"Critical: Between Life and Death" Episode #1.3

1 00:00:07,120 --> 00:00:09,880 What have we got by way of bone fragments? 2 00:00:11,080 --> 00:00:13,760 We need to find big bits, okay? 3 00:00:13,840 --> 00:00:15,240 Chunky bits. 4 00:00:18,360 --> 00:00:19,840 Is there bone there? 5 00:00:20,800 --> 00:00:23,280 Well, I'm winging it, if you want to know. 6 00:00:25,000 --> 00:00:26,960 It's so smashed. 7 00:00:27,040 --> 00:00:29,400 The planes are quite difficult to find at the moment. 8 00:00:35,720 --> 00:00:39,200 With Jack, the scan doesn't really show 9 00:00:39,280 --> 00:00:42,360 the extreme devastation that I'm seeing face-to-face. 10 00:00:43,960 --> 00:00:47,200 His surgery is immensely complicated. 11 00:00:47,280 --> 00:00:48,280 Can you see bone? 12 00:00:48,800 --> 00:00:50,400 One of the big fears I have 13 00:00:50,480 --> 00:00:53,600 is not being able to complete what I'd started. 14 00:00:53,680 --> 00:00:54,920 What's that? 15 00:00:56,120 --> 00:00:58,960 -That's rim, isn't it? -That's your biggest. 16 00:00:59,040 --> 00:01:00,600 Mm. Interesting. 17 00:01:01,720 --> 00:01:03,920 I always say that facial appearance 18 00:01:04,000 --> 00:01:06,360 and how you see yourself is really important. 19 00:01:08,720 --> 00:01:12,280 So, the responsibility to get this right is heavy. 20 00:01:14,000 --> 00:01:20,074 Watch Online Movies and Series for FREE www.osdb.link/lm 21 00:01:27,440 --> 00:01:28,800 There's a bit here. 22 00:01:31,160 --> 00:01:33,280 I mean, that's probably not bad, is it? 23 00:01:34,440 --> 00:01:36,320 This is like gold, all right? 24 00:01:37,040 --> 00:01:40,040 It's coming out of your pocket money if you lose it. 25 00:01:42,440 --> 00:01:44,520 Have we got enough bone now to press on? 26 00:01:44,600 --> 00:01:46,240 -Yes. -Yes. 27 00:01:46,320 --> 00:01:50,080 Okay. So we're gonna make Jack a new forehead and eye socket. 28 00:01:51,160 --> 00:01:53,680 Jack was very brutally attacked with an iron bar, 29 00:01:53,760 --> 00:01:56,400 and he had multiple blows to his face and his head. 30 00:01:57,640 --> 00:02:00,640 We need to peel his face back to get at the fractured bone, 31 00:02:02,480 --> 00:02:06,320 and then put it all back together again using the bone fragments 32 00:02:06,400 --> 00:02:07,520 that we've found. 33 00:02:08,200 --> 00:02:11,400 Also, titanium mesh will be screwed into place above his eye socket 34 00:02:11,480 --> 00:02:14,000 to seal the hole in the skull. 35 00:02:15,360 --> 00:02:18,000 Okay, well, let's have the bone now, please. 36 00:02:19,280 --> 00:02:20,720 Can you put that in there? 37 00:02:23,480 --> 00:02:27,200 You can feel that nice crunch as you lift the bone into the right place. 38 00:02:29,040 --> 00:02:30,400 It's visceral. 39 00:02:32,240 --> 00:02:35,000 Okay, so that's about right, isn't it? Yeah? 40 00:02:36,600 --> 00:02:40,680 With the bridge in place, we can now build the metal around that. 41 00:02:42,280 --> 00:02:44,800 -We know that it's got to be curved. -Yeah. 42 00:02:45,440 --> 00:02:47,960 Something like that, maybe. 43 00:02:50,480 --> 00:02:53,480 I try and be Steady Eddie and measured, all the way through. 44 00:02:55,360 --> 00:03:00,440 But getting the metal in the right place without damaging any of the nerves… 45 00:03:01,280 --> 00:03:05,120 That attention to detail is the most stressful. 46 00:03:08,400 --> 00:03:09,880 Five-mil screw, yeah? 47 00:03:09,960 --> 00:03:12,080 Okay. Is it tight? Yeah. 48 00:03:12,160 --> 00:03:13,840 Take it slow, so don't push it. 49 00:03:16,760 --> 00:03:19,760 If you trap the nerves, there's a definite risk 50 00:03:19,840 --> 00:03:24,200 you render that patient unable to have normal facial coordination. 51 00:03:26,120 --> 00:03:27,040 We have to be careful 52 00:03:27,120 --> 00:03:29,200 because we don't want to make it even worse. 53 00:03:31,040 --> 00:03:34,040 One mistake could alter the way the eyes move, 54 00:03:35,000 --> 00:03:37,600 or it could mean your smile becomes lopsided. 55 00:03:39,000 --> 00:03:41,720 So there's an awful lot that could go wrong. 56 00:03:43,280 --> 00:03:45,480 -I would take that edge off. -Yeah. 57 00:03:45,560 --> 00:03:47,880 -We got the piezo saw handy? -Yeah. 58 00:03:53,360 --> 00:03:55,160 -Have you got it? -I've got it. 59 00:03:55,240 --> 00:03:57,960 That looks good to meezy. Okay. 60 00:03:58,960 --> 00:04:02,840 We just need to make him a metal sheet for the forehead. 61 00:04:06,240 --> 00:04:09,720 This is gonna take the place of the bone that has been lost. 62 00:04:13,600 --> 00:04:15,440 If we don't get it right, 63 00:04:17,160 --> 00:04:21,040 there is a very real concern that he's going to be deformed. 64 00:04:24,120 --> 00:04:25,400 It's a long operation, 65 00:04:25,480 --> 00:04:29,360 and you absolutely know that things can go wrong. 66 00:04:29,960 --> 00:04:32,800 I'm feeling nervous. 67 00:04:32,880 --> 00:04:37,000 But we haven't heard any bad news, so we have to… 68 00:04:37,800 --> 00:04:41,040 We have to… Well,Ihave to tell myself it's gonna be good news. 69 00:04:41,120 --> 00:04:44,040 You have to hold on to that positivity. 70 00:04:46,680 --> 00:04:49,920 Jack's my son, and he means a great deal to us. 71 00:04:50,560 --> 00:04:51,400 Jack! 72 00:04:54,760 --> 00:04:58,440 His life and his future is in the hands of experts 73 00:04:58,520 --> 00:05:02,520 who are helping shape the rest of his life, frankly. 74 00:05:04,080 --> 00:05:05,840 This is the last bit to do. 75 00:05:07,240 --> 00:05:08,080 Screw, please. 76 00:05:15,520 --> 00:05:18,880 Okay, now, when the brain pulsates, 77 00:05:20,200 --> 00:05:21,480 the eye won't move. 78 00:05:23,600 --> 00:05:26,360 We've got the artificial forehead in place. 79 00:05:26,440 --> 00:05:28,080 Shall we see what it looks like? 80 00:05:38,760 --> 00:05:42,320 He actually has a brow. Perfect. 81 00:05:44,600 --> 00:05:46,360 Let's make him beautiful now. 82 00:05:48,200 --> 00:05:49,600 To me? 83 00:05:49,680 --> 00:05:50,840 To you. 84 00:05:54,240 --> 00:05:56,600 Everything can look aesthetically right, 85 00:05:57,880 --> 00:06:01,320 but until you see the patient talking to you the next day, 86 00:06:01,400 --> 00:06:04,800 seeing normally, then you don't really fully relax. 87 00:06:06,320 --> 00:06:08,560 He was quite smashed around his temple, 88 00:06:08,640 --> 00:06:11,880 which is where the facial nerve is, so that's a worry for me. 89 00:06:11,960 --> 00:06:13,520 So we'll see how it goes. 90 00:06:14,600 --> 00:06:17,760 You're just in the recovery room. 91 00:06:17,840 --> 00:06:20,520 All right. Good man. You're doing really well. 92 00:06:22,520 --> 00:06:26,840 After my parents' car crash, my mum had terrible facial scarring, 93 00:06:27,360 --> 00:06:30,120 and so in a lot of the patients, inevitably, I see Mum. 94 00:06:31,920 --> 00:06:33,960 And I think because of that, 95 00:06:34,040 --> 00:06:37,280 I want to give the patients the chance she never had. 96 00:06:38,640 --> 00:06:42,160 The best chance to go out and be yourself again. 97 00:06:44,640 --> 00:06:45,680 You good? 98 00:06:47,520 --> 00:06:50,520 Yeah, hi, Fiona. It's Simon here. Good news. 99 00:06:50,600 --> 00:06:52,560 Just to say the operation's done. 100 00:06:53,160 --> 00:06:58,280 We found enough bone to rebuild him with a bit of metal mesh as well. 101 00:06:59,200 --> 00:07:01,920 So he's got a titanium mesh in his head. 102 00:07:02,000 --> 00:07:04,520 It won't set metal detectors off, fortunately. 103 00:07:06,520 --> 00:07:09,840 Thank you for everyone that's done so much today. 104 00:07:10,440 --> 00:07:13,240 -Yeah, thank you very much. Thank you. -See you soon. Bye. 105 00:07:23,720 --> 00:07:26,120 You got something you can press against the wound? 106 00:07:26,200 --> 00:07:30,240 So, the injuries are to the face? Any difficulty in breathing? 107 00:07:30,320 --> 00:07:32,720 Climbed over a spiked fence, fell. 108 00:07:33,760 --> 00:07:35,040 Incisions at ribs. 109 00:07:36,080 --> 00:07:38,200 They'll need a full extraction. 110 00:07:38,280 --> 00:07:41,240 He tripped over, and a steel beam's fallen across his back. 111 00:07:41,320 --> 00:07:42,520 He's in agony. 112 00:07:46,240 --> 00:07:48,320 Morning. You all right, mate? 113 00:07:48,400 --> 00:07:50,600 -How are you doing? -Yeah, very good. 114 00:07:52,800 --> 00:07:54,040 I'm trying to lose weight. 115 00:07:54,120 --> 00:07:57,120 I'm going on a beach holiday. I need a beach bod. 116 00:07:58,200 --> 00:08:00,640 So, I've got this calorie counter, yeah? 117 00:08:00,720 --> 00:08:03,800 And it's the one where you take photos of everything. 118 00:08:03,880 --> 00:08:05,160 And you set a target. 119 00:08:05,240 --> 00:08:06,760 Hey, man. How are you? 120 00:08:06,840 --> 00:08:09,320 My calorie counter lies. It's a lying ca… 121 00:08:09,400 --> 00:08:11,800 It shows that I'm always in a deficit, 122 00:08:12,320 --> 00:08:15,000 but I don't lose weight. So… 123 00:08:15,080 --> 00:08:20,200 So, it's clear that there are missing items from my calorie counter. 124 00:08:21,760 --> 00:08:22,720 I love to cook. 125 00:08:23,360 --> 00:08:25,560 A lot of my cooking came from my mum. 126 00:08:26,160 --> 00:08:27,360 She was a teacher, 127 00:08:27,440 --> 00:08:31,920 so she'd wake up super early, like, at like 4:00 a.m. or 5:00 a.m. 128 00:08:32,000 --> 00:08:36,000 She'd cook for us for dinner, and then she'd go off to go to work. 129 00:08:36,520 --> 00:08:38,960 And so I'd wake up, smelling all these amazing dishes. 130 00:08:39,040 --> 00:08:40,760 You know? That would be my breakfast. 131 00:08:40,840 --> 00:08:42,800 She never knew, but anyway… 132 00:08:44,720 --> 00:08:47,160 Team… Sam, shall we go? 133 00:08:47,240 --> 00:08:50,400 Can you come with me quickly? Let's go to the ward together. 134 00:08:50,480 --> 00:08:54,360 My mother, she… she was very protective of us. 135 00:08:54,440 --> 00:08:57,600 You know, I grew up in a… I grew up in an estate, you know? 136 00:08:57,680 --> 00:09:00,960 I grew up in an environment which wasn't sort of perhaps 137 00:09:01,040 --> 00:09:04,920 the most conducive to achieving a lot in life. 138 00:09:05,000 --> 00:09:08,360 But my mum, she pushed me on. She had faith in me. 139 00:09:08,440 --> 00:09:12,080 A lot of my success in life is down to her, 140 00:09:12,800 --> 00:09:14,520 because she directed me, you know? 141 00:09:15,040 --> 00:09:18,240 I think the happiest moment for me was when she came to my graduation. 142 00:09:19,760 --> 00:09:21,240 She was very proud, yeah. 143 00:09:23,160 --> 00:09:25,120 Sharp scratch, my dear friend. 144 00:09:25,920 --> 00:09:29,920 So, Jared's a 26-year-old male, motorcyclist versus van, 145 00:09:30,000 --> 00:09:33,240 sustaining a significant injury to his leg. 146 00:09:33,320 --> 00:09:35,200 He has an open fracture. 147 00:09:36,760 --> 00:09:39,280 He should be in theater very shortly. 148 00:09:40,080 --> 00:09:42,400 -We'll go say hello, yeah? -Brilliant. 149 00:09:42,920 --> 00:09:44,160 Hey, Jared. 150 00:09:45,040 --> 00:09:46,080 Hey, how are you? 151 00:09:46,160 --> 00:09:51,080 So we're gonna operate on you today. We're gonna fix your broken bone. 152 00:09:51,160 --> 00:09:54,560 We're gonna put a nail, it's a metal rod, basically, 153 00:09:54,640 --> 00:09:57,320 inside the canal of your bone. 154 00:09:57,400 --> 00:10:01,200 Then the plastic surgeon will do a flap. And it will cover the defect, 155 00:10:01,280 --> 00:10:04,520 allowing you to get on with… with the healing process. 156 00:10:06,080 --> 00:10:08,720 And, uh, I really want to appreciate you guys 157 00:10:08,800 --> 00:10:12,560 in a whole different light after this as well, I can't lie. 158 00:10:12,640 --> 00:10:15,080 We'll look after you. We'll be taking you down soon. 159 00:10:15,160 --> 00:10:16,160 See you later. 160 00:10:17,360 --> 00:10:19,240 -He's a really nice guy. -Yeah. 161 00:10:25,240 --> 00:10:28,800 How do you think things will be after the operation? 162 00:10:29,800 --> 00:10:33,920 Hopefully, after this operation, it goes all well. 163 00:10:34,000 --> 00:10:38,520 If it does, I want to be the most positive aspect of myself. 164 00:10:38,600 --> 00:10:40,320 I've always been self-centered. 165 00:10:40,400 --> 00:10:41,960 -Do you know what I mean? -Yeah. 166 00:10:42,040 --> 00:10:44,040 Like, I'm really grateful. 167 00:10:46,240 --> 00:10:48,080 Yeah. 168 00:10:48,160 --> 00:10:50,680 Also, this is making me really think about 169 00:10:51,640 --> 00:10:53,800 things I need to accomplish now. 170 00:10:54,840 --> 00:10:57,360 'Cause I never had any accomplishments really, 171 00:10:57,440 --> 00:11:00,960 apart from, "I… I… I got a new bike." 172 00:11:01,040 --> 00:11:02,960 -Yeah. -"I got this." You know what I mean? 173 00:11:03,040 --> 00:11:07,200 I need to, like, look out for people as much as they look out for me. 174 00:11:08,320 --> 00:11:11,680 I really feel vulnerable, and I can't… 175 00:11:11,760 --> 00:11:14,720 Honestly, I've not seen you cry ever. 176 00:11:14,800 --> 00:11:19,000 -I know. -It's weird to see you this squidgy… 177 00:11:20,040 --> 00:11:22,240 …and soft, but it's also nice. 178 00:11:25,480 --> 00:11:26,360 So yeah. 179 00:11:26,440 --> 00:11:28,640 -Hello. -Oh, hi! 180 00:11:31,080 --> 00:11:33,200 -You all right, gorgeous? -Hello, Mama. 181 00:11:33,280 --> 00:11:35,880 Yeah, just been down and everything. 182 00:11:35,960 --> 00:11:36,920 Oh no. 183 00:11:38,000 --> 00:11:41,040 When something really profound happens to you in your life, yeah? 184 00:11:42,320 --> 00:11:47,600 And then you have strangers who kind of come to your helping hand, 185 00:11:47,680 --> 00:11:49,640 you get quite affected by it. 186 00:11:51,760 --> 00:11:53,360 You can feel their empathy. 187 00:11:54,400 --> 00:11:56,240 And I think that's what he's just felt. 188 00:11:56,320 --> 00:12:00,640 You know, he's sat there, and he's felt that same genuine empathy. 189 00:12:03,440 --> 00:12:06,480 My mother, 12 years, she had breast cancer. 190 00:12:06,560 --> 00:12:10,200 She passed away in 2009. 191 00:12:11,280 --> 00:12:14,320 But I think the care that she received was phenomenal. 192 00:12:14,400 --> 00:12:17,120 And I saw it firsthand, what they did for her, 193 00:12:17,200 --> 00:12:18,920 and it really touched me. 194 00:12:21,240 --> 00:12:23,760 So, every patient I treat, 195 00:12:24,280 --> 00:12:26,880 I treat them as if they're my mum. 196 00:12:34,960 --> 00:12:37,720 The stakes are very high in this operation. 197 00:12:39,720 --> 00:12:42,320 So, this is the tibia, and as you can see, 198 00:12:42,400 --> 00:12:46,000 there's this big fragment of bone called a butterfly fragment. 199 00:12:46,080 --> 00:12:50,680 The bone's effectively exploded, and it's spat out this wedge. 200 00:12:51,480 --> 00:12:53,800 It resembles the wing of a butterfly. 201 00:12:55,280 --> 00:12:56,400 It's huge. 202 00:12:57,080 --> 00:12:59,960 15% to 20% of the length of his entire tibia. 203 00:13:01,400 --> 00:13:03,040 If we don't fix this, 204 00:13:03,120 --> 00:13:05,760 the worst-case scenario is he loses his leg. 205 00:13:07,160 --> 00:13:09,960 This moment will dictate the rest of his life. 206 00:13:11,800 --> 00:13:15,080 So today, we're gonna do a fix and flap operation. 207 00:13:16,000 --> 00:13:19,160 This is one of the most complex operations we do. 208 00:13:19,240 --> 00:13:22,840 It's a combined operation that involves both orthopedic surgeons 209 00:13:23,440 --> 00:13:25,400 and plastic surgeons. 210 00:13:25,480 --> 00:13:27,520 That is your oblique. 211 00:13:27,600 --> 00:13:29,000 It's teamwork. 212 00:13:29,080 --> 00:13:31,840 It is like the Avengers coming together. 213 00:13:32,800 --> 00:13:34,720 We're like a combination of Hulk 214 00:13:35,560 --> 00:13:37,360 and Thor with the mallet. 215 00:13:39,400 --> 00:13:42,840 And the plastic surgeons, they're more like Doctor Strange, 216 00:13:42,920 --> 00:13:44,880 a bit more fine and soft. 217 00:13:44,960 --> 00:13:49,320 Everyone knows their skills, and we all have the same target. 218 00:13:49,920 --> 00:13:51,960 To sort out this problem. 219 00:13:53,360 --> 00:13:56,080 There's four consultants here. It's brilliant. 220 00:13:56,160 --> 00:13:59,760 This is how we roll in here. This team is the A-team. 221 00:13:59,840 --> 00:14:02,960 -I'll step in when it all goes wrong. -When it all goes… 222 00:14:04,320 --> 00:14:06,840 Myself and Asmat are the consultants 223 00:14:06,920 --> 00:14:08,760 who look after the skin side of things. 224 00:14:08,840 --> 00:14:10,680 If we're going for a smallish flap, 225 00:14:10,760 --> 00:14:12,400 that's as much as we can close. 226 00:14:13,160 --> 00:14:16,200 Ibraheim and the orthopedic team will look after the bone side. 227 00:14:16,280 --> 00:14:18,640 Let's get the drill ready, please. 228 00:14:18,720 --> 00:14:19,760 Let's go for it. 229 00:14:20,520 --> 00:14:23,360 -Before I address the butterfly fragment… -Go on. 230 00:14:23,880 --> 00:14:26,360 …I need to fix the break in Jared's tibia. 231 00:14:27,680 --> 00:14:29,920 Okay, stop there. Come out of it. 232 00:14:30,000 --> 00:14:32,280 To do this, I'm gonna pass a large metal nail 233 00:14:32,360 --> 00:14:34,880 down through the middle of Jared's tibial bone. 234 00:14:35,760 --> 00:14:38,560 This will connect his knee to his ankle 235 00:14:38,640 --> 00:14:41,920 and enable the lower leg to be solid so he can weight-bear again. 236 00:14:43,320 --> 00:14:45,520 If I don't get the alignment perfect, 237 00:14:46,040 --> 00:14:48,600 there could be major consequences for Jared, 238 00:14:49,120 --> 00:14:50,480 like shattered bone 239 00:14:51,280 --> 00:14:52,720 or torn muscle. 240 00:14:54,040 --> 00:14:55,800 This could affect his life forever. 241 00:14:57,880 --> 00:15:01,000 The biggest challenge is to ensure 242 00:15:01,080 --> 00:15:05,840 that you get the rotation and alignment perfect. 243 00:15:07,240 --> 00:15:10,320 Have we got the Bactiguard nail set open? Are we happy? 244 00:15:13,640 --> 00:15:18,120 So this nail is coated with gold, silver, and palladium. 245 00:15:18,880 --> 00:15:20,360 Can I have a mallet, please? 246 00:15:24,640 --> 00:15:27,720 And so it creates an electrical environment 247 00:15:28,320 --> 00:15:32,240 which stops bacteria from forming in this area. 248 00:15:34,360 --> 00:15:36,160 -X-ray. Shot there. -Mind your hands. 249 00:15:37,360 --> 00:15:39,640 -You're almost there. -Looks good. 250 00:15:39,720 --> 00:15:42,040 Every millimeter counts, 251 00:15:42,120 --> 00:15:45,160 so a millimeter of space can lead to disaster. 252 00:15:45,680 --> 00:15:50,240 If the fracture gap is too great, 253 00:15:50,320 --> 00:15:54,480 that will impact the ability for Jared to walk. 254 00:15:55,160 --> 00:15:57,280 Keep going. Stop. 255 00:15:58,840 --> 00:15:59,680 Shot there. 256 00:16:05,760 --> 00:16:08,360 You're in. Yeah. Good, man. Nice, nice. 257 00:16:10,320 --> 00:16:13,480 The nail is down. Everything looks in a good place. 258 00:16:15,080 --> 00:16:17,320 Now we need to move on to the butterfly fragment. 259 00:16:17,920 --> 00:16:19,640 This is really important, this is. 260 00:16:23,400 --> 00:16:27,080 This is a significant chunk of bone. 261 00:16:28,040 --> 00:16:28,880 Shot there. 262 00:16:30,120 --> 00:16:31,640 You're gonna have to push in. 263 00:16:32,280 --> 00:16:36,920 It's flipped 180 degrees, so it's facing the wrong way. 264 00:16:38,120 --> 00:16:41,480 If that fragment is not put back where it belongs, 265 00:16:43,160 --> 00:16:45,000 he may never walk ever again. 266 00:17:06,320 --> 00:17:08,760 London Ambulance Service. It's an RTC. 267 00:17:08,840 --> 00:17:10,240 LAS, who's been dispatched? 268 00:17:11,200 --> 00:17:13,680 We're screening all of the 999 calls that come in, 269 00:17:13,760 --> 00:17:16,000 looking for people with major trauma injuries. 270 00:17:16,080 --> 00:17:19,080 Blood all over the place. Caller is screaming. 271 00:17:19,160 --> 00:17:23,520 We work out how bad the injury is, what interventions they might require, 272 00:17:23,600 --> 00:17:26,400 and therefore whether we send an advanced paramedic 273 00:17:26,920 --> 00:17:28,720 or an air ambulance team. 274 00:17:30,200 --> 00:17:34,320 Kent Surrey Sussex Air Ambulance covers the South East region, 275 00:17:34,400 --> 00:17:35,760 outside of the capital. 276 00:17:46,960 --> 00:17:47,960 The day I wake up 277 00:17:48,040 --> 00:17:50,360 and that red phone goes and I don't feel a flutter 278 00:17:50,960 --> 00:17:52,840 will be the day I'll stop doing this job. 279 00:17:55,560 --> 00:17:58,520 Adult male motorcyclist. Needs a HEMS team rapidly. 280 00:17:59,720 --> 00:18:01,120 As an air ambulance charity, 281 00:18:01,200 --> 00:18:04,320 we only go to the most critically injured patients. 282 00:18:08,640 --> 00:18:11,320 And some of the things we see, no human should ever see. 283 00:18:18,800 --> 00:18:21,720 It was just me and my friend Toby out on the bike. 284 00:18:22,560 --> 00:18:25,920 We love the acceleration, the speed. Gets your adrenaline going. 285 00:18:26,000 --> 00:18:27,960 It makes you feel alive. 286 00:18:30,920 --> 00:18:32,640 We were fresh out of the gym. 287 00:18:35,840 --> 00:18:37,760 I was riding in front of Toby, 288 00:18:37,840 --> 00:18:40,120 and I saw a car coming down the road. 289 00:18:40,200 --> 00:18:43,960 As it goes past me, I heard some sort of like big, loud bang. 290 00:18:45,560 --> 00:18:47,880 I've never heard anyone scream like that before. 291 00:18:47,960 --> 00:18:49,480 Bloodcurdling sort of scream. 292 00:18:49,560 --> 00:18:52,000 "Am I gonna make it out of this?" sort of scream. 293 00:18:53,600 --> 00:18:55,200 Toby means the world to me, 294 00:18:55,760 --> 00:18:58,120 and I knew this wasn't gonna be good. 295 00:18:58,760 --> 00:19:01,360 I saw them carry Toby into the helicopter. 296 00:19:04,400 --> 00:19:07,560 It's really important we get Toby to hospital as quickly as possible. 297 00:19:07,640 --> 00:19:08,880 Minutes matter. 298 00:19:10,120 --> 00:19:13,280 But not any hospital, a major trauma center. 299 00:19:14,360 --> 00:19:16,760 That means taking him into King's College London. 300 00:19:19,680 --> 00:19:22,600 -We'll be there in two minutes. -Yeah, thank you. 301 00:19:25,600 --> 00:19:26,840 A motorbike. 302 00:19:27,720 --> 00:19:30,320 -Is that another trauma coming in? -Yeah. 303 00:19:30,880 --> 00:19:32,480 Adult's on his way in. 304 00:19:32,560 --> 00:19:34,160 Please activate the helipad. 305 00:19:38,280 --> 00:19:40,240 Toby has injuries that may kill him. 306 00:19:42,000 --> 00:19:44,160 He needs to be inside a major trauma center 307 00:19:44,240 --> 00:19:46,040 where all of the specialties 308 00:19:46,120 --> 00:19:51,640 are ready to fight for people's lives and their limbs 24-7. 309 00:19:52,760 --> 00:19:54,640 I can hear the heli. It's on the pad. 310 00:19:54,720 --> 00:19:55,720 Let's do this. 311 00:19:56,240 --> 00:19:59,280 As trauma team leader, there is apprehension. 312 00:19:59,800 --> 00:20:03,960 'Cause if someone is coming to us, the injuries are going to be bad. 313 00:20:04,560 --> 00:20:06,000 So we need to be ready for it. 314 00:20:13,000 --> 00:20:15,440 These people are incredibly vulnerable. 315 00:20:16,480 --> 00:20:18,280 They're scared. They're in pain. 316 00:20:18,360 --> 00:20:19,680 Ready, brace, lift. 317 00:20:21,840 --> 00:20:24,160 They have no idea what's going on. 318 00:20:24,680 --> 00:20:28,200 I'm constantly talking to him, constantly making sure that he's okay, 319 00:20:28,280 --> 00:20:29,680 so he feels less scared. 320 00:20:30,280 --> 00:20:31,760 Okay, Toby, we're going into the lift. 321 00:20:31,840 --> 00:20:32,680 All right. 322 00:20:32,760 --> 00:20:33,600 Okay? 323 00:20:36,800 --> 00:20:40,520 Sometimes you can feel the patient's raw emotions. 324 00:20:43,880 --> 00:20:45,480 On three. One, two… 325 00:20:47,880 --> 00:20:49,480 Okay, listen up, guys. 326 00:20:49,560 --> 00:20:50,800 Guys, this is Toby. 327 00:20:50,880 --> 00:20:54,080 Toby is 20 years old, and approximately 90 minutes ago, 328 00:20:54,160 --> 00:20:58,600 he was involved in a motorcycle RTC on a fast 60 mile-an-hour road. 329 00:20:58,680 --> 00:21:01,160 He's got some abrasions to his right upper chest. 330 00:21:01,240 --> 00:21:04,040 He's got an obvious closed right humeral fracture. 331 00:21:04,120 --> 00:21:05,680 He's got a right mid-femur. 332 00:21:05,760 --> 00:21:08,240 He's got a laceration through his knee joint 333 00:21:08,320 --> 00:21:10,320 on the right side down to his patella. 334 00:21:10,400 --> 00:21:15,480 And his right ankle has an open tib fib and a mid-foot dislocation I've reduced, 335 00:21:15,560 --> 00:21:18,360 because his right foot was white with no blood flow to it. 336 00:21:18,440 --> 00:21:19,840 -Okay. -Any questions? 337 00:21:20,680 --> 00:21:22,640 -No. That's it. -Thank you very much. 338 00:21:22,720 --> 00:21:25,200 Thank you. All right, we'll start with our primary. 339 00:21:25,280 --> 00:21:28,200 Chest expanding without obvious trauma. 340 00:21:28,800 --> 00:21:30,560 Abdomen soft and non-tender. 341 00:21:31,440 --> 00:21:34,080 Why don't we just have a quick look at this? 342 00:21:37,840 --> 00:21:38,960 Where am I? London? 343 00:21:39,040 --> 00:21:40,760 You're at King's College Hospital. 344 00:21:40,840 --> 00:21:42,480 There's a huge wound there. 345 00:21:42,560 --> 00:21:43,760 Yeah, there we go. 346 00:21:43,840 --> 00:21:48,960 I was going home from the gym, and then all of a sudden I was hit. 347 00:21:49,040 --> 00:21:54,560 And I was like sliding on top of my bike, and then I got chucked off into the bush. 348 00:21:56,440 --> 00:21:59,160 He's just gonna move your toes one by one, yeah? 349 00:22:00,520 --> 00:22:03,480 He's got quite significant limb injuries to his lower leg. 350 00:22:04,360 --> 00:22:07,960 Multiple fractures which are open, i.e. there's exposed wound. 351 00:22:09,720 --> 00:22:12,800 Your dad's on his way. I'll go and tell him you got here safely. 352 00:22:12,880 --> 00:22:14,520 All right, mate? Nice to meet you. 353 00:22:14,600 --> 00:22:16,840 -I wish you all the best. -Thank you. 354 00:22:16,920 --> 00:22:20,880 We're going to get him to a scanner to make sure we're not missing any injury. 355 00:22:21,840 --> 00:22:23,840 Right, they're ready. Let's go. 356 00:22:31,400 --> 00:22:32,760 When we've handed over, 357 00:22:32,840 --> 00:22:35,240 and we're in the aircraft, and we're flying home, 358 00:22:35,760 --> 00:22:37,240 that's the time we decompress. 359 00:22:39,000 --> 00:22:42,680 That's the time that we think about what we've just witnessed. 360 00:22:43,240 --> 00:22:46,040 And that's when you really start to reflect on the people, 361 00:22:46,120 --> 00:22:48,400 and the families, and the loved ones involved. 362 00:22:52,680 --> 00:22:54,680 We were together in the kitchen. 363 00:22:56,000 --> 00:23:01,160 Toby's friend Ollie called me and said there'd been a bad accident. 364 00:23:01,240 --> 00:23:03,320 Could one of us go to him? 365 00:23:05,480 --> 00:23:08,600 I'm totally blind, so I can't drive. 366 00:23:10,880 --> 00:23:14,440 So my husband needed to go to the scene of the accident. 367 00:23:16,440 --> 00:23:19,280 He was clearly in quite a large amount of pain. 368 00:23:20,160 --> 00:23:22,560 I was just trying to let him know I was there. 369 00:23:23,760 --> 00:23:26,600 I think that's the hardest moment for any parent, 370 00:23:26,680 --> 00:23:28,680 is when your child's in pain. 371 00:23:29,480 --> 00:23:31,480 And there's nothing you can do about it. 372 00:23:33,760 --> 00:23:36,040 Toby is our first child. 373 00:23:36,120 --> 00:23:36,960 Sorry. 374 00:23:37,040 --> 00:23:40,920 To see him like that, it's heartbreaking. 375 00:23:42,040 --> 00:23:47,280 You're just like, "Where, how, what do we do now?" 376 00:23:55,160 --> 00:23:58,400 He's got a fracture in his arm, sort of mid-shaft here. 377 00:23:59,720 --> 00:24:02,640 He has complex fractures in his knee, 378 00:24:03,720 --> 00:24:06,960 and then a nasty fracture of his femur. 379 00:24:07,040 --> 00:24:09,720 So, that bone needs straightening and correction. 380 00:24:10,480 --> 00:24:14,560 But I think the biggest concern for him is that foot is quite mangled. 381 00:24:15,880 --> 00:24:16,720 Okay. 382 00:24:18,880 --> 00:24:21,720 I cannot feel the pulse. No, I can't feel anything. 383 00:24:21,800 --> 00:24:22,960 -Let me see again? -Okay. 384 00:24:23,600 --> 00:24:28,520 We are worried that there might not be adequate blood supply to his foot. 385 00:24:29,120 --> 00:24:32,080 We need to get an ultrasound to assess the blood flow. 386 00:24:32,160 --> 00:24:34,160 The toes are looking even more dusky. 387 00:24:35,080 --> 00:24:36,880 And I can't see the arteries. 388 00:24:36,960 --> 00:24:38,040 You can't? 389 00:24:39,520 --> 00:24:40,760 Should be here. 390 00:24:41,520 --> 00:24:43,080 You can't see anything? 391 00:24:45,560 --> 00:24:49,120 I'm really hot, and my right leg is dying right now. 392 00:24:49,200 --> 00:24:51,800 It's not getting better, and it really hurts. 393 00:24:54,520 --> 00:24:59,040 It looks slightly worse than initially thought. 394 00:25:01,200 --> 00:25:04,840 My concern is that given the significance 395 00:25:04,920 --> 00:25:07,280 of the types of broken bones that he has 396 00:25:07,360 --> 00:25:08,320 and where they are 397 00:25:08,920 --> 00:25:11,160 and the potential vascular compromise, 398 00:25:11,680 --> 00:25:15,680 this is a potentially limb-threatening injury. 399 00:25:18,360 --> 00:25:21,680 We're just gonna remove the debris in your skin. 400 00:25:24,480 --> 00:25:28,720 It can be very difficult when you have severely injured trauma patients. 401 00:25:31,280 --> 00:25:35,000 This is why for my trauma shifts, I tend to wear this hat. 402 00:25:36,360 --> 00:25:37,920 I'm a fan of Harry Potter. 403 00:25:40,280 --> 00:25:43,240 The kind of work that we do in trauma is all very real. 404 00:25:43,320 --> 00:25:48,000 And sometimes you just need to be in a different world and just escape. 405 00:25:50,320 --> 00:25:54,160 Somewhere where things can be wished away with a bit of magic. 406 00:25:54,240 --> 00:25:56,200 And everything's all better. 407 00:25:58,000 --> 00:26:02,240 You want to restore people back to what they were before they came to us. 408 00:26:03,440 --> 00:26:08,560 But the reality is that sometimes it might not be possible. 409 00:26:32,440 --> 00:26:34,760 -Can I have a hook? -A hook. 410 00:26:37,880 --> 00:26:39,240 It's critical for Jared 411 00:26:39,320 --> 00:26:43,200 we get the butterfly fragment put back exactly where it belongs 412 00:26:43,280 --> 00:26:45,080 to ensure the leg can survive. 413 00:26:45,160 --> 00:26:46,800 Very soft hands, yeah? 414 00:26:53,240 --> 00:26:56,760 My children are my most precious gifts. That's it. 415 00:26:56,840 --> 00:27:01,840 And… and so you look after them as best as you possibly can. 416 00:27:04,080 --> 00:27:06,320 Jared doesn't often get shaken, 417 00:27:06,400 --> 00:27:09,360 but it will allow him to 418 00:27:10,720 --> 00:27:12,200 sit and breathe 419 00:27:13,640 --> 00:27:16,080 and decide where he wants his life to go. 420 00:27:17,920 --> 00:27:19,400 He got a bigger bike 421 00:27:19,480 --> 00:27:24,040 because he wanted to do the blood and transplants delivery. 422 00:27:25,120 --> 00:27:29,400 I think a meaningful purpose is what sits well with him. 423 00:27:30,960 --> 00:27:33,720 We want this leg to work again. 424 00:27:41,120 --> 00:27:42,800 Yeah, shot there. 425 00:27:42,880 --> 00:27:45,360 In order to put the butterfly fragment back, 426 00:27:45,440 --> 00:27:47,640 there is some force required. 427 00:27:48,760 --> 00:27:51,560 But too much force, you can make the problem worse. 428 00:27:51,640 --> 00:27:52,480 Too little force, 429 00:27:52,560 --> 00:27:55,360 you may not be able to put it back where it belongs. 430 00:27:56,400 --> 00:27:59,000 It's at least 15 centimeters long. 431 00:27:59,840 --> 00:28:01,840 And it's got muscle between it and the bone. 432 00:28:01,920 --> 00:28:02,760 Give us a shot. 433 00:28:03,840 --> 00:28:06,280 So, you can see it right there on the X-ray. 434 00:28:07,120 --> 00:28:10,960 Around the tibia, the muscle is quite bulky. 435 00:28:11,040 --> 00:28:12,520 It can get in the way, 436 00:28:13,040 --> 00:28:16,920 and it can make it very challenging to put that fragment back 437 00:28:17,600 --> 00:28:21,280 without forcefully ripping the remaining blood supply from it. 438 00:28:22,760 --> 00:28:26,000 And that's not good, because that means it may not heal. 439 00:28:26,080 --> 00:28:28,920 So now I'm trying to bring it back to where it belongs. 440 00:28:29,000 --> 00:28:31,240 We don't want to make any more holes in his leg. 441 00:28:31,320 --> 00:28:33,760 So we'll try and tickle it, bring it back in. 442 00:28:36,160 --> 00:28:40,360 Sometimes your fingers and your hands are the best tool that you've got. 443 00:28:41,080 --> 00:28:43,960 It's all to do with how you manipulate that fragment. 444 00:28:44,040 --> 00:28:44,880 Shot there. 445 00:28:46,840 --> 00:28:50,640 It's all about the feel. You push it in gently, and then I usually tap it in. 446 00:28:51,240 --> 00:28:52,920 Can I have a ball spike pusher? 447 00:28:55,440 --> 00:28:57,600 This is a tricky bit of the operation. 448 00:28:58,320 --> 00:29:01,880 There's a lot of feedback from the bone. 449 00:29:01,960 --> 00:29:04,600 It's almost like the bone speaks to you. 450 00:29:04,680 --> 00:29:05,880 Shot there. 451 00:29:06,560 --> 00:29:08,360 That fragment is saying to me… 452 00:29:08,440 --> 00:29:09,480 Shot there. 453 00:29:09,560 --> 00:29:10,880 "Gently bring me round…" 454 00:29:10,960 --> 00:29:11,800 Shot there. 455 00:29:11,880 --> 00:29:14,080 "…and I'll slot back where I belong." 456 00:29:16,200 --> 00:29:17,920 That's beautiful. Look at that. 457 00:29:19,640 --> 00:29:23,920 We managed to get it in almost within millimeters from where it should be. 458 00:29:24,440 --> 00:29:26,160 This is what we call cortical contact. 459 00:29:26,240 --> 00:29:29,600 So, how much bone and bone is touching each other. 460 00:29:29,680 --> 00:29:31,800 When they touch each other, they start to heal. 461 00:29:32,840 --> 00:29:37,160 So, that butterfly fragment is as close as it could possibly be 462 00:29:37,240 --> 00:29:40,080 without having to put any metalwork in. 463 00:29:41,120 --> 00:29:44,600 It's the most amazing feeling when an operation goes well. 464 00:29:45,520 --> 00:29:48,240 You feel like this huge weight has been lifted. 465 00:29:48,840 --> 00:29:51,320 Dude, we're going well. It's all good. 466 00:29:51,400 --> 00:29:53,080 Half the operation's gone well. 467 00:29:53,160 --> 00:29:56,040 -Now it's your half. -Half the operation's yet to go. 468 00:29:56,120 --> 00:29:56,960 I'm done. 469 00:29:59,680 --> 00:30:02,040 Orthopedic surgery is demanding. 470 00:30:02,120 --> 00:30:03,720 Mentally, you're laser-focused. 471 00:30:03,800 --> 00:30:06,000 Your brain is working at a million miles an hour 472 00:30:06,080 --> 00:30:07,160 to solve problems. 473 00:30:08,000 --> 00:30:09,920 But also physically demanding. 474 00:30:10,000 --> 00:30:12,680 You're malleting, you're hammering, you're screwdriving. 475 00:30:12,760 --> 00:30:16,040 It's fascinating how much impact it has on your body. 476 00:30:16,120 --> 00:30:19,080 And you see it when you take off your gown, 477 00:30:19,160 --> 00:30:21,240 and you're drenched in sweat. 478 00:30:21,320 --> 00:30:23,920 Sometimes you get blood on your face when you operate. 479 00:30:24,000 --> 00:30:26,400 So it's quite a horrid look coming out. 480 00:30:26,480 --> 00:30:28,800 And they see blood all splattered on your face. 481 00:30:28,880 --> 00:30:32,040 They think, "Oh gosh, you've just come out of the butcher's." 482 00:30:33,480 --> 00:30:36,240 No, I'm really pleased. This went really well. 483 00:30:36,320 --> 00:30:38,840 Now it's over to my plastic colleagues, 484 00:30:38,920 --> 00:30:41,040 who are gonna do their magic. 485 00:30:42,800 --> 00:30:43,640 Thanks, guys. 486 00:30:48,960 --> 00:30:52,240 We're now plumbing the artery to artery and two veins. 487 00:30:52,320 --> 00:30:55,360 So, this new bit of skin's going to have its own blood supply. 488 00:31:03,280 --> 00:31:04,440 Beautiful. 489 00:31:05,320 --> 00:31:08,600 Just need to now check the blood supply is strong enough. 490 00:31:12,720 --> 00:31:13,600 There you go. 491 00:31:13,680 --> 00:31:15,880 -Is it going somewhere? -Yeah. There you go. 492 00:31:15,960 --> 00:31:18,480 -That looks nice. -Yeah. Wonderful. 493 00:31:20,120 --> 00:31:22,560 So, that gives us confidence that the blood supply, 494 00:31:22,640 --> 00:31:25,920 the pressure going down into our new bit of transplanted skin and fat, 495 00:31:26,000 --> 00:31:26,960 is good enough. 496 00:31:27,640 --> 00:31:29,200 Let's stitch this. Let's go. 497 00:31:31,920 --> 00:31:33,000 Perfect. 498 00:31:33,840 --> 00:31:35,240 Can I get a… 499 00:31:35,320 --> 00:31:36,360 A croissant? 500 00:31:37,080 --> 00:31:39,360 Can I have a croissant? No, I'm joking. 501 00:31:41,640 --> 00:31:42,640 It's gone well. 502 00:31:42,720 --> 00:31:45,360 We were able to transplant skin and fat from the thigh 503 00:31:45,440 --> 00:31:48,280 down onto the lower leg to close that defect. 504 00:31:49,720 --> 00:31:52,840 Which gives the environment in which the bone to heal. 505 00:31:54,560 --> 00:31:56,520 The bone is fixed, the skin is fixed. 506 00:31:57,040 --> 00:31:59,200 It looks beautiful. It looks beautiful. 507 00:31:59,280 --> 00:32:00,160 C'est fini. 508 00:32:05,680 --> 00:32:08,680 Theater is an environment that I love to be in. 509 00:32:11,400 --> 00:32:15,160 I think every surgeon takes the patient home with them. 510 00:32:15,840 --> 00:32:18,440 You're doing your level best, you're doing your utmost, 511 00:32:18,520 --> 00:32:21,400 you know, to help that person and look after that person. 512 00:32:22,680 --> 00:32:26,720 But you're constantly thinking, "Did I do the right thing?" You know? 513 00:32:27,480 --> 00:32:32,240 Because whatever you do impacts that patient's quality of life. 514 00:32:40,840 --> 00:32:42,880 We're seeing young Jack today, 515 00:32:42,960 --> 00:32:45,840 which is the first time I've seen him after his discharge. 516 00:32:46,360 --> 00:32:48,640 I'm really keen to see how he's doing. 517 00:32:48,720 --> 00:32:51,680 This is a massive thing for a young man to go through, 518 00:32:51,760 --> 00:32:54,880 have something happen to him that he never thought would happen, 519 00:32:54,960 --> 00:32:57,720 and the consequences could be so far-reaching. 520 00:33:01,520 --> 00:33:04,920 This is Jack's scan that we took after his operation. 521 00:33:05,920 --> 00:33:09,280 Here we see the mesh repair of his forehead. 522 00:33:09,360 --> 00:33:13,800 So, you can see how the eye itself is supported by the bones that we remade. 523 00:33:15,560 --> 00:33:17,920 We spent a lot of time trying to get this right. 524 00:33:18,440 --> 00:33:20,280 So you don't really fully relax 525 00:33:20,360 --> 00:33:22,800 until you see the patient for the first time. 526 00:33:22,880 --> 00:33:25,800 -So… How you doing? Okay? -Hi. 527 00:33:28,640 --> 00:33:31,960 If we haven't got this aesthetically right, 528 00:33:32,040 --> 00:33:34,400 he will always be that man who was beaten up. 529 00:33:36,200 --> 00:33:37,880 I was out quicker than I expected. 530 00:33:37,960 --> 00:33:41,400 And it was only four or five days ago I had the operation, so… 531 00:33:41,480 --> 00:33:44,080 Made the bed for the first time in three weeks yesterday. 532 00:33:44,160 --> 00:33:47,400 Today was the first time I've tied shoelaces in three weeks. 533 00:33:48,520 --> 00:33:51,280 -Yeah. Yeah, it's about recovery. -Yeah. 534 00:33:54,240 --> 00:33:58,000 I am still very tired, and I'm normally having a sleep during the day. 535 00:33:58,080 --> 00:34:02,240 But the main psychological impact seems to be when I'm asleep at night. 536 00:34:04,520 --> 00:34:06,320 -How are you, Jack? All right? -Good. 537 00:34:06,400 --> 00:34:08,360 -How are you? -Not too bad, thank you. 538 00:34:08,440 --> 00:34:10,920 How are you in yourself? How's your mood? 539 00:34:11,520 --> 00:34:13,760 After coming out of the hospital, 540 00:34:13,840 --> 00:34:16,200 I had really vivid dreams 541 00:34:16,280 --> 00:34:18,880 about being attacked and not being able to escape. 542 00:34:18,960 --> 00:34:22,360 For instance, I've woken up yesterday drenched in sweat, 543 00:34:22,440 --> 00:34:25,240 which has made me not look forward to going to sleep too much, 544 00:34:25,320 --> 00:34:26,760 if I'm being honest. 545 00:34:26,840 --> 00:34:30,120 What we need to aim for is that you actually don't have those dreams. 546 00:34:30,200 --> 00:34:34,320 -Yeah. -And that you start to enjoy life again. 547 00:34:34,400 --> 00:34:35,400 Yeah. 548 00:34:36,520 --> 00:34:38,280 Okay, rest your head back for me. 549 00:34:38,840 --> 00:34:40,600 Just have a gentle look at the eye. 550 00:34:41,600 --> 00:34:44,200 Okay. Raise your eyebrows for me. 551 00:34:48,880 --> 00:34:51,000 The face is a road map of your life. 552 00:34:52,680 --> 00:34:56,400 When I see my mum, the first thing I see are her scars. 553 00:34:57,840 --> 00:34:59,640 The hardest thing for me is 554 00:34:59,720 --> 00:35:02,560 that she was unable to have the sort of surgery I perform. 555 00:35:07,680 --> 00:35:10,320 That's really good. The eye's moving really nicely. 556 00:35:12,240 --> 00:35:15,720 When I look from above, the contour's really perfect. 557 00:35:16,520 --> 00:35:17,360 Yeah. 558 00:35:18,280 --> 00:35:20,000 Considering how bad you were. 559 00:35:20,080 --> 00:35:22,440 I mean, he's just transformed, I mean… 560 00:35:25,360 --> 00:35:27,720 Yeah, thank you so much for everything. 561 00:35:28,960 --> 00:35:33,120 You come through all this, your life can take a dichotomy, two roads. 562 00:35:33,200 --> 00:35:36,000 You can either relive the injury and it'd be terrible, 563 00:35:36,080 --> 00:35:38,600 or you realize how precious and wonderful life is. 564 00:35:39,640 --> 00:35:41,360 Wanna take a picture of you? 565 00:35:41,960 --> 00:35:44,480 -That would be good. All three of us. -Yeah, of course. 566 00:35:44,560 --> 00:35:46,320 Come on. Okay. 567 00:35:46,400 --> 00:35:48,240 Okay. Three, two, one. 568 00:35:51,200 --> 00:35:55,320 I say to patients, "I didn't do all this work for you to stay at home." 569 00:35:56,360 --> 00:35:57,520 Because I recognize 570 00:35:57,600 --> 00:36:01,320 that you've got to put that hand out to help them out of the hole. 571 00:36:01,400 --> 00:36:05,160 Pull them up, reassuring them that they are okay. 572 00:36:06,560 --> 00:36:09,000 -Thank you for taking care of my son. -No problem. 573 00:36:09,680 --> 00:36:11,880 -All right. You know where I am, yeah? -Yeah. 574 00:36:13,240 --> 00:36:17,240 I thank our lucky stars for the trauma service we have now. 575 00:36:17,760 --> 00:36:21,120 Because we've seen patients that historically didn't survive 576 00:36:21,640 --> 00:36:23,600 go on to have a normal life. 577 00:36:30,920 --> 00:36:34,320 What kind of injury is it? Has he been able to walk on that leg? 578 00:36:34,400 --> 00:36:36,600 And is there any obvious deformity? 579 00:36:39,520 --> 00:36:40,520 Roger. Received. 580 00:36:40,600 --> 00:36:43,400 I'm gonna get an advanced paramedic along to you as well. 581 00:36:45,360 --> 00:36:49,920 Somebody's jumped out of a window and is lying unconscious on the floor. 582 00:36:58,080 --> 00:37:00,040 The leg hurts really bad. 583 00:37:00,920 --> 00:37:02,000 Can I get some painkillers? 584 00:37:02,080 --> 00:37:02,920 Yeah. 585 00:37:03,960 --> 00:37:05,680 I'm just in disbelief. 586 00:37:07,680 --> 00:37:09,640 This will affect me massively. 587 00:37:12,960 --> 00:37:15,800 The first time I met Toby, I was eight years old. 588 00:37:16,880 --> 00:37:18,400 It was more than a friendship. 589 00:37:18,480 --> 00:37:20,920 It's almost like a sibling sort of bond. 590 00:37:22,320 --> 00:37:25,400 We also worked together installing solar panels. 591 00:37:26,560 --> 00:37:29,120 We install them, do the internals, the electrical bits. 592 00:37:29,200 --> 00:37:31,560 I work with him, go to the gym with him. 593 00:37:31,640 --> 00:37:33,680 I've spent every day of my life with him. 594 00:37:37,680 --> 00:37:40,920 Toby always loves pushing everything to the max, especially in the gym. 595 00:37:41,000 --> 00:37:42,400 That's Toby's whole persona. 596 00:37:42,480 --> 00:37:43,480 Get it! 597 00:37:45,160 --> 00:37:46,400 This video here, 598 00:37:46,480 --> 00:37:50,680 I think this is within literally half an hour before the actual crash. 599 00:37:53,440 --> 00:37:56,160 The plan was to just go straight back to my house. 600 00:37:56,240 --> 00:37:58,320 But it was a lovely day. 601 00:37:59,120 --> 00:38:02,400 So I thought, "Let's go to a big hill, watch the sunset." 602 00:38:03,680 --> 00:38:05,880 That's why we took that long route back. 603 00:38:07,560 --> 00:38:10,080 So a part of me feels that it was my fault. 604 00:38:11,320 --> 00:38:13,520 Because I made the decision to go on that ride. 605 00:38:15,360 --> 00:38:19,360 I was still hearing the screams in my sleep, almost haunting me. 606 00:38:20,160 --> 00:38:21,160 Yeah. 607 00:38:29,440 --> 00:38:30,480 All right. 608 00:38:31,160 --> 00:38:35,480 So, the next case is the 20-years-old chap called Toby. 609 00:38:35,560 --> 00:38:38,360 He was on his motorbike, was hit by a car. 610 00:38:38,440 --> 00:38:40,880 Is there a picture, a clinical picture of the wound? 611 00:38:41,480 --> 00:38:42,920 Yeah. There. 612 00:38:43,480 --> 00:38:45,840 He sustained multiple injuries. 613 00:38:45,920 --> 00:38:48,560 He also has an anterior foot wound, 614 00:38:48,640 --> 00:38:51,040 where the tendon kind of is just coming out. 615 00:38:53,160 --> 00:38:56,760 The amount of force to rip a tendon through that hole is gonna be 616 00:38:56,840 --> 00:38:59,240 fairly massive, so… 617 00:38:59,320 --> 00:39:03,160 His sensation in his foot is completely lacking, below the ankle. 618 00:39:05,200 --> 00:39:08,320 At some point, we'll fix the humerus, fix the femur. 619 00:39:09,160 --> 00:39:11,920 But the time-critical thing is trying to get some blood 620 00:39:12,000 --> 00:39:13,200 into his foot again. 621 00:39:14,800 --> 00:39:17,280 He's clearly got a vascular situation. 622 00:39:17,880 --> 00:39:19,760 So that's the pressing concern. 623 00:39:22,680 --> 00:39:26,840 Vascular is about looking at the blood supply 624 00:39:26,920 --> 00:39:28,520 to all aspect of your body, 625 00:39:28,600 --> 00:39:31,160 all the way from the brain to the toes. 626 00:39:31,680 --> 00:39:35,240 We are like the plumbers of the human anatomy and the human body. 627 00:39:37,520 --> 00:39:42,600 In Toby's case, if we follow these arteries all the way down, 628 00:39:42,680 --> 00:39:45,240 suddenly we lose track of them, 629 00:39:45,840 --> 00:39:47,200 just at the ankle level. 630 00:39:47,720 --> 00:39:51,080 These vessels might have easily been either severed or damaged, 631 00:39:51,160 --> 00:39:55,360 or simply snapped as a result of the sheer force of the injury itself, 632 00:39:56,920 --> 00:40:01,560 leaving the tissue, muscles, bones, and nerves susceptible to dying. 633 00:40:01,640 --> 00:40:02,560 And dying fast. 634 00:40:04,080 --> 00:40:07,720 It's always difficult to explain to someone 635 00:40:07,800 --> 00:40:10,720 that he needs to have an immediate surgery. 636 00:40:15,560 --> 00:40:16,840 -Hi, Toby. -Hi. 637 00:40:17,920 --> 00:40:21,040 Normally, you should have three arteries 638 00:40:21,120 --> 00:40:23,440 that continue to give blood supply to the foot. 639 00:40:23,520 --> 00:40:24,600 Yeah. 640 00:40:24,680 --> 00:40:27,920 The two that cross the ankle are the most important. 641 00:40:28,000 --> 00:40:28,840 Okay. 642 00:40:28,920 --> 00:40:33,880 On the scan you had, both of them seem to have completely been disrupted 643 00:40:33,960 --> 00:40:34,960 at the ankle level. 644 00:40:35,040 --> 00:40:35,880 Right. 645 00:40:35,960 --> 00:40:39,720 The problem here, unless we improve the blood supply, 646 00:40:39,800 --> 00:40:43,640 there is a very high chance you will not be able to keep the foot. 647 00:40:45,400 --> 00:40:49,880 The most crucial element now is to try to reconnect the blood supply 648 00:40:49,960 --> 00:40:53,960 to give it every single little hope and chance for it to survive. 649 00:40:54,040 --> 00:40:54,880 Okay. 650 00:40:55,400 --> 00:40:56,240 All right. 651 00:40:58,160 --> 00:41:01,080 Don't eat and drink anything. I'm trying to rush you to theater. 652 00:41:03,120 --> 00:41:05,760 The job relies on me having two feet. 653 00:41:06,840 --> 00:41:10,800 On a busy day, I do about 30,000 steps. 654 00:41:11,400 --> 00:41:13,320 This is gonna take a toll on me. 655 00:41:15,920 --> 00:41:18,240 Toby, we'll be taking you in now, yeah? 656 00:41:21,960 --> 00:41:24,800 If we don't restore the blood supply to the foot, 657 00:41:25,680 --> 00:41:27,600 the foot is going to die. 658 00:41:30,840 --> 00:41:32,320 Toby is still very young. 659 00:41:33,200 --> 00:41:36,280 It's my job and duty to give him the best chance. 660 00:41:41,280 --> 00:41:43,920 It is like a huge burden on your shoulders. 661 00:41:44,560 --> 00:41:48,120 And a huge trust between you and the patient, 662 00:41:48,640 --> 00:41:51,320 and between you and the family. 663 00:41:51,400 --> 00:41:54,760 It's trust that they have put in you that you are gonna try your best. 664 00:41:58,360 --> 00:42:00,760 You always want to be there to support your children, 665 00:42:00,840 --> 00:42:04,040 but when it's something you can do nothing about, it's… 666 00:42:05,080 --> 00:42:06,080 It's very scary. 667 00:42:07,480 --> 00:42:08,640 You feel helpless. 668 00:42:12,400 --> 00:42:13,920 He's in theater now, 669 00:42:14,000 --> 00:42:16,400 so we're going to start with the blood supply issue. 670 00:42:17,880 --> 00:42:22,160 I don't want to scare you, but even with our huge experience, 671 00:42:22,240 --> 00:42:24,480 we can't guarantee it's going to work. 672 00:42:27,160 --> 00:42:28,920 We'll try everything we can. 673 00:42:32,160 --> 00:42:36,760 We can't even think about the potential impact on his life. 674 00:42:37,760 --> 00:42:41,120 You just have to hope everything will be as okay as possible, 675 00:42:41,200 --> 00:42:44,560 because otherwise your mind will spiral out of control. 676 00:42:45,480 --> 00:42:49,640 We have to rely on these people to do the best they can. 677 00:42:50,520 --> 00:42:53,000 We just have to put so much trust in them. 678 00:43:00,360 --> 00:43:02,120 Fantastic. Let's start. 679 00:43:03,080 --> 00:43:05,520 Okay. Smaller swabs. 680 00:43:05,600 --> 00:43:07,120 Let's have a look. 681 00:43:08,560 --> 00:43:10,640 Until you go inside the foot, 682 00:43:10,720 --> 00:43:13,200 you never know exactly what you are dealing with. 683 00:43:14,560 --> 00:43:17,240 This is all the trauma-perforate fractures. 684 00:43:17,920 --> 00:43:21,160 All these are macerated, damaged muscles. 685 00:43:21,240 --> 00:43:25,720 That artery here has been completely pulled apart. 686 00:43:27,600 --> 00:43:29,240 All this mess. 687 00:43:31,400 --> 00:43:35,880 I'm going to repair the first artery by reconnecting the two ends. 688 00:43:37,640 --> 00:43:40,080 But this might not be enough to save the foot. 689 00:43:41,200 --> 00:43:44,040 We have to find the other damaged artery as well. 690 00:43:44,600 --> 00:43:47,560 However, they can be hard to locate 691 00:43:47,640 --> 00:43:50,600 because they retract inside the damaged tissue. 692 00:43:54,000 --> 00:43:57,160 Let's try to see whether we can find the anterior tibial artery. 693 00:43:59,920 --> 00:44:04,080 It's all been damaged fully inside, and it's completely cut here. 694 00:44:05,160 --> 00:44:09,040 The force of the accident has torn it apart completely. 695 00:44:10,800 --> 00:44:12,640 This is absolutely gone. 696 00:44:14,800 --> 00:44:18,360 The artery has been totally severed. 697 00:44:20,040 --> 00:44:22,200 This was the worst of my fears. 698 00:44:22,880 --> 00:44:24,320 It's not looking good. 699 00:44:26,240 --> 00:44:28,280 Don't waste your time to repair it. 700 00:44:28,360 --> 00:44:30,640 It's not gonna work. Replace it. 701 00:44:33,720 --> 00:44:36,320 The artery has been so badly damaged, 702 00:44:36,840 --> 00:44:41,000 I will have to cut out a section of the vein from his other leg 703 00:44:41,080 --> 00:44:44,160 and use it to replace the damaged artery altogether. 704 00:44:45,600 --> 00:44:46,480 Hold this one. 705 00:44:48,440 --> 00:44:49,280 Scissors. 706 00:44:52,440 --> 00:44:55,120 Arteries and veins are incredibly delicate, 707 00:44:55,200 --> 00:44:57,400 and their walls are paper-thin. 708 00:44:57,920 --> 00:44:58,920 Excellent. 709 00:45:00,880 --> 00:45:04,880 You need absolute full focus because this is the most important part. 710 00:45:07,120 --> 00:45:08,120 Lift up. 711 00:45:11,400 --> 00:45:13,200 Can I have the green needle? 712 00:45:15,120 --> 00:45:17,920 The needle must be in the perfect position, 713 00:45:18,000 --> 00:45:19,400 in the perfect angle, 714 00:45:19,480 --> 00:45:22,200 and I'm talking about a fraction of a millimeter. 715 00:45:24,680 --> 00:45:27,600 And I have one opportunity to get it right. 716 00:45:31,680 --> 00:45:33,360 No. Stay there. Stay there. 717 00:45:34,280 --> 00:45:35,120 It's crucial. 718 00:45:35,760 --> 00:45:40,400 If we are not able to do this, he will lose his foot. 719 00:45:40,920 --> 00:45:42,360 Relax. 720 00:45:43,160 --> 00:45:45,160 It can be like defusing a bomb. 720 00:45:46,305 --> 00:46:46,271 Watch Online Movies and Series for FREE www.osdb.link/lm