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This is all tumour. Worrisome. These are worrisome features. | 0:00:03 | 0:00:05 | |
Scary to me. | 0:00:05 | 0:00:07 | |
Probably scary for Raymond as well. | 0:00:07 | 0:00:09 | |
But what's the other alternative? | 0:00:09 | 0:00:12 | |
It's important to highlight, with this set of patients, | 0:00:12 | 0:00:15 | |
the bravery of these people going through this type of procedure. | 0:00:15 | 0:00:19 | |
This is new eye-gaze technology that I'm trying out. | 0:00:19 | 0:00:22 | |
The new medication has really helped my muscles relax | 0:00:22 | 0:00:26 | |
and it makes me feel good. | 0:00:26 | 0:00:28 | |
It's normally a little tiny clot that really is the difference | 0:00:28 | 0:00:32 | |
between life and death. | 0:00:32 | 0:00:33 | |
I feel I'm one of the lucky ones, because I've had two friends, | 0:00:33 | 0:00:37 | |
similar age to me, have died in the last two months. | 0:00:37 | 0:00:41 | |
There's a very large team of people needed to make this all work. | 0:00:41 | 0:00:45 | |
It's not just the doctors. | 0:00:45 | 0:00:47 | |
Hopefully, everything goes well. | 0:00:47 | 0:00:49 | |
On occasion, you may have a death | 0:00:53 | 0:00:54 | |
and it's very hard to switch off then when you go home. | 0:00:54 | 0:00:57 | |
You're only human, even though you are a nurse or a doctor | 0:00:57 | 0:01:00 | |
or a radiographer, and you do feel the stresses and strains | 0:01:00 | 0:01:03 | |
of events that happen. | 0:01:03 | 0:01:05 | |
We've spent a year looking under the skin of the health service, | 0:01:14 | 0:01:18 | |
focusing on the large team of people | 0:01:18 | 0:01:20 | |
who dedicate their lives to saving ours. | 0:01:20 | 0:01:23 | |
Around 5,000 people in the UK are diagnosed with brain tumours every year. | 0:01:25 | 0:01:31 | |
The neurology team in the Royal Victoria Hospital perform | 0:01:31 | 0:01:34 | |
this life-saving brain surgery every day. | 0:01:34 | 0:01:36 | |
55-year-old Raymond Killen is waiting for his surgery. | 0:01:38 | 0:01:42 | |
As a porter in Musgrave, I like basically helping people, | 0:01:45 | 0:01:51 | |
you know, be a part of that. | 0:01:51 | 0:01:53 | |
Symptoms emerged seven years ago, | 0:01:53 | 0:01:56 | |
when Raymond's partner began to notice changes in his personality. | 0:01:56 | 0:01:59 | |
At the beginning, the way me and him have been, | 0:01:59 | 0:02:03 | |
and have been together for such a long time, | 0:02:03 | 0:02:07 | |
to me he just wasn't the same person. | 0:02:07 | 0:02:10 | |
I had changed. | 0:02:10 | 0:02:12 | |
The slightest wee thing, I was flying off the handle and, you know, | 0:02:12 | 0:02:15 | |
couldn't understand why I was doing this, cos I've never done it before. | 0:02:15 | 0:02:19 | |
It was just one of the wee sensations, lasted about five, ten seconds | 0:02:21 | 0:02:25 | |
and the dog could sense that I was going into one of these. | 0:02:25 | 0:02:28 | |
I thought to myself, "Well, it must be something," | 0:02:28 | 0:02:31 | |
but I honestly didn't think it was anything to do with his brain | 0:02:31 | 0:02:35 | |
or anything like that, like. | 0:02:35 | 0:02:38 | |
Just another normal day for neurosurgeon Tom Flannery, | 0:02:40 | 0:02:44 | |
doing the school run before heading in to deal with Raymond's case. | 0:02:44 | 0:02:48 | |
OK, see you later. | 0:02:48 | 0:02:49 | |
Tom diagnosed Raymond with a glioma tumour in his brain. | 0:02:55 | 0:02:59 | |
He's a guy in his mid-50s | 0:02:59 | 0:03:02 | |
who's, basically, seven years of blank-out episodes | 0:03:02 | 0:03:06 | |
and just really only presented to Neurology just towards | 0:03:06 | 0:03:10 | |
the end of last year, when he had a more obvious seizure | 0:03:10 | 0:03:13 | |
which seemed to have an effect on his speech. | 0:03:13 | 0:03:16 | |
When I first noticed it... | 0:03:16 | 0:03:19 | |
one minute he was talking and, the next thing, he just stopped. | 0:03:19 | 0:03:22 | |
So a glioma's basically a tumour of the packing cells in the brain | 0:03:24 | 0:03:28 | |
and there's a range, a spectrum, of different aggressiveness, | 0:03:28 | 0:03:31 | |
but they eventually tend to progress to a higher grade - | 0:03:31 | 0:03:35 | |
they become more aggressive. | 0:03:35 | 0:03:37 | |
This is all tumour essentially here, | 0:03:37 | 0:03:40 | |
but he has an area of contrast enhancement, | 0:03:40 | 0:03:43 | |
so the dye is leeching across into the tissue in this area, | 0:03:43 | 0:03:47 | |
indicating a more aggressive part of the tumour. | 0:03:47 | 0:03:50 | |
Worrisome. These are worrisome features. | 0:03:50 | 0:03:52 | |
Raymond urgently requires surgery. | 0:03:52 | 0:03:56 | |
A brain operation. | 0:03:56 | 0:03:57 | |
Scary to me. | 0:03:57 | 0:03:59 | |
Probably scary for Raymond as well. | 0:04:00 | 0:04:03 | |
But what's the other alternative? | 0:04:04 | 0:04:07 | |
-Might we expect something on the face? -I think so. | 0:04:08 | 0:04:11 | |
Mr Flannery relies on the expertise of speech therapist Gillian Trimble. | 0:04:11 | 0:04:15 | |
Well, speech and language therapy, it's an integral part | 0:04:15 | 0:04:19 | |
of the neurosurgical team for this type of patient. | 0:04:19 | 0:04:21 | |
Before this type of procedure being done awake, most of these | 0:04:21 | 0:04:26 | |
patients would've been referred to my team with a speech problem. | 0:04:26 | 0:04:29 | |
Anything ranging to speech absolutely gone altogether | 0:04:29 | 0:04:32 | |
to a slight change in their speech or in their comprehension. | 0:04:32 | 0:04:36 | |
Now, we're having almost 100% not with a problem. | 0:04:36 | 0:04:39 | |
That's a massive change. | 0:04:39 | 0:04:41 | |
So, Raymond, you're coming in for your operation on Monday. | 0:04:42 | 0:04:45 | |
-Yeah. -The point of this operation is that you're awake. -Yes. | 0:04:45 | 0:04:48 | |
-You will be as awake as you are now. -Uh-huh. -You won't be drowsy. | 0:04:48 | 0:04:52 | |
If you're drowsy, we wait until you're fully awake. | 0:04:52 | 0:04:55 | |
'Being able to monitor speech awake, | 0:04:55 | 0:04:57 | |
'and that has to be done by a speech and language therapist,' | 0:04:57 | 0:05:00 | |
'because any subtle change in language is what you're looking for | 0:05:00 | 0:05:03 | |
'and it can't really be done by anyone else.' | 0:05:03 | 0:05:05 | |
Whenever the surgeon is ready to take the part of your brain away | 0:05:05 | 0:05:08 | |
that he needs to take away, | 0:05:08 | 0:05:10 | |
that's whenever we start with language stimulation. | 0:05:10 | 0:05:12 | |
We started using this procedure four years ago | 0:05:12 | 0:05:15 | |
and I've done somewhere around about 100 patients. | 0:05:15 | 0:05:17 | |
Before that, you know, patients would've been asleep. | 0:05:17 | 0:05:20 | |
We'd have had no idea what the patient would be like when we woke them up. | 0:05:20 | 0:05:23 | |
The bad part of the brain has no function in it, | 0:05:23 | 0:05:25 | |
so when he touches it, there'll be no change to your speech, | 0:05:25 | 0:05:27 | |
but when he goes to good brain, the speech will dip. | 0:05:27 | 0:05:30 | |
He wants to take away without damaging any of the good brain - | 0:05:30 | 0:05:34 | |
that's the theory behind all of this. | 0:05:34 | 0:05:35 | |
Gillian needs to establish patterns in Raymond's speech to ensure that | 0:05:36 | 0:05:40 | |
the surgeon removes tumour only. | 0:05:40 | 0:05:42 | |
Are there a couple of really familiar dishes to you that would be | 0:05:42 | 0:05:46 | |
something you'd make all the time? | 0:05:46 | 0:05:47 | |
Er, yes, home-made soup. | 0:05:47 | 0:05:50 | |
-OK. -And stew. | 0:05:50 | 0:05:51 | |
Now, what I want you to do, I want you to talk me through, | 0:05:51 | 0:05:54 | |
from start to finish, how you'd make soup, | 0:05:54 | 0:05:57 | |
and the reason for that is it's the construction of the sentences, | 0:05:57 | 0:06:01 | |
it's how you find the words you're looking for, | 0:06:01 | 0:06:03 | |
it's the pattern that you're using for your speech. | 0:06:03 | 0:06:05 | |
I fill a pot with water, | 0:06:05 | 0:06:07 | |
put the peas and barley in, | 0:06:07 | 0:06:09 | |
and I cook the chicken. | 0:06:09 | 0:06:12 | |
That I do for about an hour, an hour and a half, then put the veg in it, | 0:06:12 | 0:06:16 | |
-slowly for about another couple of hours. -OK. | 0:06:16 | 0:06:20 | |
'I'm hoping this operation' | 0:06:20 | 0:06:22 | |
returns me exactly the same to what I was before, | 0:06:22 | 0:06:26 | |
and no more of these turns, and I'd be quite happy with that. | 0:06:26 | 0:06:29 | |
It's important to highlight with this set of patients | 0:06:29 | 0:06:33 | |
the bravery of these people | 0:06:33 | 0:06:34 | |
going through this type of procedure, because normally, | 0:06:34 | 0:06:37 | |
any of us that have gone for an operation, you're prepared for it, | 0:06:37 | 0:06:40 | |
you hear all about it, | 0:06:40 | 0:06:42 | |
and then you go to sleep and then you wake up when it's finished. | 0:06:42 | 0:06:45 | |
In 2015, 11 people a day were admitted | 0:06:52 | 0:06:55 | |
to hospitals across Northern Ireland with a heart attack. | 0:06:55 | 0:06:59 | |
Catheter labs have transformed the way many of these patients | 0:06:59 | 0:07:03 | |
are treated, dramatically improving outcomes. | 0:07:03 | 0:07:06 | |
In Londonderry, at Altnagelvin Hospital, | 0:07:06 | 0:07:09 | |
consultant cardiologist Aaron Peace prepares for another busy day. | 0:07:09 | 0:07:13 | |
In global terms, we sit | 0:07:14 | 0:07:17 | |
right up at the top, | 0:07:17 | 0:07:18 | |
in the top three places in the world | 0:07:18 | 0:07:20 | |
that suffer from heart attacks. | 0:07:20 | 0:07:22 | |
Cardiovascular disease is still the number one cause of death | 0:07:22 | 0:07:26 | |
in this society, surpassing all cancers combined. | 0:07:26 | 0:07:31 | |
Every third person in our community will have cardiovascular disease. | 0:07:31 | 0:07:37 | |
Billy has been admitted following a second heart attack. | 0:07:40 | 0:07:43 | |
Just a usual Sunday, like, I am a shift worker, | 0:07:43 | 0:07:46 | |
but I was off that Sunday. | 0:07:46 | 0:07:48 | |
I had been to church | 0:07:48 | 0:07:49 | |
and, when I came home, I made dinner for me and me girlfriend and my son. | 0:07:49 | 0:07:53 | |
Er, it was after I had done the dishes that I felt | 0:07:53 | 0:07:56 | |
a slight pain in my chest. | 0:07:56 | 0:07:59 | |
You know, if I put it in, like, nought to ten, | 0:07:59 | 0:08:02 | |
it would only be like a five pain. | 0:08:02 | 0:08:04 | |
It was across here, but I also felt it there, | 0:08:04 | 0:08:06 | |
on the insides of both arms. | 0:08:06 | 0:08:08 | |
Like a numbness, like, you know. | 0:08:08 | 0:08:10 | |
Dr Peace is going to be doing your procedure today. | 0:08:12 | 0:08:14 | |
We're going to get you to sign the consent form now. | 0:08:14 | 0:08:16 | |
-Right. -As you know, there is a small chance of a complication. | 0:08:16 | 0:08:19 | |
It is a very large team of people needed to make this all work. | 0:08:19 | 0:08:23 | |
It's not just the doctors. | 0:08:23 | 0:08:25 | |
Cath lab nurse, Christine McCrudden, plays a vital role in the team. | 0:08:27 | 0:08:31 | |
So, basically, this is what we do before the procedure - we scrub up. | 0:08:33 | 0:08:36 | |
We prepare the room in the morning | 0:08:36 | 0:08:38 | |
and do all our checks to make sure our equipment's all safe | 0:08:38 | 0:08:42 | |
and ready for use before the patient would come into the room. | 0:08:42 | 0:08:45 | |
She prepares meticulously for the surgical procedure. | 0:08:45 | 0:08:49 | |
So this is all sterile now, my gloves and my gown, | 0:08:49 | 0:08:51 | |
and I'm going over to the trolley, which is sterile as well. | 0:08:51 | 0:08:54 | |
Nothing's reusable that's on this at all. | 0:08:54 | 0:08:56 | |
When the consultant needs it, we have it all prepped and ready to go. | 0:08:58 | 0:09:02 | |
This is what we call our sheath. | 0:09:02 | 0:09:04 | |
So this is actually entered just under the patient's arm. | 0:09:05 | 0:09:08 | |
It is intense pressure and, especially if the patient's ill | 0:09:08 | 0:09:11 | |
and you're running trying to get drugs, IV fluids, | 0:09:11 | 0:09:13 | |
it's very hard when you go home to switch off | 0:09:13 | 0:09:16 | |
if you've had somebody very ill in and, on the odd occasion, | 0:09:16 | 0:09:20 | |
you may have a death and it's very hard to switch off then, | 0:09:20 | 0:09:22 | |
when you would go home, you know, that you know that you've done | 0:09:22 | 0:09:24 | |
everything to the best of your ability, but you know, you are only | 0:09:24 | 0:09:27 | |
human, even though you're a nurse | 0:09:27 | 0:09:29 | |
or a doctor or radiographer, you are still... | 0:09:29 | 0:09:31 | |
You're only human and you do feel the stresses and strains of... | 0:09:31 | 0:09:35 | |
of events that happen. | 0:09:35 | 0:09:36 | |
Back at the Royal Victoria Hospital, | 0:09:41 | 0:09:43 | |
neurosurgeon Tom Flannery is on his way to meet Raymond | 0:09:43 | 0:09:46 | |
before his operation. | 0:09:46 | 0:09:47 | |
I wish it was all over. | 0:09:47 | 0:09:50 | |
I'm a bit nervous, but you know, | 0:09:50 | 0:09:51 | |
it has to be done and I'm hoping that it goes through OK | 0:09:51 | 0:09:54 | |
and, you know, I'll be happy when I'm on the recovery ward. | 0:09:54 | 0:09:58 | |
You know, any brain surgery at all, we always mention to patients | 0:10:01 | 0:10:05 | |
and the relatives that there is a risk of death, | 0:10:05 | 0:10:07 | |
although that is very low, but it's there and we have to mention it. | 0:10:07 | 0:10:11 | |
I just hope he gets through it all right and everything goes well. | 0:10:11 | 0:10:14 | |
We will do our best. | 0:10:14 | 0:10:16 | |
We've got an experienced team working on Raymond here, | 0:10:16 | 0:10:18 | |
so I'll chat to you later on today, all right? | 0:10:18 | 0:10:21 | |
OK. All right, we'll see you shortly, Raymond, OK? | 0:10:21 | 0:10:23 | |
-Yeah. -OK, thanks a million. | 0:10:23 | 0:10:25 | |
Hopefully, everything goes well. | 0:10:29 | 0:10:31 | |
In the Ulster Hospital, kitchen staff prepare meals | 0:10:39 | 0:10:42 | |
for the 600 patients. That's an incredible 1,800 meals per day. | 0:10:42 | 0:10:46 | |
Diet is very important. | 0:10:46 | 0:10:48 | |
We cater all the people suffering from illnesses. | 0:10:48 | 0:10:53 | |
Laarni Jamero is one of the 35-strong staff employed in the kitchen. | 0:10:54 | 0:10:58 | |
Here in the kitchen, we used to be as one family. | 0:10:58 | 0:11:02 | |
The Northern Irish cuisine is very, very simple. | 0:11:05 | 0:11:09 | |
There are food are always potatoes, | 0:11:09 | 0:11:11 | |
but in the Philippines, we always do, er, noodles. | 0:11:11 | 0:11:15 | |
I miss working as a nutritionist dietician in the Philippines. | 0:11:18 | 0:11:21 | |
I miss my work, especially counselling the patient, | 0:11:21 | 0:11:25 | |
and making diets, special diets for the patients. | 0:11:25 | 0:11:29 | |
We have the high protein and the strained one for the patient | 0:11:29 | 0:11:33 | |
with difficulty of swallowing. | 0:11:33 | 0:11:37 | |
This is very nutritious and delicious. | 0:11:37 | 0:11:39 | |
Sometimes, it's hard work, especially if you're on 8-6 shift, | 0:11:41 | 0:11:44 | |
because you do all the vegetables, lifting stuff, | 0:11:44 | 0:11:48 | |
washing potatoes and doing the special diets. | 0:11:48 | 0:11:53 | |
You need more muscles in lifting all the stuff. | 0:11:54 | 0:11:58 | |
Raymond is now in theatre. | 0:12:01 | 0:12:02 | |
Anaesthetist Catriona injects a local anaesthetic | 0:12:04 | 0:12:07 | |
into his head to numb the area. | 0:12:07 | 0:12:09 | |
OK, a little scratch here now. | 0:12:11 | 0:12:13 | |
Just take nice, slow deep breaths. That's fine. | 0:12:13 | 0:12:15 | |
He will be awake throughout the entire procedure. | 0:12:15 | 0:12:18 | |
His head is clamped securely into place. | 0:12:20 | 0:12:23 | |
'I certainly wouldn't like to have my head clamped and not being able | 0:12:23 | 0:12:25 | |
'to move for three or four hours.' | 0:12:25 | 0:12:27 | |
OK, Raymond? | 0:12:29 | 0:12:30 | |
So it's going to start to get progressively tighter, all right? | 0:12:30 | 0:12:33 | |
Your head will not be able to move much now | 0:12:33 | 0:12:35 | |
for the rest of the operation. | 0:12:35 | 0:12:37 | |
-Are you all right? -Uh-huh. -Good man. | 0:12:38 | 0:12:40 | |
Mr Flannery uses the latest 3D technology, | 0:12:40 | 0:12:44 | |
allowing him pinpoint accuracy for the removal of the tumour. | 0:12:44 | 0:12:48 | |
The camera will match what it sees | 0:12:48 | 0:12:50 | |
with the scans that have been done just preoperatively, | 0:12:50 | 0:12:53 | |
so they're sort of merged. | 0:12:53 | 0:12:55 | |
Raymond's eye on the left. | 0:12:55 | 0:12:58 | |
Good. | 0:12:58 | 0:12:59 | |
In the ear canal itself. | 0:12:59 | 0:13:01 | |
That looks pretty good there, so... | 0:13:01 | 0:13:04 | |
He begins by carefully cutting into Raymond's scalp. | 0:13:06 | 0:13:09 | |
He then eases it away from the skull. | 0:13:12 | 0:13:15 | |
These clips are very good at stopping any scalp bleeding. | 0:13:16 | 0:13:21 | |
It's like a little clamp for the skin. | 0:13:21 | 0:13:24 | |
Mr Flannery notices something unusual. | 0:13:28 | 0:13:31 | |
It looks like you've got an old skull fracture here, Raymond. | 0:13:31 | 0:13:34 | |
Um, Raymond, we're going to start drilling now, OK? | 0:13:35 | 0:13:38 | |
So you will feel a pressure. | 0:13:38 | 0:13:41 | |
It's almost time for speech therapist Gillian to begin her work. | 0:13:48 | 0:13:52 | |
Using a powerful microscope, | 0:14:01 | 0:14:02 | |
Mr Flannery peels back the membrane to access Raymond's brain. | 0:14:02 | 0:14:06 | |
He can now begin to remove the tumour. | 0:14:10 | 0:14:12 | |
Now, can you count from 20, please, back to one? | 0:14:16 | 0:14:19 | |
Gillian covers some of the discussion topics | 0:14:19 | 0:14:21 | |
she's prepped Raymond for prior to surgery. | 0:14:21 | 0:14:24 | |
12, 11, 10, 9... | 0:14:25 | 0:14:27 | |
'To have an operation on your brain is a massive thing.' | 0:14:27 | 0:14:30 | |
When you're making soup. How do you make that? | 0:14:30 | 0:14:32 | |
Well, er, overnight, I'd steep the... | 0:14:32 | 0:14:36 | |
-soup veg... -Mm-hm. | 0:14:36 | 0:14:39 | |
The soup mixture and the peas, it'd help to soften them. | 0:14:39 | 0:14:43 | |
'To know that you actually have to participate, | 0:14:43 | 0:14:46 | |
'they know that everything they do is contributing to their outcome.' | 0:14:46 | 0:14:50 | |
Well, then we add a bit of salt but not too much. | 0:14:52 | 0:14:55 | |
Mr Flannery removes a large piece of tumour and, with Gillian's help, | 0:14:55 | 0:14:59 | |
avoids good brain. | 0:14:59 | 0:15:01 | |
'Um, I think it's important to get a handle on what the biology of | 0:15:01 | 0:15:04 | |
'the tumour is, and we will get results on that in the weeks after | 0:15:04 | 0:15:08 | |
'the operation, based on the tissue analysis.' | 0:15:08 | 0:15:11 | |
After four hours in theatre, | 0:15:13 | 0:15:15 | |
the surgeon has removed as much of the tumour as he can. | 0:15:15 | 0:15:18 | |
The final task is to repair Raymond's skull and close the wound. | 0:15:21 | 0:15:25 | |
So that's just the bone flap that was taken out in the craniotomy, | 0:15:28 | 0:15:32 | |
so what we've done is, when we put it back, | 0:15:32 | 0:15:34 | |
we've put it back together with | 0:15:34 | 0:15:36 | |
what we call mini-plates and screws. | 0:15:36 | 0:15:38 | |
These are titanium-based screws and plates. | 0:15:38 | 0:15:41 | |
I've just put one across there. As you can see, | 0:15:41 | 0:15:43 | |
there's a fracture line. | 0:15:43 | 0:15:45 | |
Once the bone flap goes back in, | 0:15:45 | 0:15:47 | |
we put three screws and tighten that to the edge of the bone. | 0:15:47 | 0:15:51 | |
These stay in place to make sure there is enough cover. | 0:15:51 | 0:15:55 | |
Well, I can only say I wouldn't like to feel it again, | 0:15:59 | 0:16:01 | |
but it was a good job. | 0:16:01 | 0:16:03 | |
Back at the Ulster Hospital, | 0:16:05 | 0:16:07 | |
Laarni and her team are ready for a busy lunchtime. | 0:16:07 | 0:16:09 | |
These are the menus. This will go to the wards | 0:16:11 | 0:16:14 | |
and then the patients will choose what they want. | 0:16:14 | 0:16:16 | |
So, after choosing it, | 0:16:16 | 0:16:19 | |
somebody will collect them and bring them here in the kitchen. | 0:16:19 | 0:16:23 | |
After that, we dish out each one onto a conveyor. | 0:16:23 | 0:16:26 | |
Today, we're feeding 500 patients. | 0:16:31 | 0:16:34 | |
Most of the patients chose stewed steak for their lunch. | 0:16:34 | 0:16:38 | |
We served 100 patients for stewed steak | 0:16:38 | 0:16:41 | |
and vegetable cheese bake for 60 patients. | 0:16:41 | 0:16:44 | |
Minced chicken is for 63 patients, | 0:16:44 | 0:16:48 | |
and then, 17 for grilled cod. | 0:16:48 | 0:16:51 | |
And for our dessert, most of them get stewed fruit sponge, | 0:16:51 | 0:16:57 | |
which is 176 patients, and the rest get jelly and ice cream. | 0:16:57 | 0:17:03 | |
After putting all the food on to a plate, it goes to this trolley. | 0:17:06 | 0:17:12 | |
This trolley will go to the wards. | 0:17:12 | 0:17:14 | |
That's lovely. Thanks very much. | 0:17:14 | 0:17:18 | |
The soup's nice. Very pleasant. | 0:17:18 | 0:17:21 | |
Um... | 0:17:21 | 0:17:24 | |
potato and leek probably. | 0:17:24 | 0:17:26 | |
I've had hospital food before and | 0:17:27 | 0:17:31 | |
haven't been able to eat it. | 0:17:31 | 0:17:33 | |
This is very pleasant, so, um, top marks to the chef. | 0:17:33 | 0:17:38 | |
In Altnagelvin's catheter lab, | 0:17:44 | 0:17:46 | |
Dr Peace begins Billy's procedure for a second stent. | 0:17:46 | 0:17:50 | |
So what we do is we just raise a wee bleb of | 0:17:52 | 0:17:56 | |
local anaesthetic and just freeze up this wee spot | 0:17:56 | 0:17:59 | |
above the pulse in your wrist. | 0:17:59 | 0:18:02 | |
-Is that all right, Billy? -Fine, that's OK. | 0:18:02 | 0:18:06 | |
And then, this is the sheath that we use to allow us | 0:18:06 | 0:18:10 | |
to put the little tubes up the arms, | 0:18:10 | 0:18:12 | |
so that we can inject the dye, the contrast, | 0:18:12 | 0:18:15 | |
and that allows us to see then the arteries in real-time | 0:18:15 | 0:18:20 | |
on the screen here in front of us. | 0:18:20 | 0:18:22 | |
We've seen progressively the mortality in patients, | 0:18:25 | 0:18:29 | |
their chances of dying, decreasing and decreasing and decreasing | 0:18:29 | 0:18:33 | |
over time with the implementation of a 24-hour service | 0:18:33 | 0:18:37 | |
for our community when they have a heart attack. | 0:18:37 | 0:18:40 | |
Now, unfortunately, there's still a very significant proportion | 0:18:40 | 0:18:43 | |
of our patients die before they ever reach hospital, | 0:18:43 | 0:18:46 | |
and that's something else that we really need to work on. | 0:18:46 | 0:18:49 | |
But in patients who actually get here, | 0:18:49 | 0:18:52 | |
being able to get rid of the clot that causes the problem, | 0:18:52 | 0:18:56 | |
cos it's normally a little tiny clot, | 0:18:56 | 0:18:59 | |
that really is the difference between life and death. | 0:18:59 | 0:19:02 | |
But it blocks off the artery. | 0:19:02 | 0:19:04 | |
That person then can just drop dead in the street. | 0:19:04 | 0:19:07 | |
We pass this guide, this wire, | 0:19:09 | 0:19:11 | |
up into the main blood vessel, the aorta, | 0:19:11 | 0:19:15 | |
and then we pass the guide catheter | 0:19:15 | 0:19:18 | |
and this acts as a tunnel, really, | 0:19:18 | 0:19:21 | |
to allow us to pass equipment up through it. | 0:19:21 | 0:19:24 | |
You'll see on the screen here now that, when I inject the dye, | 0:19:24 | 0:19:28 | |
that the catheter becomes opacified with the contrast. | 0:19:28 | 0:19:33 | |
The role of radiographer Paul is crucial for the success of this operation. | 0:19:35 | 0:19:40 | |
My role here is I'm the eyes of the operation. | 0:19:40 | 0:19:43 | |
So, at the minute, I'm just keeping an eye on the X-ray camera here. | 0:19:43 | 0:19:46 | |
Moving it into different positions. | 0:19:46 | 0:19:48 | |
It's a visual examination. | 0:19:48 | 0:19:51 | |
RAO cranial. | 0:19:51 | 0:19:53 | |
30-30. | 0:19:54 | 0:19:55 | |
What I'm doing is just enabling him to see where the end of | 0:19:55 | 0:19:58 | |
the wire is going, where the catheter's going, | 0:19:58 | 0:20:01 | |
and then, in a wee minute, he's going to put that balloon in. | 0:20:01 | 0:20:03 | |
So what we're doing is taking pictures just to get measurements | 0:20:03 | 0:20:06 | |
for the size of stent that we're going to be placing. | 0:20:06 | 0:20:08 | |
-Can we go back to the RAO cranial, please? -Yeah. | 0:20:08 | 0:20:11 | |
Just working on me now, you know it, but... | 0:20:13 | 0:20:16 | |
on the right arm and just along the chest. | 0:20:16 | 0:20:19 | |
I have my glasses on because I wanted to see the picture, what he's done. | 0:20:22 | 0:20:26 | |
So, between the two markers, we can see the stent, and so | 0:20:26 | 0:20:29 | |
what we'll do now is Patricia's going to inflate the stent. | 0:20:29 | 0:20:32 | |
Billy, are you OK? | 0:20:32 | 0:20:34 | |
-Yeah. -Go, pick it up. | 0:20:34 | 0:20:36 | |
Then, really, we'll take a quick shot of it. | 0:20:38 | 0:20:41 | |
And you can see it's like a sausage inside the vessel | 0:20:41 | 0:20:45 | |
and the balloon expands | 0:20:45 | 0:20:46 | |
and pushes the stent into the wall of the vessel. | 0:20:46 | 0:20:49 | |
After 40 minutes, Billy's life-saving surgery is complete. | 0:20:49 | 0:20:53 | |
The fascinating thing about all of this is really that | 0:20:56 | 0:20:59 | |
we treat equivalent patients who would have otherwise had surgery | 0:20:59 | 0:21:02 | |
by just putting this little tube into their wrist. | 0:21:02 | 0:21:06 | |
You're sort of scared to move that much, | 0:21:06 | 0:21:08 | |
because you know it's something inside a vein the size of nothing. | 0:21:08 | 0:21:11 | |
Billy's going to go home today. | 0:21:12 | 0:21:14 | |
We're increasingly sending patients home. | 0:21:14 | 0:21:17 | |
And same-day discharge for these types of patient | 0:21:17 | 0:21:19 | |
is an extremely safe and effective thing to do. | 0:21:19 | 0:21:22 | |
Um, patients are happy, | 0:21:22 | 0:21:24 | |
because they'd rather go home and sleep in their own bed. | 0:21:24 | 0:21:27 | |
Domestic staff are an important part of the NHS team. | 0:21:30 | 0:21:34 | |
Working the hospital now nine years. | 0:21:36 | 0:21:38 | |
I've been up on this department, working now the past five years. | 0:21:38 | 0:21:41 | |
Stephen is responsible for cleaning the cath lab before and after every procedure. | 0:21:41 | 0:21:47 | |
Obviously, after the procedures, | 0:21:47 | 0:21:49 | |
you know, everything gets terminal cleaned. | 0:21:49 | 0:21:51 | |
Whether it be the cleaning team, | 0:21:51 | 0:21:52 | |
whether it be the person in the kitchen, | 0:21:52 | 0:21:54 | |
whether it be the clerical team, | 0:21:54 | 0:21:56 | |
everyone has got a massive part to play up here. | 0:21:56 | 0:21:58 | |
It's not just down to the doctor or the nursing staff as well. | 0:21:58 | 0:22:01 | |
Recently, he's found a greater appreciation for the team | 0:22:01 | 0:22:04 | |
that he's part of, as Billy is his father. | 0:22:04 | 0:22:07 | |
Well, Billy, how are you keeping? | 0:22:07 | 0:22:08 | |
I feel not too bad, doctor. | 0:22:08 | 0:22:10 | |
I've been down here many a times, | 0:22:10 | 0:22:12 | |
but whenever it's actually a relative, the feeling like it's... | 0:22:12 | 0:22:15 | |
because, when you see people coming in here, | 0:22:15 | 0:22:17 | |
you know that they're in safe hands and what not, and... | 0:22:17 | 0:22:22 | |
obviously, the nursing staff and the doctors and whatnot are very good | 0:22:22 | 0:22:25 | |
at their jobs, but obviously when your father or any relative gets | 0:22:25 | 0:22:28 | |
brought in, it's sort in the back of your mind, gosh, | 0:22:28 | 0:22:31 | |
you know, what's going on in there? How is he? | 0:22:31 | 0:22:33 | |
You know, how's he keeping? But it still sort of baffles me to the day, | 0:22:33 | 0:22:36 | |
like, cos my dad was sort of keeping himself active and he never smoked. | 0:22:36 | 0:22:39 | |
But there you are, hey, it just shows it could happen to any of us, you know. | 0:22:39 | 0:22:44 | |
In the Royal Victoria Hospital, Dr Claire Lundy, | 0:22:52 | 0:22:55 | |
a consultant specialist in paediatric neurodisability, | 0:22:55 | 0:22:59 | |
has an appointment with 13-year-old Patrick. | 0:22:59 | 0:23:02 | |
Patrick has a really very rare form of dystonia, | 0:23:03 | 0:23:07 | |
and that's a condition which is best described | 0:23:07 | 0:23:11 | |
as having uncontrolled, unwanted movements, | 0:23:11 | 0:23:15 | |
and it arises from a problem deep in the brain. | 0:23:15 | 0:23:19 | |
I see you've brought your new DynaVox. | 0:23:19 | 0:23:21 | |
So I'm dying to see how it works. | 0:23:21 | 0:23:24 | |
By focusing on the screen, Patrick is able to activate | 0:23:24 | 0:23:27 | |
pre-created sentences that he and his mum prepared last night. | 0:23:27 | 0:23:31 | |
My name is Patrick and I am 13 years old. | 0:23:31 | 0:23:35 | |
I live in Belfast with my mum and dad and two younger sisters. | 0:23:35 | 0:23:39 | |
My sisters keep me busy. | 0:23:39 | 0:23:41 | |
Patrick, that's brilliant! | 0:23:41 | 0:23:43 | |
It's really working very, very well. | 0:23:43 | 0:23:46 | |
'In Patrick's case, eye-gaze technology has been transformational, | 0:23:46 | 0:23:50 | |
'because of his movement disorder, and can't clearly articulate | 0:23:50 | 0:23:53 | |
'what he wants to say from a day-to-day,' | 0:23:53 | 0:23:56 | |
so this kind of device is life-changing, | 0:23:56 | 0:23:58 | |
not only for the child, but for the family and the carers | 0:23:58 | 0:24:01 | |
who are trying to support an individual like Patrick. | 0:24:01 | 0:24:04 | |
'The device has leads that are implanted with a stimulator box | 0:24:04 | 0:24:08 | |
'implanted in the chest and leads that track up | 0:24:08 | 0:24:12 | |
'into the brain to provide some more electrical stimulation, | 0:24:12 | 0:24:17 | |
'and the aim of the treatment, in Patrick's case, was to | 0:24:17 | 0:24:20 | |
'provide a little more control, particularly over his limbs.' | 0:24:20 | 0:24:23 | |
So that's perfect, OK? | 0:24:23 | 0:24:26 | |
So thank you very much for letting me take a look at that. | 0:24:26 | 0:24:28 | |
'There's a lot of work and preparation goes into using eye-gaze technology. | 0:24:28 | 0:24:33 | |
'Children will work with their speech therapist and their' | 0:24:33 | 0:24:36 | |
parents or carers to choose and plan sentences | 0:24:36 | 0:24:41 | |
or phrases that are important to them on a daily basis. | 0:24:41 | 0:24:44 | |
Everyone is very impressed with how well this works | 0:24:44 | 0:24:47 | |
and I love it. | 0:24:47 | 0:24:48 | |
It helps me so much in communicating with my family and friends. | 0:24:48 | 0:24:53 | |
This is so important to me. | 0:24:53 | 0:24:55 | |
-Thanks. -Good man. | 0:24:56 | 0:24:59 | |
Well, it's my pleasure. | 0:24:59 | 0:25:01 | |
Through eye-gaze technology, for the first time for children | 0:25:01 | 0:25:03 | |
like Patrick, we're truly able to hear what THEY want to say. | 0:25:03 | 0:25:07 | |
It's been ten weeks since Billy had his stent fitted. | 0:25:24 | 0:25:28 | |
So, the same as before, we're doing that 10 to 15-minute warming up, | 0:25:29 | 0:25:33 | |
then we're going to do the circuits as normal, | 0:25:33 | 0:25:35 | |
and then your 10 to 15 minutes cooling down as well. | 0:25:35 | 0:25:38 | |
Today, Billy has a session with physiotherapist Margaret, | 0:25:38 | 0:25:41 | |
one of the team managing his post-operative care. | 0:25:41 | 0:25:43 | |
Oh, the health's now getting better, you know, the actual health side, | 0:25:45 | 0:25:49 | |
you know, getting stronger. | 0:25:49 | 0:25:51 | |
It's just, er, you get breathless easily, you know, | 0:25:51 | 0:25:54 | |
so you just try and keep within your limit. | 0:25:54 | 0:25:57 | |
Inside, your body's just that bit different, like, you know. | 0:25:59 | 0:26:02 | |
It's getting everything to talk together. | 0:26:02 | 0:26:04 | |
It's getting my mind, you know, that, | 0:26:04 | 0:26:06 | |
"You're good, you've got there," and get on with life. | 0:26:06 | 0:26:10 | |
Good, so now we've warmed up a little bit more | 0:26:10 | 0:26:14 | |
we're going to start shrugging the shoulders up. | 0:26:14 | 0:26:16 | |
I feel I'm one of the lucky ones, because I had two friends, | 0:26:16 | 0:26:20 | |
similar age to me, have died in the last two months. | 0:26:20 | 0:26:23 | |
I've got a son and a daughter | 0:26:23 | 0:26:25 | |
and they both went through the trauma too | 0:26:25 | 0:26:27 | |
with me in here, like, so... | 0:26:27 | 0:26:30 | |
Steve's a good lad. | 0:26:30 | 0:26:31 | |
When you're ill, | 0:26:31 | 0:26:33 | |
when a member of your family or a close friend is there for you, | 0:26:33 | 0:26:36 | |
it makes you feel good, but the staff were excellent anyway. | 0:26:36 | 0:26:40 | |
I've got the two stents in now and blood pressure seems to be good. | 0:26:40 | 0:26:44 | |
I'm able to do the exercises, get the rest of the body now in tune. | 0:26:44 | 0:26:49 | |
These stents have saved my life, I believe it. | 0:26:49 | 0:26:52 | |
You know, if they weren't cleared, | 0:26:52 | 0:26:53 | |
I would've sat on another so many hours, life might've been different. | 0:26:53 | 0:26:58 | |
Raymond is at home recovering from his surgery. | 0:27:05 | 0:27:09 | |
I got out of the hospital a week ago yesterday | 0:27:13 | 0:27:16 | |
and everything went according to plan. | 0:27:16 | 0:27:18 | |
I'm feeling pretty well, just the wound is sometimes a bit sore, | 0:27:18 | 0:27:22 | |
sometimes itchy - that's the way it's just... that's it healing. | 0:27:22 | 0:27:25 | |
That's the scar, | 0:27:27 | 0:27:29 | |
which I'm told will fade away and any stitches in there | 0:27:29 | 0:27:32 | |
are self-disposing. They'll just drop out. | 0:27:32 | 0:27:35 | |
Mr Flannery, as far as I'm concerned, he's an excellent surgeon. | 0:27:37 | 0:27:41 | |
Oh, he's brilliant. | 0:27:41 | 0:27:43 | |
It's a good job there's people like him. | 0:27:43 | 0:27:45 | |
I'm glad that we caught him at this stage. | 0:27:48 | 0:27:50 | |
I think maybe, a month, two months down the line, | 0:27:50 | 0:27:53 | |
it could've been a lot worse. | 0:27:53 | 0:27:54 | |
I just want me and him to be together... | 0:27:56 | 0:27:59 | |
..because we've been together a long time. | 0:28:00 | 0:28:03 | |
Well, he's my partner and I love him in my heart. | 0:28:05 | 0:28:08 | |
And I just don't know what I would do without him. | 0:28:09 | 0:28:13 |