0:00:43 > 0:00:45GREETINGS IN UKRAINIAN
0:01:00 > 0:01:03It's very difficult to cross to the other side of a street.
0:01:03 > 0:01:08It's very difficult to know whether one's being brave or reckless,
0:01:08 > 0:01:11and when one is being wise or being a coward.
0:01:36 > 0:01:39HE STARTS MACHINERY
0:01:59 > 0:02:03I like the smell and the feel of wood. It's nice stuff to handle.
0:02:03 > 0:02:10Um...and it's wonderful starting off, particularly if you have rough wood and you plane it all.
0:02:10 > 0:02:15You start off with rough planks and end up with something very beautiful at the end of it.
0:02:15 > 0:02:19I mean, this is knockabout woodwork, just making a packing case.
0:02:19 > 0:02:25I've always loved, um, using tools. I love using my hands.
0:02:28 > 0:02:32This particular shipment is five defibrillators...
0:02:34 > 0:02:40..an operating stool, which I've sat on during thousands of operations over the years,
0:02:40 > 0:02:43and now Igor will be able to sit on it and it will do active service
0:02:43 > 0:02:47in the Ukraine for many years to come, which is a nice thought.
0:02:47 > 0:02:49Nothing goes to waste.
0:02:53 > 0:02:59It is 15 years when Henry came to Kiev,
0:02:59 > 0:03:04and each time with the new ideas, with the new medical things -
0:03:04 > 0:03:07I mean, medical presents -
0:03:07 > 0:03:11some instruments, and screws,
0:03:11 > 0:03:15things like that. But after we became
0:03:15 > 0:03:17closer with each other,
0:03:17 > 0:03:22I understood that it is not a medical co-operation.
0:03:22 > 0:03:25It is much deeper,
0:03:25 > 0:03:28and we are much closer,
0:03:28 > 0:03:34his role in my life, so he is elder brother.
0:03:34 > 0:03:37Is elder brother.
0:03:37 > 0:03:40A BELL PEALS
0:03:49 > 0:03:53TRANSLATION:
0:04:12 > 0:04:14A DOG YAPS
0:05:39 > 0:05:40I first went out to Kiev in 1992,
0:05:40 > 0:05:44as I'd been asked to give some lectures on brain surgery there.
0:05:44 > 0:05:46When I was there,
0:05:46 > 0:05:50I visited one of the state hospitals and I was appalled
0:05:50 > 0:05:55to see a completely broken-down, bankrupt medical system.
0:05:57 > 0:06:01I was seeing medical problems, the like of which
0:06:01 > 0:06:05have not really been seen in the West for,
0:06:05 > 0:06:09at that time, maybe for 50 or 60 years.
0:06:09 > 0:06:12It was like going back in a time machine.
0:06:12 > 0:06:16And I remember talking to a Ukrainian doctor.
0:06:16 > 0:06:20I said I'd like to help, and he said, "It's a waste of time.
0:06:20 > 0:06:26"Anything you do is a drop in the ocean. The system will never change. Go away. You can't help."
0:06:26 > 0:06:33And I remember feeling, "Well, actually, no, I'm not going to accept that.
0:06:33 > 0:06:38"I can't really respect myself if, having seen so much suffering...
0:06:39 > 0:06:42"Surely I can do something to help."
0:06:45 > 0:06:50And then by chance, the next day, I met Igor.
0:06:53 > 0:06:57OK, it's my favourite painting.
0:06:57 > 0:07:02It's Ukrainian heroes, Cossacks, and we can compare
0:07:02 > 0:07:05Cossacks with neurosurgeons!
0:07:05 > 0:07:08There are many similarities between us,
0:07:08 > 0:07:13because they are happy because they won the battle,
0:07:13 > 0:07:16and the same happened with us
0:07:16 > 0:07:19after the successful surgery.
0:07:19 > 0:07:24Sometimes I suggest that I am in this place,
0:07:24 > 0:07:28and my colleagues sitting on the table.
0:07:28 > 0:07:33And, by the way, table means in surgery quite something,
0:07:33 > 0:07:36so it's Cossacks' table,
0:07:36 > 0:07:40but it can be surgical table also.
0:07:40 > 0:07:44So they are happy around the table,
0:07:44 > 0:07:47and we are also happy, and unhappy,
0:07:47 > 0:07:51around the neurosurgical table.
0:07:51 > 0:07:53So I like it very, very much.
0:07:54 > 0:07:57Because Igor was so extraordinary and so determined,
0:07:57 > 0:08:04he was basically questioning the official ideology of how medicine should be practised.
0:08:04 > 0:08:07- She is disabled...- Yes.
0:08:07 > 0:08:09- ..from the age of three years.- Yes.
0:08:09 > 0:08:12WOMAN SPEAKS IN UKRAINIAN
0:08:12 > 0:08:15- Because there is a tumour.- Yes.
0:08:15 > 0:08:19- There is no indications for neurosurgical treatment.- Yes.
0:08:19 > 0:08:23'As he tried to make things better, not surprisingly,
0:08:23 > 0:08:27'he had endless problems. He had death threats at one point.
0:08:27 > 0:08:31'He was sleeping in a different room every night. His department was closed.
0:08:31 > 0:08:35'God knows how many times he was sacked, his staff were sacked.
0:08:35 > 0:08:38'There were endless official committees of inquiry,
0:08:38 > 0:08:41'and I couldn't very well abandon him. I'd sort of set him up -
0:08:41 > 0:08:45'I'd brought him to the West and said, "Look! Brave new world,
0:08:45 > 0:08:47' "full of wonderful things and modern equipment."
0:08:47 > 0:08:53'So the more his professional rivals and enemies tried to destroy him,
0:08:53 > 0:08:55'the more I felt obliged to support him.
0:08:55 > 0:08:59'So I wrote articles in Ukrainian newspapers.
0:08:59 > 0:09:03'I went out to Ukraine and did unprecedented operations.
0:09:03 > 0:09:07'I provided him with secondhand medical equipment,
0:09:07 > 0:09:10'in a funny sort of way, all because of people trying to squash him.'
0:09:11 > 0:09:13This is the loose bits...
0:09:23 > 0:09:26CONGREGATION SINGS
0:10:25 > 0:10:28Is it out the front? Right.
0:10:28 > 0:10:33You get started, Patrick, with the head position we discussed.
0:10:33 > 0:10:35That's fine.
0:10:35 > 0:10:37Where's...? Oh, perforators.
0:10:37 > 0:10:40Have you got some perforators?
0:10:40 > 0:10:43- They are kind of...- They're what?
0:10:43 > 0:10:47- £100?- 100...- Come on! That's what they said!
0:10:47 > 0:10:49Three, four, five. Thank you very much.
0:10:49 > 0:10:51- You're welcome.- Thank you. I'll put those in my bag.
0:10:51 > 0:10:56- How many of these have you done before?- I've done three.
0:10:56 > 0:11:00- Three? On your own or with one of the attendants?- No, I did it.
0:11:00 > 0:11:03Well, because she's old, there should be loads of space.
0:11:03 > 0:11:06I have a very specific approach.
0:11:06 > 0:11:08So I'd have her...
0:11:08 > 0:11:12- See, like that.- Yeah. - Maybe a bit more...
0:11:12 > 0:11:15You'll find you're coming down almost vertically.
0:11:17 > 0:11:22- Presumably you used disposable perforators back then? - Almost exclusively.
0:11:22 > 0:11:25I'm trying to reuse them in Ukraine for my friend Igor.
0:11:25 > 0:11:28Well, it needn't replace the plastic clip.
0:11:28 > 0:11:30DRILLING
0:11:32 > 0:11:36Yes, I'm not sure I'll be doing the operating myself.
0:11:39 > 0:11:41That's it, that's fine.
0:11:41 > 0:11:43I think you'll find that cracks now.
0:14:13 > 0:14:17The really difficult thing about neurosurgery is knowing when to operate.
0:14:17 > 0:14:21The actual operating isn't so difficult.
0:14:21 > 0:14:26But the really difficult thing is balancing the risks of the operation
0:14:26 > 0:14:29against the risks of not operating.
0:14:36 > 0:14:39It's a bit like Russian roulette with two revolvers -
0:14:39 > 0:14:42you've got one revolver called treatment or surgery,
0:14:42 > 0:14:46and the other revolver, which is no treatment.
0:14:46 > 0:14:49And you have... It's like that with the patient.
0:14:49 > 0:14:53And you have to decide which to go for.
0:14:53 > 0:14:58Marian's epilepsy is caused by a brain tumour,
0:14:58 > 0:15:01which ultimately will kill him if it's not removed.
0:15:01 > 0:15:05He's being told in Ukraine it's inoperable.
0:15:05 > 0:15:07I think I can save him,
0:15:07 > 0:15:10but there's a very real risk I could wreck him in the process.
0:15:10 > 0:15:14Would you want to lose your personality or your intellect
0:15:14 > 0:15:15or your ability to think?
0:15:15 > 0:15:18Cos that's the sort of risks we're talking about.
0:16:02 > 0:16:07I'm trying to fill up my job plan, but every time
0:16:07 > 0:16:09I'm given a different password.
0:16:22 > 0:16:27I'm supposed to specify every few minutes of the day where I am and what I'm doing,
0:16:27 > 0:16:28as I was at school.
0:16:28 > 0:16:33Let's try that. Wednesday, ward round...
0:16:33 > 0:16:36It can't do more than one activity.
0:16:36 > 0:16:40All right, another activity, maybe...
0:16:40 > 0:16:45I do many things a day, but for some reason you can only put one thing in.
0:16:55 > 0:16:57..administrative meetings.
0:16:57 > 0:17:01I feel I shouldn't have to justify my existence like this, either.
0:17:01 > 0:17:04Tried to change that... Oh, bloody hell!
0:17:04 > 0:17:05Just...
0:17:06 > 0:17:13"The appropriate operation was started..."
0:17:13 > 0:17:15Now, will that save?
0:17:15 > 0:17:19Oh-h, bloody hell!
0:17:19 > 0:17:22I really just can't stand it any longer.
0:17:22 > 0:17:24I'll just go away...
0:18:25 > 0:18:28Igor, it's Henry. Hello.
0:18:28 > 0:18:29Hi.
0:18:29 > 0:18:36Look, I'm looking at the scans on the boy from Zolochiv again.
0:18:36 > 0:18:40The possible craniotomy, yeah?
0:18:40 > 0:18:42It's a question of when I meet him,
0:18:42 > 0:18:47trying to assess whether he could cope with this -
0:18:47 > 0:18:49whether he'd find it very stressful or not.
0:18:49 > 0:18:53Having holes drilled in your head while you're awake,
0:18:53 > 0:18:56and then the sound of the saw - it's extremely noisy
0:18:56 > 0:19:00and actually quite violent as you have to hold the patient's head quite strongly.
0:19:00 > 0:19:03Is everything else all right otherwise?
0:19:03 > 0:19:10And the plans for a doctor to see Tanya's mother, is that OK?
0:19:12 > 0:19:15..Minus 13 degrees in the daytime on Friday?
0:19:15 > 0:19:18So it may feel a bit more like winter when I'm there.
0:19:18 > 0:19:22And I'm told it's going to be hell at Heathrow
0:19:22 > 0:19:24because of all the skiers going to Austria.
0:19:24 > 0:19:29- Which wouldn't have happened if...? - No, if I flew straight to Kiev it wouldn't be a problem.
0:19:29 > 0:19:31Does anyone ski in Ukraine?
0:19:35 > 0:19:37STATION ANNOUNCEMENT
0:19:45 > 0:19:51I'm taking out some instruments again for Igor, old surplus ones,
0:19:51 > 0:19:56and I'm going to show him some very difficult operations he hasn't really done before.
0:19:56 > 0:20:00But what I'm thinking most about is going to see Tanya's mother.
0:20:00 > 0:20:06You might say why do I want to go and see the mother of a child who died several years ago?
0:20:06 > 0:20:10And I've had many patients who've died, many of them children.
0:20:10 > 0:20:13And I don't quite know the answer,
0:20:13 > 0:20:19but I just know I want to go and see Katya. I think about her and Tanya very often.
0:20:19 > 0:20:21Um...
0:20:21 > 0:20:26I suppose cos it was so much about hope,
0:20:26 > 0:20:30and failed hope, really.
0:20:31 > 0:20:32Um...
0:20:34 > 0:20:37..I can remember so clearly when I first met Tanya.
0:20:37 > 0:20:43She was very shy, and I remember she burst into tears when she was first brought into the room.
0:20:43 > 0:20:47She was very beautiful, but she had this lopsided face,
0:20:47 > 0:20:51cos half her face was paralysed because of the tumour.
0:20:53 > 0:20:55How could you see a young girl
0:20:55 > 0:20:58who was slowly dying from a brain tumour...
0:21:00 > 0:21:04..which in theory is curable, because it's not cancerous -
0:21:04 > 0:21:10how can you do nothing? How can you say, "Go away and die"?
0:21:10 > 0:21:16You'd say whatever the risks, whatever the costs, we've got to do something.
0:21:17 > 0:21:21Hope is more important than anything else in life.
0:21:21 > 0:21:25And as Katya said to me, "You gave us hope."
0:21:25 > 0:21:27And that's a very precious thing to give.
0:21:27 > 0:21:32Tanya's tumour was said to be inoperable in Ukraine,
0:21:32 > 0:21:34so I brought her to London.
0:21:34 > 0:21:36But things went horribly wrong.
0:21:38 > 0:21:42During the first operation, Tanya lost her circulating blood volume
0:21:42 > 0:21:45four times over. It was an appalling operation.
0:21:45 > 0:21:47There was a second operation,
0:21:47 > 0:21:51and I tried to remove the rest of the tumour,
0:21:51 > 0:21:54but everything went catastrophically wrong.
0:21:56 > 0:21:58Cos of my operations,
0:21:58 > 0:22:03she had a terrible last two years to her life - paralysed, disabled.
0:22:03 > 0:22:06It couldn't really have been much worse.
0:23:13 > 0:23:19So today Henry is coming,
0:23:19 > 0:23:25and our favourite topic, it's what is the meaning of the life?
0:23:25 > 0:23:26What to do?
0:23:26 > 0:23:31Is it means to... to become professor?
0:23:31 > 0:23:37Or what it means to become a minister of the public health service.
0:23:37 > 0:23:41Or is it better to be a good doctor?
0:23:41 > 0:23:44Just to be a good doctor.
0:23:45 > 0:23:48To see patients every day,
0:23:48 > 0:23:51to listen them and try to help them.
0:25:33 > 0:25:36Surgery is a risky business,
0:25:36 > 0:25:41but neurosurgery...it is 100 times more risky business.
0:25:41 > 0:25:44Marian came to our office.
0:25:46 > 0:25:50He is more or less...OK.
0:25:50 > 0:25:54But he can...can be...
0:25:54 > 0:25:59disabled, totally disabled, tomorrow or the day after tomorrow.
0:25:59 > 0:26:05And it...will be our wrong decision...
0:26:05 > 0:26:10It's a responsibility. It's a moral responsibility.
0:26:17 > 0:26:23- Ah, tired.- Tired? - Yeah, a bit tired.- Quite tired. - I got up at 2.30 in London.
0:26:23 > 0:26:27- And I came via Vienna.- Why you chose Vienna?- Because there was a strike.
0:26:27 > 0:26:31- I've got some amazing things for you in there.- Really?
0:26:31 > 0:26:35Quite amazing! Oh, totally legal! I mean, it's fine!
0:26:35 > 0:26:39It's staggering what gets thrown away.
0:26:39 > 0:26:41You will not believe what I've got.
0:26:41 > 0:26:46- And how are you?- Actually, I'm very well. It's always good to be here!
0:26:46 > 0:26:48Nice to escape the NHS,
0:26:48 > 0:26:49I can tell you!
0:26:51 > 0:26:53Oh, fantastic.
0:26:53 > 0:26:57The ambulance! How's your poor old car?
0:26:57 > 0:27:01At least two months to repair it.
0:27:12 > 0:27:16You said there was another investigation against you recently,
0:27:16 > 0:27:19in the hospital. What was the result of that?
0:27:19 > 0:27:23It is more or less normal to be investigated
0:27:23 > 0:27:26- in this country.- Yeah. - If you are successful,
0:27:26 > 0:27:31- it means that your life will be... - Difficult.- ..difficult.- Yep.
0:27:31 > 0:27:35We say in English, if you stick your head up above the parapet,
0:27:35 > 0:27:39above the wall, you are likely to have it cut off.
0:27:56 > 0:28:00Actually, although I've been to Ukraine so many times,
0:28:00 > 0:28:03- this is the first time I've seen the Dnieper frozen.- Oh?
0:28:03 > 0:28:05It's exciting. I like that.
0:28:05 > 0:28:09It's very good. And it's going to be much colder this week, isn't it?
0:28:09 > 0:28:11Mm-hm.
0:28:29 > 0:28:33I suppose one of the most bizarre and ironic aspects
0:28:33 > 0:28:36of my work with Igor is that when I first met him,
0:28:36 > 0:28:40he was really a victim of the dictatorial Soviet medical system.
0:28:41 > 0:28:44But now, 15 years later,
0:28:44 > 0:28:50he's running a very humane clinic in rooms rented in the hospital run by the KGB.
0:28:53 > 0:28:56BELL RINGS
0:28:56 > 0:29:01And the explanation is that many things have changed in the Ukraine.
0:29:01 > 0:29:05The country is now a democracy.
0:29:05 > 0:29:08And the KGB are keen to support doctors
0:29:08 > 0:29:12who will carry Ukrainian medicine hopefully forwards to a new future.
0:29:16 > 0:29:20They even have a lunchtime karaoke concert for the staff.
0:29:20 > 0:29:23MUSICAL INTRO PLAYS
0:29:45 > 0:29:48I'll get my coat off. Well, it's still...
0:29:48 > 0:29:50I've been doing this for 15 years,
0:29:50 > 0:29:54but being faced by this whole corridor of people,
0:29:54 > 0:29:58most of whom are going to have quite horrendous neurosurgery -
0:29:58 > 0:30:01still I find it very frightening, in a way. Quite daunting.
0:30:01 > 0:30:06Hope - and a lot of it is going to be hope disappointed.
0:30:06 > 0:30:09I'm a last port of call.
0:30:09 > 0:30:12I sometimes feel I raise false hope by coming here.
0:30:16 > 0:30:21One thing, there are various things you asked me for. I think you'll be quite interested.
0:30:21 > 0:30:24Here are just a few...
0:30:24 > 0:30:25throwaway perforators.
0:30:25 > 0:30:30Do you know, they cost £80 each, and they're thrown away after one use.
0:30:30 > 0:30:32I'll take these all out,
0:30:32 > 0:30:36and you can leave them there.
0:30:38 > 0:30:42This is the Ojemann stimulator we'll need - I have to take that back to London.
0:30:42 > 0:30:44That's the cortical stimulator.
0:30:44 > 0:30:47- Special drills?- Yep, they're all here. That's the drill bits.
0:30:47 > 0:30:51- There's even a craniotome. - It's a nice toy.- Oh, it's superb.
0:30:51 > 0:30:53And then you connect that there.
0:30:53 > 0:30:55Thank you, Henry.
0:30:55 > 0:30:58Right, well, look, if I could have some coffee, Igor Petrovich...
0:30:58 > 0:31:01HE SHOUTS IN UKRAINIAN
0:31:01 > 0:31:05Then maybe we should start seeing some patients.
0:31:05 > 0:31:10Otherwise Igor will be here all day, playing with the tools.
0:31:10 > 0:31:12Um... Oh!
0:31:13 > 0:31:16Thank you.
0:31:45 > 0:31:50You see, a chordoma destroys bone. This cannot be a chordoma, if you mean chordoma.
0:32:06 > 0:32:07HE SPEAKS UKRAINIAN
0:32:17 > 0:32:23- People...they stay outside... - MOBILE RINGS
0:32:23 > 0:32:28- ..in the queue... - Oh, they're ringing you?- Yeah!
0:32:35 > 0:32:38It's a child
0:32:38 > 0:32:40in their family.
0:32:40 > 0:32:43She is a grandma.
0:32:44 > 0:32:48I would judge that tumour to be inoperable, basically.
0:32:48 > 0:32:52I mean, it's in the brainstem.
0:32:52 > 0:32:56I'm afraid the child has less than a year to live.
0:32:56 > 0:32:59IGOR TRANSLATES
0:33:05 > 0:33:09Obviously, as parents and as grandparents,
0:33:09 > 0:33:13we find it very, very difficult to do nothing.
0:33:13 > 0:33:14It's very hard.
0:33:14 > 0:33:17IGOR TRANSLATES
0:33:21 > 0:33:23SHE ASKS A QUESTION
0:33:23 > 0:33:26So what to do? Something to do?
0:33:26 > 0:33:28My opinion is
0:33:28 > 0:33:33there is nothing to do but wait for the child to die.
0:33:33 > 0:33:35IGOR TRANSLATES
0:33:43 > 0:33:46Life can be very cruel.
0:33:58 > 0:34:00Oh, I'm sorry.
0:35:06 > 0:35:08MOBILE PHONES RING
0:35:14 > 0:35:18Without surgery, she probably...
0:35:18 > 0:35:23she probably will die within the next five years or so.
0:35:23 > 0:35:26Surgery is safer than no surgery.
0:35:26 > 0:35:32And she will continue to... she will continue to get worse
0:35:32 > 0:35:34as time goes by.
0:35:35 > 0:35:38All these cases I'm seeing,
0:35:38 > 0:35:41I would operate on them all in London, without any hesitation.
0:35:41 > 0:35:45Sure, there are risks, but I would be reasonably confident.
0:35:45 > 0:35:50I'd be quite certain that the risks of treatment,
0:35:50 > 0:35:54the risks of surgery, were less than the risks of no surgery.
0:35:54 > 0:35:59But when you translate that into the circumstances here,
0:35:59 > 0:36:03it's different, and it's much more difficult to know.
0:36:03 > 0:36:07So in that sense, it's...it's very frustrating.
0:36:07 > 0:36:11There are all these salvageable people.
0:36:11 > 0:36:14Ah!
0:36:29 > 0:36:33So you're looking for a... In English, it's called a jubilee clip.
0:36:33 > 0:36:37- Yeah. Many things I bought in this place.- Yes.
0:36:37 > 0:36:41- For the clinic.- Oh, really? For the hospital. Yes.
0:36:43 > 0:36:45There we are.
0:36:45 > 0:36:49That was slightly better quality than the other one, I think.
0:36:49 > 0:36:53- It's better made. It's better metal...- Very nice.
0:36:53 > 0:36:57They've got bearings here as well, which I need.
0:37:00 > 0:37:06I wish I knew the size. Did you buy your Bosch drill in a place like this?
0:37:06 > 0:37:08Er, yes.
0:37:08 > 0:37:11Do they do a 24-volt...?
0:37:11 > 0:37:12No, no.
0:37:12 > 0:37:16It's not really strong enough, that cordless drill, is it?
0:37:39 > 0:37:44Now, the problem with trying to remove all of the tumour
0:37:44 > 0:37:49is there is some risk, there is some danger,
0:37:49 > 0:37:53that the operation could leave you paralysed down the right.
0:37:53 > 0:37:58The tumour is on the left - the left side of the brain is responsible for the right side of the body.
0:37:58 > 0:38:02And there is a risk, if we try to remove all of the tumour,
0:38:02 > 0:38:06of producing paralysis of the right arm and the right leg.
0:38:12 > 0:38:17Usually, we have the patient under a general anaesthetic to begin with
0:38:17 > 0:38:22when we make the opening, the incision in the head and the bone.
0:38:22 > 0:38:26And then we wake the patient up and remove the tumour.
0:38:41 > 0:38:47So I think it would be simpler, and we have a better chance of success,
0:38:47 > 0:38:52if you are awake throughout the whole time of the operation.
0:39:19 > 0:39:22It makes the operation safer,
0:39:22 > 0:39:25because it makes the surgeon braver!
0:39:25 > 0:39:29Because I know I can see what I am doing. I can see you,
0:39:29 > 0:39:31I can talk to you,
0:39:31 > 0:39:34I can ask you to move your arm and leg, and that gives us
0:39:34 > 0:39:38a much, much better chance of removing all of the tumour.
0:39:46 > 0:39:51There will then be about ten minutes, which is not painful, but is unpleasant.
0:39:51 > 0:39:56That is when Dr Kurilets is sawing, cutting through the bone
0:39:56 > 0:40:03of your skull. That is very noisy, and you'll feel the pressure of the drill pushing on your head.
0:40:03 > 0:40:07Um, and that is unpleasant, but it's OK.
0:40:11 > 0:40:14The only part of the head which feels pain is the skin.
0:40:14 > 0:40:16That is all.
0:40:16 > 0:40:19The brain itself does not feel pain.
0:40:19 > 0:40:22So in a strange...in a strange way,
0:40:22 > 0:40:27to remove a brain tumour under local anaesthetic
0:40:27 > 0:40:31is no different from going to the dentist.
0:40:31 > 0:40:35And I really, really think we can do this,
0:40:35 > 0:40:38and I mean that from my heart.
0:40:38 > 0:40:40- OK?- OK.- Harasho?- Harasho.
0:40:51 > 0:40:54Right. We have a plan.
0:40:55 > 0:41:00- The most important, to put the plan into action.- Yes.
0:41:00 > 0:41:03Making plans, it's a Soviet...
0:41:03 > 0:41:07- Yeah, all right.- Soviet...- Soviet National Health Service.
0:41:07 > 0:41:10The National Health Service has nothing but plans now.
0:41:10 > 0:41:13But making plans, it is nothing.
0:41:44 > 0:41:46I've yet to have a...
0:41:46 > 0:41:49a catastrophic result here in Ukraine but...
0:41:49 > 0:41:51you know, I think the law...
0:41:51 > 0:41:56Sooner or later, things are going to go badly.
0:41:56 > 0:42:00But nothing ventured, nothing gained, I suppose.
0:42:02 > 0:42:05However much you tell patients there is risk...
0:42:05 > 0:42:08they never really take it in.
0:42:08 > 0:42:11If you're very nice and charming with them, they will trust you
0:42:11 > 0:42:13and think, "I'll be all right." That's human nature.
0:42:13 > 0:42:16We all think, "It's never going to happen to me."
0:42:36 > 0:42:38Are you ready to eat?
0:42:38 > 0:42:41Uh...let us play for ten minutes first, if that's all right.
0:42:41 > 0:42:46Look at this perforator. I'm sure we could use it dozens of times.
0:42:46 > 0:42:50It may be you can just make a metal sleeve to go over it.
0:42:50 > 0:42:55- You said your toolmaker has died, alas.- Yes. From brain tumour.- Yeah.
0:42:55 > 0:43:00He did a lot of good work for you. He made the operating table as well.
0:43:00 > 0:43:03And the bar for sitting position.
0:43:03 > 0:43:06- He made that?- Yes.- That's very sad. He made it very nicely.
0:43:06 > 0:43:09Need a pair of circlet pliers.
0:43:10 > 0:43:13My department, I calculated - it's unbelievable -
0:43:13 > 0:43:19- it spends £40,000 a year...- A year? - ..just on those.
0:43:19 > 0:43:21We use ten a week. They cost £80 each.
0:43:21 > 0:43:23We must use at least ten a week.
0:43:23 > 0:43:25Which is...
0:43:25 > 0:43:28800 quid a week, times 50.
0:43:28 > 0:43:29I mean, it's...
0:43:30 > 0:43:32..extraordinary.
0:43:32 > 0:43:35I use one for...
0:43:35 > 0:43:37- ten years.- Yeah, I know.
0:43:38 > 0:43:42- So it is a plastic...- There's a plastic thing there, yeah.
0:43:42 > 0:43:45There's millions of pounds a year being thrown away.
0:43:45 > 0:43:48If you had tungsten carbide tipped ones
0:43:48 > 0:43:51like you have for a router in woodworking, it would last for ever.
0:44:10 > 0:44:15- Now you've got the compressed air hose for the ventilator.- Yes.
0:44:15 > 0:44:17It fits.
0:44:17 > 0:44:19I...
0:44:20 > 0:44:23..made fixing here.
0:44:23 > 0:44:25- So we will try.- Bye-bye.
0:44:25 > 0:44:27See you tonight.
0:44:27 > 0:44:28Good luck.
0:44:28 > 0:44:29Thank you.
0:44:34 > 0:44:36You like my idea?
0:44:36 > 0:44:38Yep, fine.
0:44:38 > 0:44:40In England, I don't have to...
0:44:40 > 0:44:44plumb in the ventilators myself. We have somebody else to do that.
0:44:44 > 0:44:47You're just a one-man hospital.
0:44:47 > 0:44:50My job is to do the operation.
0:44:50 > 0:44:53- You're privileged. - Yes.- Very privileged.
0:45:01 > 0:45:04I must be responsible for everything.
0:45:04 > 0:45:07LIFT RUMBLES
0:45:07 > 0:45:08It's a long journey.
0:45:08 > 0:45:10Well, um...
0:45:10 > 0:45:1150 seconds.
0:45:11 > 0:45:13HENRY LAUGHS
0:45:15 > 0:45:18So...hundred seconds...each day.
0:45:18 > 0:45:23I saw some of those new apartment blocks they're building.
0:45:23 > 0:45:25They're 40 storeys high.
0:45:27 > 0:45:29Right, here we go.
0:45:29 > 0:45:31A difficult day.
0:46:44 > 0:46:47And can she see any light?
0:46:47 > 0:46:50And is the light in her eye now?
0:46:55 > 0:46:56Yes.
0:47:01 > 0:47:03So she's not seeing light.
0:47:06 > 0:47:10- I think...- How much time we have? - No, it's too late.
0:47:10 > 0:47:12Totally blind. It's too late.
0:47:12 > 0:47:15You have to operate for raised intracranial pressure
0:47:15 > 0:47:18before they completely lose their eyesight.
0:47:24 > 0:47:29Typical problem here, cos diagnosis is so often delayed,
0:47:29 > 0:47:32and by the time a brain scan is done...
0:47:32 > 0:47:35the damage is done.
0:47:35 > 0:47:40Even with benign tumours, people have gone blind and suffered irreversible damage.
0:47:40 > 0:47:43You get earlier diagnosis if you have more scanners,
0:47:43 > 0:47:47but even though a brain scan in the Ukraine costs 50 to 100,
0:47:47 > 0:47:50even 50 to 100 to many people here is a huge sum of money
0:47:50 > 0:47:53and they can't afford it,
0:47:53 > 0:47:55and so things get left. Left too late.
0:48:19 > 0:48:25We cannot run good treatment of the patients
0:48:25 > 0:48:30in...in our...hospitals.
0:48:30 > 0:48:35How far away do you think you are from actually starting building your own hospital?
0:48:35 > 0:48:39It depends on...on finance.
0:48:39 > 0:48:40Yeah.
0:48:40 > 0:48:44- And you had to borrow the money, presumably, from...?- We can,
0:48:44 > 0:48:49but it is very difficult to run clinic if you have...
0:48:49 > 0:48:52- A large mortgage?- Yes.- Yeah.
0:48:52 > 0:48:53From bank, so...
0:48:53 > 0:48:55This will be a first in Ukraine.
0:48:55 > 0:48:58So, here we are.
0:48:58 > 0:49:00- Yep.- That's the place.
0:49:00 > 0:49:03Oh. What a dream, heh?
0:49:03 > 0:49:05- Is it your dream?- Yeah.- Must be.
0:49:05 > 0:49:07Your own hospital, Igor.
0:49:07 > 0:49:09No, no! It's...
0:49:09 > 0:49:12- That's a field.- Yeah, I know, but... - Now it's a field.
0:49:12 > 0:49:15But it's a field of dreams.
0:49:15 > 0:49:16Yes.
0:49:16 > 0:49:17So...
0:49:17 > 0:49:19This is where it'll be?
0:49:20 > 0:49:23Isn't it fantastic?
0:49:23 > 0:49:25So exciting.
0:49:25 > 0:49:28Igor, this can be the ornamental lake...
0:49:28 > 0:49:30- Yeah?- ..for the hospital.
0:49:30 > 0:49:32HENRY LAUGHS
0:49:32 > 0:49:33I like it.
0:49:39 > 0:49:44- So the building will be there.- Here? - Will be here.
0:49:44 > 0:49:46It's a water pipe.
0:49:46 > 0:49:49Deep water pipe here.
0:49:49 > 0:49:53And the patients' rooms will look onto the courtyard?
0:49:53 > 0:49:56- Yes.- And there'll be a garden in the courtyard?- Yes.- That's wonderful.
0:49:56 > 0:50:03- The lake there...- Yes.- ..so we can go there.- And the lake is over here.
0:50:07 > 0:50:13And concerning grass, I would prefer natural grass
0:50:13 > 0:50:16- and not changing it.- Yes.
0:50:18 > 0:50:20It's filled with fish.
0:50:20 > 0:50:22Be careful!
0:50:22 > 0:50:25I'm not sure that it is strong enough.
0:50:25 > 0:50:28It looks pretty thick to me.
0:50:28 > 0:50:29- Are you happy?- Yes, yes.
0:50:29 > 0:50:32- Henry... - It's all very, very exciting.
0:50:32 > 0:50:34CAMERA CLICKS
0:50:37 > 0:50:40Igor, it's so important to have good design in hospitals
0:50:40 > 0:50:42cos hospitals are like prisons.
0:50:42 > 0:50:46They are places where a small number of people are doing nasty things
0:50:46 > 0:50:49to a large number of people.
0:51:01 > 0:51:02Nice weather(!)
0:52:29 > 0:52:32You do realise this is a very big, serious case, don't you?
0:52:32 > 0:52:34The one we're going to do now.
0:52:34 > 0:52:35Yes, Henry.
0:52:35 > 0:52:38- A risky surgery. - And the patient realises?
0:52:38 > 0:52:43The problem is that if you run a successful clinic,
0:52:43 > 0:52:48so nobody realises how risky surgery CAN be.
0:52:48 > 0:52:50- Can be.- I know. But you gotta tell them.
0:52:50 > 0:52:52Yes, I told them.
0:52:52 > 0:52:54- Told them. But they reply that... - They go like that?
0:52:54 > 0:53:00..that you...you...you had... good results.
0:53:00 > 0:53:05We asked many patients, so we suggest that...
0:53:05 > 0:53:09Yeah, but with simpler, smaller tumours. This is a terrible big tumour.
0:53:09 > 0:53:12You become less enthusiastic with years.
0:53:12 > 0:53:16What a load of crap! It's not that! It's just you're giving me more and more difficult...
0:53:16 > 0:53:20You're showing me more and more difficult operations. That's the problem.
0:53:20 > 0:53:22That's what it's about.
0:53:22 > 0:53:27Every time I come, you show me a bloody more dangerous operation.
0:53:27 > 0:53:32But you told that we should, step by step, make progress.
0:53:32 > 0:53:35Yeah, but one day we're going to make a step too far.
0:53:40 > 0:53:42Bloody Cossacks!
0:53:42 > 0:53:45HENRY MUMBLES
0:53:45 > 0:53:50Now that the die is cast, we're actually going to start the operation,
0:53:50 > 0:53:51I cheer up a bit.
0:53:51 > 0:53:53A certain amount of...
0:53:53 > 0:53:56Whether it's blood lust or training, I'm not quite sure.
0:53:56 > 0:54:00Surgery isn't just about rational altruism.
0:54:00 > 0:54:03I mean, it's a blood sport, in a way.
0:54:03 > 0:54:06Surgeons become surgeons for the excitement of it,
0:54:06 > 0:54:09and the sort of fierce joy of operating.
0:54:09 > 0:54:13So, in that sense, I suppose it is a slightly Cossack activity.
0:54:13 > 0:54:18You know, a sort of brave Ukrainian heroism, things like that.
0:54:20 > 0:54:22Right, well, off to battle.
0:54:44 > 0:54:47Everything is possible.
0:54:57 > 0:55:02Tell him it'll hurt a little bit, like being stung by a bee,
0:55:02 > 0:55:04when he puts the local anaesthetic in there.
0:55:10 > 0:55:12- Bomkee?- Bomkee?
0:55:12 > 0:55:15Bomkee is the word for bigger mosquitos.
0:55:15 > 0:55:18A bigger bomkee is a bigger mosquito? Yes.
0:55:18 > 0:55:20It's a Western Ukrainian word.
0:55:20 > 0:55:25Dr Kurilets is a bomkee. He is a big mosquito. Many people think he is a mosquito.
0:55:25 > 0:55:29He is a mosquito for the medical establishment. Aren't you, Igor?
0:55:29 > 0:55:32MACHINE BEEPS
0:55:34 > 0:55:39- That's fine. That's fine from this side, Igor. Is that all right for you?- Yes.
0:55:39 > 0:55:44Because this cage is rigidly fixed, he can do anything he likes.
0:55:48 > 0:55:50No, no, no, not at all.
0:55:50 > 0:55:52Dr Kurilets is quite happy up there.
0:55:54 > 0:55:57I can hear something scratching.
0:56:14 > 0:56:18It'll get very noisy when Dr Kurilets starts drilling,
0:56:18 > 0:56:23cos the whole skull will act like the sound board of a piano.
0:56:23 > 0:56:25So it'll be very, very loud.
0:56:32 > 0:56:34DRILLING
0:56:45 > 0:56:49A colleague of mine, a neurosurgeon, once did an experiment
0:56:49 > 0:56:52where he had a colleague of his drill a hole in his head.
0:56:52 > 0:56:55It was some scientific experiment
0:56:55 > 0:56:59with putting an electric wire into the inside of his head
0:56:59 > 0:57:00to measure the pressure.
0:57:00 > 0:57:02I mean, crazy.
0:57:02 > 0:57:04But he said it was very noisy,
0:57:04 > 0:57:07having the hole drilled in his head.
0:57:08 > 0:57:10- He can't hear anything.- He can't?
0:57:10 > 0:57:12Ah! That's interesting.
0:57:17 > 0:57:19He can't hear our voice cos of the noise. Yes, yes.
0:57:19 > 0:57:21Yeah.
0:57:21 > 0:57:25I think the 24-volt version might be better, Igor.
0:57:25 > 0:57:27DRILL SLOWS
0:57:33 > 0:57:35The battery's a bit flat.
0:57:35 > 0:57:38DRILL SLOWS FURTHER
0:57:39 > 0:57:41DRILLING STOPS
0:57:41 > 0:57:42- All the holes done.- Good.
0:57:42 > 0:57:45All right. Yeah.
0:57:47 > 0:57:48Yeah, OK.
0:57:57 > 0:58:01Igor's operating theatre is a little bit on the small side
0:58:01 > 0:58:04for all the equipment in it.
0:58:04 > 0:58:06Now...
0:58:10 > 0:58:12SUCKING NOISE
0:58:13 > 0:58:15What's he saying now?
0:58:15 > 0:58:19- He's already used to these sensations.- He's getting used to it? He's bored, yes!
0:58:19 > 0:58:23He'll probably fall asleep. We'll have to abandon the operation!
0:58:31 > 0:58:33- He'll fall asleep?- No! - He won't fall asleep?- No.
0:58:35 > 0:58:37HISS OF AIR
0:58:37 > 0:58:38We're now...we're now...
0:58:38 > 0:58:40Igor is now cutting through the skull.
0:58:42 > 0:58:45LOUD DRILLING
0:58:55 > 0:58:59To have a pulse rate of 70 while you're lying there
0:58:59 > 0:59:02having your head sawn off is, um...
0:59:02 > 0:59:03quite something!
0:59:09 > 0:59:13We'll start removing the tumour in five, ten minutes.
0:59:16 > 0:59:18That's the most important thing.
0:59:18 > 0:59:21Igor, I'll go and get scrubbed up.
0:59:21 > 0:59:24I'm feeling extremely tense at the moment.
0:59:24 > 0:59:27Admittedly, I always do before serious operations.
0:59:27 > 0:59:31I suppose it's like stage fright with experienced actors.
0:59:31 > 0:59:34The worst of all surgical sins is complacency,
0:59:34 > 0:59:39so a certain anxiety, I suspect, is necessary.
0:59:39 > 0:59:42And yet it's always a critical moment -
0:59:42 > 0:59:45will we be able to see the tumour clearly
0:59:45 > 0:59:48and is it going to be straightforward or not?
0:59:48 > 0:59:50Right.
0:59:50 > 0:59:53Igor, hang on a moment. Let's have a look.
0:59:53 > 0:59:55Where is the tumour?
0:59:55 > 0:59:58- Maybe here.- What do you mean, maybe here?
1:00:07 > 1:00:08Thank you.
1:00:08 > 1:00:12All right. Now, um... Yes, Igor, come and have a look.
1:00:12 > 1:00:16I think we can tell the difference.
1:00:16 > 1:00:19That's a little bit discoloured, but that's certainly abnormal.
1:00:19 > 1:00:23We know from the scan there's a big vein. We'll try to preserve it,
1:00:23 > 1:00:25but I think that'll be very difficult.
1:00:25 > 1:00:29I think, probably, the edges of the tumour are like that.
1:00:29 > 1:00:32So let's have the cortical stimulator now.
1:00:32 > 1:00:33The leads plug in the front.
1:00:33 > 1:00:37The two contacts... Put it there, facing up.
1:00:37 > 1:00:40- Put it here?- It doesn't matter. OK.
1:00:40 > 1:00:42I'm going to touch an electrode on his brain.
1:00:42 > 1:00:47He might feel his arm or his leg move, all right?
1:00:47 > 1:00:50CRACKLING
1:00:50 > 1:00:52All right?
1:00:53 > 1:00:57Ah, got him! That's motor here, do you see?
1:00:57 > 1:01:01OK, Marian, I'll make your hand jump.
1:01:01 > 1:01:04It's like a doll with strings. Here we go. Ready? Watch.
1:01:04 > 1:01:06There. See?
1:01:06 > 1:01:08So we're in front of the motor strip.
1:01:08 > 1:01:11No more, because I don't want to start a fit.
1:01:11 > 1:01:13Marian, OK?
1:01:13 > 1:01:15- OK. OK.- Well done.
1:01:15 > 1:01:17Right, we can turn that off now.
1:01:17 > 1:01:22So what we need to do now is open it, which we know is safe here,
1:01:22 > 1:01:25because the motor mapping, which was very easy,
1:01:25 > 1:01:27has shown us where the motor is.
1:01:27 > 1:01:28That's tumour.
1:01:31 > 1:01:37Normal brain has the consistency of very smooth cream cheese,
1:01:37 > 1:01:41fairly thick cream cheese,
1:01:41 > 1:01:43and tumours make it rubbery.
1:01:43 > 1:01:46It's slightly more rubbery and stickier and thicker.
1:01:46 > 1:01:50- SUCKING NOISE - This is all tumour, Igor.
1:01:50 > 1:01:51Tumour?
1:01:51 > 1:01:53- Karena?- Yes?
1:01:53 > 1:01:58You can tell Marian that the beastly tumour that has been ruining his life
1:01:58 > 1:02:02for so many years, I'm now starting to remove it.
1:02:02 > 1:02:04SUCKING NOISE
1:02:04 > 1:02:09You can feel, with the sucker, that that is too firm.
1:02:09 > 1:02:13That's possibly the edge. All this is tumour.
1:02:13 > 1:02:14It's actually very nice.
1:02:14 > 1:02:16This is very clear.
1:02:19 > 1:02:20LOUD SUCKING NOISE
1:02:32 > 1:02:35QUIETER SUCKING NOISE
1:02:37 > 1:02:39See what his movements are like.
1:02:39 > 1:02:42Marian is the reassuring check.
1:02:42 > 1:02:46By seeing he can move his right side
1:02:46 > 1:02:52as we continue, I know that I'm not producing any serious weakness
1:02:52 > 1:02:58in his arm as I take the tumour out. Which makes me braver.
1:03:02 > 1:03:04- Are you all right?- Yeah.- OK.
1:03:13 > 1:03:14He's having a fit.
1:03:14 > 1:03:16He's having a fit?
1:03:16 > 1:03:18A big fit? Is Obsidenenko there?
1:03:24 > 1:03:26Is he having a fit?
1:03:28 > 1:03:30What's he saying?
1:03:30 > 1:03:33He's... I don't know. He's strange to me.
1:03:35 > 1:03:40Can somebody sort him out, please? I can't sort him out. Is he having a fit at the moment?
1:03:44 > 1:03:48Could he talk to him and see if he thinks he's all right?
1:04:11 > 1:04:14Dry throat. Can we give him a drink?
1:04:14 > 1:04:18Yes. Can we give him some water, please, to wet his throat?
1:04:28 > 1:04:31- So, Marian, OK?- OK.
1:04:31 > 1:04:35Everything all right? Is he in pain? Or is he fairly comfortable?
1:04:39 > 1:04:42- No more? Is he all right?- Yeah.
1:04:42 > 1:04:45Everything is going fine. I'm happy.
1:04:45 > 1:04:47Everything is fine.
1:05:07 > 1:05:10When we're thinking or talking,
1:05:10 > 1:05:13that is billions of electrical impulses
1:05:13 > 1:05:17travelling along all these nerve fibres,
1:05:17 > 1:05:21but I always find it virtually impossible, even when the patient's awake,
1:05:21 > 1:05:26to look at the physical substance of the brain we're operating on,
1:05:26 > 1:05:30and I can't really comprehend that this is thought itself.
1:05:30 > 1:05:32Feeling itself.
1:05:32 > 1:05:35It's just too crazy and extraordinary.
1:05:35 > 1:05:36But that's what it is.
1:05:36 > 1:05:43And that is the absolutely incontrovertible evidence of modern neuroscience.
1:05:43 > 1:05:45Thought is a physical process.
1:05:45 > 1:05:47We are our brain.
1:05:50 > 1:05:52- All right, Igor?- Yeah.
1:06:06 > 1:06:07- Igor?- He just moved.
1:06:07 > 1:06:11- His hand...- He's moving all right, is he?- Yeah.- Good.
1:06:11 > 1:06:14Tell Marian I've removed the tumour.
1:06:17 > 1:06:19The tumour is gone. Hurrah!
1:06:23 > 1:06:26Let us hope a new life can begin, hey?
1:06:26 > 1:06:29We hope. We say in English, "Fingers crossed."
1:06:29 > 1:06:31Fingers crossed!
1:06:36 > 1:06:39Oh... Yeah, yeah.
1:06:39 > 1:06:40OK.
1:06:42 > 1:06:44Thank you.
1:06:49 > 1:06:51OK.
1:06:52 > 1:06:55OK?
1:07:22 > 1:07:23..Full stop.
1:07:37 > 1:07:39- Are you tired?- No, not particularly.
1:07:39 > 1:07:42- Hello.- Irena, good evening.
1:07:42 > 1:07:43Mr Marsh.
1:07:43 > 1:07:45Hello.
1:07:45 > 1:07:47He's very tired.
1:07:47 > 1:07:50I'm not very tired!
1:07:50 > 1:07:53I've just got a stiff back, that's all.
1:07:53 > 1:07:55So am I.
1:07:55 > 1:07:57Oh...
1:07:57 > 1:08:00The beer will be here.
1:08:00 > 1:08:03Domestic goddess, full-time cardiologist
1:08:03 > 1:08:05and domestic goddess... Oh...
1:08:05 > 1:08:07What?
1:08:07 > 1:08:10It went all right today. It was a big, big tumour.
1:08:10 > 1:08:13- And how is the patient? - He's all right.
1:08:16 > 1:08:19Is there a bottle-opener in there, Igor?
1:08:25 > 1:08:27- Here you are.- Thank you very much.
1:08:27 > 1:08:31I have now taught you everything I know about brain surgery.
1:08:31 > 1:08:34You're a wonderful teacher.
1:08:34 > 1:08:36You've now picked my brain clean.
1:08:39 > 1:08:42The only problem... The only problem...
1:08:42 > 1:08:45that we can kill patients.
1:08:45 > 1:08:47- Yes.- With it.
1:08:47 > 1:08:49And probably will. That's the problem.
1:08:49 > 1:08:55In Ukrainian conditions, a few deaths, medically, are acceptable.
1:08:55 > 1:08:58The tumours are so big and the conditions so difficult,
1:08:58 > 1:09:02but politically, only you can decide whether...
1:09:02 > 1:09:05Thank you ever so much, Irena.
1:09:05 > 1:09:08And they will advertise the bad case...
1:09:08 > 1:09:12- Well, your very good health. - Thank you.
1:09:44 > 1:09:47Well, if it's not too cold next week,
1:09:47 > 1:09:52I would like to go down to Kamjanetsk-Podolski if possible.
1:09:52 > 1:09:58It would be important for me because Tanya was quite an important part of my life in many ways,
1:09:58 > 1:10:00and I still think about her and her mother a lot.
1:10:00 > 1:10:06- Yes, indeed. It was a lesson for us. - Yes. Yes, it was.
1:10:06 > 1:10:07It was a very important lesson.
1:10:19 > 1:10:22- Intensive care here?- Yeah.
1:10:30 > 1:10:32- There Marian is.- Mr Marsh.
1:10:32 > 1:10:34Marian.
1:10:34 > 1:10:37THEY SPEAK IN UKRAINIAN
1:10:37 > 1:10:38Hello.
1:10:38 > 1:10:40OK?
1:10:47 > 1:10:49Any fits at all?
1:10:49 > 1:10:51No fits.
1:10:51 > 1:10:53Arms up in the air.
1:10:53 > 1:10:55Turn the palms around.
1:10:55 > 1:10:57Right round. Close your eyes.
1:10:57 > 1:10:59That's very good.
1:10:59 > 1:11:02There's no significant... That's fine.
1:11:02 > 1:11:04So he's fine. He's going to be all right.
1:11:04 > 1:11:07The only question now is if we've abolished the epilepsy.
1:11:07 > 1:11:11I think we almost certainly have, but we have to wait.
1:11:11 > 1:11:13We can sit him right now?
1:11:13 > 1:11:16Yes, yes, of course. He can get up and about.
1:11:34 > 1:11:37- Can he walk? - He can do anything he likes now.
1:11:37 > 1:11:39Get him up and about.
1:11:53 > 1:11:56He'll feel a bit... He'll feel a bit dizzy,
1:11:56 > 1:12:01because he's been lying flat for the last day. But that's fine.
1:12:01 > 1:12:03What is...what is his treatment?
1:12:03 > 1:12:05Intravenous...?
1:12:05 > 1:12:08- Nothing.- Nothing?- Nothing.
1:12:08 > 1:12:11So...it was a last chance for him.
1:12:11 > 1:12:12Yes.
1:12:30 > 1:12:33It looks better in the scan.
1:12:35 > 1:12:38Although it's probably a low-grade glioma.
1:12:38 > 1:12:40Has she developed epilepsy?
1:12:46 > 1:12:48Why was the scan done?
1:13:10 > 1:13:12This, to me, looks like liomatosis.
1:13:12 > 1:13:17It's a widely infiltrating, diffuse low-grade glioma.
1:13:20 > 1:13:22Is it possible in her age...?
1:13:22 > 1:13:25- What, to get...?- 23.- Oh, yes. Yeah.
1:13:25 > 1:13:28What is her future?
1:13:28 > 1:13:30Um...not good.
1:13:30 > 1:13:36You cannot remove the tumour by surgery because it is too extensive.
1:13:40 > 1:13:42What can we advise her?
1:13:47 > 1:13:51Well, I... Nothing, I think, is the honest answer.
1:13:51 > 1:13:54I think, what would I do in London?
1:13:54 > 1:13:59Well, we'd do a biopsy operation and then refer her to my oncological colleagues.
1:13:59 > 1:14:02But, no, the prognosis is... is not a good one.
1:14:05 > 1:14:10How many years it will take...?
1:14:10 > 1:14:13I would have thought less than five.
1:14:13 > 1:14:16But she'll probably go blind first.
1:14:16 > 1:14:21But I don't know if it's appropriate to tell her that or not.
1:14:24 > 1:14:27She said that maybe it is a viral infection
1:14:27 > 1:14:33- because she was biting... - Bitten by an insect. Hmm.
1:14:33 > 1:14:35- Encephalitis.- Hmm.
1:14:36 > 1:14:38Is it possible?
1:14:38 > 1:14:44It's unlikely, but if that belief gives her some hope and happiness
1:14:44 > 1:14:47maybe it's better to stick with that possibility.
1:14:47 > 1:14:51- I do not know what to say. - I don't know...
1:14:51 > 1:14:54When I break really bad news to patients,
1:14:54 > 1:14:57I don't talk to them on their own.
1:14:57 > 1:15:02It's a complicated business. You have to find out what they know,
1:15:02 > 1:15:04what they fear, what they understand.
1:15:04 > 1:15:10It's not an easy... You can't just say, "This is a bad tumour. Goodbye."
1:15:10 > 1:15:15It takes time, and I think you need other members of the family present, as well.
1:15:59 > 1:16:03- We must give some hope.- Yes, I know. Exactly, exactly. It's all we can do.
1:16:03 > 1:16:06The reality is, although she's young and beautiful
1:16:06 > 1:16:08and looks very well,
1:16:08 > 1:16:10the reality is, she's going to go blind
1:16:10 > 1:16:14and die probably within the next two or three years.
1:16:14 > 1:16:20None of us, all human beings, we cannot look our own...
1:16:20 > 1:16:24Particularly at that age. You can't look your own death in the face
1:16:24 > 1:16:26and shrug it away. You can't.
1:16:26 > 1:16:32So a lot of dealing with people with inoperable brain tumours
1:16:32 > 1:16:36is giving hope when there isn't really any hope.
1:16:36 > 1:16:40So there's a lot of...not exactly dishonesty involved,
1:16:40 > 1:16:41but a lot of...
1:16:41 > 1:16:43You know...
1:16:46 > 1:16:51..avoiding the truth but trying not to lie, but it's terrible.
1:17:14 > 1:17:17INAUDIBLE
1:18:36 > 1:18:40I made what I felt, in retrospect, was a big mistake many years ago
1:18:40 > 1:18:43when I saw a young child, Tanya,
1:18:43 > 1:18:47with about the biggest brain tumour I'd ever seen.
1:18:47 > 1:18:50It was a benign tumour, so in theory it was curable.
1:18:50 > 1:18:54But again, the diagnosis had been missed and delayed.
1:18:54 > 1:18:56In a sense, I was being sentimental.
1:19:01 > 1:19:03I had been swayed by emotion.
1:19:06 > 1:19:10But it's so very difficult to cross to the other side of a street.
1:19:10 > 1:19:12It's so very difficult to say no.
1:20:00 > 1:20:07And I remember the time when Katya first started visiting us....
1:20:07 > 1:20:12- Yeah.- ..in emergency hospital.
1:20:13 > 1:20:18And, um, you was frightened... what to do,
1:20:18 > 1:20:22- and what will happen with the child. - Yes.
1:20:22 > 1:20:25I think about the whole story quite a lot,
1:20:25 > 1:20:32because, in a sense, I think it was a mistake to have operated.
1:20:32 > 1:20:36If it happened again, I would say no...
1:20:36 > 1:20:39I think, probably, it's too...
1:20:39 > 1:20:41Well, I THINK I'd say that.
1:20:41 > 1:20:45But one always hopes, doesn't one?
1:21:26 > 1:21:27Mr Marsh!
1:21:27 > 1:21:28Katya.
1:21:33 > 1:21:35Right, we brought some flowers.
1:22:18 > 1:22:20Translate a bit, Igor.
1:22:20 > 1:22:21It's like a dream.
1:22:27 > 1:22:29You can tell, can't you, I was quite worried!
1:22:29 > 1:22:33I was quite nervous. I've been feeling quite nervous as well.
1:22:48 > 1:22:51- Where shall we all sit? - The table is ready.
1:22:51 > 1:22:52Looks wonderful.
1:22:57 > 1:23:00Some photographs of Tanya on the wall there, I see.
1:23:00 > 1:23:01Yes.
1:23:08 > 1:23:11And the hydrotherapy in the bottom one.
1:23:11 > 1:23:13One of her physios.
1:23:50 > 1:23:52It's wonderful. I love it.
1:23:52 > 1:23:55They are afraid the... There's something wrong!
1:23:55 > 1:23:58The food is wonderful. I'm just overcome by emotion.
1:23:58 > 1:24:01That's why I'm not eating very much at the moment.
1:24:10 > 1:24:14- He is too young.- Too young! - Too young.
1:24:52 > 1:24:54Too upset - understood.
1:25:01 > 1:25:09She will drink for us and er, maybe we should drink for her family.
1:25:09 > 1:25:12- Yes.- Tanya. Misha.
1:25:28 > 1:25:31Well, I'll make a toast - would you like to translate, Igor?
1:25:31 > 1:25:35I've been coming to Ukraine now for 15 years...
1:25:35 > 1:25:37IGOR TRANSLATES
1:25:37 > 1:25:42And in many ways I've come to love this country as much as my own.
1:25:43 > 1:25:48And Igor and I have been working together for all that time
1:25:48 > 1:25:53trying to make progress, treating patients with neurosurgical problems.
1:25:53 > 1:25:58And sometimes we succeed, and sometimes we fail.
1:25:59 > 1:26:02IGOR SPEAKS IN UKRAINIAN
1:26:07 > 1:26:10Well, I'd like to drink to all your future successes.
1:26:10 > 1:26:13And we'll never stop trying to make things better.
1:26:13 > 1:26:17IGOR SPEAKS
1:26:23 > 1:26:26WOMAN:
1:26:26 > 1:26:30THEY MAKE TOASTS
1:27:31 > 1:27:35I don't know whether I'll be thinking about anything when I die,
1:27:35 > 1:27:42but the way I see things at the moment, I'll know that what I will think mattered most
1:27:42 > 1:27:49was how I tried to help Igor and his patients and I'll think about Tanya and I'll think about Katya.
1:27:50 > 1:27:55What are we if we don't try to help others? We're nothing.
1:27:55 > 1:27:57Nothing at all.
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