Against the Odds Brain Doctors

THIS PROGRAMME CONTAINS SCENES WHICH SOME VIEWERS MAY FIND UPSETTING

It's a fantastic amazing lump of blancmange that weighs about a kilo.

The human brain has 100 billion neurons, which makes

it the most powerful learning tool in the world.

Your entire person is encapsulated in that little blob of blancmange.

Jay Jayamohan is a senior paediatric neurosurgeon

at the John Radcliffe Hospital in Oxford.

He's part of an almost hundred-strong team of consultants

who deal with every conceivable problem of the brain.

We are making life-and-death decisions.

One split second decides everything.

Each year, they perform almost four and a half thousand operations...

You're concentrating constantly.

Is it in the right place?

Stop any bleeding.

So you're already in that mindset of, "Think, think, think, think, think."

..cutting-edge procedures that carry high risk.

It can be a bit like walking on a tightrope in very high winds.

You could fall off and die.

Their interventions can mean the difference between life and death.

You've got to respect the organ.

You've got to respect the fact that what you do to it

can have huge implications for the patient.

Stef Lorenzo?

Hello. Come on in.

One of four paediatric neurosurgeons at the John Radcliffe, Jay is

doing his Tuesday follow-up clinic.

You big faker.

There is this large streak in me that refuses to grow up.

Jay's been at the hospital for nine years

and has operated on thousands of children.

I think the main reason I became a paediatric neurosurgeon is

because I'm a big kid.

Did that hurt you? What about that?

I like giggling at stupid jokes, I read comics, I watch cartoons.

'If someone says to me, "Who would you want to spend an hour with -

'"a bunch of grown-ups discussing politics or a bunch of kids'

"playing on the PlayStation?" I'd be on the PlayStation.

Beautiful. He's always good with that, isn't he?

52.6. That's only up 0.2 in a year. Brilliant. Very happy.

Jay looks after two busy children's wards - Mel's and Robin's.

At any one time, there could be 30 kids here.

Three-year-old Cerys is one of Jay's emergency patients.

Four days ago, she went to the GP with headaches and loss of appetite.

Jay suspect she may have a brain tumour.

I've come to have your sausage.

-Shall I have it?

-No.

'Well, we operate on about 40 kids' tumours per year here.

'It's the commonest solid tumour of childhood.'

-You have your sausages.

-You have your sausages with Auntie Vicky.

It is a biggie. This is on the high-risk level for what we do.

This is the cerebellum.

That would normally fill up this entire space but it's been squashed.

And that's because this large, differently-grey object

is the tumour.

Jay wants to operate as soon as possible

but first must get Cerys's mother's consent.

A lot of the things that we'll tell you will be...will be

difficult to hear.

-But there's no benefit in us lying to you.

-No.

-Or sugaring it

and making it sound, you know, just to make it sound nice.

This is on the very big end of things.

This is the big one tomorrow.

But we can't do anything about it. We've got to do it.

If we don't do it, it will kill her.

My whole world come to a standstill.

Everything stopped.

Everything.

My hope.

Everything.

You know, I know you've been able to be together

and be kind of quite happy about it in front of her.

But we all know what you're going through, even if

we haven't experienced it ourselves.

'What you realise doing a job like this is the world

'is a big unpredictable mess

'and we try to pick up the pieces from what happens.'

Until he operates, Jay won't know if Cerys's tumour is malignant.

'I'm powerless as a mother.

'The first time in my life I'm powerless. I can't do nothing.

'It's all in the doctors' hands.'

It's a very life-affirming place as well as a slightly

unfortunately life-destroying place.

There's quite a lot of things we can do to make it a much better

quality of life but it can go either way.

Cerys's tumour is in the base of her brain where breathing

and heart rate are controlled.

Jay must remove as much of it as he can

without damage to this crucial tissue.

This is the normal brain structures

and in the middle here, you can see this sort of grey, purplish substance

and that's the tumour that's poking out between the two hemispheres.

I'm getting a slow instinct about this one.

Bollocks.

This is almost certainly going to be a malignant tumour.

It's just soft, it bleeds very easily.

It's grown relatively rapidly and without any organisation.

Ah, bollocks.

That's definitely invading it there, isn't it? Invading it.

Shite-bags.

That's what that means. That means shite-bags.

The aggressive, slimy tumour

is entangled with Cerys's vital motor functions.

The further in we go and the further into the sort of clockwork,

then the more dangerous even a small damage is.

So...

..I'm worried about injury to that area which could give her

problems with swallowing and speech, the lower part of the face.

Jay has removed as much of the tumour as he can

but it's too risky to proceed further.

While Jay and his colleagues operate on over 300 children a year,

Alex Green is one of 10 neurosurgeons treating

the hospital's adult patients.

There's Bob.

'This is my fourth year as a consultant.'

I've done over 3,000 operations.

'It's a chaotic day today. I've got two possible spine operations'

and someone with a brain tumour so there's always plenty of work.

'I do a mixture of tumours, spinal operations'

and deep brain stimulation which is my great sort of favourite.

There you go. You're doing really well.

Seen a lot of human brains.

We deal with a population of around about three and a half million people

and we deal with several hundred people a year who have brain tumours.

The Neuroscience Department serves not only patients in Oxfordshire,

but also the whole of the UK.

27-year-old Chris is one of Alex's patients.

I'll get this for you, Mum. You open the door.

He lives in Aylesbury.

His mum and dad have moved in while they're doing up their home.

Chris works in property and is looking for a girlfriend.

Ladies, I'm open for business.

Come and enjoy.

I think it would actually kill me right now

if I was to have sexual intercourse with a girl.

I think it would actually kill me but I'd give it a good go.

I'm packing for my operation, which is tomorrow morning, first thing.

A week ago, Chris went to the optician with blurred vision.

A day later, a scan revealed a massive tumour.

OK, so couple of boxers for a couple of days.

If I need any more, my mum can bring me some.

I am pretty scared at the moment cos obviously they're

drilling into my head and if they make a mistake a centimetre

either side, then it's game over.

So that is pretty scary.

However, I'll get to see the pretty nurses.

Get to talk to them, so that's the icing on the cake, really.

Christopher has a tumour in his third ventricle.

It's actually causing some pressure on his brainstem here.

This is the tumour here, which is right in the middle of his brain

and so we have to get into that.

It's about as far as you can get from any access.

With big operations like this, I often wake up

in the middle of the night and find I'm thinking about them

a little bit because this sort of operation is quite rare.

There's a risk of hydrocephalus, there's a risk of infection,

there's a risk of bleeding, there's a risk of recurrence

of the tumour and there's a risk of seizures.

Look after Mum.

Ring any time.

He could get a stroke or he could die.

Love you, Dad.

You'll see my face when you wake up cos I'll come and take you off.

Oh, God!

Can you not get some pretty, young bird?

See you later. Take it easy, Chris.

Yeah, I know what you mean.

That's the skull there.

This is the sort of incision that the North American Indians

-would have made when they were scalping their victims.

-Really?

They'd make a cut in the forehead and get their hand

into the right plane and just rip the whole scalp off.

To reach the tumour deep inside Chris's brain,

Alex slices down between the two cerebral hemispheres,

penetrating as far as he dares.

So we're just down to the corpus callosum now,

which is this glistening, white structure.

So we're going to make a little hole in that and drop into the ventricle.

This is the most difficult part of the procedure.

There's this structure called the fornix which comes over

the roof of the third ventricle

and we have to go through that roof to get to the tumour.

So if we damage that, that's his short-term memory gone.

Yeah, we're in tumour. We're in tumour.

See that,

at the bottom where the sucker is?

That's all tumour.

It's like a sort of soapy...like a sort of white soapy stuff there.

Let's get a biopsy. Forceps, please.

I wonder if I could get a retractor just to...

It's just trying to get the whole lot out

but it's coming quite nicely so just get a bit of suction.

It's about two or three centimetres in total

but we'll just take it out a little bit at a time.

Alex uses a microscopic camera to check the parts Chris's brain

the human eye can't access.

It's as deep as we go.

That's the deepest part of the brain.

Everybody's beautiful on the inside.

It is really beautiful, amazing anatomy when you see it

and you realise just how intricate we are.

So everything that we could get out is out.

We think the whole tumour is out but there may just be a little

bit of capsule that is very firmly stuck to the ventricular wall and

we can't take that because it would...

there's a high chance we'd kill him.

Alex won't know if the operation is successful till

he gets the biopsy result and sees the post-op scan.

Chris's family have only had a week to come to terms with his tumour.

I haven't slept for a few days. I just felt sick inside.

Nightmare, it's just horrible.

I'd rather it be me than one of your children.

Adele won't know if her daughter Cerys's tumour is malignant

until the operation is over.

'I refuse to say the C word. I won't ask.

'I don't want to know.

'I'm too frightened.

'Three years old.

'She's a baby. She's too young.

'I know I've got to face it

'and I know what's got to be done and...

'But, like I said, I'm a mum and I'm not ready.'

Unfortunately for her long-term outlook,

there's more bad bits than good bits.

What can you do?

Every child should be treated as if they're the one that is going

to completely buck any odds and go on.

So there's always a little bit of a lottery with it.

You've got to be very plain and clear about what you're telling people.

If you have to say it's a cancer or

if you have to say it's malignant or if you have to say it's going to

kill someone, you have to say it is going to kill them.

It went OK.

We'll wait for the results,

but I'm fairly certain this is going to be a malignant tumour.

Oh, my God. No, no, no. No, no, no, no.

No! No!

No! No, no, no. No!

Adele, just wait. Listen to me. Just take some deep breaths.

Just stop for a minute. Just take some deep breaths.

Deep breaths. Keep going, keep going.

Just take your time. There is no rush, take your time.

Deep breaths in and out.

You can't have that conversation and have people coming out

not having understood what you've said.

They may choose not to accept it or they may choose to hear

it in a different way but, as much as you can, you have to make sure

that you tell them in very plain, easy-to-understand words cos,

again, their brain will be shutting down as you're talking to them,

their brain will be closing itself off to what you're saying,

as a natural defence.

So you have to be very straight, so that you can get it into

that small gap as their brain door is closing.

You've got to get that information in there.

-Just take your time until you're ready.

-What can be done?

Just wait. Just take your time and get yourself ready first.

It does not mean that there's nothing we can do.

It does not mean that, you know, that the whole thing's over.

It just means that we have to work that little bit harder to treat it.

We need to probably give her some chemotherapy after this. OK?

Today was the really, really big step.

She'll need more treatment, that's fine, but it's treatment, OK?

-OK.

-But that's what we do.

-All right? So it's not the end of the world.

-It is.

It isn't. It isn't for her. It isn't for her at all.

This is the first step in the treatment.

OK? But that is the huge big step.

After his operation,

Chris is taken to the Neuro Intensive Care Unit to recover.

All right, Chris? You been telling jokes?

-My sister.

-Sister, yeah, sister.

Yeah, the one he owes 20 grand to. Do you remember that, Chris?

50% of brain tumours are spread from cancers

around the body and about a quarter are from tumours that

come from within the brain itself and about one in ten

are benign tumours from around the surface of the brain.

'So there would be over 100 different types of brain tumour.'

'I think statistics are very important in medicine

'because we don't have certainty.'

'Life is made up of choices.'

No flying without risk.

If you look at it statistically, which I have done, the risk of death

'from microlite flying is about one death per 37 million flying hours.'

'It's a bit like doing an operation. There is always a risk.

'It's a case of doing what you can to reduce that.

'But the gains that you get out of it are so great, it's worth it.'

I'm sort of still pseudo on this detox thing

that the missus has put me on -

eating a lot of seeds

and green things that I've never heard of before.

As well as his duties in neuroscience, Jay also works in the

Craniofacial Department alongside plastic surgeon David Johnson.

They operate on a handful of children with rare genetic

disorders that malform their skulls.

It's just in the ventricle. We'll have to keep a close eye on it.

This specialisation demands high levels of skill from the neuro

and plastic surgeons who work on these tiny patients.

Rachel has bought her one-year-old daughter to see David.

Sofia has Crouzon's syndrome.

Her skull has fused too early and is squashing her growing brain.

She's got this, sort of,

saddle-shaped dip that you can see here.

A feel of her head here and a little look at her.

Do you think that this prominent area here is becoming more

-prominent with time?

-Yes, definitely. Yeah, absolutely.

-Eyes look as if they're bulging a little bit.

-Yeah, they do seem...

-There's nothing wrong with the eyes, it's the actual...

-They do seem to

-bulge more so as well at times.

-Do they?

-Yeah.

This is Sofia's CT scan from last year

and what you can see here is that the bone is full of holes

cos the brain is squashed and the brain's trying to get out

through gaps in the bone so the bone can't from normally.

She has a genetic mutation in every cell in her body,

which is preventing the skull from growing in a normal way.

We can't correct that but what we can do is to expand

the shape of her skull to give space for the brain.

Sofia's malformed skull is squeezing her brain

and blocking the flow of cerebrospinal fluid.

Without an operation, the build-up of pressure will eventually

lead to seizures, blindness, coma and death.

The past week or so, I've been trying to just block out that

this operation's been coming up.

Now that we're here, I almost want to wake her up again so that,

you know, I can play with her and hold her.

Cos I know tomorrow morning, you know,

she's going to be going down for this operation

and when I see her again,

she's going to be attached to tubes and wires

and I'm not going to be able to pick her up

and hold her for a while.

I'm not going to be able to play with her

and it's so...

..difficult to...

Cos she's such a happy little baby and when you look at her,

she seems absolutely fine but knowing that this is necessary,

it's very difficult to, sort of, accept.

It's just the pain and everything else that you think, you know,

you just don't want them to suffer in any way, shape or form.

I just wish I could take it away.

She's so tiny.

And she's, you know, been through so much already.

Anyone want to do this case?

Come on, what's the matter with you?

-Morning.

-Morning, how are you?

-Morning.

-All well?

No more questions from last night?

-No.

-I'll go down to the anaesthetic room,

make sure that everything's fine there.

Then we're ready to go. We'll come and see you afterwards.

-All right?

-Yes, that'll be the good point.

-Look at that look. Rrrr.

-Yeah, she's like that.

OK, we'll look after her for you. All right, bye-bye for now.

Jay and David are old theatre hands who've been working

together for seven years.

Morning, everybody. Hi. The big case is Sofia Timmins.

She's a little girl with Crouzon's syndrome.

We'll take the forehead off, we'll take the top portion

of the eye sockets off and then we'll take the lateral

panels off and then we'll figure out a way to put it back together again.

Jay's off to find a recovery bed for Sofia.

Without it, they can't proceed with the operation.

-Have you got a bed?

-No.

So what do you reckon for the craniofacial?

We'll let you know as soon as we know, Jay.

OK, thanks, guys.

Chris has been moved from recovery and is back on the adult ward.

I am tired. However, all things considering,

I feel pretty good about everything.

I've got a pretty nurse now, which I'm pleased about.

A young blonde bird. Keep forgetting her name, though.

-Do you want to go out some time?

-No, I'm all right, thanks.

-Oh, thanks.

-You're married anyway, aren't you?

Soon to be divorced.

Two floors up, Rachel's still waiting for news of a bed

and it's been six hours since Sofia's last feed.

-31329.

-'Morning.'

-Morning. It's Jay. I've heard we haven't got a bed yet?

'Yes, we're still waiting.'

OK, we'll keep out of it and will you ring me when you know?

-'Yes.'

-OK.

The view of the graveyard is a nice positive sight(!)

However, could be worse.

-You could be in it.

-I could be in it.

As long as I don't keep snoring in the night,

you don't suffocate me with my pillow.

Well, yeah, there is that.

Are they looking like there's going to be anything shifting?

-Yeah, well, we're just...we're phoning every hour.

-Yeah.

So we'll just keep phoning.

They've said they're not sure now if the operation's going to go

ahead today because they're not sure they've got a bed in intensive care.

-This is really annoying.

-Just got to wait.

Is she going to be cancelled?

Probably if we don't find a bed soon.

I'm going to feed her. I'm taking the decision, I'm sorry.

-I'm going to feed her.

-That's absolutely fine.

Yeah, I'm going to feed her. OK.

I'm not looking forward to this at all.

I hate any kind of pain. I'm a real screamer.

Slow and steady wins the race, remember?

-Don't hurt me.

-I won't.

-Oooow!

Chris, you need to get them out, don't you?

I do. I do apologise, nurse.

I told you I was a screamer before you started.

Ahhhh!

-Does it really hurt?

-Yes. Ow. Ow. Ow! Ow!

I've spoken to Russ.

There's still no bed and Mum breast-fed at half 12.

So we're looking at half four.

So then are we looking at not happening?

-Russ is wanting to cancel it.

-OK.

Hello. Hi. There's no hope of a bed at all,

so what we're going to have to do is cancel it today.

There just isn't any way around it, I'm afraid.

We can't do the operation. It's not safe

unless we've got the right bed in the right environment for her.

If there is a choice -

do you want to go as soon as possible, knowing...

but it may not be one of us two?

No, I'd rather you do it.

-Do you want us to wait?

-Yeah.

-OK.

So, so frustrating.

So it means we've got to go home and we've got to wait

and we've got to go through it all again.

I mean, this happens and there's nothing you can do about it.

It's part of the nature of the hospital system.

That either you have lots of empty beds lying around

so that you never cancel anyone, but then it's inefficient.

Or occasionally, you're overwhelmed.

Bummer.

Thank you, nurses. Bye.

I've had three bacon sandwiches this morning.

Cos we had to use up all this bacon. Oh, I feel bloated.

There you go. It's one of my quality shots.

No, I'm not going to be one of those people that starts learning

how to paint and speak Esperanto and ride a unicycle at the same time.

But if I do like something, I want to be good at it.

And it's really important, I think,

to have time to yourself, eh?

Just to do something relaxing rather than the archetypal thing that

we've been doing most of our lives, which is drinking.

THUD!

-INTERVIEWER:

-What was that, Jay?

That's why you don't stand close to me playing golf!

Chris's biopsy results have come back benign.

The final all-clear will be a post-op scan to make sure

the tumour is gone.

My recovery's going well. Physically, I'm doing very well.

I'm back to where I was before the operation, which is quite nice.

Got the JR tomorrow,

my check-up and then hopefully do a bit more travelling.

Today, Alex will give Chris his results.

It's always difficult to give people bad news.

We do it on quite a regular basis in neurosurgery because of what

we're dealing with, so I often call Friday morning my Grim Reaper day.

The reason I'm calling Chris today fairly urgently is that we

did a routine post-operative MRI scan

and on that scan there is the appearance of some tumour

in the brainstem or the mid-brain.

Now, this was present on the scan before the first operation

but we weren't sure if it was really tumour or just swelling.

But the new scan shows that the abnormal tissue isn't swelling,

it's tumour.

We can't get it out

because you can't operate on that bit of the brain.

It would effectively either kill him or render him extremely disabled.

Just when you think everything is going well, actually it's not

and something goes wrong and in this particular case there is this

bit of tumour that's there which I can't get at

and that's obviously very bad, both for us and for him.

-Hi there, how are you doing?

-Not too bad. Nice to see you.

-Yeah, you too. How are you?

-Good, thank you.

-Hello.

-Hi. Would you like to come this way?

-You had your scan last Friday.

-Yeah.

And there's a couple of things which I don't like on that scan.

The bit that we took out in the ventricle is gone, which is good.

So that was successful and we took that part out but this bit here

is worrying me a little bit because it would tend to suggest that there

is some tumour there in the mid-brain which is not accessible.

Now, we can't do... We can't sort this out surgically

but it might be possible to treat it using another type of treatment

such as radiotherapy to that area

or chemotherapy for certain types of tumour, so drug treatment,

but we can't really do that until we know what it is.

So what I'm proposing is to do a biopsy

and it would give us the answer as to what that bit there is.

So I'm sorry to give you bad news.

It's not the news I was hoping for, I must say.

It wasn't the news I was hoping for cos there's something going on there

that I can't get at.

OK.

Really sucks.

I was expecting to get the all-clear today, then that would have been it,

I could have gone home and celebrated but instead I've got

another operation to...

..look forward to on Thursday.

Shit.

Now my mum's going to be upset again.

Dad's going to be upset

and I'm going to have to be the strong one for them.

I don't have to be but I want to be

cos I don't want them to be upset at all.

It's very rare that you're able to say to someone, "You are cured 100%."

Usually it's, "Everything looks good at the moment,

"we'll do another scan in a year,"

or five years or whenever it is, but they're always under your eye.

It's very rare that somebody's completely cured and goes home.

Cerys has returned to the hospital to have her cancerous tumour treated

with a course of chemotherapy.

Nanny's going to come back in a minute.

I mean, the chemo and she's got obviously six weeks, every day for

six weeks of radiotherapy to come, yeah.

And it's... That's going to be tough.

-Don't panic. Come on.

-It doesn't hurt, Mum.

The treatment involves a powerful cocktail of drugs.

Jay hopes it will destroy the remnants of aggressive tumour

left inside Cerys's brain.

Surgery is not operate, finish operating, done.

And then chemotherapy begins, finishes, done.

It's all a spectrum of treatment.

Each one is interdependent on the other treatment.

Chemotherapy only works if we can get rid of

as much of the tumour as we can.

These kids are never done.

So there's never going to be an end to her treatment.

Shall we put a new one on? Yeah?

'I will never cry in front of her.

'I think, "No, you know, go upstairs, have a cry upstairs,

'"that's a bit of me time."

Shady away for a couple of hours,

have a cry and think, you know,

and I'd be lying if I said you don't think the worst cos you do.

Cerys's treatment will continue for the next five years -

only then will Jay know if the tumour has gone for good.

Chris has returned for his biopsy.

INTERCOM BEEPS

Hi there. Just got an operation this morning.

-'Pull the door, please.'

-Thanks.

I'll try not to flash everyone.

It's not very nice, is it, to see him have to go through it again?

Well, you haven't really got to go through it again,

you ain't got to have an operation.

He's got to have it lasered or something, hasn't he?

So it's a bit different this time, isn't it?

My mum doesn't actually fully understand

what's going to go on today.

She thinks it's being lasered off but...

Not today, you're having a biopsy tomorrow.

Yeah, so she's not 100% on what's going on

and I think that's quite a good thing.

She doesn't realise that they're drilling into my head and...

-Yes, we know that.

-..taking a piece out.

Yeah, you're having a biopsy and they're taking bit out

and then, next week, we'll know what's happening.

But where it is, they can't operate.

So it's got to be, like, a different operation this time, you know,

to get rid of it.

-Radiotherapy.

-Yes, so it's a bit different.

But you've got to deal with these things, haven't you?

You know, that's it. Get it done and we'll move on.

-Won't we?

-Mm-hm.

-See you later.

-See you.

-Love you. Love you, Dad.

-See you later, mate.

'It has made me think about my life and where I am

'and what I want to get out of it.'

Mostly find someone to, sort of, be with.

Another, sort of, girlfriend, long-term girlfriend.

Think I mentioned that before.

Coming off desperate now.

You seem very pretty.

'But that's one thing that's definite for me.

'I want to start a family. That kind of stuff.'

Give my mum some more grandchildren.

-Thank you.

-You're welcome.

Just some oxygen. Nothing else, I promise, just oxygen.

It's going to get tight, my darling.

It can sometimes sting a little bit as it goes in.

Give you something nice to dream about.

Chris is strapped into a hi-tech frame.

It will turn the space in his skull into a set of 3-D co-ordinates.

Once inside the scanner,

it pinpoints the tumour's exact location.

This ensures the biopsy will hit its target

without damaging the brain.

It's basically just a hand drill.

You can probably get better ones from B&Q.

Can we have the table down a bit, please?

If I set it about here, as I lean on this drill,

it'll only go in a centimetre or two.

If I set it here, then it will go into his brainstem

and, probably, that'll be the end of him.

So we'll try and set it low.

The aim is to just plunge it down a few millimetres

so that it goes through the dura, which is

the lining around the brain and then we can get the biopsy needle in.

-Quite a thick skull.

-Yeah.

That's really stiff now and we've avoided plunging in this instance,

as it's known in the trade.

So this is the biopsy needle.

That's just going through the brain now, down to the target.

I would just take maybe two or three, literally.

Thousands of biopsies are processed each year

at the John Radcliffe Hospital,

one of the country's major pathology labs

and a centre for cancer research.

Chris will have to wait at least three weeks for conclusive results.

Are we going to give you a bath?

It's almost six weeks since Sofia's operation was cancelled

and now a new date's been set.

The entire function of Sofia's brain is in danger of being

damaged by her fused skull, with devastating consequences.

It's one of those things. There isn't a choice about it.

It has to be done. You have to think, you know,

"If I don't have it done, this time next year she won't be here."

Each year, Jay and the craniofacial team

operate on just 80 to 100 children with fused skulls

but only a handful have rare genetic disorders like Sofia's.

'I've spent the last week just thinking, you know,

'"Got plenty of time, got plenty of time."

'Now it's sort of come up.

'Just thinking about it, I just want to cry.'

I'll just pop that there, Sofia. You hold onto her hands, Mum.

'It's the worst experience you could ever feel

'because although you want to stay positive, you wonder

'if that's the last time you're going to see them.'

-Thank you.

-Well done, Mum.

-I'll take good care of her, OK?

-Yeah.

'It's just the most horrible feeling out.'

Sofia's operation will be complex and risky.

Before rebuilding her new skull,

Jay and David must delicately remove the old one.

So, the things we want to do when we take the bone off is

leave the dura intact, the fibrous bag that surrounds the brain.

We want to keep that intact as much as we can.

cos if you open that, A, you could damage the brain

but, B, you could get leakage in the spinal fluid and therefore infection.

So the main things for me today -

keep the dura intact and don't trash any of the veins.

I'll shuffle, there you go.

Oh, it's a nice soft song.

We'll get rid of that.

I'm telling you, if they stop me playing music in theatre, I'm done.

I'm out of here, man.

Get the faders to the highest level possible, please.

-Beautiful.

-Thank you.

OK, for my next trick,

I think I'll take a pair of baby bone nibblers, please.

Is this the line you want, Your Majesty?

-Yeah. Straight up there.

-My Lord.

-I'll tell you if you stray.

If we just go underneath this bone here,

what will end up happening is, all these bits of the brain that

I'm poking out through the holes here,

we could end up, sort of, beheading them from the inside.

You've just got to be very, very careful.

-OK.

-Coming off?

-Yeah, coming off.

-Swab on.

Do we think about the parents? BOTH: No.

Don't think about anything other than what we're doing.

You've got to take the emotion of the parent/child situation

out of theatre.

There's a time for that sort of compassion and emotion

but it's not when you're operating.

I'll go straight down here like that, so you can hit that point.

-Ready here. Ready?

-Yeah.

-Happy?

-Yeah.

Good, yeah, yeah, yeah, yeah, good.

I can disappear soon, yeah?

-No, you're not. Not yet.

-You've got another to go yet.

Right, if all our cuts join up, this bit of bone will come straight off.

If they haven't, then we might need to do some chiselling.

There we are, so we're all fine here.

-So this is the top of the eye sockets here.

-Super.

Chris and his sister have come back to the John Radcliffe

for the results of his biopsy.

-You are a very rare person.

-I am aware of that.

-Special. We call him special.

-They call me special.

I'll tell you what it's called first and then we'll talk about

what exactly that means

and what the implications are for treatment, etcetera.

So it's something called a mixed germ cell tumour.

Effectively, it's a bit like having two different types of tumour in one.

And one part of it is called a germinoma

and one part of it is called a teratoma.

So the germinoma bit is... It is a malignant tumour.

So it is... You can imagine it like a cancerous type of tumour,

-it divides quite fast.

-So, it'll spread.

-And it is aggressive.

It won't necessarily spread but it can do.

But that bit of the tumour actually responds very well to radiotherapy.

Essentially, what we're going to have to do is to get the radiotherapist

or the neuro-oncologists who deal with these sorts of tumours to

see you and decide exactly what they think is the best course of action.

Because this is so rare,

it's very difficult to be able to predict how this is going to go.

OK.

So that is probably as clear as mud.

What's the life expectancy after having all this operation

and this stuff, what's that?

I can't say for sure.

You know, I would say we would be talking years not months.

This sort of tumour,

you're almost talking what we call case report stuff.

That's how unusual we're talking.

Say, obviously, he has a good few years and he meets someone

and he has children.

Is that something that will be passed onto children or...?

-Very unlikely.

-Very unlikely.

Because it's not, as far as we know, a genetic abnormality.

It's all right, I've got to meet someone first.

Well, you've got to find someone to take you first, haven't you?

-Yeah. Charming.

-Well, you know, you need to ask these things.

The brain is so important in the way we are.

It's also quite a complicated structure

that we don't fully understand so working with the brain

gives us the opportunity to not only make big differences,

it also gives us the opportunity to understand the way we are much more.

We know very little about the brain.

I mean, neuroscience has advanced a lot in the last 100 years but,

even so, we're only at the very beginning

of understanding of the human brain

and we don't know that we will ever understand the human brain

properly, whether we even have the capacity to understand it.

Careful, careful, careful, careful.

Cow, yeah, cow, moo.

Alex has three young children

and a wife who's a gastroenterology consultant.

I mean, how can you possibly think about work with that going on?

Switching off is actually not that difficult.

Sometimes, you know, you think about someone or you wake up

in the middle of the night having dreamt about a patient.

-In a cold sweat.

-Yeah.

Yeah, it happens occasionally, doesn't it? We have days when we've

had a difficult patient or something stressful's happened at work.

Yeah, you do have depressing situations but it's very satisfying

to be able to actually make a difference.

Several hours in, plastic surgeon David begins the task of

building a bigger and better skull to house Sofia's growing brain.

This is going to sit in here.

There's lot of plastic surgical mumbo-jumbo.

No-one really understands how they do it

but that's why they're plastic surgeons.

We take the bone off

but, when it comes to reconstruction,

we watch them planning it and we really, still, after so many years

of watching them, we still have no idea what they're doing.

But it always works.

That's why they can charge so much

for putting in a pair of plazzy boobs.

Skin will go back here, like so.

Suddenly you can see Sofia again, yeah.

How does that feel?

Pretty good, isn't it?

Beautiful. Looks good, huh?

Looks really good, actually. We've kind of brought the sides out,

brought the front forward a centimetre and a half.

-Shall I put something on?

-Go on, then.

MUSIC: "Can't Help Falling In Love" by Elvis Presley

We know the operation's nearly over.

It's been a long-lasting tradition.

Elvis means job done well, home soon.

All done.

-I'm out of here.

-See you later.

-Not if I see you first.

-Thank you so much.

-Bye-bye, now.

It's always a good feeling whenever you do an operation that goes well.

So it's good.

It's amazing.

You lucky bastard.

Give me that, you specky git.

This is someone else's.

I think mine's over...

I can see mine.

Yeah, you didn't see the one

where I completely missed it in there, though.

'I think everyone who does a job which they think makes a difference,

'it probably makes them appreciate their lives more.'

So this is nice, this is a relaxing, nice, unwinding time.

Have a bit of a laugh with your mates that you've known for years.

That's what it's all about.

-Oh, nice putt.

-One over.

-INTERVIEWER:

-Is there a similarity between golf and neurosurgery?

Yeah, if you want to count the fact that everything's unpredictable

and you never know what's going to happen.

And you have to practise your butt off to be any good at it.

That's a collection of similarities.

It can be intensely frustrating.

But, of course, the big thing,

it doesn't really matter if you're rubbish at golf, does it?

If you play a bad hole, it's frustrating, but nothing happens.

That's why it's quite nice

to be rubbish at something that doesn't matter.

Asshole. Where's the tee gone?

Game is ridiculous.

Mind you, why are we playing it in the dark?

No, it's just behind the bunker.

That'll do me.

Subtitles by Red Bee Media Ltd