The Sound Behind Surgeons: At the Edge of Life

The surgical staff at Cambridge's Royal Papworth and Addenbrooke's hospitals are recognised for their incredible skill. In both hospitals, surgeons perform some of the most intricate procedures in the world, where technical proficiency is essential since even the tiniest error with the knife could have disastrous results. They've opened their doors to the BBC in the documentary series, 'Surgeons: At the Edge of Life'. I worked across the trauma episodes as the nights sound supervisor. 

Sound supervisor preparation

I’ve worked on a variety of TV productions including daytime, dramas, reality, and live sport. Having worked in the industry for a while, you become quite skilled at knowing how to prepare. I make sure all the gear I need is in order, batteries are charged, and that I’m familiar with the format. If it’s an existing series, I’ll usually watch a few older episodes online to get a feel for the show, how it’s shot, and as a way of learning who the main characters/presenters are. My prep for “Surgeons: At the edge of Life” was no different. 

My role on the production

I would be working with friend and colleague Joel Bartholomew, a sound mixer who has worked on the series for a number of years and knew the show inside out. This particular block of filming would focus on the trauma cases arriving in the emergency department at Addenbrooke’s Hospital that required emergency surgery. This would feature in two episodes of the new series. 

Joel would cover the day shift and I would cover the night shift, each of us with an assistant to help on the floor whilst we mixed from the gallery. 

The technical aspects

There were 3 main elements to the show: 

1: The red phone - This is used to pre-warn the emergency department of an incoming emergency/trauma case and would be the start of our journey with the patient. 

2: The resus bays - Reserved for the sickest of patients, this area is where the specialist nurses and doctors would assemble ready to receive the incoming patients. Two of these bays would be prioritised for us to film in and would be rigged with cameras and mics.

3: Operating theatres - Any patient needing emergency surgery would be taken to one of the operating theatres for a potentially life saving procedure. 

The two resus bays each had two plant mics dropped from the ceiling. This would cover anyone not mic’d whilst also capturing the general atmosphere of the department. We then had 12 Audio Ltd A10 radio mics which would be given to staff within the department. Antennas hung from the ceiling fed A10 receivers which, along with the plant mics and the red phone mic, made their way to the gallery via a Dante Networking unit. We also fed a timecode transmitter which would ensure the roaming cameras within the department would stay in sync, as well as an IEM to provide monitoring for those on the floor.

The operating theatres were slightly trickier. The procedures could take place in a number of different theatres - too many to leave fully rigged all the time. Working with the hospital it was decided to rig the main theatres, approximately 4/5 in total, with network cables. This meant that we could have a second central gallery in the surgical department that had connectivity to a number of different theatres. Once the theatre for the procedure had been determined, we would take a second mobile rig fitted with radio mic receivers, an IEM transmitter, plant mics, and antenna to the theatre that would interface with the network via a digital snake. We could then place the antenna and plant mics within the theatre that would would then connect to the mobile rig that was placed just outside the theatre. This allowed us the flexibility required to move locations quickly, whilst also meaning we didn’t have to compromise on coverage whilst in theatre. 

My personal experience

All of my conversations with Joel before the shoot were based around the technical aspects of the show. We needed radio mics on key staff working in resus, plant mics to cover anyone not mic’d, and a way to film in the operating theatres that were several floors away with very little notice. At this point I didn't think to ask about the subject matter and how it could potentially be emotionally challenging. 

During my two week block I saw many patients come and go through my monitor in the gallery, all with different illnesses and injuries. Many of whom, along with their families, experiencing one of the worst days of their lives - a day that could potentially change their lives. 

Watching and listening from the gallery, it was easy to feel disconnected from what was actually going on. I feel guilty for writing about this disconnect now as these were real people with families and lives, but I’m sure others that have worked on these sorts of shows would say the same. From the comfort of the gallery what plays out on screen almost doesn’t feel real, and you become engrossed in the “story” and what will make the best possible show. But during filming a few cases really stood out and showed me how fragile life really is, one of which features in the first episode of the series. 

The one that stuck with me

A single mother arrived in the hospital following a serious car accident and it quickly became evident that she has sustained severe spinal injuries. I watched as she came into the hospital and was treated in one of the resus bays.

Doctors, nurses, specialists, all worked together to quickly identify the injuries and came up with the best plan for treatment. They each treated the patient with the utmost respect and care. I watched as this young woman went through surely one of the worst days of her life. All the while I had to remember that I had a job to do, a job that was nowhere near as important as the work the NHS staff were doing, but a job that would hopefully help to show the amazing work they do and how tirelessly they work to treat their patients. 

Post show support

After the shift that night a message was sent all crew on the shift; if anyone needed to talk about what happened, there were people available to speak to. I didn’t take them up on that offer, but instead did my usual routine and headed back to the hotel to get some rest before coming back in later that day for another night shift. This cycle continued for the duration of my block; finish a shift and head back to the hotel for a cooked breakfast before getting some sleep ready for the next evening. This was my way of coping, but it was reassuring to know that help was available. 

Ever since filming took place the mother stayed in my head, how was she, would she improve, what was the outcome? The truth is until the episode airs I have no idea what happened, so when the transmission dates for the series were announced I marked the episode in question in my diary. Thankfully she looks to be making a recovery.

Coping with difficult subject matter

There are many shows that feature difficult subject matter and I’m hoping that my experiences aren’t unique. We are all human after all and as TV crew we may not always be emotionally prepared for the situations we are put in. 

If I was prepping for this show again I would definitely think a bit more about the emotional situations I may be faced with. It is also important to have a good support network around you. Whilst I didn’t take the more formal route with production I still talked about my experiences with colleagues and family. I found the phone call home to my partner became a mini therapy session; we decided early on that it was likely I’d need to talk about my experiences and during our talks I’d often reflect on what had happened the previous night. Just talking about what happened was very therapeutic and I believe having a good support network around me was key to coping with the difficult subject matter in question. 

Final thoughts

Whilst this blog post is about TV freelancers, I also feel it’s important to highlight the work the NHS staff do on a daily basis. I feel privileged to have seen this first hand whilst filming Surgeons. They work tirelessly to ensure each patient receives the highest level of care whilst often working under extreme pressure and in difficult circumstances. 

I have nothing but respect and admiration for the work they do and the emotional toll it must take on them as human beings. 

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By Matt Hughes

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