In this week’s episode staff and patients talk about mortality and how being in A&E brings difficult questions to the fore.

60-year-old rail worker Alan is airlifted to the helipad at St George’s after being hit by a high speed train while working on the tracks. “People hit by trains generally don’t get to us because that’s never going to end well,” says team leader Daryl. “If you’re hit by a car it’s bad enough, if you’re hit by a bus that’s another thing. But hit by a train? You might as well have a plane land on top of you. The chances of you surviving that are very, very rare.”

A CT scan reveals that Alan has suffered multiple fractures and loss of blood flow to his right arm. Without circulation he will lose his arm and the medical team try everything to save it, including complicated emergency surgery. Alan’s son Kevin waits for news at the hospital and talks about how he and his father became closer after his mum’s death.

95-year-old Betty is brought in to St George’s after suffering from breathing difficulties at home. But as she arrives at hospital, Betty loses consciousness and doctors realise that the problem may be with her heart.

As Betty is treated, her son Alan talks about his mum, who brought up two young children on her own after his father left. “It probably made her strong because she had to be. She did a lot for us as kids, my sister and I, and being parents ourselves now we know what she gave up,” says Alan. “What a strain it must have been on her to make sure we had food, clothes and the rent was paid.”

But as Betty’s treatment progresses, it becomes clear that she has had a serious heart attack and her condition rapidly deteriorates.

“Our job in an emergency department is saving lives and making people feel better, but also part of our role is to allow natural death,” says consultant Will. “In those last minutes, hours, days our jobs as nurses and doctors would be to ensure that that patient is comfortable, not distressed in any way and to communicate with the family and relatives is really important.

Meanwhile 63-year-old retired engineer James was found at home after falling down stairs and has a nasty cut to his head and weakness in his arms. Doctors decide that the wound will have to be properly closed in surgery by a specialist team at the hospital.

As he’s stabilised and prepared for an overnight stay, James reflects on his life, from his wealthy grandfather’s opulent house to discovering women after leaving boarding school