0:00:02 > 0:00:06This programme contains scenes which some viewers may find upsetting
0:00:06 > 0:00:09It's a fantastic lump of blancmange.
0:00:09 > 0:00:11The human brain has a hundred billion neurons,
0:00:11 > 0:00:14which makes it the most powerful learning tool in the world.
0:00:14 > 0:00:21Your entire person is encapsulated in that little blob of blancmange.
0:00:22 > 0:00:25Jay Jayamohan is a senior paediatric neurosurgeon
0:00:25 > 0:00:28at the John Radcliffe Hospital, in Oxford.
0:00:28 > 0:00:32He's part of an almost hundred-strong team of consultants
0:00:32 > 0:00:35who deal with every conceivable problem of the brain.
0:00:37 > 0:00:39We are making life and death decisions.
0:00:39 > 0:00:43One split second decides everything.
0:00:44 > 0:00:49Each year, they perform almost 4,500 operations.
0:00:49 > 0:00:51You're concentrating constantly.
0:00:51 > 0:00:54Is it in the right place? Stop any bleeding...
0:00:54 > 0:00:58So you're already in that mindset of think, think, think, think, think.
0:00:58 > 0:01:01Cutting-edge procedures that carry high risk.
0:01:01 > 0:01:06It can be a bit like walking on a tightrope in very high winds.
0:01:06 > 0:01:08You could fall off and die.
0:01:08 > 0:01:12Their interventions can mean the difference between life and death.
0:01:14 > 0:01:16You've got to respect the organ.
0:01:16 > 0:01:18You've got to respect the fact that what you do to it
0:01:18 > 0:01:21can have huge implications for the patient.
0:01:31 > 0:01:34Jay's been at the John Radcliff for nine years.
0:01:34 > 0:01:38He's dealt with thousands of children's brains and spines,
0:01:38 > 0:01:41from those approaching adulthood to others not yet born.
0:01:43 > 0:01:48Imagine if you were preggers in this heat. Man alive.
0:01:48 > 0:01:50Can't be a lot of fun.
0:01:50 > 0:01:55Today, he's off to the Obstetrics Unit to see Nicola.
0:01:55 > 0:01:59She's seven and a half months into an unexpected pregnancy
0:01:59 > 0:02:01and there are complications.
0:02:03 > 0:02:06When we went for our 20-week scan and the lady who was scanning,
0:02:06 > 0:02:09she was just really silent the whole time
0:02:09 > 0:02:13and then, she kept saying, "I'm going to have to get my colleagues."
0:02:13 > 0:02:16So I think you know in your heart of hearts as soon as that happens.
0:02:16 > 0:02:20It's one of them moments when you just think, "Oh, my God."
0:02:21 > 0:02:25Her unborn baby's been diagnosed with spina bifida.
0:02:25 > 0:02:26Is this your first baby?
0:02:26 > 0:02:28- It's number four.- Number four.
0:02:28 > 0:02:29So she's a bit of an expert.
0:02:29 > 0:02:33Jay and obstetrics consultant Lawrence Impey
0:02:33 > 0:02:35are giving Nicola an ultrasound.
0:02:35 > 0:02:38- Do you see it there?- Yeah.
0:02:38 > 0:02:42I think that's what it is, yeah.
0:02:42 > 0:02:47There is splaying of the vertebrae above L5.
0:02:47 > 0:02:49That's exactly what I was wondering.
0:02:49 > 0:02:53They think they may have seen a tumour on the baby's spine.
0:02:56 > 0:03:01The ultrasound scans that we've got today do show
0:03:01 > 0:03:05that there is an abnormality at the bottom of your baby's spine.
0:03:05 > 0:03:11- Baby's spine actually looks widened compared to what we'd expect.- Right.
0:03:11 > 0:03:14- And that we don't tend to see in spina bifida.- OK.
0:03:14 > 0:03:17But we do tend to see it more if there's tumour,
0:03:17 > 0:03:20cos it actually physically expands out the space.
0:03:20 > 0:03:24How similar is it if you did continue to their life?
0:03:24 > 0:03:26- Well, it can be cancerous.- Yeah.
0:03:26 > 0:03:29So, um...
0:03:29 > 0:03:33- Yeah, it can be life-threatening. - It's really bad.
0:03:33 > 0:03:37- OK.- So I think we need to get the MRI scan.
0:03:37 > 0:03:42Because if I give you a different type of potential outcome for baby
0:03:42 > 0:03:43if it was going to make a difference
0:03:43 > 0:03:45to what you want to do,
0:03:45 > 0:03:46then, that's final.
0:03:46 > 0:03:49Yeah, termination was the really hard bit.
0:03:50 > 0:03:53Although Nicola is 30 weeks into her pregnancy,
0:03:53 > 0:03:56it's not too late to terminate.
0:03:56 > 0:03:59Well, the law says, beyond 24 weeks,
0:03:59 > 0:04:02you can terminate the pregnancy
0:04:02 > 0:04:06if there is a substantial risk of the baby being handicapped.
0:04:06 > 0:04:09Now, the law does not define handicapped or substantial
0:04:09 > 0:04:12and so, there are grey areas,
0:04:12 > 0:04:15but, essentially, it's not uncommon,
0:04:15 > 0:04:18for people with a serious abnormality,
0:04:18 > 0:04:20to request termination beyond 24 weeks
0:04:20 > 0:04:22and, in this country, it's legal.
0:04:22 > 0:04:24I don't know what to think.
0:04:24 > 0:04:25It's horrible.
0:04:28 > 0:04:31'If it's up to, like, 16 weeks,
0:04:31 > 0:04:35'if you lost the baby by miscarriage, it's awful,
0:04:35 > 0:04:39'but when it's a big baby and you've bonded with it...
0:04:39 > 0:04:42'Just to terminate him.
0:04:42 > 0:04:44'That's my worst nightmare.'
0:04:47 > 0:04:49The decision about whether you're prepared to have a child,
0:04:49 > 0:04:52it's not for us to do that.
0:04:52 > 0:04:54Lots of people have completely fit and well children
0:04:54 > 0:04:56and treat them terribly.
0:04:56 > 0:04:59Now, does that mean you can go and sterilize those people
0:04:59 > 0:05:01to stop them having more children?
0:05:01 > 0:05:03It's not for us to do that,
0:05:03 > 0:05:06so if the parents understand
0:05:06 > 0:05:08what the child is going to go through,
0:05:08 > 0:05:10I haven't yet found one
0:05:10 > 0:05:13where I've thought they've made the wrong decision.
0:05:15 > 0:05:17You want a decision from them.
0:05:17 > 0:05:20You want a final decision, a yes or a no.
0:05:20 > 0:05:24But, in the back of your mind, you don't really want to hear it.
0:05:28 > 0:05:29Looking at the scan,
0:05:29 > 0:05:32I think there's less evidence
0:05:32 > 0:05:35that there's a malignant tumour going on.
0:05:35 > 0:05:38It is a big spina bifida, though.
0:05:38 > 0:05:41If you want to go ahead with pregnancy,
0:05:41 > 0:05:43the chances are baby will have an element
0:05:43 > 0:05:45of difficulties and disabilities.
0:05:45 > 0:05:47Yeah, he's got quite a few more risks now
0:05:47 > 0:05:49than we previously thought.
0:05:49 > 0:05:52It's likely the baby will have problems with legs,
0:05:52 > 0:05:54with balance, with walking.
0:05:54 > 0:05:57I suspect they'll be on the more severe end.
0:05:58 > 0:06:01I mean, my job is not to, you know, decide for you,
0:06:01 > 0:06:04but, obviously, our job is to help you make a decision
0:06:04 > 0:06:08by telling you what may, what may not be required for the baby.
0:06:10 > 0:06:11If Nicola has her baby,
0:06:11 > 0:06:14it will need lifelong medical care.
0:06:14 > 0:06:17It'll be with me for 18 years.
0:06:17 > 0:06:19A lifetime involvement for Mum as well.
0:06:19 > 0:06:22You know, these guys are always closer to their parents
0:06:22 > 0:06:24cos they need a lot more attention and help.
0:06:24 > 0:06:28But um...yeah, you know when you take these kids on,
0:06:28 > 0:06:31they're going to be for your entire life.
0:06:33 > 0:06:37Jack is a lifelong patient at the hospital.
0:06:37 > 0:06:40He's now 19 and should be on the adult ward,
0:06:40 > 0:06:44but he feels more at home on the children's unit under Jay's care.
0:06:44 > 0:06:46Hi, Jack!
0:06:46 > 0:06:49'I've been looking after Jack for eight or nine years
0:06:49 > 0:06:50'since I started here.
0:06:50 > 0:06:53'And you do feel a bond with those patients
0:06:53 > 0:06:55'that you've had for a long time.'
0:06:55 > 0:06:58Jack has a genetic disease, Crouzon syndrome,
0:06:58 > 0:07:03that's caused his skull to fuse too early, damaging his brain.
0:07:03 > 0:07:04'There aren't that many cases
0:07:04 > 0:07:08'of Jack's age with his condition.
0:07:08 > 0:07:10'His face doesn't develop properly,'
0:07:10 > 0:07:12the bones of his face
0:07:12 > 0:07:16and he's clearly got a different way of his brain functioning.
0:07:16 > 0:07:20He's got a developmental level
0:07:20 > 0:07:23that's way below 19 in many ways
0:07:23 > 0:07:26and he's very interested in childish stuff.
0:07:26 > 0:07:28It's actually quite a round shape now,
0:07:28 > 0:07:30but he's had lots of operations on his head
0:07:30 > 0:07:32to try and get him to that shape.
0:07:32 > 0:07:35And part of the problem is that these kids
0:07:35 > 0:07:3830 years ago didn't used to survive.
0:07:38 > 0:07:41So a lot of the problems that we're facing now
0:07:41 > 0:07:43are, as they're becoming adults,
0:07:43 > 0:07:46we're starting to find what problems they're getting now
0:07:46 > 0:07:49because it's a new phenomenon that they're actually living that long.
0:07:49 > 0:07:52Jack's had 27 operations
0:07:52 > 0:07:55and has spent most of his childhood in hospital.
0:07:55 > 0:07:58His mum, Karen, has always been there for him.
0:07:58 > 0:08:01You just get institutionalized though, don't you?
0:08:01 > 0:08:05You just get so used to being in here.
0:08:05 > 0:08:07Is it tough being Jack's mum?
0:08:09 > 0:08:12It is sometimes when you've seen him suffer and that,
0:08:12 > 0:08:15but, other times, he's just a joy to have.
0:08:15 > 0:08:18He's just such a sweet, calm little boy.
0:08:18 > 0:08:23He's so loving and he enjoys so much in life, you know,
0:08:23 > 0:08:26He's just... He's just so easy to please.
0:08:28 > 0:08:32But when you've got to see him suffering, that is really hard.
0:08:35 > 0:08:36Jack.
0:08:37 > 0:08:39Jack.
0:08:39 > 0:08:42You're going to have to have an operation.
0:08:42 > 0:08:43Is that all right?
0:08:43 > 0:08:45Good boy.
0:08:46 > 0:08:49Jack needs more space at the back of his skull
0:08:49 > 0:08:52so that his cerebrospinal fluid can flow freely.
0:08:54 > 0:08:55I want to operate here.
0:08:55 > 0:08:58These are all abnormal blood vessels that are draining the brain,
0:08:58 > 0:09:01but coming through the skull, which is what they shouldn't do.
0:09:01 > 0:09:04So I don't want to damage those, cos if I damage those,
0:09:04 > 0:09:06I'm damaging the drainage of the brain.
0:09:06 > 0:09:07So it could give him a stroke.
0:09:09 > 0:09:11So it's going to be a bit of a ruddy nightmare.
0:09:11 > 0:09:12I mean, last time was so difficult
0:09:12 > 0:09:14and I didn't really want to go back in again,
0:09:14 > 0:09:16but he's getting worse.
0:09:16 > 0:09:17And he's getting worse progressively
0:09:17 > 0:09:19where, at the end, it may be a point
0:09:19 > 0:09:22where he starts to lose the ability
0:09:22 > 0:09:24to stand, to walk, to use his hands
0:09:24 > 0:09:26and then, maybe to swallow
0:09:26 > 0:09:29and then, he's really stuffed.
0:09:29 > 0:09:34Whenever you do something to these kids who have such a complex set-up,
0:09:34 > 0:09:37you're never quite sure of the repercussions.
0:09:37 > 0:09:41And, you know, it's a bit like this idea
0:09:41 > 0:09:44of butterflies wafting in South America
0:09:44 > 0:09:46and causing hurricanes elsewhere.
0:09:46 > 0:09:50You've got to remember they don't work the same way everyone else does.
0:09:51 > 0:09:56Turn the bi-polar down to two. I'll take some micro scissors, please.
0:09:56 > 0:09:59You can see that as you buzz the arachnoid...
0:10:01 > 0:10:03..the outer layer covering the brain,
0:10:03 > 0:10:04it shrinks.
0:10:07 > 0:10:10With Jack, if you do something to his jaw or his teeth,
0:10:10 > 0:10:12it may completely change his swallowing,
0:10:12 > 0:10:13it may change his breathing,
0:10:13 > 0:10:15it may affect so many other things.
0:10:15 > 0:10:17And some of it you can predict and plan for,
0:10:17 > 0:10:20but some of it just comes out of the blue.
0:10:20 > 0:10:22Waking up, Jack.
0:10:23 > 0:10:24Wiggle your hands for me.
0:10:24 > 0:10:26Ah, perfect.
0:10:26 > 0:10:28Can you wiggle your toes?
0:10:28 > 0:10:30Let's see if you can wiggle your toes.
0:10:32 > 0:10:35If he was a private patient, he'd be asleep for hours.
0:10:35 > 0:10:38- He's on the expensive drugs today. - Oh, is he?- Yeah...
0:10:38 > 0:10:40Oh!
0:10:40 > 0:10:43Mm, that'll be the end of my list for the next two months then.
0:10:43 > 0:10:44Pay for it.
0:10:44 > 0:10:46'As regards resources,'
0:10:46 > 0:10:48I don't care how much things cost.
0:10:48 > 0:10:51If I think it's right for my patient, I want to do it.
0:10:51 > 0:10:53Hi, Jack.
0:10:53 > 0:10:55All right?
0:10:55 > 0:10:57The one thing we have to watch out for is to make sure
0:10:57 > 0:10:59there's no leak of fluid from the back of his head.
0:10:59 > 0:11:01I think it's unlikely,
0:11:01 > 0:11:03but that's the most important thing we have to keep an eye on.
0:11:03 > 0:11:05You never know with Jack, do you?
0:11:05 > 0:11:07No. You lost weight...
0:11:07 > 0:11:11No, my Mrs told me I have to lose weight, said you're getting too fat.
0:11:11 > 0:11:13Start to lose weight.
0:11:13 > 0:11:18Yeah, I have to eat beans and...stuff
0:11:18 > 0:11:20and I go to the gym.
0:11:20 > 0:11:22And I'm not allowed to eat chocolates
0:11:22 > 0:11:25and I'm only allowed to drink once a week
0:11:25 > 0:11:28and even that's kind of frowned upon.
0:11:28 > 0:11:30So my life's really cheery.
0:11:30 > 0:11:31THEY LAUGH
0:11:31 > 0:11:34All right, guys, see you later.
0:11:34 > 0:11:36As Jay clocks off,
0:11:36 > 0:11:40the night staff take over on the Neuroscience Department.
0:11:40 > 0:11:44The Senior Registrar on call is Tim Lawrence.
0:11:44 > 0:11:46Yeah, OK. I'm scrubbed at the moment.
0:11:46 > 0:11:49So I'll come as soon as I finish the case.
0:11:50 > 0:11:54Tim's been called to the children's critical care unit.
0:11:55 > 0:11:58A two-and-a-half-year-old boy has collapsed.
0:11:58 > 0:12:02A scan shows a blood clot on Raj's brain.
0:12:02 > 0:12:04Pupils are reacting all the time.
0:12:04 > 0:12:05Yes, they're small but reactive.
0:12:09 > 0:12:12There's a large haemorrhage on the scan,
0:12:12 > 0:12:15but it's not a particularly normal-looking haemorrhage,
0:12:15 > 0:12:17so I wonder if there's something underlying it.
0:12:17 > 0:12:19Then, I'll take him to theatre.
0:12:19 > 0:12:22Take the clot out and see what's underneath it.
0:12:22 > 0:12:26It's critical they remove the blood clot straight away.
0:12:27 > 0:12:29Fiona, it's Tim, the neurosurgical reg.
0:12:29 > 0:12:32I've got to take a case to theatre right now.
0:12:32 > 0:12:34I will come and speak to them
0:12:34 > 0:12:36but I need to do this case before I come down,
0:12:36 > 0:12:38so I'll be about an hour.
0:12:42 > 0:12:44Tim will operate on Raj.
0:12:44 > 0:12:46Thanks.
0:12:46 > 0:12:51As Senior Paediatric Consultant on call, Jay comes in to supervise.
0:12:58 > 0:13:02They suspect that the clot might be caused by a tumour.
0:13:02 > 0:13:06The blood clot was fairly straightforward to take out,
0:13:06 > 0:13:09but there was abnormal-looking bits around the edges,
0:13:09 > 0:13:14so we biopsied a few of those and sent them off.
0:13:14 > 0:13:16We're going to send those off for smears now.
0:13:19 > 0:13:21They came back as showing tumour.
0:13:25 > 0:13:28We don't know enough about brain tumours yet
0:13:28 > 0:13:31to understand what pre-disposes people to brain tumours,
0:13:31 > 0:13:35other than in a few rare conditions, but, um...
0:13:35 > 0:13:39We see brain tumours in fit healthy kids.
0:13:41 > 0:13:43It seems very random.
0:13:49 > 0:13:52The best option for dealing with Raj's tumour
0:13:52 > 0:13:55is discussed at the daily handover meeting.
0:13:56 > 0:13:59Right, let's start with Rajvi Rhana.
0:13:59 > 0:14:02So this is a two-and-a-half-year-old child,
0:14:02 > 0:14:07previously fit and well except for two convulsions.
0:14:07 > 0:14:10So went to theatre and had it evacuated.
0:14:10 > 0:14:12That's the post-op scan?
0:14:12 > 0:14:14He has no movement in his left side post op,
0:14:14 > 0:14:17but he's now moving his arm and leg well.
0:14:18 > 0:14:20Jay favours surgery
0:14:20 > 0:14:25and the physical removal of the tumour as the best option.
0:14:25 > 0:14:27Then, I think it probably does warrant it at some stage.
0:14:27 > 0:14:32Probably late six weeks was when I was thinking.
0:14:35 > 0:14:36This is tumour.
0:14:37 > 0:14:40There was two options for what the tumour is.
0:14:40 > 0:14:43The first, which hopefully it isn't, is a highly-malignant tumour,
0:14:43 > 0:14:45called a glioblastoma.
0:14:45 > 0:14:47And if it is that,
0:14:47 > 0:14:50there's, there's no benefit in doing more surgery.
0:14:50 > 0:14:53Essentially, his outcome is universally bleak.
0:14:53 > 0:14:55He's going to die from it.
0:14:55 > 0:15:02But the other option is it's a slightly less malignant tumour
0:15:02 > 0:15:04known as ependymoma.
0:15:04 > 0:15:08Now, if it's that, if we can get it all out,
0:15:08 > 0:15:13if I can remove all of this tumour that we can physically see
0:15:13 > 0:15:15and then, we give him chemotherapy
0:15:15 > 0:15:18and then, maybe radiotherapy,
0:15:18 > 0:15:21we've kind of got a 30 to 40%
0:15:21 > 0:15:23five-year survival for him.
0:15:24 > 0:15:27But it may leave him paralysed down the left side of his body.
0:15:27 > 0:15:34HE LAUGHS
0:15:39 > 0:15:42Several weeks after the operation to remove his blood clot,
0:15:42 > 0:15:45Raj is back on his feet again.
0:15:52 > 0:15:57The family return to the hospital to find out what the options are.
0:15:57 > 0:16:00It's all down to what kind of tumour Raj has.
0:16:08 > 0:16:10If it is a glioblastoma,
0:16:10 > 0:16:14then, there is pretty much nothing we can do to
0:16:14 > 0:16:18that's going to enable us to lengthen his quantity of life.
0:16:19 > 0:16:22So then, we have to very much concentrate on his quality of life.
0:16:22 > 0:16:25- Do you want to have a story in the playroom?- Yes.
0:16:25 > 0:16:28Yeah, you're going to have a story.
0:16:28 > 0:16:33My personal view is we should assume that it is the more treatable one.
0:16:33 > 0:16:39His best outcome is, by me, getting rid of all of the tumour,
0:16:39 > 0:16:43which, I would say, may leave him paralysed.
0:16:46 > 0:16:49He's up against it any which way.
0:16:55 > 0:17:02I think that Mum and Dad need more time to decide
0:17:02 > 0:17:05whether they want to go for surgery
0:17:05 > 0:17:09with the attendant risks of disability for him.
0:17:10 > 0:17:12I've explained again to parents
0:17:12 > 0:17:15that we will support them fully whatever their view.
0:17:15 > 0:17:18They will contact us as soon as they've made their decision.
0:17:18 > 0:17:19Yours sincerely.
0:17:20 > 0:17:22I can't find it here.
0:17:24 > 0:17:27Ah, bags of poo!
0:17:27 > 0:17:31You can't even spell, that's an R, you dimwit.
0:17:31 > 0:17:33Brain surgeons, they're all idiots.
0:17:37 > 0:17:39Um...
0:17:39 > 0:17:40Tiring day.
0:17:43 > 0:17:47I was giving spectacularly bad news to two families.
0:17:47 > 0:17:51Is there a chance that by operating on this two-and-a-half-year-old,
0:17:51 > 0:17:53I could cure him?
0:17:53 > 0:17:54Small.
0:17:57 > 0:17:58Very small.
0:17:58 > 0:18:01I could extend his life by a few years,
0:18:01 > 0:18:05but I'll have to leave him quite severely disabled.
0:18:05 > 0:18:09Or they can keep him in the current good condition he's in,
0:18:09 > 0:18:12but accept that he's probably just got a few months,
0:18:12 > 0:18:15which is a very difficult decision for them to make
0:18:15 > 0:18:19and they're understandably having a real hard time
0:18:19 > 0:18:21working out which way to go.
0:18:21 > 0:18:24Just a really, really rubbish position to be in.
0:18:26 > 0:18:28You do what's best for the patient.
0:18:28 > 0:18:29You've got to do what's best for them.
0:18:29 > 0:18:31You've got to give them all the options
0:18:31 > 0:18:34and then recommend what you think you need to do.
0:18:34 > 0:18:36Usually, when I go home,
0:18:36 > 0:18:38I like to sit quietly somewhere
0:18:38 > 0:18:42and just um...just kind of contemplate stuff a bit more.
0:18:44 > 0:18:48Right, I'm going to go and get my girls and give them a kiss
0:18:48 > 0:18:50and be ready for the next day.
0:18:57 > 0:19:00Nicola and her husband, Stephen, have come to a decision
0:19:00 > 0:19:02back home in Northamptonshire.
0:19:07 > 0:19:09We've decided to keep the baby.
0:19:09 > 0:19:13I'm glad I kept all the baby stuff as well.
0:19:14 > 0:19:16Which is a bonus.
0:19:16 > 0:19:18We haven't had to buy as much stuff,
0:19:18 > 0:19:20cos it's another little boy,
0:19:20 > 0:19:25and, obviously, I've got Brandon, so I've got loads of stuff still.
0:19:25 > 0:19:30When we found out, it was the worst week of my life
0:19:30 > 0:19:31cos you don't know what to do.
0:19:31 > 0:19:35One minute they're telling us that it's these syndromes.
0:19:35 > 0:19:38That he wouldn't be able to survive anything.
0:19:38 > 0:19:42Then, you go to Oxford and you find out he's got spina bifida
0:19:42 > 0:19:46and I didn't know a lot about it.
0:19:46 > 0:19:48- Go!- Brandon.- Go!
0:19:48 > 0:19:52In a few days, they'll be back in hospital for Nicola's caesarean,
0:19:52 > 0:19:55leaving their teenage kids and toddler Brandon at home.
0:19:57 > 0:19:59I try to get myself ready for it,
0:19:59 > 0:20:01but, I think, the closer it's getting...
0:20:01 > 0:20:03Scary, isn't it?
0:20:03 > 0:20:04It's getting a bit scary.
0:20:06 > 0:20:11'The lady at the hospital told me the baby might not survive birth
0:20:11 > 0:20:14'and I think just something triggered inside me
0:20:14 > 0:20:17'that something like that could happen.
0:20:18 > 0:20:21'He deserves a chance.
0:20:21 > 0:20:23'It's going to be hard,
0:20:23 > 0:20:24'but life is hard.'
0:20:49 > 0:20:50Do you want to sit up a bit?
0:20:50 > 0:20:54Complications are common in patients with rare genetic disorders
0:20:54 > 0:20:57and Jack's had more than his fair share of bad luck.
0:20:57 > 0:21:00Right. Do you want Pat and Jess?
0:21:00 > 0:21:01The wound from Jack's last operation
0:21:01 > 0:21:07is leaking cerebrospinal fluid, or CSF, and won't heal.
0:21:07 > 0:21:10'"Well, I'll be a ding, dong, dang!", said the driver.'
0:21:10 > 0:21:15He is in a lot of pain, you can see, cos he can't move his neck.
0:21:15 > 0:21:17I mean, this morning I did know he was in a lot of pain
0:21:17 > 0:21:21cos he was crying and Jack never cries.
0:21:21 > 0:21:24It's a bit of a setback cos we were due to go home on Saturday.
0:21:24 > 0:21:28So now, we've got to stay until, well, another five days.
0:21:28 > 0:21:31But there's always usually setbacks with Jack
0:21:31 > 0:21:33and it just, unfortunately, it happened today.
0:21:37 > 0:21:39Hello, Jack.
0:21:39 > 0:21:42It's Tim, one of the doctors here. How you doing?
0:21:42 > 0:21:43Jack, how are you feeling?
0:21:47 > 0:21:48Jack, where do you hurt?
0:21:50 > 0:21:52Is your head hurting as well?
0:21:55 > 0:21:57Jack, I'm just going to take the dressing off.
0:21:59 > 0:22:03'The wound is not keeping the CSF inside,'
0:22:03 > 0:22:05so the CSF that normally bathes the brain
0:22:05 > 0:22:06is leaking out through the wound.
0:22:06 > 0:22:08The problem is if you're leaking CSF,
0:22:08 > 0:22:12then, it's very, very difficult to get the wound to heal.
0:22:12 > 0:22:14And while he's leaking CSF out,
0:22:14 > 0:22:17infection can get back up through the same path.
0:22:17 > 0:22:21So we can't leave him leaking CSF, it needs to be stopped.
0:22:24 > 0:22:26Hello, it's Tim, the neurosurgical reg.
0:22:26 > 0:22:29Can you put me through to Mr Jayamohan, please?
0:22:29 > 0:22:31Jay, it's Tim.
0:22:31 > 0:22:36So Jack, he is leaking decent amounts. He's dripping away.
0:22:36 > 0:22:40I can probably do a stealth scan off the image they've got.
0:22:41 > 0:22:43See you in a bit. Bye.
0:22:44 > 0:22:48We're going to do a small operation for you.
0:22:48 > 0:22:51See if we can make your neck feel a bit better.
0:22:51 > 0:22:52All right?
0:22:55 > 0:22:57It takes 16 years of training
0:22:57 > 0:23:00to become a fully-fledged neuro consultant like Jay.
0:23:00 > 0:23:03Tim's still got two years to go.
0:23:06 > 0:23:11I was in Toronto recently at the hospital for sick kids
0:23:11 > 0:23:15and they employ a radiologist or radiographer rather,
0:23:15 > 0:23:18just to look after this system in theatre.
0:23:18 > 0:23:20So we do all this, look after it.
0:23:20 > 0:23:23Set this up, sort it out when it goes wrong,
0:23:23 > 0:23:25get everything ready for the patient.
0:23:25 > 0:23:27They employ someone just to come and do that.
0:23:27 > 0:23:28So the surgeon walks in,
0:23:28 > 0:23:31these guys can set up with someone there to set it all up
0:23:31 > 0:23:33and they just come in, get on with the operating.
0:23:33 > 0:23:35It's a different world.
0:23:36 > 0:23:41Tim's hoping to relieve the pressure of excess CS fluid in Jack's brain,
0:23:41 > 0:23:43by putting in yet another drain.
0:23:43 > 0:23:48The difficulty with patients like Jack is you make operative decisions
0:23:48 > 0:23:52based on what you think is the best thing
0:23:52 > 0:23:55to try and manage the condition they have.
0:23:55 > 0:23:58But a lot of those operative decisions
0:23:58 > 0:24:00you're exposing them to huge risk.
0:24:00 > 0:24:03So, just with this operation, there's a risk of stroke,
0:24:03 > 0:24:06there's a risk of causing seizures and there's a risk to life.
0:24:06 > 0:24:10It's a decision that you think very carefully about
0:24:10 > 0:24:14and the aim is always to try and make him better.
0:24:14 > 0:24:19It's quite difficult to justify those decisions all the time,
0:24:19 > 0:24:22but that's why you have to justify those decisions all the time.
0:24:22 > 0:24:24And I think that's a big responsibility.
0:24:24 > 0:24:26And it's even harder with the kids,
0:24:26 > 0:24:29cos they can't make those decisions themselves really.
0:24:44 > 0:24:47Jack is taken to the adult Neuro Intensive Care Unit
0:24:47 > 0:24:49to recover from his operation.
0:25:08 > 0:25:10Nicola's full-term
0:25:10 > 0:25:12and has come in for her Caesarean.
0:25:13 > 0:25:16Really nervous this morning.
0:25:16 > 0:25:17- Are you?- Yeah, I'm nervous.
0:25:17 > 0:25:22Oh, obviously, and about meeting the baby, so...
0:25:22 > 0:25:24Bit nervous.
0:25:24 > 0:25:26Don't know what to expect there.
0:25:26 > 0:25:29- Probably pass out.- Oh, please don't.
0:25:29 > 0:25:31The day after Nicola gives birth,
0:25:31 > 0:25:33Jay will operate on her baby
0:25:33 > 0:25:37to remove the dangerous spina bifida sac.
0:25:37 > 0:25:39The lower back has a spina bifida,
0:25:39 > 0:25:42with a big sac coming out from her back,
0:25:42 > 0:25:45um...which is fine,
0:25:45 > 0:25:48cos the size of the sac doesn't matter
0:25:48 > 0:25:49from the closure point of view.
0:25:49 > 0:25:52It makes it more difficult for me, but we can close it.
0:25:52 > 0:25:53But the other bit we're looking at
0:25:53 > 0:25:57is at the bottom of the brain, top of the neck
0:25:57 > 0:26:00where the brain can be jammed down into the spine
0:26:00 > 0:26:02and can cause problems with breathing and swallowing.
0:26:02 > 0:26:05And that's important because it can be very difficult
0:26:05 > 0:26:09to get baby breathing and swallowing after baby's born.
0:26:16 > 0:26:18A natural birth isn't an option.
0:26:18 > 0:26:21It could rupture the baby's sac and kill him.
0:26:25 > 0:26:27- Instruments correct and sterile? - Yes.
0:26:27 > 0:26:29- No equipment issues?- No.
0:26:29 > 0:26:32- Are you all right?- Yeah.
0:26:36 > 0:26:39Everyone happy to proceed? Thank you.
0:26:40 > 0:26:44Senior obstetrician Lawrence Impey is performing Nicola's Caesarean.
0:26:46 > 0:26:48I'm actually really happy.
0:26:48 > 0:26:50We'll have to do a good job then, won't we?
0:26:50 > 0:26:52SHE LAUGHS
0:26:52 > 0:26:53It is quite a large sac.
0:26:53 > 0:26:55What we don't want to do
0:26:55 > 0:26:56is rupture that sac.
0:27:05 > 0:27:06BABY CRIES
0:27:09 > 0:27:12BABY CRIES
0:27:30 > 0:27:33A seven-pound baby boy, Jensen Ashby,
0:27:33 > 0:27:35arrives safely into the world.
0:27:46 > 0:27:47Hello.
0:27:59 > 0:28:03Tomorrow, Jay will have to perform major surgery on this tiny baby.
0:28:10 > 0:28:11It's the first time
0:28:11 > 0:28:14that 19-year-old Jack has been treated on an adult ward.
0:28:16 > 0:28:19He said he couldn't go to PDHU.
0:28:19 > 0:28:22He was better off on the intensive care of the adult side of it,
0:28:22 > 0:28:24because he's older now.
0:28:25 > 0:28:31So that was a bit trau...traumatic,
0:28:31 > 0:28:33cos we didn't expect it.
0:28:34 > 0:28:39And it's completely different to what we're used to.
0:28:53 > 0:28:54But, actually, it was pretty good...
0:28:54 > 0:28:57Jay's come to see how he's doing.
0:28:57 > 0:29:00We're just going to wave at Jack, all right?
0:29:00 > 0:29:04Hey, Jack, can you sit up for me?
0:29:04 > 0:29:05Will you lift him up, Sue?
0:29:05 > 0:29:07Sit up for us, Jack, good boy.
0:29:07 > 0:29:09Oh, good work!
0:29:10 > 0:29:13Looking good.
0:29:13 > 0:29:14Looking good, Jack.
0:29:16 > 0:29:19He's going to go back to, yeah, Mel's.
0:29:19 > 0:29:22I think we'll try and keep him as a Mel's patient at the moment.
0:29:22 > 0:29:25All right, Jack. See you later. Good work.
0:29:25 > 0:29:28I'll come back to see you later, are you all right?
0:29:28 > 0:29:31Can you ask... The nurse who was looking after him yesterday
0:29:31 > 0:29:34was going to speak to Mel's and see if we can bring his telly up.
0:29:34 > 0:29:37- It was all ready to come.- It'd be really good if we can bring it up
0:29:37 > 0:29:39cos that will make him a lot happier.
0:29:39 > 0:29:42- Keep him here today? - Yeah, absolutely.
0:29:42 > 0:29:45I just need to speak to the management about where he would go.
0:29:45 > 0:29:46Cos I'd like him to go back to Mel's,
0:29:46 > 0:29:49but it may be that he needs to go back to the adult ward.
0:29:49 > 0:29:50- All right.- But I'll talk to them
0:29:50 > 0:29:53- and I'll confirm with you guys where he's going to go.- OK.
0:29:53 > 0:29:55Do you think you'll keep him overnight?
0:29:55 > 0:29:56- Yeah, definitely.- Yeah, OK.
0:29:56 > 0:29:58So far, he's done well.
0:29:58 > 0:30:00No, he is, really doing well, actually.
0:30:00 > 0:30:02Beautiful. Thanks very much, guys.
0:30:06 > 0:30:08- Get a chance to clear with management...- Yeah.
0:30:08 > 0:30:11- Jack should come back here, as per the plan.- Yeah.
0:30:11 > 0:30:14He's still under me anyway.
0:30:15 > 0:30:18Well, no, I mean, I think, you know, he should come back.
0:30:18 > 0:30:21Jay wants to keep Jack's continuity of care.
0:30:21 > 0:30:23Who are we going to give that kid to
0:30:23 > 0:30:26and get proper, organised care?
0:30:32 > 0:30:34On the adult NICU,
0:30:34 > 0:30:36Karen can't be with Jack 24/7,
0:30:36 > 0:30:39as she can on the children's ward.
0:30:40 > 0:30:42You can't come up and visit him.
0:30:42 > 0:30:45I think it's a bit worrying for Jack because he doesn't know
0:30:45 > 0:30:46when we're going to turn up or not.
0:30:49 > 0:30:51Jay wants him to go back on Mel's Ward
0:30:51 > 0:30:53because that's where he started off.
0:30:53 > 0:30:57It just depends what the powers which be say.
0:31:04 > 0:31:07Want to try some Ready Brek?
0:31:07 > 0:31:08No? OK.
0:31:10 > 0:31:13It's mentally exhausting rather than physically exhausting.
0:31:16 > 0:31:19You can't let your guard down, you know.
0:31:19 > 0:31:22I cry at night when I'm alone.
0:31:22 > 0:31:25I don't or I try not to cry in front of Jack,
0:31:25 > 0:31:27because I don't want him to feel frightened.
0:31:27 > 0:31:30We both try and hold it together, really,
0:31:30 > 0:31:32without him seeing us get upset.
0:31:33 > 0:31:35He just means the world to...
0:31:35 > 0:31:37Well, you know, all children
0:31:37 > 0:31:39mean the world to everybody, don't they, their parents,
0:31:39 > 0:31:43but we've just been through so much together, we just...
0:31:43 > 0:31:48You know, I just pray every day that he's going to improve.
0:31:53 > 0:31:55As one of Jay's patients reaches adulthood,
0:31:55 > 0:31:57another child's care under him
0:31:57 > 0:31:59is just beginning.
0:31:59 > 0:32:01BABY CRIES
0:32:01 > 0:32:02Baby, baby.
0:32:04 > 0:32:05Trussed him up like a kipper.
0:32:07 > 0:32:09What've they done here?
0:32:09 > 0:32:11What have they...? Here.
0:32:11 > 0:32:14Have you used one of those machines at the airport
0:32:14 > 0:32:16that you wrap your luggage in?
0:32:16 > 0:32:19Today, Jay will separate the network
0:32:19 > 0:32:21of nerves in Jensen's spinal cord
0:32:21 > 0:32:23from the cushion of fatty tissue
0:32:23 > 0:32:25that's grown outside his body.
0:32:28 > 0:32:31It's closed. It's not leaking spinal fluid.
0:32:31 > 0:32:34So that's great, because if it's leaking spinal fluid
0:32:34 > 0:32:35from now until we can operate,
0:32:35 > 0:32:38that would increase the risks of an infection occurring.
0:32:38 > 0:32:42The sac, the bag is very, very thin, it's almost translucent,
0:32:42 > 0:32:45so it's not something that's going to thicken up over time if we leave it,
0:32:45 > 0:32:46so we have to close it.
0:32:46 > 0:32:48Um...
0:32:48 > 0:32:50PHONE RINGS
0:32:50 > 0:32:53Never answer a phone if you're not on the ward.
0:32:55 > 0:32:57Hello...
0:33:01 > 0:33:03Hang on a minute, hang on, you... Wait, hang on.
0:33:03 > 0:33:05You've got a confused neurosurgeon.
0:33:05 > 0:33:08I'll find someone who knows what's going on.
0:33:08 > 0:33:10See, that's why you should never answer the phone
0:33:10 > 0:33:12when you're not on the ward.
0:33:25 > 0:33:27Did you see him afterwards?
0:33:27 > 0:33:29- Yeah, very quickly, yeah.- OK.
0:33:29 > 0:33:32You know, he's got... Well, we knew he was going to have it.
0:33:32 > 0:33:34The big spina bifida, the big sac at the back.
0:33:34 > 0:33:37The skin overlying it is really thin.
0:33:37 > 0:33:40- So it's not something that we can leave, we'll have to fix it.- Yeah.
0:33:40 > 0:33:43- He hasn't peed yet.- OK.
0:33:43 > 0:33:46And the end of his penis
0:33:46 > 0:33:49- is not formed quite right.- Uh-huh.
0:33:49 > 0:33:52On his left side, his foot is turned in,
0:33:52 > 0:33:57in what, you know, you will know as...we call a club foot.
0:33:57 > 0:34:00As regards to his head and his brain,
0:34:00 > 0:34:04I've got quite good hopes that we won't need to do anything.
0:34:04 > 0:34:05So that all looks good. All right?
0:34:05 > 0:34:07- Yeah, that's great.- OK.
0:34:07 > 0:34:10- See you guys later on. I'll bring him round, OK?- Lovely.
0:34:10 > 0:34:14Baby Jensen's at the top of a busy theatre list.
0:34:14 > 0:34:16Jay has three operations today
0:34:16 > 0:34:20and, with most cases averaging six hours, it'll be a long day.
0:34:20 > 0:34:22Good morning, good morning!
0:34:22 > 0:34:24We'll do a cell count this morning.
0:34:24 > 0:34:29- If it all looks good, late afternoon or even early evening.- OK.
0:34:29 > 0:34:33Jay's won the battle to keep Jack as his patient.
0:34:33 > 0:34:36He's now well enough to have his shunt replaced.
0:34:37 > 0:34:40Jack, do you like to be here?
0:34:42 > 0:34:44You like hospital, don't you?
0:34:44 > 0:34:45Do you want to go home?
0:34:46 > 0:34:47No.
0:34:47 > 0:34:50Where do you like more?
0:34:50 > 0:34:53Adult ward or kids ward?
0:34:53 > 0:34:55Yeah, children's ward.
0:35:18 > 0:35:21Can you think of any more questions or anything else?
0:35:21 > 0:35:22No, no, it's fine.
0:35:24 > 0:35:27- OK. I'll see you later on, OK? - See you.- See you.
0:35:30 > 0:35:33I trust Dr Jay so much.
0:35:33 > 0:35:34He's really put my mind at ease,
0:35:34 > 0:35:36so I know he's safe and well
0:35:36 > 0:35:38and he'll be fine.
0:35:47 > 0:35:48An operation as delicate as this,
0:35:48 > 0:35:51on such a tiny baby,
0:35:51 > 0:35:53will demand all Jay's expertise and dexterity.
0:35:56 > 0:35:58- It's squashing his weenie a bit, is it?- Yes.
0:36:03 > 0:36:04But if I use this,
0:36:04 > 0:36:07then his jewels can go in the gap.
0:36:07 > 0:36:09Try putting them down there.
0:36:09 > 0:36:14Jay must put the nerves of Jensen's spinal cord back into place
0:36:14 > 0:36:17inside his body without further damaging his mobility.
0:36:19 > 0:36:22Where the spinal cord would normally separate off from the skin
0:36:22 > 0:36:24and become separate tissue, it's stayed joined in.
0:36:26 > 0:36:29So all of this clear, not very good tissue needs to come off,
0:36:29 > 0:36:30but I need to be very careful
0:36:30 > 0:36:32I don't damage
0:36:32 > 0:36:34the spine tissue underneath.
0:36:34 > 0:36:36Once I open this up,
0:36:36 > 0:36:38if infection gets in there,
0:36:38 > 0:36:39it could be meningitis.
0:36:39 > 0:36:42Meningitis and paralysis.
0:36:42 > 0:36:45It's amazing, isn't it, what parents have to put up with?
0:36:49 > 0:36:52Let's try it and see if it gives us a better view.
0:36:54 > 0:36:56Makes you look like a rhino, Jay.
0:36:56 > 0:36:59Some people would say with my conk
0:36:59 > 0:37:00I was already there,
0:37:00 > 0:37:02but thanks for not saying it.
0:37:02 > 0:37:05It's the source of my power, my nose, you know.
0:37:05 > 0:37:07I might go round my mates' house when it's dark
0:37:07 > 0:37:09and just look in through the window like that...
0:37:09 > 0:37:11THEY LAUGH
0:37:14 > 0:37:15Thank you.
0:37:15 > 0:37:17All of this is going to have to come off,
0:37:17 > 0:37:19but what I'm going to want to do now
0:37:19 > 0:37:22is to look at the anatomy inside the sac
0:37:22 > 0:37:23and work out where we are.
0:37:25 > 0:37:27We're finding nerve tissue pretty much straight away.
0:37:27 > 0:37:29Come look down here.
0:37:29 > 0:37:32See that pink strawberry?
0:37:32 > 0:37:34That's the nerve tissue.
0:37:34 > 0:37:39So now we know we can relatively safely take this away...
0:37:41 > 0:37:43..because we've kind of found the area
0:37:43 > 0:37:45that we need to protect and concentrate on.
0:37:45 > 0:37:47We've taken the cap off the mushroom.
0:37:47 > 0:37:51It's like taking an excess bit of fat off someone.
0:37:51 > 0:37:53Doing a fatectomy.
0:37:53 > 0:37:56But this is the sort of the stalk of the mushroom.
0:37:58 > 0:37:59What would be ideal is
0:37:59 > 0:38:02if we could get this nerve tissue back in through that hole
0:38:02 > 0:38:07and then close that fissure up to give it as many layers as possible.
0:38:07 > 0:38:08It is going in...
0:38:09 > 0:38:12..with a little bit of discussion.
0:38:12 > 0:38:13Jay covers the nerves
0:38:13 > 0:38:17with as much skin and muscle as possible to act as protection
0:38:17 > 0:38:18as there's no vertebrae at the base
0:38:18 > 0:38:21of Jensen's spine to encase it.
0:38:21 > 0:38:24It means that there's less tension on the wound.
0:38:24 > 0:38:27It's called a dog ear.
0:38:27 > 0:38:29It's satisfying because you've got
0:38:29 > 0:38:32such an obvious appearance change
0:38:32 > 0:38:34and difference for the family.
0:38:34 > 0:38:38This is the first part of a long, long family of operations
0:38:38 > 0:38:40that he's going to need.
0:38:40 > 0:38:44You know, he's going to be with me until he's 18.
0:38:44 > 0:38:46He's likely to need more surgery.
0:38:46 > 0:38:50He's likely to need regular follow-ups and scans and stuff,
0:38:50 > 0:38:54so it's quite a long process for him
0:38:54 > 0:38:56and for us.
0:38:56 > 0:38:58What else is on the list?
0:38:58 > 0:39:00Jay's next patient,
0:39:00 > 0:39:01six-year-old Ollie,
0:39:01 > 0:39:03is having a lumbar puncture.
0:39:05 > 0:39:07Why am I saying sorry? You bumped into me.
0:39:07 > 0:39:10Right, James, it's all lining up
0:39:10 > 0:39:12for you to really get a chance to do this, isn't it?
0:39:12 > 0:39:14Jay has many trainee neurosurgeons
0:39:14 > 0:39:16under his eye
0:39:16 > 0:39:18and he's a hard task master.
0:39:18 > 0:39:22I think I encourage them in a nice family way and I'm very gentle.
0:39:22 > 0:39:24They probably think I'm an absolute git.
0:39:24 > 0:39:27They know I'm going to abuse them if they haven't done their work
0:39:27 > 0:39:30and they know they're going to get a hard time if they don't do
0:39:30 > 0:39:32100% efforts for the patients.
0:39:32 > 0:39:35It's people like you that make me want to retire.
0:39:35 > 0:39:36THEY CHUCKLE
0:39:36 > 0:39:39I don't scream at anyone. I scream generally.
0:39:39 > 0:39:41Do I shout?
0:39:41 > 0:39:44Sister's saying I shout and I bully and I scream...
0:39:44 > 0:39:45Yes, you are a bully.
0:39:45 > 0:39:46SHE LAUGHS
0:39:46 > 0:39:48Can you believe that?
0:39:48 > 0:39:51I did say earlier on you can always tell when you're coming in the ward
0:39:51 > 0:39:53cos you've got that distinctive voice, haven't you?
0:39:53 > 0:39:55- You're not helping, Karen. - Oh, all right.
0:39:55 > 0:39:58THEY LAUGH
0:39:58 > 0:40:00Actually, a lot of people probably say I'm a bit of an arse,
0:40:00 > 0:40:03but you start becoming a bit of a pompous arse about it.
0:40:03 > 0:40:06You think that because you do such an amazing job,
0:40:06 > 0:40:08it makes you an amazing person.
0:40:08 > 0:40:09End up a bit of a weirdo.
0:40:09 > 0:40:11What would I say to James?
0:40:11 > 0:40:15You know, standard advice like try not to steal from work.
0:40:15 > 0:40:18And if you do steal, don't leave fingerprints.
0:40:21 > 0:40:23Don't drop equipment.
0:40:23 > 0:40:24As long as you do all those,
0:40:24 > 0:40:26'then, we're all happy.'
0:40:26 > 0:40:27- There you go.- Well done.
0:40:27 > 0:40:30I'm going to leave, I'm quitting because of Sunshine.
0:40:30 > 0:40:32Not me!
0:40:32 > 0:40:33That's a lie, man.
0:40:33 > 0:40:34SHE LAUGHS
0:40:34 > 0:40:37That's terrible. Can you believe that?
0:40:38 > 0:40:41I think I might be fairly demanding.
0:40:41 > 0:40:43My wife says I'm very high-maintenance.
0:40:46 > 0:40:51But, you know, all I want is for everyone to do their job perfectly.
0:40:51 > 0:40:52We'll all get along great.
0:40:56 > 0:40:58It's not like this on bloody ER, is it?
0:41:02 > 0:41:04Last patient in is Jack.
0:41:04 > 0:41:06He's having his shunt replaced.
0:41:06 > 0:41:08A regular procedure for him.
0:41:08 > 0:41:10- Are we good to go?- Yeah.
0:41:10 > 0:41:13It's his seventh major operation in the last six weeks.
0:41:19 > 0:41:22I'm going home to play on the PlayStation.
0:41:25 > 0:41:27Someone's going to get it tonight online.
0:41:27 > 0:41:31'Jack, he'll be under our care, really, I think until we retire.'
0:41:31 > 0:41:34I can't imagine we're going to be discharging him ever.
0:41:48 > 0:41:52'My wife always says that patients come first
0:41:52 > 0:41:56'and, in a funny way, I guess they do.
0:41:57 > 0:42:01'But not because I don't love my family completely,
0:42:01 > 0:42:05'but it's because if anything happens to one of my patients,
0:42:05 > 0:42:08'I need to be there to help them.'
0:42:09 > 0:42:11Poing, poing!
0:42:11 > 0:42:12I'm not going to bump my head.
0:42:12 > 0:42:14No, you move that twig out the way.
0:42:14 > 0:42:16So it's not in the way.
0:42:16 > 0:42:18MURMURING IN THE BACKGROUND
0:42:18 > 0:42:20What are those two saying?
0:42:21 > 0:42:23They're crazy, man.
0:42:24 > 0:42:28There's a boat and look, there's duckies living on that little island.
0:42:28 > 0:42:30'Even if you're not at work, you spend a lot of time
0:42:30 > 0:42:32'thinking about stuff
0:42:32 > 0:42:35'and contemplating things that've happened.'
0:42:35 > 0:42:38Sometimes you feel absolutely rubbish.
0:42:38 > 0:42:40You've then got to think,
0:42:40 > 0:42:44"Oh, actually, imagine being that kid or that parent
0:42:44 > 0:42:48"and what must it be like," and that's what drives you on.
0:42:49 > 0:42:50HE LAUGHS
0:42:50 > 0:42:54That was the longest story I've ever heard.
0:42:54 > 0:43:00For me, having kids hasn't weakened my resolve or drive
0:43:00 > 0:43:04or whatever you want to call it to do my job, it's strengthened it.
0:43:06 > 0:43:08Daddy, you've got a little cut on your shoulder.
0:43:08 > 0:43:12- I've got a little cut on my shoulder? - Yeah, that one.
0:43:12 > 0:43:14Ah, that's old.
0:43:14 > 0:43:15They always get better, honey.
0:43:15 > 0:43:17Yeah, they can.
0:43:17 > 0:43:21You can get a sense of what it must feel like for these families.
0:43:21 > 0:43:26I mean it's just... It's unfathomable
0:43:26 > 0:43:30what they go through with a flip of a coin.
0:43:33 > 0:43:36Are they nice? Are they yummy?
0:43:36 > 0:43:40You do for your patients what you would want if it was one of your children.
0:43:40 > 0:43:41And if one of my children was sick,
0:43:41 > 0:43:46I would want somebody who put 100% in for them.
0:43:46 > 0:43:47Look, look up there!
0:43:47 > 0:43:52- Oh! There's people going on holiday. Wave bye!- Bye!
0:43:52 > 0:43:54Turkey...
0:43:54 > 0:43:55Turkey.
0:43:55 > 0:43:57Turkey pork. Turkey pork.
0:43:57 > 0:43:59THEY CHUCKLE
0:43:59 > 0:44:01Turkey pork.
0:44:16 > 0:44:19It's been three months since Raj had his blood clot removed.
0:44:22 > 0:44:24- How was your break?- Good.
0:44:24 > 0:44:26Where did you go?
0:44:26 > 0:44:29His parents have spent time thinking and talking to family
0:44:29 > 0:44:32and they've come to a decision.
0:44:32 > 0:44:34At the time, you thought
0:44:34 > 0:44:37you definitely wanted to have something done,
0:44:37 > 0:44:39but you weren't sure
0:44:39 > 0:44:44whether you were in agreement about doing the more aggressive operation
0:44:44 > 0:44:49that could leave him virtually paralysed,
0:44:49 > 0:44:52but which was really the only operation
0:44:52 > 0:44:55that had any long-term potential for him.
0:44:58 > 0:45:02Now that you've had a chance to think, have you made your mind up?
0:45:02 > 0:45:04Or do you want to talk about it more?
0:45:04 > 0:45:05I think we're looking at going...
0:45:05 > 0:45:07With the operation.
0:45:07 > 0:45:11With the operation - total removal will give him the best prognosis eventually.
0:45:11 > 0:45:15The outcome of any brain surgery is uncertain,
0:45:15 > 0:45:18so Jay must prepare Raj's parents for the worst.
0:45:19 > 0:45:21It's a big operation,
0:45:21 > 0:45:23so there's a risk to his life
0:45:23 > 0:45:26- that he won't make it through the operation...- Yeah.
0:45:26 > 0:45:29- ..or not wake up afterwards.- OK.
0:45:29 > 0:45:33But we will take every care with him
0:45:33 > 0:45:37and give him the same care that we would want for one of our kids.
0:45:41 > 0:45:43OK?
0:45:43 > 0:45:44THEY SIGH
0:45:44 > 0:45:46There's no way, unlike adults,
0:45:46 > 0:45:48there's no way we can prepare him
0:45:48 > 0:45:50for not being able to use his arm and legs.
0:45:50 > 0:45:52No good telling him today,
0:45:52 > 0:45:55cos that's going to make no sense to him whatsoever.
0:45:55 > 0:45:59So that initial period when things don't work properly,
0:45:59 > 0:46:01he's going to be quite distressed
0:46:01 > 0:46:05and we just have to talk him through it and just keep him calm.
0:46:05 > 0:46:08When you're around him afterwards,
0:46:08 > 0:46:10as much as possible,
0:46:10 > 0:46:12- just choke it down.- Uh-huh.
0:46:12 > 0:46:18Because if he senses that you guys are really stressed and upset,
0:46:18 > 0:46:20especially if he doesn't know what's going on,
0:46:20 > 0:46:24- he'll just think, "Right, I'm getting stressed out," you know.- Yeah.
0:46:24 > 0:46:26But if you need to get upset, that's fine.
0:46:26 > 0:46:31- But, generally, we find that kids pick up on their parents a lot.- OK.
0:46:31 > 0:46:32HE SOBS
0:46:32 > 0:46:34Hurt.
0:46:34 > 0:46:36Does it hurt?
0:46:36 > 0:46:37It's better.
0:46:37 > 0:46:38It's better now, that's good.
0:46:38 > 0:46:42'Doing nothing for me wasn't an option.
0:46:42 > 0:46:45'If there's some hope, then it's worth going for it.'
0:46:45 > 0:46:49There's that chance that, you know, he could have...
0:46:49 > 0:46:51you know, some time left, basically.
0:46:58 > 0:47:02He knows his way around now, so he thinks he can do what he likes.
0:47:02 > 0:47:03SHE CHUCKLES
0:47:03 > 0:47:06Cos he's quite energetic and all over the place,
0:47:06 > 0:47:09that's probably part of his personality
0:47:09 > 0:47:10I think I'm going to miss.
0:47:10 > 0:47:13HE LAUGHS
0:47:15 > 0:47:17You do start doing things like watching how he moves
0:47:17 > 0:47:19and watching how he runs around and...
0:47:20 > 0:47:23..you know, you find yourself thinking, "Oh, gosh,
0:47:23 > 0:47:26"he might not be able to do that afterwards" or "he won't be able to do that."
0:47:26 > 0:47:29And that's the hardest part, but...
0:47:29 > 0:47:31I think it's the best thing for him.
0:47:31 > 0:47:35That's why we're doing it, it's the best thing for him, really.
0:47:48 > 0:47:50He's going to be fine...
0:47:50 > 0:47:52SHE CRIES
0:48:00 > 0:48:02Catch her! Go catch her!
0:48:04 > 0:48:05Oh!
0:48:05 > 0:48:07SHE LAUGHS
0:48:09 > 0:48:11Bye, buddy!
0:48:11 > 0:48:12Love you!
0:48:28 > 0:48:31Just hold him really tight. OK.
0:48:31 > 0:48:33If you can just support his bottom for me.
0:48:33 > 0:48:36- Lawrence has got his head. - I've got my cardigan there.
0:48:36 > 0:48:37OK, sorry.
0:48:37 > 0:48:39That's it.
0:48:39 > 0:48:43He's asleep, we're going to give him a little bit of oxygen.
0:48:43 > 0:48:44OK.
0:48:44 > 0:48:46Well done.
0:48:46 > 0:48:48Do you want to give him a kiss?
0:48:49 > 0:48:51I love you, baby.
0:49:14 > 0:49:17It's emotionally very hard.
0:49:18 > 0:49:20That was all I could do to stop myself from wailing
0:49:20 > 0:49:22in the conversation I've just had.
0:49:22 > 0:49:25But you have to fight it back, chuck it down your throat.
0:49:25 > 0:49:28Cos you can't, you need to be the strong one for the parents
0:49:28 > 0:49:32and even if you're choking up, you have to just keep it hidden.
0:49:33 > 0:49:36And you can't let it influence your decision.
0:49:39 > 0:49:41MUSIC PLAYS
0:49:43 > 0:49:46If Raj has the more aggressive GBM tumour,
0:49:46 > 0:49:47Jay will stop the operation.
0:49:52 > 0:49:54If it's the less invasive ependymoma,
0:49:54 > 0:49:56he'll try to take it all out,
0:49:56 > 0:49:58without damaging too much limb function.
0:50:05 > 0:50:08Jay's first task is to send tissue off for biopsy.
0:50:12 > 0:50:14That's all tumour there.
0:50:14 > 0:50:16It's just kind of stuck onto the dura there.
0:50:16 > 0:50:20Raj's dura, the protective membrane around the brain,
0:50:20 > 0:50:22is riddled with cancer cells.
0:50:23 > 0:50:28Generally, we find that tumours that invade the dura are more aggressive.
0:50:28 > 0:50:30I don't think there's going to be any dura left here.
0:50:30 > 0:50:32I think this dura's coming off.
0:50:32 > 0:50:36So we're going to throw this dura away. Take it out.
0:50:36 > 0:50:37Can the dura grow again?
0:50:37 > 0:50:40Um...
0:50:40 > 0:50:43Yes, it can, but it won't matter.
0:50:43 > 0:50:45It doesn't matter.
0:50:45 > 0:50:46Why not?
0:50:49 > 0:50:53Because that's not going to be what's important for him.
0:50:53 > 0:50:55Fighting the tumour, that's going to be important,
0:50:55 > 0:50:57so whether dura grows back or not, we don't care.
0:50:57 > 0:51:00We want to get rid of as much tumour as we can.
0:51:00 > 0:51:02If we had a choice, I'd put it back.
0:51:05 > 0:51:07But we must, must get this tumour out.
0:51:09 > 0:51:11Now, we can remove that.
0:51:11 > 0:51:12That's a specimen.
0:51:12 > 0:51:14That needs to be labelled
0:51:14 > 0:51:15"dura over tumour", please.
0:51:17 > 0:51:20It takes the lab just under an hour to process the biopsy
0:51:20 > 0:51:23and call the results through to Jay.
0:51:23 > 0:51:25Sure, Emily, if you were going to come back to me now
0:51:25 > 0:51:28and say it's definitively GBM, I was going to stop.
0:51:29 > 0:51:33Well, I think if there's any chance that this is a malignant ependymoma,
0:51:33 > 0:51:36I'm going to reset it plus normal brain around it,
0:51:36 > 0:51:38that's his only chance.
0:51:41 > 0:51:43I am, but we've all decided to give him
0:51:43 > 0:51:45the benefit of the doubt on this one.
0:51:45 > 0:51:48We're in an optimistic mood today, mate.
0:51:48 > 0:51:49HE LAUGHS
0:51:49 > 0:51:52OK, thanks a lot. Cheers.
0:51:52 > 0:51:54Thank you.
0:51:54 > 0:51:56Right, some ependymoma components.
0:51:58 > 0:51:59Still could be a GBM,
0:51:59 > 0:52:01but certainly some things that look like ependymoma,
0:52:01 > 0:52:03so we'll get it all out.
0:52:03 > 0:52:05By hook or by crook, this is all coming out.
0:52:07 > 0:52:10So there's still, there's still hope.
0:52:10 > 0:52:12And we live on it.
0:52:18 > 0:52:20You happy for me to take it from there?
0:52:20 > 0:52:22Looks all right there, doesn't it?
0:52:22 > 0:52:24Anything that's definitively tumour down there.
0:52:24 > 0:52:26It's distinctly tumour.
0:52:28 > 0:52:29We've gutted out
0:52:29 > 0:52:30the centre of the tumour
0:52:30 > 0:52:32and what we've found now
0:52:32 > 0:52:34is the fingers of the tumour
0:52:34 > 0:52:36that are going frontwards into the motor strip,
0:52:36 > 0:52:38the movement part of the brain,
0:52:38 > 0:52:41so what we've done is mapped out
0:52:41 > 0:52:43where tumour looks
0:52:43 > 0:52:45and, then given it another few millimetres
0:52:45 > 0:52:47of what looks like normal brain
0:52:47 > 0:52:49to take into account those fingers
0:52:49 > 0:52:50that will have gone in
0:52:50 > 0:52:52and we're essentially going to have
0:52:52 > 0:52:55to remove all that bit of brain and tumour together
0:52:55 > 0:52:56and then try and take it out.
0:53:01 > 0:53:03Is it all in one piece?
0:53:03 > 0:53:04Retractor, please.
0:53:04 > 0:53:06Sorry, hold off, because we'll see if we can take it out.
0:53:06 > 0:53:11Although Jay's removed healthy brain tissue from Raj's motor area,
0:53:11 > 0:53:13it's impossible to say
0:53:13 > 0:53:14what the consequence will be.
0:53:17 > 0:53:20That doesn't look so much like tumour there, does it?
0:53:20 > 0:53:22So what is it, then?
0:53:22 > 0:53:25Is it tumour or is it grey matter?
0:53:26 > 0:53:29It's not all nicely coloured like on a text book,
0:53:29 > 0:53:32where you've got yellow bits and green bits and purple bits.
0:53:32 > 0:53:34It all looks the same.
0:53:34 > 0:53:37So you're having to work out from your memory, this should be this,
0:53:37 > 0:53:41but the way everyone's brain develops is different.
0:53:41 > 0:53:44So although it should be this in him, it may not be.
0:53:44 > 0:53:46I think that's grey matter.
0:53:48 > 0:53:49OK.
0:53:51 > 0:53:54I think we probably are done, aren't we?
0:53:54 > 0:53:56That looks pretty good, doesn't it?
0:54:01 > 0:54:02Beauty.
0:54:04 > 0:54:07Raj has been in theatre for six hours.
0:54:07 > 0:54:12His family will have to wait to find out how much movement he has left.
0:54:42 > 0:54:43Hello, you!
0:54:44 > 0:54:46Hello.
0:54:46 > 0:54:47Rajvi, wakey-wakey.
0:54:47 > 0:54:48HE CRIES
0:54:48 > 0:54:50Oh, mate, I'm sorry, fella.
0:54:54 > 0:54:55OK.
0:54:57 > 0:54:59All right, sorry, big man.
0:54:59 > 0:55:00Definitely there.
0:55:00 > 0:55:04OK, whenever he's ready to go, good.
0:55:04 > 0:55:05I'll go and catch up with Mum.
0:55:07 > 0:55:09Hiya. All done.
0:55:09 > 0:55:12He is moving his leg.
0:55:12 > 0:55:14- OK.- That's a good sign. - Not moving his arm.
0:55:16 > 0:55:20We took out the tumour, it looked fairly clear from what we could see,
0:55:20 > 0:55:24so we couldn't see any tumour left there at all.
0:55:24 > 0:55:26All right? So, so far, pretty good
0:55:26 > 0:55:28and we'll see how he does.
0:55:28 > 0:55:32- So you're happy with everything? - Yeah.- Thank you.
0:55:32 > 0:55:35All right? I'll see you later on, OK?
0:55:36 > 0:55:39- Take care, man, appreciate it lots. - No problem.
0:55:41 > 0:55:44I would love to say it's because of my brilliance and my skill,
0:55:44 > 0:55:46but it's not, really, is it?
0:55:46 > 0:55:50Most of it is you do as much as you can safely and carefully
0:55:50 > 0:55:51and then, at the end of the day,
0:55:51 > 0:55:55it is down to luck in a lot of these cases.
0:55:55 > 0:55:56HE CRIES
0:55:56 > 0:55:59- It's all right.- All right, darling.
0:55:59 > 0:56:01HE CRIES
0:56:01 > 0:56:04- That's his left side.- Yep.
0:56:04 > 0:56:07His arms are moving, his legs are moving. It's good.
0:56:07 > 0:56:08It's a brilliant sign.
0:56:11 > 0:56:14It's been the worst roller-coaster ride ever
0:56:14 > 0:56:17and now, it's just the best thing.
0:56:20 > 0:56:21Just relieved, really.
0:56:21 > 0:56:22And the fact that he's moving
0:56:22 > 0:56:24his left side is just amazing.
0:56:27 > 0:56:28Good, really good.
0:56:31 > 0:56:33Let him rest up overnight, all right?
0:56:33 > 0:56:36- If I don't see you later, I'll see you tomorrow morning.- Thank you.
0:56:36 > 0:56:38- Cheers.- Take care, mate.
0:56:38 > 0:56:42Kiss this hairy arse goodbye!
0:56:42 > 0:56:44HE LAUGHS
0:56:44 > 0:56:47Jensen's making good progress
0:56:47 > 0:56:49and is going home with Mum and Dad today.
0:56:49 > 0:56:51Good boy!
0:56:51 > 0:56:53He is eight days old today.
0:56:56 > 0:56:59You're doing very well, aren't you?
0:56:59 > 0:57:02Special boy, aren't you. You, chubby chups.
0:57:04 > 0:57:05You are gorgeous.
0:57:09 > 0:57:11Jack hopes he'll soon be discharged too.
0:57:13 > 0:57:16That yellow one, I think is dying, Jack.
0:57:16 > 0:57:18It's swinging on its side.
0:57:18 > 0:57:20After an 11-week stay in hospital,
0:57:20 > 0:57:22Karen is counting the days.
0:57:25 > 0:57:28Jay knows he'll see both patients again.
0:57:29 > 0:57:31I'm not going to do any work tonight.
0:57:32 > 0:57:36I'll do a little bit, I suppose.
0:57:39 > 0:57:41Hopefully, we'll put ourselves out of business
0:57:41 > 0:57:45in many parts of our job and we won't ever have to do it for a brain tumour
0:57:45 > 0:57:48and hopefully never have to treat somebody
0:57:48 > 0:57:52with lots of the congenital diseases that we have to do...
0:57:52 > 0:57:55again. It'd be great.
0:57:55 > 0:57:56Retire early!
0:57:57 > 0:57:59Fantastic!
0:58:02 > 0:58:04HE BABBLES
0:58:09 > 0:58:12Raj now has full use of all of is limbs
0:58:12 > 0:58:15and is responding well to chemotherapy.
0:58:17 > 0:58:20HE LAUGHS
0:58:49 > 0:58:52Subtitles by Red Bee Media Ltd