- 6 days ago
999.the.critical.list.S01E03
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00:00Hi, are you bleeping emergency bleep?
00:04The patient from ED is coming in here now.
00:09Behind the scenes of every major hospital in the UK,
00:12there is an emergency list that few of us have ever heard of.
00:17The emergency list is a list of the sickest patients in the hospital,
00:21the patients who need emergency surgery.
00:24He's a sick patient who needs expediting.
00:27This critical list evolves by the hour
00:29as patients are added and prioritised.
00:34They've just booked this one also as a catwalk.
00:37We weigh things up.
00:38This list is about order of priority of the sickest patients first.
00:42We follow the critical list at a time
00:44when the NHS is facing unprecedented pressure.
00:48The list is full.
00:49We're seeing more and more people come through the door.
00:51It's the toughest time for the emergency list that I have ever known.
00:55But with patients hours away from being critically ill,
00:58staff are forced to make impossible decisions.
01:01Why is she taking priority over him?
01:04Of who goes next.
01:05Because reality's hitting me.
01:07And who must wait.
01:09I cannot stay indefinitely in hospital.
01:12Never think that we don't think you're important to us, you are.
01:21Without the emergency list, these patients, they would deteriorate,
01:26they would be taking hospital beds up for days,
01:28they would be in critical care.
01:30These patients would probably die.
01:33Just make sure I wake up.
01:57David's a 65-year-old gentleman.
01:59He's got black toes, he's got dry gangrene.
02:02And overnight, his leg has taken a turn for the worse
02:06and his calf has become extremely tender
02:08and he's got no motor function or sensory function in his foot.
02:14A lack of blood supply means that David's left leg is dying fast.
02:19He needs urgent surgery.
02:21David.
02:23We've had a discussion with the other consultants
02:25about what's been going on with your leg.
02:27We've had two previous bypasses,
02:29taking blood supply from where it's good, bypassing the blockages.
02:32It appears that it hasn't worked and it's got to the point now
02:35where the muscles in your leg have started to die.
02:38And without the proposed operation of an above-knee amputation,
02:42that would potentially threaten your life.
02:44Never would.
02:45It is what it is, it is what it is, unfortunately, yeah.
02:48But without this, there is a significant risk of death, OK?
02:53David's leg is gangrenous.
02:55If it's not removed, his bloodstream could become poisoned.
02:59Vascular consultant Mr Ormisher needs to add him to the emergency list
03:04and get him into theatre as soon as possible.
03:08Is it environmental issues that he's having?
03:10Is this sort of diabetes?
03:12This is predominantly through smoking.
03:15But in a lot of our population, it is smoking combined with diabetes, yeah.
03:21In Blackburn, we carry out approximately 100 amputations per year,
03:25major amputations.
03:28Increasingly, the NHS is under stress,
03:31so I think at some point, as individuals,
03:33we need to take some responsibility, some ownership,
03:36be that losing some weight, stopping smoking,
03:39or, you know, positively affecting our lives with exercise,
03:42I think it is our responsibility, inevitably,
03:44to make sure that we live healthier for longer.
03:50Hello, I had a shave.
03:52Oh, all very good.
03:54We had a task yesterday, it didn't look good.
03:56Booking a gang physical care for a left above-knee amputation.
04:00OK.
04:01What's on in theatre at the moment?
04:03So, they're doing a sick abscess and a sick appendix.
04:06It's like, this guy's on ITU on no-ad and stuff.
04:09He's a sick patient, so he needs expediting.
04:14Becky is one of the theatre coordinators.
04:17It's her job to keep the emergency list moving.
04:20OK, so, we've just had a vascular case booked,
04:23which is a necrotic leg,
04:25so this patient is probably going to be the next case in theatre six,
04:28so I'm going to try and organise all that.
04:32There are 11 surgical theatres.
04:36There are 11 surgical theatres,
04:38but only one is dedicated to unplanned emergency procedures, theatre six.
04:44Chris, good morning. I'm fine.
04:46Before confirming whose procedure will go first,
04:49consultant Mr Sheikh must assess the next most urgent patient.
04:54My next stop will be checking that appendix patient,
04:57making sure, what I was told this morning in the handover,
05:00that the patient is unwell, but not as unwell as this patient,
05:03and if that is fine, then we can carry on with our plan.
05:06If not, then we have to think of another method.
05:08And we've got Mitchell.
05:10Mitchell, Mr Sheikh, I'm one of the surgical consultants.
05:13I understand you've had an ultrasound scan,
05:15and we think you've got appendicitis.
05:17All the appendicitises that come through the hospital
05:20present as an emergency.
05:22And Jem, she's had some antibiotics, has she?
05:24It has the potential to get infected and then burst,
05:27which creates infection and sepsis.
05:30So there? Yeah. Generally.
05:32And ultimately, this can be life-threatening.
05:35So we want to treat it as soon as possible in the emergency theatre.
05:39We've got another extremely sick person who unfortunately has to go.
05:42You were going next. They have to come in in between.
05:44I'm sorry about that.
05:46No decision is taken without an element of risk.
05:49If things change in any way from yourself, we'll get you in.
05:51Yeah, no worries. Thank you.
05:53Right, OK, carry on with the antibiotics, folks.
05:55I don't want to make the wrong call,
05:57and delay in treatment can have potential and significant consequences.
06:01You can walk away and in half an hour,
06:04the clinical picture of the patient would have changed completely
06:07without any predictors.
06:14I'm one of those people.
06:16If I'm in pain, I just kind of get on with it.
06:19And then 36 can go home.
06:2122-year-old Mitchell came to A&E nine hours ago.
06:25Cos I didn't want to come and there's nothing to be wrong with me,
06:28and then wasting time for these guys, it's not really fair.
06:31But it started on Friday and it just got worse as the days have gone on.
06:36And then the pain just got, like, really bad.
06:39I was crying and my partner forced me to come.
06:44So, I'm originally from Blackburn.
06:48I was a foster child.
06:50I've been with my foster family for about 15 years.
06:53I love them.
06:55My family gets, my biological family, foster family,
06:58they get along so well.
07:00So, I love that, you know.
07:02So, yeah, hopefully they're coming today,
07:04but it depends where my surgery is.
07:06With Mr Sheikh satisfied Mitchell's condition is currently stable,
07:1136 can prepare for an emergency amputation.
07:14We will prep the leg, OK?
07:17Knife the skin, we need to have ties ready.
07:19I'll transfix the femoral artery and femoral vein.
07:22Then we'll use the saw, I'll bevel the edge of the femur
07:25and then we'll start closing up.
07:27David, in about half an hour we're going to take this leg off.
07:31Is that going to work, really?
07:33No, you're going to be asleep before it's all done.
07:35Yeah. I'm allergic to pain.
07:37What else are you allergic to? Doctors.
07:39Besides them.
07:41A vascular amputation is generally considered
07:44a higher clinical priority than acute appendicitis
07:48and will also bump other less critical cases
07:51further down the list.
08:00So, I'm just at the hospital.
08:02They've taken my blood pressure and all that kind of stuff.
08:05Hopefully a case of I'll get the surgery pretty soon.
08:08But I'm going to give it another hour, find out what's going on
08:12and then go from there cos my belly's rumbling.
08:16I need food!
08:18That way you get sorted and get back to normal and get back to work.
08:22Yeah. Bye. Bye.
08:25I have something called hydrogenitis.
08:27I've got hair follicles that will turn in on themselves
08:30and then they'll start going into my skin.
08:32That then creates abscesses.
08:34Unfortunately for me, I've got it in the worst place possible,
08:37so I've got an abscess that big, right by my bum hole
08:40and I'm walking like I've got a pineapple up my bum.
08:4337-year-old animal technician Jenny
08:45has already been on the list for two days.
08:48I've come in here by A&E. I was dropped off by my mum.
08:52Then I've been discharged.
08:53Then I've been told to come back yesterday
08:55and then I've been told to come back again today.
08:57Now I'm on a zero-hours contract.
08:59I've lost three days' worth of wages as it is coming here.
09:02Hopefully, day three. Fingers crossed.
09:07So, this lady came in two days ago.
09:11They only do life or limb, really, after midnight.
09:15And then she wasn't put on yesterday's list.
09:18Big case is yesterday.
09:22Hi, bleep an emergency bleep.
09:24So, I suppose a lot of patients
09:26don't have much understanding of an emergency list.
09:30You want to book an emergency case?
09:32Right, you've rung the right number then.
09:34Where the list changes due to how sick other patients are.
09:38What is it for?
09:40Right, I'll put it on this today then.
09:42We don't bump patients easily.
09:44We want the patients to come in, have their operation and go,
09:48unfortunately, they've got too many patients and too little space.
09:55Just keep your arms in the wheelchair, Julie,
09:58so we don't catch them.
10:0059-year-old Julie is on the list for an urgent rectal examination
10:04under anaesthetic.
10:06She's come in with evidence of bleeding from her rectum,
10:10but she's also got these groin abscesses,
10:12so the difficulty is it's almost like she's got two conditions going on.
10:17Before her procedure, Mr Shake has requested a full body scan.
10:21Hello. Eric, do you look for a CT?
10:24I am getting scared now.
10:26What's panicking you?
10:28I don't like doctors and I'm scared of doctors,
10:30if you see what I mean.
10:32So, it panics me.
10:37Went to the doctor six months ago cos I had piles.
10:41Is it Jewish?
10:43I had creams, antibiotics, nothing worked.
10:48So I carried on having telephone conversations with doctors,
10:54waiting for the blood test results to come back.
10:58I got referred to have a camera
11:01and I'm still waiting for that referral and it's not come through.
11:06No.
11:09Carried on working.
11:13Cos I thought, it's only piles.
11:16But then two weeks ago, I had two lumps appear in my groin
11:22and I totally ignored it because I didn't...
11:26I was too scared to go to the hospital
11:30because I knew the back of my head it would work bad.
11:35But if I put it at the back of my head, it would just disappear.
11:39You would think it would never be you.
11:53There's a lot of deprivation in the area.
11:56Some of our patients have to make choices of feeding themselves
11:59or feeding their children, no healthy diet.
12:02If you get hurt, then your physical health's going to deteriorate,
12:05your mental health's going to struggle.
12:07There's smoking and drinking.
12:09There's a lot of patients who are on that list who've got a lot of issues
12:13and they're caused by smoking and alcohol.
12:15They're not looking after themselves, they're not getting the exercise.
12:18It's a tough time at the moment, especially around in this area.
12:24Give me that diathermy, please.
12:26Then I retract down, you pull up and we get through it.
12:31In theatre six, 65-year-old David is having his left leg amputated.
12:37Blocked arteries have prevented blood flow reaching his toes,
12:41causing his leg to die.
12:43A little blood vessel in there. Tie, please.
12:46We're always very careful about blood loss,
12:48but even more so with this gentleman
12:50because he's cardiovascularly compromised,
12:53we need to be really careful.
12:55So within 30 days of having a major amputation,
12:58probably 6% of people will die.
13:00These patients are at really high risk for a stroke
13:03or a high risk for a heart attack.
13:05This life-saving procedure has impacted the entire emergency list.
13:10In a patient that's really sick,
13:12it's something that needs getting sorted sooner rather than later.
13:15I don't want to be getting a phone call in the middle of the night
13:18saying that we need to do something now.
13:20If this guy was to arrest, you'd want a full team around.
13:23So getting big cases like this done in daylight hours,
13:27on the emergency list, it's always going to be vital.
13:30I don't think he'd wait another day or two
13:33to get him on the elective list.
13:47They were just nipped out for a coffee then.
13:49They were waiting there but they were waiting for you to come back.
13:52I'll send them in.
13:53Julie is expecting the results of her scan.
13:57I'm waiting for the report to come back on Julie,
14:01which has just come back, so I'm going to have a quick look at that
14:04because it might be that actually the plan changes for Julie.
14:07So it does look like what they thought it may be.
14:12It is a suspected cancer.
14:14PHONE RINGS
14:15Hello? Hi, it's Becky.
14:17Have you seen the report?
14:19Right, OK, thank you.
14:21Thanks, bye.
14:23So Mr Sheikh's actually just with the family now, and Julie,
14:26so he's going to go through things with them
14:29and then we'll hopefully get her down to theatre quite quickly.
14:34I'm going to get upset now because it's just...
14:39..because reality is hitting me.
14:41I know. I know, I know.
14:49Hello. Hello, come in.
14:51Christine. Come in, Christine.
14:53Christine, do you understand what's wrong?
14:56What information has been given to you so far?
14:59And I'll pick it up from there.
15:01Briefly, obviously we know we're dealing with cancer.
15:04Yeah.
15:06As far as where it's gone in certain regions,
15:10you're not clear exactly?
15:13So the problem is just near her back passage area.
15:16Yes.
15:17And she's got these two big areas in her groin
15:20which are the glands in the groin,
15:22and that's because the problem in the back passage area
15:25in terms of its lymphatic drainage,
15:27where it drains out, it goes into the groin,
15:29pretty much like breast problems drain into the armpit.
15:32Same way back passage problems will drain into the groin.
15:36So when we looked at it on the scan,
15:38it's quite a long way up into the back passage as well.
15:41So what we need to do is take a biopsy, obviously,
15:44of the back passage and of this growth,
15:46and then we'll probably need to divert the stream of poo,
15:50which is by giving her a stomach.
15:52Oh, yeah.
15:53Yeah, which...
15:55It's the worst fear!
15:57Do you know what? It's the worst fear!
15:59It's OK. Listen, it's OK.
16:02Primary care is one place
16:04where a lot of these problems can be tackled or dealt with.
16:08But, again, access to primary care is restricted.
16:11Getting an appointment with your primary care physician
16:15is significantly delayed.
16:17They then get out of hand
16:19and then they result in an emergency presentation
16:22for that patient.
16:24Please, can they have the operation when I'm...
16:26I know you're doing it today, but just give me time with...
16:29You've got a couple of hours, don't worry about it. All right.
16:32And then that produces the pressure on the emergency service.
16:35And that's subject to nobody comes downstairs in A&E
16:37with a knife sticking out of their tummy,
16:39in which case I have to do that first ahead of you.
16:41We, as clinicians, want to deliver the service,
16:44but what is restricting us is the ability,
16:46because of lack of the infrastructure,
16:48lack of the facilities, lack of the estate,
16:50lack of the manpower, to deal with that.
16:52Do you know what I'm going to ask now, don't you? Yeah.
16:54Can I just go down for a bloody fag before I go?
16:56You can go down for a fag.
16:58And then we're going to stop it,
17:00cos we need to be healthy, Mother.
17:02Yes, we will.
17:03We do need more investment.
17:05When we know clearly that the health in this area is deprived
17:09and it needs more support,
17:11that's where the frustration does come in.
17:14Mr Sheikh wants to bump Julie up the list for an urgent biopsy
17:18so that she can begin her cancer treatment as soon as possible.
17:23Will that impact the list at all, or will she...?
17:26It is probably going to change the list.
17:28So there is another lady waiting for surgery with an abscess.
17:31She's probably going to be bumped a little bit again,
17:34but she will end up waiting and having surgery after Julie,
17:37providing nothing else life-threatening comes in.
17:44This guy's been a heavy smoker. Previous heart attack and balls.
17:47Atherosclerosis of the coronary arteries.
17:49So he's had a similar picture in the arteries that supply the legs.
17:52This is like a heart attack in his leg, essentially.
17:55Throw it up.
17:57There you go.
17:58Across the UK, last year there was approximately 3,000
18:01major limb amputations.
18:02When we say major limb amputations, it's not toes,
18:05it's not the back of the foot, it's not the back of the foot,
18:08it's not the front of the foot.
18:10When we say major limb amputations, it's not toes,
18:13it's taking a leg off at the level above the knee or below the knee.
18:16Take that out, put it in the limb bin.
18:19It's a big number, yeah, and the problem is it's not going down either.
18:22Right, swabs, please.
18:24It's not just impacting on the amount of money we have to spend
18:27as a society when they're in hospital.
18:29These people really struggle when they go home.
18:31Getting near the end now.
18:33We'll be giving it a wash and closing up soon.
18:35They need housing modifications. Some people need rehousing.
18:38It puts significant pressure on family members.
18:40Family members have to stop working to care for these people.
18:43So the societal impact of an amputation is massive.
18:46We did that to save his life, you know,
18:48but this is going to be an ongoing problem for him
18:51and the wider community around this patient when he goes home.
18:55We've got good systems in place, but it is a real drain,
18:58and if we can avoid an amputation at all costs,
19:00we should definitely do that.
19:08BEEPING
19:10Hi, bleep in a minute, please.
19:12OK, and what is she for?
19:15Dental abscess.
19:17We have got a lot on.
19:19Give her a drink now.
19:21She's definitely, definitely not going to be done in the next two hours.
19:24Whilst Nikki adds a seventh person to the emergency list
19:27and Mr Sheikh discusses the lower-priority patients with his registrar...
19:31Are you OK, Jenny?
19:33..there is some good news for Jenny.
19:35I'm just going to let you know
19:37that we're going to get you a bed on the ward.
19:39You can stay on your side and be a bit more comfortable
19:41whilst you're waiting for theatre,
19:43cos we're not sure when you're going to theatre yet from there.
19:45Is that all right? Yeah. Thank you.
19:47Jenny has been in hospital nil by mouth for three days,
19:51waiting for surgery on a pilonidal abscess,
19:54but she's not the only abscess case on the list.
19:57You've seen the abscesses? Yes, seen him, he's consented.
20:00Which one of the gentlemen? Multiple pre-anal abscesses.
20:03So we're, I think, just going to drain those two. Fine.
20:06And then this lady's down in Siku, or is she also on a ward now?
20:09She's in Siku, she's had day three coming in,
20:11so we have requested a bed for her. OK.
20:13And we're trying to get her... Get her done, whatever time, so keep her...
20:16..today or tomorrow. OK, fine.
20:18So, in addition to this, what else has come on the list
20:21is a stent from urology, and then there's a dental abscess.
20:24OK, we've done one and we've put on three more.
20:27So, it's OK.
20:30Hiya, Mum, you're on loudspeaker. Yeah, all right.
20:33So, I've been moved up onto the ward now,
20:36and then hopefully I'll be going up for surgery soon.
20:40You must be absolutely starving.
20:42I'll certainly be looking for a fry-up when I get released, definitely.
20:46You've got a fry-up? All right. All right, then.
20:49All right, love you. Love you, bye.
20:51Bye! Bye! Bye!
20:54Sorry.
21:00THEY SING
21:06They're like rat's tails. I know, it's like dreadlocks.
21:10I'm just going to my office, and then I'm going...
21:13To make a brew.
21:15..she hates my brews, and every time I do it, it's a test.
21:18So, two tea bags and what?
21:20One sweetener and a tiny bit of milk.
21:23She makes a rubbish brew.
21:26Do you want a hug? Thank you.
21:29On the ward, Mitchell's biological mum, Colette,
21:33is coming to take over waiting duties from foster mum, Bernie.
21:37How would you describe Bernie Mitchell?
21:39Kind, caring, think of everybody else before herself.
21:44I'll say goodbye.
21:46I'm going to walk down to the front.
21:48I'll walk down to the front anyway.
21:50Was it hard for you, too? Yeah, of course.
21:53Except somebody else to look after your child, yeah.
21:56She's brilliant, you know, she took Mitchell in
21:59and looked after him for me when I couldn't.
22:04Because I had breast cancer.
22:07I can't talk now, I can't.
22:10But, yeah, she's done good by her.
22:17How are you feeling about your surgery?
22:20Are you worried? No.
22:22Just crack on with it.
22:24Do you feel like this crack-on attitude comes from
22:27having such a supportive family?
22:29I think so, I think being through what, like,
22:32I've been through a lot in my life,
22:34I just kind of just...
22:36You learn to deal with it and you just get on with it, don't you?
22:40Yeah.
22:41Do you feel like you're a family fighter?
22:43Oh, definitely.
22:44It has to be done. We have no choice.
22:52It came back to above 94%.
22:57In A&E, registrar Omar Ali has been alerted to a patient
23:01with severe abdominal pain.
23:03I had a look at your blood results.
23:05The inflammatory markers, one of them is really high.
23:08We are in the middle of the corridor.
23:10I don't think it's the right place to examine you,
23:12so let me find a little bit of privacy and then have a feel of your tummy
23:15and then we'll have a chat, all right?
23:17He must assess how urgently 39-year-old Mohamed needs surgery.
23:37Mohamed has the same condition as Mitchell,
23:40but his case is significantly more advanced.
23:44I just want to get rid of the pain. It's too much, I can't bear it.
23:47You have two identical patients.
23:49The appendix starts to swell at the same time,
23:51but it may burst in 48 hours in one,
23:53it may take seven days to burst in the other.
23:55So we therefore have to go by the clinical parameters
23:58that the patient shows.
24:00The clinical signs and symptoms are the key in managing
24:03where this patient goes on the emergency list.
24:06Hi, a bleep in emergency, please.
24:08I'm in A&E.
24:10We've got a patient for theatre six, please.
24:12As Mohamed's condition is critical,
24:14he is expedited ahead of less urgent cases.
24:17Of course she can. Go on.
24:19Every additional hour Mitchell's surgery is delayed
24:22significantly increases the risk of a ruptured appendix,
24:26while Jenny's procedure is likely to be pushed back further.
24:30Patients are building up now.
24:32If there's much more booked, and depending on the category,
24:35we may end up bumping her again till tomorrow.
24:43BEEP
24:49All the patients on the emergency list are having to wait longer
24:53as an acute case has come in.
24:5739-year-old Mohamed has been rushed into theatre six
25:01with a suspected burst appendix
25:03and is at risk of developing life-threatening sepsis.
25:07You can see there is pus in between the bowel loops,
25:11so clinical suspicion was right.
25:13It seems like perforated,
25:15so that's why we took him earlier than other cases,
25:18so you can actually see the finding.
25:20There is pus in almost two quadrants already.
25:23The starting point is the appendix gets blocked,
25:25it gets swollen, that's what causes the pain,
25:27and then it'll burst.
25:28It bursts, that means that the content,
25:30which is fecal matter, which is very high in bacteria,
25:33leaks out of the bowel,
25:34and then that can get drawn into the bloodstream
25:37and creating what's called a systemic form of sepsis,
25:40and ultimately this can be life-threatening.
25:43After draining the pus,
25:45the appendix needs to be carefully removed from the bowel.
25:48That appendix is just attached to the colon there.
25:52You can see it's quite inflamed.
25:54The tip is gangrenous, so we'll just secure it properly
25:58and then take a better look.
26:01Excellent.
26:10Make sure it's black and white.
26:14David is in intensive care,
26:17recovering from his emergency leg amputation.
26:22PHONE RINGS
26:25Hiya, it's Jackie. Can I help you?
26:28What relative are you to him?
26:31No, I can tell you he's had the operation,
26:33but I can't really give you too much information over the phone
26:36cos you're not next of kin,
26:38but you're quite welcome to come and visit him if you want.
26:42Who was that?
26:43That was his landlady, but they're really good friends, actually.
26:46She's been concerned at him at home for a long time,
26:49so she's going to come up with some Lucas aid tomorrow.
26:53If you were told that you're going to have your legs chopped off,
26:56you'd be absolutely devastated,
26:58so David's got a lot to deal with at the moment and it's really sad,
27:01so we'll try and support him as much as we can.
27:05That's as good as James.
27:07Just buy a big telly.
27:09I wouldn't be as happy as Larry in the house.
27:12They get wheelchairs and buses, eh?
27:15If I want to go out, I'll go out, but if I don't, I won't.
27:21Do you have any family now, any kids?
27:23I've got one lad.
27:25Do you speak to him?
27:26I haven't spoken to him since 2000.
27:292000?
27:30When we split up, ex-wife.
27:32I went back to Wolverhampton and his mum and him and the family
27:36went to live in Denby.
27:40Last time I heard, he was a copper.
27:42He's a police officer?
27:43Yeah.
27:44A tall police officer.
27:46Is he very tall?
27:47Yeah.
27:50Do you have any regrets about...?
27:52What I've done in life?
27:54No, about smoking and maybe...?
27:56Oh, yeah, of course I do.
27:57First thing on your bloody mind, you.
27:59First thing on your bloody mind, you.
28:01You stupid git.
28:03So if you could go back in time and change something,
28:05what would you change?
28:06Never started smoking.
28:08Without doubt.
28:11They always say, oh, it never happens to me,
28:13it never happens to me, but...
28:16You never know what's around that corner, my love.
28:21You never know what's around that corner.
28:30And then we close the skin.
28:32In theatre, Mohamed's been on the table for 90 minutes,
28:36without complication.
28:38We managed to take the appendix out without any injury to the bowels
28:41or the bladder or any structure.
28:4348 hours of observations and antibiotics.
28:46Then he can go home afterwards.
28:50With Theatre 6 now free...
28:54..Mitchell can finally be called for her appendix operation.
28:59Following a 25-hour wait.
29:02Bye. Bye.
29:04But as late afternoon approaches,
29:07with six cases still remaining on the emergency list,
29:10there's a threat that some could be bumped until tomorrow.
29:14It was perfect before when I did it.
29:16I know, I'm going very warm.
29:18Bob on. 369.
29:21Why don't you strip off a little bit?
29:24So the anaesthetist has just come in
29:27and he's said that at least two patients are before me.
29:31If any emergencies come in between that time,
29:33then I'm going to be booked down the list.
29:35So I'm currently... I've been waiting for over three days.
29:39I've had no food, no drink in that entire time.
29:43And I'm now going to be, by the looks of it, going back home tonight.
29:48Still on nil by a mile,
29:50so still won't be able to eat anything or drink anything.
29:53And then I'll be told to come back in the morning
29:55to go through the whole process again.
29:57This is why you've got so many problems in the NHS,
29:59is because they're doing stuff like this.
30:01It's just not... It's not efficient at all, is it?
30:04I need to get rid of that, don't I?
30:07Yes. Yeah, yeah, yeah.
30:09We do not like to postpone patients to the next day,
30:12but unfortunately there are many days that we do.
30:15I'm taking up a bed that's much needed,
30:17simply because they're not actually putting in for the surgery
30:20and it's a 30-minute surgery.
30:22I do understand why people get frustrated.
30:24They can't see what's going on and they don't know the situation.
30:27I'm very laid-back and want to see the good side in everything and stuff,
30:31but how can I argue with my friend that's going,
30:34they're not providing you with treatment, they're denying you treatment,
30:37is what effectively is happening.
30:39It's not really obvious, this.
30:41We are seeing so many more patients than we've ever seen before.
30:45Hi, Dean, are you bleeping emergency bleep?
30:47Sick patients, more complex than we've had before.
30:51We can't do that.
30:52How are we going to get that patient here from Preston?
30:55I think it's a combination of ageing population,
30:58lack of access to GPs, dentists.
31:02There's a lot of unemployment around here.
31:05People's mental health suffers.
31:07They don't seek treatment as much.
31:09When they do seek treatment, they're far sicker.
31:11Well, it's another more complex patient on the emergency list,
31:15takes more time.
31:16We'll put it on tomorrow's list.
31:18I can't promise when it'll be. We'll do it when we can.
31:21There are days we look at that list and think,
31:24we're never going to finish this,
31:26we're never going to get through all these patients.
31:28It is definitely unprecedented.
31:33I'm just nipping to Theatre 8 because I believe Theatre 8 are finishing.
31:37Yes, they are.
31:38To relieve pressure on the emergency list,
31:41Nikki is looking to see if any planned elective procedures
31:45in other operating theatres have finished for the day.
31:49Is your list finishing as well?
31:51We've got staff in ten other theatres besides ourselves
31:54that are there till six o'clock.
31:56She is hoping that surgical teams from the other theatres
31:59will take some of the remaining cases.
32:02I heard a rumour that you're finishing.
32:04You didn't hear anything. It's all in your head.
32:08I keep my eye on all theatres.
32:11If there is a list that's finished early,
32:14we're going, asking these staff, can you just do this for us?
32:17Can you do this operation for us? Can you get these patients done?
32:20We might do abscesses in here.
32:22I don't think we're going to do too long.
32:24Come on, we'll get them out.
32:30I'm the juggler of the list.
32:32Theatre 8 has finished their major case,
32:34so we've got an hour, an hour and a half-ish time in there,
32:38which we can use very wisely.
32:40So we'll get one of these two cases, two abscess cases, done.
32:45Omar, will you speak to Mr Sheik?
32:48Does he want to do Jenny or the man?
32:50Theatre 8 has finished a bit early,
32:52so we could get, you know, the complex for anal abscess patient.
32:57The man? For him to be done.
32:59In eight.
33:01We've nearly won.
33:03I'm just going to see in nine and see where they're at with their patient,
33:07see if we can get Julie done.
33:10How long do you think there is at most?
33:12Do a point where they'll say enough is enough
33:15and then we'll do it in the morning.
33:17What time do you reckon? Maybe latest six o'clock.
33:22Finished. You finished?
33:24Right, we're just looking at this other case for you.
33:27Mr Sheik will do it, he'll have it done within an hour.
33:30No.
33:31We know that means yes.
33:33As if to be seven watching that learner!
33:36I know, but this lady needs you.
33:39No pressure. There's always pressure with you.
33:42With one abscess case and Julie's cancer biopsy
33:47now taking place in other theatres,
33:49Jenny will be next in Theatre 6, after Mitchell's appendix surgery.
33:58It's going to be a minor now.
34:01It's going to be a minor now.
34:04I'm just watching everybody.
34:06Mitchell is waiting to go to the anaesthetic room.
34:09Are you nervous? A bit.
34:12I'll be all right. I won't feel anything.
34:15I have mascara on my nose.
34:17It's pretty, so eyelashes.
34:20Am I there? Yeah.
34:22I've not used it since I was a teenager.
34:24Have we not? I've only got my eyelashes done.
34:26Since you were a teenager? That weren't long ago, were it?
34:2922. 20.
34:31You're 22? I'm 22.
34:33That's how old I were when I had my first baby.
34:37I was, yeah, 21 when I had mine.
34:40Oh, have you got a baby?
34:42Yeah, we're still birthed, but...
34:44Oh, sorry. No, it's OK.
34:48I've been with my fellow for about eight years,
34:50been together since school.
34:52Last year was going really well.
34:54Things kept getting better and then we hit a bit of a bump.
35:00I gave birth to my son on the 4th of October.
35:05I was 25 weeks.
35:07And my son was born sleeping.
35:10We don't know the cause, it's just yet.
35:16Well, it's his due date tomorrow,
35:18so it's going to be, like, a bit of sweet,
35:21cos hopefully I won't be here.
35:23So we're going to just go for food and a blue release.
35:26Family day, really.
35:28You going to get off to sleep now? Yeah.
35:30It's going to feel a little calm and tingly going up your arm
35:33and the next thing you're going to wake up,
35:35you're nearly finished.
35:37Up until I had him, I was really poorly.
35:39And then after I've had him, I've been really poorly.
35:42So, I don't know. Well, it's all connected, I'm not too sure.
35:46We'll take really good care of you.
35:48We'll see you when you wake up, OK? Yeah.
35:52Hello, yes, who's this speaking?
35:54Hi, it's Beckham Theatres.
35:56Jenny's due to come down to theatre,
35:58so I've just spoke to the theatre team.
36:00She's looking at being next on the list,
36:02so if you just... Will you just let her know?
36:04Yeah, to get her ready, yeah.
36:06All right, thanks. Bye.
36:08So, apparently, she's going to be next.
36:11Jenny, they're on their way to pick you up for theatre.
36:13In a minute, have you got everything on?
36:15You got your... Oh, yeah.
36:17But they wanted to give her a guideline
36:19of when she was going to be done.
36:21I think she's quite anxious.
36:23Hey, hey, you going down to do a drink-out?
36:25Oh, you screamed in my ear, that's really loud.
36:28Hold on, you're on loudspeaker. Sorry.
36:30Yeah. Yeah, I'm going down now.
36:33So, I should be, like, done pretty soon-ish, hopefully.
36:38I'm just feeling very...
36:40..impressed.
36:42I don't know what to say.
36:44I'm just feeling very...
36:46..in myself and just want to get it done,
36:50get it on, get a big fat munch,
36:52and then I'll be happy then.
36:55I'm back to work, hopefully, in 24 hours after surgery.
36:59All right, all right, I'll see you in a bit.
37:01All right, all right, bye, bye.
37:07And then let's have a look at the other operate.
37:09In theatre six,
37:11Registrar Ali has removed Mitchell's appendix
37:14but has discovered a new area of concern.
37:17We have a problem with the pathology in that ovary.
37:20He's asked for a second opinion from Mr Butt.
37:24So, she's got this ovarian cyst.
37:27Can I have a picture, please?
37:30We have this lady, we have some pathology found in ovary.
37:34We need to make out what is exact nature of the cyst.
37:40Your uterus is very red.
37:42Large cysts can cause the ovary to twist, creating torsion.
37:46If left untreated, it has the potential to cause infertility.
37:51The cyst may also be cancerous.
37:54I'll just put him on in a minute.
37:56Mr Butt needs a further opinion.
37:58I am surgical consultant on call.
38:00You need a specialty-specific surgeon to see, which is gynaecology.
38:05It looks like a quite a big ovarian cyst.
38:08We just need your opinion whether to leave it or if you want to do it.
38:11So, you need to have a gynaecologist on call to see and decide
38:16they want to remove it or they want to leave it like this.
38:19You have no one here, your registrar, anyone here in Blackburn right now?
38:23The gynaecologist is based in Burnley, more than 10 miles away.
38:28Nobody answered us.
38:30There is some congestion around the ovarian vessel and congestion on the tubes.
38:34So, we need to rule out, is there any torsion of the cyst
38:37or is it looking like something sinister?
38:51I want somebody to have a look. If you want, I can send you the picture.
38:55In theatre six, Mitchell's operation is on hold
38:59while Mr Butt waits for a gynaecologist.
39:02Will you just give him the heads-up, obviously,
39:04the way it's going to be quiet on the farm?
39:07But the delay will have further consequences for Jenny.
39:11I've just rang them all.
39:13It's not them until at least after six. I know.
39:16Just being messed about all the time.
39:18I've just rang them. The patient that's in theatre now,
39:20there's just been a bit of a problem.
39:22So, they've had to stop.
39:24I'm literally, I'm going to lose an entire week's worth of wage.
39:27Living on your own, you've got to provide for yourself,
39:29provide for your own rent, provide for your food.
39:32I'm going to have to borrow half family and friends
39:35to meet those bills that I've got, because I actually live,
39:39it is like the breadline, I live paycheque to paycheque.
39:42It's NHS for you.
39:49As a result of the backlog of patients on the list,
39:52several theatres are now occupied by emergency patients.
39:57Are you all right? I thought I'd be OK.
40:00Julie has been taken to Theatre 9,
40:03where Mr Sheikh wants to take a biopsy
40:06to confirm her cancer diagnosis.
40:08Worrying is just going to make Mum feel ten times more anxious.
40:12Julie's three daughters are waiting for her
40:15to come out of the operation.
40:17Whatever happens now, every bridge, we just approach it as it comes,
40:20because we don't know, do we?
40:27Yeah, that's normal lining, normal lining.
40:30And...
40:32That's fine. Right, let's prep it.
40:34We'll do the camera test.
40:36It seems like rather than a rectal cancer growing outward,
40:39this is an anal cancer growing inwards.
40:41What does that mean for the patients?
40:44The anal group respond quite well, some of them,
40:47to chemotherapy, radiotherapy,
40:49and therefore can have a good prognosis.
40:54What are the most common reasons for getting a cancer of that kind?
40:58Mainly environmental factors, genetics, infections,
41:01which then can trigger a cancerous response.
41:04Smoking is a risk factor for a lot of things.
41:06Diet is a risk factor for bowel cancer in particular,
41:09so it's a multifactorial problem.
41:13With Julie's biopsy finished, Mr Sheikh has gone to Theatre 6
41:18to find out about the delay with Mitchell's operation.
41:23Hello, folks. What do we have?
41:26Can we tilt the patient towards us a little bit, please?
41:30If the cyst on Mitchell's ovary is left untreated,
41:33it could potentially lead to infertility.
41:37I just feel it's taken a long time, but I know they're busy.
41:40Bernie has been Mitchell's foster mum for 15 years.
41:44She's very strong-willed.
41:46When she says she's going to do something, she'll do it.
41:49She took her driving test, she's passed, she's been to uni,
41:53felt pregnant, it wasn't expected.
41:55She sailed right through it until the tragedy.
42:00Who's coming?
42:03And then, even when she'd lost the baby,
42:07anybody that would talk to her,
42:09she'd make them feel so at ease about talking about it.
42:12She really has amazed me.
42:14She's a very strong person.
42:16Are you a proud mum? Yeah.
42:19I haven't hit you yet.
42:21So, can we put this window a little bit, monitor here, this side,
42:25so you can have a look?
42:30How old is she? 22.
42:35Oh, it's a simple cyst. You could pop it.
42:38Yeah. That's OK.
42:40Thanks, Axel. What's your name, sir?
42:42George. OK. Thank you.
42:44No worries. Thanks a lot.
42:46So, it is a simple cyst which will regress by itself.
42:58They're really fond, eh? They've said this before.
43:01No, they're physically here.
43:04My name's Adele and we've got Sarah.
43:06They've come to take you to theatre. OK.
43:08See you later. See you later.
43:10After three days of waiting, Jenny is finally called to theatre.
43:14Well, you'll be able to have something to eat and drink soon.
43:17Oh, bacon, eggs, sausage.
43:19But you've got to have two types of eggs, though.
43:21You've got to have your poached eggs and your fried eggs as well.
43:24No fried bread for me.
43:26Because if you're going to be bad...
43:28You might as well be fully bad.
43:35On the recovery ward, Julie has woken from her anaesthetic.
43:40It better come in July.
43:42Julie, you can't think like that.
43:44No, you can't, cos you don't know.
43:46You don't know. And we don't.
43:48We can't say, well, yeah, if you came in July,
43:50things would be different.
43:52Cos they may well not have been different in July in any way, shape or form.
43:55But if they'd removed my piles, would I not have got it?
43:58We don't know. We don't know.
44:00We can't say.
44:04Well done!
44:06Yeah, well done!
44:09I just can't do this, please.
44:11Yes, you can.
44:14You've got to take it one day at a time.
44:16You can't do it. One step at a time.
44:18I don't think my brain can do it.
44:20Yes, you can. It will. Slow and steady, yeah.
44:22One day at a time.
44:25I don't want my life routine to change.
44:29I'm the doer of the family.
44:31Well, then you do for as long as you can do.
44:33Yeah.
44:35Don't let this stop you.
44:37Listen, why are you talking like your life's just going to stop, thank you?
44:41You just need to get back on the horse and carry on.
44:44You're going to have really hard days and you'll have really good days.
44:48But at the end of it, you will look back and you'll think,
44:51I've done it.
44:53You'll do it, because I know you'll do it for Teddy and Freya
44:57and your grandkids, like...
44:59And yourself. And yourself, yeah.
45:01You've already proved to me that you're going to smash it.
45:05You're a very determined woman.
45:09Thanks very much for your help.
45:11It's all right. I'll bob up and see you tomorrow and see how you're getting on.
45:13All right, yeah.
45:15Take it one day at a time. I'll see you tomorrow.
45:19Yeah, I have sat there, and why is it us?
45:22And life is so cruel.
45:25But, you know, it won't define my mum, my sisters.
45:28We're warriors.
45:31Where would you like to be in five years' time?
45:34To be a social worker.
45:36I'd love to be a foster carer.
45:39My hopes and wishes to be a mum again.
45:44How are you feeling? Yeah.
45:47That was quick. That was quick. It was, wasn't it?
45:50What are you most excited for?
45:53A fry-up.
45:55I've got a fry-up on my new mum's house.
45:59Yeah, I think the people in this area,
46:02especially Blackburn-Burnley, are very tough people.
46:06They're used to sticking things out,
46:10and they do, people just battle on.
46:13They are a tough bunch here.
46:15Crisp.
46:17Oh, yeah.
46:19Worthish.
46:21Oh!
46:23You like Worthish?
46:25Oh, yeah.
46:27Oh, they're lovely too.
46:29Well, you shouldn't believe what you see.
46:57You
46:59You
47:01You
47:03You
47:05You
47:07You
47:09You
47:11You
47:13You
47:15You
47:17You
47:19You
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