Original subtitles

Hello, A&E resus.

After dark, and while most of us sleep,

A&E departments across the UK work through the night.

Jack, do you know where you are?

Well, we hope not.

With unprecedented access to the night shift

of one of Britain's major trauma centres...

SHE MOANS It hurts!

..this series reveals a working environment

that's not for the faint-hearted.

What are you doing? You idiot!

The night shift can be a war zone that you have to survive.

Ow! Get off!

Occasionally, our department looks like a police station.

They deserve a medal - what these people have to put up with.

And, at night, road traffic collisions are more serious.

I think you got hit by a motorbike, do you remember that?

No.

And both drug...

Can you open your eyes for me?

..and alcohol-related admissions increase.

You rascal, you.

We follow the incredible staff of Hull Royal Infirmary.

He's dancing in there.

Morning, sir. Welcome to Hull.

It's a job like no other.

Things affect you more on a night.

The job gets to you...

..but it's because you care.

Hello.

I'll just go and put me coat away.

It's the start of the night shift

and the emergency department is already full.

So, let's start with room eight.

The OPD.

She's using a six recent, chest infection,

she's really working quite hard.

Right, room ten has just been picked up.

Just to let you know, he's going to ICU.

OK, thank you.

HE YAWNS

I've been working all day, ten hours, then end up here.

We have 36 people waiting to be seen.

Please would you consider seeing your own GP tomorrow,

if you think it can wait?

It's just, to be seen, you've got to wait.

Can't do anything else.

But not everyone is happy to wait.

You haven't got a caring bone in your body.

You're being rude and nasty to your BLEEP patients.

Just calm down. Calm down.

No, she's being rude.

Let's see what's going on.

Come out here.

It's your hospital, you don't care about me.

Come on, this way.

What's going on?

I was in a room, I didn't like it,

so I walked away.

Five minutes, I calmed down,

I've come back down, asked her where, which room I was in,

and she's just BLEEP me off.

Are you still booked in there?

Yeah. What's your name?

Jamie McAllister.

Right, do you want to just stay here?

Just stay with these chaps here...

Oh, no, no, no. BLEEP off.

I'd rather die.

Are you OK, Debbie?

You know, it's unbelievable.

I've had 15 incidents in one night where security

have had to come and help us and deal with that.

And it's not, you don't want to come to work for that.

It's not only walk-in emergencies the team are treating.

Ambulances rush in a stream of critically injured patients

late into the night.

PHONE RINGS

Hello, A&E resus.

OK, what do you mean by head injury?

Yep, does he maintain his blood pressure at that?

An 18-year-old male is on his way in with paramedics

after a serious moped accident.

Let's keep the trauma board ready.

I'll see what the patients like and I'll hand over to you. Cool.

Dr Jeremy Osman is in charge of prepping the trauma team.

A lot of things need to be done in a short space of time,

so somebody needs to do an initial assessment.

You can allocate tasks to people who can perform those tasks

as quickly as possible.

Kid on a motorbike, fell off there,

sort of imminent.

About two minutes away, guys.

The first few minutes when the patient arrives

is of crucial importance.

The time that we can do the assessment of the patient,

the quicker, the better, you know,

very important in decreasing mortality.

Right, guys, this is Jack, rider on a motorcycle.

We don't know what speed and he did have a helmet on,

but that was removed before we got to him.

Right, bilaterally, his arms are open on the elbows, both sides.

So, he has had clamycin and five of morphine.

He is quite nauseous.

He's got some bruising coming out on his chest at this moment in time,

but everything else is stable.

Jack, try and keep these legs straight for us

cos we're just going to lift you onto the bed, mate.

Ready, steady, go.

Well done, well done.

Jack, do you know where you are?

You're in hospital.

He looks awfully white.

He does. He's very cold as well.

Pupil size three, bilaterally reactive.

Having been thrown a considerable distance from the moped,

doctors are concerned Jack may have sustained a brain injury

and internal bleeding.

So, some abrasions over his upper abdomen and chest.

How is your pain at the moment?

Sorry?

You feel sick?

Yeah.

Andy?

Put a cannula in his foot.

Sats 100, pulse rate of 96.

We're going to give your arm a real good wash, all right?

The exposed bone and shoulder must be secured by the orthopaedic

surgeon to avoid infection before lead consultant,

Dr Osman, can assess any internal damage.

As quick as you can for that and then we'll do a scan.

How are you doing there? All right?

HE MOANS IN PAIN

That's it, well done.

All right, darling.

Brilliant, well done.

Well done, that's it. What a star.

That's it, you've done it.

Hey.

Yeah, well done.

When he's secured, you're fine to go. Yep? Yep.

An emergency CT scan is organised to help doctors determine

the severity of his brain, chest and spinal injuries.

Jack, we just need to get you from this table onto the bed.

No, no, no, no.

What do you want to wait for?

OK, we'll go on three.

One, two, three.

No!

No, that hurts.

I know, I'm sorry, Jack.

CT is the only way that we can identify internal bleeding.

It's very easy to bleed to death into your chest,

into your abdomen, into your pelvis.

It does directly relate to how likely there are to survive,

if they are severely injured.

Well, we hope not cos you're here.

But it is a serious injury...

..and we'll do everything we can to make you OK.

They don't need to be on.

I'm not going to hurt anybody.

Deep breaths, doctors are going to help you.

She's been out drinking, yep.

Been involved in some sort of altercation?

Altercation, yep. Erm...

PHONE RINGS

Hello, A&E majors.

Don't let...! Tell him!

Don't BLEEP touch me!

Don't touch me!

Hello?

In hospital.

I'm not coming to Hull right now, you know?

I'm not coming.

My mum.

She's like, "You best be all right." I was like "Mum, I'm fine."

21-year-old student Kevin

is awaiting X-ray results after injuring his leg.

I was getting chased by a dog around the house.

A Chihuahua.

This dog is like, imagine, like, a rottweiler

and I went to leap over a sofa, but the end of the sofa's,

like, came apart and I just went with it.

I don't know what I've done to it, to be honest.

Kevin, yeah? Right, I'm going to push you in this way.

You can leave that there.

Sweetheart, how tall, are you? 6'3. Wow.

OK, so I'm going to show you your X-ray.

So this is looking directly at your ankle,

so this side is where you're painful.

I don't know if you can see it.

Hairline fracture.

But it's not a hairline fracture, it's, you've broken it.

Yeah.

So...don't blame the Chihuahua.

No. I knew it, I felt it.

Did you? Yeah.

Absolutely, and I even said, like, "There's a dent in my foot."

A dent? Yeah.

So, what were going to do is we're going to put a cast on.

Not what you wanted to hear, is it?

Oh, my gosh, man.

Right, I'll go and see if the potting shed's empty

and we'll crack on. Pardon the pun.

You can cry on my shoulder, Kevin.

So, I'll take you down, show you where you need to be.

Does this thing not, like, go forward.

Is what?

Why does it not go forward?

You tend to walk backwards with it.

I don't understand the technology behind this.

I don't think there's much technology in it.

I honestly don't get it.

Just pop your right arm back onto your chest, darling.

Just pick it up off the inside.

18-year-old Jack is having an emergency CT scan to check for

life-threatening injuries after he crashed a moped.

Please breathe in and hold your breath.

Start breathing again.

Dr Osman and the radiography team are looking for organ damage

and internal bleeding.

The left side arterial chest injury.

It's sort of from about here down.

The results show that Jack has a lacerated spleen and liver,

with extensive internal bleeding.

We're going to get you some more painkillers soon,

Jack, and then we'll tell you what you've done to yourself. OK?

Can I have a drink?

No, you can't have a drink cos you might need an operation, my friend.

There's a great big organ in your body called your liver

and you've got a tear in it from where you banged yourself,

and that's bleeding into your tummy.

So, we need the surgeons to decide whether he needs an operation,

whether he needs something else to try and stop the bleeding.

So, I'm going to make some more rice crispy buns.

This was my cake.

Oh, nice.

Mary Berry eat your heart out.

I know, get yourself on Bake Off.

Karen, are you free to help me do a pot?

Yeah, yeah.

Do you mean my whole leg?

Up to your knee.

HE LAUGHS

You're joking, right?

Be like from there.

Medical student Kevin has broken his ankle bone.

Tell her the story.

I fell off the end of, like, a sofa.

The what?

End of a sofa. Right.

Cos running away from a dog.

You were running away from your dog?

Is it a big dog?

It was a Chihuahua, Karen.

Ah, right.

But it's a vicious one.

Oh, I can tell.

I can tell!

Right, shuffle your bottom back.

Well, this cast that's going on now is going to be non weight-bearing.

Really?

Yeah, so, until you've been seen in fracture clinic,

you need to not put any weight through this cast at all.

It's completely non weight-bearing.

You're looking at me really needy.

I'm going to shed a tear, mate.

We'll let you have a moment.

Do you need to have a moment?

Sorry, love.

Turn you over.

Ah!

Oh, oh, oh, oh, oh!

Argh!

Right, just lower it down for me.

I'll sit you up again now.

That's better, isn't it?

Yeah, yeah.

These are all right.

Right, let me just see this technique. See how safe you are.

So, you're back and forward with them. Thank you very much.

See you later.

I can tell you now that if ever you're going to get someone

that's going to faint on you, or they are a bit queasy,

or they feel a bit faint, it's always the 6'3" burly fellas.

I don't think I've ever seen it so packed.

Was out in town, drank too much, I reckon.

After being escorted out by security for swearing at staff,

41-year-old Jimmy has been allowed back in to have his hand assessed.

It looks like it's stopped bleeding.

Andrew Rennie is the doctor in charge.

Why, why's it stopped bleeding?

I think you've injured one of the vessels.

Vessels? Can I get a coffee?

Yeah, how do you take it?

Make sure it's white.

He's convinced it's bleeding through, I'm not. OK.

I'll go and make him a drink, keep him happy.

He's quite a character, but nice. OK.

All right?

At two o'clock last night, loads of kids come round and started

terrorising me, kicking my tent and things like that.

I'm sick of being homeless. I get hit, I get hit every day...

..by somebody.

But, just pure bullies.

And it's shit.

He was initially a little bit argumentative and a bit upset,

so this seems to have calmed him down

and, well, it doesn't do any harm really, just to make him a drink,

keep him calm, while the specialist then sees him, so win-win.

Right...

Are you James?

I'm Christie, I'm one of the plastic surgery doctors.

How you doing?

There's your sugar.

So what happened here then?

Broke all me fingers, I've got all me bones sticking through.

Yep.

Loads of kids and one of them pulled a blade out, slashed me,

and the other one I had me hands, like,

cos I was on the floor, he stamped, stamped on me hand.

Ouch.

OK.

Can you make a fist?

No.

Can you try for me?

No.

It hurts too much.

Just push against my finger.

I can't.

It, it's like, I can't explain it. Them two fingers are locked.

OK.

What you do have is tendons that run down your finger

and these are what are responsible for lifting your fingers up, OK?

Where this cut is and the fact that you are struggling to

lift your finger up means that you might have cut a tendon, OK?

So, Jimmy, I think these fingers have probably been locked

for a little while, I don't think this is new, OK?

It's something that can be fixed, but you do need to come back

to see us tomorrow and we can try and fix it for you tomorrow.

My primary concern is this wound here, OK?

So, we need to have a proper look in that

and see exactly what the damage is.

So, what we will do...

Jimmy, are you listening to me?

Yeah?

What we'll do is we'll put a dressing on this, OK?

Make it nice and clean, and send you home on some antibiotics

cos this is, this is high risk of getting infectious.

I haven't got a home.

Where do you normally go back to?

A tent. OK.

Can you go back to there tonight

and come back to see us tomorrow morning?

No, cos me tent's trashed.

Them kids jumped on the tent

and I don't know if I've got anywhere to sleep tonight.

All right, fine.

Well, I'll have a chat with the A&E doctors and see what they say, OK?

The thing is, if you go...

Sleep in a doorway somewhere.

Listen to me, if you go, you have to come back tomorrow.

Cos if this is damaged and we don't fix it,

then you will not be able to use that finger properly again,

all right? So it is important that you go.

What, what do you think about getting this guy home?

I mean, I say home.

Oh.

I just don't think he'll come back.

I can't pre-emptively admit him,

thinking that something's going to go wrong though,

that's the only issue... No. Can I? OK.

No. So, it means home with antibiotics.

It means home with antibiotics.

Well, it's stopped bleeding, so that's the only reason why...

Yeah, well, it's got a great big clot sitting in there, hasn't it?

Yeah, and it had a pressure bandage on it earlier.

So if we put that back on and he elevates it, and he should.

Yeah, yeah.

I'm glad you agree with me then.

Yeah, it's tough.

Yeah, I don't think we have an option -

other than to send him away.

It's not a hotel, it's a hospital.

And, unfortunately,

if you admit everybody that doesn't need to be there,

that patient that turns up that is very sick and does need a bed

immediately won't have those things.

PHONE RINGS

No, no, no. Definitely not.

All right then, thank you. Bye-bye, bye.

Jack, got your family here for you.

After crashing and being thrown from a moped, 18-year-old

Jack was rushed into A&E.

His CT scan has revealed a lacerated liver and internal bleeding.

He's got some blood going into a drip cos, obviously,

he's bleeding and he's a bit zonked with the

painkillers we've given him, but he's OK.

Love ya, love you, darling.

I've got two children who are, who are both grown up.

Thankfully, neither of them have been in,

had any life-threatening injuries or illness.

I can't begin to imagine what the parents

of unwell children go through.

Dr Osman has consulted with a specialist about how best to

proceed with treatment.

The surgeons have seen him and they don't think that the

best thing at the moment is doing an operation immediately.

But, as I say, we are going to keep a close eye on him and see.

You are going to go into the intensive care unit now

and be looked at quite closely and, if the situation changes,

then he may well need an operation to stop the bleeding

and...take it from there.

You've got a tube in your bladder, Jack, so you don't need a wee.

Oh, you're joking? No. I need a wee, mate.

You don't need a wee cos you've got a tube

in your bladder that's draining it.

Trust me, I need a wee. Trust me, I'm a doctor.

What's going on? It hasn't stopped bleeding.

Well, there's... Don't worry about the floor.

41-year-old Jimmy has damaged the tendons in his fingers after

being attacked whilst sleeping rough.

Jimmy, just leave the floor.

Let me look at your finger? I can't, I can't.

Plastic specialist, Doctor Brennen, needs to stop

the bleeding from a deep cut on Jimmy's finger.

He's starting to bleed again and what I think

he's doing is dislodging that clot.

Yes, absolutely.

Um, do we have any chloramphenicol ointment?

And we can put some chloramphenicol over, then we can do some gauze

and an Adaptec compression dressing.

Ah. Why don't we do that? That's sometimes why I ask you guys

because you come up with all these clever things.

Well, when you spend, you know, 16 hours a day in the hospital,

you pick up all these little tips.

All right, shall we get this finger fixed?

I've lost three pints, easy.

I would be very surprised if you've lost three pints.

I don't know, dizzy, I'm tired...

..felt really weak and can't do ought. OK.

And it's cos of that.

Do you think that might have something to do

with being beaten up, as well, though?

That won't stop it. I've done that, I've done that...

I promise you, I'll stop it.

..50 times. I promise you I can stop it. Right, we'll see.

This is why I'm here.

Great.

What is it?

So this is just a bandage to help...

Soak it up? Yeah, essentially.

Tight as fuck.

It's supposed to be tight to stop the bleeding.

Hey, stop, stop, stop. It's fine.

HE MOANS IN PAIN

Fuck, fuck, fuck.

Fuck, fuck, fuck, fuck, fuck.

Argh, stop, stop, stop a minute.

Jimmy, keep still, keep still, keep still.

Jimmy will need to return to hospital

during the day to fix his tendons.

We'll give you a big sympathy bandage.

HE LAUGHS

So what time do you need to come back tomorrow?

I don't know. Between 9-11. All right.

OK? Yeah.

What time do you need to come back tomorrow? Between 9-11.

Very good. We'll see you tomorrow, OK?

What's your name? Christie. Christie, thank you, darling.

You're welcome. Nice to meet you.

Discharging Jimmy tonight means he will probably have to sleep rough,

but hospital beds are always in great demand.

Sometimes the toughest decisions seem to be the most

simple ones, you know?

Do we send someone home or do we do we bring them in?

Sometimes why I ask you guys, see, it's not

so much I think this patient needs admitting,

it's more I think this patient needs probably a bit more...

..whatever you want to call it.

A bit of TLC.

I like to think we try.

Jimmy, do you need another drink before you go?

Yeah, please. And then you can... Coffee.

Three sugars? Yeah, please.

Nice one, you are a star.

Sometimes, with medicine, it's not always about being medicine.

It's also about looking after the person as a whole

and sometimes that involves making drinks,

looking after and hearing about their problems.

So, I'll go and give this to Jimmy.

Take care of yourself. Thank you.

Any swelling, anything getting worse, then come back in and let us

know sooner. Yeah.

All right, you look after yourself. Thank you.

As Jimmy leaves hospital, the security team give him

back the alcohol confiscated earlier in the night.

What are we doing with these?

I'm just taking them back to the person who has them.

Cos it's his property, so we can't indefinitely keep them off him.

I'll be in the doorway, got me sleeping bag.

I'll be in a doorway, I'll be happy enough.

It is 1:51.

Right then, Jimmy, keep yourself safe, mate, all right?

I'm unsure where he's off to now.

It's awkward cos you do want to let them stay, but,

at the same time, if you let one stay, you have to let them all stay.

See you later. See you later, Jimmy. See you in a bit.

You seem to be losing quite a bit of blood.

Hull Royal ED Resus. GCS.

Is it an open fracture or a closed?

And how long are you going to be?

OK, thank you so much. Bye-bye.

Five, ten minutes.

Paramedics are rushing a 76-year-old lady into resus after a nasty

fall in her home.

She's accompanied by two of her daughters.

So, there's just a few things going on, Margaret,

so you'll feel lots of hands.

This is Margaret, she's fallen from standing.

She's literally just arrived, so just going to have a quick handover

and get her on the monitor.

Was it in the living room or...? Yeah, in the living room,

so she's just fallen backwards.

Said she felt a bit dizzy, fell back, it caused the whole event.

No loss of consciousness.

Fracture, dislocation of her right leg.

Do you feel cold? A little bit.

A little bit. Let's get this blanket on.

She said that her...

..the pain was a five to six before the anaesthetic

and a five to six after because she wanted to come home.

Dr Jehad Abed is in charge of her treatment.

Hello. Hello.

What's your name, ma'am? Margaret Lodges.

Margaret, I'm one of the doctors here.

OK, so tell me what happened then, why you ended up in hospital.

I'm sure you know you are in hospital.

I just, yeah, I just fell backwards.

How did you, someone pushed you or anything?

No, I've got a Zimmer frame. You've got a Zimmer frame?

Yes. And you fell backward? Yes.

Did you trip or you felt dizzy or you tripped, what happened?

Bit of pain, that's all. OK.

She didn't want to come to hospital as she always says, "Oh, no, it's

"all right." But when me sister went, she was,

my two sisters went, she was screaming in pain,

like a child, so obviously the pain was really bad.

So...but whether she's confused

because of what's happening now or not, I don't know.

I just need to see what's happening here.

I don't know, I haven't seen the wound.

If they say, if it's an open fracture means the bone

itself is broke and gone through the skin and just gone out.

This is what we call the open fracture.

So that was something you would probably see without an X-ray,

would be, you'd be, oops, she's bleeding there.

OK. I think it's more on the ankle rather than trying not to

move the leg because it will be quite painful

if you start doing this.

Right.

So what we're seeing here is quite big, deep

laceration on the medial side of the right ankle.

The pain threshold is different from,

compared from the older generation to the newer generation.

The older generation, they try just...to hide their pain,

to hide their symptoms.

Quite a faint pulse.

Cold.

Any pain here? Does it hurt? No.

There it does. I am really sorry. So nothing at the back.

We need a few X-rays and, if it's broke, you will be

admitted in hospital and you will be going to the orthopaedic department.

You're going to need some surgery - if it is broke.

I'll have to stop in?

Very likely.

When elderly people have falls and they break their bones,

if left untreated, it can end up in amputation.

Most of the time, they will require surgical intervention.

They can get side effects related to the operation.

They can get infection from hospital,

they can get sepsis and some of them

actually die in hospital after just a simple fracture.

And who's at home with you?

Meself. Are you normally independent? Yeah.

We'll look after you, we'll get you sorted, OK?

Have you got any medical problems?

Loads.

She don't want to come into hospital, she wants to stay at home,

so that's why she's saying it's not as bad as what it really is.

And because she's terminal, she's terminal with cancer, you see,

so...and she, her wishes are to stay at home and she's,

she's said "Oh, if I go in hospital, I might not come out."

So, we think that's all on her mind and that as well.

She started off with a breast cancer, then it went into her lung

and then her spine...

..and then.. She's deteriorated these last couple of weeks. Yeah.

So, before it gets too late, cos it's like early doors now

and Holly gets to three o'clock in the morning and wants a pizza and

nowhere's open, I don't know if I can eat pizza

and work at the same time.

Why?

THEY TALK OVER EACH OTHER

You can't eat on the shop floor anyway.

Pizza is the easiest.

Staff nurse Lucy Brodie has worked at Hull Royal Infirmary

for just over a year.

Hello, it's me again. What's your date of birth?

21st. Happy Birthday for tomorrow.

Yeah. Is that why you was out tonight?

No, I were just out for a drink.

Her patient, 63-year-old Barry,

was injured while witnessing a pub fight.

They said I were unconscious, but I don't remember it.

Well, you won't do.

Oh, yeah.

It would be a medical mystery

if you decided to remember being unconscious.

When you get a really good character that comes into A&E, it does make

your night shift because, obviously, you can get along with that

person, you can have a bit of banter,

you can, you can have a good chat.

It's me birthday tomorrow.

You won't be still here tomorrow,

but, if you are, I'll bring you a birthday cake in.

It makes your night shift, they make you laugh, they make you smile.

Let's see if we can see your brain.

You'll be good if you can see that.

These people are the reason that we come to work on,

especially on a night shift.

You might need some stitches in that.

Think so? Yeah.

Nobody wants to work a night shift,

everybody would rather be at home, in bed asleep...

..personally, I would.

You've got multiple little cuts.

I'll get you down to see the doc.

There's certain criteria. I think you're very nice.

You definitely need a scan then, don't ya?

There's three in front of you because

it has to be done in a priority order.

Can we have security, please?

Security have been alerted to a man

with a razor blades in the waiting area.

He's not been abusive or anything like that, has he?

Where have you cut your hand?

Let me see where you've cut your hands.

Cut, I don't want to do it over here.

No, no, no, I get that.

I cut it there.

A patient has self-harmed while waiting to see a doctor.

Thing is, it's based on...impulse.

So, I can be fine and then the next minute I want to die.

Want to come through?

Right, have a seat on there for me.

So, what's brought you in tonight?

Honestly, like, I just feel like breaking down,

I've lost too much.

I've lost everything and I don't care about myself any more.

Senior nurse Laura Young needs to assess

the patient before she can refer them to the mental health team.

You still feel quite suicidal?

What a sight to see.

Slashed my hands. In front of everybody? No. OK.

In the toilet. OK.

Do you want to have...show me?

I don't know, I know there's one there and one there,

but I'm not sure.

Right, let's do your blood pressure.

Have you self-harmed before? I have, yeah... OK.

..in the past. OK.

And is it normally your hands, or...?

No, it's normally my upper arm.

We have a fair few patients who see us as their support network,

so we will see them quite a bit,

which I find quite upsetting,

as a nurse, that there is nowhere out there

for them to be able to go to.

But, honestly, I said to you, didn't I?

If I don't get the help tonight, I will chop my fingers off,

I will, cos I can get razors anywhere and I will.

I'm not arsed about blood or nothing.

I will literally cut my fingers off until they help me.

All he had was one used needle, basic signs of heroin use.

We'll get him around to majors, let them know what's gone on.

All she said is if it's a blood clot then it might affect

limbs and things, yeah, microsystems.

I really am fucking suffering this time. I know you are, I know.

Bad.

We might give you some medication, like antibiotics.

OK? Right. Thank you.

76-year-old Margaret needs an X-ray to assess

the severity of the damage to her ankle after a fall.

Margaret, can we just roll your leg, that's it, is that...?

Do you remember when I said we weren't sure, there might be

something? OK.

We have got a fracture, dislocated ankle joint.

It's quite badly displaced, it's out of the joint.

Hmm, yeah, it's quite bad-looking there.

We're just thinking, if she has to have an operation,

will she get through it?

You know, with all of her other, other problems she's got.

So, we're just concerned about that because of, with

lung cancer and everything that,

if her body can take it, you know?

Like, so, we're a bit concerned,

if she has to have an operation, what'll happen.

So, that's on our mind at the moment.

You've got something called a fracture dislocation

of the right ankle joint.

Right. Right out of the joint...

Yeah. ..so it will need more manipulation here.

Right. It can be quite painful.

We'll try to give you some sort of sedation to get this sorted.

That means you will be staying tonight.

We are an ageing population

and, if you have like a snapshot of the department, even at night,

or any time of the day, most of what we see nowadays is an elderly

people or elderly patients.

I have been reading something about your breast cancer

and it's spreading into your lungs, is that right?

And you've asked, you've asked the oncology doctor for what

we call the do not resuscitate form.

Is that right? That's right, that's right. Fine.

We might need to rewrite another one here, just to make the other

health care professionals aware

about your wishes of do not resuscitate.

Are you happy with that? Yes. OK.

Have you got a favourite type of patient? I'm not sure.

Ones that come in and go straight home.

Go home, yeah, that's the one.

Luc, how do you get to sleep after a night shift?

So I have a little routine,

I walk in the door, go in, say hello to the kids.

I have me wee, wash me hands, brush me teeth, wash me face, dump

me uniform in the wash, get in me jamas,

get in bed, and I'm like that.

Straight out? Straight out.

Knock, knock. Hello.

Hello, Barry.

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

I was just having a nice sleep then. Oh, I'm so sorry to disturb you.

These hotels are rubbish.

Ex-doorman Barry sustained a deep wound to his head after being

caught up in pub fight and has been waiting for staples in his scalp.

We'll get you patched up and get you on your way.

Can I be honest about this?

It does hurt a bit - when the staples go in.

Yeah, don't worry about it.

But it's for a very short period of time.

OK, ready? Grit, grit your teeth.

Tell me if you need a break.

How many more?

Right, let me count, right, one, two, three.

Argh!

You can spend a lot of time putting local anaesthetic in, but,

when you inject it in, it does actually sting quite a bit.

Right, there's eight staples there.

You have to kind of, weigh up, do you just crack on

and get it done really quickly, accepting that it's going to

hurt for a short period of time?

Or do you mess around for ages with local anaesthetic?

And that can be just as painful and distressing.

Have it taken out with your GP practice in five-to-seven days.

I think staples give a really good result and they are quick and easy.

Bit sore, but normally that pain's quite sort-lived.

Have you been under mental health before? Yeah.

OK, and what was that for, the same?

Um, it was suicidal thoughts.

While waiting to see a doctor,

this patient self-harmed inside a hospital toilet.

I just started going at it and it didn't hurt at the time,

but it hurts now.

As an A&E nurse, we are trained in how to fix somebody who's

completely ruined themselves or have been in some sort of accident.

But knowing that they are not mentally fixed

and there's nothing that we can actually do about that is

a serious situation, in my eyes.

Becoming alcohol dependant? No, I wouldn't. No.

I drink to try and...

..get rid of how I'm feeling. Right.

But when I wake up the next morning, it doesn't help

and it's even worse.

Well, we'll sort your hand out, but then we'll have to refer you

to mental health and they'll have to come

and see you and assess you properly. All right?

And then we'll see what they want to do from there.

Is that all right? Yeah. Perfect.

Take a seat back in the waiting room.

Mental health has completely changed

in the last ten years that I've been nursing.

We can see ten cases a shift, really, and it's

a massive increase cos I don't think they have the support.

And we're the only place open on a night

that can give the support if we need to.

You'll be tired as well, though, mam.

You want a drink?

We'll have to ask them if you can have something.

Bet you could drink a cup of tea, couldn't you?

I just want to go home. Yeah.

76-year-old Margaret is desperate to return home

after fracturing her ankle.

She's also suffering from terminal cancer.

It's just when I move, you know? Then I feel it.

So I try and keep it still.

Don't move your foot. Don't move.

They told you not to move your foot.

It wasn't like this, initially.

It was more like stable.

Because she keeps moving, so I think the best thing,

we just need to do it back in as soon as.

Can you feel me touching there? No.

And there? No.

At this point of time, we need to get your ankle

in a decent position - what that will do is

it will get the pressure off your nerves and vessels. OK?

We'll give you some medication, actually, to put you to

a state of a sleep, sort of thing, OK?

So you won't go completely to sleep, but you will not remember anything.

Does that sound good? It does. Good.

Can you take a nice deep breath for me, please, Margaret? Thank you.

So we're going to give this white stuff through your veins now.

It might sting as it goes up your arm.

We'll see you when it's all done, all right?

Margaret? Margaret? OK, I think Margaret has gone to sleep.

Oops, she's started snoring.

MARGARET SNORES

OK, that was a big one.

Under sedation, the most dangerous thing is losing the airway.

When the patient goes to the spasm,

you'll be struggling to get oxygen on.

It can go quite serious and quite disastrous, actually.

You happy she's relaxed enough for you as well?

Yes, good.

I don't think she'll remember anything. No.

I'm breathing for her, she's not making a proper breathing effort.

So, as you can see, it's quite, what we call, obstructed airway.

Sometimes you have to do a bit of lift, jaw lift, like this.

She's started breathing now though.

Good, that's a nice deep breath there.

Dr Abed and the orthopaedic team must now secure the ankle

joint back into place.

Margaret? Hello?

Open your eyes, Margaret.

Do you know where you are, Margaret, now?

Do you know where are you?

OK, so do you remember what we've done?

What we've done?

Right, we'll just get this covered, then it's all...

..yeah, it's dried now.

Maybe, being an emergency physician,

you are the first point of contact with the sick patient

and sometimes you can get challenging

cases that...they are quite sick

and you try to do something,

and it can be quite tricky.

At the end of the night shift, I feel that...I have achieved

something by saving people's life, treating the sick and ill people...

..which actually makes me quite proud of myself.

Night-night.

Right, guys, this is Jack, a rider on a motorcycle.

Sharp scratch.

Try and relax. I'm in. I'm in!

And it didn't hurt at the time, but it hurts now.

I have to be really poorly to get an ambulance or anything.

PHONE RINGS

Resus.

Next time...

When a car rolls, absolute worst-case scenario

is patient has fatal injuries and dies.

Everything is screaming out,

we need to get a neurosurgeon down straight away.

Fuck off! Argh!

Hey, hey, hey, hey!

I did think I was going to get spit in my face,

but, thankfully, I didn't.