999 The Critical List S01E02
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00:00Hi, are you bleeping emergency bleep?
00:04The patient from ED is coming in here now.
00:08Behind the scenes of every major hospital in the UK,
00:12there is an emergency list that few of us have ever heard of.
00:16The emergency list is a list of the sickest patients in the hospital,
00:20the patients who need emergency surgery.
00:24He's a sick patient who needs expediting. This critical list evolves
00:28by the hour as patients are added
00:32and prioritised.
00:34They've just booked this one also as a cat one.
00:36We weigh things up. This list is about order of priority of the sickest patients first.
00:41We follow the critical list at a time when the NHS is facing unprecedented pressure.
00:47The list is full.
00:49We see more and more people come through the door.
00:51It's the toughest time for the emergency list that I have ever known.
00:54But with patients hours away from being critically ill,
00:57staff are forced to make impossible decisions.
01:01Why is she taking priority over him?
01:03Of who goes next.
01:05Because the reality is 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 as you are.
01:15Oh, thank you.
01:18You're all right.
01:19Oh!
01:20Without the emergency list, these patients, they would deteriorate.
01:25They would be taking hospital beds up for days.
01:28They would be in critical care.
01:30These patients would probably die.
01:32Just make sure I wake up.
01:34Just make sure I wake up.
01:45What's surname, love?
01:47Ali?
01:48Can we have a skin marker, please?
01:54The Royal Blackburn Hospital in Lancashire has 11 operating theatres.
02:01But only one is dedicated to unplanned emergency surgery.
02:05Theatre 6.
02:06That's the one.
02:07That's the one.
02:08It's fully expanded now, isn't it?
02:09It's fully expanded.
02:10Each day, patients needing urgent surgery are added to an emergency list
02:16and prioritised by the consultant on duty.
02:19Try and work out where the hell to start, if I'm perfectly honest.
02:22On call this week is Mr Nick Haywood.
02:25Has this been getting worse?
02:26Uh, yes, it has.
02:28I think when you look at the workload that we have as an emergency consultant,
02:32you can see that it's just unmanageable.
02:34Hello.
02:35Good morning.
02:36How are you feeling today?
02:37Because if you've got 30 patients and that's going to take just five minutes per patient,
02:45you're looking at a few hours' work just to get round those patients.
02:49That's better than yesterday.
02:50And then we've got to be in theatre operating on those patients.
02:54Because he's got no symptoms.
02:56You'd say we're at a broken point.
02:58Sometimes we feel that the system's broken and we're trying to fix it whilst trying to continue working.
03:03Just give him some fluids.
03:05Make sure he's on some antibiotics.
03:06He'll be all right to go with.
03:07It's just a day-on-day challenge every single day that everyone comes in to work.
03:11And you can see it across the rest of the staff.
03:14The ends are cold.
03:15Oh, I'm sorry.
03:17We're coping, essentially.
03:19We've got a camera in the tummy.
03:21Have a look at the appendix.
03:22Yeah.
03:23And take your appendix out if it's your appendix.
03:25Is that OK?
03:26OK.
03:27There are currently seven patients on the list.
03:30Where possible, children are prioritised for surgery.
03:34So eight-year-old Lola will be first in theatre six.
03:38Morning, Vanessa.
03:40Before he goes to operate, Mr. Hayward has time to visit one more patient.
03:45Not right?
03:46OK.
03:47I don't feel where we are, actually.
03:50OK.
03:51Can we get her an ECG some point later?
03:53Mum of six, Vanessa, was admitted to hospital two days ago, with what doctors suspect is an incarcerated hernia.
04:00Can I have a look at your tummy again?
04:02Yes.
04:03It's a potentially life-threatening condition that can cause the bowel to die.
04:08Vanessa's CT scan suggested that she needed a laparotomy, which is essentially where we cut the abdomen open and we go in.
04:17The consequence of that can be quite severe on somebody's body physiologically.
04:23And in the case of Vanessa, she's adamant she didn't want to take any risk that would make her quality of life worse.
04:29I'll come back and talk to you a bit later, because I've probably got a few complicated discussions to have with you about where we go from here.
04:37Is that OK?
04:38Yeah, that's fine.
04:3961-year-old Vanessa must decide whether or not to go ahead with major surgery.
04:48What are you thinking at the moment, Vanessa?
04:50Thinking.
04:51All sorts.
04:53It's hard.
04:55Cos I know my health's not that good.
04:59If I went through surgery, I could be in intensive care for months.
05:05If I don't go through with it, I'll just die anyway.
05:12So, what's the point in putting myself through all that?
05:20It is a big decision to make.
05:22Are you ready?
05:23Ready.
05:24Very strong.
05:25In theatre six, registrar Oladelli will operate on Lola alongside Mr. Haywood.
05:39I'm just trying to ring the consultant, let him know the patient is on table and we are good to go.
05:44We have a lot of patients today and we have to crack and see how many we can sort out before the day runs out.
05:52You never sleep.
05:53There's never a boring day.
05:54There's never a time to chill.
05:56And the patient will always keep coming.
05:58There's no end.
06:02I'm just in constant pain.
06:04It's agony.
06:0559-year-old Julie has a perianal abscess and has been waiting for surgery for three days.
06:11I struggle to sit.
06:13I struggle to stand because I'm so tired, because it's keeping me awake at night.
06:18I'm taking so many painkillers, I don't know which planet I'm on.
06:24Left untreated, an abscess can burst and cause sepsis, potentially fatal blood poisoning.
06:30Have you been in hospital for anything like this before?
06:33No.
06:34I have ulcerative colitis, so I've had my large intestine out and I have a ileostomy, so a bag, basically.
06:42It remains sort of there.
06:46I mean, I do have a reasonably active life.
06:49I've got three dogs.
06:50Yeah, I did have four, but I lost one just before Christmas with my little monsters.
06:55Yeah, my horse is a Welsh cob, so I do a lot of competing with my horse and my dogs.
07:03That's my life.
07:05So, I'm on the list. Hopefully I'll get done.
07:08It does obviously depend on if they get any emergencies coming in.
07:12I could get knocked off the list, but I'm just hoping that that doesn't happen.
07:17PHONE RINGS
07:22Hi, are you bleeping emergency bleep?
07:24In charge of managing the growing number of patients on the list...
07:27Oh, what is it for?
07:29..is theatre six coordinator, Nicky Tingle.
07:33I think he had a hernia repair.
07:35So, this patient, Graham, was operated on the emergency list last Monday.
07:42And he's out of the lead, so they need to do an evacuation of haematoma.
07:45It's Nicky's job to keep the list moving.
07:48We are on a battle every day to get all the patients in beds,
07:51all the patients out of recovery, keep all the lists running.
07:55So, this is Graham. It's a return to theatre, so we'll need an IR1.
07:59They don't know if it's starred yet. They're going to let the tutor know.
08:0261-year-old Graham requires surgery on a haematoma,
08:06a leaking blood vessel, and has just been added to today's list.
08:10So, any major health problems apart from this that we need to worry about?
08:13No, it just keeps sending shooting pains.
08:16Any further delay in treatment carries with it a risk of internal bleeding.
08:21Had my hernia done, so I went home,
08:24and then the day after, it just started hurting a little bit.
08:27So, the doctor said, you'd better come back to hospital,
08:29it looks infected.
08:31I mean, I've been in pain for four days.
08:34So, hopefully, it'll get sorted today.
08:35PHONE RINGS
08:43PHONE RINGS
08:45Hi, are you bleeping emergency bleep?
08:48OK, right, who is it?
08:50Yeah, cat one.
08:52OK.
08:54Down in the emergency department, a 27-year-old man is critically ill
08:59with a suspected bowel obstruction.
09:01I think it's got adhesions.
09:03They may have had some surgery in the past.
09:06As you're healing, some tissues can stick your bowel together
09:09in different places, and it can cause an obstruction.
09:12So, he's going to look in with the camera first,
09:14see what he can see, and then maybe do a laparotomy.
09:16But they want him to go now.
09:21As a category one case,
09:24this patient becomes the most urgent
09:26and moves to the top of the list.
09:28So, you've got a cat one, laparoscopy,
09:32plus or minus per C.
09:33They think it's adhesions.
09:35Why is he a cat one?
09:37His bowel could perforate,
09:39and then it'd be peritonitis septic,
09:41and he could die.
09:43But over in critical care,
09:44another category one patient needs to be added to the list.
09:4830-year-old Emma has been ill in hospital for two weeks,
09:52but her condition has deteriorated.
09:57Doctors are concerned she, too,
09:59has a potentially fatal issue with her bowel.
10:02I don't think he's shot.
10:04She's so special to us.
10:06Do you know where the family are?
10:09With two critically ill patients,
10:11both in need of surgery,
10:14Mr. Hayward has to decide who goes first.
10:17I think the most difficult thing to have to deal with
10:20is when you're bombarded with two or three things
10:23that need sorting at the same time,
10:25and you're having to make a decision immediately.
10:27There's a huge sense of responsibility as a consultant surgeon,
10:31knowing that, realistically, the buck stops with you.
10:33PHONE RINGS
10:36PHONE RINGS
10:37PHONE RINGS
10:39I'm just going to go into this theater here. Are you OK? Yeah.
10:56At the Royal Blackburn Hospital, two patients with life-threatening conditions require urgent surgery.
11:04Who's the ICU on? We haven't got an ICU on books.
11:07Oh, very good. We'll just brief for an ICU on.
11:09We haven't got it even booked. They need to sort their shit out today.
11:13We'll just brief for it in here.
11:15This patient's not even been booked.
11:17Right, so just tell me, why is she taking priority over him?
11:23Because she's systemically unwell on ICU, needing inotropes.
11:28In an ideal world, we'd do them both together.
11:30So, at the moment, we've got two patients that need to go to the theater for a laparotomy.
11:35One of them is a young girl who's got gas within the blood vessels in the liver that's probably come from somewhere in part of the bowel.
11:44And then we've got a patient who's got an obstruction from his bowel. His bowel's twisted.
11:48He needs an operation as well. But she's a bit more unwell. So, she needs to go first. And then the plan is to get him done afterwards as well as trying to manage the rest of the list.
11:59With Emma bumped to the top of the list, the other patients will have to wait.
12:06It's a big shock. You've just thrown everything all at once.
12:09It's a big shock. I mean, it's a lot to take in, really.
12:12Graham and Michelle's daughter, Emma, has Rett syndrome, a rare genetic disorder that impairs speech and motor skills.
12:19This is a picture of her.
12:21When she's happy.
12:22When she's happy.
12:23She has such a good quality of life, even though she needs 24-hour care, but she's so loved.
12:30What's that?
12:32We've been told the outcome might not be what we want, but we have to go through with it.
12:38Yeah, she's all right now.
12:40So, they've said they'll look after her and we've put our trust in them.
12:43What else can you do?
12:45We still want her to recover.
12:50Well, I think that was just...
12:52It's unbearable to think that we won't have her.
12:57We need her to recover.
13:00We love her so well.
13:02It's chaos this week already.
13:20How far is the week?
13:21Monday.
13:22I don't even think it's 3 o'clock, is it?
13:25I've already aged 20 years today.
13:29Eight patients remain on the emergency list,
13:31but the immediate priority for coordinators Nicky and Becky
13:35is the CAT1 bowel obstruction.
13:39I'll let them know that patients arrived.
13:43They've found a short gap in operations in Theatre 5,
13:47but Major Abdominal Surgery needs a specialist consultant.
13:51I've just spoken to Remy Ahmad.
13:53He's actually not on duty as such.
13:55We need to find another surgeon.
13:57He's just been here.
13:58Has he found another surgeon?
14:00No.
14:00Trying to locate surgeons at times can be really difficult.
14:05Before starting Emma's surgery in Theatre 6,
14:09Mr Haywood needs to give an update to Julie.
14:12I'm hoping to do this this evening.
14:13You're still hoping?
14:14Yes.
14:15I'd like to do it myself,
14:17because I'll probably look after you going forward.
14:19So I want to know what it's looking like
14:21to be able to sort it out long-term.
14:23So it's going to happen?
14:23Providing nobody comes in through ED...
14:29Lock the doors!
14:29Lock the doors!
14:30I'll let you know if it's any different,
14:32but the plan is still...
14:33I think I will stay and do it, OK?
14:35How are you feeling, Julie?
14:36Just tired and headache.
14:38I'm a bit fed up,
14:40because I'm thinking,
14:42is this going to get cancelled again?
14:44What's your gut saying?
14:48I'm not listening to it.
14:53Hiya, are you OK?
14:54Are you at Blackburn?
14:56Becky has managed to arrange a surgeon
14:58to come from nearby Burnley Hospital.
15:01Mr Alumin's free,
15:03so Dan's going to ring him...
15:05Oh, he's free?
15:05..and, yeah, he's going to ring him
15:06and get him to come down.
15:08So we've got any cities now, right?
15:09Got everything.
15:10With a new team now in place...
15:12..come to give a hand.
15:14We need you.
15:15The emergency bowel operation
15:17can proceed in Theatre 5,
15:19led by Mr Alumin.
15:21I was in Burnley,
15:23but because there's so many cases
15:25in the emergency theatre,
15:26I got called in to help out.
15:29The two Category 1 cases
15:31are now in theatre and off the list,
15:34so Julie, Graham and four other patients
15:37are a step closer to receiving their treatment.
15:42THEY CONFER
15:43MUSIC PLAYS
15:44THEY CONFER
15:45THEY CONFER
15:46THEY CONFER
15:47THEY CONFER
15:48THEY CONFER
15:49THEY CONFER
15:50THEY CONFER
15:51THEY CONFER
15:52THEY CONFER
15:53THEY CONFER
15:54Hello?
15:55Where are you?
15:56I'm here now.
15:58Right.
16:00Is that your husband?
16:01Yes.
16:03How long have you been married?
16:05Right here.
16:07Um, all together.
16:11Long time.
16:14Like a prison sentence.
16:1761-year-old Vanessa
16:19has been considering
16:20whether or not to go ahead
16:22with major surgery.
16:24How did you meet?
16:26I met him at train station
16:28at Accurton.
16:29Can we come in?
16:36Can we come in?
16:38Are you doing that?
16:39Yeah.
16:40I'm in the decision.
16:45I'm not going down to turn up
16:49and I could die on table anyway.
16:52What's he told me?
16:55How I could come through
16:57but being intended to care
16:59for mum's on edge.
17:00No, I'm not doing that.
17:02As long as he can keep me comfortable
17:04and that can really
17:07I'm happy with that.
17:10So are you going to get better?
17:12Eh?
17:13So you want to die?
17:14I'm not bothered.
17:15Well, I am.
17:17I think it's my decision.
17:21It's one of the hardest decisions
17:23I'll have to make
17:24but I'm not bothered.
17:25I'm doing what I think's right.
17:31Vanessa's been struggling
17:32with her health recently
17:33and I don't think
17:35she's got the fight in her really
17:36at the moment.
17:38So she's still going to be looked after.
17:41She's still going to be in the hospital
17:43and she may change her mind.
17:45That's collapsed, yeah.
17:47The emergency list is currently running in two theatres.
17:51Release the main one if you want
17:52and then go back to the other.
17:53In theatre five,
17:54Mr Allermann,
17:55who was rushed over from Burnley Hospital
17:57is operating on a bowel obstruction.
17:59If there's a blockage and you leave it,
18:00it's like someone squeezing on the bowel.
18:02First of all, the stool can't get through.
18:03Secondly, it can lead to ischemic bowel
18:04which is the blood supply gets cut off.
18:05That could be life threatening.
18:06While in theatre six...
18:07OK, gas on please.
18:08Low flow to start.
18:09Mr Haywood is operating on Emma.
18:12In an ideal world,
18:13we'd be able to just get them all done when we can.
18:15But we already know that cases during the rest of the week
18:20are starting to mount up,
18:21so that if we don't do this,
18:22it will have a knock-on effect for the rest of the week.
18:23Hi, bleeping emergency bleep.
18:24I am not going to tell you,
18:25but we got that.
18:26It is supposed to be a little bit of a gun
18:27which is the blood supply gets cut off.
18:28It is supposed to be a little bit of a gun
18:29which is the blood supply gets cut off.
18:30That could be life threatening.
18:31While in theatre six...
18:32OK, gas on please.
18:33Low flow to start.
18:34Mr Haywood is operating on Emma.
18:35In an ideal world,
18:36we'd be able to just get them all done when we can.
18:37But we already know that cases
18:38during the rest of the week
18:39are starting to mount up.
18:40If we don't do this,
18:42Hi, bleep and emergency bleep.
18:44A third category one laparotomy case has come into the emergency department.
18:49Mental Paul in here, mental.
18:52They must operate immediately and the case has been rushed to the top of the list.
18:57Just when you think that the shit couldn't hit the fan anymore.
19:00But don't worry, things couldn't get any worse.
19:03So Nicky must find another theatre and a third surgical team.
19:08They've just booked this one also as a cat one.
19:10Who's doing that one in five then?
19:12Alumin.
19:13So yeah, if you want us to do another one.
19:15We're going four.
19:16Who's the surgeon in there who's going to do it, Darren?
19:18Darren, yeah.
19:19Has Darren agreed to it? Yeah.
19:20In order to treat the new emergency,
19:23two other patients with planned procedures will now have their surgeries cancelled.
19:28Nicole, are you all right with this?
19:30We'd love to know what's going on.
19:31Theatre eight, they're cancelling the two lap callers they've got left
19:35and just doing that one laparotomy.
19:37The emergency patients really do need to take the priority
19:41and that sometimes then affects what we can do with our elective patients coming in.
19:46The thing is, they're emergencies, they're emergencies aren't they?
19:48You're going to have to, you're going to have to do them.
19:50Sometimes we have to cancel elective work
19:52because we have to provide the most optimal care for the most life-threatening conditions first.
19:57Right. Photograph, please.
20:06In theatre six, Mr. Hayward is yet to locate the suspected hole in Emma's bowel.
20:13What I'm doing at the moment is something called a diagnostic laparoscopy.
20:17So, we're able to put a camera through a small cut into the abdomen
20:21and then we're able to look around at all the bits of the bowel.
20:27Well, the bowel's not unhealthy, is it?
20:29No, it's not unhealthy at all.
20:32I'm having a good look around.
20:33There's nothing to suggest there's a hole in any of the gut anywhere, which is reassuring.
20:38Emma's rare genetic condition means she's been unable to communicate her symptoms to doctors.
20:46With surgery, when you operate on someone, you generally have an idea of what's going on
20:50based on speaking to a patient to elicit their history.
20:54In patients who can't communicate that history to us, or maybe can't tell us that they've got pain or where it is,
21:01we're reliant on the imaging that we get, the scans, the blood tests, and put all that together.
21:09Okay, so that's fine, so the colon's fine.
21:11Let's go all the way back around here, Deli.
21:13And sometimes you may have a scan that shows one thing,
21:16and when you get in to have a look in with a camera, for instance, into the abdomen,
21:21you find something that's a bit different.
21:24So that's completely normal.
21:25She's got what looks like a bit of fluid kind of in the tissues.
21:32Working diagnosis at the moment is whatever we're seeing in the bowel or in the abdomen
21:35is secondary to some other condition that's going on that's causing the changes, which you can see sometimes.
21:43Emma and the two other bowel procedures are having a major impact on the ever-growing emergency list,
21:48and it's become unlikely some patients will receive their treatments tonight.
21:5415 minutes before, it came up, and as soon as they were walking around that corner,
21:58they sent a messenger by to cancel it.
22:01Apparently, they've got three emergencies.
22:05We've all heard that adage before.
22:08Say, oh, we've got an emergency.
22:10Well, that's what they say to try and justify it, so I'm a little bit upset.
22:15You feel as if they just shove you in bed and just leave you.
22:19So that's what it feels happening to me.
22:23Hi, bleeping emergency bleep.
22:28What is it for?
22:30I'm feeling a bit stressed out this list now today.
22:34We've got a lot to do.
22:36It makes me feel like I'm not doing my job very well,
22:39but it's totally out of my control.
22:45It's the toughest time for the emergency list that I have ever known.
22:49We're transferring patients to the next day, sometimes the following day.
22:54We've got so many patients on, so many demands on emergency services at the moment.
23:00We are sinking.
23:01The NHS is, I don't know how we're going to get out of it.
23:07Ideally, Julie's going to get done.
23:10I really do want her to be done.
23:12She's been waiting a long time.
23:15So far, Julie has been waiting at the hospital for three days.
23:19I've just been sent across by Mr Haywood.
23:21It's going a bit crazy, you know, you know that.
23:24It's an abnormal situation. Normally, it doesn't happen.
23:28We barely opened a second theater. It's now opened a third theater.
23:32There are patients who are really unwell, who need urgent treatment and operation.
23:37So if you want to stay around another two to three hours,
23:41probably we'll be able to get you done today.
23:44I think it's worth waiting.
23:46If anything changes, we personally will come and speak to you.
23:50Thank you. Thank you for getting with us.
23:52I know it's quite a bit of an ask.
23:55OK. OK.
23:56OK.
24:00It's just the letdown again.
24:11I've had months and months of pain and not being able to function,
24:15not being able to sleep.
24:17And I just want it finished.
24:19We've got a laparoscopy in five, a laparotomy in eight.
24:40We've got the other one in theatre six.
24:42It's early evening at Blackburn Royal Hospital and with three theaters open
24:48and seven patients still waiting for treatment,
24:51the emergency list is running beyond capacity.
24:55What have we got left to do?
24:56Kevin, Stephen, he's not started till 7pm.
25:01There is Julie, still waiting.
25:04Vanessa has refused the surgery, but he won't let us take her off the list.
25:08Usman, laparopendix, Graham, got a haematoma, six.
25:13And it is now quarter past four.
25:16It's impossible.
25:17Right, I will go and do a walkthrough.
25:22In theatre six...
25:24So, ready for another photograph.
25:26Mr Hayward is investigating whether or not to remove a part of Emma's bowel,
25:31suspected of having perforated.
25:33So, the question is whether she has a problem with her bowel that needs surgery to rectify her illness,
25:40or whether there's an underlying condition that is giving us the findings that we see on the CT scan
25:46that doesn't need anything further.
25:48So, the operation we're doing now, called the diagnostic laparoscopy,
25:52allows us to look at the quality of the bowel that the CT scan hasn't been able to clarify for us.
25:58But at the moment, I will do more harm than good by trying to remove something that doesn't require removal.
26:06So, we'll have to explore other reasons for her being unwell on the ITU when she goes back.
26:16When we're managing patients who are non-verbal,
26:19who can't communicate with us in the standard ways,
26:22you never really can understand that patient's wishes.
26:25You know, you hope you're doing the right thing for them.
26:30But sometimes, you just never know.
26:35Hello. Hello.
26:36Good news in a way. I'm not going to do anything.
26:40There's no significant problem with the blood supply to the bowel.
26:43The bowel looks all OK.
26:44And I've left a little drain, a plastic tube that goes in.
26:46There was a bit of fluid in there.
26:48So, she's unwell from something.
26:50Right.
26:50But it's not being driven by anything that I can see.
26:54I can't explain some of the other findings on the scan.
26:57The best thing to do is keep her on antibiotics and bring her back here
27:00and see what happens, see where she goes.
27:02That's a nice shot.
27:04OK.
27:04Yeah, yeah, thanks.
27:05Thank you very much.
27:06OK, no, you're welcome.
27:07Yeah.
27:07Yeah.
27:08You'll be exhausted, so you get some rest.
27:10Yeah, yeah.
27:11OK.
27:11All right.
27:12Yeah.
27:12Right, yeah, right.
27:13I'll check it from her.
27:14Thanks very much.
27:15All right.
27:16All right.
27:17All right.
27:18Oh, my God.
27:19Oh, thank you.
27:21Yeah.
27:22Oh, God.
27:28Hello, you OK?
27:30Yeah, not too bad.
27:31Crazy chaos, as always.
27:33As two more cases are added to the emergency list,
27:36down in recovery, there is another problem.
27:40Look how many patients you've got in here, as well.
27:42Yeah, none of them have got any beds.
27:43Nobody's moving.
27:45There are no spare beds up on the wards
27:47for recovery patients to go to.
27:49One space left.
27:52That's got no monitor or CERNA abilities.
27:57There's just nobody moving.
27:59Whilst it's at capacity, Nicky is unable to keep the list moving,
28:04adding to the delays.
28:06If there's no beds on the wards, our patients can't leave recovery.
28:11If they can't leave recovery, patients can't go into surgery
28:14and have their operation, it's not ideal.
28:16Far from ideal.
28:18We have a finite number of resources, a finite number of staff,
28:20more and more patients coming into the hospital within a system
28:23that is essentially so much under strain.
28:26I think we do very well with what we have.
28:30Exactly.
28:30Dom's wrong.
28:31They want to run another emergency till midnight.
28:35Tonight?
28:36Which consultant will come and work till midnight?
28:38The effort and the goodwill from the staff is why it keeps going.
28:42Most of the team that are on long days have been here
28:44since seven o'clock this morning or eight o'clock.
28:46They're working till six.
28:47They won't stay till midnight.
28:48The more busy we get, the more strain it has on that goodwill.
28:56So you and Aaron are on the late as well?
28:58Who else? And you? You're on till six?
29:01Yeah.
29:02Seven, doing all right?
29:05Hi, Nicky. It's Nicola. Are you OK?
29:06In order to balance staff welfare, treat the most urgent patients
29:12and keep spare capacity available for any overnight life or limb emergencies...
29:16All right.
29:17Nicky and Mr Haywood need to reduce the numbers on tonight's list.
29:22All right, okey-doke. OK, bye.
29:26So, everything else on the list?
29:27Carboshed?
29:29Yeah.
29:30The four most urgent cases will be done by the evening shift.
29:35The remaining five cases, including Vanessa, Graeme and Julie,
29:40will be delayed until tomorrow.
29:43He said Julie's too complex for the reg, which we worked out.
29:48Julie has been waiting for treatment on her perianal abscess for four days.
29:53I'm just here to appeal and explain to you what is going on.
29:57I really want to apologise for not being able to get to you today.
30:00As I speak with you, I have another patient who's got a life-training emergency
30:04that are still going to try and find a way to get them to theatre tonight.
30:06What we plan to do is to get you to the world and let's try again tomorrow.
30:11I really want to apologise.
30:12This could go on forever. You're always going to get emergencies coming in.
30:15It's never stopped.
30:16This could go on for six months.
30:18I cannot stay indefinitely in hospital.
30:20I just physically can't do it. I have responsibilities.
30:25I know.
30:25When do we get to the point where I am prioritised?
30:29You are...
30:30I'm never, ever going to be a priority.
30:31No, you're always important.
30:33That's...
30:34But I'm not prioritised. Whether I'm important or not...
30:36But the thing is, today, we had to open two theatres, which is not normal.
30:40We had to get surgeons outside to help us with the patients,
30:45because there was no way I'm going to cover almost 14 patients.
30:49There's no way.
30:51So that's how much we had to go today.
30:53I so wish I'd close my shift by eight, but I said I'm not going anywhere
30:57until I see everybody I haven't touched today and speak to them one-on-one.
31:02We understand. We apologise.
31:05But we've been on our feet all day.
31:09We're stretched out to the thinness.
31:11But never think that we don't think you're important to us.
31:14You are. You are a partner.
31:15The reason why we come to work every day, and we have to sort you out.
31:20THEY CONFER
31:25Nicky's shift is over for the day.
31:29How are you feeling about tomorrow?
31:31We've got Julie, we've got the right hemicolectomy,
31:34we've got Vanessa, we've got Usman, and we've also got Graham.
31:39Tomorrow is off to a busy start.
31:42But we've got a plan.
31:43We're hoping it works.
31:46Everybody knows that the emergency list is busy.
31:50She actually said she would stay till midnight.
31:52Are you up for staying?
31:54If it's going on, yeah.
31:56The people who tend to work in there are the people who are interested in
32:00a crazy day.
32:01Emma, we've just had another appendix box.
32:04Oh, brilliant.
32:05But we just manage it.
32:07We love it.
32:08Keep calm.
32:09And carry on.
32:10There are the odd times when it's absolute carnage,
32:14and you can't see how you're going to get out of this, but we always do.
32:18See you next Tuesday.
32:20Get out, North girl.
32:22We work well together.
32:23The staff work well together.
32:25Everyone's got each other's backs.
32:27And I'm going.
32:28It's been a pleasure.
32:29Thank you for your help today.
32:30No problemo.
32:32People keep going because they know all these patients need looking after.
32:36So someone always comes up with a plan.
32:38And calm is restored.
33:00You've actually come through to the main reception of the hospital.
33:03I don't know if that's what you need.
33:05Yeah.
33:07You naughty boy.
33:10Oh, shit.
33:12Right, let's look at the list.
33:14Good morning.
33:16We've sent for the first patient, which is Julie, for her EUA rectum.
33:20Thank goodness for that.
33:24Where am I? Where am I? Oh, my God.
33:26I'm just one step closer.
33:32Hello.
33:33Julie, I'm Nicola.
33:35One of the nurses.
33:36Are you OK?
33:36I am, yeah.
33:38Good.
33:39I think we're in a state of shock.
33:41We are too.
33:42We've been waiting.
33:43We have been trying.
33:44We've been saying, Julie, Julie, Julie.
33:46We'll see you now.
33:47Yeah.
33:49It's been annoying.
33:51But I do understand.
33:53Biscuits and a bag of crisps.
33:54That's it.
33:55These last few days, yeah, they've just been so busy with emergencies.
33:59And, you know, you could be selfish and stamp your feet and jump up and down.
34:03What's the point?
34:06At the end of the day, although I'm in a lot of pain, it's not life or death.
34:09And there's been people that it has been life or death.
34:12So just got to get on with it.
34:15I don't think I'm 100% convinced until I'm on that table with a needle in my arm going to sleep.
34:24If I went down for the heart, I don't think I'd pull through with all my medical problems.
34:36Despite still being on the list, Vanessa hasn't changed her mind about surgery.
34:41Tell me, what have your family said about your decision, though?
34:45They want me to have it done.
34:48My older son said, if you don't have it done, I'm not going to speak to you.
34:51I said, you can't be like that.
34:53I said, it's my choice at the end of the day.
34:56Would you want to keep going through pain and pain and pain?
35:00I said, because I don't.
35:05Hello, Vanessa.
35:07Can I have a look at your tummy? Is that OK?
35:10A second review of her scan suggests the swelling could be due to a hole in the bowel,
35:15allowing faecal matter to leak outwards, creating an abscess.
35:21Right. I've been having to think about what we should do.
35:23Yeah.
35:25The bowel, it's really close to the skin.
35:28I think, obviously, you don't want to have any major surgery.
35:31Yeah.
35:31Is that still the...?
35:32Yeah.
35:33Still the same thing.
35:34What I'm thinking we could do is make a little hole there with some local anaesthetic,
35:39and then allow it just to drain out.
35:41It may help with the pain that you have.
35:43And then we deal with the consequences afterwards.
35:45Yeah.
35:46How do you feel about it?
35:48Yeah.
35:48And then we'll swell in again.
35:50Yeah.
35:52Yeah, yeah.
35:53I think if we're going to do it, do it in theatre.
35:55In theatre?
35:56Yeah, we'll take you down.
35:57You won't be asleep, but it's just at a better area to be able to do things
36:00than just on the ward down here.
36:02I know you don't want anything major, but it's also trying to do something
36:06that may help you along to get better to potentially get you home.
36:10Yeah.
36:13Lovely.
36:13OK.
36:15See you a bit later.
36:17He doesn't feel better, that doctor.
36:19What's he called?
36:20Nick Heywood.
36:22Mr. Heywood.
36:22Mr. Heywood.
36:25He explains everything.
36:28That's why I like him.
36:29Can we give Mr Nick a call, tell him that I've started and I need him to come here now?
36:40Yeah.
36:40In theatre six, surgery on Julie's perianal abscess is proving difficult for registrar Oladelli.
36:48It's a bit tricky.
36:52A patient who's got a previous inflammatory bowel disease, so she's got multiple surgeries.
36:59MRI shows she's got a small abscess within the thin layers of the muscle,
37:04so we can't strain that easily.
37:06You know, the problem's causing her pain at the moment, this abscess.
37:12If you feel that around that nine o'clock position, yeah, I could feel it there.
37:16I put it in a needle, I couldn't get it.
37:20These complications of people that have had inflammatory bowel disease
37:24are often a lot more tricky to solve.
37:28Julie's abscess is located within a section of her bowel that has become sealed off.
37:32Yeah.
37:33Symptoms, not great.
37:34Clinical director, Mr Vettoni, is called to assist.
37:39Can't get in.
37:40Is it strict?
37:40I think it's strict.
37:42Do you think the stenosis is strict?
37:44No.
37:44It's quite difficult to get to where the abscess is.
37:47So we're trying to probe a bit further, cost minimal damage,
37:52while trying to relieve the pressure.
37:54So it's not straightforward.
38:04We need to drain the abscess, that's within the two rings of sphincter muscle.
38:14So she's got an abscess between the internal and external sphincter.
38:18Yeah.
38:19In theatre six, consultant surgeon, Mr Haywood, and clinical director, Mr Vettoni, need to drain
38:26Julie's perianal abscess.
38:27It's all taller than five rows.
38:30Yeah, I was just going to go in here and open that up.
38:33I think so.
38:34But due to the effects of multiple previous surgeries, they're unable to get to it.
38:40And just in terms of the abscess, you see, it might be better to do it transversely.
38:44We expose the sphincter and just allow it to drain.
38:49Mr Haywood will cut into the sphincter muscle to drain the abscess.
38:53Yeah, it's the pressure that's within it that's causing the discomfort.
38:57And by releasing that pressure, the pain should improve.
39:01She's got a chronic cavity.
39:03She also has a fistula, which is an abnormal track that runs between the anal canal,
39:08which is probably feeding this cavity.
39:11If we allow this to just heal up, she'll end up with the same problem again.
39:15So what we do is we put a little thread through and tie it so that hangs out.
39:20And that keeps the track open to allow it to drain.
39:23Is it nice to finally get patients sorted?
39:26Yes, it's nice to find a patient sorted.
39:28It's my job. It's what I'm paid to do.
39:31And a relief that, okay, I've got one sorted.
39:33And you get a call that you've got three more new ones.
39:36And it never ends.
39:41She's got a really quite complex case.
39:43And this is the start of quite a long road to try and sort her ongoing problems out.
39:49So we'll look after her here as a team.
39:53There's going to be a combination of surgery and painkillers and things
39:56that will hopefully enable her to get on with the life that she wants to live.
40:11PHONE RINGS
40:16My call's first in the queue. I didn't know I did that.
40:18Nicky and the team are trying to reach Mr Haywood.
40:21I bet if I'm in the hospital, they can put me through.
40:24To find out which of yesterday's patients to call for next.
40:27If you get three before me, I'll be fuming.
40:36Is that Nick?
40:36Yeah. Nicky, it's Matt, RDP in theatres.
40:39No. Are you joking?
40:41Nicky's trying to get hold of you.
40:42We're just wondering which case you want to do next in six.
40:44We've got Vanessa, and we've also got Graham.
40:48OK, nice.
40:52We're here to take you down, Vanessa.
40:5361-year-old Vanessa will be next in theatre six.
40:58I'm going to bring you down to theatre reception.
40:59We'll get you checked in and get the ball rolling, all right?
41:02Yeah, I'm scared.
41:03You'll be fine, don't worry. We've got good teams down there.
41:07Vanessa has been in hospital for four days.
41:10As she is too frightened for major surgery,
41:13Mr Hayward has persuaded her to have a small procedure
41:16and a local anaesthetic.
41:18One, two, three.
41:21She's really quite anxious.
41:23She has been quite a lot all week.
41:25We'll have to put some sterile drapes around you.
41:28We won't cover you up.
41:30And there'll always be someone at this end that you can talk to.
41:33Lift your head up again for me, sweetheart.
41:35In order to fix this definitively,
41:37she's likely to need major surgery.
41:40But we're hoping that by just draining this out,
41:43it'll help with the pain and it'll also provide some relief
41:47and prevent some ongoing infection.
41:51I'm just going to put a bit of local anaesthetic in
41:53so you might feel a sharp scratch.
41:57Oh, my God.
41:58I think one of the reasons the list is getting a lot busier
42:03is that the patients that we're seeing coming through the door are more elderly.
42:08They're more frail.
42:09They have more medical problems.
42:10Are you feeling so, nurse?
42:13Oh, cold.
42:14They're having longer recoveries.
42:16They're spending longer time in hospital.
42:19That puts a huge amount of pressure on the trust.
42:22But every patient deserves a chance.
42:25And that's what we're trying to do.
42:27We're trying to provide a chance for people to get better.
42:29And in many ways, trying to save their life the best way we can.
42:33You can see the air that was in the cavity has made it drop down.
42:39How are you feeling there before?
42:43A bit all right?
42:44I don't think we're going to be too much longer.
42:46No, we're nearly done.
42:47OK.
42:50We will see what happens.
42:52I mean, we'll know over the next few days whether there's any bowel content
42:55going to come out of it or not.
42:56But we're hoping that actually whatever's gone on us will just heal itself up on its own
43:04and avoid that need for any major surgery.
43:08Great.
43:09Well done.
43:10So we'll take the drapes down and then you've got a little bag over it now, like I said.
43:15So we'll see what comes out of it.
43:17OK?
43:18Get you back into your bed.
43:19Get you back up to the ward.
43:21Back upstairs for mid-morning biscuit.
43:25Yeah.
43:25All right.
43:26Come on, my little lovely.
43:29With Vanessa out of theatre...
43:30Bye, Vanessa.
43:32Bye.
43:33..Graham's three-day wait for surgery on his haematoma is finally over.
43:38Hello.
43:39Yeah, are you wanting me?
43:40I'm going to take to theatre.
43:41You're not pushing a blow at me.
43:43Absolutely.
43:44I've pushed bigger than you.
43:45I'm fine.
43:47You'll be fine.
43:47OK, for you.
43:49I just have been fairness here.
43:53You're doing good.
43:54We've done good.
43:55We've done good.
43:56We've done good.
43:57Whilst Mr Hayward still doesn't know the underlying cause of Emma's infection,
44:01she is slowly recovering.
44:03At the minute, we're on a ward, which is fantastic.
44:07And she looks tons better.
44:10But we need to establish a drinking and eating pattern,
44:13because she's totally lost that at the minute.
44:15And until we can do that, we can't move forward.
44:19Come on.
44:20Keep trying.
44:22We'll just need to sit it out and Emma will hopefully do it in her own time
44:26and we'll get her back to where she needs to be.
44:30After a night's recovery, Julie is ready to be discharged.
44:36How does it feel that you've finally gone home?
44:39Oh, relieved.
44:40Yeah, I want to get back to my dogs.
44:44I have got to have more stuff the surgeon has found,
44:47but he just wants me to get over this first.
44:49So it'll be nice, just have a break from it all.
44:54I'll keep him tucked.
44:55Yeah.
44:58I will.
44:59You're not picking kids up?
45:00No.
45:10Is that my fish pie?
45:16I've been looking forward to this all day.
45:19Do you have any salt on that tree?
45:21Yeah, it's here.
45:22Oh, I've got to have my salt.
45:23I'm terrible.
45:24Is that enough or do you want another?
45:25Another.
45:26Another one of them?
45:27Ooh, it'll cost you.
45:30I've amazed me.
45:32Everyone has been so good, because they knew where I was scared I were.
45:37It gave me inspiration and the will to live now.
45:43There's light at the end of the tunnel, mate.
45:47I expect him for you to sleep leaping.
45:49What's the patient's name?
45:51The emergency list is an ever-moving situation.
45:54So the effort that goes in to managing that list is phenomenal.
45:58Sometimes I wonder how it's achieved.
46:01I don't know anyone that I work with that is shy from work.
46:04Everyone's working incredibly hard, working through their breaks.
46:08You see that across the board with every member of staff.
46:11Surgeons coming in to operate.
46:13Anaesthetists putting people to sleep.
46:15The operation department team readying the theatre.
46:19The coordinators that are running up and down the corridor, day or night.
46:23Everyone I work with is completely dedicated to what we do.
46:26And that's the nature of everyone that I come across who works in the NHS.
46:31We are now with the parents.
46:32Let's get started.
46:33Thanks, friends.
46:34We are having a happy day.
46:35We are having a happy day.
46:38Let's make the streets.
46:39They are having a happy day.
46:40Let's go to the airport.
46:41We are having an amazing journey.
46:42Let's do it.
46:42Let's do it.