0:00:02 > 0:00:07THIS PROGRAMME CONTAINS SCENES WHICH SOME VIEWERS MAY FIND UPSETTING
0:00:07 > 0:00:10It's a fantastic amazing lump of blancmange that weighs about a kilo.
0:00:10 > 0:00:12The human brain has 100 billion neurons, which makes
0:00:12 > 0:00:14it 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.
0:00:29 > 0:00:33He's part of an almost hundred-strong team of consultants
0:00:33 > 0:00:36who deal with every conceivable problem of the brain.
0:00:36 > 0:00:38We are making life-and-death decisions.
0:00:38 > 0:00:43One split second decides everything.
0:00:45 > 0:00:49Each year, they perform almost four and a half thousand operations...
0:00:49 > 0:00:51You're concentrating constantly.
0:00:51 > 0:00:53Is it in the right place?
0:00:53 > 0:00:54Stop any bleeding.
0:00:54 > 0:00:58So you're already in that mindset of, "Think, think, think, think, think."
0:00:58 > 0:01:01..cutting-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.
0:01:28 > 0:01:31Stef Lorenzo?
0:01:31 > 0:01:33Hello. Come on in.
0:01:33 > 0:01:38One of four paediatric neurosurgeons at the John Radcliffe, Jay is
0:01:38 > 0:01:41doing his Tuesday follow-up clinic.
0:01:41 > 0:01:43You big faker.
0:01:43 > 0:01:47There is this large streak in me that refuses to grow up.
0:01:47 > 0:01:50Jay's been at the hospital for nine years
0:01:50 > 0:01:54and has operated on thousands of children.
0:01:54 > 0:01:57I think the main reason I became a paediatric neurosurgeon is
0:01:57 > 0:01:59because I'm a big kid.
0:01:59 > 0:02:02Did that hurt you? What about that?
0:02:02 > 0:02:07I like giggling at stupid jokes, I read comics, I watch cartoons.
0:02:07 > 0:02:11'If someone says to me, "Who would you want to spend an hour with -
0:02:11 > 0:02:14'"a bunch of grown-ups discussing politics or a bunch of kids'
0:02:14 > 0:02:19"playing on the PlayStation?" I'd be on the PlayStation.
0:02:19 > 0:02:23Beautiful. He's always good with that, isn't he?
0:02:23 > 0:02:2952.6. That's only up 0.2 in a year. Brilliant. Very happy.
0:02:37 > 0:02:43Jay looks after two busy children's wards - Mel's and Robin's.
0:02:43 > 0:02:45At any one time, there could be 30 kids here.
0:02:47 > 0:02:52Three-year-old Cerys is one of Jay's emergency patients.
0:02:52 > 0:02:57Four days ago, she went to the GP with headaches and loss of appetite.
0:02:57 > 0:03:00Jay suspect she may have a brain tumour.
0:03:02 > 0:03:05I've come to have your sausage.
0:03:05 > 0:03:08- Shall I have it?- No.
0:03:08 > 0:03:13'Well, we operate on about 40 kids' tumours per year here.
0:03:13 > 0:03:16'It's the commonest solid tumour of childhood.'
0:03:16 > 0:03:20- You have your sausages.- You have your sausages with Auntie Vicky.
0:03:24 > 0:03:30It is a biggie. This is on the high-risk level for what we do.
0:03:30 > 0:03:31This is the cerebellum.
0:03:31 > 0:03:35That would normally fill up this entire space but it's been squashed.
0:03:35 > 0:03:42And that's because this large, differently-grey object
0:03:42 > 0:03:43is the tumour.
0:03:45 > 0:03:48Jay wants to operate as soon as possible
0:03:48 > 0:03:52but first must get Cerys's mother's consent.
0:03:52 > 0:03:55A lot of the things that we'll tell you will be...will be
0:03:55 > 0:03:56difficult to hear.
0:03:57 > 0:04:01- But there's no benefit in us lying to you.- No.- Or sugaring it
0:04:01 > 0:04:05and making it sound, you know, just to make it sound nice.
0:04:05 > 0:04:09This is on the very big end of things.
0:04:09 > 0:04:10This is the big one tomorrow.
0:04:10 > 0:04:16But we can't do anything about it. We've got to do it.
0:04:16 > 0:04:18If we don't do it, it will kill her.
0:04:20 > 0:04:22My whole world come to a standstill.
0:04:22 > 0:04:25Everything stopped.
0:04:25 > 0:04:26Everything.
0:04:26 > 0:04:28My hope.
0:04:29 > 0:04:30Everything.
0:04:34 > 0:04:36You know, I know you've been able to be together
0:04:36 > 0:04:40and be kind of quite happy about it in front of her.
0:04:40 > 0:04:42But we all know what you're going through, even if
0:04:42 > 0:04:45we haven't experienced it ourselves.
0:04:45 > 0:04:49'What you realise doing a job like this is the world
0:04:49 > 0:04:51'is a big unpredictable mess
0:04:51 > 0:04:56'and we try to pick up the pieces from what happens.'
0:05:00 > 0:05:04Until he operates, Jay won't know if Cerys's tumour is malignant.
0:05:09 > 0:05:11'I'm powerless as a mother.
0:05:11 > 0:05:15'The first time in my life I'm powerless. I can't do nothing.
0:05:15 > 0:05:16'It's all in the doctors' hands.'
0:05:20 > 0:05:24It's a very life-affirming place as well as a slightly
0:05:24 > 0:05:27unfortunately life-destroying place.
0:05:27 > 0:05:29There's quite a lot of things we can do to make it a much better
0:05:29 > 0:05:32quality of life but it can go either way.
0:05:32 > 0:05:35Cerys's tumour is in the base of her brain where breathing
0:05:35 > 0:05:37and heart rate are controlled.
0:05:37 > 0:05:40Jay must remove as much of it as he can
0:05:40 > 0:05:43without damage to this crucial tissue.
0:05:43 > 0:05:45This is the normal brain structures
0:05:45 > 0:05:49and in the middle here, you can see this sort of grey, purplish substance
0:05:49 > 0:05:54and that's the tumour that's poking out between the two hemispheres.
0:05:54 > 0:05:57I'm getting a slow instinct about this one.
0:05:58 > 0:05:59Bollocks.
0:06:00 > 0:06:04This is almost certainly going to be a malignant tumour.
0:06:04 > 0:06:08It's just soft, it bleeds very easily.
0:06:08 > 0:06:12It's grown relatively rapidly and without any organisation.
0:06:16 > 0:06:18Ah, bollocks.
0:06:18 > 0:06:22That's definitely invading it there, isn't it? Invading it.
0:06:25 > 0:06:27Shite-bags.
0:06:30 > 0:06:32That's what that means. That means shite-bags.
0:06:34 > 0:06:36The aggressive, slimy tumour
0:06:36 > 0:06:40is entangled with Cerys's vital motor functions.
0:06:42 > 0:06:46The further in we go and the further into the sort of clockwork,
0:06:46 > 0:06:49then the more dangerous even a small damage is.
0:06:49 > 0:06:50So...
0:06:52 > 0:06:56..I'm worried about injury to that area which could give her
0:06:56 > 0:06:59problems with swallowing and speech, the lower part of the face.
0:07:01 > 0:07:04Jay has removed as much of the tumour as he can
0:07:04 > 0:07:07but it's too risky to proceed further.
0:07:12 > 0:07:16While Jay and his colleagues operate on over 300 children a year,
0:07:16 > 0:07:19Alex Green is one of 10 neurosurgeons treating
0:07:19 > 0:07:21the hospital's adult patients.
0:07:24 > 0:07:25There's Bob.
0:07:27 > 0:07:30'This is my fourth year as a consultant.'
0:07:30 > 0:07:33I've done over 3,000 operations.
0:07:37 > 0:07:41'It's a chaotic day today. I've got two possible spine operations'
0:07:41 > 0:07:45and someone with a brain tumour so there's always plenty of work.
0:07:45 > 0:07:49'I do a mixture of tumours, spinal operations'
0:07:49 > 0:07:53and deep brain stimulation which is my great sort of favourite.
0:07:53 > 0:07:55There you go. You're doing really well.
0:07:57 > 0:08:00Seen a lot of human brains.
0:08:03 > 0:08:07We deal with a population of around about three and a half million people
0:08:07 > 0:08:11and we deal with several hundred people a year who have brain tumours.
0:08:11 > 0:08:15The Neuroscience Department serves not only patients in Oxfordshire,
0:08:15 > 0:08:17but also the whole of the UK.
0:08:20 > 0:08:2427-year-old Chris is one of Alex's patients.
0:08:24 > 0:08:28I'll get this for you, Mum. You open the door.
0:08:28 > 0:08:30He lives in Aylesbury.
0:08:30 > 0:08:34His mum and dad have moved in while they're doing up their home.
0:08:38 > 0:08:41Chris works in property and is looking for a girlfriend.
0:08:42 > 0:08:47Ladies, I'm open for business.
0:08:47 > 0:08:48Come and enjoy.
0:08:50 > 0:08:53I think it would actually kill me right now
0:08:53 > 0:08:57if I was to have sexual intercourse with a girl.
0:08:57 > 0:09:01I think it would actually kill me but I'd give it a good go.
0:09:01 > 0:09:05I'm packing for my operation, which is tomorrow morning, first thing.
0:09:06 > 0:09:10A week ago, Chris went to the optician with blurred vision.
0:09:10 > 0:09:14A day later, a scan revealed a massive tumour.
0:09:14 > 0:09:17OK, so couple of boxers for a couple of days.
0:09:17 > 0:09:21If I need any more, my mum can bring me some.
0:09:22 > 0:09:28I am pretty scared at the moment cos obviously they're
0:09:28 > 0:09:33drilling into my head and if they make a mistake a centimetre
0:09:33 > 0:09:36either side, then it's game over.
0:09:36 > 0:09:38So that is pretty scary.
0:09:38 > 0:09:42However, I'll get to see the pretty nurses.
0:09:42 > 0:09:48Get to talk to them, so that's the icing on the cake, really.
0:09:48 > 0:09:52Christopher has a tumour in his third ventricle.
0:09:52 > 0:09:55It's actually causing some pressure on his brainstem here.
0:09:55 > 0:09:59This is the tumour here, which is right in the middle of his brain
0:09:59 > 0:10:01and so we have to get into that.
0:10:01 > 0:10:05It's about as far as you can get from any access.
0:10:05 > 0:10:07With big operations like this, I often wake up
0:10:07 > 0:10:10in the middle of the night and find I'm thinking about them
0:10:10 > 0:10:13a little bit because this sort of operation is quite rare.
0:10:16 > 0:10:20There's a risk of hydrocephalus, there's a risk of infection,
0:10:20 > 0:10:23there's a risk of bleeding, there's a risk of recurrence
0:10:23 > 0:10:25of the tumour and there's a risk of seizures.
0:10:26 > 0:10:27Look after Mum.
0:10:28 > 0:10:30Ring any time.
0:10:30 > 0:10:33He could get a stroke or he could die.
0:10:35 > 0:10:39Love you, Dad.
0:10:39 > 0:10:41You'll see my face when you wake up cos I'll come and take you off.
0:10:41 > 0:10:44Oh, God!
0:10:44 > 0:10:46Can you not get some pretty, young bird?
0:10:51 > 0:10:53See you later. Take it easy, Chris.
0:11:00 > 0:11:01Yeah, I know what you mean.
0:11:05 > 0:11:06That's the skull there.
0:11:06 > 0:11:09This is the sort of incision that the North American Indians
0:11:09 > 0:11:12- would have made when they were scalping their victims.- Really?
0:11:12 > 0:11:17They'd make a cut in the forehead and get their hand
0:11:17 > 0:11:20into the right plane and just rip the whole scalp off.
0:11:23 > 0:11:26To reach the tumour deep inside Chris's brain,
0:11:26 > 0:11:30Alex slices down between the two cerebral hemispheres,
0:11:30 > 0:11:32penetrating as far as he dares.
0:11:35 > 0:11:38So we're just down to the corpus callosum now,
0:11:38 > 0:11:40which is this glistening, white structure.
0:11:42 > 0:11:46So we're going to make a little hole in that and drop into the ventricle.
0:11:47 > 0:11:50This is the most difficult part of the procedure.
0:11:51 > 0:11:54There's this structure called the fornix which comes over
0:11:54 > 0:11:56the roof of the third ventricle
0:11:56 > 0:11:59and we have to go through that roof to get to the tumour.
0:11:59 > 0:12:02So if we damage that, that's his short-term memory gone.
0:12:06 > 0:12:10Yeah, we're in tumour. We're in tumour.
0:12:10 > 0:12:12See that,
0:12:12 > 0:12:14at the bottom where the sucker is?
0:12:14 > 0:12:16That's all tumour.
0:12:16 > 0:12:21It's like a sort of soapy...like a sort of white soapy stuff there.
0:12:22 > 0:12:24Let's get a biopsy. Forceps, please.
0:12:24 > 0:12:27I wonder if I could get a retractor just to...
0:12:30 > 0:12:32It's just trying to get the whole lot out
0:12:32 > 0:12:35but it's coming quite nicely so just get a bit of suction.
0:12:35 > 0:12:40It's about two or three centimetres in total
0:12:40 > 0:12:42but we'll just take it out a little bit at a time.
0:12:46 > 0:12:50Alex uses a microscopic camera to check the parts Chris's brain
0:12:50 > 0:12:52the human eye can't access.
0:12:55 > 0:12:57It's as deep as we go.
0:12:57 > 0:13:00That's the deepest part of the brain.
0:13:00 > 0:13:02Everybody's beautiful on the inside.
0:13:04 > 0:13:07It is really beautiful, amazing anatomy when you see it
0:13:07 > 0:13:11and you realise just how intricate we are.
0:13:12 > 0:13:15So everything that we could get out is out.
0:13:15 > 0:13:19We think the whole tumour is out but there may just be a little
0:13:19 > 0:13:23bit of capsule that is very firmly stuck to the ventricular wall and
0:13:23 > 0:13:26we can't take that because it would...
0:13:26 > 0:13:28there's a high chance we'd kill him.
0:13:30 > 0:13:33Alex won't know if the operation is successful till
0:13:33 > 0:13:36he gets the biopsy result and sees the post-op scan.
0:13:41 > 0:13:45Chris's family have only had a week to come to terms with his tumour.
0:13:47 > 0:13:52I haven't slept for a few days. I just felt sick inside.
0:13:54 > 0:13:56Nightmare, it's just horrible.
0:13:56 > 0:14:00I'd rather it be me than one of your children.
0:14:10 > 0:14:14Adele won't know if her daughter Cerys's tumour is malignant
0:14:14 > 0:14:15until the operation is over.
0:14:17 > 0:14:20'I refuse to say the C word. I won't ask.
0:14:20 > 0:14:22'I don't want to know.
0:14:22 > 0:14:25'I'm too frightened.
0:14:25 > 0:14:26'Three years old.
0:14:26 > 0:14:28'She's a baby. She's too young.
0:14:29 > 0:14:32'I know I've got to face it
0:14:32 > 0:14:35'and I know what's got to be done and...
0:14:35 > 0:14:37'But, like I said, I'm a mum and I'm not ready.'
0:14:42 > 0:14:47Unfortunately for her long-term outlook,
0:14:47 > 0:14:49there's more bad bits than good bits.
0:14:53 > 0:14:55What can you do?
0:14:56 > 0:15:00Every child should be treated as if they're the one that is going
0:15:00 > 0:15:03to completely buck any odds and go on.
0:15:05 > 0:15:11So there's always a little bit of a lottery with it.
0:15:16 > 0:15:20You've got to be very plain and clear about what you're telling people.
0:15:22 > 0:15:23If you have to say it's a cancer or
0:15:23 > 0:15:26if you have to say it's malignant or if you have to say it's going to
0:15:26 > 0:15:29kill someone, you have to say it is going to kill them.
0:15:30 > 0:15:33It went OK.
0:15:33 > 0:15:35We'll wait for the results,
0:15:35 > 0:15:39but I'm fairly certain this is going to be a malignant tumour.
0:15:39 > 0:15:45Oh, my God. No, no, no. No, no, no, no.
0:15:46 > 0:15:50No! No!
0:15:54 > 0:15:57No! No, no, no. No!
0:15:57 > 0:16:03Adele, just wait. Listen to me. Just take some deep breaths.
0:16:03 > 0:16:07Just stop for a minute. Just take some deep breaths.
0:16:07 > 0:16:10Deep breaths. Keep going, keep going.
0:16:16 > 0:16:19Just take your time. There is no rush, take your time.
0:16:19 > 0:16:21Deep breaths in and out.
0:16:22 > 0:16:27You can't have that conversation and have people coming out
0:16:27 > 0:16:29not having understood what you've said.
0:16:29 > 0:16:35They may choose not to accept it or they may choose to hear
0:16:35 > 0:16:38it in a different way but, as much as you can, you have to make sure
0:16:38 > 0:16:43that you tell them in very plain, easy-to-understand words cos,
0:16:43 > 0:16:47again, their brain will be shutting down as you're talking to them,
0:16:47 > 0:16:51their brain will be closing itself off to what you're saying,
0:16:51 > 0:16:53as a natural defence.
0:16:53 > 0:16:56So you have to be very straight, so that you can get it into
0:16:56 > 0:17:00that small gap as their brain door is closing.
0:17:01 > 0:17:03You've got to get that information in there.
0:17:07 > 0:17:09- Just take your time until you're ready.- What can be done?
0:17:09 > 0:17:13Just wait. Just take your time and get yourself ready first.
0:17:14 > 0:17:17It does not mean that there's nothing we can do.
0:17:17 > 0:17:20It does not mean that, you know, that the whole thing's over.
0:17:20 > 0:17:24It just means that we have to work that little bit harder to treat it.
0:17:24 > 0:17:28We need to probably give her some chemotherapy after this. OK?
0:17:28 > 0:17:30Today was the really, really big step.
0:17:30 > 0:17:36She'll need more treatment, that's fine, but it's treatment, OK?
0:17:36 > 0:17:38- OK.- But that's what we do.
0:17:41 > 0:17:44- All right? So it's not the end of the world.- It is.
0:17:44 > 0:17:48It isn't. It isn't for her. It isn't for her at all.
0:17:48 > 0:17:51This is the first step in the treatment.
0:17:51 > 0:17:54OK? But that is the huge big step.
0:18:08 > 0:18:10After his operation,
0:18:10 > 0:18:14Chris is taken to the Neuro Intensive Care Unit to recover.
0:18:15 > 0:18:19All right, Chris? You been telling jokes?
0:18:19 > 0:18:23- My sister.- Sister, yeah, sister.
0:18:23 > 0:18:27Yeah, the one he owes 20 grand to. Do you remember that, Chris?
0:18:30 > 0:18:3350% of brain tumours are spread from cancers
0:18:33 > 0:18:38around the body and about a quarter are from tumours that
0:18:38 > 0:18:43come from within the brain itself and about one in ten
0:18:43 > 0:18:46are benign tumours from around the surface of the brain.
0:18:46 > 0:18:49'So there would be over 100 different types of brain tumour.'
0:18:52 > 0:18:55'I think statistics are very important in medicine
0:18:55 > 0:18:57'because we don't have certainty.'
0:19:01 > 0:19:03'Life is made up of choices.'
0:19:04 > 0:19:07No flying without risk.
0:19:07 > 0:19:13If you look at it statistically, which I have done, the risk of death
0:19:13 > 0:19:18'from microlite flying is about one death per 37 million flying hours.'
0:19:20 > 0:19:23'It's a bit like doing an operation. There is always a risk.
0:19:23 > 0:19:27'It's a case of doing what you can to reduce that.
0:19:27 > 0:19:30'But the gains that you get out of it are so great, it's worth it.'
0:19:38 > 0:19:42I'm sort of still pseudo on this detox thing
0:19:42 > 0:19:44that the missus has put me on -
0:19:44 > 0:19:47eating a lot of seeds
0:19:47 > 0:19:49and green things that I've never heard of before.
0:19:49 > 0:19:53As well as his duties in neuroscience, Jay also works in the
0:19:53 > 0:19:58Craniofacial Department alongside plastic surgeon David Johnson.
0:19:59 > 0:20:02They operate on a handful of children with rare genetic
0:20:02 > 0:20:04disorders that malform their skulls.
0:20:06 > 0:20:10It's just in the ventricle. We'll have to keep a close eye on it.
0:20:10 > 0:20:14This specialisation demands high levels of skill from the neuro
0:20:14 > 0:20:17and plastic surgeons who work on these tiny patients.
0:20:20 > 0:20:23Rachel has bought her one-year-old daughter to see David.
0:20:25 > 0:20:27Sofia has Crouzon's syndrome.
0:20:27 > 0:20:31Her skull has fused too early and is squashing her growing brain.
0:20:33 > 0:20:34She's got this, sort of,
0:20:34 > 0:20:37saddle-shaped dip that you can see here.
0:20:37 > 0:20:41A feel of her head here and a little look at her.
0:20:41 > 0:20:44Do you think that this prominent area here is becoming more
0:20:44 > 0:20:47- prominent with time? - Yes, definitely. Yeah, absolutely.
0:20:47 > 0:20:50- Eyes look as if they're bulging a little bit.- Yeah, they do seem...
0:20:50 > 0:20:53- There's nothing wrong with the eyes, it's the actual...- They do seem to
0:20:53 > 0:20:55- bulge more so as well at times. - Do they?- Yeah.
0:20:57 > 0:21:00This is Sofia's CT scan from last year
0:21:00 > 0:21:05and what you can see here is that the bone is full of holes
0:21:05 > 0:21:09cos the brain is squashed and the brain's trying to get out
0:21:09 > 0:21:12through gaps in the bone so the bone can't from normally.
0:21:12 > 0:21:16She has a genetic mutation in every cell in her body,
0:21:16 > 0:21:21which is preventing the skull from growing in a normal way.
0:21:21 > 0:21:25We can't correct that but what we can do is to expand
0:21:25 > 0:21:28the shape of her skull to give space for the brain.
0:21:37 > 0:21:40Sofia's malformed skull is squeezing her brain
0:21:40 > 0:21:43and blocking the flow of cerebrospinal fluid.
0:21:46 > 0:21:49Without an operation, the build-up of pressure will eventually
0:21:49 > 0:21:53lead to seizures, blindness, coma and death.
0:21:58 > 0:22:02The past week or so, I've been trying to just block out that
0:22:02 > 0:22:04this operation's been coming up.
0:22:04 > 0:22:11Now that we're here, I almost want to wake her up again so that,
0:22:11 > 0:22:15you know, I can play with her and hold her.
0:22:15 > 0:22:17Cos I know tomorrow morning, you know,
0:22:17 > 0:22:21she's going to be going down for this operation
0:22:21 > 0:22:23and when I see her again,
0:22:23 > 0:22:26she's going to be attached to tubes and wires
0:22:26 > 0:22:32and I'm not going to be able to pick her up
0:22:32 > 0:22:34and hold her for a while.
0:22:35 > 0:22:37I'm not going to be able to play with her
0:22:37 > 0:22:40and it's so...
0:22:42 > 0:22:43..difficult to...
0:22:45 > 0:22:49Cos she's such a happy little baby and when you look at her,
0:22:49 > 0:22:55she seems absolutely fine but knowing that this is necessary,
0:22:55 > 0:23:01it's very difficult to, sort of, accept.
0:23:01 > 0:23:05It's just the pain and everything else that you think, you know,
0:23:05 > 0:23:09you just don't want them to suffer in any way, shape or form.
0:23:13 > 0:23:15I just wish I could take it away.
0:23:28 > 0:23:29She's so tiny.
0:23:33 > 0:23:36And she's, you know, been through so much already.
0:23:59 > 0:24:01Anyone want to do this case?
0:24:03 > 0:24:06Come on, what's the matter with you?
0:24:06 > 0:24:10- Morning.- Morning, how are you? - Morning.- All well?
0:24:13 > 0:24:16No more questions from last night?
0:24:16 > 0:24:18- No.- I'll go down to the anaesthetic room,
0:24:18 > 0:24:20make sure that everything's fine there.
0:24:20 > 0:24:24Then we're ready to go. We'll come and see you afterwards.
0:24:24 > 0:24:28- All right?- Yes, that'll be the good point.
0:24:28 > 0:24:31- Look at that look. Rrrr. - Yeah, she's like that.
0:24:31 > 0:24:34OK, we'll look after her for you. All right, bye-bye for now.
0:24:41 > 0:24:44Jay and David are old theatre hands who've been working
0:24:44 > 0:24:46together for seven years.
0:24:47 > 0:24:52Morning, everybody. Hi. The big case is Sofia Timmins.
0:24:52 > 0:24:54She's a little girl with Crouzon's syndrome.
0:24:54 > 0:24:58We'll take the forehead off, we'll take the top portion
0:24:58 > 0:25:02of the eye sockets off and then we'll take the lateral
0:25:02 > 0:25:05panels off and then we'll figure out a way to put it back together again.
0:25:05 > 0:25:09Jay's off to find a recovery bed for Sofia.
0:25:09 > 0:25:12Without it, they can't proceed with the operation.
0:25:12 > 0:25:15- Have you got a bed?- No.
0:25:15 > 0:25:17So what do you reckon for the craniofacial?
0:25:17 > 0:25:19We'll let you know as soon as we know, Jay.
0:25:19 > 0:25:20OK, thanks, guys.
0:25:25 > 0:25:29Chris has been moved from recovery and is back on the adult ward.
0:25:33 > 0:25:35I am tired. However, all things considering,
0:25:35 > 0:25:38I feel pretty good about everything.
0:25:38 > 0:25:41I've got a pretty nurse now, which I'm pleased about.
0:25:41 > 0:25:45A young blonde bird. Keep forgetting her name, though.
0:25:45 > 0:25:48- Do you want to go out some time? - No, I'm all right, thanks.
0:25:48 > 0:25:50- Oh, thanks. - You're married anyway, aren't you?
0:25:50 > 0:25:52Soon to be divorced.
0:25:53 > 0:25:57Two floors up, Rachel's still waiting for news of a bed
0:25:57 > 0:26:00and it's been six hours since Sofia's last feed.
0:26:05 > 0:26:11- 31329.- 'Morning.'- Morning. It's Jay. I've heard we haven't got a bed yet?
0:26:11 > 0:26:13'Yes, we're still waiting.'
0:26:13 > 0:26:17OK, we'll keep out of it and will you ring me when you know?
0:26:17 > 0:26:19- 'Yes.'- OK.
0:26:26 > 0:26:31The view of the graveyard is a nice positive sight(!)
0:26:31 > 0:26:34However, could be worse.
0:26:36 > 0:26:38- You could be in it. - I could be in it.
0:26:38 > 0:26:40As long as I don't keep snoring in the night,
0:26:40 > 0:26:43you don't suffocate me with my pillow.
0:26:43 > 0:26:44Well, yeah, there is that.
0:26:53 > 0:26:56Are they looking like there's going to be anything shifting?
0:26:56 > 0:26:59- Yeah, well, we're just...we're phoning every hour.- Yeah.
0:26:59 > 0:27:01So we'll just keep phoning.
0:27:01 > 0:27:04They've said they're not sure now if the operation's going to go
0:27:04 > 0:27:09ahead today because they're not sure they've got a bed in intensive care.
0:27:10 > 0:27:14- This is really annoying. - Just got to wait.
0:27:14 > 0:27:16Is she going to be cancelled?
0:27:16 > 0:27:18Probably if we don't find a bed soon.
0:27:18 > 0:27:22I'm going to feed her. I'm taking the decision, I'm sorry.
0:27:22 > 0:27:24- I'm going to feed her. - That's absolutely fine.
0:27:24 > 0:27:27Yeah, I'm going to feed her. OK.
0:27:37 > 0:27:39I'm not looking forward to this at all.
0:27:39 > 0:27:43I hate any kind of pain. I'm a real screamer.
0:27:47 > 0:27:51Slow and steady wins the race, remember?
0:27:51 > 0:27:54- Don't hurt me.- I won't.- Oooow!
0:27:54 > 0:27:56Chris, you need to get them out, don't you?
0:27:56 > 0:27:58I do. I do apologise, nurse.
0:27:58 > 0:28:00I told you I was a screamer before you started.
0:28:00 > 0:28:04Ahhhh!
0:28:04 > 0:28:10- Does it really hurt?- Yes. Ow. Ow. Ow! Ow!
0:28:13 > 0:28:15I've spoken to Russ.
0:28:15 > 0:28:20There's still no bed and Mum breast-fed at half 12.
0:28:20 > 0:28:23So we're looking at half four.
0:28:23 > 0:28:25So then are we looking at not happening?
0:28:25 > 0:28:27- Russ is wanting to cancel it.- OK.
0:28:31 > 0:28:35Hello. Hi. There's no hope of a bed at all,
0:28:35 > 0:28:38so what we're going to have to do is cancel it today.
0:28:38 > 0:28:40There just isn't any way around it, I'm afraid.
0:28:40 > 0:28:42We can't do the operation. It's not safe
0:28:42 > 0:28:46unless we've got the right bed in the right environment for her.
0:28:46 > 0:28:48If there is a choice -
0:28:48 > 0:28:51do you want to go as soon as possible, knowing...
0:28:51 > 0:28:54but it may not be one of us two?
0:28:54 > 0:28:56No, I'd rather you do it.
0:28:56 > 0:28:59- Do you want us to wait?- Yeah.- OK.
0:28:59 > 0:29:02So, so frustrating.
0:29:07 > 0:29:11So it means we've got to go home and we've got to wait
0:29:11 > 0:29:14and we've got to go through it all again.
0:29:20 > 0:29:23I mean, this happens and there's nothing you can do about it.
0:29:23 > 0:29:27It's part of the nature of the hospital system.
0:29:27 > 0:29:29That either you have lots of empty beds lying around
0:29:29 > 0:29:32so that you never cancel anyone, but then it's inefficient.
0:29:32 > 0:29:36Or occasionally, you're overwhelmed.
0:29:36 > 0:29:37Bummer.
0:29:37 > 0:29:40Thank you, nurses. Bye.
0:29:50 > 0:29:52I've had three bacon sandwiches this morning.
0:29:52 > 0:29:57Cos we had to use up all this bacon. Oh, I feel bloated.
0:30:03 > 0:30:06There you go. It's one of my quality shots.
0:30:09 > 0:30:12No, I'm not going to be one of those people that starts learning
0:30:12 > 0:30:16how to paint and speak Esperanto and ride a unicycle at the same time.
0:30:22 > 0:30:24But if I do like something, I want to be good at it.
0:30:29 > 0:30:31And it's really important, I think,
0:30:31 > 0:30:33to have time to yourself, eh?
0:30:34 > 0:30:38Just to do something relaxing rather than the archetypal thing that
0:30:38 > 0:30:41we've been doing most of our lives, which is drinking.
0:30:43 > 0:30:45THUD!
0:30:47 > 0:30:49- INTERVIEWER:- What was that, Jay?
0:30:49 > 0:30:52That's why you don't stand close to me playing golf!
0:31:05 > 0:31:08Chris's biopsy results have come back benign.
0:31:10 > 0:31:14The final all-clear will be a post-op scan to make sure
0:31:14 > 0:31:15the tumour is gone.
0:31:28 > 0:31:32My recovery's going well. Physically, I'm doing very well.
0:31:32 > 0:31:36I'm back to where I was before the operation, which is quite nice.
0:31:36 > 0:31:38Got the JR tomorrow,
0:31:38 > 0:31:42my check-up and then hopefully do a bit more travelling.
0:32:00 > 0:32:03Today, Alex will give Chris his results.
0:32:08 > 0:32:11It's always difficult to give people bad news.
0:32:12 > 0:32:17We do it on quite a regular basis in neurosurgery because of what
0:32:17 > 0:32:22we're dealing with, so I often call Friday morning my Grim Reaper day.
0:32:25 > 0:32:28The reason I'm calling Chris today fairly urgently is that we
0:32:28 > 0:32:31did a routine post-operative MRI scan
0:32:31 > 0:32:36and on that scan there is the appearance of some tumour
0:32:36 > 0:32:38in the brainstem or the mid-brain.
0:32:38 > 0:32:44Now, this was present on the scan before the first operation
0:32:44 > 0:32:48but we weren't sure if it was really tumour or just swelling.
0:32:49 > 0:32:53But the new scan shows that the abnormal tissue isn't swelling,
0:32:53 > 0:32:54it's tumour.
0:32:56 > 0:32:57We can't get it out
0:32:57 > 0:33:00because you can't operate on that bit of the brain.
0:33:00 > 0:33:05It would effectively either kill him or render him extremely disabled.
0:33:05 > 0:33:09Just when you think everything is going well, actually it's not
0:33:09 > 0:33:12and something goes wrong and in this particular case there is this
0:33:12 > 0:33:14bit of tumour that's there which I can't get at
0:33:14 > 0:33:20and that's obviously very bad, both for us and for him.
0:33:23 > 0:33:25- Hi there, how are you doing? - Not too bad. Nice to see you.
0:33:25 > 0:33:28- Yeah, you too. How are you? - Good, thank you.
0:33:28 > 0:33:31- Hello.- Hi. Would you like to come this way?
0:33:39 > 0:33:41- You had your scan last Friday.- Yeah.
0:33:41 > 0:33:45And there's a couple of things which I don't like on that scan.
0:33:45 > 0:33:50The bit that we took out in the ventricle is gone, which is good.
0:33:50 > 0:33:55So that was successful and we took that part out but this bit here
0:33:55 > 0:34:03is worrying me a little bit because it would tend to suggest that there
0:34:03 > 0:34:07is some tumour there in the mid-brain which is not accessible.
0:34:09 > 0:34:13Now, we can't do... We can't sort this out surgically
0:34:13 > 0:34:18but it might be possible to treat it using another type of treatment
0:34:18 > 0:34:20such as radiotherapy to that area
0:34:20 > 0:34:24or chemotherapy for certain types of tumour, so drug treatment,
0:34:24 > 0:34:27but we can't really do that until we know what it is.
0:34:27 > 0:34:30So what I'm proposing is to do a biopsy
0:34:30 > 0:34:35and it would give us the answer as to what that bit there is.
0:34:35 > 0:34:37So I'm sorry to give you bad news.
0:34:37 > 0:34:39It's not the news I was hoping for, I must say.
0:34:39 > 0:34:43It wasn't the news I was hoping for cos there's something going on there
0:34:43 > 0:34:45that I can't get at.
0:34:48 > 0:34:49OK.
0:35:16 > 0:35:17Really sucks.
0:35:20 > 0:35:23I was expecting to get the all-clear today, then that would have been it,
0:35:23 > 0:35:29I could have gone home and celebrated but instead I've got
0:35:29 > 0:35:30another operation to...
0:35:33 > 0:35:35..look forward to on Thursday.
0:35:39 > 0:35:40Shit.
0:35:42 > 0:35:44Now my mum's going to be upset again.
0:35:44 > 0:35:47Dad's going to be upset
0:35:47 > 0:35:49and I'm going to have to be the strong one for them.
0:35:49 > 0:35:52I don't have to be but I want to be
0:35:52 > 0:35:54cos I don't want them to be upset at all.
0:36:06 > 0:36:11It's very rare that you're able to say to someone, "You are cured 100%."
0:36:11 > 0:36:14Usually it's, "Everything looks good at the moment,
0:36:14 > 0:36:17"we'll do another scan in a year,"
0:36:17 > 0:36:23or five years or whenever it is, but they're always under your eye.
0:36:23 > 0:36:27It's very rare that somebody's completely cured and goes home.
0:36:29 > 0:36:33Cerys has returned to the hospital to have her cancerous tumour treated
0:36:33 > 0:36:35with a course of chemotherapy.
0:36:35 > 0:36:38Nanny's going to come back in a minute.
0:36:38 > 0:36:42I mean, the chemo and she's got obviously six weeks, every day for
0:36:42 > 0:36:44six weeks of radiotherapy to come, yeah.
0:36:44 > 0:36:47And it's... That's going to be tough.
0:36:49 > 0:36:53- Don't panic. Come on. - It doesn't hurt, Mum.
0:36:54 > 0:36:57The treatment involves a powerful cocktail of drugs.
0:36:57 > 0:37:01Jay hopes it will destroy the remnants of aggressive tumour
0:37:01 > 0:37:03left inside Cerys's brain.
0:37:04 > 0:37:10Surgery is not operate, finish operating, done.
0:37:10 > 0:37:13And then chemotherapy begins, finishes, done.
0:37:13 > 0:37:15It's all a spectrum of treatment.
0:37:15 > 0:37:18Each one is interdependent on the other treatment.
0:37:18 > 0:37:21Chemotherapy only works if we can get rid of
0:37:21 > 0:37:23as much of the tumour as we can.
0:37:23 > 0:37:25These kids are never done.
0:37:27 > 0:37:31So there's never going to be an end to her treatment.
0:37:33 > 0:37:37Shall we put a new one on? Yeah?
0:37:37 > 0:37:39'I will never cry in front of her.
0:37:39 > 0:37:43'I think, "No, you know, go upstairs, have a cry upstairs,
0:37:43 > 0:37:44'"that's a bit of me time."
0:37:44 > 0:37:47Shady away for a couple of hours,
0:37:47 > 0:37:49have a cry and think, you know,
0:37:49 > 0:37:53and I'd be lying if I said you don't think the worst cos you do.
0:37:53 > 0:37:57Cerys's treatment will continue for the next five years -
0:37:57 > 0:38:00only then will Jay know if the tumour has gone for good.
0:38:10 > 0:38:12Chris has returned for his biopsy.
0:38:14 > 0:38:15INTERCOM BEEPS
0:38:19 > 0:38:22Hi there. Just got an operation this morning.
0:38:22 > 0:38:24- 'Pull the door, please.'- Thanks.
0:38:34 > 0:38:35I'll try not to flash everyone.
0:38:35 > 0:38:41It's not very nice, is it, to see him have to go through it again?
0:38:41 > 0:38:43Well, you haven't really got to go through it again,
0:38:43 > 0:38:46you ain't got to have an operation.
0:38:46 > 0:38:48He's got to have it lasered or something, hasn't he?
0:38:48 > 0:38:51So it's a bit different this time, isn't it?
0:38:51 > 0:38:53My mum doesn't actually fully understand
0:38:53 > 0:38:55what's going to go on today.
0:38:55 > 0:38:59She thinks it's being lasered off but...
0:38:59 > 0:39:02Not today, you're having a biopsy tomorrow.
0:39:02 > 0:39:04Yeah, so she's not 100% on what's going on
0:39:04 > 0:39:06and I think that's quite a good thing.
0:39:06 > 0:39:09She doesn't realise that they're drilling into my head and...
0:39:09 > 0:39:11- Yes, we know that. - ..taking a piece out.
0:39:11 > 0:39:14Yeah, you're having a biopsy and they're taking bit out
0:39:14 > 0:39:17and then, next week, we'll know what's happening.
0:39:17 > 0:39:19But where it is, they can't operate.
0:39:20 > 0:39:28So it's got to be, like, a different operation this time, you know,
0:39:28 > 0:39:29to get rid of it.
0:39:29 > 0:39:34- Radiotherapy. - Yes, so it's a bit different.
0:39:34 > 0:39:36But you've got to deal with these things, haven't you?
0:39:36 > 0:39:41You know, that's it. Get it done and we'll move on.
0:39:43 > 0:39:44- Won't we?- Mm-hm.
0:39:56 > 0:40:00- See you later.- See you.- Love you. Love you, Dad.- See you later, mate.
0:40:12 > 0:40:15'It has made me think about my life and where I am
0:40:15 > 0:40:18'and what I want to get out of it.'
0:40:18 > 0:40:23Mostly find someone to, sort of, be with.
0:40:23 > 0:40:27Another, sort of, girlfriend, long-term girlfriend.
0:40:27 > 0:40:29Think I mentioned that before.
0:40:29 > 0:40:31Coming off desperate now.
0:40:33 > 0:40:35You seem very pretty.
0:40:37 > 0:40:39'But that's one thing that's definite for me.
0:40:39 > 0:40:42'I want to start a family. That kind of stuff.'
0:40:44 > 0:40:47Give my mum some more grandchildren.
0:40:47 > 0:40:49- Thank you.- You're welcome.
0:40:53 > 0:40:56Just some oxygen. Nothing else, I promise, just oxygen.
0:40:56 > 0:40:59It's going to get tight, my darling.
0:40:59 > 0:41:01It can sometimes sting a little bit as it goes in.
0:41:03 > 0:41:05Give you something nice to dream about.
0:41:10 > 0:41:13Chris is strapped into a hi-tech frame.
0:41:15 > 0:41:19It will turn the space in his skull into a set of 3-D co-ordinates.
0:41:21 > 0:41:23Once inside the scanner,
0:41:23 > 0:41:26it pinpoints the tumour's exact location.
0:41:29 > 0:41:31This ensures the biopsy will hit its target
0:41:31 > 0:41:33without damaging the brain.
0:41:36 > 0:41:39It's basically just a hand drill.
0:41:39 > 0:41:41You can probably get better ones from B&Q.
0:41:41 > 0:41:44Can we have the table down a bit, please?
0:41:47 > 0:41:50If I set it about here, as I lean on this drill,
0:41:50 > 0:41:53it'll only go in a centimetre or two.
0:41:53 > 0:41:56If I set it here, then it will go into his brainstem
0:41:56 > 0:41:59and, probably, that'll be the end of him.
0:41:59 > 0:42:00So we'll try and set it low.
0:42:04 > 0:42:07The aim is to just plunge it down a few millimetres
0:42:07 > 0:42:09so that it goes through the dura, which is
0:42:09 > 0:42:14the lining around the brain and then we can get the biopsy needle in.
0:42:14 > 0:42:15- Quite a thick skull.- Yeah.
0:42:15 > 0:42:20That's really stiff now and we've avoided plunging in this instance,
0:42:20 > 0:42:22as it's known in the trade.
0:42:25 > 0:42:27So this is the biopsy needle.
0:42:29 > 0:42:32That's just going through the brain now, down to the target.
0:42:36 > 0:42:39I would just take maybe two or three, literally.
0:42:49 > 0:42:51Thousands of biopsies are processed each year
0:42:51 > 0:42:53at the John Radcliffe Hospital,
0:42:53 > 0:42:55one of the country's major pathology labs
0:42:55 > 0:42:57and a centre for cancer research.
0:43:05 > 0:43:09Chris will have to wait at least three weeks for conclusive results.
0:43:21 > 0:43:23Are we going to give you a bath?
0:43:24 > 0:43:28It's almost six weeks since Sofia's operation was cancelled
0:43:28 > 0:43:30and now a new date's been set.
0:43:39 > 0:43:42The entire function of Sofia's brain is in danger of being
0:43:42 > 0:43:47damaged by her fused skull, with devastating consequences.
0:43:53 > 0:43:55It's one of those things. There isn't a choice about it.
0:43:55 > 0:43:58It has to be done. You have to think, you know,
0:43:58 > 0:44:02"If I don't have it done, this time next year she won't be here."
0:44:13 > 0:44:16Each year, Jay and the craniofacial team
0:44:16 > 0:44:21operate on just 80 to 100 children with fused skulls
0:44:21 > 0:44:26but only a handful have rare genetic disorders like Sofia's.
0:44:26 > 0:44:30'I've spent the last week just thinking, you know,
0:44:30 > 0:44:33'"Got plenty of time, got plenty of time."
0:44:33 > 0:44:35'Now it's sort of come up.
0:44:35 > 0:44:37'Just thinking about it, I just want to cry.'
0:44:49 > 0:44:52I'll just pop that there, Sofia. You hold onto her hands, Mum.
0:44:54 > 0:44:57'It's the worst experience you could ever feel
0:44:57 > 0:45:03'because although you want to stay positive, you wonder
0:45:03 > 0:45:06'if that's the last time you're going to see them.'
0:45:12 > 0:45:14- Thank you.- Well done, Mum.
0:45:18 > 0:45:19- I'll take good care of her, OK?- Yeah.
0:45:27 > 0:45:30'It's just the most horrible feeling out.'
0:45:36 > 0:45:41Sofia's operation will be complex and risky.
0:45:41 > 0:45:43Before rebuilding her new skull,
0:45:43 > 0:45:46Jay and David must delicately remove the old one.
0:45:49 > 0:45:53So, the things we want to do when we take the bone off is
0:45:53 > 0:45:57leave the dura intact, the fibrous bag that surrounds the brain.
0:45:57 > 0:45:59We want to keep that intact as much as we can.
0:45:59 > 0:46:01cos if you open that, A, you could damage the brain
0:46:01 > 0:46:05but, B, you could get leakage in the spinal fluid and therefore infection.
0:46:05 > 0:46:07So the main things for me today -
0:46:07 > 0:46:11keep the dura intact and don't trash any of the veins.
0:46:13 > 0:46:16I'll shuffle, there you go.
0:46:16 > 0:46:17Oh, it's a nice soft song.
0:46:19 > 0:46:20We'll get rid of that.
0:46:23 > 0:46:28I'm telling you, if they stop me playing music in theatre, I'm done.
0:46:28 > 0:46:30I'm out of here, man.
0:46:30 > 0:46:33Get the faders to the highest level possible, please.
0:46:38 > 0:46:40- Beautiful.- Thank you.
0:46:42 > 0:46:44OK, for my next trick,
0:46:44 > 0:46:47I think I'll take a pair of baby bone nibblers, please.
0:46:47 > 0:46:49Is this the line you want, Your Majesty?
0:46:49 > 0:46:53- Yeah. Straight up there.- My Lord. - I'll tell you if you stray.
0:46:53 > 0:46:55If we just go underneath this bone here,
0:46:55 > 0:46:58what will end up happening is, all these bits of the brain that
0:46:58 > 0:47:00I'm poking out through the holes here,
0:47:00 > 0:47:03we could end up, sort of, beheading them from the inside.
0:47:03 > 0:47:05You've just got to be very, very careful.
0:47:12 > 0:47:15- OK.- Coming off? - Yeah, coming off.- Swab on.
0:47:31 > 0:47:34Do we think about the parents? BOTH: No.
0:47:34 > 0:47:38Don't think about anything other than what we're doing.
0:47:38 > 0:47:44You've got to take the emotion of the parent/child situation
0:47:44 > 0:47:45out of theatre.
0:47:45 > 0:47:48There's a time for that sort of compassion and emotion
0:47:48 > 0:47:51but it's not when you're operating.
0:47:51 > 0:47:54I'll go straight down here like that, so you can hit that point.
0:47:56 > 0:47:59- Ready here. Ready?- Yeah. - Happy?- Yeah.
0:47:59 > 0:48:02Good, yeah, yeah, yeah, yeah, good.
0:48:02 > 0:48:04I can disappear soon, yeah?
0:48:04 > 0:48:07- No, you're not. Not yet. - You've got another to go yet.
0:48:07 > 0:48:11Right, if all our cuts join up, this bit of bone will come straight off.
0:48:11 > 0:48:14If they haven't, then we might need to do some chiselling.
0:48:16 > 0:48:18There we are, so we're all fine here.
0:48:18 > 0:48:22- So this is the top of the eye sockets here.- Super.
0:48:36 > 0:48:39Chris and his sister have come back to the John Radcliffe
0:48:39 > 0:48:41for the results of his biopsy.
0:48:46 > 0:48:50- You are a very rare person. - I am aware of that.
0:48:50 > 0:48:53- Special. We call him special. - They call me special.
0:48:53 > 0:48:56I'll tell you what it's called first and then we'll talk about
0:48:56 > 0:48:57what exactly that means
0:48:57 > 0:49:01and what the implications are for treatment, etcetera.
0:49:01 > 0:49:04So it's something called a mixed germ cell tumour.
0:49:04 > 0:49:08Effectively, it's a bit like having two different types of tumour in one.
0:49:08 > 0:49:11And one part of it is called a germinoma
0:49:11 > 0:49:14and one part of it is called a teratoma.
0:49:14 > 0:49:19So the germinoma bit is... It is a malignant tumour.
0:49:19 > 0:49:23So it is... You can imagine it like a cancerous type of tumour,
0:49:23 > 0:49:27- it divides quite fast.- So, it'll spread.- And it is aggressive.
0:49:27 > 0:49:31It won't necessarily spread but it can do.
0:49:31 > 0:49:37But that bit of the tumour actually responds very well to radiotherapy.
0:49:37 > 0:49:40Essentially, what we're going to have to do is to get the radiotherapist
0:49:40 > 0:49:44or the neuro-oncologists who deal with these sorts of tumours to
0:49:44 > 0:49:47see you and decide exactly what they think is the best course of action.
0:49:47 > 0:49:49Because this is so rare,
0:49:49 > 0:49:54it's very difficult to be able to predict how this is going to go.
0:49:54 > 0:49:55OK.
0:49:56 > 0:49:58So that is probably as clear as mud.
0:50:00 > 0:50:06What's the life expectancy after having all this operation
0:50:06 > 0:50:09and this stuff, what's that?
0:50:10 > 0:50:13I can't say for sure.
0:50:13 > 0:50:18You know, I would say we would be talking years not months.
0:50:18 > 0:50:20This sort of tumour,
0:50:20 > 0:50:25you're almost talking what we call case report stuff.
0:50:25 > 0:50:27That's how unusual we're talking.
0:50:28 > 0:50:31Say, obviously, he has a good few years and he meets someone
0:50:31 > 0:50:33and he has children.
0:50:33 > 0:50:36Is that something that will be passed onto children or...?
0:50:36 > 0:50:38- Very unlikely.- Very unlikely.
0:50:38 > 0:50:42Because it's not, as far as we know, a genetic abnormality.
0:50:42 > 0:50:45It's all right, I've got to meet someone first.
0:50:45 > 0:50:49Well, you've got to find someone to take you first, haven't you?
0:50:49 > 0:50:53- Yeah. Charming.- Well, you know, you need to ask these things.
0:51:45 > 0:51:52The brain is so important in the way we are.
0:51:52 > 0:51:54It's also quite a complicated structure
0:51:54 > 0:51:58that we don't fully understand so working with the brain
0:51:58 > 0:52:02gives us the opportunity to not only make big differences,
0:52:02 > 0:52:06it also gives us the opportunity to understand the way we are much more.
0:52:19 > 0:52:22We know very little about the brain.
0:52:22 > 0:52:26I mean, neuroscience has advanced a lot in the last 100 years but,
0:52:26 > 0:52:29even so, we're only at the very beginning
0:52:29 > 0:52:31of understanding of the human brain
0:52:31 > 0:52:34and we don't know that we will ever understand the human brain
0:52:34 > 0:52:38properly, whether we even have the capacity to understand it.
0:52:38 > 0:52:40Careful, careful, careful, careful.
0:52:40 > 0:52:42Cow, yeah, cow, moo.
0:52:44 > 0:52:46Alex has three young children
0:52:46 > 0:52:49and a wife who's a gastroenterology consultant.
0:52:50 > 0:52:56I mean, how can you possibly think about work with that going on?
0:52:56 > 0:52:59Switching off is actually not that difficult.
0:52:59 > 0:53:02Sometimes, you know, you think about someone or you wake up
0:53:02 > 0:53:06in the middle of the night having dreamt about a patient.
0:53:06 > 0:53:09- In a cold sweat.- Yeah.
0:53:09 > 0:53:12Yeah, it happens occasionally, doesn't it? We have days when we've
0:53:12 > 0:53:15had a difficult patient or something stressful's happened at work.
0:53:15 > 0:53:21Yeah, you do have depressing situations but it's very satisfying
0:53:21 > 0:53:25to be able to actually make a difference.
0:53:31 > 0:53:36Several hours in, plastic surgeon David begins the task of
0:53:36 > 0:53:40building a bigger and better skull to house Sofia's growing brain.
0:53:45 > 0:53:48This is going to sit in here.
0:53:49 > 0:53:51There's lot of plastic surgical mumbo-jumbo.
0:53:51 > 0:53:54No-one really understands how they do it
0:53:54 > 0:53:57but that's why they're plastic surgeons.
0:53:57 > 0:53:59We take the bone off
0:53:59 > 0:54:02but, when it comes to reconstruction,
0:54:02 > 0:54:05we watch them planning it and we really, still, after so many years
0:54:05 > 0:54:08of watching them, we still have no idea what they're doing.
0:54:08 > 0:54:09But it always works.
0:54:15 > 0:54:16That's why they can charge so much
0:54:16 > 0:54:19for putting in a pair of plazzy boobs.
0:54:26 > 0:54:28Skin will go back here, like so.
0:54:28 > 0:54:32Suddenly you can see Sofia again, yeah.
0:54:32 > 0:54:33How does that feel?
0:54:34 > 0:54:37Pretty good, isn't it?
0:54:37 > 0:54:39Beautiful. Looks good, huh?
0:54:39 > 0:54:42Looks really good, actually. We've kind of brought the sides out,
0:54:42 > 0:54:44brought the front forward a centimetre and a half.
0:54:44 > 0:54:46- Shall I put something on? - Go on, then.
0:54:46 > 0:54:50MUSIC: "Can't Help Falling In Love" by Elvis Presley
0:54:50 > 0:54:51We know the operation's nearly over.
0:54:51 > 0:54:54It's been a long-lasting tradition.
0:54:54 > 0:54:58Elvis means job done well, home soon.
0:54:58 > 0:54:59All done.
0:55:02 > 0:55:07- I'm out of here.- See you later. - Not if I see you first.
0:55:20 > 0:55:22- Thank you so much.- Bye-bye, now.
0:55:22 > 0:55:26It's always a good feeling whenever you do an operation that goes well.
0:55:26 > 0:55:29So it's good.
0:55:43 > 0:55:44It's amazing.
0:56:20 > 0:56:22You lucky bastard.
0:56:22 > 0:56:24Give me that, you specky git.
0:56:24 > 0:56:26This is someone else's.
0:56:28 > 0:56:29I think mine's over...
0:56:29 > 0:56:31I can see mine.
0:56:31 > 0:56:32Yeah, you didn't see the one
0:56:32 > 0:56:35where I completely missed it in there, though.
0:56:39 > 0:56:45'I think everyone who does a job which they think makes a difference,
0:56:45 > 0:56:49'it probably makes them appreciate their lives more.'
0:56:49 > 0:56:53So this is nice, this is a relaxing, nice, unwinding time.
0:56:53 > 0:56:56Have a bit of a laugh with your mates that you've known for years.
0:56:56 > 0:56:58That's what it's all about.
0:57:00 > 0:57:02- Oh, nice putt.- One over.
0:57:02 > 0:57:05- INTERVIEWER:- Is there a similarity between golf and neurosurgery?
0:57:08 > 0:57:11Yeah, if you want to count the fact that everything's unpredictable
0:57:11 > 0:57:13and you never know what's going to happen.
0:57:13 > 0:57:17And you have to practise your butt off to be any good at it.
0:57:18 > 0:57:21That's a collection of similarities.
0:57:21 > 0:57:22It can be intensely frustrating.
0:57:28 > 0:57:32But, of course, the big thing,
0:57:32 > 0:57:36it doesn't really matter if you're rubbish at golf, does it?
0:57:36 > 0:57:38If you play a bad hole, it's frustrating, but nothing happens.
0:57:38 > 0:57:40That's why it's quite nice
0:57:40 > 0:57:42to be rubbish at something that doesn't matter.
0:57:47 > 0:57:51Asshole. Where's the tee gone?
0:57:51 > 0:57:53Game is ridiculous.
0:57:53 > 0:57:56Mind you, why are we playing it in the dark?
0:57:58 > 0:58:01No, it's just behind the bunker.
0:58:01 > 0:58:02That'll do me.
0:58:25 > 0:58:28Subtitles by Red Bee Media Ltd