- 2 days ago
A&E After Dark - Season 7 Episode 5
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Short filmTranscript
00:03after dark while the nation sleeps 16 year old male who was shot the A&E nightship begins
00:11can be very dangerous we deal with a lot of aggressive patients things can escalate this
00:18gentleman has been punched kicked can't be quite scary when it's just you and one violent vision
00:24across the UK we join the staff of three of the most challenged emergency departments
00:29it's always busy it's always under pressure time is of the essence and the medics who face danger
00:36each shift most shifts I see more place than nurses with the amount of drugs and alcohol
00:41admissions rising have you been drinking today the risk of violence and abuse looms large every
00:47night please don't swear like that they try to attack and stop calm yourself down people can
00:55become aggressive you've been punched kicked you see the good bad and the ugly yeah we'll get
01:02security the emergency department is like a battlefield it's like organized chaos
01:19after dark violence against NHS staff is at a record high and doctors and nurses face it every time
01:29they're on shift sometimes we have to call the police they can attack the security they can they attack
01:43nurses I don't think the public is aware they don't understand what we're going through violence and
01:50aggression doesn't just stop at our doors it continues on the streets that can be quite scary
01:55scary for us and for everybody you're right there a better day than you got into a fight
02:1836 year old miss arc is in resus
02:24after being assaulted outside his home he's just minutes away from losing his vision
02:36emergency doctor fraser will be treating him
02:41we see a lot of patients come in who are victims of assault being punched in the face can be
02:45fatal
02:46with this patient he had bleeding behind his eye the pressure that that bleeding causes can squash
02:54the nerve and so you can go blind in the space of an hour it's a real time critical emergency
03:01this is just oxygen you have to do a procedure called a lateral canthotomy where you cut the
03:07ligaments that keep the eyeball in place and essentially relieve the swelling that's squashing the nerve that
03:15goes into the back of the eye with the pressure building behind his eye they have just minutes to act
03:24ketamine's going in right we're gonna make you feel funny just have nice dreams
03:30dr ed administers a fast acting sedative hey buddy you there so the night team can fight to save his
03:38vision
03:44that looks like ligament there yep so that's the superior ligament let's cut the superior first
03:52cut this the superior because it's advisable to go both in this circumstance so it'll give us some room to
04:21the swelling the swelling is making the next cut
04:27much more difficult
04:35patient had bleeding under the surface of their eye
04:38so it was it was particularly swollen it made it quite difficult to see exactly what we were
04:43supposed to be cutting it's supposed to be cutting
04:47it's a better grip i feel it's bigger to the skin so i mean i don't know what else we
04:51can cut
04:53consultant dr susie is also on shift when someone has increasing pressure on the back of the eye you
05:00will start to get compression of the nerve fibers that provide the sensation of a vision so if you don't
05:07just release that pressure that person will lose their sight and they will become blind and it will be permanent
05:25this lady's new she can probably step down but not to the corridor also working the weekend in newham's recess
05:31is dr ella
05:37she can step down
05:41a patient drifting in and out of consciousness is being brought in by ambulance
05:47you're at hospital now okay give us two minutes and then we'll come in all right
06:00yeah
06:01hi my love my name's ella i'm one of the doctors i'm just going to hear what's going on and
06:08then
06:08we're going to make you feel better okay i was witnessed by bystanders to collapse on the side
06:15of the pavement tonight outside of her address complaining of abdominal pain
06:18has deprecated herself and had five vomits with us okay i'm still complaining of abdominal pain
06:24she's been in and out of a altered conscious state with gcs 14 as her best with us what do
06:30we think
06:30it is oh she has said that for the last three days she's been having crack and heroin
06:36i do see drug overdoses all the time and it's an enormous part of our workload pupils pupils are size
06:42two even reactive but they may be size one now the main questions to ask are what are the
06:48overdosed on do we need to reverse that drug do they need any life support for that overdose
06:54can you open your eyes for me have you got any pain anywhere there in your stomach
07:02sorry honey it's gonna fuse for me here okay vomiting and a painful hard stomach
07:07can indicate life-threatening internal bleeding oh i want to have a little listen to your breathing
07:16so gretchen let's do some fluids clean up a little bit i don't think we need to do any scans
07:21or anything
07:21now currently we're going to give her some fluids some anti-sickness so she can tell us a bit more
07:27about why she's vomiting how she feels her tummy's nice and soft so i'm not in a rush doing any
07:31scans
07:32right now she's quite young sharp scratch my main concern for her is is she withdrawing from cracking
07:41heroin and it's making her feel really miserable it's going to be quite hard to manage that so we
07:45might need to give her some other things to make her feel a little bit better can we clean her
07:49off a bit
07:50thanks guys i know it's not the nicest well be quick don't worry patients who are using drugs they
07:58often have an untold story a non-confused well person doesn't allow themselves to be covered in excrement
08:06it shows that this person is is clearly in in need of of help yes it does add burden to
08:12the nhs but
08:13that is what we're here for we're here for accidents and emergencies and drug overdoses are emergencies
08:42you're not drunk when you first come in to me
08:47obviously drugs and alcohol are a big problem i've been witnessing violence and aggression
08:52it is difficult to be on the receiving end i think that's definitely gotten worse
08:58from 2023 to 24 the nhs saw over 1 million alcohol related admissions many arriving after dark
09:06so you and you and you and you can f*** off at night everything gets worse when you mix in
09:14alcohol
09:14and violence and aggression against our staff and it can feel like a police station sometimes
09:39in east london 36 year old nissarg has been violently assaulted outside his home
09:46well done he's at imminent risk of losing his sight the night team are performing an emergency
09:52procedure you made a small lab will cut through the skin so you need to try and buy yourself
09:57down your window procedure we need to do is called the natural camphotomy it's not something that we do
10:03very often it is a time critical intervention identified a bit of the ligament but we couldn't get enough
10:10of it clamped to cut he's got quite a large swelling to the globe itself to relieve the pressure on
10:17his
10:17optic nerve the night team have to cut the ligament inside his eye socket if i take away the upper
10:24lid with
10:24the two four steps now dr susie needs to work around the swelling to cut a second one
10:33oh it does kill me though oh i'm going to give him another 20
10:44pop out there isn't it
10:48see if we get anything
10:52i'm just going to hold it for a little bit
11:09well done my friend yeah it's more forward so that's good
11:15i'm trying to find him a very small piece of anatomy to cut was really challenging we will see
11:22if we've been successful the team must wait to see if nisarg's site is saved and if the damage goes
11:29any deeper we're going to do a ct just to assess the bones and see if there's any fractures in
11:35the
11:36socket itself to ensure that there's nothing beyond that and into the brain okay it's coming
11:43around from your sedation my friend when someone is punched in the face um with significant force
11:50there are all sorts of complications you would be thinking about significant brain injury facial
11:56fractures these things can happen in an instant and change that person's life forever
12:01and it's something that we need to do some other investigations
12:16a and e north for nourish medical trauma
12:19we've got some iv fluids up nearly 3 a.m in norwich
12:23so it's been going at this rate since midnight really dr lucia is looking after a patient whose
12:30heart is racing out of control still going fast isn't it his heart rate on the monitor was 200 beats
12:38per
12:38minute the normal rate is 60 to 100 he can't maintain that heart rate of 200 for a long time
12:45eventually um it will become tired and potentially stop all right sweetheart so if you can pop your
12:52hands straight for me that's fine it is unusual it's rare um but sometimes people do have this
12:59condition where they go into the spontaneous fast rhythm in the slightest jolt drove his heart into this
13:06fast rate dr lucia consults the cardiology department for the first critical move in his treatment
13:15i've given him a bladder syringe and he's tried about four or five attempts
13:20and basically it's not really changed so we're going to give you six milligrams of adenosine yes yes
13:27adenosine is a little bit like a jump starting the heart again you give it quite fast into a vein
13:34it stops the heart and then restarts it and hopefully it comes back at the right rhythm
13:41between 60 to 100 beats per minute which is the normal rate all right sweetheart so adenosine going
13:48in now and the flush the first time i did it a number of years ago when i gave the
13:54adenosine it was
13:54quite scary um when you didn't see the heart rhythm on the monitor lift your arm up
14:03raising his arm helps the drug hit his heart in seconds
14:10still going fast isn't it it is it's not done it has it with the heart still racing at 200
14:19beats per
14:19minute the adenosine has failed so once we're ready dr lucia tries again with double the dose
14:3012 milligrams of tenazine going through and big flush there we go lift his arm up beautiful
14:39nice breathing can we get a little bit of oxygen on if that's all right two liters extra oxygen supports
14:48the patient's heart as the night team fight to slow it down the rate hasn't made a blind bit of
14:54difference has it so um i'm gonna do 18 now dr lucia administers a third and final dose any more
15:04could
15:04stop his heart altogether okay so we're gonna do 18 so adenosine gone through flush gone through lift it up
15:17oh that was awful sorry sweet adenosine acts fast triggering an overwhelming wave of nausea and
15:26breathlessness during that episode when the heart is racing it is scary they feel terrible they tell us
15:34that they feel terrible we're looking promising we're looking promising oh hang on
15:47and then it kicks in again the final dose has failed the patient's heart is still stuck in critical
15:56overdrive the fact that we've done third one and it hasn't worked i'll just give her a ring now so
16:01she's
16:01fully aware basically the heart's beating differently and there's no set pattern
16:09if you don't intervene ultimately the outcome can be for it to stop
16:28on average ambulance crews respond to nearly 3 000 falls every 24 hours
16:34bringing some of the most life-changing emergencies into a and e after dark
16:40it's gonna have a lift here i'm okay in the middle of his night shift dr aditya has been called
16:46to
16:46see 40 year old delivery driver akram you can feel my heart yeah who was brought in by ambulance after
16:54falling down the stairs but it's swollen here yeah here's good are you able to bend your elbow
17:02i don't think no i can do this okay we'll get you some x-ray sorted
17:07thank you but before you do it just give me anything oh we'll get you some pain relief i've
17:11already prescribed it to you okay do you need some help getting up yeah okay thank you okay getting an
17:16x-ray as quick as possible as is really crucial because the further we delay the x-rays it can
17:22lead to
17:23nerve damage can lead to vessel damage to reveal the impact of akram's fall dr aditya needs to check
17:30all the bones in his arm from shoulder to wrist yeah forearm's fine is okay yeah desiccated
17:42oh yeah it's not her mouth dislocation is serious can lead to nerve damage making the lymph usable for
17:49the patient with akram's mobility and his job on the line dr aditya and the team need to urgently
17:56realign his elbow this part of your bone should be in this socket so we need to put it back
18:03in the right
18:18now we've got the maid who's just been in a road traffic collision
18:24she's been crossing the road driver hasn't seen her he's turned the corner and hit her
18:28okay any um past medical history any blood thinners she's on clopidogrel tonight in newham
18:35dr rosie's in charge of the recess team we've got a head injury a pedestrian bus car recess can be
18:41often the most chaotic place in the whole hospital can you tell me if you're in pain there
18:46often the patients are really sick especially when it's a pedestrian hit by a car we're super
18:51careful about those because the the risk of injuries is really high after dark pedestrians are over twice
18:58as likely to be struck and the consequences can be life-threatening i see you he's here okay yeah
19:18okay here we go well done well done
19:23our main concern is she's got a significant head injury especially given that she's vomited now two
19:28times um especially when she's lying flat which can suggest a raise in her intracranial pressure
19:33yes okay hello my name is testing one of the ane doctors you can just lie your head back for
19:40me
19:40okay the night team must run urgent neurological checks in case 63 year old paramuswari has a
19:47critical bleed on the brain deep breath big breath very good again okay my dear that's fine i'm just
19:58gonna shine this is gonna shine this in your eyes okay there's a light coming in your eyes okay good
20:07okay pp is equal and reactive two millimeters any pain in your legs
20:16just the hand okay and your head brilliant let's leave the wrist for now because we'll get it x-rayed
20:21so
20:21i don't know yeah and then there's this obvious is it boggy it is okay all right okay there's a
20:30particular type of boggy swelling that you can get on the head they're fairly rare but it can suggest a
20:37skull fracture sorry my dear we're gonna keep her in that position we're gonna sort of ct trauma series
20:44for her we're gonna get you some scan for your head okay okay we'll get you some and some painkillers
20:51okay hopefully we can get her into a scan fairly quickly so we'll know exactly what we're dealing with
21:01following the crash paramuswari's sons called for an ambulance i was in shock when i quickly came and i
21:07saw my mother on the floor was the last thing i hope to see but i'm seeing it
21:14strongest woman i've made in my my life hi how are you doing so i'm raising one of the doctors
21:20i'm worried about her head at this point so i definitely want to make sure there's nothing
21:23in the head yeah there's lots of reasons people vomit including if they are shocked or an injury but
21:29having something worrying in the brain is a reason why people vomit as well so we're going to see
21:32everything and then x-ray the wrist as well if you have bleeding on the brain it can expand
21:39all that blood expands it has nowhere to go and the skull can't expand so it just compresses the
21:45really critical areas of the brain the ones that control your motor function or your speech
21:55and obviously the worst case is your ability to regulate your breathing and your heart rate as well
22:01it can lead to disabilities and possibly death in really severe cases
22:33what's going on everyone seems to be coming in for a fight
22:36after dark a andes across the country are facing more aggressive patients than ever before
22:44the night shift can be a bit chaotic a bit crazy
22:46it can suddenly make the department feel very unsafe
22:54can really ramp everyone's anxiety levels up
22:57ain't no man alive who can handle me i'm sorry but many patients on the night shift
23:03are also the victims of aggression and assault
23:22well done my friend you're coming coming around in newham dr fraser is looking after 36 year old nissarg
23:30he was attacked outside his home and rushed into emergency eye surgery
23:35i'm just gonna pop this off we don't need the oxygen anymore okay
23:38now the pressure around his eye has dropped the 19 need to check whether they were able to save his
23:44eyesight
23:46i'm just i'm having a look at your vision again are you awake enough for me to look at your
23:49vision
23:50here you go
24:01oh my god okay now i can see that's good cover your left eye yeah can you see my face
24:10i can see okay how many fingers four music to my ears he's had a a punch that's
24:19forceful enough to give him bleeding behind his eyes so what else might that have done is that
24:23broken any bones in his face make sure he's not got any bleeding in his brain
24:27what we need to do now is just because you've had a quite significant head injury
24:31uh we're gonna do a scan of your head okay nissarg is taken for an urgent head scan
24:42to check for any life-threatening injuries
24:47yep
24:50he waits in majors while the night team examine the scans
24:54the thing is celebrating festival with my two-year-old daughter the guy came you know he's arguing me
25:03like i have my daughter in my hand and he's trying to punch me and i just pulled her back
25:10and that's
25:12why my face is like this and he just punched me in my face and my eyes
25:22is your eye painful yes and now it's been here as well yes the ct scan showed that there's a
25:28broken
25:29bone in your face and around your eye what we're going to need to do is get you followed up
25:35by the
25:36facial surgeons as well for an appointment to see whether they need to do anything sometimes when
25:41you've got you know fractured eye socket then the muscles that move your eye can squish through the
25:45uh the gaps in the broken bones and that can mean that you can't move your eyes properly
25:50but the uh immediate priority for him was was getting him seen by an eye doctor
25:55we're gonna get you seen by the ophthalmologist in the morning all right some of the most dramatic
26:00cases of you know injury and trauma from violence in the community uh will happen at night
26:06it was a pretty horrible assault it's what sounds like a completely trivial
26:09argument and someone's punching him in the face so it's pretty horrible thing to happen
26:29it's still in svt he did revert back five cyber speeds but then just went straight back into
26:36the night shift dr lucia is looking after a patient whose heart is beating around double
26:42the speed it should be we give six milligrams at 246 no effect and then at 250 i gave 12
26:51milligrams
26:52of adenosine no effect with the first treatment failing to calm his heart dr lucia calls the cardiology
27:00specialist so we just we just need to dc well i'll have a word with daniel because obviously she
27:06needs to be in resource if we're going to do that as well they devise a new treatment plan so
27:12spoken to
27:13cardiology so what he's recommended is actually dc cardioversion oh no i really don't want to do that
27:21okay the quickest way to get the heart back to the normal rhythm is we put defibrillator pads on and
27:30jolt the heart with electricity back into the normal rhythm but you can imagine um that situation not
27:39being very very you know pleasant so you have to put yourself in the position of the patient it makes
27:49people really really really really frightened it's more than one way to skin a cat so don't worry it's
27:55all good dr lucia refers back to the cardiology specialists on what else can be done give him
28:04metoprolol what dose would you recommend there is one other medication they can try metoprolol is a beta
28:14blocker this works in a different way um and slows the heart down yep so give that 312. unlike adenosine
28:26which resets the heart metoprolol works the opposite way blocking adrenaline to gently calm the heart rate
28:35it's coming down it's getting there slowly and then once you go back to normal get your nice cup of
28:42tea
28:47nearly nearly nearly
28:52get out of it the rate is is better than what it was whereas before you were sort of like
28:58about 200
29:00you feel better much better good a sigh of relief a sigh of relief as soon as you get the
29:09rate back to
29:11the normal rate the patient just feels miraculously better and that's what we're here to do do an ecg
29:19and then unfortunately you're going to have to look at our ugly faces for a couple of hours now
29:38in newham 63 year old paramaswari is having urgent scans
29:44after she was hit by a car while walking to temple after dark
29:54her sons are translating for the night team
29:59how's pain at the minute it's terrible we'll give us some morphine
30:03we'll get morphine on the dandurum
30:06my brother called me saying mom's had an accident we need to come
30:10and she was still regaining consciousness she didn't know what was happening
30:15and then gcs is 15. leading her care dr rosie is reviewing the scans
30:27hello
30:31hello how are you doing yeah i've just come to explain about the scan are you guys happy to
30:36translate or do you want a translator here no no are you sure okay so obviously we've scanned um
30:42head neck and all the body here what it does show which is what we were suspecting unfortunately
30:48there is a bleed on the brain okay there's a bleed over where she's got the bump but there's also
30:55a
30:55little bit on the back um she does have a fracture of her wrist as well unfortunately but that that
31:00is
31:01very manageable we can sort that out okay so unfortunately the ct scan has showed that she
31:07has a bleed on the brain brain bleeding in the very bit ct scan only shows exactly what's happening
31:15at one point in time so it's really really important we monitor her carefully um that
31:19means doing neurological observations regularly keep your head nice and still for me just follow
31:25finger with your eyes okay there's lots of things that can happen after you have a bleed on the brain
31:36the main concern is that if you have bleeding it can expand it can compress certain areas of the brain
31:44can you squeeze my hand for me and this side can you pull my hand into you
31:51very good and pull out push out out out out so their neurology is assessed in various ways for
31:59example the power of your limbs the coordination your ability to feel on your skin these are all things
32:06that can be affected by the bleed on the brain if i touch her there does she feel that feel
32:12the same on
32:12both sides okay okay what about here
32:33the same feels the same yeah here
32:43on that side she doesn't feed anything this side okay okay okay that's right so we'll have
32:49to have a chat with the neurosurgeons obviously i'm one of the a&e doctors but one of the neurosurgeons
32:52will have to have a look at all the scans and decide what's what's best for her okay all right
32:56thank you
33:00at the moment her neurological assessment is actually pretty good but my biggest concern
33:05is the risk of further bleeding she's on a blood thinner as well clopidogrel for a previous stroke
33:12which makes it a little bit more concerning blood thinning medication protects paramuswari from a stroke
33:19by preventing her blood from clotting but with the bleed on the brain it could make things far worse
33:26i have spoken to the hematologist at the london and they have suggested to give the platelets
33:32yes one pool of platelets given the risk dr rosie speaks to out of hours blood specialists
33:39the platelets are a component you get in your blood so we all have platelets just swimming
33:43around in our blood to help us clot when we bleed this patient is on a anti-platelet agent called
33:49clopidogrel and so we've asked the hematologist and we are giving her some extra platelets sort of help
33:55that clotting process the main concern if she re-bleeds is that we get a big collection of blood in
34:02the brain
34:02that then compresses the brain including a lot of the the major areas that are you know in control of
34:07our you know speech our movements our breathing with the emergency treatment on its way paramuswari
34:14stays in resus under close monitoring giving her the best possible chance of survival it's a shock
34:21it's a massive shock but fingers crossed praying to god that everything will be fine again
34:40i'll try to prioritize him okay thanks for letting me know thanks in belfast 83 year old ian is brought
34:46in teresa's hello taking the lead on his care is dr alice what's brought you in tonight
34:59okay do you have trouble with the tummy before not really no can i have a failure tell me
35:06to grab some gloves there's a severe pain there's something see there no not there no no just there
35:16there what came first the pain or the vomiting well the pain the pain came first a bit of a
35:23stiffness
35:23itself to where the pain was okay became intense is your health usually good that's reasonable yes yeah
35:33i'm a farmer i always worry whenever a farmer comes in because you don't come to see us with nothing
35:40no no he's coming with tummy pain he's got a high lactate he's tender and he's been vomiting his
35:47bowels aren't opening so i'm worried he's either got a blockage in his bowel or a blockage in an
35:51artery supplying the bowel here's you
35:58ian's wife has arrived to sit with him i've been married well since 1967 a long time and uh
36:07we don't really have arguments he has a heart problem he has a pacemaker fitted quite some time
36:15but this is different this is around the tummy area
36:18yeah he just felt poorly after he had his evening meal really sick and uh was actually vomiting
36:27it uh it happens with age or as i say too many birthdays so here we are the right place
36:38hi kiva it's alice one of the ed regs in the royal could i chat to you about ct abdomen
36:43pelvis
36:44i can only feel his tummy and look at him i can't see what's going on in the inside or
36:49as a ct can give
36:50me good images of the abdomen and it can tell us a bit more about what's going on uh what
36:56did you farm
36:59cattle sheep beef or dairy beef well rare breeds oh still on the farm are you still live on the
37:10chest
37:10yeah all right we'll give you a little bit this morphine okay and then if you need more i can
37:15give you some more in a wee bit okay i was just hoping that you weren't scared of needles because
37:21it's always the big strong men that cope on me whenever i put a needle into them and they do
37:26a
37:26lot of shooting with needles they do do a lot of shouting i know i snuck in while you were
37:32distracted there
37:33ah you did do a bit of shouting there i did yes you're gonna go up for your scan now
37:50so we are going
37:51for the ct scan okay this gentleman i'm worried about a bowel obstruction i'm worried about an aortic
38:00aneurysm i'm worried about mesenteric ischemia i'm worried about pancreatitis any older gentleman
38:07that presents with tummy pain it can be potentially fatal
38:29you can feel my heart yeah it's fine everywhere in the middle of the night 40 year old delivery
38:35driver akram has blown his elbow out of his socket so clearly from the x-rays it shows that you
38:42have
38:43dislocated the elbow but it's going to be difficult procedure to put it back to care we'll try to sedate
38:46you as much as possible with his ability to drive on the line it needs to be realigned urgently
38:53a treatment that requires two senior doctors dr aditya and dr zoe
39:00so i'm going to use a mask just because it makes it a little bit easier for you to get
39:03gas and air
39:04into your system the night team use penthrox for fast acting pain relief
39:10deep breaths doing well it will relax akram's muscles within minutes
39:17deep breaths it's quite physically intensive procedure both for the patient and for the
39:31doctors who are performing the procedure
39:35it requires traction and counter traction and put the bone back in place keep you taking deep breaths
39:43it's still awkward to bend is it the procedure needs extra force
39:50while zoe anchors akram's elbow in place dr aditya pulls the forearm further from the socket
39:57giving the joint more opportunity to slot back into natural alignment
40:08so
40:09it's okay you've done so well there
40:12looks better how's it feeling well now the next bit's getting this cast on
40:19so falling down the stairs can be quite serious it can result in head traumas and other severe
40:25traumas like chest trauma how does your elbow feel this is being still being we'll keep you in here
40:30for now okay until the next day are ready to come and get you okay so all in all yeah
40:35he was pretty
40:35lucky to just have a dislocated elbow rather than any other traumas yeah i did feel it it was stupid
40:42did you like that
40:54on the other side of the hospital oh oh
41:00emergency dr alice wants to diagnose 83 year old ian's severe abdominal pain breathe in and hold your breath
41:12he waits for his ct results with wife joan is this still as painful as it was all right
41:18painful up there oh that's right you have a right selection of stuff here as long as you don't move
41:25all right yeah and have you felt sick again no your report's back
41:32you reported your scans back so it's not actually the tummy at all it's the pancreas
41:40right it's not very happy right now it's got a bit inflamed right your pancreas can cause loads
41:48of issues it's really important in regulating a lot of things including the sugar levels in your blood
41:53but can be incredibly sore it can also become necrotic so it can die um and then that can make
41:59you really
41:59really sick and his hasn't reached that stage yet it's just inflamed um but he needs careful
42:05observation and pain management do you have any questions for me no no we're gonna be here
42:10yeah oh well i would say you're coming in for bed and breakfast he doesn't need to go for theater
42:15he can be managed conservatively which is good because in somebody his age going for a big operation
42:21can be very difficult you might want to get yourself home i'm here okay if you need me
42:29most people with pancreatitis you can tell from the front door because they are screaming and they're
42:33writhing in agony he is like just very stoic okay see you in the morning bye-bye
42:45okay sorry about all that classic farmer yeah um yeah it's farmers
42:54three dollars thank you you're very welcome
43:05what's really important is that we continue to check your vision
43:18so we're going to do a few scans for you for the head and the neck
43:31i have checked the x-ray is perfect do you feel less pain now it's less pain yeah oh very
43:37good
43:46so what's next what's next what's next is that the surgeons will come and see you
43:52so
44:17so
44:26you
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