24 Hours in A&E (2011–…): Season 20, Episode 1 - Pressure Point - full transcript

The world might feel a bit more
chaotic and a bit more divided.

It's easy to forget sometimes

that there are constants.

Your home's still your home,

your family's still your
family.

And all the structures of our
society are still there

to look after you
if you need it.

Here we go!

George's resus. Adult male,
code red trauma. Ten minutes.

There's been an explosion
on a building site.

Part red, 200.



Imagine having to work here.

PHONE RINGS
Hello, A&E - can I help?

St George's, London.

It's all gonna kick off now.

One of Britain's busiest
A&E departments.

Are we ready to roll?
Carry on, CPR.

We need to fix that,
or you won't survive.

Say, "Aaah!"

A place where life...

Would you say I was fit,
doctor?

Honestly, I think
I'm quite fit.

...love...

...and loss...

Oh, Mum.



I'm so sorry.

...unfold every single day.

For every bad thing that
you see,

there is something equally
wonderful out there.

Filmed across one
24-hour period,

these are the stories of a
nation and its health service.

I thought I was gonna die.

You're definitely not
gonna die,

you've got too many good
doctors and nurses here!

Whatever happens, it's going
to be OK.

I love you.

I love you, too.

Morning.

Hi, erm, do you want me to...
Oh, do you want me to...

Where are you? Here, love.

I don't know what is going on.

You've not given us time
to log in,

you've just...
You've come too early.

You all right?

Nurse Chris is coordinating
resus today.

I'm always in early, always.

I have been since the day I
started this job.

I hear you're all stocked up
and ready to go.

I'm just going round
and checking,

code red trolley's got
a few bits missing...

Yeah. It weighs people.

I like to come in and see
exactly what I'm dealing with.

So it's just a pat slide
that you use as normal.

And then, if I...

'I am a magnet for shifts from
hell

'so be prepared is'

definitely the key!

There you go! Whether you like
it or not.

PHONE RINGS
Here we go!

George's resus. We'll see you
soon.

Bye!

PHONE RINGS
Charlie kilo.

When the phone is going
constantly,

you start to feel, "This is
going to be a hard day".

PHONE RINGS

George's resus.

Adult...
PHONE RINGS

Seven minutes.

There's more people coming into
the hospital

than there are leaving it

and in resus there are only
eight bays.

We don't have any space
at the moment.

Three's going, now.

Two minutes. Child's gonna go
into seven

and stroke's gonna go
into one.

We really have got nowhere...

When you are over capacity,

the last thing you want to hear
is...

HEMS paediatric trauma.

PHONE RINGS

George's resus.

This is adult to paediatric.

What's the mechanism?

Excellent, what's your ETA?

And age?

12. Thank you so much.

Paediatric trauma call by HEMS
air,

ETA 22 zero minutes.

A 12-year-old boy is being
airlifted to St George's

after being hit by a motorcycle
at speed.

Could you put out
a paediatric trauma call

to A&E resus and activate
hefipad?

Chris. Yeah.

Helipad? Yes, helipad,
20 minutes.

The boy's mother was at home
when she received the news.

It's a 12-year-old versus
a motorcycle.

Isolated tib fib fracture which
is open on the right-hand side.

HEMS doctor Sarah was
at the scene.

If the fracture is open, that
means that there's also damage

to the skin.

So we're gonna set that up for
trauma.

'And if the fracture is
displaced,

'the bone may be pointing
grossly in the wrong direction.'

That may affect blood supply
and nerve supply

and it could be a
limb-threatening injury.

20 minutes.

'It's really important to try
and reduce that'

and what that means is
essentially

put it back in a position
that it was in before it broke.

We've had a partial reduction
by HEMS on scene

with some ketamine, but I don't
think they can do anything

in the back of a helicopter.

'What we can provide
at the roadside'

is good pain relief,
immediate reduction,

emergency interventions.

What the patient actually needs
is an orthopaedic surgeon

and the theatre, so it's
important we get that patient

to them as quickly
as possible.

Ready?

Slide. OK.

So George, we're going to put
you onto another bed.

Ready, steady...

Thank you. Gonna hear all about
you now, OK?

12-year-old George has arrived
at St George's

after being hit by a motorbike
at speed.

So this is George.
George is 12.

He was a pedestrian hit
by a motorbike

in a residential street,

estimated less than 30 miles
an hour.

And on full primary survey,

appears to have an isolated
right tib-fib open fracture,

though he had a partial
reduction under ketamine

and mum Caroline is just
over here.

You wanna come in? My name's
Faisal, one of the A&E consultants.

Why don't you come
and just stand...

Then you can hold his hand,
let him know you're here.

OK, let's go. Hi.

'George, he's...'

He's shy.

Big breath in.

'He had a late start in life.'

In learning how to speak,
in making friends.

Any evidence of any
chest bruising?

Nothing at all. Perfect.
Thank you.

'And he liked playing on his
own an awful lot, as well.'

Which I used to think, aww...

You know, why aren't you
playing with others?

'He was just starting to make
ffiends

'through playing football.'

We gonna assess?

'I was so scared how this would
affect him.'

Perfect.

Just from his neck point
of view,

do you mind just...

We need some extra people here,

we need some bed movements,

we need to really start
chatting to people,

cos right now we've got...
Two more coming in?

Yeah. So there's a bradycardia
with a respiratory...

with a heart rate of 70
and I've got one on their way.

My name's Alex, one of
the doctors -

I'm going to come round,
we're going to via X-ray

and then just take you
round to Paeds majors,

where there's more space.

So we'll head round there.

We'll look after him.

AMBULANCE SIREN

Bare ambulances are coming.

Why does it feel like it's gone
really busy all of a sudden?

How about 6-D?

Miss, miss.

Um... F-7.

Hit. Yeah!

Had you hit that one already?
No.

L-1.

L-1.

How? No - I-1.

Oh!

Miss.

You again.

Well...

I don't know.

You mean miss my birthday.

Oh, my gosh.

Nine-year-old Amber has been
brought into A&E by mum Chanel

with acute stomach pains
and vomiting.

My birthday. Hooray!

Are you kidding me?

I tried!

The kids would be messing
around.

They'd be like...gimme the
food! Gimme the food!

Please.

Uhhh...

Amber.

Come in.

Have a seat.

My name's Barry, I'm one
of the doctors.

Pleased to meet you.

Can you tell me what's brought
you into hospital?

I had a tummy ache yesterday.
Yep.

And I was sick last night.

Whereabouts did it start?
It started in the middle.

Do you want to jump up onto
the bed for me?

Have a quick press
on your tummy.

Is that sore at all or is that
painful?

Mm.

It hurts a bit there.
A little bit? Yeah.

Say "ahh".

Ahh.

Can you stand up, I'm gonna ask
you to do something weird.

I want you to jump up and down
on the spot for me.

Hurts a bit, like, there.

Hurts a bit there. OK.
Right, have a seat again.

I think we should get the blood
tests done.

Let me have a chat
with the nurses,

who kindly come and do
the bloods for me.

Good. It takes about an hour or
so to come back.

Cheers. just have a seat
in there.

NURSE: Adult priority call,
ETA ten minutes.

What does that mean?

AMBULANCE SIREN

Sorry, guys, you're gonna have
to hold for about five minutes,

I'm afraid. I've got
no space here.

Sorry. It's gonna be
a tricky day.

You got another coming?

16 is also going to be
empty now.

What's going?

A 26-year-old man has been
brought into resus

after losing control
of his moped.

His mother is on her way
to St George's.

That day was just a normal day.

I was expecting him home
from work.

But then I suddenly hear my
phone ringing.

Resus, we need another doctor,
please.

I had a little cramp in my
stomach.

I said, "Oh my god, why is he
phoning, why isn't he home?"

As soon as I said "Hello",

I knew something had happened.

Right. My name's Manny,
one of the consultants.

Nice to meet you.
What's your name?

Tanvir, nice to meet
you, boss.

The reason we're doing all
of this

is cos your mechanism
of injury is significant.

And you bashed your head.

Was your helmet
not strapped on?

How'd it come off?

You've got bumps and grazes to
your head.

So part of the reason is cos
you're a little bit groggy

and confused, we're gonna do
a full assessment on you. OK?

Change into this, and lie
yourself down there.

Hi, guys.

This is Tanvir. He was moped
25 miles an hour.

He doesn't actually recall
that. He's come off the moped

to avoid a fox.

His helmet's somehow come off,
he's got a head injury,

he's GCS 14.
And he's got other injuries.

'Helmets, they only work up to
a certain point.'

The fact that you're going from
25 miles an hour to stop

in a split second would mean
that your brain hits the front

of your skull.

That can result in significant
life-threatening injury.

'With head injuries, we see
enormous variety'

in the symptoms that patients
can present with.

'One of these things is
amnesia.'

What we're gonna do is run
you through the full scan,

because you've got a bump on
your head,

you don't remember how it's
happened, it's to make sure

you've got no injury, especially
cos you've been going quite fast.

As soon as they told me
he had an accident,

he's at St George's, I wanted
to get to the hospital.

I think it's just
a mother's instinct,

I just wanted to see if I can
take away his pain somehow.

You're doing well, boss.
You're really doing well.

'But I also thought,

'I don't know if I'll be able
to cope with this.'

NURSE: Hello. Can I just shine a
light in your eyes quickly?

Is that all right?
Just look straight at me.

Do you remember anything yet,
or still a bit muddled?

No idea. OK. No problem.

We'lljust check if the scanner's
ready.

Which I think... Yeah.
Let's go.

26-year-old Tanveer
needs an urgent CT scan.

He has no memory
of coming off his moped.

His mother, Kamal,
has arrived at St George's.

Ready, steady, and slide.
There we go.

Just keep nice and still for me.

CT MACHINE: Breathe in and
hold your breath.

CT MACHINE: Breathe in and
hold your breath.

NURSE: OK, just going to start
the injection.

Just keep nice and still.

OK, all done.

All good?

Huh?

Don't know. Maybe.

It's bizarre, isn't it?

I keep asking to go up
to the helicopter pad,

but they won't let me.

Ooh, George. Yeah.

We're privileged, aren't we?

Mind you, it's not in good
circumstances, is it, George?

No. But I suppose it
has a little perk. Yeah.

George is waiting for an X-ray
to assess the damage to his leg.

His father, Richard,
has arrived at St George's.

Hello, George. Hi. OK, so.

And we're looking at that right leg.
Yeah.

Yes.

So what did you do?

Crashed into a motorbike.

Oh, no. Was that
coming out of school?

Yeah.

OK, nice and still.

Thank you so much.
Thank you.

I was always worried about George.

I was 42 when I had him.

And I know there's a risk
when you're older to have children.

But I wanted to take
that risk really.

Lovely. That's as exciting
as it gets.

When George was one,
it was in the middle of the night,

George was so hot, he was crying.

OK, nice and still.

And I brought him into mine
and Richard's bed...

...and suddenly I said, "Richard,
he's not right. What's wrong?"

And he started foaming
at the mouth.

Richard was holding him,
and he just...

He said, "He's got limp,"

and his lips turned blue.

He had blood coming out of his ear.

I really thought,
"My God, he's going to die.

"I was so lucky to have him, and now
he might be taken away from me."

He went into hospital.

He was kept in for a couple of days.

And it was due to his ear.

Later we found out
this affected his hearing.

Do you think you can
hold on to here?

So, growing up,
he had a severe speech delay.

Well done.
You've got the X-rays we needed.

This might sound bad,

but I didn't stay with him
in the hospital.

My husband stayed with him.

I find it emotionally too much.

Cos of what had happened
when I was growing up.

Yeah.

He's been very, very brave.
Very brave.

DOCTOR: Hello. Hi.
I'm one of the orthopaedic doctors.

Going to have a little peek
under there.

You all right? Not squeamish?

Seen it before? Happy?

All right. So it looks
like you've broken the...tibia,

your shin bone under there.

All right.

And what we'll need to do is decide
the best way to fix it for you.

The guy's going to come and
put some plaster on.

It's going to replace this thing.

It's just a temporary plaster, that
one. That won't be the definitive.

Good. But you're normally fit
and healthy, run around, play sport?

Yeah. What's your favourite?

Who do you support?

Brentford, unusual. Good lad.

OK, we'll look after him.

Get the right thing done.

Mum, do you have a coin?

I want to spend money within
George's Hospital,

because I know
it's a really good place.

I've not seen this movie before.
Have you?

It's Pets.
And I don't... I don't like Pets.

But you wanted a puppy.

I want it so bad.

Realistically, think about
all the pets

that we've gone through, Amber.

Paul Rabbit now lives with auntie.

All our fishes died.

But that's not my fault,
that's your fault.

You weren't cleaning the fish.
I was cleaning it.

You're making it out like I'm
a fish murderer.

You weren't feeding it.

GAS PS

Doctors have received
Amber's blood test results.

Yeah.

Um, it's fine.

Great.
Good.

I think it was never
an easy decision for my mum to make

for us to come back to the UK,

but ultimately, she wasn't making
it for herself, because

if she was, she probably would have
made a different decision.

When we came back to the UK,

and the plan was that Dad would
kind of follow us and we'd...we'd

start a new life in the UK,
but he just...

he just never came.

Mum just did mum, dad,
and everything in-between.

She had to try
and get money together.

She had to work all of the jobs
under the sun

to be able to support us.

And, at the same time,
she obviously was heartbroken

cos Dad had left as well.

And she does sometimes say that
she'd sometimes put us to bed

and she'd just in
the living room and cry.

She was dealing with all of that,
but you never would have known it.

It was always just the three of us
against the world.

Up until, you know,
we got a bit older

and then we started
having our own families.

And Mum, she was always there.

Like, she just held my hand
and she just said,

"You're going to be an amazing mum."

Now I'm a mum,
it's easier to...to understand

that we make all of our choices
for our kids, basically.

Thank you very much.

I've always said that if I could
be half the mum my mum was,

that would be, like, spot on,
that would be enough for me.

She was always there,

and that's definitely how I'm trying
to bring up Amber as well.

Home time.

It's a code red trauma. We're just
going to take him round to CT.

There's another trauma that's just
come into 8. OK. Yeah.

Do you mind starting that? 8, yeah.
Orthopaedic with the child there.

PHONE RINGS

George's resus. Give me a standby.

You grab a life pack
out of your truck, pop her on it,

cos I've got nothing... I've got no
space at the moment.

I'm going to have the
split the bay.

It's going to take me ten minutes.

I'll keep you posted.
Sorry, go ahead.

Sorry, love.

Tanveer is awaiting the results
of his CT scan.

Doctors are concerned
about his memory loss.

Thank you. How did this get on me?

Wait, what? How long was I asleep?

When did I hurt my head?

Shit.

Oh, I'm so confused.

What happened to my face?

When?

'I'm here.'

Tanveer's sister, Harleen,
has arrived in resus.

Hello.

I have no idea.

Did I fall off the bike?

You fell off the bike.

How'd I manage that?

I heard it was to avoid a fox.

Are you kidding me?

All things considering,
I feel all right.

Physically?

Feel like I got...beat up.

And mentally?

Fine.

Knock, knock. I'm James, I'm one of
the orthopaedic doctors.

So what I'm going to do is,

I'm just going to give you
a quick head to toe.

No problem.
And check everything out.

Any pain in your neck at all?

Just stiffness, no pain.

OK. just have a
look around your head.

KAMA I:

Got a little bump around the front
of your head here.

Yeah. Is it
hurting at all at the back?

No, it doesn't really hurt.

We'll get you to move your neck
a little bit more in a sec,

when I sit you up.

A little bit... You've got a bit
of abrasion around the ankle here.

Is that tender there?

It just feels funny.

I'm going...
I was going to sit you up.

All right, you've done it yourself.
Good man.

The good news from our side is

that we haven't found any
obvious bony breaks.

We... I don't think you've done
anything more than had

a bit of a scrape,
and obviously you hit your head.

But the scan has shown
that there hasn't been any bleeding

or skull fractures
or anything like that.

So that's all really good news.

I'll just write done a
few more things.

All right, OK.

So...

So what happened?

So you came off your bike
while going to work.

Thank you.

Well, all things considered,
I think I'm pretty decent.

I feel like I've been to the gym
and I'm just achy.

Hiya. Hiya.

How's the head feeling?

It's all right, to be honest.

Just feel a bit groggy,
like I slept for way too long.

Yeah. OK.

Well, I'm just having a chat with
the A&E doctors about next steps.

Because you... You remember what
I just...

what we were talking about

about ten minutes ago,
the scan results?

No. No? I don't recall.

Can you remember people who have
seen you here already today?

As in people I know of or...?
People who...

Other doctors that have come in.

No. Not...not really, to be honest.

Can you remember me examining you,
or going through stuff?

No. No?

Everything that you do is determined
by your function of your brain.

So seeing a patient that's
not their self can be terrifying.

There's no
bleeding in the head.

I can't find any bony injuries here.

But you've got a lot of memory loss,

and the memory loss
is perhaps continuing

considering that we had a chat
about five, ten minutes ago. OK.

So we...
We may need to...

We may need to just keep you in
for some observations.

OK. All right.

Sometimes when the amnesia's so bad,

you worry more that something might
happen in the future.

I went back in again-.

Yeah, he couldn't remember me
five, ten minutes ago.

Yeah. Yeah, yeah, yeah.

Do you mind doing a quick message
to the neurosurgeons?

It's very difficult to know

whether the amnesia's
going to be permanent.

Oh, what happened?

We're just about to bring up his
X-rays.

NARRATOR: Doctors have received the
results of George's X-ray.

Hello! So, the X-rays don't look
too bad at all.

All right, so... Good. ..l
think there is a good chance

that this will be fixed with a
manipulation into a plaster

and then possibly a bit of
scaffolding temporarily for

a short spell on the outside.

You may still play football
for Brentford.

Or, if you're unlucky, for Arsenal.
Yeah, if you're unlucky.

If you're really bad, you can
play for West Ham.

All right! See you soon. Cheers.

Right, what we're going to do is,

we're going to put a cast on this.

All right?
Yes.

If you can help support his knee...

Big breathe in.

Well done.

Before having my children I was
nervous about how I would

open up to them emotionally.

That's it, you're doing really well.

When I was growing up we didn't
really talk about anything.

We didn't tell each other that we
loved each other or how we felt.

Well done. Well done. You're doing
really well, George.

When my friends used to go out,
their mums used to say

to them how lovely they'd look.
My mum would never comment.

If you asked her she'd say, "It's
OK if you like that sort of thing."

My mum would even find it hard
to hug me.

She says, "I don't have to tell you
how I feel - you should know,

"through my actions."

I wish she could've told me.

Toward his toe... That's it..

I decided, as soon
as I had children,

that we would do things differently.

And then support his heel
with your other hand.

Growing up, George found it
hard to communicate.

But now he would tell me that he
loves me on a constant basis.

You're very brave.

And he always wants me to say it
back to him.

It'll feel really good, this -
nice and warm.

That's it. So, if I take that, take
out that one and then hold it.

He has taught me to be more
open with my feelings.

He wants me to tell him how I feel
about him and to open up to him.

He's done really well, yeah.

And now I tell my mum I love her
every time I speak to her.

And, just these last few years,
she'll say to me...

She says, "I love you too."

And that meant...
That meant the world to me.

You all right?
Yeah?

Yeah, it feels good.

I'm actually doing the paediatric
operating tomorrow so... OK.