"Critical: Between Life and Death" Episode #1.4

1 00:00:05,960 --> 00:00:08,240 -[intense music playing] -[ambulances blaring] 2 00:00:10,640 --> 00:00:12,320 [Hani] What's the blood pressure? 3 00:00:13,520 --> 00:00:15,480 The pulse is very, very weak. 4 00:00:16,640 --> 00:00:19,560 We need to push his blood pressure above 120, please. 5 00:00:19,640 --> 00:00:20,680 [man] 120? 6 00:00:20,760 --> 00:00:21,720 [Hani] Yes, please. 7 00:00:24,440 --> 00:00:27,080 Otherwise, everything we've done now is gonna block. 8 00:00:28,520 --> 00:00:31,480 Toby has got significant damage to the foot 9 00:00:31,560 --> 00:00:33,920 from his motorbike accident. 10 00:00:34,000 --> 00:00:39,680 The survival of Toby's foot depends on a good blood supply. 11 00:00:42,040 --> 00:00:43,800 The pressure is still low. 12 00:00:44,880 --> 00:00:46,200 We need to push it up. 13 00:00:46,280 --> 00:00:47,840 [man] I just pushed it up. 14 00:00:47,920 --> 00:00:49,320 [intense music continues] 15 00:00:57,040 --> 00:00:58,360 [Hani] Lovely. 16 00:01:02,200 --> 00:01:03,960 We're not far from finishing. 17 00:01:04,760 --> 00:01:06,360 Pull a little bit. 18 00:01:09,320 --> 00:01:10,400 Perfect. 19 00:01:11,720 --> 00:01:16,120 The vein has now been sewn to replace the damaged section of the artery. 20 00:01:16,840 --> 00:01:20,080 So, in theory, blood should flow into the foot. 21 00:01:20,920 --> 00:01:22,160 Doppler, please. 22 00:01:23,760 --> 00:01:26,600 The Doppler machine gives an audible signal 23 00:01:26,680 --> 00:01:30,160 of the blood flow in the vessels. 24 00:01:30,240 --> 00:01:33,000 What I want to hear is a strong signal. 25 00:01:34,200 --> 00:01:36,520 What I don't want to hear is silence. 26 00:01:39,800 --> 00:01:41,280 This is the moment of truth. 27 00:01:43,320 --> 00:01:44,680 [heart beating] 28 00:01:49,560 --> 00:01:50,680 [tense music playing] 29 00:01:52,000 --> 00:01:58,074 Do you want subtitles for any video? -=[ ai.OpenSubtitles.com ]=- 30 00:02:00,600 --> 00:02:02,120 [Hani] Is the Doppler on? 31 00:02:08,440 --> 00:02:10,880 Can you press it one more time, please? 32 00:02:14,240 --> 00:02:17,840 In surgery, it's well known that the best chance of getting it right 33 00:02:17,920 --> 00:02:19,120 is the first chance. 34 00:02:19,640 --> 00:02:21,600 So there is always this extra pressure. 35 00:02:23,600 --> 00:02:25,200 You have time ticking. 36 00:02:26,360 --> 00:02:28,440 The foot is on the verge of dying. 37 00:02:30,000 --> 00:02:33,480 We need to hear a strong pulsatile signal. 38 00:02:40,480 --> 00:02:41,960 [pulse thumping] 39 00:02:44,720 --> 00:02:46,360 [Hani] It sounds good. 40 00:02:46,440 --> 00:02:50,200 This is very good. It's all now filling up nicely. 41 00:02:53,800 --> 00:02:57,920 The relationship between you and the patient is a special relationship. 42 00:02:59,080 --> 00:03:00,480 In Toby's case, 43 00:03:00,560 --> 00:03:05,560 it's a promise between me and him that I will try my best to save the foot. 44 00:03:06,720 --> 00:03:10,040 You do the surgery with the hope that it will work, 45 00:03:10,840 --> 00:03:13,200 but you have to wait to see the effect. 46 00:03:15,960 --> 00:03:16,960 Perfect. 47 00:03:17,880 --> 00:03:18,880 I'm done. 48 00:03:19,960 --> 00:03:24,120 We managed to reconnect all the arteries that were damaged to his foot. 49 00:03:24,200 --> 00:03:28,920 However, he does have a lot of damage to the soft tissue and the fractures. 50 00:03:29,000 --> 00:03:31,320 So we will now be guided by our colleagues. 51 00:03:31,920 --> 00:03:33,400 [Toby surgeon] Thanks, mate. 52 00:03:34,720 --> 00:03:36,600 Toby has complex injuries. 53 00:03:36,680 --> 00:03:38,400 So it's what we call polytrauma, 54 00:03:38,480 --> 00:03:41,240 which is the worst top-tier level of injury. 55 00:03:41,840 --> 00:03:45,560 It's got circulation now to his foot, which is good news. 56 00:03:45,640 --> 00:03:47,720 But it's not a happy leg. 57 00:03:47,800 --> 00:03:50,600 We have to stabilize his femur still. 58 00:03:51,760 --> 00:03:55,560 The next part of the operation is to try and salvage the limb. 59 00:03:56,080 --> 00:03:58,520 Big Langenbeck back, please. Lovely. 60 00:03:59,080 --> 00:04:03,040 He's lost a fair amount of blood. Also, his nerve has been ruptured. 61 00:04:04,680 --> 00:04:05,960 Okay, go for it. 62 00:04:07,240 --> 00:04:09,080 It's a bad situation to be in. 63 00:04:09,160 --> 00:04:10,000 [man] Thank you. 64 00:04:11,160 --> 00:04:14,760 [Toby surgeon] Our long bones allow us to move around, of course. 65 00:04:16,320 --> 00:04:19,040 But they also are blood-producing factories. 66 00:04:20,120 --> 00:04:22,120 There's about a liter of blood in a femur, 67 00:04:22,200 --> 00:04:24,560 and we only have about five liters of blood inside us. 68 00:04:24,640 --> 00:04:27,720 So, if you have a smashed femur like he has, 69 00:04:27,800 --> 00:04:31,200 it's like having a conical flask full of Ribena, 70 00:04:31,280 --> 00:04:34,200 and if you break it on the floor, all the blood comes out. 71 00:04:34,720 --> 00:04:38,280 Losing blood is not a good thing, so we need to stabilize his femur. 72 00:04:39,080 --> 00:04:42,840 We put some pins into the bone above and below the fracture. 73 00:04:42,920 --> 00:04:45,240 Okay, let's have X-ray there, please. 74 00:04:45,920 --> 00:04:49,760 And then attach some rods, which are a bit like scaffolding pipes, 75 00:04:49,840 --> 00:04:53,160 on the outside of the limb to stabilize the bones and the fracture. 76 00:04:53,760 --> 00:04:54,840 X-ray again. 77 00:04:56,240 --> 00:04:58,160 Okay. Right, we'll go with that. 78 00:04:59,360 --> 00:05:02,040 Unfortunately, Toby has a combination of injuries, 79 00:05:02,120 --> 00:05:03,640 not just bones, 80 00:05:03,720 --> 00:05:06,600 but also his blood vessels, and particularly the arteries. 81 00:05:07,280 --> 00:05:11,040 Biggest problem he's got, given the nature of the injury to his foot, 82 00:05:11,120 --> 00:05:14,840 is whether the tissue is going to survive. 83 00:05:15,920 --> 00:05:18,320 There's still a very high risk of an amputation. 84 00:05:28,720 --> 00:05:30,720 [alarm blaring] 85 00:05:30,800 --> 00:05:32,640 [automated voice] New incident details received. 86 00:05:32,720 --> 00:05:34,560 Been reported as an RTC, car versus car. 87 00:05:35,520 --> 00:05:36,560 [woman] Okay, then. 88 00:05:36,640 --> 00:05:40,240 [man 1] This is a HEMS activation. ETA ten minutes to you. 89 00:05:40,800 --> 00:05:42,640 [man 2] Okay, ready? Copy. 90 00:05:43,400 --> 00:05:45,200 [man 1] We've got help coming now. 91 00:05:46,320 --> 00:05:47,520 [phone rings] 92 00:05:47,600 --> 00:05:49,240 [woman] Medic one, go ahead. 93 00:05:49,320 --> 00:05:51,040 [man] It's a trauma in South London. 94 00:05:51,880 --> 00:05:54,280 What's the blood doing? Is it trickling down his arm? 95 00:05:54,360 --> 00:05:56,080 Or is it spurting out? 96 00:05:56,160 --> 00:05:57,720 Oh my goodness. 97 00:05:58,880 --> 00:06:00,600 Lots of blood all over the floor. 98 00:06:00,680 --> 00:06:03,800 We're gonna get someone down to help you very shortly, okay? 99 00:06:03,880 --> 00:06:05,800 [man 1] Let's go to George's. 100 00:06:06,520 --> 00:06:08,080 [man 2] ETA ten minutes. 101 00:06:08,920 --> 00:06:10,360 Nasty injury. 102 00:06:11,880 --> 00:06:13,640 [phone rings] 103 00:06:15,200 --> 00:06:16,560 Hello, St George's. Resus. 104 00:06:16,640 --> 00:06:18,960 It's an adult male, major trauma call, 105 00:06:19,040 --> 00:06:21,520 and he's got an ETA of ten minutes to you. 106 00:06:22,120 --> 00:06:24,760 [woman] Adult male trauma call. ETA ten minutes. 107 00:06:24,840 --> 00:06:29,600 We've got a 29-year-old male coming in with a significant wound to his arm. 108 00:06:29,680 --> 00:06:30,760 [sirens blaring] 109 00:06:30,840 --> 00:06:32,480 [woman] Let's get stuff out for bloods. 110 00:06:32,560 --> 00:06:35,480 Grab some gray cannulas from the next cubicle. 111 00:06:35,560 --> 00:06:37,120 They wouldn't give us a pre-alert 112 00:06:37,200 --> 00:06:39,960 unless they thought there was a serious injury to the arm. 113 00:06:40,600 --> 00:06:42,160 Do we have a tray for bloods? 114 00:06:42,240 --> 00:06:45,080 So the most concerning thing would be an injury to the artery. 115 00:06:46,960 --> 00:06:48,760 It can be very serious. 116 00:06:50,120 --> 00:06:52,240 You can bleed to death from an artery injury. 117 00:06:55,280 --> 00:06:57,880 [woman 1] So, this is 29-year-old Mani, 118 00:06:57,960 --> 00:06:59,640 who was at a building site working 119 00:06:59,720 --> 00:07:04,040 when he was going up the stairs, tripped, and fell into two panels 120 00:07:04,120 --> 00:07:05,480 of kinda thin glass. 121 00:07:05,560 --> 00:07:07,360 He's cut his elbow. 122 00:07:07,440 --> 00:07:11,400 When bent, you can see to the bone, and a massive laceration to his wrist. 123 00:07:11,480 --> 00:07:15,080 His colleagues then applied a tourniquet, and that's when I got there. 124 00:07:15,160 --> 00:07:17,520 He's got no other obvious injuries. 125 00:07:17,600 --> 00:07:21,160 However, on our way literally pulling up, it started bleeding again. 126 00:07:21,240 --> 00:07:22,200 Quite bad, innit? 127 00:07:22,280 --> 00:07:23,880 [Melissa] A lot of blood on the scene? 128 00:07:23,960 --> 00:07:26,720 -Just under 500 mils of blood loss. -Okay. 129 00:07:27,280 --> 00:07:29,320 -[Mani] It was pissing out. -[woman 2] Nice. 130 00:07:29,400 --> 00:07:30,240 [people giggle] 131 00:07:30,320 --> 00:07:31,840 Sorry, excuse the language. 132 00:07:31,920 --> 00:07:32,880 That's all right. 133 00:07:32,960 --> 00:07:34,680 [woman 3] We get it more when it's like that. 134 00:07:35,560 --> 00:07:36,800 [woman 1] That's Mani for you. 135 00:07:36,880 --> 00:07:40,880 [Melissa] Thank you. Can we transfer him onto a monitor and get the primary survey? 136 00:07:40,960 --> 00:07:41,920 [man] Hey, Mani. 137 00:07:42,000 --> 00:07:45,560 -We might need to cut this off. -[Mani] That's fine. All good. Yeah. 138 00:07:47,760 --> 00:07:49,680 Apologies for any smelly feet. 139 00:07:49,760 --> 00:07:51,120 [people chuckle] 140 00:07:51,960 --> 00:07:55,480 -I'm gonna be overnight, ain't I? -Yeah, you're not going home today. 141 00:07:56,240 --> 00:07:58,080 [Mani] We won't celebrate our birthday tomorrow. 142 00:07:58,160 --> 00:08:00,080 [woman 4] It's your birthday tomorrow? 143 00:08:00,160 --> 00:08:01,520 [woman 5] Thirtieth birthday. 144 00:08:01,600 --> 00:08:02,960 -Thirtieth? -Yeah. 145 00:08:03,040 --> 00:08:04,760 -Oh, right. Okay. -Oh, mate! 146 00:08:04,840 --> 00:08:08,240 You're gonna have to redo that next year. You can't be doing that. 147 00:08:08,320 --> 00:08:09,760 We'll all have a party. 148 00:08:13,640 --> 00:08:15,440 [man] Can you move your fingers? 149 00:08:16,160 --> 00:08:18,080 -[Mani] No. -No? 150 00:08:20,440 --> 00:08:22,680 -Can you feel my touch here? -No. 151 00:08:23,920 --> 00:08:24,760 [man] No? 152 00:08:25,440 --> 00:08:28,120 [Mani] My last two fingers, I can't move them. 153 00:08:28,200 --> 00:08:29,720 [woman 3] We're gonna have a look. 154 00:08:29,800 --> 00:08:31,440 We'll see what's going on. Okay? 155 00:08:32,440 --> 00:08:35,240 [Melissa] A glass injury is often very similar to a knife wound. 156 00:08:35,320 --> 00:08:38,160 It can cut straight through pretty much anything. 157 00:08:39,000 --> 00:08:41,880 One of the most crucial things that we would check straight away 158 00:08:41,960 --> 00:08:43,080 is blood supply. 159 00:08:43,840 --> 00:08:45,720 And part of that is checking for a pulse. 160 00:08:47,920 --> 00:08:50,680 -[woman 3] What do you do for a living? -[Mani] Double glazing. 161 00:08:50,760 --> 00:08:52,880 You're not doing a good advert for it either. 162 00:08:52,960 --> 00:08:54,080 I have to say this. 163 00:08:54,680 --> 00:08:58,000 [Melissa] I assume he normally puts it up rather than puts himself through it. 164 00:08:58,080 --> 00:08:59,560 Yeah, 100%. 165 00:09:00,480 --> 00:09:02,000 [Melissa] Let's have a look. 166 00:09:02,880 --> 00:09:04,960 [woman 3] I'd look away if you don't wanna have a look. 167 00:09:05,040 --> 00:09:06,040 I don't wanna… 168 00:09:06,560 --> 00:09:08,760 -If you don't wanna see. -[Melissa] Hang on. 169 00:09:10,360 --> 00:09:12,120 -You're doing very well. -Man. 170 00:09:12,640 --> 00:09:13,480 [Melissa] Okay. 171 00:09:13,560 --> 00:09:15,960 [Mani] Fucking hell, that's a bad one, innit? 172 00:09:17,400 --> 00:09:20,040 Want more green stuff? You good? We're checking your pulse. 173 00:09:20,120 --> 00:09:22,360 We don't wanna poke your wound too hard. 174 00:09:22,440 --> 00:09:23,520 I can't feel it anyways. 175 00:09:23,600 --> 00:09:24,840 I can't find anything. 176 00:09:27,160 --> 00:09:28,680 [Melissa] You can't feel anything? 177 00:09:30,080 --> 00:09:31,640 -[Mani] No. -Okay. 178 00:09:32,280 --> 00:09:35,200 If we can't feel a pulse, then that's extremely worrying. 179 00:09:37,200 --> 00:09:39,440 If he's lost the main artery, 180 00:09:39,520 --> 00:09:42,680 then he could lose the whole blood supply to that hand. 181 00:09:42,760 --> 00:09:44,640 It could be a life-changing injury. 182 00:09:45,160 --> 00:09:46,840 We'll need to get an X-ray. 183 00:09:46,920 --> 00:09:48,240 Your fingers are numb, 184 00:09:48,320 --> 00:09:51,480 which means you likely have cut the nerve that's angled. 185 00:09:51,560 --> 00:09:54,560 So we can see there's some tendon injuries there as well. 186 00:09:54,640 --> 00:09:58,400 And the fact that it was spurting suggests you might have cut the artery too. 187 00:09:58,480 --> 00:10:00,840 So it's definitely gonna need an operation. 188 00:10:01,400 --> 00:10:02,440 [woman] You're doing good. 189 00:10:05,600 --> 00:10:09,880 I'm Manraj's middle sister. He has a big family. 190 00:10:10,400 --> 00:10:14,440 So, we are three sisters, and he's our baby brother. 191 00:10:16,120 --> 00:10:20,800 I'd describe him as a giant gentleman. 192 00:10:21,400 --> 00:10:24,120 Lively, kind. 193 00:10:24,920 --> 00:10:29,120 -You're a good guy. You're a funny guy. -Yeah. Favorite patient of the day. 194 00:10:31,400 --> 00:10:32,960 My father received a phone call. 195 00:10:33,040 --> 00:10:34,920 [woman] Let's just get this X-ray done. 196 00:10:35,000 --> 00:10:37,240 [Vee] He's had a terrible accident. 197 00:10:37,320 --> 00:10:39,360 He's bleeding out heavily. 198 00:10:40,040 --> 00:10:41,800 An ambulance has been called. 199 00:10:43,120 --> 00:10:45,400 I just felt sick to the stomach. 200 00:10:46,000 --> 00:10:47,680 [Mani] I think it's still oozing out blood. 201 00:10:47,760 --> 00:10:48,840 [man] Don't worry about it. 202 00:10:52,120 --> 00:10:54,520 [Vee] He's just started his own business. 203 00:10:55,320 --> 00:10:57,600 Oh! Fuck it. Oh man! 204 00:10:58,160 --> 00:10:59,520 [man] Get it raised a bit. 205 00:11:00,320 --> 00:11:02,760 [Vee] We don't know the extent of the damage. 206 00:11:04,680 --> 00:11:06,080 Difficult times ahead. 207 00:11:08,400 --> 00:11:09,960 [Melissa] Yeah, not nice. 208 00:11:11,680 --> 00:11:15,400 Mani has cut through his tendons, his artery and his nerves. 209 00:11:16,800 --> 00:11:19,120 The longer you leave an injury like this, 210 00:11:19,200 --> 00:11:22,160 the more likely there's going to be long-term consequences. 211 00:11:23,680 --> 00:11:26,400 The worst-case scenario is that he could lose his hand. 212 00:11:27,600 --> 00:11:30,440 The plastics team are the hand specialists. 213 00:11:30,520 --> 00:11:33,080 It's critical that they look at this very urgently. 214 00:11:38,360 --> 00:11:40,920 Manraj presented with a foreign body glass 215 00:11:41,000 --> 00:11:43,240 penetrating injury bilateral hands, elbow. 216 00:11:43,320 --> 00:11:44,480 In terms of his fallout, 217 00:11:44,560 --> 00:11:47,560 he had immediate on-the-nerve sensory deficit, 218 00:11:47,640 --> 00:11:49,520 and he's got motor deficit as well. 219 00:11:49,600 --> 00:11:52,000 You don't want to be doing that on your own. 220 00:11:52,600 --> 00:11:54,560 I think you need two people for that case. 221 00:11:54,640 --> 00:11:55,480 Yeah. 222 00:11:59,160 --> 00:12:01,720 [woman] Whenever someone hears "plastic surgeon," 223 00:12:01,800 --> 00:12:04,720 they would immediately think cosmetic surgery. 224 00:12:04,800 --> 00:12:08,480 Breast implant work or Botox or fillers of any kind. 225 00:12:08,560 --> 00:12:12,920 But often in major trauma, the plastic surgeon gets involved 226 00:12:13,000 --> 00:12:15,960 to save someone's limb or life, for that matter. 227 00:12:18,160 --> 00:12:23,080 Being a healthcare professional has taken me to so many places. 228 00:12:24,240 --> 00:12:27,400 As a medical student, I went to South Africa 229 00:12:27,480 --> 00:12:30,760 to work in essentially what looked like a hut hospital. 230 00:12:31,360 --> 00:12:36,280 They had a security guard with a gun and men bleeding with stab injuries, 231 00:12:36,360 --> 00:12:38,000 with gunshot wounds. 232 00:12:39,080 --> 00:12:44,600 Being a doctor, it's a very emotionally exhausting occupation. 233 00:12:46,600 --> 00:12:50,000 But there are always elements of surprises along the way. 234 00:12:52,520 --> 00:12:58,360 In 2021, I worked in New Zealand, and very quickly, should luck have it, 235 00:12:58,440 --> 00:13:01,680 I met my boyfriend Mickey when I was out there. 236 00:13:02,880 --> 00:13:07,320 We would spend many weekends travelling and hiking, 237 00:13:07,400 --> 00:13:11,080 and it's really important to have that safe space. 238 00:13:13,640 --> 00:13:14,960 Somebody to rely on. 239 00:13:17,960 --> 00:13:23,680 Because every day you realize that trauma can happen in a split second. 240 00:13:24,480 --> 00:13:26,280 It does not discriminate. 241 00:13:28,800 --> 00:13:31,080 We are all vulnerable to it. 242 00:13:36,000 --> 00:13:38,320 [Mani] How's it going, bud? Yeah, not too bad. 243 00:13:38,400 --> 00:13:41,800 What it is, though, I'm in hospital waiting for some surgery. 244 00:13:41,880 --> 00:13:44,120 I'm gonna get one of the boys to give you a call, 245 00:13:44,200 --> 00:13:47,080 and get my fitter down there to get that window fitted for you. 246 00:13:47,680 --> 00:13:49,560 Thank you. Take care now. 247 00:13:52,040 --> 00:13:54,200 Day in the life of a window fitter. 248 00:13:54,280 --> 00:13:55,960 It doesn't stop with me laid up. 249 00:13:58,640 --> 00:14:01,080 I'll be in the window trade ten years next year. 250 00:14:01,760 --> 00:14:03,160 Just me and my dad do it. 251 00:14:03,920 --> 00:14:05,520 Just the two of us, really. 252 00:14:06,320 --> 00:14:08,320 When it happened, I was on my own. 253 00:14:08,400 --> 00:14:10,880 I was going upstairs, and I ended up tripping, 254 00:14:10,960 --> 00:14:13,040 putting my hand through the glass. 255 00:14:13,120 --> 00:14:14,360 Went through two panes. 256 00:14:14,960 --> 00:14:16,800 Builder that was there called 999. 257 00:14:17,760 --> 00:14:19,320 I'll tell you something. 258 00:14:19,400 --> 00:14:22,760 I actually did not want to work this week 'cause it was my birthday. 259 00:14:23,480 --> 00:14:26,160 But needs is a must, so I had to work. 260 00:14:28,720 --> 00:14:31,680 Had I stuck to my guns, I don't think I'd be here right now. 261 00:14:33,560 --> 00:14:35,680 I'd be somewhere enjoying my 30th. 262 00:14:35,760 --> 00:14:38,240 But here we are over here, enjoying it, innit? 263 00:14:39,520 --> 00:14:43,240 We'll be enjoying it a bit more after the operation's done, to be honest. 264 00:14:47,120 --> 00:14:50,120 [Shan Shan] This operation is really crucial for Mani. 265 00:14:50,200 --> 00:14:53,160 His injury is quite significant and severe. 266 00:14:54,200 --> 00:14:57,000 He has cut through multiple soft tissue structures. 267 00:14:57,080 --> 00:15:00,120 But only in theater will we definitively find out 268 00:15:00,200 --> 00:15:02,320 what structures are damaged. 269 00:15:05,200 --> 00:15:06,640 But as it stands, 270 00:15:07,200 --> 00:15:08,880 he's got no hand function. 271 00:15:12,400 --> 00:15:14,400 [alarm blaring] 272 00:15:15,000 --> 00:15:16,240 [man 1] 150, go ahead. 273 00:15:16,320 --> 00:15:19,280 [woman] 1597, correct, over. Has he been able to walk on that leg? 274 00:15:19,360 --> 00:15:21,160 I'm gonna get help down to you now. 275 00:15:21,240 --> 00:15:22,640 [intense music playing] 276 00:15:23,440 --> 00:15:24,560 Copy, medic one, thank you. 277 00:15:26,600 --> 00:15:28,040 They're gonna go to King's. 278 00:15:39,360 --> 00:15:42,200 [man] Toby's a young guy who had a motorcycle accident. 279 00:15:43,680 --> 00:15:47,840 He injured both his arms and his legs, to such a significant degree 280 00:15:47,920 --> 00:15:50,080 that the blood supply was lost to his right leg. 281 00:15:52,080 --> 00:15:55,600 Despite all of the heroic attempts by our surgeons 282 00:15:55,680 --> 00:15:57,960 to resupply the foot with blood, 283 00:15:59,080 --> 00:16:02,680 unfortunately the vascular reconstruction failed. 284 00:16:03,600 --> 00:16:06,680 So, we had to make a decision between life and limb. 285 00:16:07,520 --> 00:16:08,840 And we chose life. 286 00:16:14,120 --> 00:16:15,880 [Toby] I just remember crying. 287 00:16:17,080 --> 00:16:18,160 I just looked down 288 00:16:18,240 --> 00:16:21,200 and just kept looking at it, really. 289 00:16:23,400 --> 00:16:24,680 Kept touching it, 290 00:16:25,320 --> 00:16:27,960 processing that my foot is not there anymore. 291 00:16:29,680 --> 00:16:32,000 I just thought it could be fixed. 292 00:16:32,520 --> 00:16:35,440 It was going to be fine. I got here in time. 293 00:16:36,040 --> 00:16:37,360 Unfortunately, not. 294 00:16:39,440 --> 00:16:42,640 I'm still trying to understand how my life's gonna change. 295 00:16:46,280 --> 00:16:47,160 [Toby laughs] 296 00:16:53,040 --> 00:16:54,600 [Jessica] It's heartbreaking. 297 00:16:55,640 --> 00:17:01,560 There is absolutely nothing we can do to make this situation better. 298 00:17:03,280 --> 00:17:07,680 He does understand what's happened, but I'm not sure he's processed 299 00:17:07,760 --> 00:17:08,840 what that means. 300 00:17:09,640 --> 00:17:11,760 He's not gonna be able to go to the gym. 301 00:17:12,560 --> 00:17:14,480 He's not gonna be able to work for a while. 302 00:17:15,960 --> 00:17:18,760 We don't know what can be done to help him get back 303 00:17:18,840 --> 00:17:21,640 to some kind of normality. 304 00:17:26,520 --> 00:17:28,800 As a blind person myself, 305 00:17:29,560 --> 00:17:32,200 the world can be very difficult. 306 00:17:33,200 --> 00:17:38,320 Most people, I find, see the disability before they see the person. 307 00:17:39,360 --> 00:17:42,440 And it's, "How can he get through that?" 308 00:17:43,680 --> 00:17:45,800 I think that is my biggest concern. 309 00:17:46,920 --> 00:17:49,520 It's so hard because your thought just… 310 00:17:50,720 --> 00:17:53,320 All your thoughts go out to him, and you want to be there, 311 00:17:53,400 --> 00:17:54,840 and you want to support him. 312 00:18:02,400 --> 00:18:06,000 [Ed] When a patient goes through a catastrophic injury like Toby, 313 00:18:06,520 --> 00:18:08,280 it's a long road of recovery. 314 00:18:09,400 --> 00:18:13,280 As a doctor, you wanna get them back to doing whatever they love, back to work, 315 00:18:13,360 --> 00:18:17,200 back with their families, and in no pain, which is the key thing. 316 00:18:19,880 --> 00:18:22,480 I had a bit of a roundabout way into medicine. 317 00:18:22,560 --> 00:18:24,280 I had no idea what I wanted to do. 318 00:18:24,360 --> 00:18:27,680 So, actually, I ended up going and work for an investment bank. 319 00:18:27,760 --> 00:18:31,480 Work was really interesting. The people were dreadful. Um… 320 00:18:31,560 --> 00:18:35,680 They would climb over the dead bodies of their parents to make more money. 321 00:18:37,840 --> 00:18:40,440 I went out for dinner with my sister, who's a doctor. 322 00:18:40,520 --> 00:18:43,440 And she told me about a graduate degree in medicine. 323 00:18:43,520 --> 00:18:47,800 So I started medical school when I was 26. 324 00:18:47,880 --> 00:18:51,760 As a plastic surgeon, there's a bit of art in making something look good. 325 00:18:51,840 --> 00:18:53,760 But ultimately, for me, 326 00:18:54,360 --> 00:18:57,600 it's about putting people back together again after major trauma. 327 00:19:02,400 --> 00:19:04,520 Can you just show me the report of the CT? 328 00:19:06,600 --> 00:19:10,400 My orthopedic colleagues have fixed Toby's femur fracture. 329 00:19:10,480 --> 00:19:14,560 And we performed a guillotine amputation, which is a rapid amputation. 330 00:19:15,680 --> 00:19:20,520 So, he needs a plate, and we need to finalize his stump and shorten it. 331 00:19:22,880 --> 00:19:25,240 Now we need to take stock, 332 00:19:25,320 --> 00:19:29,360 see how much of the soft tissue is healthy, how much skin survives, 333 00:19:29,880 --> 00:19:33,720 and then carefully turn it into a definitive amputation 334 00:19:33,800 --> 00:19:37,240 that is robust enough to allow him to wear a prosthesis 335 00:19:37,320 --> 00:19:38,920 and hopefully walk again. 336 00:19:40,000 --> 00:19:42,360 Trauma, by the nature, there's big wounds, 337 00:19:42,440 --> 00:19:46,600 big injuries, big cuts, and so rarely do you just break one thing. 338 00:19:47,720 --> 00:19:49,080 He's a polytrauma patient, 339 00:19:49,160 --> 00:19:52,080 so he's got a closed right arm fracture as well. 340 00:19:52,600 --> 00:19:54,600 That arm's gonna take you what, an hour? 341 00:19:54,680 --> 00:19:58,080 -It's a big-- -[man] The humerus? Yeah, sure. At least. 342 00:19:58,600 --> 00:20:01,360 Soft tissue and bones will all break all at the same time, 343 00:20:01,440 --> 00:20:06,240 so the ability to get a plastic surgeon and an orthopedic surgeon in the same room 344 00:20:06,320 --> 00:20:09,200 to do the operation at the same time is unrivalled. 345 00:20:12,720 --> 00:20:18,800 My colleague, Ash, will focus on his arm, whilst I'll focus on the soft tissue. 346 00:20:19,320 --> 00:20:21,640 -Do you have to do it lateral? -[Ash] No, supine. 347 00:20:21,720 --> 00:20:23,880 Okay, then I can do the leg at the same time. 348 00:20:23,960 --> 00:20:25,320 [Ash] Yeah, exactly. 349 00:20:25,400 --> 00:20:26,800 [Ed] Ash is a unique individual. 350 00:20:26,880 --> 00:20:29,520 He lives and breathes trauma, and he's passionate about it, 351 00:20:29,600 --> 00:20:31,480 and he's really good at it. 352 00:20:31,560 --> 00:20:36,600 I can look at a fracture fixed by Ash and five other surgeons, 353 00:20:36,680 --> 00:20:38,680 and I'll know exactly which one he did. 354 00:20:40,080 --> 00:20:43,560 [Ash] Working with a great team around me is really a privilege. 355 00:20:44,800 --> 00:20:50,040 There was a solid year where Ed and I did every single open fracture case. 356 00:20:50,120 --> 00:20:51,800 Ed I implicitly trust, you know. 357 00:20:51,880 --> 00:20:54,560 One of the few people I'd let operate on any of my family, 358 00:20:54,640 --> 00:20:55,480 without question. 359 00:20:58,000 --> 00:21:01,320 -[woman] Is that your lunch? -Yeah, I'm gonna mix it all together. 360 00:21:01,400 --> 00:21:03,480 So, when I was doing my fellowship, 361 00:21:03,560 --> 00:21:07,480 I had to find the cheapest food around because I was fairly poor at that time. 362 00:21:07,560 --> 00:21:10,320 So this is my lunch then, and I literally can't… 363 00:21:10,400 --> 00:21:12,480 I like it too much now to not eat it. 364 00:21:13,520 --> 00:21:16,720 Ed thinks it's boring, but I still find it lovely. 365 00:21:17,320 --> 00:21:19,320 Just need to get some crisps now. 366 00:21:20,160 --> 00:21:23,120 [Ed] He's very methodical. He's very precise. 367 00:21:24,000 --> 00:21:27,440 So yeah, it doesn't surprise me he eats the same thing every day. 368 00:21:28,040 --> 00:21:31,520 [Ash] Couscous, avocado, falafel and crisps all mixed up. 369 00:21:31,600 --> 00:21:33,240 Same lunch for eight years. 370 00:21:34,080 --> 00:21:34,920 That's it. 371 00:21:38,520 --> 00:21:39,720 [tense music playing] 372 00:21:48,520 --> 00:21:51,440 [Ed] If we don't get a good definitive amputation, 373 00:21:51,520 --> 00:21:55,600 then Toby could be left in a wheelchair for the rest of his life. 374 00:21:57,200 --> 00:22:00,960 I just want something to put over there. A dressing of some kind. 375 00:22:02,200 --> 00:22:07,200 It's a really important operation that will define his future. 376 00:22:09,200 --> 00:22:11,680 This isn't a straightforward amputation. 377 00:22:14,000 --> 00:22:18,160 He's lost quite a lot of muscle, which you would normally look to use. 378 00:22:18,240 --> 00:22:21,600 You gotta think on your feet, work with what you've got. 379 00:22:25,560 --> 00:22:28,800 Plan A was, "Do it like this," and then you go, "That's not gonna work." 380 00:22:28,880 --> 00:22:32,600 So yeah, it can be quite challenging, but that's the beauty of trauma. 381 00:22:32,680 --> 00:22:35,960 'Cause you never know what you're gonna do until you get there. 382 00:22:39,240 --> 00:22:40,640 Still bits of road in here. 383 00:22:41,840 --> 00:22:42,680 Jesus. 384 00:22:43,200 --> 00:22:45,280 Can I get a three-liter bag of saline, please? 385 00:22:46,840 --> 00:22:50,160 Major amputations are pretty bloody. 386 00:22:51,560 --> 00:22:53,240 It can be brutal at times. 387 00:22:53,840 --> 00:22:55,400 There's a bit of pus in here. 388 00:22:56,160 --> 00:22:58,360 [Ash] Let's keep our stuff separate. 389 00:22:59,280 --> 00:23:03,360 [Ed] If we see a lot of pus in a wound, it can be a bit of a red flag. 390 00:23:03,440 --> 00:23:05,880 And infections can be life-threatening. 391 00:23:09,040 --> 00:23:11,640 It's all really mashed down here, unfortunately. 392 00:23:13,040 --> 00:23:15,200 It's difficult to see where his sural nerve is 393 00:23:15,280 --> 00:23:16,640 and his saphenous nerve. 394 00:23:18,800 --> 00:23:19,800 Tricky. 395 00:23:21,600 --> 00:23:26,360 All of the nerves are going to be damaged below the level of the amputation. 396 00:23:27,960 --> 00:23:31,760 The nerves end up firing these wrong signals, 397 00:23:31,840 --> 00:23:35,120 telling the brain the toes are curling or the foot is burning. 398 00:23:35,200 --> 00:23:37,520 Electric shock-like sensations. 399 00:23:38,560 --> 00:23:40,120 To prevent phantom limb pain, 400 00:23:40,200 --> 00:23:41,800 we move the nerve endings 401 00:23:41,880 --> 00:23:44,720 into other nerves and muscles. 402 00:23:44,800 --> 00:23:48,640 And that gives that nerve something to do and somewhere to go. 403 00:23:54,040 --> 00:23:55,480 We're hampered by the fact 404 00:23:55,560 --> 00:23:58,200 that his muscles have been cut really quite short. 405 00:23:58,280 --> 00:24:01,760 So, unfortunately, it doesn't quite follow the textbook. 406 00:24:03,680 --> 00:24:06,760 You have to kinda work out what you've got, what you need, 407 00:24:07,360 --> 00:24:12,080 and how you can salvage the situation with the structure you've got. 408 00:24:12,160 --> 00:24:14,080 That's trauma, really, isn't it? 409 00:24:15,080 --> 00:24:18,760 So, Ash is getting on and fixing his arm. 410 00:24:19,560 --> 00:24:23,400 If we can fix his arm in a timely manner, along with his leg, 411 00:24:23,480 --> 00:24:26,720 then he's got a good arm that he can use with crutches. 412 00:24:26,800 --> 00:24:29,360 And so he can start his physio that much sooner. 413 00:24:30,240 --> 00:24:33,160 [Ash] See some biceps there. That deltoid is going slightly different, 414 00:24:33,240 --> 00:24:35,640 so your vein would probably be around here. 415 00:24:36,960 --> 00:24:40,440 It's been a little while since his injury, so his fracture is trying to heal. 416 00:24:40,520 --> 00:24:43,680 So we need to release it a bit so we can make it a bit more mobile 417 00:24:43,760 --> 00:24:46,320 so we can then put the jigsaw back together. 418 00:24:48,240 --> 00:24:49,080 Thank you. 419 00:24:53,400 --> 00:24:56,120 So, we've got the plate inside. We're gonna centralize it 420 00:24:56,200 --> 00:24:58,480 just to make sure it's sitting on the bone properly 421 00:24:58,560 --> 00:25:01,160 to help really hold it in a very robust manner. 422 00:25:02,320 --> 00:25:04,960 Lots of length, as much as you can. More. 423 00:25:05,560 --> 00:25:06,400 Yeah. Nice. 424 00:25:10,320 --> 00:25:11,480 X-ray there. 425 00:25:15,200 --> 00:25:16,320 That's great. Okay. 426 00:25:16,400 --> 00:25:19,800 So, we're happy with everything. So now we're just gonna close up. 427 00:25:21,440 --> 00:25:24,440 [Ed] This is slowly coming back together. It's quite tricky. 428 00:25:25,160 --> 00:25:27,960 Not enough muscle to cover the end of the stump. 429 00:25:30,520 --> 00:25:32,600 I've reattached the muscles where I can. 430 00:25:33,120 --> 00:25:34,840 He's got flexion and extension. 431 00:25:35,360 --> 00:25:38,200 But I think I've managed to achieve what we set out to do. 432 00:25:40,720 --> 00:25:43,920 At the end, you know that every stitch that you put in, 433 00:25:44,600 --> 00:25:47,080 you're either gonna thank or regret. 434 00:25:47,160 --> 00:25:48,400 You have to get it right. 435 00:25:51,120 --> 00:25:54,760 Someone who's 19, 20, whatever you end up doing, 436 00:25:54,840 --> 00:25:57,440 they're gonna live with for 60, 70 years. 437 00:25:57,520 --> 00:26:00,040 So you have to make sure that whatever you do is robust 438 00:26:00,120 --> 00:26:01,360 and it's gonna last them. 439 00:26:04,560 --> 00:26:06,720 Yeah. Ugh. Um… 440 00:26:07,720 --> 00:26:08,840 Yeah, it's tricky. 441 00:26:09,560 --> 00:26:10,720 I… I… I think, um, 442 00:26:12,160 --> 00:26:15,560 the traumatic amputation kinda doesn't leave you with much 443 00:26:16,080 --> 00:26:18,000 to move around. 444 00:26:18,080 --> 00:26:20,600 But I was able to find the key nerves, 445 00:26:20,680 --> 00:26:23,960 shorten the bone to a decent level, cover the bone end with muscle. 446 00:26:24,680 --> 00:26:26,800 That gives it a decent amount of padding. 447 00:26:28,440 --> 00:26:32,600 We'll only really know how well it's gone after he starts rehab. 448 00:26:33,160 --> 00:26:37,360 So, hopefully, we'll be able to get him onto a prosthesis relatively quickly. 449 00:26:39,120 --> 00:26:41,120 You have to have maturity to be a doctor 450 00:26:41,200 --> 00:26:43,240 because you are in a very privileged position. 451 00:26:43,320 --> 00:26:45,760 You're managing patients who are probably 452 00:26:45,840 --> 00:26:48,520 in their most vulnerable period of their life. 453 00:26:49,200 --> 00:26:52,320 It's not about me. It's not about how I feel. 454 00:26:52,400 --> 00:26:55,080 It's about knowing that what you've done 455 00:26:55,160 --> 00:26:58,720 will put your patient in the best possible position 456 00:26:58,800 --> 00:27:00,320 to get back to normal. 457 00:27:06,720 --> 00:27:08,000 [intense music playing] 458 00:27:08,080 --> 00:27:11,800 [woman] Twenty-year-old male, tripped over, head injury, GCS3. 459 00:27:12,400 --> 00:27:14,520 AP60's en route, ETA of 20 minutes. 460 00:27:18,000 --> 00:27:19,280 [sirens blaring] 461 00:27:26,320 --> 00:27:29,960 [Shan Shan] My fascination with anatomy started early. 462 00:27:31,400 --> 00:27:33,760 I grew up in China in the '80s. 463 00:27:35,160 --> 00:27:36,600 And when I was six years old, 464 00:27:36,680 --> 00:27:39,040 my dad used to give me a little plastic basket 465 00:27:39,120 --> 00:27:42,120 and some change, and he used to send me to the fish market. 466 00:27:42,720 --> 00:27:44,960 The fishermen, they thought it was hilarious 467 00:27:45,040 --> 00:27:47,360 seeing a little child with a little basket 468 00:27:48,160 --> 00:27:49,760 and some change. 469 00:27:49,840 --> 00:27:52,200 And so they were always very kind to me. 470 00:27:53,520 --> 00:27:56,880 When I brought the fish back, my dad would take me to the kitchen 471 00:27:56,960 --> 00:27:59,360 and show me which bits of the fins to cut. 472 00:28:00,360 --> 00:28:02,560 And then he would use a pair of scissors, 473 00:28:02,640 --> 00:28:06,120 open up the fish's belly and rip out the organs. 474 00:28:06,960 --> 00:28:10,280 And I used to be very eager and say, "No, I want to do it." 475 00:28:10,360 --> 00:28:12,440 And so he would teach me how to do it. 476 00:28:14,280 --> 00:28:17,160 I found that whole process very visceral. 477 00:28:17,240 --> 00:28:18,080 I loved it. 478 00:28:20,640 --> 00:28:22,280 That was one of the key moments 479 00:28:22,360 --> 00:28:25,360 that led to me becoming a plastic surgeon today. 480 00:28:30,800 --> 00:28:32,360 [Alice] Have a nice sleep for your 30th. 481 00:28:33,000 --> 00:28:35,240 I'll have to celebrate twice as hard next year. 482 00:28:35,320 --> 00:28:36,200 [Alice] Yeah. 483 00:28:41,000 --> 00:28:44,120 [Shan Shan] Like many other surgeons, I'm my own worst enemy 484 00:28:44,200 --> 00:28:46,320 because I just want everything to be perfect. 485 00:28:47,120 --> 00:28:51,720 [Alice] Okay. Surgical site's marked. Imaging has been reviewed this morning. 486 00:28:51,800 --> 00:28:54,160 But to be a good plastic surgeon… 487 00:28:56,600 --> 00:28:58,320 you have to be a perfectionist. 488 00:28:59,040 --> 00:29:02,520 [Alice] You can see here, he's lost his normal cascade. 489 00:29:02,600 --> 00:29:06,720 Every finger should be held like that. So you can see how these are straighter. 490 00:29:06,800 --> 00:29:10,160 Plastic surgery is the most intricate of all specialties. 491 00:29:10,760 --> 00:29:14,840 We do microsurgery, connecting tiny blood vessels and nerves 492 00:29:14,920 --> 00:29:17,920 that are less than one millimeter in diameter. 493 00:29:19,080 --> 00:29:21,440 [Alice] We wrote up on the board the structures. 494 00:29:21,520 --> 00:29:24,200 So you want to identify what's broken, what needs fixing. 495 00:29:24,280 --> 00:29:28,840 P. FDS. Okey dokey. 496 00:29:29,760 --> 00:29:32,520 [Shan Shan] With Mani's job as a manual worker, 497 00:29:32,600 --> 00:29:36,600 knowing that patient's livelihood is entirely destroyed 498 00:29:36,680 --> 00:29:38,440 if he cannot use the hand, 499 00:29:39,280 --> 00:29:40,920 that is a lot of pressure. 500 00:29:42,400 --> 00:29:43,480 All right. 501 00:29:43,560 --> 00:29:46,760 [Alice] Pretty much everything that we thought was gone is gone. 502 00:29:49,800 --> 00:29:52,120 [Shan Shan] Mani has a significant injury. 503 00:29:52,800 --> 00:29:54,880 He has cut through ten tendons. 504 00:29:56,640 --> 00:29:58,840 Tendons essentially are structures 505 00:29:58,920 --> 00:30:02,120 that join the muscle onto the bone. 506 00:30:02,200 --> 00:30:04,400 He's gone through several layers of tendons 507 00:30:04,480 --> 00:30:08,360 that connect your forearm and the joints of the fingers 508 00:30:08,440 --> 00:30:11,040 that allow you to open and close your hand. 509 00:30:11,840 --> 00:30:15,920 And also he's cut through one artery and one of the main nerves. 510 00:30:17,160 --> 00:30:21,400 If we don't repair every single thing, he will be left without his hand. 511 00:30:22,760 --> 00:30:25,080 So spaghetti-like. 512 00:30:25,960 --> 00:30:28,720 Plastic surgery is a bit like origami sometimes, 513 00:30:28,800 --> 00:30:32,960 figuring out what's damaged and how to reorientate everything. 514 00:30:33,640 --> 00:30:36,000 [Alice] He has shredded this at the worst place. 515 00:30:36,760 --> 00:30:39,040 He's cut it where tendon becomes muscle. 516 00:30:40,560 --> 00:30:44,040 [Shan Shan] When the tendon has been cut very close to the muscle, 517 00:30:44,120 --> 00:30:45,680 the muscle will contract, 518 00:30:46,280 --> 00:30:50,080 so the tendon end is buried within the muscle itself. 519 00:30:51,200 --> 00:30:53,440 [Alice] It would have slipped back if it helped me. 520 00:30:53,520 --> 00:30:55,640 [Shan Shan] Tendons, they're like elastic bands, 521 00:30:55,720 --> 00:31:00,440 and they do retract in your forearms and become quite difficult to find. 522 00:31:00,520 --> 00:31:03,120 -[tense music playing] -Take that arm out. Perfect. 523 00:31:03,640 --> 00:31:06,080 So we're having to extend the wound 524 00:31:06,160 --> 00:31:09,440 to find out where the retracted tendons are. 525 00:31:20,040 --> 00:31:22,640 This one's really retracted. 526 00:31:23,760 --> 00:31:26,280 -And they have even to extend more. -[Alice] More. 527 00:31:26,360 --> 00:31:28,240 [Shan Shan] This is crazy. 528 00:31:29,600 --> 00:31:32,600 The more you cut off, the more it will affect the function. 529 00:31:32,680 --> 00:31:34,400 [heart beating loudly] 530 00:31:37,320 --> 00:31:40,080 In theater, it often is high pressure, 531 00:31:40,800 --> 00:31:43,160 but as soon as I'm wielding a knife, 532 00:31:43,240 --> 00:31:45,880 everything else completely zones out, 533 00:31:45,960 --> 00:31:48,560 and I'm absolutely focused on what I'm doing. 534 00:31:49,080 --> 00:31:50,560 We can't make mistakes. 535 00:31:54,480 --> 00:31:56,600 [Alice] There's something down there. 536 00:31:56,680 --> 00:32:00,040 -Part of a FDP ring, is it? -[Shan Shan] It's definitely a FDP ring. 537 00:32:00,640 --> 00:32:02,360 Now we're starting to see them. 538 00:32:03,240 --> 00:32:04,400 -That is that. -[Alice] Yeah. 539 00:32:04,480 --> 00:32:06,720 -[Shan Shan] That is to that bit. -[Alice] Yeah. 540 00:32:06,800 --> 00:32:09,040 [Shan Shan] So I'm gonna repair that big one. 541 00:32:09,720 --> 00:32:10,680 [Alice] Yeah. Nice. 542 00:32:15,000 --> 00:32:18,280 [Shan Shan] It's quite remarkable, really, when you think about these little tendons. 543 00:32:18,360 --> 00:32:20,000 Tiny little structures that you see 544 00:32:20,080 --> 00:32:22,440 essentially can carry your entire body weight. 545 00:32:23,400 --> 00:32:25,920 That is the index. Now I'm gonna do the middle. 546 00:32:28,280 --> 00:32:31,720 There's a lot of misperception of surgeons and our jobs, 547 00:32:31,800 --> 00:32:34,520 certainly our society in general. 548 00:32:35,080 --> 00:32:39,040 You know, people always think that women do other things, 549 00:32:39,120 --> 00:32:42,280 but I would say in plastic surgery specifically… 550 00:32:42,360 --> 00:32:43,560 [Alice] We've got a few girls. 551 00:32:43,640 --> 00:32:46,080 [Shan Shan] There is a higher proportion of female surgeons. 552 00:32:47,040 --> 00:32:48,760 -[Alice] Girl power. -[Shan Shan laughs] 553 00:32:50,080 --> 00:32:52,000 [Shan Shan] All right, so believe it or not, 554 00:32:52,080 --> 00:32:55,880 after all those knots, we've just repaired the tendons. 555 00:32:57,200 --> 00:32:59,440 [Alice] Dream team. Thanks so much. 556 00:33:01,120 --> 00:33:05,160 Teamwork makes a dream work, and it's absolutely true in surgery. 557 00:33:06,240 --> 00:33:10,440 I liken it to Formula One cars and having their wheels changed. 558 00:33:10,520 --> 00:33:11,800 Everybody has a role 559 00:33:11,880 --> 00:33:15,080 and everybody does their specific role really well 560 00:33:15,680 --> 00:33:18,240 to get the best outcome for the patient. 561 00:33:20,240 --> 00:33:22,160 [Alice] We're gonna repair the ulnar artery 562 00:33:22,240 --> 00:33:24,080 and the ulnar nerve under the microscope. 563 00:33:24,160 --> 00:33:27,680 Can I have a stay suture and an artery clip? 564 00:33:30,120 --> 00:33:33,120 Just getting the two ends of the vessel prepared. 565 00:33:35,080 --> 00:33:38,880 [Shan Shan] The ulnar artery delivers blood to keep the hand alive. 566 00:33:39,920 --> 00:33:41,400 When we repair an artery, 567 00:33:41,480 --> 00:33:46,040 we want the tube to reconnect so that blood can easily flow through it. 568 00:33:46,120 --> 00:33:48,200 [tense music playing] 569 00:33:48,280 --> 00:33:50,880 [Alice] I'm gonna do one more here, and then loops. 570 00:33:57,600 --> 00:33:59,280 Right. Moment of truth. 571 00:34:00,080 --> 00:34:03,960 We do a test to check the blood's flowing and not getting stopped somewhere. 572 00:34:08,840 --> 00:34:10,480 We've got a pulse again. 573 00:34:10,560 --> 00:34:13,480 [Shan Shan] We now move on to the nerve. 574 00:34:13,560 --> 00:34:16,720 The nerves are there to supply sensation to the hand. 575 00:34:17,320 --> 00:34:19,560 [Alice] This is why the patient can't feel his fingers, 576 00:34:19,640 --> 00:34:20,960 because he's cut it in half. 577 00:34:21,680 --> 00:34:24,360 [Shan Shan] Nerve repair requires using the right instrument 578 00:34:24,440 --> 00:34:27,480 to help to bring the ends of the nerve together. 579 00:34:28,000 --> 00:34:30,320 We do sometimes also use glue. 580 00:34:31,400 --> 00:34:34,040 [Alice] It's called Tisseel. Basically, nerve glue. 581 00:34:34,640 --> 00:34:39,760 [Shan Shan] The glue is synthetic fibrin, which we all make when we have a cut. 582 00:34:39,840 --> 00:34:43,120 The gunkiness of the wound that forms very quickly, 583 00:34:43,880 --> 00:34:45,720 that essentially is fibrin. 584 00:34:45,800 --> 00:34:47,120 [tense music continues] 585 00:34:54,960 --> 00:34:57,040 That nerve is intact. 586 00:34:57,560 --> 00:34:58,520 Job well done. 587 00:34:59,960 --> 00:35:01,280 We'll finish off here. 588 00:35:01,360 --> 00:35:02,640 [emotional music playing] 589 00:35:08,200 --> 00:35:12,080 When you know that you've done the best possible job that you can, 590 00:35:12,160 --> 00:35:16,400 and that the patient hopefully will get a good result, it's exhilarating. 591 00:35:17,360 --> 00:35:19,200 That's incredible for me. 592 00:35:21,200 --> 00:35:23,440 Okay. Thank you everyone. 593 00:35:25,720 --> 00:35:29,840 Trauma is a unique journey to each person and their family. 594 00:35:33,880 --> 00:35:38,440 And I know the devastating effect of a major trauma firsthand. 595 00:35:42,560 --> 00:35:44,120 Life was beautiful. 596 00:35:44,960 --> 00:35:48,880 Mickey and I, we led a very hedonistic life 597 00:35:48,960 --> 00:35:51,040 just full of laughter and joy. 598 00:35:54,040 --> 00:35:55,280 We'd do crazy things 599 00:35:55,360 --> 00:35:58,600 like hiking at 3:00 in the morning just to see a sunrise 600 00:35:59,120 --> 00:36:03,120 or hiking in the dark just to see the stars. Um… 601 00:36:04,120 --> 00:36:06,680 He was… He was my best friend. 602 00:36:09,080 --> 00:36:11,840 On 18th March, um… 603 00:36:12,480 --> 00:36:16,120 I went to a clinic 604 00:36:17,120 --> 00:36:20,200 around two, three hours' drive from where I was based. 605 00:36:20,720 --> 00:36:24,200 Mickey insisted that he wanted to join me on that journey. 606 00:36:25,240 --> 00:36:27,920 I drove most of the time, 607 00:36:28,000 --> 00:36:32,640 but on this particular day, I was feeling very tired. 608 00:36:33,240 --> 00:36:37,440 For the first time, I actually asked him, "Do you mind driving us home?" 609 00:36:38,080 --> 00:36:39,360 And he did. 610 00:36:42,680 --> 00:36:44,880 Within ten minutes of that journey 611 00:36:46,680 --> 00:36:50,680 we were hit by an oil tanker at high speed. 612 00:36:53,120 --> 00:36:56,040 I remember the car spinning, 613 00:36:56,640 --> 00:36:59,000 and I remember Mickey reaching out, 614 00:37:00,040 --> 00:37:01,560 grabbing my hand. 615 00:37:03,120 --> 00:37:08,200 And the last thing he said to me was, "I love you, Shan Shan." 616 00:37:10,320 --> 00:37:11,440 And that was it. 617 00:37:14,680 --> 00:37:19,240 So I had multiple injuries that kept me in ICU. 618 00:37:21,880 --> 00:37:25,240 I remember, days after the accident, 619 00:37:26,240 --> 00:37:27,080 this 620 00:37:28,000 --> 00:37:29,320 amazing nurse 621 00:37:30,360 --> 00:37:33,080 telling me that Mickey didn't make it. 622 00:37:33,160 --> 00:37:34,640 [emotional music continues] 623 00:37:36,280 --> 00:37:37,840 In that split second, 624 00:37:37,920 --> 00:37:41,280 it was as if a bomb had gone off 625 00:37:41,880 --> 00:37:44,880 that excavated everything that I had. 626 00:37:50,040 --> 00:37:51,800 I think I suffered from 627 00:37:52,680 --> 00:37:55,000 extreme survivor's guilt 628 00:37:56,440 --> 00:37:58,080 that I got to live. 629 00:38:01,440 --> 00:38:04,840 Trauma patients often carry a psychological burden. 630 00:38:05,880 --> 00:38:07,840 People will feel 631 00:38:08,560 --> 00:38:09,560 disbelief… 632 00:38:12,360 --> 00:38:13,480 anger, 633 00:38:14,360 --> 00:38:15,920 and regret. 634 00:38:16,720 --> 00:38:19,240 But forgiveness is critical, 635 00:38:21,120 --> 00:38:23,240 because life is so precious, 636 00:38:24,960 --> 00:38:27,240 and there is light at the end of the tunnel. 637 00:38:30,200 --> 00:38:31,640 We're happy to send you home. 638 00:38:32,400 --> 00:38:34,480 All right. I'll see you later. Bye. 639 00:38:36,240 --> 00:38:39,400 [Shan Shan] Being a major trauma patient myself 640 00:38:39,480 --> 00:38:42,600 has really made me appreciate 641 00:38:42,680 --> 00:38:46,920 the totality of what trauma and trauma recovery is. 642 00:38:47,000 --> 00:38:49,080 And it's really helped me 643 00:38:49,640 --> 00:38:53,360 to better manage my patients and their family. 644 00:39:05,120 --> 00:39:08,120 [Ibraheim] Okay. Postoperatives from yesterday. 645 00:39:08,200 --> 00:39:10,760 Let's go through them. This is Jared. 646 00:39:11,480 --> 00:39:13,040 He's a really nice guy. 647 00:39:14,360 --> 00:39:18,080 That butterfly fragment was quite difficult to reduce. 648 00:39:18,160 --> 00:39:19,640 I… I think it's in a good… 649 00:39:19,720 --> 00:39:20,560 Looks good now. 650 00:39:20,640 --> 00:39:22,320 [Ibraheim] Yeah. It looks… 651 00:39:22,400 --> 00:39:25,680 And it was flipped as well. So, now we've got it in the right place. 652 00:39:28,480 --> 00:39:29,320 [woman] Morning. 653 00:39:31,240 --> 00:39:33,160 -[Ibraheim] Hi, Jared. -[man] Hi there. 654 00:39:33,920 --> 00:39:35,080 Sorry for waking you up. 655 00:39:37,040 --> 00:39:38,960 [Ibraheim] Operation went really well yesterday. 656 00:39:39,040 --> 00:39:41,280 It went really well. So I'm really pleased. 657 00:39:41,800 --> 00:39:44,680 We got the job done. We put the nail down, the metal rod 658 00:39:44,760 --> 00:39:46,720 inside your canal, so… 659 00:39:47,240 --> 00:39:48,640 So really happy with that. 660 00:39:48,720 --> 00:39:52,800 You're gonna start getting you to dangle your foot off the edge of the bed. Yeah? 661 00:39:53,360 --> 00:39:55,560 And then we'll slowly get you up and about. 662 00:39:56,680 --> 00:39:59,840 [man] So, from our side, Jared, if dangling is good, 663 00:39:59,920 --> 00:40:03,880 just keep the leg down as much as you want from day four or five. 664 00:40:04,560 --> 00:40:07,720 Okay? And from there on, you can start doing physio and everything. 665 00:40:07,800 --> 00:40:09,840 We'll tell you the regimen. Don't worry. 666 00:40:10,840 --> 00:40:12,160 Yeah, look like you. 667 00:40:12,240 --> 00:40:13,600 [Ibraheim and Jared laugh] 668 00:40:13,680 --> 00:40:15,760 Well, why don't you want to look like me? 669 00:40:18,320 --> 00:40:21,080 [man] You're doing well, so we're feeling positive. 670 00:40:21,160 --> 00:40:22,920 -[woman] Yeah. It's good. -Thank you. 671 00:40:23,000 --> 00:40:24,520 [emotional music playing] 672 00:40:24,600 --> 00:40:26,600 [man] Hopefully, you can get some rest. 673 00:40:29,080 --> 00:40:32,720 [Ibraheim] It's the most amazing feeling to see someone who, 674 00:40:33,680 --> 00:40:38,400 in that moment of having an accident, their whole life has stopped. 675 00:40:40,120 --> 00:40:45,040 And then you go in, and your whole aim is to make them better. 676 00:40:46,200 --> 00:40:50,080 You then start to see them in the recovery phase in clinic, 677 00:40:50,160 --> 00:40:52,520 and you watch them go through the cycle. 678 00:40:54,200 --> 00:40:56,880 To see that person on the road to recovery, 679 00:40:58,240 --> 00:41:01,440 there's nothing that can replace that feeling. 680 00:41:03,560 --> 00:41:07,400 I never knew I was gonna appreciate the NHS to this magnitude. 681 00:41:08,760 --> 00:41:10,640 Until these things happen to you, 682 00:41:10,720 --> 00:41:16,240 you wouldn't know how unappreciative or how much of a… 683 00:41:17,840 --> 00:41:19,320 I don't know how to say this. 684 00:41:20,160 --> 00:41:22,360 How much of an arse you are. 685 00:41:24,280 --> 00:41:27,360 This situation has given me a little epiphany 686 00:41:27,440 --> 00:41:32,240 in terms of really living certain moments, you know? 687 00:41:32,320 --> 00:41:35,800 'Cause you just don't know when they're gonna be taken away. 688 00:41:36,320 --> 00:41:38,680 I've never felt this feeling before. 689 00:41:38,760 --> 00:41:40,960 I'm gonna live my happiest days now. 690 00:41:41,040 --> 00:41:41,920 You know? 691 00:41:42,720 --> 00:41:44,160 So, we shall see. 692 00:41:53,600 --> 00:41:55,080 [phone ringing] 693 00:41:57,240 --> 00:41:59,240 [woman 1] Someone has beaten up my boyfriend. 694 00:41:59,320 --> 00:42:01,560 He's not breathing. There's blood everywhere. 695 00:42:01,640 --> 00:42:04,720 There's blood everywhere. 696 00:42:04,800 --> 00:42:05,640 Please! 697 00:42:05,720 --> 00:42:06,720 [heart beating] 698 00:42:07,640 --> 00:42:08,880 [phone rings] 699 00:42:08,960 --> 00:42:10,080 [man 1] 50, go ahead. Yeah? 700 00:42:10,160 --> 00:42:13,800 [man 2] Got a crew request for assault on a male. 701 00:42:13,880 --> 00:42:16,560 He's currently unconscious following a head injury. 702 00:42:16,640 --> 00:42:18,000 [woman 2] Okay. 703 00:42:18,080 --> 00:42:19,440 [dramatic music playing] 704 00:42:20,760 --> 00:42:24,160 [woman 2] People describe it as being a bit like a coiled spring ready to go. 705 00:42:26,520 --> 00:42:27,960 We're drilled. We're trained. 706 00:42:28,040 --> 00:42:30,440 We know that somebody's got a significant head injury. 707 00:42:31,360 --> 00:42:34,440 [woman 1] His name's Isaac. He's 23. 708 00:42:35,040 --> 00:42:37,560 Head injuries are very time-critical. 709 00:42:37,640 --> 00:42:39,080 [sirens blaring] 710 00:42:39,160 --> 00:42:40,280 And there's many things 711 00:42:40,360 --> 00:42:42,440 that could be going on inside Isaac's skull. 712 00:42:42,520 --> 00:42:44,600 Some of which are life-threatening. 713 00:42:46,480 --> 00:42:48,720 [woman 1] He's laying on the floor. [sobbing] 714 00:42:49,800 --> 00:42:51,680 Isaac! Isaac! 715 00:42:51,760 --> 00:42:52,920 [sirens blaring] 716 00:42:53,600 --> 00:42:55,000 God, his eyes are just blank. 717 00:42:56,560 --> 00:42:59,160 He's not responding. Is there an ambulance coming? 718 00:43:01,480 --> 00:43:04,400 Isaac had his head stamped on a number of times. 719 00:43:04,480 --> 00:43:07,200 We assumed he had a critical brain bleed. 720 00:43:08,240 --> 00:43:10,640 He needs to go to a major trauma center 721 00:43:10,720 --> 00:43:13,080 with neurosurgeons on site as quickly as possible. 722 00:43:13,160 --> 00:43:15,680 [woman 3] Adult male. Trauma call. ETA 15 minutes. 723 00:43:18,280 --> 00:43:19,880 Hi, it's Jim, A&E consultant. 724 00:43:19,960 --> 00:43:23,440 There's a young male who's been assaulted. They're coming to us by land. 725 00:43:23,520 --> 00:43:25,160 He's got a significant head injury. 726 00:43:32,440 --> 00:43:33,440 [Kat] This is Isaac. 727 00:43:33,520 --> 00:43:37,760 At about 21:00 hours, he was assaulted, but we believe he's been stamped on. 728 00:43:37,840 --> 00:43:38,760 Injuries top to toe. 729 00:43:38,840 --> 00:43:41,760 He's probably got an intracranial bleed 'cause he was agitated. 730 00:43:41,840 --> 00:43:45,520 He had a sedation of 30 of ketamine and then an RSI. 731 00:43:45,600 --> 00:43:48,200 He's got a bruising over the top right side of his chest, 732 00:43:48,280 --> 00:43:49,960 so possible rib fractures. 733 00:43:50,040 --> 00:43:52,200 He's got a significant left-sided facial injury. 734 00:43:52,280 --> 00:43:53,960 We're concerned about his eye. 735 00:43:54,480 --> 00:43:57,240 If we get him off the scoop and get him onto our monitoring 736 00:43:57,320 --> 00:43:58,600 and onto our ventilator. 737 00:43:58,680 --> 00:43:59,800 [man 1] Ready? 738 00:43:59,880 --> 00:44:01,480 One, two, three. 739 00:44:02,240 --> 00:44:05,240 [Jim] Okay. And if we start the primary survey, please. 740 00:44:05,320 --> 00:44:08,880 [woman] Trachea center, bruise over the right side, 741 00:44:08,960 --> 00:44:11,080 no surgical emphysema. 742 00:44:13,760 --> 00:44:17,000 [Jim] Isaac's eyes are not responding to the torch shone in them. 743 00:44:17,080 --> 00:44:20,600 As swelling increases in the brain, it will compress the cranial nerves 744 00:44:20,680 --> 00:44:23,280 and affect the nerves that supply the pupil. 745 00:44:24,040 --> 00:44:25,720 Hi, it's Jim, A&E consultant. 746 00:44:25,800 --> 00:44:28,120 Could you protocol a trauma scan for me, please? 747 00:44:28,920 --> 00:44:32,840 The priority with a big head injury is to get a CT scan 'cause we wanna know 748 00:44:32,920 --> 00:44:36,200 if there's a time-critical injury that needs a neurosurgeon immediately. 749 00:44:37,080 --> 00:44:39,320 He's intubated. I just want to scan everything. 750 00:44:39,400 --> 00:44:40,280 [man 2] Ready to roll? 751 00:44:41,200 --> 00:44:43,960 Your brain is contained within a rigid box, the skull, 752 00:44:44,040 --> 00:44:47,600 and so if your brain swells up, there's nowhere for that swelling to go, 753 00:44:47,680 --> 00:44:52,240 so that effectively squishes your brain, and that can have profound consequences. 754 00:44:53,200 --> 00:44:54,360 We're most worried about, 755 00:44:54,440 --> 00:44:57,640 in the immediate stage, that it's life-changing. 756 00:44:58,720 --> 00:45:00,720 Or that it's life-ending. 757 00:45:04,360 --> 00:45:05,680 [dramatic music playing] 757 00:45:06,305 --> 00:46:06,225