense music playing] 43 00:02:41,000 --> 00:02:47,074 Watch Online Movies and Series for FREE www.osdb.link/lm 44 00:02:48,320 --> 00:02:50,800 [man] We've heard from the neurosurgeons 45 00:02:50,880 --> 00:02:54,160 that Grace's head scan has been completed. 46 00:02:56,040 --> 00:02:59,240 Thankfully, there is no significant change. 47 00:02:59,320 --> 00:03:01,800 We're actually happy to proceed with her surgery. 48 00:03:07,360 --> 00:03:10,440 [Paul] You're in a very privileged position as a surgeon. 49 00:03:10,520 --> 00:03:13,000 People are gifting you great faith and trust 50 00:03:13,080 --> 00:03:15,240 in what you're about to do to them. 51 00:03:16,480 --> 00:03:20,000 Grace is quite similar in age to my older daughter. 52 00:03:20,840 --> 00:03:23,520 As a parent, there is always a certain empathy 53 00:03:23,600 --> 00:03:26,480 and how that's affecting the family especially. 54 00:03:26,560 --> 00:03:29,360 So, on three. One, two, three. 55 00:03:30,680 --> 00:03:32,520 [dramatic music playing] 56 00:03:33,480 --> 00:03:35,400 [Paul] What we'll do to treat Grace's fracture 57 00:03:35,480 --> 00:03:38,640 is insert some screws through her pelvic bone. 58 00:03:39,520 --> 00:03:41,760 The surgery is minimally invasive, 59 00:03:41,840 --> 00:03:45,080 but any pelvic surgery is a high-risk operation. 60 00:03:45,160 --> 00:03:46,640 Okay, let's do this. 61 00:03:47,960 --> 00:03:50,360 X-rays. Come a bit further in. 62 00:03:50,440 --> 00:03:53,440 Let's see if we can get both in one image. Stop there. Picture. 63 00:03:53,520 --> 00:03:56,840 It's an operation that's entirely guided by the images we're taking. 64 00:03:57,720 --> 00:04:00,720 Using imaging, I'm going to insert my guide wire. 65 00:04:00,800 --> 00:04:02,120 Can I get the mallet? 66 00:04:05,960 --> 00:04:09,920 Creating the pathway that the screw is going to be safe to pass in. 67 00:04:10,680 --> 00:04:12,680 It's quite a tight corridor. 68 00:04:12,760 --> 00:04:13,960 X-ray there, please. 69 00:04:14,040 --> 00:04:15,800 You have to be precise. 70 00:04:16,680 --> 00:04:18,040 The biggest risk would be 71 00:04:18,120 --> 00:04:21,400 a few millimeters the wrong direction will endanger the nerve roots. 72 00:04:23,040 --> 00:04:24,560 Oh, we're skiting off, aren't we? 73 00:04:24,640 --> 00:04:26,880 We're going a bit posterior. Do it now on power. 74 00:04:26,960 --> 00:04:28,200 -You got it? -[Tom] I have it. 75 00:04:29,600 --> 00:04:33,400 [Paul] Just back it out a little bit so we're more at your entry point. 76 00:04:35,160 --> 00:04:37,600 Okay. And now you should have the wiggle in the wire. 77 00:04:39,320 --> 00:04:42,040 I think surgery is kind of a team sport 78 00:04:42,120 --> 00:04:44,000 in a sense that it's working together, 79 00:04:44,080 --> 00:04:47,040 having different roles, and having a goal at the end of it, 80 00:04:47,120 --> 00:04:49,240 but the difference is we've always got to win. 81 00:04:50,800 --> 00:04:53,280 Losing isn't where we go when we start an operation. 82 00:04:53,360 --> 00:04:55,200 It's just how long it takes to win. 83 00:04:56,000 --> 00:04:57,040 [Tom] X-ray. 84 00:04:57,120 --> 00:05:02,680 [Paul] Just above the level of the pelvis, the spinal column becomes myriad nerves 85 00:05:02,760 --> 00:05:06,320 that then travel out down your legs that we call the horse's tail. 86 00:05:07,520 --> 00:05:09,840 The risks of damaging the horse's tail 87 00:05:09,920 --> 00:05:13,160 is that you can damage the nerve coming out of L5 88 00:05:13,240 --> 00:05:15,440 and get paralysis in your foot. 89 00:05:16,440 --> 00:05:19,800 Or we can damage the nerves that control bladder and bowel function, 90 00:05:19,880 --> 00:05:22,000 so you can end up with incontinence. 91 00:05:23,480 --> 00:05:27,960 In Grace's case, as a young person, both would be pretty catastrophic. 92 00:05:29,040 --> 00:05:30,280 Go a centimeter more. 93 00:05:32,560 --> 00:05:33,400 Stop. 94 00:05:34,440 --> 00:05:36,000 We might be a bit close. 95 00:05:36,080 --> 00:05:37,800 [dramatic music playing] 96 00:05:39,760 --> 00:05:42,720 Reverse. I think it's not quite right. 97 00:05:43,240 --> 00:05:45,960 We're getting close to where the nerve root's going to exit. 98 00:05:47,640 --> 00:05:49,320 There's no margin for error. 99 00:05:53,520 --> 00:05:55,000 -Okay. Holding it? -[Tom] I am. 100 00:05:57,400 --> 00:05:58,240 [Paul] Okay. 101 00:06:00,080 --> 00:06:01,080 X-ray. 102 00:06:01,160 --> 00:06:05,000 If we're not careful, we can suddenly push it further and cause a deformity. 103 00:06:09,920 --> 00:06:11,960 Better, right? That looks perfect. 104 00:06:13,120 --> 00:06:15,760 Okay, so I want you to do a couple of centimeters, right? 105 00:06:15,840 --> 00:06:19,240 Now, the journey may have various paths. 106 00:06:19,800 --> 00:06:21,400 Keep going. Keep tracking. 107 00:06:21,480 --> 00:06:24,480 But it's really rewarding, at the end of that case, thinking, 108 00:06:24,560 --> 00:06:28,440 "Great job. We've achieved our goals, and the patient's going to be better 109 00:06:28,520 --> 00:06:29,760 as a result of that." 110 00:06:30,280 --> 00:06:32,360 -How does that feel? -[Tom] Nice. 111 00:06:32,440 --> 00:06:36,480 On the face of it, it's a really bizarre job we have. 112 00:06:36,560 --> 00:06:39,840 Um… but I can't deny it is fun. 113 00:06:44,640 --> 00:06:45,760 Well done, guys. 114 00:06:46,280 --> 00:06:49,000 It's like delivering minor miracles to people. 115 00:06:49,080 --> 00:06:51,640 -That went really nicely. -[woman] One, two, three. 116 00:06:52,920 --> 00:06:54,640 It's Friday, fish-and-chip day. 117 00:06:56,000 --> 00:06:59,040 [Paul] We've managed to complete Grace's pelvic surgery, 118 00:06:59,120 --> 00:07:00,240 which is excellent. 119 00:07:00,840 --> 00:07:04,320 So now it's just about seeing whether or not her brain injury recovers. 120 00:07:05,240 --> 00:07:08,000 Whether there'll be any long-reaching consequence, 121 00:07:08,080 --> 00:07:09,440 we just don't know yet. 122 00:07:12,920 --> 00:07:14,440 [tense music playing] 123 00:07:16,320 --> 00:07:18,880 [man 1] Try and stay calm. I know it's difficult. 124 00:07:18,960 --> 00:07:20,240 [sirens blaring] 125 00:07:20,320 --> 00:07:22,680 [woman 1] And has she been fully alert since the injury? 126 00:07:24,000 --> 00:07:28,400 [man 2] So, he's laying on the floor. What's happened? Is he talking to you? 127 00:07:30,800 --> 00:07:34,000 [woman 2] We'll get someone to help you. Just stay exactly as you are. 128 00:07:46,480 --> 00:07:48,000 [Teddy] If they take it off, 129 00:07:48,080 --> 00:07:50,480 you should keep the finger in your purse or something. 130 00:07:50,560 --> 00:07:52,120 [Carla] Oh my God, is he having a laugh? 131 00:07:52,200 --> 00:07:54,680 You want me to walk around with your finger in my bag? 132 00:07:54,760 --> 00:07:58,040 And then be like, "Yeah, it wasn't just a cut, thank you very much." 133 00:07:58,120 --> 00:08:00,440 Shall I put the ring on it as well? [laughs] 134 00:08:03,440 --> 00:08:06,440 I'd rather get a phone call to say, "Teddy’s walked out of school," 135 00:08:06,520 --> 00:08:08,480 rather than get a phone call to say, 136 00:08:08,560 --> 00:08:11,000 "I've jumped over a fence and cut my finger off." 137 00:08:11,080 --> 00:08:13,520 But they found his ring, the caretaker found it, 138 00:08:13,600 --> 00:08:17,720 and it was still attached to the pole that took his finger off. 139 00:08:18,480 --> 00:08:20,120 [Teddy] I'm finishing school this week. 140 00:08:20,200 --> 00:08:23,920 I'll miss out on the leavers' day prom, all the rest of that. 141 00:08:24,000 --> 00:08:26,400 It's just, like, ruined my whole summer. 142 00:08:27,560 --> 00:08:30,240 [Carla] You're more upset about missing the summer than the finger. 143 00:08:30,320 --> 00:08:31,440 [Teddy] Yeah, I am. 144 00:08:34,880 --> 00:08:36,560 [intense music building] 145 00:08:38,120 --> 00:08:40,320 [Ibrahim] Teddy underwent a ten-hour surgery 146 00:08:40,400 --> 00:08:42,200 where we reattached the finger 147 00:08:42,800 --> 00:08:45,800 and reconnected all the structures, 148 00:08:45,880 --> 00:08:47,720 including blood vessels. 149 00:08:47,800 --> 00:08:52,760 We rely on blood flow, first of all, to keep that body part alive. 150 00:08:54,200 --> 00:08:58,920 It's now just over 72 hours since his operation's finished. 151 00:08:59,000 --> 00:09:03,960 So today will be a case of seeing what the color of the finger is like. 152 00:09:04,720 --> 00:09:05,560 Morning, Teddy. 153 00:09:05,640 --> 00:09:07,800 I'll pinprick the tip of the finger. 154 00:09:08,320 --> 00:09:09,960 Just start by unravelling you. 155 00:09:11,120 --> 00:09:13,640 And if it's bright red, this is good. 156 00:09:13,720 --> 00:09:15,160 If it's a darker red, 157 00:09:15,240 --> 00:09:17,880 then not enough blood is being drained from the finger. 158 00:09:18,480 --> 00:09:22,200 I need to be sure there is blood flowing to and from it 159 00:09:22,280 --> 00:09:24,120 so that the tissues don't die. 160 00:09:27,720 --> 00:09:31,080 So, the color to the fingertip is dark. 161 00:09:33,040 --> 00:09:34,840 It appears the finger's struggling. 162 00:09:36,400 --> 00:09:37,680 [Jon] Is it dead? 163 00:09:42,120 --> 00:09:43,840 [Ibrahim] It's certainly deteriorated. 164 00:09:45,920 --> 00:09:48,720 And you're definitely not out of the woods completely yet. 165 00:09:50,320 --> 00:09:51,160 Okay. 166 00:09:52,080 --> 00:09:55,240 If the amount of blood that's reaching the finger 167 00:09:55,320 --> 00:09:59,320 is too much for the veins to drain the finger, 168 00:09:59,400 --> 00:10:01,160 then that finger can become congested. 169 00:10:02,120 --> 00:10:03,600 There's too much blood there, 170 00:10:03,680 --> 00:10:06,360 and that can lead to the finger not surviving. 171 00:10:06,960 --> 00:10:08,960 Bear with me. I'll speak to the nursing team. 172 00:10:10,000 --> 00:10:12,240 We have one more trick up our sleeve. 173 00:10:12,760 --> 00:10:14,400 [dramatic music playing] 174 00:10:21,520 --> 00:10:23,040 They look ugly, all right? 175 00:10:23,560 --> 00:10:27,240 But they are a good organism. They are very helpful. 176 00:10:28,520 --> 00:10:31,040 Leeches are anticoagulant. They are antimicrobial. 177 00:10:31,120 --> 00:10:34,680 They are little amazing suckers, as a matter of fact. 178 00:10:34,760 --> 00:10:37,680 I thought it was a joke. I thought it was medieval medicine. 179 00:10:37,760 --> 00:10:40,320 I didn't think they actually used leeches still. 180 00:10:40,880 --> 00:10:42,200 He wasn't happy at all. 181 00:10:42,280 --> 00:10:45,720 "What is that, Dad? What is that?" He didn't know what a leech was. 182 00:10:45,800 --> 00:10:48,280 -I did know what a leech was. -[Jon] Such a liar. 183 00:10:50,200 --> 00:10:53,440 [Ibrahim] Medicinal leeches are a recognized form of treatment 184 00:10:53,520 --> 00:10:57,320 in plastic surgery. Particularly in microsurgery. 185 00:10:57,400 --> 00:11:00,680 We still often rely on methods 186 00:11:00,760 --> 00:11:04,440 which have been used since medieval times. 187 00:11:05,920 --> 00:11:08,760 [Clement] It's time for me to do my leeching, please. Sure. 188 00:11:08,840 --> 00:11:09,680 Yeah. 189 00:11:10,200 --> 00:11:11,480 [Clement] So, Teddy, 190 00:11:11,560 --> 00:11:16,000 what will happen is that the leech will help draw the blood to that end. 191 00:11:18,800 --> 00:11:23,160 Then the leech will suck the blood and release the excess blood 192 00:11:23,240 --> 00:11:25,640 which is causing the congestion from the region. 193 00:11:28,640 --> 00:11:31,600 [Carla] Can you feel it, Teddy? No, don't feel anything. 194 00:11:32,120 --> 00:11:35,960 [Clement] The saliva of the leech contains analgesics 195 00:11:36,040 --> 00:11:41,200 which helps prevent any pain to the individual when applied. 196 00:11:42,920 --> 00:11:44,760 [Jon] Why don't you have a little look, Ted? 197 00:11:44,840 --> 00:11:45,920 No, I don't want to. 198 00:11:48,320 --> 00:11:49,680 [Jon] It's gone a nicer color. 199 00:11:49,760 --> 00:11:52,480 Mm-hm. It's lighter a bit, isn’t it? 200 00:11:53,920 --> 00:11:58,080 As a team, we would apply the leech every three hours. 201 00:11:59,280 --> 00:12:00,160 Knock, knock. 202 00:12:04,240 --> 00:12:05,760 [woman] This one's just not feeding. 203 00:12:08,920 --> 00:12:11,080 You often get a lazy leech, 204 00:12:11,160 --> 00:12:15,960 but seeing as it's been quite a few now that haven't done too much, 205 00:12:16,040 --> 00:12:18,040 maybe it's a bit too congested. 206 00:12:18,120 --> 00:12:22,320 Maybe the blood is not free-flowing enough to make it a nice, easy meal. 207 00:12:24,640 --> 00:12:26,920 [Carla] It's scary to think that we are waiting to see 208 00:12:27,000 --> 00:12:28,800 whether or not these leeches work, 209 00:12:29,560 --> 00:12:32,240 whether or not that's going to save his finger or not. 210 00:12:38,880 --> 00:12:40,560 [emotional music playing] 211 00:12:45,880 --> 00:12:48,360 [Karen] Come on, Grace. Time to wake up, darling. 212 00:12:53,120 --> 00:12:54,280 Come on, baby girl. 213 00:13:00,840 --> 00:13:01,880 [Tom] Knock, knock. 214 00:13:03,320 --> 00:13:04,200 Hi. 215 00:13:05,280 --> 00:13:09,480 [Tom] So, from our perspective, it's gone as well as we possibly could. 216 00:13:10,120 --> 00:13:12,800 It'd be nice to see her wake up so we can take the tube out. 217 00:13:12,880 --> 00:13:14,800 That's not been as nice. 218 00:13:15,320 --> 00:13:18,760 They're trying to wake her up now, but she's not really… 219 00:13:18,840 --> 00:13:20,880 -[Tom] Responding yet. -[Karen] …responding yet. 220 00:13:20,960 --> 00:13:22,280 It's been a hard day. 221 00:13:24,840 --> 00:13:27,120 -I just need her to wake up. -[Tom] Yeah. 222 00:13:27,960 --> 00:13:30,640 Which, hopefully, you are going to do soon, Grace. 223 00:13:30,720 --> 00:13:32,280 [emotional music continues] 224 00:13:36,760 --> 00:13:39,920 The brain injury is the most concerning thing 225 00:13:40,480 --> 00:13:45,480 because you can't help but think, "Is she gonna be Grace anymore?" 226 00:13:52,040 --> 00:13:53,760 Right here with you, okay? 227 00:13:54,880 --> 00:13:56,160 And you are safe. 228 00:13:57,400 --> 00:14:00,680 There's no real medical evidence that shows that holding somebody's hand 229 00:14:00,760 --> 00:14:03,720 or speaking to them changes their outcome. 230 00:14:05,320 --> 00:14:07,680 There's also no evidence to say that it doesn't. 231 00:14:08,800 --> 00:14:12,960 I don't think that everything is explainable by medical science as yet. 232 00:14:16,640 --> 00:14:18,000 Miracles can happen. 233 00:14:19,560 --> 00:14:21,480 I was born with a hole in my heart. 234 00:14:22,720 --> 00:14:25,640 They told me that I'd always have to carry around a card, 235 00:14:25,720 --> 00:14:27,720 saying that I had a heart defect. 236 00:14:29,320 --> 00:14:31,800 And I was under follow-up for that for several years 237 00:14:31,880 --> 00:14:35,680 before my parents took me to their local church and prayed for me. 238 00:14:39,520 --> 00:14:42,360 Then they took me back for one more appointment, 239 00:14:43,320 --> 00:14:46,680 and the doctors said that I couldn't be the person 240 00:14:46,760 --> 00:14:50,280 that had been born with this thing because there was no evidence of it. 241 00:14:51,360 --> 00:14:53,200 And so, from my perspective, 242 00:14:53,280 --> 00:14:56,640 I think it's incredibly important that we have hope, 243 00:14:57,240 --> 00:15:00,560 that we have belief that things are going to get better. 244 00:15:01,160 --> 00:15:05,360 And I think the support of the loved ones that we have is really important. 245 00:15:12,640 --> 00:15:14,480 [thrilling music playing] 246 00:15:15,000 --> 00:15:16,640 [man 1] London Ambulance Service. 247 00:15:16,720 --> 00:15:19,000 RTC, motorbike versus tree. 248 00:15:19,080 --> 00:15:20,560 Just down from the M25. 249 00:15:20,640 --> 00:15:21,840 That sounds bad. 250 00:15:22,480 --> 00:15:26,560 [woman 1] There's an unconscious RTC in TW7, Isleworth. 251 00:15:26,640 --> 00:15:31,280 It's a adult male motorcyclist. And he's got an abdominal injury. 252 00:15:31,360 --> 00:15:32,800 [phone rings] 253 00:15:33,440 --> 00:15:34,760 [woman 2] St Mary's. 254 00:15:34,840 --> 00:15:38,240 [man 2] Adult Trauma Team. 255 00:15:39,280 --> 00:15:42,280 [woman 3] We've got a 38-year-old male coming in. 256 00:15:42,360 --> 00:15:44,360 He was driving his motorcycle this morning, 257 00:15:44,440 --> 00:15:48,360 and he's clipped a curb and come off into a central reservation. 258 00:15:48,880 --> 00:15:50,800 [sirens blaring] 259 00:15:51,840 --> 00:15:54,320 [man 1] AB60, can I have a blue call to St Mary's? 260 00:15:54,400 --> 00:15:56,200 ETA will be ten minutes. 261 00:15:57,280 --> 00:15:58,120 [man 2] Received. 262 00:15:58,200 --> 00:16:01,000 Patient's gonna be transported to St Mary's Major Trauma Center, 263 00:16:01,080 --> 00:16:03,360 and you'll be there in ten minutes. 264 00:16:04,880 --> 00:16:07,400 [Pip] Motorcycle incidents can be really serious. 265 00:16:08,040 --> 00:16:12,040 That transfer of energy can cause significant injuries. 266 00:16:13,040 --> 00:16:16,680 And these injuries can become critical if we don't act on them quickly enough. 267 00:16:19,080 --> 00:16:20,240 [man] Everyone ready? 268 00:16:20,960 --> 00:16:23,680 This is Abdi. He's a 38-year-old male. 269 00:16:23,760 --> 00:16:25,480 He was riding a motorcycle. 270 00:16:25,560 --> 00:16:27,280 He's hit the curb and gone over. 271 00:16:27,360 --> 00:16:29,520 He's got a right humeral fracture. 272 00:16:29,600 --> 00:16:33,400 There is a large laceration to his left leg down to the bone, 273 00:16:33,480 --> 00:16:36,080 and he has pain all down the right-hand side 274 00:16:36,160 --> 00:16:37,800 and round to his back as well. 275 00:16:37,880 --> 00:16:38,720 Thank you. 276 00:16:38,800 --> 00:16:41,880 [Pip] Could you give him two grams of TXA as well? 277 00:16:42,480 --> 00:16:46,160 Abdi, how are you? My name is Mohammed. I'm one of the doctors in here. 278 00:16:46,240 --> 00:16:47,200 [Abdi] Alhamdulillah. 279 00:16:47,280 --> 00:16:48,120 Alhamdulillah. 280 00:16:48,640 --> 00:16:50,040 -Where are you from? -[Abdi] Somalia. 281 00:16:50,120 --> 00:16:52,560 [Mohammed] Somalia? Okay. I'm from Jordan, okay? 282 00:16:53,080 --> 00:16:53,960 Just relax. 283 00:16:54,040 --> 00:16:56,280 I'm gonna just feel your neck. 284 00:16:56,360 --> 00:16:59,040 Trachea is central. Airway is patent. 285 00:16:59,640 --> 00:17:00,800 Look at me. 286 00:17:01,520 --> 00:17:02,400 Good. 287 00:17:02,480 --> 00:17:04,000 So, I'm gonna feel your tummy. 288 00:17:04,080 --> 00:17:07,720 If you feel any pain anywhere I press, just tell me, okay? Here? 289 00:17:07,800 --> 00:17:09,400 [Abdi] It's mainly all up here. 290 00:17:09,480 --> 00:17:10,560 [Mohammed] All up there? 291 00:17:11,160 --> 00:17:13,160 We're gonna take him to the CT. 292 00:17:13,240 --> 00:17:14,360 One, two, three. 293 00:17:21,160 --> 00:17:22,880 [Pip] He's got multiple injuries. 294 00:17:23,400 --> 00:17:27,400 The main thing that we're concerned about is active bleeding in his liver. 295 00:17:28,000 --> 00:17:30,320 He's also got an injury to his spleen. 296 00:17:30,400 --> 00:17:31,600 Thank you very much. 297 00:17:32,160 --> 00:17:33,160 Right, let's go. 298 00:17:33,840 --> 00:17:37,160 Abdi's injuries have the potential to be life-threatening. 299 00:17:37,960 --> 00:17:40,320 We need a trauma surgeon to come and assess him. 300 00:17:40,400 --> 00:17:42,800 So, I'm gonna call my colleague, Maryam. 301 00:17:42,880 --> 00:17:45,760 Have you guys been told about the man that's down in resus? 302 00:17:45,840 --> 00:17:46,800 [Maryam] I'll come down. 303 00:17:46,880 --> 00:17:48,520 [Pip] Perfect. See you in a sec. 304 00:17:50,960 --> 00:17:52,920 [tense music playing] 305 00:17:55,200 --> 00:17:58,680 When you're part of the trauma team, you're there as your best. 306 00:17:58,760 --> 00:18:01,640 You're there as your Usain Bolt moment all the time. 307 00:18:03,040 --> 00:18:04,520 The adrenaline just kicks in, 308 00:18:04,600 --> 00:18:07,120 so you have no choice but to give it your all. 309 00:18:08,800 --> 00:18:10,160 [Pip] He's on his way to work… 310 00:18:10,240 --> 00:18:12,000 -It's motorbike, motorcycle? -Motorbike. 311 00:18:12,080 --> 00:18:14,840 He's clipped a curb and come off. 312 00:18:14,920 --> 00:18:18,800 [Maryam] Teamwork is crucial, but when it comes to the decision-making, 313 00:18:18,880 --> 00:18:21,800 you have to make a decision before you make an incision. 314 00:18:21,880 --> 00:18:24,240 It is very much, you know, on you. 315 00:18:25,840 --> 00:18:28,360 Hi. I'm Maryam, the trauma consultant. 316 00:18:29,560 --> 00:18:31,600 I'm just gonna have a gentle feel, okay? 317 00:18:32,240 --> 00:18:35,360 Just let me know if it bothers you anywhere I press, all right? 318 00:18:35,880 --> 00:18:37,600 The hematoma is getting worse, 319 00:18:37,680 --> 00:18:40,240 so that needs to be resolved quite quickly. 320 00:18:40,840 --> 00:18:45,360 You have a significant injury to your liver and also to your spleen. 321 00:18:45,960 --> 00:18:49,320 So that's why you're getting a lot of the pain here, on the right side. 322 00:18:49,400 --> 00:18:52,280 We need to speak to our interventional radiologist, 323 00:18:52,360 --> 00:18:54,320 and they'll try and stop the bleeding. 324 00:18:54,400 --> 00:18:56,120 Is there anybody you want us to call? 325 00:18:56,200 --> 00:18:57,720 Could I just call my mum? 326 00:18:58,840 --> 00:19:00,520 [phone ringing] 327 00:19:01,080 --> 00:19:02,040 [in Somali] Hello, Mum. 328 00:19:02,120 --> 00:19:04,680 While I was heading to work, I fell off of the motorbike. 329 00:19:04,760 --> 00:19:06,360 [woman] What are your injuries? 330 00:19:07,680 --> 00:19:11,600 Do not worry, Mum, okay? If you will do anything, just pray for me. 331 00:19:13,480 --> 00:19:16,440 They're waiting for me, Mum. I will call you later, okay? 332 00:19:18,240 --> 00:19:20,800 [Pip in English] Have you spoken to everybody you want to speak to? 333 00:19:20,880 --> 00:19:23,080 Yeah? Okay. These guys are gonna take you up now. 334 00:19:24,960 --> 00:19:26,720 Thank you, guys. Thank you all. 335 00:19:29,800 --> 00:19:30,960 [man] So, trauma patient. 336 00:19:31,040 --> 00:19:34,920 Urgent procedure to get into the artery and embolize a bleeding tributary. 337 00:19:35,520 --> 00:19:37,440 We are pinhole surgeons, 338 00:19:38,920 --> 00:19:42,880 and our plan is to navigate a tube and a wire up through the aorta, 339 00:19:42,960 --> 00:19:44,640 the main artery of the abdomen. 340 00:19:44,720 --> 00:19:47,560 We are then going to use a directional catheter 341 00:19:47,640 --> 00:19:51,760 to get into this artery here to block that to stop the bleeding. 342 00:19:51,840 --> 00:19:54,640 You're bleeding inside, and you can lose a lot of blood. 343 00:19:56,520 --> 00:19:59,400 [Abdi] I work in decontamination and sterilization. 344 00:19:59,480 --> 00:20:03,320 Process all the instruments these guys use to do their procedures. 345 00:20:04,480 --> 00:20:05,680 So, it's like a… 346 00:20:06,480 --> 00:20:08,880 It's like a circle that's coming around on itself. 347 00:20:10,040 --> 00:20:13,360 I've never been in an accident like this before. 348 00:20:14,000 --> 00:20:16,280 It feels like I've been hit by a truck. 349 00:20:16,360 --> 00:20:18,920 But what can you do, you know? 350 00:20:19,440 --> 00:20:20,760 [man 1] He's consented. 351 00:20:20,840 --> 00:20:22,360 -[Rob] Cool, let's do it. -[man 1] Yep. 352 00:20:22,440 --> 00:20:25,160 [Rob] Okay, final question. Is everyone leaded? 353 00:20:25,240 --> 00:20:27,480 -We're good to go now, Rob. -[Rob] Thank you. 354 00:20:28,600 --> 00:20:30,240 I just want to say something. 355 00:20:30,320 --> 00:20:31,160 [man 2] Yeah. 356 00:20:37,560 --> 00:20:39,080 He just wants to say a prayer. 357 00:20:40,480 --> 00:20:42,400 Nice, slow, deep breaths for me. 358 00:20:43,080 --> 00:20:44,840 [Rob] Let's try and get into this. 359 00:20:44,920 --> 00:20:46,440 Can I have the wire, please? 360 00:20:47,360 --> 00:20:48,960 It's less than a millimeter in width. 361 00:20:49,040 --> 00:20:52,080 I'm gonna try and navigate this through the blood vessels. 362 00:20:53,600 --> 00:20:56,000 That's great. All the way in, straight in. 363 00:20:56,520 --> 00:20:58,480 [man 3] Is there more bleeding distally as well? 364 00:20:59,080 --> 00:21:00,040 [Rob] Holy moly. 365 00:21:00,560 --> 00:21:01,880 [exhales loudly] 366 00:21:03,000 --> 00:21:05,240 This is a nasty, nasty trauma. 367 00:21:05,840 --> 00:21:07,400 He's lucky to be alive, isn't he? 368 00:21:07,480 --> 00:21:09,000 [intense music playing] 369 00:21:10,800 --> 00:21:14,080 The vessels are sheared off from the impact and the force. 370 00:21:14,600 --> 00:21:17,400 We just put some little beads down the arteries. 371 00:21:17,480 --> 00:21:19,880 So the beads are gonna travel with the blood flow 372 00:21:19,960 --> 00:21:23,800 and just nest in the very distal arteries and block those truncated vessels. 373 00:21:26,400 --> 00:21:27,320 Perfect. 374 00:21:27,840 --> 00:21:29,920 I'm happy with the liver now. Okay? 375 00:21:31,320 --> 00:21:33,880 We've stopped the bleeding in the liver, 376 00:21:33,960 --> 00:21:37,400 but in motorbike accidents, you can be bleeding from multiple sites. 377 00:21:38,360 --> 00:21:42,200 He has to be handed over to my trauma surgical colleagues now. 378 00:21:42,280 --> 00:21:43,520 [man 4] Ready, steady, slide. 379 00:21:43,600 --> 00:21:46,720 [Rob] They have to examine Abdi inside really carefully. 380 00:21:48,600 --> 00:21:52,320 It is risky moving someone like Abdi who is bleeding, 381 00:21:53,000 --> 00:21:55,960 but when it comes to trauma, it's a balance of risks. 382 00:21:59,560 --> 00:22:02,000 There is no perfect in medicine. 383 00:22:18,080 --> 00:22:21,400 It's been 24 days since Isaac was admitted to hospital 384 00:22:22,080 --> 00:22:24,000 following an alleged assault. 385 00:22:24,520 --> 00:22:26,400 Isaac is getting better. 386 00:22:26,480 --> 00:22:29,280 [Isaac] I need to take that off as well, don't I? 387 00:22:29,360 --> 00:22:31,280 [Stacey] I have seen glimmers of hope. 388 00:22:31,360 --> 00:22:34,880 Some really nice traits of Isaac before he was injured. 389 00:22:35,480 --> 00:22:39,320 He's very generous and he's very family orientated, 390 00:22:39,400 --> 00:22:40,680 which is a lovely trait. 391 00:22:46,480 --> 00:22:50,280 That's just part of the process, and part of getting home, 392 00:22:51,080 --> 00:22:53,520 and part of making me better. 393 00:22:54,480 --> 00:22:57,640 So, it's all right. I'm happy with doing it. 394 00:22:59,320 --> 00:23:01,880 Isaac being in hospital has been the longest time 395 00:23:01,960 --> 00:23:03,720 that we've actually ever been apart. 396 00:23:04,920 --> 00:23:07,840 It's been really difficult not having him at home. 397 00:23:08,520 --> 00:23:11,920 I can see some of Isaac is coming back. 398 00:23:12,840 --> 00:23:15,360 [woman 1] Oh my gosh, he can't go any quicker. Go. 399 00:23:15,960 --> 00:23:18,120 -[Isaac] Thank you for having me. -See you later. 400 00:23:18,200 --> 00:23:19,320 All right, see ya. 401 00:23:20,040 --> 00:23:23,080 We all would want some magic tablet or magic wand 402 00:23:23,160 --> 00:23:25,240 where we can just make everyone better, 403 00:23:25,840 --> 00:23:28,560 but that's not the reality of brain injury. 404 00:23:28,640 --> 00:23:30,080 People's lives change, 405 00:23:31,320 --> 00:23:34,160 but it's encouraging the families to recognize 406 00:23:34,240 --> 00:23:37,280 that these really small wins are actually massive. 407 00:23:37,880 --> 00:23:40,640 -[Isaac] I'm happy to be leaving here. -[woman 2] I can imagine. 408 00:23:40,720 --> 00:23:42,080 [Isaac] I know that. 409 00:23:42,160 --> 00:23:44,680 But I'll miss everyone. 410 00:23:44,760 --> 00:23:46,240 [emotional music playing] 411 00:23:46,320 --> 00:23:49,120 I appreciate all the help they've given me. 412 00:23:50,640 --> 00:23:52,720 Yeah, I'm just lucky to be alive. 413 00:23:57,680 --> 00:23:59,720 [Stacey] Trauma doesn't discriminate. 414 00:24:00,240 --> 00:24:03,160 Rich, poor. It can touch anyone. 415 00:24:06,560 --> 00:24:08,760 And nobody's expecting it. 416 00:24:09,880 --> 00:24:14,240 The biggest challenge I see is the patient not returning to who they were. 417 00:24:14,920 --> 00:24:18,440 Um… And that's really difficult for families. 418 00:24:26,240 --> 00:24:28,640 [Karen] Grace is squeezing my hand. 419 00:24:29,160 --> 00:24:31,360 She's turned her head to my voice. 420 00:24:31,440 --> 00:24:33,880 But she's still so out of it. 421 00:24:36,360 --> 00:24:37,920 [dramatic music playing] 422 00:24:40,920 --> 00:24:42,320 [man] Grace was hit by a car, 423 00:24:42,400 --> 00:24:46,440 and that impact caused her to be thrown off to the side of the road. 424 00:24:47,760 --> 00:24:49,080 This is Grace's scan, 425 00:24:49,160 --> 00:24:52,240 and we can see that her brain would have rattled around in her skull, 426 00:24:52,320 --> 00:24:53,320 causing some bruising. 427 00:24:53,400 --> 00:24:55,800 And the other part of the injury 428 00:24:55,880 --> 00:24:59,240 is the kind of shearing forces that would have occurred in the brain. 429 00:25:00,200 --> 00:25:01,680 Hi. Is it Grace and family? 430 00:25:01,760 --> 00:25:04,400 My name's Harri. I'm one of the neurology consultants. 431 00:25:04,480 --> 00:25:06,240 I work in the neuro rehab team. 432 00:25:08,120 --> 00:25:11,680 The brain consists of millions of neurons which transmit information 433 00:25:11,760 --> 00:25:14,080 between different parts of your brain. 434 00:25:14,160 --> 00:25:17,040 If you tear these, 435 00:25:17,120 --> 00:25:20,920 you disrupt the brain's ability to do all the complex functions that it can do. 436 00:25:24,560 --> 00:25:27,240 Is it okay if I try and see if I can wake up Grace a bit? 437 00:25:27,320 --> 00:25:28,360 [Karen] Yeah. 438 00:25:29,800 --> 00:25:32,720 My name's Harri. I'm one of the neurologists here. 439 00:25:35,080 --> 00:25:36,080 [Karen] Grace. 440 00:25:36,800 --> 00:25:38,720 [Harri] Can you open your eyes for me? 441 00:25:40,160 --> 00:25:41,200 [Karen] Grace. 442 00:25:43,920 --> 00:25:45,920 [Harri] Would Grace be okay if I just feel her hand? 443 00:25:46,000 --> 00:25:48,640 -Yeah. -[Harri] Is she quite sensitive to touch? 444 00:25:48,720 --> 00:25:49,960 [Karen] She can be. 445 00:25:52,720 --> 00:25:55,280 [Harri] Let me hold your hand if that's okay, Grace. 446 00:25:57,800 --> 00:25:58,760 Hello, Grace. 447 00:25:59,280 --> 00:26:01,000 [Karen] Grace, open your eyes, darling. 448 00:26:02,920 --> 00:26:04,480 Want to wake up for the doctors? 449 00:26:06,040 --> 00:26:07,040 It's Mum. 450 00:26:09,960 --> 00:26:10,800 Grace. 451 00:26:12,720 --> 00:26:14,240 -[Harri] Hello, Grace. -Hello, Grace. 452 00:26:20,800 --> 00:26:24,960 [Karen] Seeing her open her eyes just for that brief second, 453 00:26:25,480 --> 00:26:28,120 it's like all your Christmases come at once. 454 00:26:29,400 --> 00:26:31,320 Because you know she's in there. 455 00:26:33,520 --> 00:26:34,600 Hi, darling. 456 00:26:36,320 --> 00:26:39,480 I can feel you holding on to me. I know you're listening. 457 00:26:41,800 --> 00:26:44,000 [Harri] After someone who has a head injury wakes up, 458 00:26:44,080 --> 00:26:46,600 they can be in this stage in which they're very confused 459 00:26:46,680 --> 00:26:48,080 and very disorientated. 460 00:26:48,160 --> 00:26:50,800 But this will change over the next few days. 461 00:26:51,680 --> 00:26:54,800 And then we'll see a little bit more what impact the head injury has. 462 00:26:54,880 --> 00:26:55,720 [Karen] Yeah. 463 00:26:55,800 --> 00:26:59,560 [Harri] For her parents, it really is this emotional roller coaster 464 00:26:59,640 --> 00:27:03,600 where they feel they may have lost their loved one to knowing they're now alive. 465 00:27:04,120 --> 00:27:06,800 But then go through almost a kind of mourning-type phase 466 00:27:06,880 --> 00:27:09,320 of realizing that things are significantly different. 467 00:27:09,400 --> 00:27:10,800 [emotional music playing] 468 00:27:13,480 --> 00:27:17,360 And that this could be their reality for not just the next few weeks, 469 00:27:17,440 --> 00:27:18,640 but months to years. 470 00:27:35,040 --> 00:27:36,600 [thrilling music playing] 471 00:27:39,160 --> 00:27:43,640 Abdi has had his liver embolized to try and control the bleeding. 472 00:27:45,680 --> 00:27:48,040 But we can see from the scans 473 00:27:48,560 --> 00:27:51,440 that there's still blood inside the abdomen. 474 00:27:53,880 --> 00:27:58,640 Every day a trauma patient comes in that is severely injured, 475 00:27:58,720 --> 00:28:04,040 I always feel I can relate to what people are going through 476 00:28:05,120 --> 00:28:08,440 because of my personal journey to get to trauma surgery. 477 00:28:12,480 --> 00:28:18,120 We were in our teenage times of everybody just learning how to drive. 478 00:28:18,200 --> 00:28:21,160 And I remember very clearly it was a Friday night, 479 00:28:21,240 --> 00:28:23,400 and one of them rang me saying we're going out 480 00:28:23,480 --> 00:28:25,720 and this person has a new car. 481 00:28:25,800 --> 00:28:28,240 And I was like, "Oh, yes. I'll have to ask my mum." 482 00:28:28,320 --> 00:28:29,880 [emotional music playing] 483 00:28:32,600 --> 00:28:36,360 And I remember my mother saying I couldn't go. Um… 484 00:28:36,440 --> 00:28:39,320 You know, I was like, "Okay, fine. I'm not going with you guys, 485 00:28:39,400 --> 00:28:42,240 but have fun and we'll talk tomorrow." 486 00:28:44,320 --> 00:28:47,880 Uh… but that was a tomorrow that I never spoke to my friends about 487 00:28:48,600 --> 00:28:51,720 because they were involved in a road traffic accident. 488 00:28:52,240 --> 00:28:54,400 And one of them died. 489 00:28:56,400 --> 00:29:00,760 I just could not quite comprehend or believe or accept it. 490 00:29:02,120 --> 00:29:03,120 Um… 491 00:29:08,720 --> 00:29:10,080 Sorry. Yeah. 492 00:29:10,720 --> 00:29:14,000 It was amazing. Her name was Maryam as well. [chuckles sadly] 493 00:29:14,080 --> 00:29:18,880 Um… and… and yeah, she was always, you know, 494 00:29:19,880 --> 00:29:23,080 our go-to person, our sort of sorter. 495 00:29:25,240 --> 00:29:27,000 Yeah, an incredible human being. 496 00:29:31,200 --> 00:29:34,080 And, um, I wanted to do something. 497 00:29:37,640 --> 00:29:39,480 And so I developed a new focus. 498 00:29:41,280 --> 00:29:42,600 All right to start. 499 00:29:42,680 --> 00:29:47,160 I really wanted to be part of that, helping people as much as I can 500 00:29:47,240 --> 00:29:49,240 when they are severely injured. 501 00:29:49,320 --> 00:29:51,280 [tense music playing] 502 00:29:53,360 --> 00:29:56,880 We know that Abdi's spleen is still bleeding, 503 00:29:56,960 --> 00:30:00,800 but it may be that there are other organs that are also damaged. 504 00:30:02,720 --> 00:30:04,680 Even if people do get to hospital on time, 505 00:30:04,760 --> 00:30:07,400 they can still die from internal bleeding. 506 00:30:09,040 --> 00:30:13,040 The plan for Abdi is keyhole surgery to try and stop that bleeding. 507 00:30:13,880 --> 00:30:17,080 We've opened up a little space just above the belly button. 508 00:30:17,720 --> 00:30:20,880 Then we're going to put the camera in to see what we see inside. 509 00:30:23,920 --> 00:30:25,240 Large intestines. 510 00:30:27,080 --> 00:30:29,680 This is all the abnormal blood that's inside. 511 00:30:31,480 --> 00:30:34,680 There's probably about a liter of blood in there. 512 00:30:36,160 --> 00:30:37,760 I can't quite see properly. 513 00:30:38,800 --> 00:30:40,600 [woman] Is it compromising things? 514 00:30:41,880 --> 00:30:44,360 [Maryam] We only have a certain amount of blood 515 00:30:44,440 --> 00:30:47,040 that's circulating within our system. 516 00:30:47,120 --> 00:30:49,360 So if it's being lost somewhere, 517 00:30:49,440 --> 00:30:53,360 there isn't enough to go back to the heart for the heart to be able to pump it. 518 00:30:53,880 --> 00:30:57,400 And eventually, the heart has nothing to pump, 519 00:30:57,480 --> 00:30:59,040 and then the heart stops. 520 00:31:00,520 --> 00:31:04,840 There's a bit too much blood, so we can't see where it's potentially coming from. 521 00:31:06,880 --> 00:31:09,240 The safer thing is to convert to an open operation. 522 00:31:11,440 --> 00:31:12,880 Can we have a knife, please? 523 00:31:17,080 --> 00:31:19,240 When things are not quite right, I'm grateful 524 00:31:19,320 --> 00:31:22,600 that I have a very religious and spiritual aspect of my life, 525 00:31:22,680 --> 00:31:27,200 and I'm able to tune into that to calm my brain, my mind. 526 00:31:28,840 --> 00:31:31,320 Now that I've converted to an open operation, 527 00:31:31,400 --> 00:31:34,120 I have to be systematically looking at every organ 528 00:31:34,200 --> 00:31:36,200 to find out exactly what's bleeding. 529 00:31:36,280 --> 00:31:39,160 I mentally have a clockface in my head. 530 00:31:39,240 --> 00:31:40,840 [music intensifies] 531 00:31:42,320 --> 00:31:45,480 Twelve is the middle where the breastbone is. 532 00:31:46,000 --> 00:31:48,520 The left colon is at three o'clock. 533 00:31:48,600 --> 00:31:51,120 And then at six o'clock, I'm looking at the rectum. 534 00:31:51,200 --> 00:31:55,840 Nine is the right colon. And then going back again to 12. 535 00:31:55,920 --> 00:31:58,840 Walking through all the organs in the abdomen. 536 00:31:59,840 --> 00:32:03,720 The fact that you don't know exactly what's bleeding is primarily the problem. 537 00:32:04,320 --> 00:32:06,240 Every second matters. 538 00:32:06,960 --> 00:32:08,680 This is the small intestine. 539 00:32:10,520 --> 00:32:12,880 The small intestine is about three meters long. 540 00:32:14,040 --> 00:32:16,400 So far, we can't see any obvious injury. 541 00:32:18,080 --> 00:32:21,160 Your brain is trying to put a jigsaw puzzle together. 542 00:32:23,280 --> 00:32:25,000 Now, the large intestine. 543 00:32:28,320 --> 00:32:30,240 -[woman] Is that okay? -[Maryam] Yeah. 544 00:32:31,080 --> 00:32:32,720 So this is the stomach. 545 00:32:34,280 --> 00:32:37,920 And we can't see any injury there, which is good news. 546 00:32:38,000 --> 00:32:40,520 -[woman] Have a look at the spleen? -[Maryam] Yeah. 547 00:32:44,240 --> 00:32:45,600 This is the spleen. 548 00:32:46,280 --> 00:32:48,240 This is the area that's bleeding. 549 00:32:50,440 --> 00:32:52,800 And slightly more on the inner side of it. 550 00:32:52,880 --> 00:32:55,040 So we need to be really gentle here. 551 00:32:56,200 --> 00:33:00,160 So I'm going to try this special foam-like gel, 552 00:33:00,240 --> 00:33:02,000 and that can stop bleeding. 553 00:33:07,240 --> 00:33:09,960 So we'll leave that and see if that does the trick. 554 00:33:10,040 --> 00:33:11,560 [intense music continues] 555 00:33:20,160 --> 00:33:21,560 [woman] I think it's still bleeding. 556 00:33:22,360 --> 00:33:23,800 [Maryam] We need to stop it. 557 00:33:24,800 --> 00:33:26,320 [woman] Can you suture it? 558 00:33:26,400 --> 00:33:27,240 [Maryam] No. 559 00:33:29,440 --> 00:33:31,280 The spleen is part of the immune system. 560 00:33:31,360 --> 00:33:34,400 It's very important when it comes to fighting infections. 561 00:33:34,960 --> 00:33:39,120 So removing the spleen is always something we avoid doing 562 00:33:39,200 --> 00:33:40,760 unless we really have to. 563 00:33:41,840 --> 00:33:43,800 But sometimes you have no choice. 564 00:33:45,160 --> 00:33:46,880 We're gonna take the spleen out. 565 00:33:57,720 --> 00:33:59,160 -[woman] Thank you. -[Maryam] Okay. 566 00:33:59,240 --> 00:34:03,880 So that was bleeding here, here. And there's a cut in the middle there. 567 00:34:11,640 --> 00:34:13,480 So, start closing. 568 00:34:14,280 --> 00:34:16,000 -[woman] You okay? -[Maryam] Yeah. 569 00:34:20,480 --> 00:34:23,840 I'm quite happy that the spleen was the source of the bleeding. 570 00:34:23,920 --> 00:34:27,880 And now that's been controlled, and we can end the operation. 571 00:34:30,040 --> 00:34:32,040 Abdi has been through a lot today. 572 00:34:33,760 --> 00:34:38,680 If he didn't get to hospital at the time, he could have died from internal bleeding. 573 00:34:43,280 --> 00:34:45,640 He is still very much in a critical state. 574 00:34:45,720 --> 00:34:49,640 So the next 24, 48 hours, he will need close monitoring 575 00:34:49,720 --> 00:34:52,840 to make sure that there are no further complications. 576 00:35:02,840 --> 00:35:04,480 [sirens blaring] 577 00:35:16,040 --> 00:35:17,520 [woman] If you sit there, Teddy. 578 00:35:17,600 --> 00:35:20,760 So I'm just gonna cut the bandage, okay? Not anything else. 579 00:35:20,840 --> 00:35:22,640 -[Teddy] Not my finger. -No. 580 00:35:23,520 --> 00:35:26,640 Today, we're seeing a young lad called Teddy, who's 16. 581 00:35:26,720 --> 00:35:29,160 Unfortunately, he ripped his finger off. 582 00:35:30,000 --> 00:35:33,960 Despite best efforts of all the staff and the surgeons here at the hospital, 583 00:35:34,040 --> 00:35:38,840 even with using some leech therapy, we weren't able to salvage the finger. 584 00:35:39,440 --> 00:35:42,720 -Do you want me to look first? -[Isaac] I don't think I want to see it. 585 00:35:42,800 --> 00:35:44,640 -[Carla] You all right? -[Isaac] No. 586 00:35:44,720 --> 00:35:46,040 You’ve gone all sweaty. 587 00:35:46,120 --> 00:35:47,240 Yeah, I'm very hot. 588 00:35:47,320 --> 00:35:49,680 -[Carla] You going funny? -[woman] Just lie down, Teddy. 589 00:35:49,760 --> 00:35:51,200 [Carla] Keep your eyes shut. 590 00:35:54,400 --> 00:35:55,720 [Isaac] What do you think? 591 00:35:56,240 --> 00:35:59,160 It looks really tidy. It looks really clean. 592 00:35:59,840 --> 00:36:02,560 [Isaac] Will I have a dressing on it while in physio? 593 00:36:02,640 --> 00:36:04,120 I don’t wanna look at it. 594 00:36:04,200 --> 00:36:05,920 -It's a lot, isn't it? -[woman] Yeah. 595 00:36:10,160 --> 00:36:14,080 [Jane] Since the accident, Teddy has probably not used or moved his hand. 596 00:36:14,160 --> 00:36:17,880 But we do need to today start on trying to get the muscles working, 597 00:36:17,960 --> 00:36:20,440 try and get the neural pathways connected 598 00:36:20,520 --> 00:36:23,240 in order to get him progressing and using his hand normally. 599 00:36:24,640 --> 00:36:28,080 Do you play PlayStation, Xbox? 600 00:36:28,160 --> 00:36:30,160 -I do, but I haven't been 'cause-- -Yeah? 601 00:36:30,240 --> 00:36:32,520 I haven't been able to hold the controller. 602 00:36:32,600 --> 00:36:35,880 You can play your PlayStation if you want to, okay? 603 00:36:37,440 --> 00:36:39,760 Take your thumb out to the side for me. 604 00:36:40,360 --> 00:36:43,920 Are you able to get it and touch it to the bottom of that little finger? 605 00:36:44,480 --> 00:36:45,560 Excellent. 606 00:36:46,080 --> 00:36:48,280 Is there anything he shouldn’t do? Like go to… 607 00:36:48,360 --> 00:36:49,360 [Jane] Don't get it wet. 608 00:36:49,440 --> 00:36:50,720 …after-parties, after-prom? 609 00:36:50,800 --> 00:36:53,080 He should avoid them, yeah? 610 00:36:53,640 --> 00:36:55,120 When is prom? Is it tonight? 611 00:36:55,200 --> 00:36:56,840 -[Carla] Friday. -Friday. 612 00:36:56,920 --> 00:36:59,120 -[Teddy] Yeah. -[Jane] You're gonna go, aren't ya? 613 00:36:59,200 --> 00:37:01,200 -[Teddy] I'm going to go to prom. -[Jane] Yeah. 614 00:37:01,280 --> 00:37:04,400 But I'm trying to persuade her to let me go after-party. 615 00:37:04,480 --> 00:37:08,360 [Jane] I can't tell him not to go. Depends on what you're doing at your after-party. 616 00:37:08,440 --> 00:37:11,640 You're not helping me. You're going completely siding with him. 617 00:37:11,720 --> 00:37:13,760 [Jane] I'm really sorry. [laughs] 618 00:37:15,560 --> 00:37:19,280 This is definitely a lesson that I wouldn't want him to have, 619 00:37:19,360 --> 00:37:22,920 but his attitude is it's not gonna stop him from doing anything. 620 00:37:23,000 --> 00:37:26,000 Teddy goes to college in September. He's doing an electrician course. 621 00:37:26,080 --> 00:37:28,440 -Thank you so much. -See you later. Bye. 622 00:37:28,960 --> 00:37:31,960 I'm super proud that he's dealing with it the way he is. 623 00:37:36,480 --> 00:37:38,080 [tense music playing] 624 00:37:41,440 --> 00:37:43,680 [Harri] Okay, so we're starting with Grace. 625 00:37:43,760 --> 00:37:47,040 Just to remind everyone, Grace was struck by a car on 10th June, 626 00:37:47,120 --> 00:37:49,440 had a traumatic brain injury and pelvic fractures 627 00:37:49,520 --> 00:37:51,480 that she had fixed on the 14th. 628 00:37:52,960 --> 00:37:55,240 Grace has been with us for a few weeks now. 629 00:37:55,320 --> 00:37:59,240 Initially, Grace was very tired and confused, but now she's doing well, 630 00:37:59,320 --> 00:38:01,560 awake and able to engage in the rehabilitation. 631 00:38:02,880 --> 00:38:05,720 Recovery from a brain injury is difficult to predict, however. 632 00:38:05,800 --> 00:38:08,680 Every brain is unique and everyone's recovery is unique. 633 00:38:08,760 --> 00:38:09,960 -Hi, Grace. -[Grace] Hello. 634 00:38:10,040 --> 00:38:11,120 [man] Morning, Grace. 635 00:38:13,880 --> 00:38:16,280 With regards to what brought you in, 636 00:38:16,360 --> 00:38:19,640 did you have much chance to kind of talk or understand about that? 637 00:38:21,240 --> 00:38:23,080 I had a brain injury, didn't I? 638 00:38:23,160 --> 00:38:25,600 -[Karen] You have a brain injury, yeah. -[both chuckle] 639 00:38:27,080 --> 00:38:29,240 [Harri] It's variable how much it'll affect you, 640 00:38:29,320 --> 00:38:33,040 but some things you might notice is concentration might be a bit tricky, 641 00:38:33,120 --> 00:38:36,840 and more complex problem-solving, so not doing your basic day-to-day tasks. 642 00:38:37,560 --> 00:38:40,960 The main areas that were affected were the frontal lobes 643 00:38:41,040 --> 00:38:42,880 and also the temporal lobe, 644 00:38:42,960 --> 00:38:45,640 which is often involved in actually not our verbal memory, 645 00:38:45,720 --> 00:38:47,080 but more of our visual memory. 646 00:38:47,880 --> 00:38:49,800 [Karen] We're just very lucky and very grateful 647 00:38:49,880 --> 00:38:52,120 that Grace is still there for the most part. 648 00:38:52,200 --> 00:38:54,120 Okay. Well done. 649 00:38:54,200 --> 00:38:58,080 But she's lost probably about eight months of memory. 650 00:39:00,120 --> 00:39:03,680 She doesn't even remember her baby brother Morgan being born in February. 651 00:39:03,760 --> 00:39:05,920 That's completely gone. 652 00:39:07,240 --> 00:39:09,360 Doesn't remember coming to see him in hospital, 653 00:39:09,440 --> 00:39:11,720 holding him for the first time, anything like that. 654 00:39:11,800 --> 00:39:13,480 That's just been wiped. 655 00:39:16,920 --> 00:39:19,000 [Harri] As part of post-traumatic amnesia, 656 00:39:19,080 --> 00:39:22,480 patients like Grace can have problems with short-term memory. 657 00:39:22,560 --> 00:39:25,840 Memories of events that happened before the injury can be lost. 658 00:39:26,360 --> 00:39:29,880 It's very much akin to the film Memento, 659 00:39:29,960 --> 00:39:34,120 in which she's effectively living each moment without a real awareness 660 00:39:34,200 --> 00:39:36,320 or recollection of what happened before. 661 00:39:39,520 --> 00:39:42,200 Unfortunately, we don't have medications or surgery 662 00:39:42,280 --> 00:39:44,840 to fix the damage, really, that's been done. 663 00:39:45,440 --> 00:39:47,960 But what you can do is use visual aids. 664 00:39:48,040 --> 00:39:53,320 So we've asked Karen to bring in pictures, objects from home. 665 00:39:56,400 --> 00:40:01,600 Those images and objects will act as a scaffold for her 666 00:40:01,680 --> 00:40:03,240 to reform those memories. 667 00:40:04,560 --> 00:40:08,760 [Karen] We're putting in pictures, just, you know, Grace with the dogs, 668 00:40:08,840 --> 00:40:12,880 and then photos like with her friends at birthday parties and things like that. 669 00:40:14,640 --> 00:40:16,440 Hopefully, the memories will come back. 670 00:40:16,520 --> 00:40:18,800 We just don't know how long that's gonna take. 671 00:40:24,160 --> 00:40:27,720 Look at the difference of you here, and then in that photo up there. 672 00:40:27,800 --> 00:40:28,880 How you've changed. 673 00:40:29,920 --> 00:40:32,600 -[Grace] That was year four as well. -[man] Very good. 674 00:40:33,600 --> 00:40:36,200 [Harri] Memory is a really complicated function. 675 00:40:36,280 --> 00:40:39,040 But for Grace, youth is definitely on her side. 676 00:40:39,760 --> 00:40:42,080 That one's from Joanna. That one's from Ted. 677 00:40:42,160 --> 00:40:43,320 It's a bit bent, innit? 678 00:40:44,080 --> 00:40:47,360 [Harri] The fantastic thing about the brain of a 17-year-old 679 00:40:47,440 --> 00:40:49,840 is its capacity to rewire. 680 00:40:49,920 --> 00:40:51,520 We call it neuroplasticity. 681 00:40:51,600 --> 00:40:55,080 Grace's ability to repair those connections 682 00:40:55,160 --> 00:40:57,280 that have been disrupted as part of this injury 683 00:40:57,360 --> 00:41:00,640 are so much higher, which stands her in really good stead for the future. 684 00:41:00,720 --> 00:41:02,840 -She was so drunk. -She was very dr… 685 00:41:17,680 --> 00:41:19,520 -[Maryam] Morning. -[Abdi] Morning. 686 00:41:19,600 --> 00:41:20,880 How's your pain? 687 00:41:20,960 --> 00:41:22,280 -I can tolerate it. -[Maryam] Okay. 688 00:41:22,360 --> 00:41:24,880 And we can give you more stuff on top of what we have. 689 00:41:24,960 --> 00:41:26,520 Okay, there's no need to be brave. 690 00:41:26,600 --> 00:41:28,120 -If I need more, I'll ask. -Good. 691 00:41:28,200 --> 00:41:29,960 So, essentially, yesterday we did try 692 00:41:30,040 --> 00:41:33,200 and do the operation keyhole, but the spleen kept on bleeding a bit 693 00:41:33,280 --> 00:41:35,600 as much as we tried to sort of leave it in there. 694 00:41:35,680 --> 00:41:37,720 So you don't have a spleen, I'm afraid. 695 00:41:39,640 --> 00:41:43,400 Life is perfectly normal without it, apart from having to take antibiotics. 696 00:41:46,120 --> 00:41:48,560 [Abdi] I'm here breathing another day. 697 00:41:48,640 --> 00:41:51,760 Yeah, just really grateful for this system that we have. 698 00:41:52,360 --> 00:41:55,160 It's a whole village to make this operation work. 699 00:41:55,680 --> 00:41:58,840 This has made me realize not to take anything for granted. 700 00:42:00,360 --> 00:42:01,720 [Maryam] Keeping people alive 701 00:42:01,800 --> 00:42:04,400 gives you a good feeling, should I say, inside. 702 00:42:06,480 --> 00:42:09,040 I play my small part, 703 00:42:09,880 --> 00:42:13,000 but it's all down to a lot of people together. 704 00:42:13,080 --> 00:42:17,000 ♪ Sometimes I feel like Throwing my hands up in the air ♪ 705 00:42:17,840 --> 00:42:21,240 ♪ I know I can count on you ♪ 706 00:42:21,320 --> 00:42:23,640 We see people at their absolute lowest. 707 00:42:25,960 --> 00:42:29,560 But the London trauma network has the ability to pick up the pieces 708 00:42:29,640 --> 00:42:31,120 and put them back together. 709 00:42:31,200 --> 00:42:33,680 ["You've Got the Love" instrumental playing] 710 00:42:40,920 --> 00:42:42,920 I made him smile. Look. 711 00:42:43,840 --> 00:42:46,320 [Karen] The progress is just astounding. 712 00:42:46,400 --> 00:42:50,000 You know she's there, and you're going to get her back. 713 00:42:50,080 --> 00:42:51,400 ♪ You've got the love ♪ 714 00:42:52,120 --> 00:42:54,880 [Carla] Teddy's not letting it bother him, which is amazing. 715 00:42:54,960 --> 00:42:57,680 It could be like a cool chat-up line, can't it? 716 00:42:57,760 --> 00:43:00,160 [Paul] It's a journey. There's highs and lows in it. 717 00:43:00,240 --> 00:43:01,680 It can be transformative. 718 00:43:01,760 --> 00:43:04,040 ♪ You've got the love ♪ 719 00:43:05,000 --> 00:43:07,440 [Toby] I think my prosthetic looks pretty cool. 720 00:43:07,520 --> 00:43:10,360 Definitely want to show it off to people I used to go to gym with. 721 00:43:11,520 --> 00:43:12,800 [Ollie] There we go, son! 722 00:43:16,400 --> 00:43:20,480 [Ash] Saving lives, returning people to their families, to their loved ones. 723 00:43:20,560 --> 00:43:22,560 I think the NHS is absolutely incredible. 724 00:43:23,160 --> 00:43:24,880 [Mel] Welcome home! 725 00:43:24,960 --> 00:43:26,720 -You all right, Mum? -Yeah! 726 00:43:27,240 --> 00:43:28,600 Welcome home. 727 00:43:30,640 --> 00:43:33,920 We pride ourselves on pushing the boundaries of what's possible. 728 00:43:34,600 --> 00:43:36,640 [Simon] We've got the artificial forehead in place. 729 00:43:37,440 --> 00:43:39,320 Shall we just see what it looks like? 730 00:43:40,120 --> 00:43:43,440 [Ibraheim] You realize how fragile we are, 731 00:43:43,520 --> 00:43:46,960 yet how amazing the human body is. 732 00:43:47,640 --> 00:43:50,120 It fascinates me every time when I operate, 733 00:43:50,200 --> 00:43:52,960 how we put people back together again. 734 00:43:53,640 --> 00:43:54,680 [Simon] Perfect. 735 00:43:54,760 --> 00:43:58,040 ♪ I know I can count on you ♪ 736 00:44:00,440 --> 00:44:01,680 [Jack] They thought I might die, 737 00:44:01,760 --> 00:44:04,720 and then after that, they thought I might have brain damage. 738 00:44:05,240 --> 00:44:08,040 The level of care I've had, honestly, phenomenal. 739 00:44:09,360 --> 00:44:13,280 We're saving lives that 15, 20 years ago, they wouldn't survive. 740 00:44:14,120 --> 00:44:17,080 They've put me back together, like Humpty Dumpty. 741 00:44:24,200 --> 00:44:26,680 [Mamoun] Since the setting up of London Major Trauma System, 742 00:44:26,760 --> 00:44:28,360 thousands of lives have been saved. 743 00:44:28,440 --> 00:44:31,080 The city relies upon us. 744 00:44:31,160 --> 00:44:34,080 ♪ But you've got the love I need to see me through ♪ 745 00:44:38,600 --> 00:44:39,920 [tense music playing] 745 00:44:40,305 --> 00:45:40,860