"Critical: Between Life and Death" Episode #1.5

1 00:00:06,000 --> 00:00:07,840 [intense music playing] 2 00:00:07,920 --> 00:00:09,400 [alarm blaring] 3 00:00:09,480 --> 00:00:10,920 [Jim] It's a HEMS trauma. 4 00:00:12,600 --> 00:00:13,560 GCS seven. 5 00:00:14,080 --> 00:00:16,160 He's intubated. I just wanna scan everything. 6 00:00:17,120 --> 00:00:18,160 Okay. 7 00:00:19,840 --> 00:00:22,760 Isaac, he's a 22-year-old male who's been assaulted. 8 00:00:22,840 --> 00:00:23,800 Slide. 9 00:00:23,880 --> 00:00:26,880 He's been kicked in the head and has got a significant head injury. 10 00:00:28,400 --> 00:00:31,840 [woman 1] There is a girlfriend who was quite upset at the scene. 11 00:00:31,920 --> 00:00:32,920 [Jim] Yeah. She's coming. 12 00:00:33,000 --> 00:00:34,080 [woman 1] Ruby. Is she here? 13 00:00:34,160 --> 00:00:35,640 [Jim] No, she's on the way. 14 00:00:36,520 --> 00:00:39,800 [woman 2] Isaac and Ruby had gone to a friend's house. 15 00:00:39,880 --> 00:00:44,760 Suddenly, they heard screaming and shouting going on outside. 16 00:00:46,680 --> 00:00:51,360 I got a call saying Isaac's been hurt 17 00:00:51,440 --> 00:00:54,200 and it was really, really serious. 18 00:00:54,800 --> 00:00:55,880 Me heart drops. 19 00:00:56,760 --> 00:00:57,960 Panic sets in. 20 00:00:58,040 --> 00:00:59,640 [intense music continues] 21 00:01:00,280 --> 00:01:03,840 A policeman said they had taken him to the Royal London. 22 00:01:04,560 --> 00:01:06,520 They already had Ruby in the car. 23 00:01:08,560 --> 00:01:10,680 There's a subarach there, I think. 24 00:01:12,640 --> 00:01:14,240 Let me call a neurosurgeon. 25 00:01:15,400 --> 00:01:17,640 Hi, it's Jim in resus, one of the ED consultants. 26 00:01:17,720 --> 00:01:20,680 I was calling about a guy who's come in with HEMS. 27 00:01:20,760 --> 00:01:23,720 Head injuries are really impossible to predict. 28 00:01:23,800 --> 00:01:26,760 For some people, the consequences might be minor. 29 00:01:26,840 --> 00:01:28,720 For others, it's time-critical. 30 00:01:30,840 --> 00:01:32,840 It was absolutely terrifying 31 00:01:32,920 --> 00:01:36,880 because Isaac is just my world. 32 00:01:37,480 --> 00:01:39,360 [Jim] This one is gonna go to critical care. 33 00:01:40,280 --> 00:01:43,360 There is uncertainty around what the future holds for Isaac. 34 00:01:43,440 --> 00:01:46,160 -[heart beating] -[faint sirens blaring] 35 00:01:48,000 --> 00:01:54,074 Watch Online Movies and Series for FREE www.osdb.link/lm 36 00:01:55,480 --> 00:01:57,400 -[woman 1] Good morning. -[woman 2] Hi. 37 00:01:57,480 --> 00:01:59,280 [alarm beeping] 38 00:02:00,360 --> 00:02:03,120 [woman 1] Isaac suffered an assault a few days ago 39 00:02:03,200 --> 00:02:06,200 and has sustained a severe head injury. 40 00:02:09,080 --> 00:02:13,560 He's on the breathing machine and being treated with high-dose sedation 41 00:02:14,080 --> 00:02:16,640 and monitoring of the pressure inside his brain. 42 00:02:17,600 --> 00:02:21,240 The only way to tell how he's doing neurologically 43 00:02:21,320 --> 00:02:24,160 is to reduce sedation and wake him up. 44 00:02:24,680 --> 00:02:27,240 But he needs to be stable to do that. 45 00:02:28,600 --> 00:02:29,800 Let's have a look at him. 46 00:02:30,680 --> 00:02:34,000 There's swelling around this eye in particular. 47 00:02:34,080 --> 00:02:34,920 [man] Yeah. 48 00:02:35,000 --> 00:02:38,280 [Marie] We'll have to keep an eye on that. He's got a lot of bruising. 49 00:02:38,360 --> 00:02:40,200 Any evidence of CSF leak? 50 00:02:40,280 --> 00:02:43,880 No, but he's got quite a lot of blood from the right side of the ear. 51 00:02:46,520 --> 00:02:49,520 The brain is housed in somewhat of a fortress, 52 00:02:50,040 --> 00:02:53,160 but it was never meant to withstand 53 00:02:53,240 --> 00:02:56,720 the kicks and the stamps that Isaac sustained. 54 00:02:58,200 --> 00:03:01,360 As a result, it's caused brain bruising and bleeding, 55 00:03:01,440 --> 00:03:05,280 as well as multiple areas of tears in the brain tissue. 56 00:03:06,760 --> 00:03:11,000 This is not the type of brain trauma that requires neurosurgery 57 00:03:11,080 --> 00:03:14,880 but neuroprotection in a critical care setting. 58 00:03:18,520 --> 00:03:21,440 [Marie] His pressure monitor is showing very good numbers. 59 00:03:21,520 --> 00:03:23,840 And looking back at the scan, 60 00:03:23,920 --> 00:03:27,760 I feel it would be safe to try and wake him up today. 61 00:03:30,120 --> 00:03:33,600 I'd try and bring down the fentanyl a bit and see how he gets on. 62 00:03:34,120 --> 00:03:36,560 -You've met his mum, have you? -[woman] Yeah. 63 00:03:36,640 --> 00:03:38,400 And his girlfriend Ruby. 64 00:03:38,480 --> 00:03:40,800 -They'll come back in at two o'clock. -[Marie] Okay. 65 00:03:45,400 --> 00:03:47,120 [Mel] Isaac's my only child. 66 00:03:47,840 --> 00:03:50,040 It took me 18 years to have him. 67 00:03:51,560 --> 00:03:53,560 He was an IVF baby. 68 00:03:55,440 --> 00:03:58,040 Having him was an absolute miracle. 69 00:03:58,120 --> 00:03:59,840 It's totally gone! 70 00:04:01,560 --> 00:04:04,400 He was just a lovely little lad. 71 00:04:06,080 --> 00:04:09,080 I've got one here of him on his first birthday. 72 00:04:10,640 --> 00:04:13,880 He used to make me little cards with, "I love you, Mum." 73 00:04:15,440 --> 00:04:19,120 He was very independent from a very early age. 74 00:04:19,200 --> 00:04:23,520 And as he got older, he wanted to be successful, 75 00:04:23,600 --> 00:04:28,200 earning his own money and have his own building business. 76 00:04:29,560 --> 00:04:33,520 And when Isaac met Ruby, it was an absolute blessing. 77 00:04:33,600 --> 00:04:35,560 It was, I felt, the making of him. 78 00:04:37,000 --> 00:04:41,280 They were making plans for holidays and what they want in the house. 79 00:04:41,840 --> 00:04:46,800 It was just lovely to watch and being able to be part of that as well. 80 00:04:46,880 --> 00:04:48,080 [emotional music playing] 81 00:04:48,160 --> 00:04:50,880 They were looking ahead to the future together. 82 00:04:59,160 --> 00:05:01,200 [Marie] We've managed to reduce sedation, 83 00:05:02,280 --> 00:05:04,040 take his breathing tube out. 84 00:05:04,800 --> 00:05:07,960 So he's now breathing for himself, so that's good. 85 00:05:08,040 --> 00:05:09,640 Your little teddy here. 86 00:05:16,320 --> 00:05:19,920 [Mel] When I see him there with all the tubes and everything in him, 87 00:05:20,800 --> 00:05:25,560 I just see my baby beside me having just been born to then seeing him… 88 00:05:28,680 --> 00:05:30,880 [Marie] His family have just arrived. 89 00:05:31,400 --> 00:05:34,200 We'd hope that he can communicate with them. 90 00:05:36,040 --> 00:05:39,160 If he's opening his eyes and obeying commands, 91 00:05:39,240 --> 00:05:40,440 that's a good start. 92 00:05:44,440 --> 00:05:47,760 [Curtis] There are parts of the brain that make us individuals. 93 00:05:48,440 --> 00:05:51,640 Memories of life and interaction. 94 00:05:51,720 --> 00:05:54,040 Our loves and our hates. 95 00:05:55,480 --> 00:05:57,200 When the patient wakes up, 96 00:05:58,120 --> 00:06:01,480 their injuries are no longer life-threatening. 97 00:06:03,000 --> 00:06:07,000 But brain damage can have significant consequences 98 00:06:07,080 --> 00:06:13,000 on what the outside person might perceive as personality changes. 99 00:06:14,800 --> 00:06:19,080 The families aren't necessarily getting the same person back. 100 00:06:24,880 --> 00:06:26,160 [Isaac coughs] 101 00:06:29,960 --> 00:06:31,520 All right. Do you wanna cough? 102 00:06:33,240 --> 00:06:35,040 Would you like a sip of water? 103 00:06:35,640 --> 00:06:37,120 [emotional music playing] 104 00:06:40,360 --> 00:06:43,440 I don't think he's understanding what's going-- 105 00:06:43,520 --> 00:06:45,400 [woman] Has he asked any questions? 106 00:06:45,480 --> 00:06:46,520 No. 107 00:06:49,800 --> 00:06:52,360 [Marie] Lots of other teams will be getting involved 108 00:06:52,440 --> 00:06:55,800 to assess his memory, and functionality, and personality. 109 00:06:59,120 --> 00:07:02,360 He may need very specific rehabilitation. 110 00:07:03,520 --> 00:07:08,120 But it will take time to know whether he will be the same person he was before. 111 00:07:13,800 --> 00:07:15,080 [thrilling music playing] 112 00:07:19,000 --> 00:07:20,400 [sirens blaring] 113 00:07:24,160 --> 00:07:26,520 130, hello. It's Rory on the APP desk. 114 00:07:26,600 --> 00:07:29,920 The London Major Trauma System covers London and the South East. 115 00:07:30,000 --> 00:07:34,200 As well as the four major trauma centers, there are 35 trauma units. 116 00:07:35,400 --> 00:07:37,360 They are specialist hospitals. 117 00:07:37,440 --> 00:07:39,680 And Southend is the furthest east. 118 00:07:42,960 --> 00:07:44,040 [boy] Oh my God. 119 00:07:45,480 --> 00:07:47,440 This is gonna change everything. 120 00:07:48,040 --> 00:07:49,960 This is gonna be weird to write. 121 00:07:51,000 --> 00:07:52,960 -Yeah. -Weird to play my PlayStation. 122 00:07:55,480 --> 00:07:57,400 I've got a missing finger, Mum. 123 00:08:01,880 --> 00:08:04,480 [woman 1] When you rang, I thought you were just being dramatic. 124 00:08:04,560 --> 00:08:06,280 I'm surprised I didn't pass out. 125 00:08:06,360 --> 00:08:09,080 It's gonna be so weird when everyone finds out. 126 00:08:09,600 --> 00:08:12,520 Maybe you might be able to keep it as a souvenir. 127 00:08:12,600 --> 00:08:13,960 [boy] No, that's weird. 128 00:08:14,480 --> 00:08:18,280 He rang us and said, "Mum, my finger just fell off." 129 00:08:18,360 --> 00:08:21,320 [woman 1] He wanted to leave school early and jumped over the fence. 130 00:08:21,400 --> 00:08:26,720 And he's caught his ring on the fence and it's took his finger completely off. 131 00:08:26,800 --> 00:08:29,520 He's supposed to be studying for his science exams tomorrow. 132 00:08:29,600 --> 00:08:32,800 -This happened at 12:00. -He was bunking off for the last hour. 133 00:08:33,600 --> 00:08:37,560 Then we pulled up. He was in someone's garden with his finger in a bag. 134 00:08:37,640 --> 00:08:40,320 The gardener, he didn't say a word. He looked in shock. 135 00:08:40,400 --> 00:08:42,760 -And his mate was like… -Pale white. 136 00:08:44,360 --> 00:08:46,840 -[woman 2] Are you allergic to something? -[Teddy] No. 137 00:08:46,920 --> 00:08:47,760 [Jon] School. 138 00:08:48,920 --> 00:08:50,240 Science, obviously. 139 00:08:52,480 --> 00:08:55,640 He's a naughty boy. Who would jump off the fence? 140 00:08:55,720 --> 00:08:58,440 Who does that? Only naughty boys do that. 141 00:08:58,520 --> 00:09:00,480 You have an X-ray in a minute. 142 00:09:01,000 --> 00:09:03,120 These things can happen to teenagers. 143 00:09:03,200 --> 00:09:05,480 Specifically, teenage boys. 144 00:09:05,560 --> 00:09:07,520 [man] We need water. Double bag. 145 00:09:07,600 --> 00:09:09,360 We're getting more ice. 146 00:09:09,440 --> 00:09:12,800 We need to keep the finger inside a container with ice 147 00:09:12,880 --> 00:09:17,200 to keep it fresh because if any side of the finger's gone, 148 00:09:17,280 --> 00:09:19,640 has died, they can't do anything with it. 149 00:09:21,680 --> 00:09:22,840 [woman] Is it Teddy's? 150 00:09:25,160 --> 00:09:27,560 Your Mum's gonna be behind the screen. Okay? 151 00:09:28,840 --> 00:09:32,800 Okay, we just need you to stretch your hand out to your right, okay? 152 00:09:35,520 --> 00:09:38,360 [Carla] I'm not the mum that says my boy's an angel. 153 00:09:39,760 --> 00:09:42,240 Teddy has bunked off school before. 154 00:09:42,320 --> 00:09:45,800 If I didn't get a phone call a week about Teddy, it was a good week. 155 00:09:46,600 --> 00:09:49,960 Not so much for being naughty. Just cheeky. 156 00:09:52,320 --> 00:09:53,400 He loves football. 157 00:09:54,600 --> 00:09:56,440 He's West Ham crazy. 158 00:09:56,520 --> 00:10:00,280 Tells all his friends and his brother he used to play for West Ham Under-8s. 159 00:10:01,560 --> 00:10:05,840 He loves messing around and making jokes, but he's a really lovely boy. 160 00:10:07,160 --> 00:10:08,320 [woman] He's finished. 161 00:10:08,400 --> 00:10:09,600 [Carla] Okay. Thank you. 162 00:10:10,400 --> 00:10:11,760 All done. 163 00:10:12,800 --> 00:10:16,360 [Bernadette] I don't know if they are gonna be able to reattach it. 164 00:10:17,200 --> 00:10:21,720 But any cases like Teddy's, we send to Broomfield Hospital 165 00:10:22,280 --> 00:10:25,400 because they have excellent plastic surgeons. 166 00:10:25,480 --> 00:10:26,960 [thrilling music playing] 167 00:10:27,040 --> 00:10:29,080 Time is really critical right now. 168 00:10:34,400 --> 00:10:39,080 Broomfield is world-renowned in the field of reconstructive microsurgery. 169 00:10:39,880 --> 00:10:45,720 And it's well-known for its hand surgery and high levels of specialist care. 170 00:10:48,240 --> 00:10:49,280 Hi, Teddy. 171 00:10:51,880 --> 00:10:54,320 When's the last time you had anything to eat or drink? 172 00:10:55,040 --> 00:10:56,760 [Teddy] Bag of sweets about eleven o'clock. 173 00:10:56,840 --> 00:10:59,880 [Ibrahim] Okay. So we'll just cover that back up again. 174 00:10:59,960 --> 00:11:02,320 Get you seen by the anesthetist, okay? 175 00:11:02,880 --> 00:11:05,360 And then we'll get you straight into theater. 176 00:11:07,600 --> 00:11:10,240 On the spectrum of traumatic finger amputations, 177 00:11:10,320 --> 00:11:13,480 Teddy's, it's towards the worst end of the scale. 178 00:11:14,080 --> 00:11:17,280 It's not a clean cut. It's been pulled apart. 179 00:11:18,000 --> 00:11:22,040 And the trauma is across different levels throughout the soft tissue structures, 180 00:11:22,120 --> 00:11:23,440 as well as the bone. 181 00:11:23,960 --> 00:11:27,480 So it's very difficult to successfully reattach. 182 00:11:28,960 --> 00:11:31,560 -The aim is first to reconnect the finger. -[Carla] Yeah. 183 00:11:31,640 --> 00:11:35,520 [Ibrahim] Fix the bone. Fix the tendons, the arteries and the nerves, 184 00:11:35,600 --> 00:11:36,680 and the veins. 185 00:11:36,760 --> 00:11:40,120 So it needs to run on a blood supply in order for it to survive. 186 00:11:40,840 --> 00:11:41,880 -Okay? -[Teddy] Yeah. 187 00:11:42,400 --> 00:11:45,200 Do you think you'll be able to fix it? 188 00:11:45,800 --> 00:11:47,520 -The finger? -[Ibrahim] That's the intention. 189 00:11:48,120 --> 00:11:49,520 Will it have feeling in it? 190 00:11:49,600 --> 00:11:52,720 The nerve heals at about a millimeter a day. 191 00:11:53,680 --> 00:11:55,680 So difficult to know exactly 192 00:11:55,760 --> 00:11:59,160 what feeling you'll get until 18 months down the line. 193 00:11:59,680 --> 00:12:01,120 Try our best, certainly. 194 00:12:02,720 --> 00:12:05,360 [Teddy] I'm worried about what's gonna happen in surgery, 195 00:12:05,440 --> 00:12:08,160 but there's nothing I can do about it, really. 196 00:12:09,640 --> 00:12:10,800 Yeah, just worried. 197 00:12:13,280 --> 00:12:17,440 Look, if you wanna cry, you can cry. You are in the best place for it. 198 00:12:18,720 --> 00:12:24,040 As a father, it's tough seeing a child who has sustained an injury. 199 00:12:25,600 --> 00:12:28,320 There is a lot of pressure to make it right. 200 00:12:29,720 --> 00:12:32,680 But there is never a guarantee with anything that we do. 201 00:12:36,800 --> 00:12:38,320 [faint sirens blaring] 202 00:12:40,160 --> 00:12:41,640 [thrilling music playing] 203 00:12:41,720 --> 00:12:42,800 [man] Okay, ready? 204 00:12:58,240 --> 00:13:01,040 -[man] Nice, isn't it? -[Issac] It's the best card in the world. 205 00:13:03,880 --> 00:13:07,240 [woman] Following an assault, Isaac spent five days in intensive care. 206 00:13:07,320 --> 00:13:11,440 No surgery. And then was stepped down to our neurosurgical unit. 207 00:13:14,000 --> 00:13:16,360 So, on the neurosurgical unit, 208 00:13:16,440 --> 00:13:20,280 obviously, the doctors make all of the really important decisions. 209 00:13:20,360 --> 00:13:22,640 But we run the show. 210 00:13:25,880 --> 00:13:28,160 Brain injury patients are the biggest challenge 211 00:13:28,240 --> 00:13:29,560 of the trauma network. 212 00:13:30,560 --> 00:13:31,680 Patients come to us 213 00:13:31,760 --> 00:13:34,280 when they're not critically unwell anymore. 214 00:13:34,960 --> 00:13:37,600 But they have a really long journey ahead of them. 215 00:13:39,080 --> 00:13:42,920 So our first job is to figure out how bad the brain injury is. 216 00:13:44,080 --> 00:13:47,200 He was making word-finding difficulty errors and things like that. 217 00:13:47,280 --> 00:13:49,080 He's got some memory coming back. 218 00:13:49,760 --> 00:13:52,760 But right now he's so easily distractible. 219 00:13:53,280 --> 00:13:55,440 He's got a much shorter fuse. 220 00:13:55,520 --> 00:13:58,040 A lot of things he doesn't know how to manage yet. 221 00:14:00,200 --> 00:14:04,320 Every brain injury patient is complex and never straightforward. 222 00:14:05,920 --> 00:14:07,840 To understand the injury, 223 00:14:07,920 --> 00:14:11,320 we need to assess not only the cognitive changes 224 00:14:11,960 --> 00:14:14,200 but behavioral changes as well. 225 00:14:15,840 --> 00:14:16,760 And to do that, 226 00:14:16,840 --> 00:14:20,440 we need to establish the person they were before their injury. 227 00:14:23,720 --> 00:14:28,200 [Carla] Isaac's always been a very kind and loving, gentle person. 228 00:14:29,720 --> 00:14:31,880 I loved just being with him. 229 00:14:31,960 --> 00:14:34,320 And we were always doing something together. 230 00:14:35,560 --> 00:14:37,560 He started doing scootering, 231 00:14:37,640 --> 00:14:39,760 and I would drive him all round the country 232 00:14:39,840 --> 00:14:41,320 to different skate parks. 233 00:14:42,760 --> 00:14:46,200 And he actually ended up scootering for Scoot GB. 234 00:14:48,520 --> 00:14:52,960 And then as he got a bit older, into motorbikes. That became a passion. 235 00:14:56,400 --> 00:14:59,120 He used to come out riding horses with me. 236 00:15:00,960 --> 00:15:04,640 We'd often go for a nice meal, just me and him, together, 237 00:15:04,720 --> 00:15:06,920 which was always quality time. 238 00:15:07,000 --> 00:15:10,040 And I could have my arm in his, walking around the town. 239 00:15:10,120 --> 00:15:11,800 He was never fazed by that. 240 00:15:13,200 --> 00:15:15,160 And I really love that about him. 241 00:15:20,000 --> 00:15:25,200 I worry he won't be the same loving son that I had before. 242 00:15:27,920 --> 00:15:31,160 Ruby and I have been with him from the start, so… 243 00:15:31,680 --> 00:15:35,280 Right, that's irrelevant to the bigger picture of things, Mum. 244 00:15:36,040 --> 00:15:38,200 We've all come a long way 245 00:15:38,280 --> 00:15:41,760 since the time when you weren't even wanting to be with me 246 00:15:41,840 --> 00:15:42,680 at one point. 247 00:15:44,520 --> 00:15:46,640 [Carla] I've always wanted to be with you. 248 00:15:47,680 --> 00:15:50,840 [Isaac] Especially, in this hospital. 249 00:15:52,280 --> 00:15:54,440 [Carla] You've only been in this hospital. 250 00:15:55,960 --> 00:15:57,560 -I don't know. -[Carla] Yeah. 251 00:15:57,640 --> 00:16:01,440 So you went from critical to high dependency. 252 00:16:01,520 --> 00:16:03,640 -And now-- -So I don't know, you think, then? 253 00:16:03,720 --> 00:16:06,320 -[Carla] No. And now on to this ward. -'Cause I… 254 00:16:07,200 --> 00:16:09,920 -[Carla] You're just forgetting. -So I don't know. 255 00:16:11,800 --> 00:16:14,760 There's… I'm perfectly fine. There's nothing wrong with me. 256 00:16:19,240 --> 00:16:20,080 I'm just gonna… 257 00:16:20,160 --> 00:16:21,640 -[Carla] Okay. -I want to sit. 258 00:16:24,360 --> 00:16:27,320 [Carla] It is still early days, darling. 259 00:16:32,680 --> 00:16:34,720 You're a bloody imbecile, you know that? 260 00:16:37,880 --> 00:16:38,720 [Carla] Okay. 261 00:16:40,960 --> 00:16:42,360 Everything's my fault. 262 00:16:43,840 --> 00:16:46,880 No, nothing is your fault. You're just an imbecile. 263 00:16:46,960 --> 00:16:47,800 Okay. 264 00:16:51,520 --> 00:16:55,080 [Stacey] We often see people acting completely out of character. 265 00:16:55,160 --> 00:16:57,600 It's really quite distressing for the family, 266 00:16:57,680 --> 00:17:01,760 because they have complete disinhibition. 267 00:17:01,840 --> 00:17:04,920 And they will literally say the most inappropriate things. 268 00:17:06,680 --> 00:17:10,160 But if you don't understand that you have a brain injury, 269 00:17:10,920 --> 00:17:13,080 you don't understand what you're doing. 270 00:17:14,680 --> 00:17:17,960 It's really hard for families coming to terms with the fact 271 00:17:18,040 --> 00:17:21,160 that their loved one might be completely different. 272 00:17:21,240 --> 00:17:22,600 [tense music playing] 273 00:17:25,680 --> 00:17:30,520 I think we're all in agreeance that the change is quite clear-cut. 274 00:17:31,680 --> 00:17:34,400 It's like a character. It's not really him. 275 00:17:35,360 --> 00:17:39,160 "You're an imbecile" is the new word. He's never called me that before. 276 00:17:39,240 --> 00:17:42,120 [Stacey] I know it's really hard not to take it personally. 277 00:17:42,200 --> 00:17:44,680 But the stuff he's saying, he doesn't mean it. 278 00:17:44,760 --> 00:17:46,760 -[Carla] No. -And it is all brain injury. 279 00:17:47,280 --> 00:17:50,480 He thinks, "Once I go home, everything will be back to normal." 280 00:17:51,160 --> 00:17:53,480 But that is definitely not the case. 281 00:17:54,240 --> 00:17:57,680 Anger and irritability is a massive one, with fatigue. 282 00:17:57,760 --> 00:18:00,960 We're not just talking about kinda feeling tired and needing a rest. 283 00:18:01,040 --> 00:18:03,080 -It can translate in lots of ways. -Yeah. 284 00:18:03,160 --> 00:18:07,840 He's just not an easy person to look after because of the way he is. 285 00:18:08,440 --> 00:18:09,680 [Stacey] It's hard to manage. 286 00:18:09,760 --> 00:18:12,800 Especially with someone that thinks there's nothing wrong with them. 287 00:18:14,240 --> 00:18:16,080 We don't know the full picture yet. 288 00:18:16,920 --> 00:18:20,680 Before we make any plans going forward, we need to do some more assessments. 289 00:18:21,520 --> 00:18:24,200 And this will include testing his cognitive function. 290 00:18:27,440 --> 00:18:31,800 [Carla] Our whole lives have been turned upside down by this incident. 291 00:18:33,080 --> 00:18:37,640 But he doesn't realize how serious his injury is. 292 00:18:39,200 --> 00:18:42,600 As a mother, all you want to do is take your child home. 293 00:18:44,800 --> 00:18:46,880 But I know that won't be happening. 294 00:18:59,360 --> 00:19:03,520 [Ed] Toby had a catastrophic injury to his right lower leg 295 00:19:03,600 --> 00:19:05,600 following a motorcycle accident. 296 00:19:06,440 --> 00:19:08,800 And he's got a long journey of recovery. 297 00:19:09,440 --> 00:19:11,560 As his wounds heal, 298 00:19:11,640 --> 00:19:16,000 you know, the hard work starts at Lambeth Amputee Rehab Unit, 299 00:19:16,080 --> 00:19:18,080 where he will learn to walk again. 300 00:19:21,880 --> 00:19:25,880 Looking at the leg, this is like normal to me now. 301 00:19:26,480 --> 00:19:30,120 I can lift it up and down. I can go side to side. 302 00:19:30,680 --> 00:19:33,560 Um… so I'm getting movement back slowly. 303 00:19:34,840 --> 00:19:37,720 I'm still trying to understand how my life's gonna change. 304 00:19:38,240 --> 00:19:42,200 I like a routine. I just did work, did gym. 305 00:19:43,080 --> 00:19:46,320 I was doing a powerlifting competition this year. 306 00:19:47,520 --> 00:19:49,040 I liked riding my bike. 307 00:19:50,040 --> 00:19:52,920 I did like 4-5,000 miles on it. 308 00:19:53,000 --> 00:19:55,080 And I've had it like four months. 309 00:19:56,280 --> 00:20:00,080 Everything in life now has just been crashed into. 310 00:20:04,960 --> 00:20:09,000 [Ed] The psychological impact of major trauma is often overlooked. 311 00:20:09,600 --> 00:20:14,080 Nobody goes to work thinking, "I'm going to get hit by a bus today." 312 00:20:14,920 --> 00:20:18,000 That split-second change will unfortunately dictate 313 00:20:18,080 --> 00:20:19,440 the rest of their life. 314 00:20:19,520 --> 00:20:21,480 -[sirens blaring] -Guys, this is Toby. 315 00:20:22,360 --> 00:20:24,760 Right lower limb has extended orthopedic injury. 316 00:20:25,280 --> 00:20:28,080 [Ed] We had to make a decision between life and limb. 317 00:20:28,880 --> 00:20:29,960 And we chose life. 318 00:20:31,520 --> 00:20:34,600 [Toby] It's now gonna be about trying to do everything I can 319 00:20:34,680 --> 00:20:37,640 to make sure I can get back to the life that I had. 320 00:20:40,080 --> 00:20:45,200 Today is Toby's first day trying on the prosthetic limb. 321 00:20:45,800 --> 00:20:46,760 It'll be a big day. 322 00:20:47,760 --> 00:20:51,240 And it's the first step to getting his independence back. 323 00:20:53,000 --> 00:20:54,480 -Excited for this. -Good. 324 00:20:56,440 --> 00:20:58,920 So, we've got the prosthetic leg. 325 00:20:59,440 --> 00:21:02,920 And it's all set up, so I think we just need to give it a go. 326 00:21:03,000 --> 00:21:05,840 -Just let me know if anything's painful. -[Toby] Yeah. 327 00:21:05,920 --> 00:21:06,800 [Beth] There we go. 328 00:21:06,880 --> 00:21:08,440 [emotional music playing] 329 00:21:08,520 --> 00:21:11,400 I just want you to push this bit inside here. 330 00:21:11,480 --> 00:21:12,520 [Toby] Inside that? 331 00:21:14,280 --> 00:21:15,680 About there? Push? 332 00:21:15,760 --> 00:21:19,600 Maybe just put it down a bit more. Right, how's that feeling? 333 00:21:19,680 --> 00:21:21,000 Yeah, feels all right. 334 00:21:21,800 --> 00:21:24,880 -[Beth] Right. So, when you're ready… -[Toby] Yeah. 335 00:21:24,960 --> 00:21:27,760 -Just stand and we'll have a look. -[Toby] Yeah. 336 00:21:29,120 --> 00:21:31,360 Yeah. Get rid of that. 337 00:21:33,600 --> 00:21:34,440 [Beth] Good. 338 00:21:35,160 --> 00:21:36,960 Okay. Yeah. 339 00:21:37,040 --> 00:21:39,800 -It looks pretty level, so… -[Toby] Yeah. 340 00:21:39,880 --> 00:21:42,400 [Beth] I think if you're up for it, 341 00:21:43,320 --> 00:21:45,240 we could do a little bit of walking. 342 00:21:45,320 --> 00:21:46,680 -[Toby] Yeah. -Yeah? 343 00:21:46,760 --> 00:21:49,600 So, if you want to just walk towards me. 344 00:21:53,320 --> 00:21:54,200 That's good. 345 00:22:00,920 --> 00:22:02,600 [emotional music intensifies] 346 00:22:04,480 --> 00:22:07,760 And then if you do a little turn. Walk back. 347 00:22:14,600 --> 00:22:16,000 How did that feel? 348 00:22:16,880 --> 00:22:17,920 It feels strange. 349 00:22:18,560 --> 00:22:20,520 [Beth] Just a completely new feeling? 350 00:22:20,600 --> 00:22:21,680 New feeling. Yeah. 351 00:22:22,320 --> 00:22:24,760 [Beth] That's really good for your first time as well. 352 00:22:24,840 --> 00:22:25,840 [woman] Toby! 353 00:22:25,920 --> 00:22:29,560 You've just done your first walk and made it look so easy. 354 00:22:29,640 --> 00:22:31,440 Yeah. Felt pretty good to do that. 355 00:22:31,520 --> 00:22:33,400 -[woman] Really good. Good. -Yeah. 356 00:22:35,040 --> 00:22:37,960 Pretty happy just to be walking on a leg again 357 00:22:38,040 --> 00:22:39,800 with an actual shoe on. 358 00:22:39,880 --> 00:22:43,920 You're gonna be giving your mum a heart attack again soon, aren't you? 359 00:22:45,520 --> 00:22:48,440 [Toby] I can take it… There's two ways. I can sit here and cry about it, 360 00:22:48,520 --> 00:22:51,040 or I can just get on with life. 361 00:22:56,680 --> 00:22:58,680 [tense music playing] 362 00:23:03,200 --> 00:23:07,800 [Ibrahim] I think there's probably aspects in plastic surgery of all trades. 363 00:23:09,160 --> 00:23:10,840 We all learn how to sew. 364 00:23:11,680 --> 00:23:15,840 There's an element of plumbing through reconnecting arteries, 365 00:23:15,920 --> 00:23:17,440 veins, nerves. 366 00:23:18,720 --> 00:23:23,640 And an element of design, restoring form and function. 367 00:23:26,120 --> 00:23:28,080 Reattaching a detached finger 368 00:23:28,160 --> 00:23:31,800 can be one of the hardest microsurgical procedures. 369 00:23:32,800 --> 00:23:37,160 I'd say it's more intricate than repairing a broken arm. 370 00:23:39,840 --> 00:23:43,040 [Jon] It's amazing that they're gonna stick it all back together. 371 00:23:44,880 --> 00:23:50,800 [Ibrahim] This is an emergency operation that requires expedient intervention. 372 00:23:51,560 --> 00:23:57,360 If it fails, it will result in loss of the originally amputated part. 373 00:23:58,720 --> 00:24:02,400 Fingers, especially for a child, are essential to daily life. 374 00:24:02,960 --> 00:24:04,360 So there's a lot at stake. 375 00:24:07,040 --> 00:24:08,240 Ready to start? 376 00:24:12,200 --> 00:24:17,160 The first part of the procedure is to secure the finger back to his hand. 377 00:24:18,920 --> 00:24:23,040 We fix the bone using a small metal wire. 378 00:24:23,120 --> 00:24:26,200 And the finger is skewered onto the hand. 379 00:24:26,840 --> 00:24:29,560 -[man 1] Okay. On your call. -[Ibrahim] Yep. Go for it. 380 00:24:31,240 --> 00:24:33,480 And that will give a stability to the digit. 381 00:24:36,440 --> 00:24:40,080 Once the finger's in, which it looks like it is, 382 00:24:40,680 --> 00:24:42,200 we'll have a look at the X-ray. 383 00:24:43,240 --> 00:24:44,240 Good. 384 00:24:44,320 --> 00:24:46,520 So, with the finger being stable, 385 00:24:47,200 --> 00:24:51,560 now there's time pressure to connect the structures around the bone 386 00:24:51,640 --> 00:24:54,480 and restore blood flow in order to keep the digit alive. 387 00:24:54,560 --> 00:24:56,200 [intense music playing] 388 00:24:58,200 --> 00:25:01,200 We reconnect the tendons first. 389 00:25:02,640 --> 00:25:05,760 The instruments that we use are very delicate. 390 00:25:07,120 --> 00:25:11,520 They're so small that they're used by jewelers when handling diamonds. 391 00:25:12,600 --> 00:25:17,240 And the sutures are often thinner than a human hair, 392 00:25:17,320 --> 00:25:19,720 which makes it even more challenging. 393 00:25:21,520 --> 00:25:24,200 The tendons are now connected. 394 00:25:25,680 --> 00:25:27,640 Can I get a microscope in next, please? 395 00:25:29,760 --> 00:25:34,440 It's now a case of reattaching the arteries and then the veins. 396 00:25:36,280 --> 00:25:38,760 We use powerful operating microscopes 397 00:25:38,840 --> 00:25:43,280 where even the smallest movement can produce quite an exaggerated movement. 398 00:25:44,600 --> 00:25:46,320 Everyone has a slight tremor. 399 00:25:46,960 --> 00:25:51,560 So it requires skill and intense focus. 400 00:25:53,720 --> 00:25:55,680 So we've got another three hours. 401 00:25:56,200 --> 00:25:57,200 That's my guess. 402 00:26:00,160 --> 00:26:03,560 If you're a parent, and got your son or daughter in here, 403 00:26:03,640 --> 00:26:05,240 it can be quite worrying. 404 00:26:06,400 --> 00:26:09,200 It's a long operation, so they keep in touch. 405 00:26:10,600 --> 00:26:13,360 I said, "Will take some time, obviously, but so far so good." 406 00:26:14,000 --> 00:26:16,000 Fingers crossed, pardon the pun. 407 00:26:19,360 --> 00:26:23,320 [Carla] He's just about to leave school. It should be the time of his life. 408 00:26:23,400 --> 00:26:26,120 Getting his exam results, celebrating with his mates. 409 00:26:26,640 --> 00:26:29,160 When I see him crying and I see him break down, 410 00:26:29,240 --> 00:26:31,800 it then ruins me and breaks me to think that he's scared, 411 00:26:31,880 --> 00:26:33,960 and I hate that there's nothing I can do. 412 00:26:34,960 --> 00:26:36,720 I'm terrified it's gonna be life-changing. 413 00:26:38,080 --> 00:26:40,920 I'm terrified he'll not be the Teddy that I know. 414 00:26:41,760 --> 00:26:44,680 I don't want him to lose that spark, that confidence. 415 00:26:44,760 --> 00:26:47,400 I don't want him to lose that funny chappy side of him 416 00:26:47,480 --> 00:26:51,080 because he's insecure about having a missing finger. 417 00:26:59,160 --> 00:27:02,200 [man 2] If we could get two fresh people at it now. 418 00:27:04,200 --> 00:27:06,520 [Ibrahim] It's important to swap in and out 419 00:27:07,440 --> 00:27:10,160 because the surgeries that we do are very long. 420 00:27:10,800 --> 00:27:15,080 And we're aware of the effects of fatigue on concentration. 421 00:27:16,400 --> 00:27:19,720 We may have already been working for a good eight hours. 422 00:27:20,680 --> 00:27:22,360 So it's all teamwork. 423 00:27:24,360 --> 00:27:29,400 When we have done the artery, we then turn our attention to the veins. 424 00:27:29,480 --> 00:27:30,920 [intense music playing] 425 00:27:32,760 --> 00:27:36,120 The arteries take blood into the finger, 426 00:27:36,200 --> 00:27:39,240 and the veins will take blood back around the body 427 00:27:39,320 --> 00:27:43,560 to the heart, to the lungs where it then gets reoxygenated. 428 00:27:44,560 --> 00:27:47,880 We need to be sure there's blood flowing to and from it 429 00:27:47,960 --> 00:27:49,920 so that the tissues don't die. 430 00:27:55,120 --> 00:27:57,720 It's one of the final stages of the operation now. 431 00:27:58,240 --> 00:27:59,960 Blood travels through the vein 432 00:28:00,040 --> 00:28:02,760 under lesser pressure than it does the artery. 433 00:28:02,840 --> 00:28:05,240 So it just needs one more stitch. 434 00:28:11,680 --> 00:28:12,960 [man 3] So, it's filling. 435 00:28:16,240 --> 00:28:19,120 [Ibrahim] We need to make sure that blood is able to reach 436 00:28:19,200 --> 00:28:20,760 the tip of Teddy's finger. 437 00:28:22,640 --> 00:28:24,600 We're using the pinprick test. 438 00:28:26,400 --> 00:28:29,720 There is definitely an element of holding your breath. 439 00:28:34,560 --> 00:28:36,000 [man 1] We have fresh blood. 440 00:28:36,680 --> 00:28:38,960 The finger's bleeding well. 441 00:28:40,400 --> 00:28:42,440 [man 4] There's nothing more rewarding than that. 442 00:28:42,520 --> 00:28:44,760 Particularly at one o'clock in the morning. 443 00:28:46,440 --> 00:28:48,160 Well done, team. Well done. 444 00:28:50,120 --> 00:28:53,320 [Ibrahim] The next sort of 72 hours is crucial. 445 00:28:54,360 --> 00:28:57,040 It's important that circulation is maintained, 446 00:28:57,560 --> 00:29:00,160 or the finger will need to be amputated. 447 00:29:01,520 --> 00:29:05,000 At this stage, we have done everything possible. 448 00:29:12,280 --> 00:29:13,640 [alarm blaring] 449 00:29:18,120 --> 00:29:19,640 Heli55, I've got a job for you. 450 00:29:22,160 --> 00:29:23,520 Harlow, please. 451 00:29:24,960 --> 00:29:26,560 Female been hit by a car. 452 00:29:27,200 --> 00:29:28,560 Bull's-eyed the windscreen. 453 00:29:29,360 --> 00:29:31,800 She's got a mass on the back of her head. 454 00:29:32,520 --> 00:29:34,240 Okay, mate. We're on our way. 455 00:29:36,120 --> 00:29:37,760 [Rob] As a prehospital care team, 456 00:29:37,840 --> 00:29:42,600 we're sent to the most seriously traumatically injured patients. 457 00:29:43,440 --> 00:29:48,720 My job is to provide the absolute best care to the patient in front of me. 458 00:29:51,840 --> 00:29:53,560 The scene was difficult. 459 00:29:53,640 --> 00:29:56,760 A 17-year-old girl who isn't opening her eyes properly, 460 00:29:57,360 --> 00:29:59,240 who isn't moving her limbs normally. 461 00:29:59,840 --> 00:30:01,640 Now leaving for Royal London. 462 00:30:01,720 --> 00:30:04,560 It became obvious that her injury could kill her. 463 00:30:05,800 --> 00:30:08,160 Absolutely could kill her. 464 00:30:08,760 --> 00:30:10,240 [dramatic music playing] 465 00:30:13,400 --> 00:30:15,720 [woman] I was at home looking after the baby. 466 00:30:17,040 --> 00:30:20,800 And there was a knock at the door. And there was two police officers. 467 00:30:21,560 --> 00:30:23,880 And they just asked if I'm Grace's mum. 468 00:30:24,880 --> 00:30:27,720 I think I went into shock instantly 469 00:30:27,800 --> 00:30:30,120 and just said, "Yeah. What's happened to her?" 470 00:30:30,960 --> 00:30:32,840 It is like someone's punched you in the face. 471 00:30:36,120 --> 00:30:38,800 -[dramatic music playing] -[phone ringing] 472 00:30:41,600 --> 00:30:43,120 [woman] Royal London, resus. 473 00:30:45,040 --> 00:30:48,400 So, we're gonna be getting a female. Pedestrian versus car. 474 00:30:48,480 --> 00:30:50,360 She's currently intubated and ventilated. 475 00:30:50,440 --> 00:30:53,960 She's got a known head injury with an open wound, I believe. 476 00:30:54,040 --> 00:30:55,240 Land in one minute. 477 00:31:02,120 --> 00:31:04,600 Okay, so this is the patient arriving now. 478 00:31:06,200 --> 00:31:09,720 When you arrive at a major trauma center, there's a sense of relief. 479 00:31:11,560 --> 00:31:15,920 Because I trust and believe in the people we're handing over to 480 00:31:16,600 --> 00:31:19,880 to try to give her the best possible chance of living. 481 00:31:22,720 --> 00:31:25,720 Let's get her on to the ventilator, and we'll get a handover. 482 00:31:26,240 --> 00:31:28,040 [man 1] So, a 17-year-old female 483 00:31:28,120 --> 00:31:31,760 at about 12:45 was hit by a car whilst crossing the road. 484 00:31:32,560 --> 00:31:36,760 So injuries, she's got an obvious open head injury with a boggy swelling 485 00:31:37,320 --> 00:31:39,160 right-sided occiput. 486 00:31:39,240 --> 00:31:41,080 We've seen her move all four limbs, 487 00:31:41,160 --> 00:31:43,920 and her pupils have always been size six and reacted. 488 00:31:44,000 --> 00:31:45,800 They've come down a bit post-RSI. 489 00:31:45,880 --> 00:31:48,640 -[Lisa] You said no family? -None that we've found. 490 00:31:48,720 --> 00:31:50,280 So, she had a college ID. 491 00:31:50,360 --> 00:31:52,000 -I think the police have it. -[man 2] Yeah. 492 00:31:52,080 --> 00:31:54,200 Police, they've located the home address. 493 00:31:54,280 --> 00:31:56,680 Lovely. Thank you. We'll start the primary survey. 494 00:31:58,240 --> 00:31:59,560 Get the monitoring attached. 495 00:31:59,640 --> 00:32:03,080 [man 3] Her central trachea, at two by 22 centimeters. 496 00:32:03,160 --> 00:32:05,520 So there's some abrasions to the right. 497 00:32:06,880 --> 00:32:10,480 [Lisa] So let's get package up to go and be on the move in the next 60 seconds 498 00:32:10,560 --> 00:32:11,720 towards CT. 499 00:32:12,880 --> 00:32:15,800 I'm concerned that she may have a significant head injury. 500 00:32:16,720 --> 00:32:18,960 [man 3] We have equal bilateral air entry. 501 00:32:19,520 --> 00:32:24,240 She has potential for pelvic injuries, fractures of her limbs, internal bleeding. 502 00:32:25,840 --> 00:32:30,640 Therefore, it's really important for us to get her into CT as quickly as possible. 503 00:32:37,520 --> 00:32:39,560 [man 4] Is that blood at the back? 504 00:32:40,160 --> 00:32:42,600 [Lisa] Certainly a little bit of blood down here. 505 00:32:42,680 --> 00:32:44,640 She's got quite a nasty head injury. 506 00:32:46,920 --> 00:32:50,400 [woman] She's got a contusion there. There's like a blush there. 507 00:32:50,480 --> 00:32:51,520 -[Lisa] Yeah. -Yeah. 508 00:32:52,440 --> 00:32:55,080 [Lisa] Grace has got a subdural bleed. 509 00:32:55,720 --> 00:32:58,440 And she's got some bruising within the brain tissue itself. 510 00:32:59,640 --> 00:33:02,320 [woman] She's got nasty pelvic fractures. 511 00:33:03,360 --> 00:33:05,240 [Lisa] How do we get her back around? 512 00:33:08,160 --> 00:33:09,040 Are you ready? 513 00:33:11,560 --> 00:33:16,000 The police told us that Grace had been hit on the zebra crossing 514 00:33:16,080 --> 00:33:17,880 when she was walking home. 515 00:33:20,360 --> 00:33:21,400 This is our baby. 516 00:33:21,480 --> 00:33:23,240 [emotional music playing] 517 00:33:29,920 --> 00:33:32,760 Seeing your child, no matter how old they are, 518 00:33:32,840 --> 00:33:37,160 sitting in a hospital bed bandaged up, you know, black and blue in places, 519 00:33:37,240 --> 00:33:39,320 it's just devastating. 520 00:33:45,520 --> 00:33:48,360 [Lisa] Grace has potentially got life-changing injuries. 521 00:33:49,200 --> 00:33:51,160 She's got some serious pelvic fractures. 522 00:33:51,240 --> 00:33:52,680 She'll need an operation. 523 00:33:53,960 --> 00:33:57,280 But my biggest concern here is the injuries to her brain. 524 00:33:57,360 --> 00:33:59,240 So she'll be taken to intensive care 525 00:33:59,320 --> 00:34:02,440 to make sure things don't change 'cause the brain is likely to swell. 526 00:34:05,040 --> 00:34:07,000 [man] Ready, brace, slide. 527 00:34:10,840 --> 00:34:14,600 [Karen] For us, the brain injury is the most concerning thing. 528 00:34:16,040 --> 00:34:18,760 We don't know if she's gonna get through this. 529 00:34:43,680 --> 00:34:46,640 [Isaac] I know I've had a terrible injury. 530 00:34:47,560 --> 00:34:50,840 But I don't remember anything that happened. 531 00:34:50,920 --> 00:34:54,640 It was, uh, quite a shock when someone told me what happened. 532 00:34:56,720 --> 00:34:59,840 Other people might think there is stuff wrong with me. 533 00:34:59,920 --> 00:35:03,200 I'm just the same person I used to be, and I haven't changed. 534 00:35:04,840 --> 00:35:07,760 So, I'm looking forward to getting out of here 535 00:35:07,840 --> 00:35:09,280 and going back home. 536 00:35:09,360 --> 00:35:10,680 [tense music playing] 537 00:35:13,320 --> 00:35:17,800 For any of our patients, home is at the front of your thoughts. 538 00:35:19,480 --> 00:35:22,480 You don't understand why no one will allow you to leave. 539 00:35:23,000 --> 00:35:25,800 Your family are not supportive of what you want. 540 00:35:26,440 --> 00:35:27,800 "Why are you leaving me here?" 541 00:35:27,880 --> 00:35:30,360 "Why are you letting these people keep me here?" 542 00:35:31,600 --> 00:35:33,280 We've all got the same goal. 543 00:35:33,360 --> 00:35:34,960 We all want you to go home. 544 00:35:35,040 --> 00:35:38,480 But we want you to go home as the best Isaac that you can be. 545 00:35:38,560 --> 00:35:41,640 And to do that, there's some steps we have to follow along the way. 546 00:35:45,240 --> 00:35:48,360 [woman] We know that Isaac has an injury to the front part of his brain 547 00:35:48,440 --> 00:35:50,920 that has caused changes to his personality and behavior 548 00:35:51,000 --> 00:35:52,560 that we're seeing on the wards. 549 00:35:53,360 --> 00:35:56,520 But we also know that brain injury impacts their thinking skills, 550 00:35:56,600 --> 00:35:58,600 and that's what we also want to assess. 551 00:36:00,160 --> 00:36:02,480 We do this by running a test every single day. 552 00:36:03,080 --> 00:36:06,200 And we know if Isaac is still having difficulties with today's test, 553 00:36:06,280 --> 00:36:09,640 there's an indication he might have a long-term brain injury 554 00:36:09,720 --> 00:36:11,880 and will need further rehabilitation. 555 00:36:13,280 --> 00:36:14,120 Hi, Isaac. 556 00:36:14,200 --> 00:36:16,000 -Are you all right? -[Kayla] Yeah. How are you? 557 00:36:16,080 --> 00:36:17,240 I'm good. Thank you. 558 00:36:17,320 --> 00:36:19,480 [Kayla] Isaac, do you remember who I am? 559 00:36:20,080 --> 00:36:20,960 -Yeah? -Yeah. 560 00:36:21,040 --> 00:36:23,000 -You're Kayla. -Yeah. And what do I do? 561 00:36:23,600 --> 00:36:26,400 You are my occupational therapist. 562 00:36:26,480 --> 00:36:28,120 Yeah. Exactly. Well done. 563 00:36:28,760 --> 00:36:30,120 And where are we right now? 564 00:36:30,800 --> 00:36:31,800 Uh… 565 00:36:33,680 --> 00:36:35,680 What's the name of this hospital again? 566 00:36:39,760 --> 00:36:41,160 So, you're at the hospital. 567 00:36:42,600 --> 00:36:46,240 And can you remember the three items that I wanted you to remember? 568 00:36:46,320 --> 00:36:47,680 -An umbrella. -Yup. 569 00:36:47,760 --> 00:36:48,600 -Yeah? -Yeah. 570 00:36:50,560 --> 00:36:51,400 What else? 571 00:36:52,880 --> 00:36:54,720 -So, two other objects. -Yeah. 572 00:36:56,480 --> 00:36:57,440 Uh… 573 00:36:58,360 --> 00:37:01,520 -I've got the umbrella. Didn't I? -[Kayla] You've said umbrella. 574 00:37:02,720 --> 00:37:04,560 I might give you some clues, okay? 575 00:37:05,280 --> 00:37:08,480 So, like, the umbrella was something you'd use outside. 576 00:37:09,080 --> 00:37:12,080 Another one is something you might use at breakfast. 577 00:37:13,040 --> 00:37:15,000 Which photo have you seen before? 578 00:37:15,720 --> 00:37:16,560 [Isaac] The cup. 579 00:37:17,080 --> 00:37:18,160 -Yeah. -I've seen that. 580 00:37:18,240 --> 00:37:19,320 [Kayla] Yeah. Well done. 581 00:37:19,400 --> 00:37:21,640 -[Isaac] So, is that the one? -[Kayla] Yeah. 582 00:37:21,720 --> 00:37:22,960 It's the cup, then. 583 00:37:23,720 --> 00:37:25,840 [Kayla] Do you know what time of day it is? 584 00:37:25,920 --> 00:37:26,880 [Isaac] Um… 585 00:37:27,440 --> 00:37:29,960 One o'clock? Twelve o'clock? 586 00:37:30,040 --> 00:37:32,320 Is it morning, afternoon, or evening? 587 00:37:32,400 --> 00:37:33,240 Ten o'clock? 588 00:37:34,080 --> 00:37:36,520 -Morning, afternoon, or evening? -Morning. 589 00:37:37,040 --> 00:37:39,680 Yeah. And how might you know what time it is? 590 00:37:40,680 --> 00:37:41,840 How do I… 591 00:37:41,920 --> 00:37:44,640 Remember what time it is. What time of the day it is. 592 00:37:44,720 --> 00:37:47,640 -Just off of what I feel. -Yeah. 593 00:37:47,720 --> 00:37:50,880 If I've had a shower or not yet, and whatever else I've done. 594 00:37:50,960 --> 00:37:52,000 Yeah. 595 00:37:52,800 --> 00:37:54,320 I'll see you again tomorrow. 596 00:37:54,400 --> 00:37:56,640 -Yeah. See you again tomorrow. -[Kayla] Yeah. 597 00:37:59,400 --> 00:38:01,920 He's not orientated to the time of day it is, 598 00:38:02,000 --> 00:38:03,560 or what day it is, or where he is, 599 00:38:03,640 --> 00:38:06,920 and so those skills we've been doing since we were a child 600 00:38:07,000 --> 00:38:08,560 are quite difficult at the moment. 601 00:38:10,760 --> 00:38:12,920 I have seen him looking at the exit, 602 00:38:13,000 --> 00:38:16,440 and he can often be seen packing his bags, trying to leave. 603 00:38:18,040 --> 00:38:22,600 But I do anticipate he will be going to some sort of rehab unit. 604 00:38:24,600 --> 00:38:27,800 When someone sustains a frontal lobe brain injury, 605 00:38:27,880 --> 00:38:31,600 we see lots of cognitive changes that affect social norms 606 00:38:31,680 --> 00:38:32,800 and our personalities. 607 00:38:33,840 --> 00:38:37,320 So patients leaving the hospital too early 608 00:38:37,400 --> 00:38:41,200 could be a risk to themselves, or they could be a risk to others. 609 00:38:42,680 --> 00:38:45,240 So when they're not in that protective environment 610 00:38:45,320 --> 00:38:46,680 of being in a hospital, 611 00:38:46,760 --> 00:38:50,840 and without us being in control of their decisions, 612 00:38:51,920 --> 00:38:55,520 things could escalate quite quickly in the home environment. 613 00:38:59,360 --> 00:39:00,880 [dramatic music playing] 614 00:39:04,320 --> 00:39:05,280 Come on, then. 615 00:39:08,200 --> 00:39:09,400 [Isaac] What is this, then? 616 00:39:09,480 --> 00:39:11,880 [Mel] It's about trying to discuss what's best for you. 617 00:39:11,960 --> 00:39:13,600 [Isaac] Yeah, I know what it is. 618 00:39:13,680 --> 00:39:16,360 Go home. That's all I want to do. 619 00:39:19,840 --> 00:39:23,400 Isaac, he thinks this is a prison and we're keeping him against his will. 620 00:39:23,480 --> 00:39:26,400 And he's a grown man that's used to making decisions for himself, 621 00:39:26,480 --> 00:39:28,480 and we've taken that away from him. 622 00:39:29,560 --> 00:39:31,960 Telling someone, "You can't go home," 623 00:39:32,720 --> 00:39:35,880 I anticipate it might be a difficult conversation. 624 00:39:38,360 --> 00:39:42,760 [Kayla] So, Isaac, we've been doing cognitive assessments. 625 00:39:42,840 --> 00:39:45,560 What we were trying to look at was your ability 626 00:39:45,640 --> 00:39:47,640 to make complex decisions. 627 00:39:47,720 --> 00:39:50,480 And what we found out at the end of that 628 00:39:50,560 --> 00:39:55,120 is that we don't believe you have capacity to make the decision to leave hospital. 629 00:39:55,200 --> 00:39:57,000 And you need to go to rehab. 630 00:39:57,800 --> 00:40:01,520 That being said, Isaac, we're still trying to help you get home. 631 00:40:02,200 --> 00:40:04,760 -It's driving me nuts being in here. -[Stacey] Yeah. 632 00:40:04,840 --> 00:40:09,560 [Isaac] For me to be at home, it would do my brain a lot of good. 633 00:40:09,640 --> 00:40:12,400 -There's nothing even wrong with me now. -[Kayla] Okay. 634 00:40:12,920 --> 00:40:16,480 So, I'm in here with a… 635 00:40:16,560 --> 00:40:20,200 -I'm sorry, what was that? -[Stacey] No, I'm just listening. 636 00:40:20,280 --> 00:40:22,840 Is there something still wrong with me, then? 637 00:40:24,720 --> 00:40:27,320 'Cause as far as I'm concerned, I haven't changed one bit. 638 00:40:27,400 --> 00:40:28,840 I'm still the same person. 639 00:40:28,920 --> 00:40:30,480 So I think you saying that, Isaac, 640 00:40:30,560 --> 00:40:33,800 is a really nice leading on to what we're gonna talk about next. 641 00:40:33,880 --> 00:40:38,360 Which is the changes your mum and Ruby have seen in you since your brain injury. 642 00:40:38,880 --> 00:40:41,080 I don't believe he still fully understands. 643 00:40:41,160 --> 00:40:44,800 Like, he thinks he can go back to work, go and get a pint. 644 00:40:45,640 --> 00:40:49,520 And that worries me because of what could potentially happen. 645 00:40:50,760 --> 00:40:54,720 [Isaac] I haven't said to you about going back to work. 646 00:40:54,800 --> 00:40:58,440 I haven't said anything about going for a pint… 647 00:40:58,520 --> 00:40:59,760 -Okay. -Of beer. 648 00:40:59,840 --> 00:41:01,040 -Okay. -At all. 649 00:41:01,120 --> 00:41:02,000 -Okay. -[Kayla] Isaac-- 650 00:41:02,080 --> 00:41:04,560 Although that'd be a good thing to do. 651 00:41:04,640 --> 00:41:07,080 -I'm so… Are you all right, Mum? -[Mel] No. 652 00:41:07,160 --> 00:41:09,960 -Do you wanna stop this meeting? -No, not at all. 653 00:41:10,040 --> 00:41:13,800 This is what it's for, and to air what we feel. 654 00:41:13,880 --> 00:41:17,080 -I obviously want you home. -[Isaac] I think this meeting is no good. 655 00:41:17,160 --> 00:41:18,880 And I think we should stop it now. 656 00:41:20,640 --> 00:41:21,760 I've recovered. 657 00:41:22,360 --> 00:41:23,880 From the minute I woke up, 658 00:41:24,400 --> 00:41:26,880 all I wanted to do was leave this hospital. 659 00:41:27,400 --> 00:41:30,680 And none of you have listened to what I've said. 660 00:41:30,760 --> 00:41:31,880 I think what we wanted-- 661 00:41:31,960 --> 00:41:35,680 [Isaac] So, you'd rather keep me in here and piss me off even more, then. 662 00:41:35,760 --> 00:41:39,400 No, I think we'd rather make sure you're safe, Isaac. Okay? 663 00:41:39,480 --> 00:41:41,040 [Mel] We all want you to come home, 664 00:41:41,120 --> 00:41:44,160 but there still needs to be the support network in place. 665 00:41:44,240 --> 00:41:45,640 Like I've tried to explain to you. 666 00:41:45,720 --> 00:41:47,760 [Isaac] This meeting, there's no point in it. 667 00:41:47,840 --> 00:41:50,440 -I'm lucky to not be dead. -[Mel] You are. 668 00:41:50,520 --> 00:41:52,560 -[Isaac] I can talk. I can walk. -[Mel] You can. 669 00:41:52,640 --> 00:41:54,520 People in here can't even fucking walk. 670 00:41:54,600 --> 00:41:57,280 [Mel] No, I know. And it's awful. 671 00:41:57,360 --> 00:41:58,400 Yeah, it is. 672 00:41:58,480 --> 00:42:00,080 [Stacey] Kayla said when we're done, 673 00:42:00,160 --> 00:42:03,440 she's gonna call the rehab workers in the community 674 00:42:03,520 --> 00:42:06,760 and get an idea of how long it takes after the referral. 675 00:42:06,840 --> 00:42:09,960 So when we've done that, we can come and speak to you. 676 00:42:11,080 --> 00:42:11,920 All right? 677 00:42:14,800 --> 00:42:17,160 [Isaac] All right. Let's leave it at that, then. 678 00:42:17,240 --> 00:42:18,520 -[Stacey] Okay. -[Kayla] Okay. 679 00:42:25,440 --> 00:42:28,280 [Stacey] To do this job, you have to have a very thick skin. 680 00:42:28,360 --> 00:42:30,760 And you have to be really firm, 681 00:42:31,880 --> 00:42:33,320 but in a kind way. 682 00:42:35,600 --> 00:42:38,040 I'm a bit like my nan in that way. 683 00:42:39,360 --> 00:42:41,960 She was a East End girl, 684 00:42:42,040 --> 00:42:46,520 very strong-willed and a very strong personality, 685 00:42:46,600 --> 00:42:50,360 but also had a real soft side to her. 686 00:42:51,640 --> 00:42:52,760 [Kayla] Thanks, Isaac. 687 00:42:55,680 --> 00:42:56,600 -All right? -Yeah. 688 00:42:56,680 --> 00:42:57,680 Okay. 689 00:43:00,680 --> 00:43:03,080 [Stacey] We don't know what the future holds. 690 00:43:05,160 --> 00:43:08,520 We have to be honest, and we have to give people the facts. 691 00:43:09,720 --> 00:43:12,880 But our job is never to take away someone's hope. 692 00:43:14,120 --> 00:43:18,240 Even if someone has got a really long journey ahead of them. 693 00:43:19,480 --> 00:43:21,960 There we go, darling. We're getting there. 694 00:43:25,600 --> 00:43:28,520 It's just not an experience you expect to have to, you know, 695 00:43:28,600 --> 00:43:33,200 brush dried blood and bits of debris and that out of your child's hair. 696 00:43:36,480 --> 00:43:39,320 [man] Grace was admitted to our hospital a few days ago. 697 00:43:39,840 --> 00:43:43,320 She was a pedestrian crossing a road, and she was hit by a vehicle. 698 00:43:43,400 --> 00:43:46,040 It's resulted in significant injuries. 699 00:43:46,120 --> 00:43:47,440 [dramatic music playing] 700 00:43:49,000 --> 00:43:49,840 Morning. 701 00:43:49,920 --> 00:43:53,760 The impact has been such that it's crunched in her pelvic bone. 702 00:43:54,680 --> 00:43:58,600 But the other injury, and the injury that's dictated her care to now, 703 00:43:58,680 --> 00:44:00,760 has actually been her head injury. 704 00:44:01,480 --> 00:44:04,320 The neurosurgeons have been managing her brain injury. 705 00:44:05,120 --> 00:44:06,120 She seems stable. 706 00:44:06,200 --> 00:44:10,680 They're happy now that the brain injury does not need any surgical intervention. 707 00:44:11,200 --> 00:44:16,040 So today, we got the green light for us to go towards fixing her pelvis. 708 00:44:16,680 --> 00:44:18,160 [intense music playing] 709 00:44:21,440 --> 00:44:22,480 [man] Okay. 710 00:44:25,920 --> 00:44:29,160 [Paul] Pelvic surgery is inevitably high-risk surgery. 711 00:44:29,240 --> 00:44:32,160 We're putting metalwork very close 712 00:44:32,240 --> 00:44:34,960 to the structures that sit within the pelvis 713 00:44:35,040 --> 00:44:36,640 that we've got to preserve. 714 00:44:37,600 --> 00:44:41,240 If we damage them, it has life-changing consequences. 715 00:44:50,080 --> 00:44:50,920 Hey, guys. 716 00:44:51,000 --> 00:44:51,840 Slight hiccup. 717 00:44:51,920 --> 00:44:52,760 [Paul] Okay. 718 00:44:57,240 --> 00:45:00,680 Okay, so there is a bit of a change in plan. 719 00:45:01,560 --> 00:45:04,240 Grace's condition has deteriorated somewhat. 720 00:45:04,320 --> 00:45:06,040 She's much less responsive. 721 00:45:06,720 --> 00:45:10,520 So we need to figure out what's going on in regard to Grace's brain. 722 00:45:11,240 --> 00:45:13,040 Do an emergency brain scan. 723 00:45:15,280 --> 00:45:18,800 There's a concern that something could be evolving inside her brain. 724 00:45:18,880 --> 00:45:21,960 Has she had a bleed, or is there some swelling to her brain? 725 00:45:22,040 --> 00:45:24,480 This can be life-changing or life-ending. 726 00:45:26,960 --> 00:45:28,640 [intense music playing] 726 00:45:29,305 --> 00:46:29,602