www.able.co.nz Able 2023 BORIS JOHNSON: First of all, let's be in no doubt this has been a sad, sad day. 563 more cases, a record. REPORTER: Doctors and healthcare staff are saying that a shortage of kit and a lack of clarity over what should be worn, when and where, could potentially cost them their lives. MAN: One trust said to me today that they've only got three swabs per day to test staff. WOMAN: There are stories from the front line of doctors living in mobile homes at the moment. They don't want to infect their families. MAN: You've got deaths rising in a straight line. We've had a big leap in cases. BORIS JOHNSON: Our thoughts go out to the families of the victims, but let's be in no doubt that if we can follow the programme that we're currently set upon, then I've absolutely no doubt that we will begin to start to push those numbers down, and we'll turn the tide of the coronavirus. ABBEY: OK, bank staff, agencies? No one at all? MAN OVER PHONE: I've tried them all, and they're all full. What about DJC locums? WOMAN: The issue of staff absence is huge. You know, staff themselves really want to get back to the front line. ABBEY: No. God, no, it's fine. You just take it easy. That sounds really... YOUNG WOMAN: Look, I'm really sorry, Abbey. I still can't even get a test. Yeah. MAN: Lots of hospitals are reporting unease that they may run out of oxygen, sedatives, anaesthetic. What system do you have in place? ABBEY: Yeah, but can Anj swing over to cover for me? MAN: Anj is down too. I only just heard myself. Oh, shit. So we can't cover the ward SHO bleep. Firm A is down. Half of Firm B is Urology F1s. And Firm C is basically just Sunil and Grace, so... Hi, it's Abbey. Yeah, so basically just totally failed on that one. All the staffing banks are empty. -Hi. -Morning. -Hey. -Hiya. Thank God you're back. Are you OK? No, I'm shattered. I mean it's not nothing. No. Staffing told me about the current shitshow. I know. Half of the hospital is off sick or isolating. You'll be lucky if you get an orthopod as an SHO today. Save us. -Hi, Emma. -Hiya. Ant, how are you feeling? Yeah, not bad, thanks. So... we had three deaths overnight, bed four's in their last hours and ITU are on their way to review 12 & 16, but the pit's rammed, so... -Right. -Yeah. How's Divina? Not great. Emma, look, I-- I don't know if anyone's thanking you for volunteering, but it really is wonderful. Everyone in my year has. -WOMAN: I need some help in here, she's unresponsive! -Coming. Cardiac arrest, call, please! Emma, could you get the PPE trolley? Get the defib, please. Danielle Evans, 43, COVID day 10, type 2 Diabetes. She was stable on six litres, but in the past half-hour she's needed more, and now she's just crashed. -She's arresting ` Compressions, please. -No, no, no, we need Level 3 PPE. -Why isn't there a supply by the beds? -We don't have enough kit. Where's that PPE, Emma? PPE's here. Does this patient have an active DNAR? No, she's for resus. I've just had it. I could get on with compressions. No, that's not allowed. They're aerosol-generating. Get the pads on. Thank you. We're running out of time. -I'll help you with that. -Yep. Connect electrodes. -Ready? -Yup. Non-shockable rhythm. We need to start CPR. We're wasting time here. Ant, stop it! Emma, curtain, please. -Nearly there, Ant? -Yeah, seconds away. ABBEY: No, Emma, outside. Droplets. -Get the EMI bag, please. -Yup. ANT: Get ready. ABBEY: OK, start compressions. ANT: We've wasted too much time. You OK? Yeah. ABBEY: Right, are you OK to call the next of kin? Just let me know if there's any problems or if you need anything. Thanks, Maddie. Right... Shall we go round? Yeah. I think we should start with Mr Williams. He had a bit of a rough night. He's on the high flow now, but sats are still low. Thank you. -ABBEY: Hello, Mr Williams. -(WHEEZES) Emma's just going to quickly present your story. She's keeping us all up to speed. OK, this is Mr Williams, 81. I met Mr-- Archie in the cupboard in EAU. That bloody cupboard. He had flash pulmonary oedema, went to resus, and since then has been doing amazingly well, really. But then seven days ago, tested positive for COVID, and has sadly deteriorated since then. He's got his wife Florence at home. She's not allowed here, obviously. Thanks, Emma. She did well, didn't she? Archie, I think we need to talk about doing a bit more for your breathing. I'm afraid catching COVID's really knocked you for six. Your lungs are struggling a bit and you're getting tired, so I want to give you a form of breathing support called CPAP. What we do is we put a mask on your face that's strapped quite tightly. Then the CPAP machine pushes air into your lungs for you. Will it hurt? I'm afraid it can feel quite aggressive, quite claustrophobic, yes. And if I don't? Archie, I want to be completely honest with you. Without CPAP... I'm not sure you can survive this. I love my life, but not at all costs. Emma, can you get my photos? -OK. Of course. -The code is-- It's 4th of April. Wedding day. I've had a blessed life with Florence. We met... in an orchestra. I was a second violin. She was... a cell-- A cellist. Archie? Shall we try this? And if it's too much, then we'll talk about what we're going to do. Yeah? Emma, how do you feel about phoning Mr Williams' wife? You know him. You could talk her through what's going on. Uh... yeah. Sure. OK? OK. Good. Moisturise your hand. There we go. All right, my darling. Shall we get your cross out? Is that any better, Divina, my love? Hello, Mr Williams. How are you doing? I've got something for you. We sent one of these to Florence too. You have a matching one. You're all right. ANT: Hey, Mr Williams. I've got the mask here that we spoke about earlier, so I'm just gonna change that round for you now. There we go. Take this one off you. Well done. There you go. Straight on. You let me know if that's too tight, OK? There we are. How does that feel? You're doing great, Mr Williams. You OK? Just hold your heart and think of Florence. So, this might feel a bit of a powerful blast, but it will stabilise, OK? You'll get used to it. A bit like having your head out the car window on the motorway. You're doing really well. How does that feel? Good? Hi, Sally. Did you want to have a chat? Is that gonna happen to me? No. No. You're doing well. Yes, you have COVID. But your sats are holding. Is that good? I'm confident. Well, I'm glad someone is. I thought it would be breast cancer that killed me, not coming into hospital. It got in before we knew. I'm so sorry you caught it in here. But no one is giving up on you, Sally, I promise. Look, I know you've had your restaging scan done, so I'll speak to the radiologists, see if they can hurry the report along while you're in, and I'll come straight up to see you as soon as it's on the system. Yeah? OK. Great. -Hi there. -Hey. Just checking in. -Yep, what's your name? -Dr Abbey Henderson. Yeah, got you right here. Staying with us for nine days. Mummy. Mummy, Mummy, Mummy! Hi. -Hey. Divina? -Mummy. Mummy, Mummy, Mummy. Mummy, Daddy wouldn't let me watch any screens after dinner and he shouted at me for no reason. You said I was allowed cartoons when you were at work, so I basically hate Daddy now. Can't win. Tom. Say hello to your mum. Tom? Are you going to say hello from under there? Hey, love. I miss you. Are you OK? Tom, come on. What is it? Please tell me. You shouldn't be there. You should be here. You've just left us to look after all the patients at work, everyone else's family. So, what do you want me to say? Look, I'm not gonna lie to you, Tommy. I know this is really hard, but -- If you catch it, you'll die, so it basically means you don't even care about us. Oh, my God, Tom, I am so careful. I promise you. You can't promise us you won't die. Sweetheart... I'm sorry, love. I told him you're fit and well, it'll be like the flu. -He's obviously scared, you know? -Have they eaten? Yeah. Yeah. I should eat, so... We'll try again in the morning, OK? (MONITOR ALARM BEEPS) Sats 60. Still falling. -58. -Oxygen? 100%. Let's prone her. Emergency prone, please, in here. Quickly. PPE on everybody. Straighter, please. All right, Divina, we're gonna pop you on your front. This should help with your breathing, OK? Quick as you can, everyone, please. She's a Ward ACA from Level 6, thank you. -Take that. -Thank you. That's it. One more. OK, secured. On my pull, we're gonna slide her in this direction, all right? -Happy, everyone? -Yeah. -Ready. Ready, steady, slide. We're gonna put her on her side. Go. Right, nearly there. Change over. Nearly there, Divina. Nearly there, OK? You'll feel better on your front. -Everyone happy? -Yeah. Gently now. Go. All right. Still ventilating. Back on, please. Hold, please, everyone. Probe back on. 45. Come on, Divina. We tried to get her on the haemofilter, but her BP's too unstable. 43. Come on. 43. Come on, Divina. Her sats aren't improving at all. It's not working. Hey. Hi, Enrico, it's Metin Ozkul here again. Yeah, hi. So, we hoped the proning might help with Divina's breathing, but.. I'm afraid it stopped working for her. The CT scan we did of her lungs shows they really are very badly damaged. We tried to put her on a machine a bit like dialysis, but she was too unstable for that, so... I'm really very sorry, Enrico, but, uh... we've explored all the treatments we have. Enrico, I think it's time we consider stopping active treatments, and move towards palliative care. What do you mean? What does this mean? Hi. Hi. Hello, Enrico. -Hi, yeah. -It's Abbey Henderson. What Doctor Ozkul is saying is that we've reached a point now where we need to focus on Divina's end-of-life care. Mm-hm. She's receiving a lot of invasive treatments at the moment that aren't helping her, and we can remove a lot of that, which would make her much more comfortable. VOICE BREAKS: Yeah. Enrico, I'm so sorry to say you can't come and visit Divina. The rules prevent any visits to ITU. She didn't have the right PPE, but she wanted to keep going. -She was so brave. -She was. She was. We'll be praying for her. Yeah. She will be so alone. Hi, Enrico. -Hi, I'm Jules. -Hi. Yeah. I'm the nurse looking after Divina here in ITU. We're gonna take such good care of her, Enrico, that's my promise. I promise you that. I promise you she will not be alone. SOBBING: I know. Thanks. I know. -I'm so sorry, my love. -I need to go now. -I'm so sorry. -I need to go. (DISCONNECTED TONE) ...a 250-mil bolus... -Yeah. -...and monitor his BP. We've been told medically fit patients with a care home bed have to be discharged straight away, no delays. -Is he unwell? -Well, no, but he hasn't been tested for COVID, though. They said it doesn't matter, we're not allowed to wait for tests. But we've had two confirmed cases in here today. Yeah, well, just keep a close eye on him... Don't you think we should be just a little bit more-- It's taking five days to get test results back. He can't sit here until then. We need to be sure that he's not positive. If he takes COVID back to the care home, the other residents are sitting ducks. If he sits here for five days, he's probably going to get COVID, isn't he? Can I help at all? Thanks, Abbey. Emma and I were just discussing discharges to care homes. All the discharge planners have been told not to wait for negative tests. There's ambulances queuing to the roundabout. Which patient is this? OK, no COVID symptoms on admission. UTI, treated with antibiotics, medically fit for discharge. Is there a new suspicion of COVID? No, it's just that we've had others confirmed in here today. -OK. -The national guidance says don't wait for negative COVID tests. Yes, the patient's going home. His care home is his home. And he doesn't have COVID, so... Well, to be fair to Emma, we don't know that without testing. So, what shall we do? (SIGHS DEEPLY) I don't think we have a choice, do we? There's no tests. He's going to have to go back to his care home. BORIS JOHNSON: And we're also massively increasing testing, and I want to say a special word about testing because it is so important, and as I've said for weeks and weeks, this is the way through. This is how we will unlock the coronavirus puzzle. This is how we will defeat it in the end. And what we need to do is... Sally? Sorry to wake you. Oh, hi, Doctor. Oh, God, what's going on? Your scan is clear. What? Really? The scan report just came on the system. There's no sign of cancer. I think we can hope for the best now. Oh, my God. I'll go through it all with you in the morning. I just wanted you to know. And we'll get you away as soon as we can. Oh, God, thank you, Doctor. It's a team effort. Thank you, thank you. Thank you so much. Could you pass me my phone? Are you heading home, then? No. God, when do you all sleep? We don't, really. Hi. Hi. Yeah, no, I'm fine. Oh, my God, love. I'm clear. Side room seven. -Thank you. -No problem. What's your name, Doctor? -Abbey. -Abbey. E.Y. You're all done. Thank you. (EXHALES) (VENTILATOR HISSES, CLICKS) (PAGER BLEEPS) Let's talk later. OK, Divina, we're gonna turn off some of these machines now. (CHIRPING BEEP) (DIAL CLICKS) (TRILLING BEEP) (STEADY BEEPING) (ALARM CHIMES) (ALARM STOPS) OK. There we go, Divina. That's it. You can rest now, my love. No more pain. (VENTILATOR CONTINUES) "Divina, every day I came to work your smile told me how to do my job." "I'll miss you. We'll look after your family." "Love you, Alison." "I will love you forever, my darling, my beloved Divina." It's from Enrico. Beautiful, wasn't it? Now some from us too. Everyone's written to you. This is from Lauren. "Dear Divina, I was still a student when we met." "Your smile lit up the ward." "I will always remember your love and kindness." (INHALES DEEPLY) (SIGHS) (VENTILATOR HISSES, CLICKS) (BEEP) (VENTILATOR STOPS) This one's from Vicky. She's just had her baby, by the way. "I can't believe you're gone. We're gonna miss you so much." YOUNG WOMAN: Thank you, Mr Hancock. Could I firstly ask, how many frontline NHS workers have died from COVID-19? And secondly, could I ask, when a healthcare worker does pass away, has there been some form of investigatory process put in place? Yes, I think this is a question for you, Ruth. OK, thank you very much. We know that any death, if it were due to coronavirus, is a tragic one. (PAGER BLEEPS) (PAGER BLEEPS) RUTH MAY: We do have numbers of people that have died, whether they're nurses, midwives, healthcare assistants, doctors. It would be inappropriate for me right now to go into listing them and numbering them. ABBEY: I'm so sorry to have to share this news with you all, but I'm afraid Divina passed away overnight. Enrico and the kids send their thanks. There's some counselling being arranged. I'll put the details on the board. Please use it. The trust is going to provide some extra ward cover, so if anyone feels unable to work, you absolutely must go home. (PAGER BLEEPS) Oh, sorry, everyone. Abbey, can I just say something? Please. Look, I don't want to speak for anyone, I don't know about you guys, but I know that-- I know what Divina would have been doing today. She would have carried on caring for her patients. So I think I'm just gonna do that, if that's OK. Thanks, Tracey. We've seen, very sadly, four doctors die so far and some nurses. They've not even counted the nurses, Matt. -I've got to have a conversation with you. -OK, we'll talk about that. Sorry, Doreen, just say that again? Well, we haven't even counted the nurses yet, cos I keep asking for the stats on nurses that are ill and-- OK. I didn't know that, we will sort that out. The, um-- But... You've killed him. This place has killed him. You've murdered my dad. Please keep your volume down. There are other patients here. Hello, I'm Dr Henderson, I'm the consultant on the ward. -My dad has COVID because of you. -You've killed him. -OK, I just need to come up to speed. -So you tell me-- -You sent someone back to his care home with COVID, now they've all got it. This lady's father was admitted last night from Pennyfield. -OK. -Dad, it's OK. We recently discharged a patient from the cold zone back there. She doesn't have a fucking clue what's going on! -OK, I'd really appreciate it... -Pennyfield House. -...if you didn't use language like that and threaten staff. - Dad is the 11th resident to get it there, did you know that? -I didn't know that, madam, no. Seven people are dead because you didn't test them before you sent them back there! And now you've got your beds for the younger ones. Murderers. She's right. We're killing people with these discharges. OK, I hear you. -No, Abbey, they're dying. -But can we not do this -in the middle of the ward-- -And it's literally us sending COVID in to kill people. She's right. Ant, you need to calm down. Now. I'm going to talk to the CEO about this, OK? What, like you did about the PPE? We'll both go. Right now. Abbey? Good to see you. Come on in. Thanks. So I'm just gonna jump straight in, if that's OK. Suits me. We need to delay these discharges to care homes until we can ensure that patients have a negative COVID test. Without symptoms? Yes. They incubate the virus asymptomatically and return to the nursing homes, and we're seeing admissions from those same nursing homes down the line. Is that causal? -Sorry? -Have you demonstrated a causal link? Yeah. The index cases are the patients coming in and out of here. Are you serious? I can't shut down hospital discharges on that scale. You just need to authorise testing. It would be risking skyrocketing hospital-acquired COVID infection because of anecdotal community transmission. It's not anecdotal. This comes from the Department of Health. Every single trust has the same set of orders. -Orders? -Yes, get 15,000 people out of hospital beds right now. Clear them out. No need for negative tests. Even if there were enough tests for clinically well people-- -They have coronavirus. -It takes five days to get results back. We can't wait that long. Then you need to come down and write that in the notes. I'm sorry? That you're taking over the care of these patients from the clinical teams. Abbey, these are not my rules. This comes straight from the top. Look, residents can be isolated once they're back in their care homes. How about patients with dementia? You're welcome on to the wards to show us how that might work. Discharge them home or to isolatable beds, but not to care homes, or they're gonna die in their hundreds. This isn't your decision. Please just do your job. Doing your job down there is a potential death sentence. Members of our team, the most exposed members of staff, are wearing aprons and bin bags and going home wondering if they're gonna die in the night. I truly am sorry about your colleagues. As a hospital trust-- Oh, it's just HCAs and staff grades to you, isn't it, in the firing line. Do you know who's dying down there? Certainly not the white people up here. Sorry. I was out of line earlier. No, no, it's, uh... Dad's got COVID. He got admitted last week. Oh, God. I'm so sorry. Yeah. There's no plan, is there? No. They're just making this up as they go along. Those live, those don't. They're just numbers. Have you made a will? (BREATHING DEVICES HISS, BEEP) Hey. Hi, love, you OK? Oh, is it 3 already? Yeah. Yeah, we're just... She's gonna break her neck doing that. Robby, Robby, do a cartwheel for Mummy. (NICK LAUGHS) She's really good. -She's almost got it. -You're a nightmare. Tom, it's your mum. -Hi, darling. -FLAT: Hi. Abbey? We're heading up now. -OK. We are gathered here today to remember Divina, a loving wife and mother to her family. And I would now like to ask Enrico to come forward to say a few words. She died doing what she loved. Even in the last few weeks when she came home so tired, she would say to me, "This is my work." Me and the kids are so proud of her. I don't know what happens now. It was Divina who knew how to take us through any dark times that came to us as a family. But I feel, I know... (PAGER BLEEPS) that we will find our way somehow. That with the help of God and our friends, we will continue in this world. But I also know that... I will always be alone without you, my darling. (CLATTERING, CHEERING SWELLS) (CLATTERING, CHEERING CONTINUES) WOMAN: Thank you! Thank you, NHS! Oh, that looks so good on you. Thank you. If in doubt, go all out. I know. (BOTH CHUCKLE) There. -How's that? -There you go, you look gorgeous. And here she comes! (CHEERING) Thank you all so much. I don't ever wanna see any of you lot ever again. Florence. Archie's finding CPAP too hard. He's decided to stop. (FLORENCE CRIES SOFTLY) And I'm afraid without it, his lungs can't keep going. But even with it, we don't-- ...what to do. We just want to offer you the chance to come in and visit the ward. You're allowed in now, now that it's an end-of-life situation. I want to. But my arthritis, my rheumatoid arthritis... -Right. -I'm on immunosuppression. That's a really tricky situation, Florence. You need to be careful. TEARFULLY: OK. I don't want him to be alone. (BREATHES SHAKILY) (MONITOR BLEEPS) (MAN COUGHS) Hi, Mr Williams. I hope you're feeling a bit more comfortable now. (UNZIPS BAG) All right. All I'll say, Mr Williams, is keep your expectations low. (PLAYS GENTLE GAELIC FOLK TUNE) Hope that wasn't too painful. (PAGER BLEEPS) All right then, Mr Williams. -Hey. -Hey. Heading in? Yeah. I'll see you in there a bit later. I'm just popping back for a quick shower. -Are you on again? -Oh, yeah. (EXHALES HEAVILY) You're doing really well. Doesn't feel like it. No. Don't suppose it ever does, but you are. You were right about that patient. The one we had to discharge back to the care home. We shouldn't have sent him back. Just because it's harm we can't see, doesn't mean we're not doing it. Yeah. And we're meant to do no harm. All right. See you in a bit. See you in a bit. (BREATHES SHAKILY) (RINGING TONE) (RINGING TONE) I wake up and sometimes, honestly, it's like I've wet the bed. Soaked. How does that feel? (RINGING TONE) Hi, this is Nick Henderson. Please leave a message and I'll get back to you. Can't breathe. Sometimes screaming. I wake the kids, actually. MAN: Can you say more about the feeling of drowning? JULES: There are bodies everywhere. They've all got masks on. Their eyes are really wide. Um... I'm scrabbling in the water to reach the surface... and I'm pushing away the bodies that are blocking my way. I promise you I've never had a thought like that in my life. Just terrified. What are you terrified of? Sleep.