Episode 2 Children's Ward

Wrexham Maelor Hospital is the second-largest hospital in Wales.

And for the first time ever,

it has allowed cameras to follow its every move.

You don't want to die, do you? Not at your age.

With 34 wards and nearly 700 beds,

it's a busy hospital and its children's ward is no exception.

You don't know what's going to come through that door.

We can see anything from surgical children that come in for

tonsillectomies to complex children with heart conditions.

Can I just hold your hand?

Every year it sees over 5,000 children.

Children are poorly, but they are very quick to turn round.

Some are happy to be there.

Others can't wait to go home.

But they all have one thing in common.

You will come home one day, I promise.

Dr Nick Nelhans has always wanted to be a children's doctor.

I think as a medical student, I didn't really have much idea what I wanted to do and I went through

a phase where I was going to be a surgeon

and then sort of decided it wasn't really for me.

I think the thing that I really enjoy about kids is that

because, as a general paediatrician,

children can come in with any problem,

from something really benign to something really serious.

-How's the babies?

-They are absolutely grand, thank you.

-Great.

-Yes, not got many, as you can see.

-And there's one going home?

-One going home, yes.

Back down to South Wales.

-Brilliant, brilliant. Well, shall we start the ward round, then?

-Yes, absolutely. Come on, then.

He's now one of the most senior doctors in Wrexham Maelor,

the Clinical Director of Paediatric Services.

A lot of being a consultant is a lot of administration and that sort of

thing, so it's actually quite nice to get your hands dirty and see

people and that's what I went into the job for, I guess.

Good morning, and how are you and Indy?

-Yeah, we're good.

-Good.

-Yeah, she's doing well.

-She's snuggling in?

-Yeah.

-Tolerating feeds?

-Yeah, really well.

-Good.

-She's breast-feeding on demand.

-Peeing and pooing?

-Yes, definitely.

-Breast-feeding on demand?

-Breast-feeding on demand.

-Clever girl. Clever girl.

Because you've got that variety of possibilities,

you always have to try and think, you know,

ahead of the game and the other thing I quite enjoy,

even if children are quite poorly,

if you do or you or the team do the right thing,

they improve very quickly and it sort of appeals to my sort of

short-term-ism.

CHILD CRIES

What? What?

What's the matter?

-Hello.

-Hello.

-Come to see you. How are you doing, Billy?

-Fine.

-Fine. Now...

I think the other thing about kids is they're actually quite good fun.

Let's see what they've said about you. And you obviously need to

listen to this, to make sure we've not said anything wrong.

So, 29 years old.

-No.

-Ten. Is that right?

-Yes.

-Cool.

Next on Dr Nick's ward round,

an 11-year-old girl in overnight

because she's been struggling to breathe.

Miss Lydia. I'm Dr Nelhans, I'm delighted to see you.

Can I have a quick listen to you, is that OK?

I'm going to have a quick listen to your chest and what I want you to do

is really, really big deep breaths. Go...

Can you do that?

Cos I've got old ears, see,

and if you don't breathe really, really loud,

I'll think you're not breathing, I'll think you're a zombie.

Wow.

Lovely.

And again...

And again.

And last one.

Lovely. Well done, Lydia.

Now, let's see how good you are at maths.

Oh, God!

I bet you're really good. So, in this, there's 100, yeah?

If you take this without using that, how much gets into your lungs?

50%?

10%.

However, you've answered my next question, if you use this and this,

how much gets into your lungs?

-50%.

-So that's five times as much medicine, so when you're taking your

puffers, always use this.

So, you're going to promise me you're always going to use that,

aren't you? OK, Miss Lydia.

Hello, Children's Ward ward clerk, can I help you?

Levi, a 13-year-old Type 1 diabetic,

hasn't done what he promised the doctors.

It was this morning he got up sick.

And he's been sick all day.

He's had some drink, but he's been vomiting the drink back up.

Last night Levi was out with his friends

drinking high-sugar energy drinks.

Type 1 diabetics are warned against doing this because their

bodies don't produce insulin,

which processes the sugar.

Levi now has ketoacidosis and is in serious danger of slipping

into a coma.

-Why are you cross?

-Because he doesn't listen to me...

..when he's meant to.

And he's not taking his insulin when he should do.

Consultant Dr Kamal Weerasinghe

is immediately on the case.

Not taking insulin means Levi's body is now burning fat to produce energy

which is releasing acidic ketones into his blood.

This has serious life-threatening consequences.

There's no time to waste.

Are you and Levi friends?

Not at the moment!

I don't think... He's not friendly

with anybody in the hospital now,

is he? Yeah.

But then the only thing is that he needs help now.

He says he hates having it, doesn't like doing it.

He hates having diabetes.

Kamal says you're allowed one piece of ice.

Sorry. I brought you a few.

It's to freshen your mouth up.

I'll pop it on there for you.

Usually when they get to teenagers,

their management is a little more tricky when they're diabetic because

they, you know, they want to go out with their friends and they want to

eat what their friends are eating and sometimes there's alcohol

involved and partying until late at night and less sleep,

so their management is a bit more tricky

when they get to teenagers, yep.

Not taking his insulin means Levi's blood sugars are out of control

and his ketone level is eight times what it should be.

He needs intravenous fluids to rehydrate the body and insulin

to break down the sugar. But too much too soon

could prove disastrous.

It needs to be done slowly and carefully.

This is the worst stages of the diabetes, apparently.

Nobody hits this stage of diabetes, cos it's the worst.

Our team has been visiting home,

but even in spite of us visiting,

nothing had worked very well.

So basically...

..for him, we'll attempt to retrain him, if possible.

Teenagers, with teenagers it's not sometimes...

Not with everybody, but some teenagers...

But then this is one of the challenges with teenagers.

Levi, can I just check your blood sugar and your ketones again?

So, his ketones have gone up, 5.2.

And his blood sugar is 18.7.

His blood sugars are still too high.

Nurses will keep checking on him every two hours.

I'm Annabel, Oliver's big sister and he's my little...

The tiniest brother I have.

He's been having lots of problems, like sickness and operations,

like on his heart because he had holes.

Because of his heart, he couldn't breathe that well and he has to have

an oxygen tank.

But the doctors are letting him out without his oxygen tank.

He just has it at night now, doesn't he?

Yep, he just has it at night.

Dr Nick Nelhans called us to the hospital.

I'm pretty sure it was one of the nurses that rang, but I can't

honestly remember. But they said I needed to come to the hospital

as soon as possible and they'd had some test results back.

So I went as fast as I could to the hospital and then...

..he just... He told me that he was going to have...

..issues and he told me what the name of it was,

he gave me like a massive wad of paper...

..of what the condition was and stuff.

And then it was just... I don't really remember what happened from

then. I remember running out of the hospital with Patrick

and bursting into tears on some random person.

It was not nice.

It was awful.

Oliver has a condition called 49, XXXXY.

He has 49 chromosomes rather than the normal 46.

It affects one in 100,000 and because it affects different

patients in different ways, the long-term consequences are unknown.

The only things that we knew was that he'd have developmental delays,

learning disabilities,

he'd have speech and language delays and he'd be infertile.

Those were the things they could tell us would definitely happen,

but the degree of which depends very much on Oliver.

Yeah, he got quite agitated yesterday evening.

-Any particular reason?

-I think he couldn't breathe.

-Yeah. It was just all...?

-He just got a bit panicky.

Yeah, yeah. Better have a little listen to you, then, young man.

I met Oliver, I think, on the ward round the day after he was born.

Hello, good buddy. Arranged for him to have some genetic bloods done

which showed he had a very rare

condition that I've never seen in my entire career,

it's a very unusual syndrome and it's obviously had quite significant

effects on his life.

OK. And listening to his chest,

there's a lot of transmittance sound,

sort of nasal congestion sort of noises,

but his actual chest itself sounds absolutely beautiful.

He just sounds a little bit snuffly.

Although he initially did quite well,

at the beginning of December, he got a chest infection,

which is obviously very common in children this time of year and after

that he wasn't coping very well and ended up having cardiac surgery.

We went home for 2½ weeks.

It was a nice 2½ weeks and then we've been in hospital ever since.

Despite being six months old,

Oliver has shown no signs of wanting to feed,

so the ward have been giving

him an overnight liquid feed through a tube down his nose.

Basically, he couldn't come home while he was on a continuous feed

because he needed constant supervision

and the longer he was in hospital,

the more things he was catching and I just wanted him home,

I just wanted to be a real family again and I wanted to...

I wanted him to be able to mix with the other children and while he was

stuck in hospital, it just wasn't going to happen.

So now Oliver is scheduled to have an operation to put the feeding tube

directly into his stomach.

Once that is done, Oliver - and his mum - can go home.

Next in, 16-year-old Gethin.

Gethin's come in because he's got unexplained sores that come up

periodically all over his body.

It looks awful and it does look like a burn, doesn't it?

And they come up really quickly so we've no idea why.

And every time the consultant has seen him,

they're all drying up so he said, "Right, next time...

"Next time they come up, bring him in, onto children's ward."

Because he's got open access,

because he's deaf-blind, congenitally deaf-blind.

He does have a bit of residual vision, so he can see a little bit,

but not enough that they think it's...

..functional. This is a new thing.

He's only had it for a few months.

We actually... School tried it.

He goes to Seashell Trust in Manchester and they thought, right,

we'll try a cane and see how he gets on.

See what he does. Apart from the one time where he swung it around

like a lightsaber, which was brilliant.

Other than that, he marched off down the corridor and went, right,

this is what I've been missing, this is, like, now my independence.

The sores on Gethin's body need to be swabbed to test for bugs.

But Gethin can't properly see or hear anything that's going on

which makes a simple procedure difficult.

-Do you think he'll turn over to you, Mum?

-Yes, yes, he will.

-Can he feel this first, because...?

-Yeah, absolutely.

-So he'll know what's coming.

-I won't open it.

Here you go.

Just on the back of your neck, just here, just softly.

Is that all right?

-To Mum?

-To Mum or to me?

Mum or Roz, which is it going to be?

-That's fantastic.

-Very gently.

Do your neck first.

You can keep looking this way. Are you looking?

It'll just be...

It's not done yet.

You're going to touch it, you're going to touch it.

-Can I just hold your hand?

-It'll be super quick.

-All right, darling.

-Well done, well done.

Tiny one now, just you seem to have turned all the way round.

Oh, where we going?

-Run away!

-I nearly got it.

Are you going to come back?

-Shall I go and try and catch him?

-You could do.

Attempts to swab Gethin's sores have moved from the nurses station

to the corridor...

..to the playroom.

After a long chase, success!

Fantastic.

-Yay!

-Good boy.

-High five. Is that the tube it came out of?

Good boy.

9pm, and through the rotating front doors go the day shift and the

visitors to be replaced by staff who will look after the hospital

until tomorrow morning.

A night shift does tend to be a little bit quieter because obviously

the children are asleep.

Obviously it can be quite high stress if a little baby's poorly

or you have someone come in to our high dependency unit, obviously,

you know, all action stations go and sometimes people aren't aware

of that, but it actually is quite busy behind closed doors.

So, as soon as patients are discharged and leave the bed space,

we strip the bed spaces down,

get them all washed and then obviously this is one of the admission bays

so it's ready for anybody else that needs to come in.

And the first patient of the night, little baby Ada, who has jaundice.

She has a yellow tinge to her skin.

We've got a little one who might potentially be coming into us,

needing phototherapy and we're wondering if we could borrow one of

your phototherapy units and cots, if possible.

Thank you!

Jaundice is caused by a build-up of bilirubin,

a yellow substance we all have in our blood when red cells are broken down.

Trouble is, Ada's liver isn't getting rid of it as it should,

so she looks a bit yellow and needs a bit of help.

BABY CRIES

We'll pop the baby in the hot cot to keep them nice and warm because

we're going to strip them down so that they can get the best benefit from the light.

The lights will help the baby to metabolise the bilirubin in their blood.

I'll pop you in your cubicle.

This is where she'll be living for the next few days and then obviously

she'll keep having blood tests taken and then if the bilirubin levels

come down in her blood, then she'll get to go home.

-OK.

-OK.

Go on. Thank you.

Let me get her sorted...

And to protect sensitive newborn eyes from bright lights,

Ada will be wearing felt sunglasses for the duration of her stay on the

children's ward.

There we are.

A bit of Velcro, that'll do the job.

I know they're not perfect but they're on, they're protecting her eyes.

Right, you're going to have to try and settle down now. I know it's not like being snuggled up but...

Come on, sh, sh, sh.

At 11.30 at night, Levi, the diabetic teenager,

who hasn't been taking his insulin,

is still only being allowed a few crushed ice cubes.

So, we'll do this then and I'll go get the other nurse to check your

insulin ready for tonight, OK?

What about the doctors about the drink?

Yeah, as soon as I can get them.

There we are. Better.

Your blood sugars are 8.7.

And your ketones are 2.4.

So your ketones have gone up by 0.3 a little bit.

They were 2.1 in the last reading, weren't they?

But your blood sugar has come down from 11 to 8.7.

His blood results are heading the right way,

but are still far from normal.

Nurses will continue to monitor through the night.

He's getting really agitated cos he can't have a drink.

OK. Have you offered him some ice?

Yeah, he's had ice about half an hour ago.

-He can have a little bit more.

-Yeah.

For Oliver, the little boy with the rare genetic condition, XXXXY,

it's been a tough night.

He's supposed to be going to Alder Hey today but he was up all night

being sick and generally not very happy.

But they're taking him anyway, so I'm guessing that we'll go and then

they'll make the decision at Alder Hey as to whether or not it's safe

to operate. In theory,

we should be back tomorrow, but Oliver never does

what Oliver's supposed to do.

Are you going to be cross with me now?

Yeah?

Oh, don't make me feel bad.

He gets over it quick. It'll be fine.

Oliver, who was fed overnight through a tube down his nose,

has yet again pulled out the tube.

It's the reason he has to spend his nights in hospital.

Put down the one he had it down anyway because he's more comfortable

if he's having an operation.

Right, let's pop this on your face.

Oh, I know.

Come here, darling. You're going to tell me off, aren't you?

Has he got a vest on?

No, he's on his fourth change of clothes

since six o'clock this morning.

So, no, we haven't put a vest on.

Oh, dear.

Today's operation in Liverpool will put the tube directly into his

stomach. He won't be able to pull it out which means for the first time

ever, Oliver can be safely fed overnight at home.

-I'm sorry.

-He's only making that noise to make you feel bad.

-I know he is.

-It's fake.

It's pretend.

Have you recovered a little bit now?

Oh, I'm sorry.

I'm sorry, sweetie.

Oh, sweetheart.

Hi, it's just Steph calling from Wrexham Maelor.

We are supposed to be having a patient transferred over to yourself

today for insertion of a peg, it's for Oliver Ashton.

I was just wanting to make sure that you definitely had a bed for him before I send him.

Yeah, fine, thank you.

Thanks, bye-bye.

-Do you want me to come back in 20 minutes then?

-If you don't mind.

-See how you're getting on.

-Is that OK?

-Yeah, that's fine.

-All right, thank you.

-Bye.

Exasperated with her son's behaviour,

Levi's mother has enlisted the help of his big brother Luke,

who's come in to lay down the law.

Do you want to sit there?

So, what happened, then? Why are you in hospital?

-I didn't take my needles.

-Why?

-It's not funny though, is it, Levi?

Why aren't you taking them?

I am taking them, just not taking them at the right time.

What's more important than taking your needle?

That can save your life.

-Come on.

-Nothing.

So, would you rather go out and play and die or take a needle and be alive a long time?

-Take a needle, obviously.

-There you go. Otherwise next time you come in

here, you won't be coming out. You'll be going out in a box.

You will. You're lucky now, you just about missed it.

You know what I mean? A bit longer, you'd have been dead.

It's not going to take long, is it?

It takes two minutes to put a needle in your arm.

It would take about four hours if it was me, like, cos I'm scared of them.

Do you know what I mean? You're not bothered, so it takes two minutes to come in, just go bump, and then

you're back out to play then you can do what you want for the rest of the day, can't you?

That's all you have to do, got to start listening.

You don't want to die, do you? Not at your age.

I'm scared of dying now and I'm 24.

You'll end up dead, you will.

Maybe the scare is what you need.

I said that since day one, since you haven't been taking them properly,

the scare will give you it, you know.

I've just spoken to Alder Hey, you're going to hate me.

-There's no bed, is there?

-There's no bed.

But they're going to ring me

when there is a bed available and then I'll ring transport and get him

sorted. I'm sorry.

It's not as simple as that, because when they've got a bed, there won't be any transport.

No, I asked the transport lady and said, look,

cos we've already had it booked, if a bed's free today,

how quickly can we get transport?

And because you've already had it booked today,

hopefully they'll be able to speed it up.

But we're lunchtime already,

they're not going to be able to do the operation today, are they?

No. No, they're not.

We just want to go home and be a family and now,

I don't know how long we're going to have to wait.

I know. It's rubbish.

-Oh, I'm sorry.

-It's not your fault.

All right, as soon as something happens.

-OK, no worries.

-If you need to off-load and...

I need coffee, is what I need.

I can do coffee. Sugar and milk?

-Just milk, please.

-Milk, OK.

Sorry, Mr. Oh, he's sleeping.

Not leaving us yet, pal.

Right, coffee, milk. Sort that out for you.

Thank you.

Are you going to be sick again? You look like you are.

It's all right, dude, you've got a reprieve.

Yeah, because he gets so sick with the anaesthetics, it's just like,

you psych yourself up for it and it's like, and I was OK,

I was stressed but I was OK

and I've had a week where I've not slept very well.

You know, I've had a couple of hours a night and that's it.

And then this was like, we were going home,

this was our next step towards home and now it's gone again.

I don't know why I keep doing this, because every time they're like,

"Oh, there's a chance you could be going home," I get all excited

and I push for that and that's what I focus on

and then it gets taken away and...

We're back to stuck.

Sweetheart.

You will come home one day, I promise.

You will. You'll be home one day, I promise.

Yeah? Get tortured by your brother and sister.

They're really looking forward to it.

Having been forced to face his own mortality,

Levi is finally playing ball.

Have you got your pen?

-Where's the pen?

-There's your pen.

Before the ward send him home,

they need to know he's learnt his lesson and is capable of taking

responsibility for his own diabetes.

That's good, 0.1 for ketones.

What was it before?

He doesn't like it, like any teenager, you know?

He doesn't want to do it, so we figured out a way how we can fit

that into his life so he can still go to school,

hang out with his friends and...

Without feeling he's left out.

Without feeling different.

Eight, nine, ten.

So, fingers crossed it'll go to plan and he's going to come back in

another six to eight weeks' time,

get seen in clinic and see how we're getting on.

So he can go home today,

if he keeps to it and his ketones stay down.

OK. Well done.

You've done really well then by yourself.

-How did it feel?

-Fine, cos I've been doing it for years.

-Oh, so you're OK now?

-Yeah, he's been doing it since he had it.

Great, well done. I'm going to lock this away now, OK.

Thanks.