WEBVTT - Episode 1: The Fall 0:00:06.480 --> 0:00:10.000 My name is Hedley Thomas. In two thousand and five, 0:00:10.240 --> 0:00:14.520 my reporting exposed shocking medical negligence at the heart of 0:00:14.560 --> 0:00:19.040 a major healthcare system. An overseas trained surgeon who was 0:00:19.200 --> 0:00:24.160 nicknamed Doctor Death by the nurses, doctors and hospital administrators 0:00:24.239 --> 0:00:30.240 left patients mutilated, incapacitated, even dead. Sick to Death is 0:00:30.320 --> 0:00:32.800 based on my book of the same name, and it's 0:00:32.840 --> 0:00:36.880 the true story of doctor Jan Patel's lies and manipulation 0:00:37.320 --> 0:00:39.400 and the herculean effort it took. 0:00:39.200 --> 0:00:40.599 To finally stop him. 0:00:41.120 --> 0:00:45.440 We've used voice actors throughout this series and on occasion 0:00:45.600 --> 0:00:48.519 the real people from this story have read their words 0:00:48.600 --> 0:00:49.080 for us. 0:00:50.240 --> 0:00:53.000 It is brought to you by me and the Australian. 0:01:00.320 --> 0:01:08.280 Chapter one, Happy Days, January two thousand and two. Jared 0:01:08.360 --> 0:01:11.240 Neville put the last bag in the family car as 0:01:11.280 --> 0:01:15.120 his wife Lorraine urged the three children to hurry downstairs. 0:01:16.200 --> 0:01:20.080 A fit, middle aged public health physician for Queensland Health, 0:01:20.360 --> 0:01:24.000 Jared ran beside the Brisbane River most mornings, even in 0:01:24.080 --> 0:01:27.840 the subtropical humidity of summer, before going to work to 0:01:27.880 --> 0:01:31.039 plan policy for the well being of a few million men, 0:01:31.280 --> 0:01:36.000 women and children. They were known, in accordance with the 0:01:36.080 --> 0:01:42.920 corporate vernacular as clients. The years had been kind to Jared. 0:01:43.520 --> 0:01:46.880 He remained free of the stress of providing clinical care 0:01:47.080 --> 0:01:51.960 in an organization starved of funds, while his friends, many 0:01:52.000 --> 0:01:55.360 of them fellow graduates of the University of Queensland's medical 0:01:55.400 --> 0:01:58.640 school in the leafy grounds of Hurston, had opted for 0:01:58.720 --> 0:02:03.480 careers in operating the US with late night callouts, long hours, 0:02:04.200 --> 0:02:09.640 and eventually private rooms. As highly paid specialists, Jered enjoyed 0:02:09.639 --> 0:02:14.360 a steady public service routine. He was adept at his 0:02:14.440 --> 0:02:18.560 office job, never shirking unpopular assignments, such as telling his 0:02:18.680 --> 0:02:23.359 political masters the unpalatable reality about the effect of their policies. 0:02:24.680 --> 0:02:26.440 He would never reach the top of. 0:02:26.400 --> 0:02:32.079 A highly politicized bureaucracy, nor did he aspire to. They 0:02:32.160 --> 0:02:36.280 made a handsome couple, Jared and Lorraine, a tall and 0:02:36.400 --> 0:02:39.320 softly spoken teacher. She met Jared when he was a 0:02:39.400 --> 0:02:44.800 rural GP five years after his graduation. Their motto might 0:02:44.840 --> 0:02:49.600 have been permanence and stability. They were stylish but not flashy, 0:02:50.120 --> 0:02:55.440 professional but not elitist. They were Catholic, with middle class values, 0:02:55.680 --> 0:02:59.919 healthy children, secure careers, and a comfortable, newly renovated house 0:03:00.200 --> 0:03:03.040 on a hill in the Brisbane middle class suburb of 0:03:03.160 --> 0:03:11.240 Tuwong Laura aged fourteen, Eleise ten and Michael eight needed 0:03:11.280 --> 0:03:14.160 little encouragement to leave their Brisbane home at the height 0:03:14.200 --> 0:03:17.880 of the summer heat wave. Across the city, thousands of 0:03:17.880 --> 0:03:21.760 people without air conditioning were seeking refuge in shopping centers 0:03:21.800 --> 0:03:25.880 and cinemas. Temperatures were about to soar into the high 0:03:25.919 --> 0:03:29.800 thirties with only limited relief from the scattered showers and 0:03:29.919 --> 0:03:35.120 afternoon storms. The Nevils were going somewhere infinitely more appealing. 0:03:36.000 --> 0:03:38.720 In two hours, they would arrive at King's Beach in 0:03:38.840 --> 0:03:42.880 Caloundra for the start of an annual holiday ritual exploring 0:03:42.960 --> 0:03:47.120 rock pools, swimming in the surf, lazing around the pool 0:03:47.760 --> 0:03:52.520 and choosing from the dinner specials at nearby restaurants. As 0:03:52.640 --> 0:03:55.480 Jered knows, the car one of the perks of his 0:03:55.600 --> 0:03:59.280 package with Queensland Health, down the neatly paved driveway and 0:03:59.360 --> 0:04:02.480 turned left onto Milton Road for the drive north. The 0:04:02.600 --> 0:04:08.120 rain felt uneasy. Usually the Neville family would stay at 0:04:08.240 --> 0:04:13.960 Pandanas Court in Caloundra for the Christmas holidays. Their familiarity 0:04:14.080 --> 0:04:17.000 over the years with the old block of units closest 0:04:17.000 --> 0:04:20.400 to the beach was part of the fun. Returning to 0:04:20.480 --> 0:04:24.680 Pandanas was a bit like visiting a favorite Auntie. Notwithstanding 0:04:24.760 --> 0:04:29.600 her flaws, she was safe and would not produce any surprises. 0:04:31.279 --> 0:04:34.279 When Lorraine had called months earlier to make the usual 0:04:34.320 --> 0:04:38.640 holiday booking, the woman at Henzel's real estate agency explained 0:04:38.680 --> 0:04:42.840 that Pandanas would not be available this time. The old 0:04:42.880 --> 0:04:46.320 block was being redeveloped and Auntie was to receive an 0:04:46.400 --> 0:04:52.640 overdue facelift. Instead, Lorraine was offered a unit in Monterey Lodge, 0:04:52.920 --> 0:04:56.320 a block not known to her. The plan was to 0:04:56.360 --> 0:04:59.920 spend a week there, dash back to Brisbane the following Saturday, 0:05:00.440 --> 0:05:03.719 unload the car, water the garden, check the mail, feed, 0:05:03.720 --> 0:05:06.680 the children, return calls, load the car again, and drive 0:05:06.760 --> 0:05:10.000 across the city to catch the afternoon ferry from Cleveland 0:05:10.040 --> 0:05:16.640 to Stradbroke Island for a further seven days holidaying. Lorrain's 0:05:16.680 --> 0:05:21.400 first impression of unit three at Monterey Lodge confirmed her unease. 0:05:22.320 --> 0:05:26.960 The living space was long, dark and narrow. The floor 0:05:27.000 --> 0:05:30.440 throughout seemed to be hard concrete with a thin wood 0:05:30.520 --> 0:05:37.000 veneer surface. The place felt auste and uninviting. Before they 0:05:37.080 --> 0:05:40.279 had begun to unpack. Before Lorrain could take in the 0:05:40.360 --> 0:05:44.440 natural beauty of the water beyond the buildings. She had regrets. 0:05:45.640 --> 0:05:48.680 As Lorraine tried to bury her misgivings and put on 0:05:48.720 --> 0:05:53.039 a bright face, and Jered carried the bags inside. Elise 0:05:53.200 --> 0:05:58.200 ran to the second bedroom and squealed with delight. As expected, 0:05:58.480 --> 0:06:03.520 there was a set of bunks. They were unspectacular, lightly 0:06:03.600 --> 0:06:07.200 framed and well used. They stood exactly one point four 0:06:07.240 --> 0:06:10.880 to three meters high in one corner of the room. 0:06:11.320 --> 0:06:14.640 The top bunk had been promised days earlier to Elise, 0:06:15.080 --> 0:06:18.880 who excitedly told her friends and reminded Michael and Laura 0:06:18.960 --> 0:06:22.560 that she would soon be towering over them morning and night. 0:06:23.839 --> 0:06:27.640 A bright girl with sparkling blue eyes, a cherubic face, 0:06:28.080 --> 0:06:32.000 and a gift for bringing calm and laughter into awkward situations. 0:06:32.279 --> 0:06:35.760 Elise looked at the top bunk and beamed. She clambered 0:06:35.839 --> 0:06:39.720 up and bounced on the mattress. A trundle bed had 0:06:39.760 --> 0:06:43.560 been stored under the lower bed. The rain dragged it 0:06:43.600 --> 0:06:46.559 out on the Saturday afternoon and put it against the wall, 0:06:46.800 --> 0:06:51.680 forming an L shape with the bunks. The rain frowned 0:06:51.760 --> 0:06:54.960 at the glass top table in the room. It was 0:06:55.000 --> 0:06:58.400 an accident. Waiting to happen. She carried it into the 0:06:58.440 --> 0:07:02.960 main bedroom, where she and Jared would be sleeping. Next, 0:07:03.000 --> 0:07:05.960 she hauled a low set of wooden bedside draws from 0:07:05.960 --> 0:07:10.800 the main bedroom to the children's room. As Lorraine had feared, 0:07:11.040 --> 0:07:15.600 the unit was hot, its bricks absorbed heat throughout the day, 0:07:16.200 --> 0:07:19.160 The windows missed the best of the sea breezes, and 0:07:19.200 --> 0:07:22.840 there were no ceiling fans. Lorraine put one of the 0:07:22.880 --> 0:07:26.600 electric fans she had brought from Brisbane on the bedside draws. 0:07:27.760 --> 0:07:30.480 At least the children would be comfortable as they slept. 0:07:31.920 --> 0:07:36.160 Lorraine took one more precaution before satisfying herself that she 0:07:36.240 --> 0:07:39.480 had made the best of things. She spread quilts and 0:07:39.520 --> 0:07:43.840 blankets along the floor below the bunk beds. Michael, who 0:07:43.840 --> 0:07:46.520 would be in the bottom bunk, was a restless sleeper, 0:07:46.640 --> 0:07:50.120 though neither he nor Elise had any history of falling 0:07:50.160 --> 0:07:54.840 out of bed, but just in case, the quilts might 0:07:54.960 --> 0:08:03.000 soften an unlikely accidental fall. The family woke to a 0:08:03.040 --> 0:08:06.080 glorious Sunday morning and devoted it to the beach and 0:08:06.120 --> 0:08:11.600 the pool. Lorraine's worries eased as the sun disappeared behind 0:08:11.640 --> 0:08:15.480 the glasshouse mountains. The family walked to Bullcock Beach for 0:08:15.640 --> 0:08:19.640 fish and chips at a sidewalk table. After they returned 0:08:19.640 --> 0:08:22.600 to the unit, Michael went to bed first. He was 0:08:22.640 --> 0:08:25.800 sleeping soundly by nine pm when Lorraine. 0:08:25.440 --> 0:08:26.680 Checked on him. 0:08:27.320 --> 0:08:31.840 Elise, nestled beside her mother on the sofa, stayed contentedly, 0:08:31.920 --> 0:08:35.040 reading her novel. From time to time, she looked up 0:08:35.040 --> 0:08:39.120 at the TV. An hour after Michael had turned in, 0:08:39.440 --> 0:08:42.640 Elise was ready for bed. She kissed her parents and 0:08:42.720 --> 0:08:45.680 smiled as Lorraine tucked her in for a second night 0:08:45.800 --> 0:08:49.480 in the top bunk. Lorraine, who had made a point 0:08:49.520 --> 0:08:52.680 of picking the children's clutter off the floor to prevent 0:08:52.720 --> 0:08:56.040 a stumble in the dark, did not notice something amiss 0:08:56.080 --> 0:08:59.800 as she turned out the lights. The family had no 0:09:00.080 --> 0:09:04.520 experience with bunk beds. The safety rails that prevent a 0:09:04.640 --> 0:09:09.360 child from rolling out were not there, as they were 0:09:09.400 --> 0:09:12.319 on holidays. Laura was allowed to stay up with her 0:09:12.360 --> 0:09:16.760 parents until the late movie ended. Shortly before midnight, they 0:09:16.800 --> 0:09:20.400 all went to bed, and within minutes everyone was sleeping. 0:09:21.600 --> 0:09:25.560 At one fifty am, the rain woke up. Suddenly, Jered 0:09:25.640 --> 0:09:29.360 sat upright. They had both heard it, a loud noise, 0:09:29.679 --> 0:09:34.280 a heavy thud. In the seconds that followed moaning noises 0:09:34.400 --> 0:09:38.560 drifted from the bedroom, and instantly the rain guessed what 0:09:38.720 --> 0:09:42.200 had happened. Oh my god, Jared, I think Alisea has 0:09:42.200 --> 0:09:45.920 fallen out of bed. They hurried to the bedroom, where 0:09:45.920 --> 0:09:49.400 Elise was lying curled up on her right side. She 0:09:49.600 --> 0:09:52.320 was on the quilt on the floor, with her head 0:09:52.360 --> 0:09:56.000 towards the narrow shelf and doorless cupboard in the room. 0:09:56.240 --> 0:09:59.080 The rain frantically moved the small drawers with the fan 0:09:59.200 --> 0:10:01.880 on top so Shit and Jared could both fit in 0:10:01.920 --> 0:10:06.160 the room more easily to tend their stricken child. Lorraine 0:10:06.160 --> 0:10:10.800 needed immediate affirmation that Elise had not broken any limbs. 0:10:11.400 --> 0:10:12.880 Elise, are you okay? 0:10:13.559 --> 0:10:14.920 Can you move your arms and legs? 0:10:16.040 --> 0:10:19.560 Elise could move her limbs, but Lorraine's relief was tempered 0:10:19.600 --> 0:10:23.400 by a new fear. Elise was in great pain. In 0:10:23.480 --> 0:10:25.720 the half light, she cried out. 0:10:26.360 --> 0:10:27.599 My head hurts. 0:10:28.400 --> 0:10:31.840 Jared tried to contain his own anxiety in the gloomy 0:10:31.840 --> 0:10:34.760 bedroom as Elise lay on the floor with her Winnie 0:10:34.760 --> 0:10:38.560 the Pooh Teddy bear rubbing her head and whimpering softly. 0:10:39.440 --> 0:10:42.880 He took charge. He was the doctor. He might not 0:10:43.040 --> 0:10:46.360 have practiced medicine for eighteen years but he knew something 0:10:46.400 --> 0:10:50.720 about head injury. He spoke in as measured a tone 0:10:50.840 --> 0:10:52.000 as he could manage. 0:10:52.600 --> 0:10:55.199 Try and keep calm. I'll take her to our bed 0:10:55.240 --> 0:10:56.080 and have a look at her. 0:10:57.000 --> 0:11:01.400 Jared checked Elise's limbs, neck, chest and stomach for breaks 0:11:01.520 --> 0:11:04.600 or pain. He carried her to the main bedroom and 0:11:04.679 --> 0:11:08.400 brought the mattress from her top bunk. They lay her 0:11:08.440 --> 0:11:11.600 down on it on the floor in their room. She 0:11:11.720 --> 0:11:16.319 continued moaning in obvious pain. She was touching the left 0:11:16.360 --> 0:11:17.360 side of her head. 0:11:18.480 --> 0:11:20.040 My head hurts a lot here. 0:11:21.360 --> 0:11:25.480 Lorraine, shaking with worry and fear, wanted to rush Elise 0:11:25.520 --> 0:11:31.440 to hospital. She was becoming frantic. Gered resisted. He doubted 0:11:31.440 --> 0:11:36.040 Elise had been unconscious after the fall. He persuaded Lorraine 0:11:36.040 --> 0:11:38.480 that they could safely watch her in the unit for 0:11:38.600 --> 0:11:44.400 the time being. Stop panicking, Everything will be okay, Alise 0:11:44.520 --> 0:11:45.120 piped up. 0:11:45.920 --> 0:11:50.400 Yes, mummy, don't panic for making me worry. I'm sorry, 0:11:50.800 --> 0:11:53.439 everything would be all right. No, it won't, mum, There's 0:11:53.480 --> 0:11:54.360 something really wrong. 0:12:06.000 --> 0:12:14.199 Chapter two, The Shift January two thousand and two. Andrew 0:12:14.240 --> 0:12:16.800 Donovan looked at the clock on the wall above one 0:12:16.800 --> 0:12:22.080 of the Cloundra Hospital ward beds. It was almost three am. 0:12:22.440 --> 0:12:26.400 He sighed with relief. He wouldn't wish the graveyard shift 0:12:26.480 --> 0:12:29.920 on his worst enemy. He knew exactly how long he 0:12:30.000 --> 0:12:33.920 had been going without arrest, having come on duty at 0:12:34.000 --> 0:12:36.880 eight am the previous day. Who was at the nineteen 0:12:37.080 --> 0:12:41.439 hour mark of a twenty four hour shift. Donovan, a 0:12:41.559 --> 0:12:45.480 father of two young children, was exhausted. He would never 0:12:45.600 --> 0:12:48.800 touch alcohol while it worked, but the effect of his 0:12:48.960 --> 0:12:52.400 fatigue equated to a blood alcohol reading of zero point 0:12:52.520 --> 0:12:58.640 zero five percent. Long distance truck drivers could be forced 0:12:58.679 --> 0:13:03.120 off the road if found working dangerously long hours. Economic 0:13:03.160 --> 0:13:06.960 necessity and demanding bosses forced the drivers to stay awake 0:13:07.080 --> 0:13:11.720 with amphetamines as they hurtled down the country's highways. Airline 0:13:11.760 --> 0:13:16.559 operators had much more to lose. The repercussions from carnage 0:13:16.600 --> 0:13:19.839 caused by a mack truck colliding with a family car 0:13:19.880 --> 0:13:23.040 when nothing compared with those that might follow a Boeing 0:13:23.120 --> 0:13:27.920 seven four seven plowing into a mountain due to pilot fatigue. 0:13:28.080 --> 0:13:31.920 Australian pilots were permitted a maximum number of hours in 0:13:32.000 --> 0:13:36.040 the cockpit on long haul flights, after which strict regulations 0:13:36.200 --> 0:13:41.080 stipulated a lengthy rest in the bunks nurses too, were 0:13:41.120 --> 0:13:46.160 banned from working excessive hours, yet doctors like Donoman in 0:13:46.240 --> 0:13:50.760 Queensland's public hospitals were given no choice. At this time 0:13:50.800 --> 0:13:53.920 of year, when many of the senior doctors were holidaying 0:13:53.960 --> 0:13:57.480 with their own families, those on the bottom rung were 0:13:57.480 --> 0:14:02.040 in greater demand than usual. The chronic shortage of doctors 0:14:02.160 --> 0:14:05.679 nationally was worse in Queensland, which had the lowest number 0:14:05.720 --> 0:14:09.200 of registered doctors per head of population of any state 0:14:09.320 --> 0:14:14.240 or territory. There were about two thousand, five hundred more 0:14:14.280 --> 0:14:18.679 doctors in Victoria, a state with a similar population but 0:14:18.840 --> 0:14:24.680 without the challenges unique to Queensland of decentralization, poor working conditions, 0:14:25.040 --> 0:14:31.520 and remote and indigenous communities. Andrew Donovan had few complaints. 0:14:32.080 --> 0:14:35.400 He would do the hours a rite of passage and 0:14:35.560 --> 0:14:38.720 move up the ranks. He was not the most junior 0:14:38.720 --> 0:14:42.240 doctor in Queensland, but he was the least experienced doctor 0:14:42.280 --> 0:14:45.120 to be put in charge of the eighty bed Caloundra 0:14:45.240 --> 0:14:49.760 Hospital overnight. For the duration of this shift, he was 0:14:49.800 --> 0:14:54.480 the only doctor on duty. A quietly ambitious thirty seven 0:14:54.560 --> 0:14:58.480 year old Donovan did not look like a newcomer to medicine, 0:14:58.880 --> 0:15:02.560 but he only began studying medicine in his late twenties. 0:15:03.440 --> 0:15:08.160 His confidence and age sometimes made his patients suspect wrongly 0:15:08.480 --> 0:15:13.320 that he was experienced. Just two years after receiving his 0:15:13.440 --> 0:15:17.040 Bachelor of Medicine and Bachelor of Surgery from the University 0:15:17.040 --> 0:15:21.080 of Queensland, he was making clinical decisions without having to 0:15:21.240 --> 0:15:25.960 defer to senior colleagues. Donovan had worked in hospitals known 0:15:26.000 --> 0:15:29.040 as God's Waiting Rooms because they catered to a large 0:15:29.080 --> 0:15:33.160 population of elderly retirees who had moved to the Sunshine 0:15:33.200 --> 0:15:38.240 Coast for its warm climate, beaches and lawn bowls. As 0:15:38.280 --> 0:15:42.200 a junior house officer, almost the lowest ranking doctor on 0:15:42.240 --> 0:15:45.800 the scale, he had treated worn out knees, supporting the 0:15:45.840 --> 0:15:51.160 overweight and the sedentary. He had treated gynecological issues common 0:15:51.160 --> 0:15:57.040 to elderly women who had born children. During rotations in pediatrics, 0:15:57.240 --> 0:16:03.600 orthopedics and esthetics, obstetric skynecology and emergency medicine. He had 0:16:03.680 --> 0:16:06.560 seen dozens of bright eyed babies at the start of 0:16:06.600 --> 0:16:10.560 life and the old and frail who was soon to depart. 0:16:12.040 --> 0:16:16.200 Maybe they sensed in his bedside manner a contagious energy 0:16:16.440 --> 0:16:21.080 and enthusiasm for medicine. After driving taxis to pay his 0:16:21.240 --> 0:16:24.680 way through medical school. He had large bills and a 0:16:24.720 --> 0:16:28.760 meager salary, but he was doing what he loved. His 0:16:28.920 --> 0:16:34.119 colleagues had noted the positive feedback from his patients. Somewhere 0:16:34.160 --> 0:16:39.480 within the Queensland Health bureaucracy, a secret document headed review 0:16:39.640 --> 0:16:45.560 of emergency services Sunshine Coast Health Service District flagged potential 0:16:45.640 --> 0:16:50.120 dangers at Caloundra Hospital. The review had been compiled by 0:16:50.200 --> 0:16:54.000 a small team of experts who had been investigating the resources, 0:16:54.360 --> 0:16:58.880 safety and performance of emergency departments along the coastal Strip. 0:17:00.080 --> 0:17:04.879 It was conducted on a confidential basis. Its author, doctor 0:17:04.920 --> 0:17:09.640 William Rodgers, found that the Caloundra Emergency department needed a 0:17:09.680 --> 0:17:14.920 minimum of four principal house officers. A principal house officer 0:17:15.119 --> 0:17:21.199 is a doctor in a third year of practical experience postgraduate. Further, 0:17:21.720 --> 0:17:25.760 their responsibility should not be stretched to looking after inpatients 0:17:25.840 --> 0:17:29.159 as well as those coming into the emergency department during 0:17:29.240 --> 0:17:34.159 normal working hours. Doctor Donovan, who knew nothing of the 0:17:34.200 --> 0:17:38.280 three month old report and its unheeded recommendations, was two 0:17:38.440 --> 0:17:41.920 years away from being made a principal house officer. When 0:17:41.960 --> 0:17:46.280 he began his faithful shift in early January, he had 0:17:46.359 --> 0:17:52.080 responsibility for the entire hospital. The nurses in the emergency department, 0:17:52.359 --> 0:17:56.200 Beverly Duncan and Diane Forbes, who had come on duty 0:17:56.240 --> 0:17:59.520 at ten forty five pm, were taking a break after 0:17:59.520 --> 0:18:03.879 a busy few hours. The patients were presenting with relatively 0:18:04.000 --> 0:18:09.840 minor ailments, and certainly none with emergencies. Most simply sought 0:18:10.000 --> 0:18:15.680 free treatment. Uniquely, with beds in short supply and resources 0:18:15.880 --> 0:18:21.359 strictly limited, the hospital also had a bizarre practice. It 0:18:21.440 --> 0:18:34.119 did not admit children. Chapter three We Need Help January 0:18:34.320 --> 0:18:39.440 two thousand and two. Elise was talking a little as 0:18:39.520 --> 0:18:44.080 Lorraine held an ice pack to her head. Around three am. 0:18:44.240 --> 0:18:48.440 She became agitated, flailing her arms and crying out with 0:18:48.480 --> 0:18:52.480 the pain. Laura and Michael, who had woken in the 0:18:52.520 --> 0:18:57.320 frantic commotion after the fall, looked on helplessly. Elise vomited. 0:18:58.200 --> 0:19:01.640 It was the last sign Jared needed. He knew then 0:19:01.720 --> 0:19:04.680 that she had to go to hospital urgently and would 0:19:04.720 --> 0:19:11.480 probably need a CTE or computerized tomography scan with detailed 0:19:11.520 --> 0:19:16.240 two dimensional computer enhanced X ray images. A ct scan 0:19:16.440 --> 0:19:20.800 could highlight any abnormalities such as bleeding in Elisa's brain 0:19:21.280 --> 0:19:24.840 or a fracture in her skull. He was about to 0:19:24.880 --> 0:19:28.080 tell the Rain of his decision. She beat him to 0:19:28.119 --> 0:19:31.160 it as a least moaned and complained about the yucky 0:19:31.240 --> 0:19:32.840 taste of vomit in her mouth. 0:19:33.800 --> 0:19:36.000 Right, we're going to the hospital now. 0:19:36.560 --> 0:19:40.600 Lorrain was emphatic as she cleaned Elisa's face and clothes 0:19:40.640 --> 0:19:45.600 and quickly got changed. Jered's appearance of calm had dissolved. 0:19:46.000 --> 0:19:49.800 Now he too was shaking. The fear was sensed by 0:19:49.880 --> 0:19:53.080 Laura and Michael, who huddled together on the trundle bed. 0:19:53.800 --> 0:19:56.960 They were frightened for release and worried about being in 0:19:57.040 --> 0:20:01.680 the unfamiliar unit alone. Jane cradled Elise in the back 0:20:01.760 --> 0:20:04.119 seat of the car as her head rested on a 0:20:04.160 --> 0:20:06.720 pillow that had been snatched up on the way out, 0:20:07.760 --> 0:20:11.840 Jared drove to the nearby Clownd Republic Hospital in West Terrace, 0:20:11.880 --> 0:20:14.280 but later would not even remember the route he took. 0:20:15.720 --> 0:20:19.720 He jabbed the illuminated night bell outside the emergency department 0:20:19.840 --> 0:20:23.320 until Beverly Duncan answered through the intercom and then opened 0:20:23.320 --> 0:20:28.560 the door. Jered quickly explained what had happened. A fall, 0:20:29.200 --> 0:20:34.440 a head striking a hard floor, ongoing pain, headache, vomiting. 0:20:35.880 --> 0:20:38.800 They were directed to a room in the emergency department, 0:20:38.840 --> 0:20:42.000 where Elise lay very quiet on the bed during a 0:20:42.040 --> 0:20:46.199 brief examination by Duncan, a United Kingdom trained nurse, who 0:20:46.280 --> 0:20:49.480 scrawled details on a clipboard and peered at the frightened 0:20:49.520 --> 0:20:54.960 child's pupils while shining a torch. Elisa's pulse rate measured 0:20:55.000 --> 0:20:59.960 fifty four a low reading. An oxymeter on her finger 0:21:00.200 --> 0:21:04.120 measured her oxygen saturation levels. As Duncan made small talk 0:21:04.200 --> 0:21:08.560 with Jared, he explained that he was a nonpracticing doctor, 0:21:09.000 --> 0:21:12.679 one of the sixty thousand staff of Queensland Health. 0:21:13.400 --> 0:21:14.320 They were colleagues. 0:21:15.440 --> 0:21:19.480 Duncan noted a child who was quietly spoken and unhappy. 0:21:20.480 --> 0:21:23.800 Where does it hurt? I'm aching all over, but many 0:21:23.840 --> 0:21:25.760 I've got a headache. 0:21:26.080 --> 0:21:30.640 Duncan found the aching all over answer strange. There was 0:21:30.680 --> 0:21:34.600 no obvious deformity to any limbs, no swelling, and no 0:21:34.840 --> 0:21:39.679 specific pain suggestive of a fracture. Lorraine was asked to 0:21:39.760 --> 0:21:42.800 leave the room to fill in forms at the front counter. 0:21:44.040 --> 0:21:45.960 I can hardly write as I'm shaking so. 0:21:46.000 --> 0:21:51.720 Much, Duncan, it seemed to Lorraine ignored her and walked away, 0:21:52.240 --> 0:21:55.159 leaving the distraught mother wondering what she had done to 0:21:55.200 --> 0:21:58.399 receive a cold reception. At three twenty five am with 0:21:58.480 --> 0:22:02.600 an injured child, Lorraine returned to the assessment room to 0:22:02.640 --> 0:22:06.680 remark to Jered the lack of empathy. She weighed their options. 0:22:07.200 --> 0:22:11.400 They were in an open, functioning emergency department staffed by 0:22:11.440 --> 0:22:16.320 health professionals. Complaining might be counterproductive. It could lead to 0:22:16.359 --> 0:22:20.560 a lease being ignored. The alternative of leaving to find 0:22:20.680 --> 0:22:27.040 other medical help seemed impossible, so they waited. Doctor Andrew 0:22:27.080 --> 0:22:29.639 Donovan was at a bench writing up his notes for 0:22:29.680 --> 0:22:33.400 another patient, a man in a wheelchair, When Duncan explained 0:22:33.400 --> 0:22:37.480 the basics a ten year old girl on holidays a 0:22:37.560 --> 0:22:42.440 fall from a top bunk, generalized aches and pains, vomiting, 0:22:42.720 --> 0:22:46.879 no loss of consciousness. In the central area of the 0:22:46.880 --> 0:22:52.160 emergency department, Nurse Duncan, doctor Donovan, and Nurse Diane Forbes 0:22:52.200 --> 0:22:58.000 discussed Elsa's vital signs. The chit chat seemed interminable to Lorraine, 0:22:58.240 --> 0:23:03.080 who was near breaking point. Sensing no urgency among the staff, 0:23:03.160 --> 0:23:06.320 she pleaded with Jared, who still felt guilty for keeping 0:23:06.320 --> 0:23:09.800 Elise in the Monterey unit for the first hour. She 0:23:09.960 --> 0:23:14.080 wanted Jared to beg for action. Jared directed a question 0:23:14.280 --> 0:23:16.800 to the nurse Forbes, who was sitting back at the 0:23:16.880 --> 0:23:18.000 nursing station. 0:23:18.920 --> 0:23:22.440 How long will the doctor be Please? Is anyone going 0:23:22.480 --> 0:23:24.680 to come and see my daughter? We are very worried. 0:23:25.040 --> 0:23:27.600 My wife is very concerned. Can you come now, at 0:23:27.680 --> 0:23:28.639 least for her sake? 0:23:30.640 --> 0:23:34.200 Nurse Forbes had heard the questions a thousand times before. 0:23:34.920 --> 0:23:38.520 Everyone wanted to be seen yesterday. It was as if 0:23:38.560 --> 0:23:43.400 nobody else mattered or even existed. The patients, emotional and 0:23:43.520 --> 0:23:47.120 sometimes abusive, had no idea how busy the staff were, 0:23:47.600 --> 0:23:52.320 and knew nothing about the pressures of competing priorities like paperwork. No, 0:23:52.600 --> 0:23:56.919 there was no point in arguing. Forbes nodded towards the 0:23:56.920 --> 0:23:59.400 bench where doctor Donovan was writing notes. 0:24:00.440 --> 0:24:04.600 He's just that will be with you. Shortly as the. 0:24:04.560 --> 0:24:08.000 Doctor walked into the assessment room, time was running out. 0:24:08.040 --> 0:24:08.680 For Elise. 0:24:09.680 --> 0:24:12.800 A drop or two of blood had already seeped into 0:24:12.840 --> 0:24:13.600 her left ear. 0:24:14.600 --> 0:24:16.120 The fall from the bunk. 0:24:15.920 --> 0:24:20.280 Had fractured Elisa's skull and damaged the middle meningeal artery 0:24:20.359 --> 0:24:25.280 in her brain. Without surgery to drain the blood, which 0:24:25.359 --> 0:24:29.440 might have been obvious during a thorough examination, the growing 0:24:29.560 --> 0:24:33.320 clot would force the soft tissue in Elisa's brain against 0:24:33.320 --> 0:24:38.360 the immovable bones in her skull. If left untreated, her 0:24:38.400 --> 0:24:57.159 brain could herniate, causing catastrophic injury. Chapter four, The Nursing Life. 0:24:59.240 --> 0:25:04.360 Tony Hoffmann went to the thesaurus just to be sure. Maverick. 0:25:05.160 --> 0:25:08.520 She liked the word, but as with many nicknames, it 0:25:08.600 --> 0:25:17.080 could be misconstrued. What else might it mean? Independent, nonconformist individual. Yes, 0:25:17.840 --> 0:25:20.920 Hoffman had to agree that she was something of a maverick. 0:25:22.440 --> 0:25:25.560 The nickname had been given to her in circumstances that 0:25:25.640 --> 0:25:29.960 were moderately controversial. As the senior nurse in charge of 0:25:30.000 --> 0:25:34.840 Bunderberg based hospitals combined intensive care and coronary care units. 0:25:34.880 --> 0:25:38.399 Since her arrival in two thousand, Hoffman made a strong 0:25:38.520 --> 0:25:42.879 case over unsafe hours being worked by her staff. Most 0:25:42.920 --> 0:25:46.800 of the fifteen nurses in the intensive care unit were exhausted. 0:25:47.920 --> 0:25:51.480 The fatigue, which stemmed from their early morning starts and 0:25:51.640 --> 0:25:56.400 late finishes, was affecting clinical care. A tired nurse could 0:25:56.440 --> 0:26:00.600 be dangerous, particularly in the ICU or intensive care unit, 0:26:00.720 --> 0:26:04.320 where the critically ill patients had the most tenuous hold 0:26:04.520 --> 0:26:08.560 on life. The nurses were not meant to leave the 0:26:08.600 --> 0:26:12.360 bedsides of patients being helped to breathe by ventilating equipment. 0:26:12.920 --> 0:26:16.640 It only took a short lapse in concentration or momentary 0:26:16.840 --> 0:26:22.080 inattention for a fatal mistake to be made. Without farsaw rancor, 0:26:22.320 --> 0:26:26.640 Hoffman had argued a case for more nurses and safer hours. 0:26:27.600 --> 0:26:30.880 Glennis Goodman, the director of nursing at the hospital, took 0:26:30.920 --> 0:26:35.520 Hoffman's submission to the next level. Eventually, the logic and 0:26:35.680 --> 0:26:40.840 common sense of the argument were accepted, more nurses were employed, 0:26:41.200 --> 0:26:45.159 the dangerous shifts were abolished. The patients in the ICU 0:26:45.320 --> 0:26:48.280 did not know that a fundamental change to the nursing 0:26:48.400 --> 0:26:52.399 roster gave them better odds of survival, but the staff knew. 0:26:53.720 --> 0:26:57.320 Hoffman won immediate and long lasting respect from the other 0:26:57.440 --> 0:27:00.280 nurses for her willingness to back them as as well 0:27:00.320 --> 0:27:05.040 as the patients. Tony Hoffman was a rarity, a middle 0:27:05.080 --> 0:27:08.320 manager prepared to raise her head above the parapet and 0:27:08.400 --> 0:27:12.080 speak out against convention and systems that had been imposed 0:27:12.080 --> 0:27:15.600 by her superiors and grudgingly accepted. 0:27:15.160 --> 0:27:15.960 By the staff. 0:27:17.320 --> 0:27:21.960 But in Queensland Health, an organization run down by political 0:27:22.000 --> 0:27:27.600 interference and financial neglect, Hoffman's style of robust, outspokenness was 0:27:27.720 --> 0:27:32.919 rarely rewarded. The mavericks who agitated for something outside the 0:27:32.960 --> 0:27:40.600 square were usually the first to be muzzled. Rebel, loner, misfit. 0:27:41.240 --> 0:27:44.679 Although it pained Hoffman to admit it, she probably was 0:27:44.720 --> 0:27:48.960 a loner, maybe even a misfit. She did not have 0:27:49.040 --> 0:27:53.200 a boyfriend, yet all her best friends were married. They 0:27:53.280 --> 0:27:57.160 spent every spare moment with their children, talking about their children, 0:27:57.280 --> 0:28:02.000 or planning events around their children. Her younger sister, Marie, 0:28:02.160 --> 0:28:05.680 was run off her feet with her two kids. At 0:28:05.760 --> 0:28:10.359 times when the demands of parenthood seemed limitless, Hoffman felt 0:28:10.400 --> 0:28:16.040 fortunate to have avoided those responsibilities. When the challenges in 0:28:16.119 --> 0:28:20.679 the ICU were unrelenting and the deadlines for her university 0:28:20.720 --> 0:28:25.439 assignments seemed impossible, she consoled herself that her life's journey 0:28:25.720 --> 0:28:29.600 was as it should be. At least she had her freedom. 0:28:30.200 --> 0:28:33.000 At least she had the time after work to devote 0:28:33.000 --> 0:28:38.320 to study, even if there were occasional bouts of loneliness. Still, 0:28:38.960 --> 0:28:42.720