0:00:02 > 0:00:03ALARMS BLARE
0:00:06 > 0:00:09Just move yourselves over to the side for a minute.
0:00:09 > 0:00:14This winter, one of Britain's busiest NHS Trusts opened its doors...
0:00:14 > 0:00:16We have to look after the patients
0:00:16 > 0:00:19whether they come from Buck Palace or the park bench.
0:00:19 > 0:00:22..to show us what's really happening inside our hospitals.
0:00:22 > 0:00:23We've got lots of patients now,
0:00:23 > 0:00:27competing for an unknown number of beds.
0:00:27 > 0:00:31Every week, more than 20,000 people are treated here.
0:00:31 > 0:00:35- The pressure's just gone.- What?! Has it completely gone?
0:00:35 > 0:00:39And the numbers, as well as our expectations, are rising.
0:00:40 > 0:00:42We just had our worst ten days on record.
0:00:42 > 0:00:45There's nowhere in the hospital to move anybody.
0:00:45 > 0:00:48At some point, somebody will be telling us whether we're allowed to do any work.
0:00:48 > 0:00:52This is a place with some of the best specialists in the world...
0:00:52 > 0:00:53The tumour's out. Job done.
0:00:53 > 0:00:55..where lives are transformed.
0:00:55 > 0:00:58This is saving his life. It has to work.
0:00:58 > 0:01:00But they are operating at a time when the NHS
0:01:00 > 0:01:02has never been under more pressure.
0:01:02 > 0:01:05- Any beds?- No.- No beds for anyone?- No.
0:01:06 > 0:01:10It does feel to me like the elastic's
0:01:10 > 0:01:15a bit nearer to breaking now than it ever was.
0:01:15 > 0:01:17Its very future under scrutiny.
0:01:17 > 0:01:19All right, I think we will go out on red,
0:01:19 > 0:01:21because we're under real pressure in the emergency department.
0:01:21 > 0:01:25We're aware of the problems. Anybody got a solution(?)
0:01:25 > 0:01:28Following the patients from the moment they are admitted...
0:01:28 > 0:01:31Anything I've done up to this point means nothing
0:01:31 > 0:01:34compared to when you can literally give a bit of yourself
0:01:34 > 0:01:36to save someone else.
0:01:36 > 0:01:38..to the moment they leave.
0:01:38 > 0:01:40It's all good news. The cancer's gone.
0:01:40 > 0:01:42You don't need any more treatment.
0:01:42 > 0:01:46- Fantastic!- Thank you so much.
0:01:46 > 0:01:50Week by week, we reveal the complex decisions the staff must make
0:01:50 > 0:01:52about who to care for next.
0:01:54 > 0:01:58That patient is coming to me to be operated on, and if I don't do it,
0:01:58 > 0:02:01then there's only one inevitable outcome - they're going to die.
0:02:07 > 0:02:11Just been brought in by ambulance. Onset of stroke symptoms.
0:02:11 > 0:02:14Gerry? Just look at me.
0:02:14 > 0:02:17Keep your eyes open nice and wide.
0:02:17 > 0:02:19Look at me, look at me, look at me.
0:02:19 > 0:02:22Gerry? Look at me? Can you see me all right?
0:02:22 > 0:02:2587-year-old Gerry has been brought into Charing Cross Hospital
0:02:25 > 0:02:27after suffering a stroke.
0:02:27 > 0:02:29Gerry, can you see my hand waving?
0:02:29 > 0:02:31A medical emergency that occurs when the blood supply
0:02:31 > 0:02:33to part of the brain is cut off.
0:02:35 > 0:02:38Gerry, open your eyes and look at me.
0:02:38 > 0:02:41Family just suddenly saw him go.
0:02:41 > 0:02:43I got a telephone call from my son to say
0:02:43 > 0:02:46Dad wasn't well, come home quickly.
0:02:46 > 0:02:48Just one look, and I knew what was happening.
0:02:48 > 0:02:50Gerry, same on the right.
0:02:50 > 0:02:53Gerry is being looked after by doctors from the hospital's
0:02:53 > 0:02:55acute stroke unit.
0:02:55 > 0:02:5970% of their patients are over 65.
0:02:59 > 0:03:02The longer you wait to try and restore blood flow
0:03:02 > 0:03:06to a part of the brain that's been affected, the more brain cells,
0:03:06 > 0:03:07or neurons, will die.
0:03:07 > 0:03:10Hi, there. Are you family? Wife, OK.
0:03:10 > 0:03:13- He's never had a stroke as far as you're aware?- No.
0:03:13 > 0:03:15- He's never had any brain surgery. - No, no.
0:03:15 > 0:03:18- He's never had a brain haemorrhage before?- No.
0:03:18 > 0:03:22We need to rush, and the first thing we need to do is to do a brain scan.
0:03:22 > 0:03:25This has all been quite slow. Let's speed up a bit.
0:03:25 > 0:03:29We want to get treatment into Gerry as quickly as possible.
0:03:29 > 0:03:32Rydell, do you want to run ahead and tell CC we're coming.
0:03:32 > 0:03:34Well done, Gerry. You're doing OK.
0:03:37 > 0:03:41We're going to do a quick scan of your head, which is quite important.
0:03:44 > 0:03:47Sorry, guys.
0:03:47 > 0:03:48I've a stroke.
0:03:48 > 0:03:50We called up, they said come up.
0:03:52 > 0:03:53OK, what do you want to do?
0:03:57 > 0:04:00- It's going to take about five minutes.- That's fine, then.- Yep.
0:04:00 > 0:04:04All right, let's get this done. One, two, three...
0:04:04 > 0:04:07As a stroke patient, Gerry has priority for the CT scanner,
0:04:07 > 0:04:10so doctors can quickly decide if he's suitable
0:04:10 > 0:04:13for an emergency treatment known as thrombolysis.
0:04:13 > 0:04:16He's late eighties, he's got no neurological history.
0:04:16 > 0:04:20We really need to look at the scan, and then we'll make a decision.
0:04:22 > 0:04:23There are no contraindications,
0:04:23 > 0:04:26so we should just go ahead and give thrombosic therapy.
0:04:26 > 0:04:29I'm going to go downstairs to make sure the family are happy.
0:04:30 > 0:04:33Gerry is a candidate for thrombolysis,
0:04:33 > 0:04:38which is a medical injection that is aimed to break down the blood clot.
0:04:38 > 0:04:40Giving thrombolysis to the wrong patients
0:04:40 > 0:04:43can cause haemorrhage, or bleeding.
0:04:43 > 0:04:45And that haemorrhage can be life-threatening,
0:04:45 > 0:04:47and can even cause death.
0:04:47 > 0:04:49Em, Rydell, can you get the thrombolysis ready?
0:04:49 > 0:04:51I've prepped it already.
0:04:53 > 0:04:55Come and sit down for a while. OK.
0:04:55 > 0:04:58Gerry's just having the last few scans.
0:04:58 > 0:05:01There's no bleeding into the head as far as we can tell, so it looks like
0:05:01 > 0:05:04this is a stroke that's been caused by a blood clot,
0:05:04 > 0:05:08and the best course would be to give him this clot-busting treatment.
0:05:08 > 0:05:12However, it's also important to know it's not a miracle cure, at all.
0:05:12 > 0:05:15And one of its most serious side-effects is bleeding.
0:05:15 > 0:05:19And that bleeding could potentially be life-threatening.
0:05:22 > 0:05:26- You know, we've got to understand that all treatments can go wrong. - Yes.
0:05:26 > 0:05:28- I trust you.- Sure.
0:05:28 > 0:05:33- And he's then... As far as I'm concerned, he's in safe hands.- Sure.
0:05:33 > 0:05:35All right, I'll be with you soon.
0:05:40 > 0:05:44Would you time two minutes for me? And just give her 30-second updates.
0:05:45 > 0:05:47- That's one minute.- OK, well done.
0:05:47 > 0:05:49It's just such a shock.
0:05:49 > 0:05:54But, he's 87, and we know...
0:05:54 > 0:05:56that it's inevitable that something's going to happen
0:05:56 > 0:05:57at some point.
0:05:59 > 0:06:01Age is a very strong risk factor for strokes,
0:06:01 > 0:06:05so with an ageing population, you'd expect the incidence of stroke to rise.
0:06:05 > 0:06:09Every year that goes by, we're feeling incredibly stretched.
0:06:09 > 0:06:14We don't want standards to drop, and it feel like standards are slipping.
0:06:14 > 0:06:16OK. Well done.
0:06:16 > 0:06:19It will be several hours before Gerry's wife, Margaret,
0:06:19 > 0:06:22knows how well he's responding to treatment.
0:06:30 > 0:06:33Along with Charing Cross, Hammersmith is one of
0:06:33 > 0:06:37the five hospitals that make up Imperial College Healthcare NHS Trust.
0:06:40 > 0:06:43Retired carpenter John requires an operation
0:06:43 > 0:06:45to replace a valve in his heart.
0:06:46 > 0:06:49If you're on the top floor, you might have a nice view.
0:06:53 > 0:06:56John's procedure, known as a TAVI,
0:06:56 > 0:06:58a transcatheter aortic valve importation,
0:06:58 > 0:07:02will be conducted by consultant cardiologist Iqbal Malick.
0:07:02 > 0:07:06A TAVI is a way of deploying a new valve inside the heart
0:07:06 > 0:07:09without cutting the patient too much.
0:07:09 > 0:07:11It's an insane thing to even consider, isn't it?
0:07:11 > 0:07:15A squashed valve goes into an artery while the patient's awake.
0:07:15 > 0:07:19You track back to the heart and pop the new valve into position.
0:07:19 > 0:07:21The patient goes home the next day.
0:07:21 > 0:07:23That's something that would have been
0:07:23 > 0:07:25ludicrous to consider ten years ago.
0:07:26 > 0:07:28- So, you're 98.- And a half.
0:07:28 > 0:07:31- And a half! You've never had a stroke?- No.
0:07:31 > 0:07:35- You don't have diabetes?- No. - You don't look 98.- Thank you.
0:07:35 > 0:07:38- Age is just a number, you see.- Yeah.
0:07:41 > 0:07:45At 98, John will be the oldest patient ever operated on
0:07:45 > 0:07:48by the TAVI team.
0:07:48 > 0:07:50Some of the team is nervous that we'll be seen as lunatics
0:07:50 > 0:07:53doing a 98-year-old.
0:07:53 > 0:07:55I don't think so. I'm going to lead a team.
0:07:55 > 0:07:58I don't think so, I think they can do what they like.
0:07:58 > 0:08:00I bet you when it's their granny they'll be asking for
0:08:00 > 0:08:03a 98-year-old to have their TAVI done.
0:08:03 > 0:08:05Have you done any other 98-year-olds?
0:08:05 > 0:08:07That would be a no, I think. I think we're...
0:08:07 > 0:08:11We're not far off it, I think we've done 95, but, em... Yeah.
0:08:13 > 0:08:16They did, yeah.
0:08:16 > 0:08:18Let's go through the case. So, he's 98.
0:08:18 > 0:08:21We know his creatinine's 200. It hasn't changed.
0:08:21 > 0:08:24Renal team's seen him, don't want to do anything in particular.
0:08:24 > 0:08:27The average age for TAVI is 80,
0:08:27 > 0:08:30so these are patients who can't have open-heart surgery,
0:08:30 > 0:08:32and a number of years ago we couldn't offer patients anything.
0:08:32 > 0:08:36So, now we're in a privileged position of offering TAVI
0:08:36 > 0:08:37to these elderly patients.
0:08:39 > 0:08:42He's got so much more in him. He's still so full of life.
0:08:44 > 0:08:48My grandparents are my favourite people in the entire world, so...
0:08:49 > 0:08:51I'm sure it's the same for everyone.
0:08:53 > 0:08:57How many times have you been to hospital before in your life?
0:08:57 > 0:09:00I had some varicose veins out...
0:09:00 > 0:09:02Em...
0:09:02 > 0:09:05Oh, when I was...
0:09:05 > 0:09:07About 50 years ago, now.
0:09:09 > 0:09:12That was the last time you've been?
0:09:12 > 0:09:14Yeah.
0:09:16 > 0:09:20He's incredible. At the age of 87, he walked up Vesuvius.
0:09:20 > 0:09:22I think he only stopped running races against
0:09:22 > 0:09:25me and my brother around the age of 90,
0:09:25 > 0:09:27and he would try and win, as well,
0:09:27 > 0:09:30this wasn't like he was trying to let us win.
0:09:35 > 0:09:38She says they haven't done anybody my age before.
0:09:38 > 0:09:41But it's not about age, that's what we were saying to you before,
0:09:41 > 0:09:44it's not just about age, it's about how fit you are, otherwise.
0:09:44 > 0:09:45You'll be running out of here.
0:09:45 > 0:09:47HE LAUGHS
0:09:49 > 0:09:51"Three choices.
0:09:51 > 0:09:54"Give up, give in,
0:09:54 > 0:09:56"or give it your all."
0:10:00 > 0:10:04Is now a good time to ask you what you'd like for Christmas?
0:10:04 > 0:10:06I'd like to be alive.
0:10:16 > 0:10:19Mr Rowland? Hi, Dr Malik.
0:10:19 > 0:10:21- Hi.- Nice to see you. - And you.
0:10:21 > 0:10:23OK, so...
0:10:23 > 0:10:25- Can you hear me OK?- Yeah.
0:10:25 > 0:10:27You've been through the risks before.
0:10:27 > 0:10:29- Yeah.- You know what we're talking about,
0:10:29 > 0:10:31but I will double check that you do understand.
0:10:31 > 0:10:33Just as a short memory test, what is the problem
0:10:33 > 0:10:35that you had with your heart?
0:10:35 > 0:10:39Well, I get out of breath very quickly and couldn't walk very far.
0:10:39 > 0:10:41Yeah, OK.
0:10:41 > 0:10:43- In terms of risk...- Yeah.
0:10:43 > 0:10:46..if we did 100 cases, OK,
0:10:46 > 0:10:49then about five of them would have a bad problem.
0:10:49 > 0:10:51- One in 20?- Yeah. And that problem...
0:10:51 > 0:10:54When you say they have a problem, will it mean they would be dead?
0:10:54 > 0:10:58Death, stroke, bleeding, heart attack.
0:10:58 > 0:10:59OK?
0:10:59 > 0:11:02Is that an acceptable level of risk for you?
0:11:02 > 0:11:04- Yeah, well, I haven't much alternative.- OK.
0:11:04 > 0:11:06What's your date of birth, John?
0:11:06 > 0:11:08March 1918.
0:11:08 > 0:11:101918, my goodness.
0:11:10 > 0:11:13OK, and can I just get you to sign on the dotted line, John?
0:11:13 > 0:11:16If you're up for having this procedure done.
0:11:17 > 0:11:20It's a miraculous treatment for the older patients that we
0:11:20 > 0:11:23couldn't treat before, that we are now treating.
0:11:23 > 0:11:26Every cardiologist would hope to have one really important
0:11:26 > 0:11:29step that has suddenly changed in their lifetime that they can
0:11:29 > 0:11:33experience and I think for me, at the age of 50 now, it's TAVI.
0:11:39 > 0:11:41Demand for heart valve procedure TAVI
0:11:41 > 0:11:44has tripled at Hammersmith in the last three years.
0:11:44 > 0:11:46What, the old valve, the other valve?
0:11:46 > 0:11:49John is the second of these patients on Iqbal's list today.
0:11:49 > 0:11:52The first is a patient in their 80s.
0:11:52 > 0:11:54Is that pressure...
0:11:54 > 0:11:57- Who are you calling?- Rex.
0:11:57 > 0:12:01- It's bleeding too much, so he thinks he might want to open.- OK.
0:12:03 > 0:12:08OK, so this is an unexpected complication in the first procedure.
0:12:08 > 0:12:13MONITOR BEEPS
0:12:13 > 0:12:15The first case hasn't gone according to plan,
0:12:15 > 0:12:17because there's been some bleeding internally.
0:12:17 > 0:12:20TAVIs, you can't quite predict what's going on.
0:12:20 > 0:12:22Normally, they are very straightforward and this is
0:12:22 > 0:12:25the first for the year where we've had a major complication.
0:12:28 > 0:12:30It's now likely that the patient will need
0:12:30 > 0:12:32a post-operative intensive-care bed.
0:12:34 > 0:12:37But that means one won't be available for 98-year-old John,
0:12:37 > 0:12:40if his operation runs into trouble.
0:12:40 > 0:12:41I'm trying to find another bed.
0:12:41 > 0:12:43Sometimes, if they've got an incapacity here,
0:12:43 > 0:12:46we can use one of their intensive-care beds
0:12:46 > 0:12:50as a backup fallback. For the next case.
0:12:50 > 0:12:53- Hello, are you the boss? - I am today, yes.
0:12:53 > 0:12:55You may have heard, we had a bit of an emergency
0:12:55 > 0:12:57- in the first procedure today.- Yes.
0:12:57 > 0:12:59We have therefore lost our ICU bed.
0:12:59 > 0:13:03- But we have a second TAVI.- Yeah.
0:13:03 > 0:13:07We need a fallback critical-care bed, because he's...he's 98.
0:13:07 > 0:13:10- Yeah.- Otherwise quite well, no previous surgeries.
0:13:10 > 0:13:11We are full at the moment.
0:13:11 > 0:13:1416 inpatients and 16 bed spaces.
0:13:14 > 0:13:17Two of the patients were going to go and I think one
0:13:17 > 0:13:20was a cardiology patient.
0:13:20 > 0:13:22So, the deal is, we have to take one back?
0:13:22 > 0:13:24- Yeah, there will be a degree of swapping, but...- OK.
0:13:24 > 0:13:26PHONE RINGS
0:13:26 > 0:13:29We are in some difficulty in there.
0:13:29 > 0:13:31The bleeding has restarted and therefore,
0:13:31 > 0:13:34we can't really think about other cases.
0:13:34 > 0:13:37We have a senior surgeon operating, but I think the rest of the day in
0:13:37 > 0:13:40this particular lab is not going to be working out.
0:13:40 > 0:13:42I think we are going to have to cancel the TAVI.
0:13:42 > 0:13:45This is not just realistic. We're not even ready now
0:13:45 > 0:13:46and by the time he gets on, it will be four.
0:13:46 > 0:13:49By the time we finish it, six. If something goes wrong at six,
0:13:49 > 0:13:51we are much less coverage, so... I think it's safety first.
0:13:56 > 0:13:57HE SIGHS
0:13:57 > 0:14:00Operating out of hours on elective cases that are high-risk
0:14:00 > 0:14:03is not clever. I think if it all went well, I'd be finished by five.
0:14:03 > 0:14:05You know, I think that's fine.
0:14:05 > 0:14:07But actually, if it didn't go so well,
0:14:07 > 0:14:11then the complication is being managed out of hours, with,
0:14:11 > 0:14:13you know, less team around.
0:14:13 > 0:14:15'I think it's unfortunate.'
0:14:20 > 0:14:23So, old Father Time has defeated us.
0:14:23 > 0:14:25- My luck. - Exactly, just your luck.
0:14:25 > 0:14:29But the thing that has destabilised us is a very rare eventuality,
0:14:29 > 0:14:31so, sorry about today. OK?
0:14:31 > 0:14:33I'm going to get them to give you a cup of tea,
0:14:33 > 0:14:37give you some food, because we've kept you starved all day.
0:14:37 > 0:14:39- OK?- Thank you very much.- OK.
0:14:40 > 0:14:43OK, so I'm just coming down now.
0:14:43 > 0:14:45Yeah.
0:14:45 > 0:14:47Something he wasn't expecting and we were quite certain that it
0:14:47 > 0:14:49was going to happen today.
0:14:51 > 0:14:52And...
0:14:54 > 0:14:55But what can you do?
0:14:57 > 0:15:01We know that there is a risk to doing the procedure,
0:15:01 > 0:15:02but we were told by the cardiologist,
0:15:02 > 0:15:05without this operation, he has a 50% chance of sudden death.
0:15:08 > 0:15:10John will have to come back next week
0:15:10 > 0:15:12for another attempt at the procedure.
0:15:24 > 0:15:26Boring!
0:15:26 > 0:15:30I like shows like Casualty, Holby City, House.
0:15:30 > 0:15:33Grey's Anatomy. I like stuff like that.
0:15:33 > 0:15:38Because I'd like to be a children's nurse,
0:15:38 > 0:15:41and help...people like me.
0:15:43 > 0:15:46- How are you doing?- OK.- Good.
0:15:46 > 0:15:49The Trust's paediatric centre offers pioneering treatments
0:15:49 > 0:15:52for patients up to 19 years old.
0:15:52 > 0:15:54Just lift that up for me a little bit.
0:15:55 > 0:16:00Debbie was diagnosed with sickle cell disease when she was three.
0:16:00 > 0:16:03'Sickle cell, it's like a blood disorder.
0:16:03 > 0:16:08'It causes pain in the joints, and your arms, and your knees
0:16:08 > 0:16:12'and your legs, but it can affect any part of the body, really.'
0:16:12 > 0:16:14- Can I pop this here?- Yeah.
0:16:14 > 0:16:17'But more severely, your brain.
0:16:17 > 0:16:21'It can cause strokes and neurological problems,
0:16:21 > 0:16:23'and that's what happened to me.'
0:16:24 > 0:16:28That's when they considered that I need a transplant,
0:16:28 > 0:16:31so that I don't get any more damage to my brain.
0:16:33 > 0:16:35- Thank you. - NURSE LAUGHS
0:16:35 > 0:16:38The only cure for sickle cell disease is a bone marrow transplant,
0:16:38 > 0:16:43which 18-year-old Debbie has been waiting for since 2009.
0:16:43 > 0:16:45Yeah.
0:16:45 > 0:16:47A standard bone marrow transplant requires
0:16:47 > 0:16:51the donor's tissue type to be a 100% match.
0:16:53 > 0:16:57Doctors have been unable to find Debbie a suitable donor.
0:16:57 > 0:16:59But a new treatment is offering her a lifeline.
0:17:01 > 0:17:04- Sally, how is Deborah today? - Not feeling very well.
0:17:04 > 0:17:07Would you mind giving me her chart, so I can have a look at it.
0:17:07 > 0:17:08In normal circumstances,
0:17:08 > 0:17:12were you to do a 50% mismatched transplant,
0:17:12 > 0:17:15that would almost certainly
0:17:15 > 0:17:17lead to the patient dying,
0:17:17 > 0:17:21from the new bone marrow attacking the body of the patient.
0:17:21 > 0:17:25But we now have a method which will enable this new bone marrow,
0:17:25 > 0:17:28which is only 50% match, not to be rejected by her body.
0:17:33 > 0:17:35- AUTOMATED VOICE:- Doors opening.
0:17:35 > 0:17:39This new method allows Debbie's 22-year-old brother Sam
0:17:39 > 0:17:42to be her donor, even though his tissue type
0:17:42 > 0:17:44is only a 50% match with hers.
0:17:44 > 0:17:46I'm here to see Debbie.
0:17:46 > 0:17:49Deborah. Erm, 13.
0:17:49 > 0:17:50What way, that way or...?
0:17:50 > 0:17:52'Bless her, because the illness,
0:17:52 > 0:17:54'she hasn't had that 18-year-old life at all,'
0:17:54 > 0:18:00so if I can give her a chance, a fighting chance,
0:18:00 > 0:18:04to obviously never have to be in that condition again,
0:18:04 > 0:18:08or go through all the crises she's been going through again...
0:18:08 > 0:18:13Because she's got SO much to catch up on and so much more to do.
0:18:15 > 0:18:18'And I remember when we used to go to the same primary school,
0:18:18 > 0:18:21'me always looking out for her, going into the younger playground
0:18:21 > 0:18:23'to see if she's all right.
0:18:23 > 0:18:26'So, luckily enough, I was a close match.'
0:18:26 > 0:18:27Debbie.
0:18:29 > 0:18:32- Aww. - Have you been worrying about things?
0:18:32 > 0:18:35- No.- Because all that worry is for us, OK?
0:18:38 > 0:18:39She's worried, OK.
0:18:41 > 0:18:42Yeah.
0:18:42 > 0:18:44ALL LAUGH
0:18:44 > 0:18:45At the moment,
0:18:45 > 0:18:49this type of transplant for sickle cell disease is only funded
0:18:49 > 0:18:52for children and young adolescents
0:18:52 > 0:18:53up to the age of 19.
0:18:53 > 0:18:55And then you have some more of the mesna,
0:18:55 > 0:18:58which is a kidney protection, running afterwards.
0:18:58 > 0:19:00- INTERVIEWER:- Is there a risk of death
0:19:00 > 0:19:01with this type of bone marrow transplant?
0:19:01 > 0:19:03Yes, there is a risk of death,
0:19:03 > 0:19:10and the risk does goes up with the degree of mismatch of the donor.
0:19:11 > 0:19:13However, as current situation stands,
0:19:13 > 0:19:17this is Debbie's last chance to get her bone marrow transplant.
0:19:19 > 0:19:21They said it will come with loads of risks,
0:19:21 > 0:19:26but I just want to have it, so that I can continue with my life.
0:19:36 > 0:19:39Gerry? Hello. How are you feeling now?
0:19:39 > 0:19:41HE ATTEMPTS TO SPEAK
0:19:41 > 0:19:44It's two-and-a-half hours since stroke patient Gerry
0:19:44 > 0:19:46was brought into A&E.
0:19:46 > 0:19:48..better view. Gerry, what year is it now?
0:19:48 > 0:19:50Oh...
0:19:50 > 0:19:52INDISTINCT
0:19:55 > 0:19:58- Don't worry about that, that's fine.- I don't know.
0:20:00 > 0:20:02Touch my finger.
0:20:05 > 0:20:09See my finger? Gerry, can you see my finger there? Touch your nose.
0:20:11 > 0:20:13Perfect.
0:20:16 > 0:20:17How old are you?
0:20:20 > 0:20:22Do you know what day it is today?
0:20:22 > 0:20:24Good.
0:20:24 > 0:20:25Lift up your leg.
0:20:27 > 0:20:30OK, five seconds. One, two, three..
0:20:30 > 0:20:32They have saved us here.
0:20:32 > 0:20:36They've got Gerry moving again, they've got him talking again.
0:20:36 > 0:20:40The change is remarkable in such a short space of time.
0:20:40 > 0:20:42How are you feeling, Gerry?
0:20:42 > 0:20:44Oh, that's good.
0:20:44 > 0:20:46Yeah, it's VERY good.
0:20:47 > 0:20:49I think you're going to do fine,
0:20:49 > 0:20:53but we need to keep you in hospital for a few days.
0:20:53 > 0:20:55OK.
0:20:55 > 0:20:57- We'll pop in a bit later on, OK? - OK.- Nice to see you.
0:20:57 > 0:21:00- Thank you.- All the best. - Thank you very much.
0:21:00 > 0:21:04Gerry will recover at Charing Cross Hospital's Hyper-Acute Stroke Unit,
0:21:04 > 0:21:08or HASU, one of eight specialist stroke centres in London.
0:21:08 > 0:21:10The thing that everyone worries about
0:21:10 > 0:21:12with someone who's had a stroke is,
0:21:12 > 0:21:14they're at risk of having another stroke.
0:21:14 > 0:21:17So he's not out of the woods at all, we're going to have to
0:21:17 > 0:21:20closely monitor him, he's got very powerful medication on the board.
0:21:20 > 0:21:24Things look promising, let's keep our fingers crossed.
0:21:27 > 0:21:29SIREN WAILS
0:21:33 > 0:21:34I'm going to put it over the top,
0:21:34 > 0:21:37because it will be finished before that, probably.
0:21:38 > 0:21:4218-year-old Debbie is preparing for her bone marrow transplant
0:21:42 > 0:21:46by receiving chemotherapy to deplete her immune system.
0:21:46 > 0:21:48Chemotherapy just makes you feel completely lifeless.
0:21:48 > 0:21:51You don't want to eat, it makes you feel so sick.
0:21:51 > 0:21:53You've got no energy whatsoever
0:21:53 > 0:21:55and you just can't do anything.
0:22:05 > 0:22:06Ohh.
0:22:07 > 0:22:09Hey, Dad.
0:22:11 > 0:22:13How is she?
0:22:13 > 0:22:17Ohh. It's horrible seeing her like this, though.
0:22:18 > 0:22:21I know. I'm here.
0:22:22 > 0:22:23How are you feeling?
0:22:25 > 0:22:27I don't feel good.
0:22:28 > 0:22:33Aww. I didn't realise it was to this extent.
0:22:33 > 0:22:36- Yeah.- Debbie.
0:22:36 > 0:22:38HE BLOWS HER A KISS
0:22:38 > 0:22:39Don't worry.
0:22:44 > 0:22:45I'll see you soon, yeah?
0:22:49 > 0:22:52That was, er, very difficult to see.
0:22:52 > 0:22:56Never seen her like that, ever.
0:22:56 > 0:22:59Ever. And I've never really heard her say she feels not good.
0:22:59 > 0:23:01Even if she don't feel good,
0:23:01 > 0:23:03she'll say she feels all right, know what I mean?
0:23:03 > 0:23:06She was always very optimistic, but obviously the chemo
0:23:06 > 0:23:11has rendered her into that sort of state, hasn't it? So...
0:23:11 > 0:23:14It's very hard. Very hard to see.
0:23:23 > 0:23:26Debbie is travelling to Hammersmith Hospital,
0:23:26 > 0:23:29where she will receive a high dose of radiation.
0:23:29 > 0:23:34Are they on their way? Right, great. Thanks, bye.
0:23:34 > 0:23:36It's the last stage of treatment before her transplant.
0:23:36 > 0:23:39Hi, Deborah, my name's Faye, I'm one of the radiographers
0:23:39 > 0:23:41doing your treatment today.
0:23:41 > 0:23:44We're going to be putting some little measuring devices
0:23:44 > 0:23:45onto your skin.
0:23:45 > 0:23:48Just do a small little dose first, and then once we're happy,
0:23:48 > 0:23:50we'll then do the main part of the treatment.
0:23:50 > 0:23:53You OK? Do you want some water?
0:23:53 > 0:23:55Headache.
0:23:58 > 0:23:59Would you like to have the lights down?
0:23:59 > 0:24:03- LEENA:- The whole thing is a bit like a Trojan horse.
0:24:04 > 0:24:06We're trying to get past the guards.
0:24:06 > 0:24:08See you in a bit, Deborah.
0:24:09 > 0:24:12If we don't do it, then there will be a lot of reaction between
0:24:12 > 0:24:14the two immune systems, one of Debbie's
0:24:14 > 0:24:16and one of the new bone marrow.
0:24:16 > 0:24:21We've got a gantry of 270, colls of zero,
0:24:21 > 0:24:22and the Y, 25 on the Xs.
0:24:22 > 0:24:24We've checked we're all covered.
0:24:24 > 0:24:26- Yep.- They're ready.
0:24:27 > 0:24:29We're good to go here.
0:24:33 > 0:24:34CLICKING
0:24:38 > 0:24:42She doesn't seem very well at all, has she been like this today or...?
0:24:42 > 0:24:43About a week now.
0:24:57 > 0:24:59She's very nervous about today.
0:24:59 > 0:25:01It's the not knowing, isn't it?
0:25:01 > 0:25:02Right lateral.
0:25:13 > 0:25:14All finished.
0:25:38 > 0:25:40Deborah, how are you?
0:25:42 > 0:25:44- How are you, darling? - WEAKLY:- Not well.
0:25:46 > 0:25:49You have pain in your eyes when you look at me?
0:25:51 > 0:25:54Debbie's immune system is now so depleted,
0:25:54 > 0:25:57even a mild virus could kill her.
0:25:57 > 0:26:01Would you mind if I quickly touch your tummy? Would that be OK?
0:26:01 > 0:26:04You can see that though it is fantastic that we are now
0:26:04 > 0:26:06able to carry a transplant,
0:26:06 > 0:26:09the truth is that the treatment itself is very tough.
0:26:11 > 0:26:14Sorry, I have a little bit of cold hands.
0:26:14 > 0:26:17The doses we use in transplantation are far higher than we would
0:26:17 > 0:26:19use usually in the treatment of cancer.
0:26:19 > 0:26:22So the number of side-effects these children suffer,
0:26:22 > 0:26:26and these young people suffer, is substantial.
0:26:26 > 0:26:30OK. It's a difficult time. We'll leave you in peace.
0:26:30 > 0:26:31- FATHER:- All right, thank you.
0:26:38 > 0:26:40SIREN WAILS
0:26:40 > 0:26:43So we are going to attend the TAVI multi-disciplinary team meeting.
0:26:43 > 0:26:46Which is a meeting we have every week, essentially,
0:26:46 > 0:26:51to discuss all cases that we are considering for the TAVI procedure.
0:26:53 > 0:26:56For a second time, consultant cardiologist Ghada Mikhail
0:26:56 > 0:27:01is preparing for 98-year-old John's heart valve procedure.
0:27:01 > 0:27:04So it's the multi-disciplinary, it's attended by cardiologists,
0:27:04 > 0:27:08surgeons, echo imaging doctors, CT doctors - all the TAVI team.
0:27:10 > 0:27:15OK, good morning. So, the first case is Mr John Rowland, 98.
0:27:15 > 0:27:17This case was the case we were supposed to do last week
0:27:17 > 0:27:21and it got cancelled, so we're just rediscussing him cos he's booked...
0:27:21 > 0:27:23- Can I just answer first?- Yes. - So, 98?- 98.
0:27:23 > 0:27:26You need to persuade me that there is no frailty.
0:27:26 > 0:27:28Can we just re-review the echo?
0:27:28 > 0:27:30Do you want to take us through the echo?
0:27:32 > 0:27:36In many ways, we are - and the NHS is - a victim of its own success.
0:27:36 > 0:27:40So we have so many elderly patients now,
0:27:40 > 0:27:45and we are getting into discussions about life expectancy
0:27:45 > 0:27:48when patients are already in their nineties.
0:27:48 > 0:27:51But the PA pressure was up as well, with a good ventricle,
0:27:51 > 0:27:52how do you explain that?
0:27:52 > 0:27:54Overall LV function looks preserved.
0:27:54 > 0:27:56'With the TAVI MDT, it's particularly difficult,
0:27:56 > 0:28:00'because this is a high-risk group of patients. Cost does come into it.
0:28:00 > 0:28:03'I have a responsibility to manage resources effectively.'
0:28:03 > 0:28:06But actually, we try and pick the winners on clinical grounds,
0:28:06 > 0:28:09and we have to decide,
0:28:09 > 0:28:13does he have enough reserve to come through the procedure?
0:28:13 > 0:28:17Because I'm afraid it is the case that you can have an outcome
0:28:17 > 0:28:19which is a fate worse than death.
0:28:19 > 0:28:21So it is quite challenging.
0:28:21 > 0:28:23Is that a recent change or...?
0:28:23 > 0:28:26He's had increasing shortness of breath over the past six months.
0:28:26 > 0:28:29Six months ago, apparently, he was walking about four miles,
0:28:29 > 0:28:31and now he can only walk about 200 metres.
0:28:31 > 0:28:34He's never smoked, he's got good lung function,
0:28:34 > 0:28:36- with severe... - THUMP
0:28:36 > 0:28:39..and slightly raised pulmonary artery pressures.
0:28:39 > 0:28:42He's got a very supportive family as well who are all
0:28:42 > 0:28:44sort of onboard with TAVI.
0:28:44 > 0:28:47He's just very keen to have something done.
0:28:47 > 0:28:51He wants to continue living and have a good quality of life,
0:28:51 > 0:28:54and wants to be less symptomatic, but he's not low-risk.
0:28:54 > 0:28:57At 98, he's not going to be low-risk.
0:28:57 > 0:29:00I'd want a clear statement that he understands that as well.
0:29:00 > 0:29:01The last conversation we had with him,
0:29:01 > 0:29:04he will accept risk just to feel better.
0:29:05 > 0:29:08OK? Fantastic.
0:29:08 > 0:29:10So he's all set.
0:29:10 > 0:29:12'We can't be ageist.
0:29:12 > 0:29:14'We are dealing with an ageing population,'
0:29:14 > 0:29:17and he wants a better quality of life.
0:29:17 > 0:29:20We can't deny a patient that, no matter what their age is.
0:29:24 > 0:29:25Don't rush.
0:29:26 > 0:29:29No, you don't need to go quickly, we can just take our time.
0:29:29 > 0:29:31Enjoy the sense of deja vu.
0:29:31 > 0:29:33A week after he was first cancelled,
0:29:33 > 0:29:36John is back at Hammersmith Hospital.
0:29:36 > 0:29:40You couldn't possibly say anything about quantity of life -
0:29:40 > 0:29:43how long we'll make him live - but he's a very active 98
0:29:43 > 0:29:46and his quality of life has really got worse.
0:29:46 > 0:29:48It's very important that he's up for it,
0:29:48 > 0:29:52his family is up for it and the team is up for it.
0:29:53 > 0:29:56Can you just look up John Rowland's blood results?
0:29:56 > 0:29:59If any of the team had dissented, then we'd think again.
0:29:59 > 0:30:00Yes?
0:30:04 > 0:30:07- Do you want to sit on the chair, Grandad?- Thank you.
0:30:08 > 0:30:11Are you happy to be having the operation?
0:30:11 > 0:30:15I'm not happy to be having it but what's the alternative?
0:30:18 > 0:30:21Because I'm getting worse all the time recently.
0:30:23 > 0:30:25I can only walk about...
0:30:25 > 0:30:31I used to walk miles and now I can only walk a couple of hundred yards
0:30:31 > 0:30:34and I'm out of wind.
0:30:34 > 0:30:38I am genuinely terrified that something might happen to him
0:30:38 > 0:30:40because I can't...
0:30:40 > 0:30:43honestly can't bear the thought of life without my grandad in it.
0:30:52 > 0:30:54It's just about waiting now, isn't it?
0:31:11 > 0:31:13I am very, very, very nervous,
0:31:13 > 0:31:19because at the end of the day it's just got to work.
0:31:23 > 0:31:2822-year-old Sam is donating his bone marrow in an attempt to cure
0:31:28 > 0:31:31his 18-year-old sister Debbie of sickle cell disease.
0:31:31 > 0:31:35So he's consented for mobilisation with G-CSF injections
0:31:35 > 0:31:38for stem cells and to undergo a bone-marrow harvest
0:31:38 > 0:31:41under sedation on theatre.
0:31:41 > 0:31:43All right, Sam, do you know why you're here today?
0:31:44 > 0:31:49- To donate bone marrow to my little sister.- OK. We're good to go.
0:31:49 > 0:31:53I'm starting with something, it's not the anaesthesia yet
0:31:53 > 0:31:57but it's just something to relax you a bit.
0:31:58 > 0:32:00What are you thinking about, Sam?
0:32:00 > 0:32:02I don't know. I'm just scared,
0:32:02 > 0:32:07like, all these machines and... I just want it to go well.
0:32:10 > 0:32:14Anything I've done up to this point means nothing
0:32:14 > 0:32:19compared to when you can literally give a bit of yourself
0:32:19 > 0:32:20to save someone else.
0:32:20 > 0:32:24Now, THAT'S doing something, that's responsibility.
0:32:26 > 0:32:27OK. Ladies, are you ready?
0:32:31 > 0:32:35The harvesting of bone marrow from Sam's hips is being conducted
0:32:35 > 0:32:40by an expert team at Hammersmith Hospital's centre for haematology.
0:32:40 > 0:32:41Ready, steady, move!
0:32:44 > 0:32:46When we do the bone-marrow harvest,
0:32:46 > 0:32:49the areas that we need are the posterior iliac crest,
0:32:49 > 0:32:52which are just the bones that you will feel
0:32:52 > 0:32:53on the bottom of your back.
0:32:53 > 0:32:57That is the exact place where we have to put the needle through
0:32:57 > 0:32:58and extract the marrow.
0:33:07 > 0:33:10The whole process will last less than two hours.
0:33:13 > 0:33:17So with his white-cell count of 58, we have to collect 700ml.
0:33:21 > 0:33:24So we are taking 5ml per syringe.
0:33:31 > 0:33:35At the end of the day it is the gift of hope.
0:33:35 > 0:33:36Just the gift of life.
0:33:38 > 0:33:40It's quite similar to blood.
0:33:40 > 0:33:43So you wouldn't be able to distinguish.
0:33:47 > 0:33:51Before Sam's bone marrow can be transplanted into Debbie,
0:33:51 > 0:33:53it must be tested in the haematology lab.
0:33:54 > 0:33:59One of the big requirements of the whole process is that the product
0:33:59 > 0:34:01is sterile and free of contamination.
0:34:06 > 0:34:09So before we do any processing with the harvest we take
0:34:09 > 0:34:15some blood cultures, just to make sure that the product that we've got
0:34:15 > 0:34:20from Sam is harvested in a sterile way
0:34:20 > 0:34:25and then that there's no microbial contamination.
0:34:30 > 0:34:33Hi, Deborah. Are you all set?
0:34:33 > 0:34:35Uh...yeah.
0:34:36 > 0:34:3915 years after being diagnosed with sickle cell disease,
0:34:39 > 0:34:43Debbie is receiving the new bone marrow that could cure her.
0:34:43 > 0:34:45So these are your cells.
0:34:47 > 0:34:49- Can I take a picture of it? - Yeah, you can.
0:34:49 > 0:34:53- It's all your brother's bone marrow. - Cool.
0:34:53 > 0:34:55It's just like a blood transfusion.
0:34:55 > 0:35:01Debbie's half-match transplant has the risk of rejection,
0:35:01 > 0:35:04so the body rejects literally the new tissue.
0:35:04 > 0:35:08- So you're going to have 15 drops in 15 seconds.- OK.
0:35:08 > 0:35:14However, 90% of the children not only survive the transplant
0:35:14 > 0:35:17but also are cured of the underlying disease.
0:35:17 > 0:35:18How long will it be?
0:35:18 > 0:35:22It will be about three and a half hours.
0:35:22 > 0:35:23But unfortunately,
0:35:23 > 0:35:27some complications can never be completely prevented.
0:35:27 > 0:35:29It will be a few weeks before doctors know
0:35:29 > 0:35:32if the bone-marrow transplant is a success.
0:35:51 > 0:35:54- It's a rather large box.- It is!
0:35:54 > 0:35:57What's inside, Angela?
0:35:57 > 0:35:59It's going to be John's new heart valve.
0:36:01 > 0:36:04John's new heart valve has been shipped to Hammersmith
0:36:04 > 0:36:07from the United States.
0:36:08 > 0:36:12Comes with lots of important kit to try and help us make it
0:36:12 > 0:36:15small enough to fit inside the body.
0:36:15 > 0:36:17So that's the actual valve itself.
0:36:17 > 0:36:18I'll check we've got the right size.
0:36:18 > 0:36:2126 valve, and it's the correct size we've got there.
0:36:23 > 0:36:25The valve itself is the most expensive part.
0:36:25 > 0:36:29These TAVI valves cost anywhere between £12,000 and £18,000.
0:36:29 > 0:36:32And then there's the time taken for the procedure,
0:36:32 > 0:36:35and so I think if you wrapped up all of that,
0:36:35 > 0:36:37you probably wouldn't get much change from 30K, I would think.
0:36:39 > 0:36:42But it's cost-effective, because if he came in with heart failure
0:36:42 > 0:36:45he's likely to stay two weeks on the first admission,
0:36:45 > 0:36:47probably ten days on the second admission, and if he makes it
0:36:47 > 0:36:50to a third admission that's probably another two weeks.
0:36:50 > 0:36:53You can see that very quickly we've got to beyond 30 days
0:36:53 > 0:36:57at £1,000 a day, and we are then going to be in credit,
0:36:57 > 0:37:03so we're not spending £30,000 on a patient because we fancy it.
0:37:03 > 0:37:07We are spending £30,000 not only to help him and his symptoms,
0:37:07 > 0:37:11but I would have a very strong argument that that
0:37:11 > 0:37:13is actually going to save the NHS money in the long run.
0:37:13 > 0:37:17OK, Iqbal the operator, the other operator.
0:37:17 > 0:37:20Dani, anaesthetic nurse. Julie, anaesthetic fellow.
0:37:20 > 0:37:22OK, fantastic, so there's a large team around.
0:37:25 > 0:37:26Very good team. Thank goodness!
0:37:29 > 0:37:30Lot of brains, exactly.
0:37:30 > 0:37:32Some of them working as well.
0:37:32 > 0:37:35So we've got your name sorted out, the procedure,
0:37:35 > 0:37:37it's a transfemoral TAVI, right leg is the main access.
0:37:37 > 0:37:4026mm S3 valve, we just checked that all.
0:37:40 > 0:37:42So, John, you're part of the team,
0:37:42 > 0:37:45so we need to keep you nice and still.
0:37:51 > 0:37:54John will be awake throughout the procedure.
0:37:55 > 0:37:56Ready?
0:37:58 > 0:37:59OK, that's that pipe in,
0:37:59 > 0:38:04so, John, we're just making a track for our big pipe to go in.
0:38:04 > 0:38:06Hopefully it's not too uncomfortable.
0:38:06 > 0:38:08Pair of forceps.
0:38:08 > 0:38:11Basically what we're doing is we're going through the right
0:38:11 > 0:38:15femoral artery, which will lead us up into the heart.
0:38:15 > 0:38:18Once the big pipe is in, we're pretty much committed to the valve,
0:38:18 > 0:38:20so that's the time we take the valve.
0:38:20 > 0:38:22It's prepped over on the other table.
0:38:22 > 0:38:25So that's what the valve looks like, that's the three cusps.
0:38:25 > 0:38:29We've squashed the valve into something the size of a Bic biro.
0:38:30 > 0:38:34And then as soon as we're ready to go they'll hand it over to us,
0:38:34 > 0:38:35we can put it in.
0:38:37 > 0:38:39Can I have the wire?
0:38:39 > 0:38:43- The clip.- Just take the clip from there.
0:38:43 > 0:38:45So a bit of pushing now, John.
0:38:45 > 0:38:46Bit of pushing.
0:38:48 > 0:38:53It's quite a tough push, the valve is a bit like a boa constrictor.
0:38:53 > 0:38:56It's expanding as we go.
0:38:56 > 0:38:58All right, John?
0:38:58 > 0:39:01You're doing very well.
0:39:01 > 0:39:05OK, so everyone quiet, ready. Casing on.
0:39:08 > 0:39:12Balloon up, slowly, slowly, slowly.
0:39:12 > 0:39:15Balloon down. Casing off.
0:39:17 > 0:39:19And the pressure back.
0:39:19 > 0:39:20Let him recover.
0:39:20 > 0:39:22So there's the new valve here.
0:39:22 > 0:39:25Looks in a very good position, which is good.
0:39:25 > 0:39:29We're going to put some colour on that.
0:39:29 > 0:39:30Look at that.
0:39:30 > 0:39:33Amazing flow, going forwards without turbulence,
0:39:33 > 0:39:37- no leak coming backwards that we can see.- Well done.
0:39:37 > 0:39:40We've done this more than 300 times so it's like
0:39:40 > 0:39:44a Formula One pit stop, isn't it?
0:39:44 > 0:39:47Hello. It's all done! We are all finished!
0:39:47 > 0:39:51It's all gone very well. All right?
0:39:54 > 0:39:57Do you want to look to the right?
0:39:57 > 0:39:59Just a bit slow to respond.
0:39:59 > 0:40:01Very slow.
0:40:03 > 0:40:05John? John?
0:40:05 > 0:40:07John?
0:40:07 > 0:40:11Still with us, John? John? John!
0:40:11 > 0:40:14Hello, there! Hi, John.
0:40:52 > 0:40:55John, just repeat your name for me, can you do that?
0:40:55 > 0:40:59Tell me your name.
0:40:59 > 0:41:00John?
0:41:00 > 0:41:05Squeeze my fingers. Squeeze my fingers, John.
0:41:05 > 0:41:07John, move your toes.
0:41:10 > 0:41:12Can you feel that?
0:41:12 > 0:41:14All right, John.
0:41:14 > 0:41:18There's been no improvement at all since the TAVI finished,
0:41:18 > 0:41:22so unfortunately it looks... that he's had a neurological event.
0:41:24 > 0:41:27We've done all the tests to try and minimise the risk
0:41:27 > 0:41:31and we didn't really think his risk of stroke was going to be
0:41:31 > 0:41:33any higher than any other patient.
0:41:33 > 0:41:35Hi, it's Dr Malik here in the cath lab.
0:41:35 > 0:41:38I need to be put through to 999 London Ambulance
0:41:38 > 0:41:40to get a critical-care transfer.
0:41:40 > 0:41:41Time is of the essence.
0:41:41 > 0:41:43If there's going to be any recovery,
0:41:43 > 0:41:45a complication has to be dealt with quickly.
0:41:45 > 0:41:49They've had a stroke, we need to transfer with critical-care transfer
0:41:49 > 0:41:51to the HASU at Charing Cross.
0:42:09 > 0:42:10We have a critical transfer
0:42:10 > 0:42:13from Hammersmith Hospital to Charing Cross.
0:42:13 > 0:42:17We have a 98-year-old male
0:42:17 > 0:42:22who had a stroke during a procedure.
0:42:22 > 0:42:26Oh, hi, it's Dr Malik here from the Hammersmith Hospital.
0:42:26 > 0:42:30Unfortunately, there has been a complication during the procedure.
0:42:30 > 0:42:35Are you in a position to talk about that? OK. He's still with us.
0:42:35 > 0:42:39The problem is we think there's a stroke, so our only hope
0:42:39 > 0:42:43is that he's in that one third that recover completely and not
0:42:43 > 0:42:45the one third that do very, very badly,
0:42:45 > 0:42:48and we can't tell really at this very early stage
0:42:48 > 0:42:50which group he's going to be in.
0:42:50 > 0:42:52All right, sorry the news is not better.
0:42:55 > 0:42:58No problem, all the best now. Bye now. Bye.
0:43:01 > 0:43:02Hmm.
0:43:05 > 0:43:08All right, John. We're at a different hospital now.
0:43:08 > 0:43:11John has been brought to the trust's hyper-acute stroke unit
0:43:11 > 0:43:13at Charing Cross hospital.
0:43:16 > 0:43:18Lift this right arm for me, please.
0:43:18 > 0:43:20John, your right arm.
0:43:20 > 0:43:23I know you're trying. Your right arm. Try your best.
0:43:23 > 0:43:26That one, can you lift it up?
0:43:26 > 0:43:29Just going to extend your right leg to prevent any bleeding.
0:43:29 > 0:43:33Sorry, sir, I'm just trying to check.
0:43:33 > 0:43:34You've probably had a stroke, we think.
0:43:38 > 0:43:42- Right side?- Right side weakness. - There's the artery.
0:43:42 > 0:43:45So just here, this is the middle cerebral artery,
0:43:45 > 0:43:48which supplies most of the left side of the brain.
0:43:48 > 0:43:52You can see here there's a bright spot which indicates a thrombus,
0:43:52 > 0:43:54a clot inside a blood vessel,
0:43:54 > 0:43:57and that would explain his right-side symptoms.
0:43:57 > 0:44:00It's actually a very important part of the brain.
0:44:00 > 0:44:02So losing that part of the brain would give him
0:44:02 > 0:44:05a significant neurological deficit.
0:44:05 > 0:44:08What does that part of the brain do?
0:44:08 > 0:44:11It's certainly his more complex neurological functions,
0:44:11 > 0:44:16his power sensation to the right side of his body.
0:44:18 > 0:44:21I think this would certainly be a candidate for thrombectomy.
0:44:22 > 0:44:25Just two hours after his heart procedure,
0:44:25 > 0:44:2998-year-old John must now undergo an operation on his brain.
0:44:31 > 0:44:33We're planning to do a thrombectomy,
0:44:33 > 0:44:38which is where we go up through the blood vessels in the groin,
0:44:38 > 0:44:40up past the heart, through the neck,
0:44:40 > 0:44:42into the blood vessels of the brain,
0:44:42 > 0:44:46and the plan is to try and grab that clot, fish it out
0:44:46 > 0:44:50and hopefully restore the flow of blood to that part of John's brain.
0:44:55 > 0:44:57I've heard people describe thrombectomy
0:44:57 > 0:44:59- as a kind of miracle cure to stroke? - Yeah.
0:44:59 > 0:45:02It is occasions where the stroke is severe.
0:45:02 > 0:45:05At the moment it's only Monday to Friday, nine to five?
0:45:05 > 0:45:08- Absolutely, yes.- So what happens outside of those hours?
0:45:08 > 0:45:12Well, these patients are going to do, as they have been doing
0:45:12 > 0:45:15up to now, badly, unfortunately.
0:45:18 > 0:45:20OK, John, you're doing really well.
0:45:21 > 0:45:24So we've got a stent deployed where the clot it,
0:45:24 > 0:45:26to try and grab it, and we've also got
0:45:26 > 0:45:29a big suction catheter to try and suck it at the same time.
0:45:29 > 0:45:31The older the patient, the more twisted the vessels,
0:45:31 > 0:45:33certainly in someone who's 98.
0:45:33 > 0:45:36It's very difficult to get all the equipment up there.
0:45:37 > 0:45:39John, you're doing really well.
0:45:39 > 0:45:40OK.
0:45:40 > 0:45:44If we see the stent, it's a very fine structure.
0:45:44 > 0:45:46It's like a cylindrical mesh.
0:45:46 > 0:45:48So that's going into his brain?
0:45:48 > 0:45:50So that's going into his brain, into the blood vessel
0:45:50 > 0:45:51where the blockage is.
0:45:51 > 0:45:55And by pulling it back you're hoping that's going to catch the clot.
0:45:57 > 0:46:00Nice and still, you're doing well, sir.
0:46:01 > 0:46:03So we're quite deep now into the vessels.
0:46:03 > 0:46:05Close to the limits of how far we can go.
0:46:07 > 0:46:09Really still, John.
0:46:09 > 0:46:12The clot has migrated from the major trunk of the artery
0:46:12 > 0:46:16much deeper into one of the branches.
0:46:16 > 0:46:19The blockage starts about there.
0:46:19 > 0:46:22However, the clot probably goes beyond that.
0:46:22 > 0:46:25It may not come back, we'll see what it's like.
0:46:29 > 0:46:31There's, like, some hard stuff there.
0:46:31 > 0:46:33This may well be clotting hard
0:46:33 > 0:46:37and be much harder to pull out.
0:46:37 > 0:46:39Fingers crossed.
0:46:39 > 0:46:40JOHN GROANS
0:46:40 > 0:46:42You're doing very well, sir.
0:46:57 > 0:46:59OK, John.
0:46:59 > 0:47:01We've got the clot out.
0:47:01 > 0:47:04Hopefully you'll feel better in a few minutes. OK.
0:47:04 > 0:47:08We have some clot stuck at the end of that stent.
0:47:08 > 0:47:12If you see here at the end of the tubing.
0:47:12 > 0:47:14I don't know if you can zoom in.
0:47:14 > 0:47:16There's a black bit that's just come off there,
0:47:16 > 0:47:19a very dark bit. It's obviously blocked a major blood vessel
0:47:19 > 0:47:21that's supplying the left side of his brain.
0:47:21 > 0:47:24So now you can see that that area of brain
0:47:24 > 0:47:26before that wasn't filling is now filling.
0:47:26 > 0:47:28It's amazing you can take that out.
0:47:28 > 0:47:30Yeah, I mean, when it works, it works very well.
0:47:30 > 0:47:33It often does. It usually does.
0:47:33 > 0:47:36All right, sir, all the best. I'll see you upstairs.
0:47:38 > 0:47:41Hopefully, that makes a significant difference.
0:47:41 > 0:47:42All right?
0:47:42 > 0:47:45There's another stroke just coming in.
0:47:45 > 0:47:47- Really?- Yes.
0:47:47 > 0:47:49- So...- Another stroke.
0:47:50 > 0:47:52One in, one out.
0:47:55 > 0:47:58Can I ask you, let's just have a look at your arms, first, Gerry.
0:47:58 > 0:48:02Can I ask you just to squeeze my fingers as hard as you can.
0:48:02 > 0:48:03That's it.
0:48:03 > 0:48:07It's six days since Gerry had his stroke.
0:48:07 > 0:48:09Lovely. Hard as you can, Gerry. Go on.
0:48:09 > 0:48:10That's it.
0:48:15 > 0:48:18OK, keep going down, we're going to head straight for the doors.
0:48:18 > 0:48:21- To the door?- Yeah, just to the doors and have a touch
0:48:21 > 0:48:23- and we're going to turn around and go back.- OK.
0:48:23 > 0:48:25All right?
0:48:26 > 0:48:29What is it like seeing Gerry walk like that
0:48:29 > 0:48:30after what's happened to him?
0:48:32 > 0:48:34Sorry.
0:48:41 > 0:48:43Gerry is recovering well.
0:48:44 > 0:48:46It was last Thursday...
0:48:46 > 0:48:49But further tests reveal a narrowing of one of the blood vessels
0:48:49 > 0:48:53that supplies his brain, putting him at risk of another stroke.
0:48:53 > 0:48:56So we're having a multi-disciplinary team meeting
0:48:56 > 0:48:58with the vascular surgeons and also the stroke team
0:48:58 > 0:49:01and we're having to make a decision on what we think
0:49:01 > 0:49:03the best treatment is for Gerry.
0:49:03 > 0:49:06Is there any indication for carotid endarterectomy?
0:49:06 > 0:49:08I think we have to look at the benefits.
0:49:08 > 0:49:11Certain people can benefit from an operation to clear out the narrowing
0:49:11 > 0:49:13to prevent further strokes.
0:49:13 > 0:49:17I personally don't think he should have his carotid done.
0:49:17 > 0:49:21From my viewpoint, I don't think he is clear-cut at all
0:49:21 > 0:49:23as to whether we should offer him surgery or not.
0:49:23 > 0:49:26I'd quite like to see the patient and then I'll make a judgment.
0:49:26 > 0:49:29- Yeah.- So I'll go and see him this afternoon.
0:49:32 > 0:49:35We're weighing up the risks because the purpose of doing the operation
0:49:35 > 0:49:37is to reduce his stroke risk.
0:49:37 > 0:49:40He could possibly die having the operation.
0:49:40 > 0:49:44Doctors will let Gerry decide whether he wants surgery or not.
0:49:46 > 0:49:48Hello, sir.
0:49:48 > 0:49:52I'm Professor Davies and we've just had our meeting to discuss
0:49:52 > 0:49:57whether you should have an operation to reduce the risk of having
0:49:57 > 0:50:03a stroke, or whether we should just carry on with various medicines.
0:50:03 > 0:50:07I personally think your risks of going on to have an operation
0:50:07 > 0:50:10are such that it's a very difficult balance.
0:50:10 > 0:50:13My advice would be that you would be better off having
0:50:13 > 0:50:17the appropriate medicines and see how you get on.
0:50:17 > 0:50:21Now, do you have any immediate thoughts about what I've said?
0:50:26 > 0:50:30OK. We will tell them that that's what is your preference.
0:50:30 > 0:50:33So, all in all, I can only say "cheerio"
0:50:33 > 0:50:35because there's nothing for me to do
0:50:35 > 0:50:39and I will, um, get Dr Halse to come back and see you and go from there.
0:50:39 > 0:50:40Nice to see you. OK.
0:50:40 > 0:50:42Nice to see you again.
0:50:42 > 0:50:43Take care.
0:50:45 > 0:50:48I think there are quite a lot of people who have decided,
0:50:48 > 0:50:50particularly as they get older,
0:50:50 > 0:50:54that they do not want to have a surgical intervention.
0:50:54 > 0:50:58It's a known surgical intervention that comes with a given risk
0:50:58 > 0:51:01and therefore feel that they would like nature to take its course.
0:51:03 > 0:51:07You've got to sort of weigh up the pros and cons and I think...
0:51:08 > 0:51:12There are a lot of risks, regardless in what way you look at it
0:51:12 > 0:51:15but I think having an operation, the risk is much bigger.
0:51:15 > 0:51:16I think that, anyway.
0:51:16 > 0:51:18I tend to agree with Gerry.
0:51:18 > 0:51:20For once.
0:51:20 > 0:51:22THEY LAUGH
0:51:30 > 0:51:32Have you been sleeping?
0:51:33 > 0:51:35- Hmm?- Yeah.
0:51:35 > 0:51:37- OK.- Yeah.
0:51:41 > 0:51:43Since her bone-marrow transplant,
0:51:43 > 0:51:46Debbie's blood samples have been sent to the lab every day to see if
0:51:46 > 0:51:50her brother's cells have taken hold, a process known as engraftment.
0:51:50 > 0:51:53Carrie calling from Grand Union ward, we've got some urgent
0:51:53 > 0:51:55bloods to be collected, please.
0:52:00 > 0:52:04So far the results have yet to show conclusive evidence it's working.
0:52:08 > 0:52:12I'm just logging on so that I can look at the results of her
0:52:12 > 0:52:13blood tests today.
0:52:13 > 0:52:17The finishing of engraftment is a neutrophil count of more than 0.5
0:52:17 > 0:52:18on three consecutive days.
0:52:20 > 0:52:24If today is also over 0.5
0:52:24 > 0:52:25then...
0:52:27 > 0:52:28..she's winning.
0:52:30 > 0:52:31Hello, Debbie.
0:52:32 > 0:52:35Do you know what's been happening with your blood counts?
0:52:35 > 0:52:36Do you know what they are today?
0:52:36 > 0:52:38No.
0:52:39 > 0:52:41I'll give you the news.
0:52:41 > 0:52:43- Yes.- Yeah.
0:52:43 > 0:52:45- It's 1.8 today.- OK.
0:52:45 > 0:52:50Which means it's a third day in a row that it's been more than 0.5,
0:52:50 > 0:52:54- which means you have engrafted. - Yeah.
0:52:54 > 0:52:56So your new bone marrow is working.
0:52:56 > 0:52:59- Yeah.- Yes, that's right.
0:53:01 > 0:53:03- So...- Congratulations.- Yeah...
0:53:05 > 0:53:06So you and your team, Team Debbie,
0:53:06 > 0:53:08are doing really well.
0:53:10 > 0:53:11- That's good.- That is good.
0:53:11 > 0:53:13It's like a little bit of magic, isn't it?
0:53:13 > 0:53:15- Yeah.- Yeah.
0:53:16 > 0:53:17From a patient's point of view,
0:53:17 > 0:53:20being able to establish normal reaction is a key moment.
0:53:22 > 0:53:24The transplant has worked
0:53:24 > 0:53:26and it has been cured.
0:53:27 > 0:53:30Look at that smile.
0:53:30 > 0:53:32- I'm excited.- Of course.
0:53:32 > 0:53:35- The first step is that you can go out for a little walk.- Yeah.
0:53:35 > 0:53:36OK.
0:53:38 > 0:53:40Is it nice doing that bit of the job?
0:53:40 > 0:53:41Always the best bit.
0:53:43 > 0:53:47Overall, in the UK, care of sickle cell in childhood is
0:53:47 > 0:53:50absolutely excellent and it's world-class.
0:53:52 > 0:53:55You came here alive and you're going back alive.
0:53:55 > 0:53:57- That's God for you.- Yeah.
0:53:59 > 0:54:01She's very fond of me and I'm fond of her.
0:54:01 > 0:54:03I don't think we can...
0:54:04 > 0:54:05..live...
0:54:06 > 0:54:07..a day apart.
0:54:08 > 0:54:10What does it feel like to be outside?
0:54:10 > 0:54:12Good.
0:54:12 > 0:54:14I like it.
0:54:15 > 0:54:17It's a bit cold.
0:54:26 > 0:54:32I was worried and I was considering that perhaps I had, um...
0:54:33 > 0:54:36..been a little bit too positive in terms of the way
0:54:36 > 0:54:38I presented things to him.
0:54:38 > 0:54:40That maybe it would have been better if he hadn't had the TAVI.
0:54:40 > 0:54:43- Hello.- Hello.
0:54:43 > 0:54:45How are you?
0:54:47 > 0:54:49- How are you?- Getting there.
0:54:49 > 0:54:50Good.
0:54:52 > 0:54:54How has your day been?
0:54:54 > 0:54:56It's been all right.
0:54:56 > 0:54:58He's actually doing remarkably well, I have to say.
0:55:01 > 0:55:04He has had some initial problems with his speech
0:55:04 > 0:55:07and a little bit of his memory and actually all those things
0:55:07 > 0:55:09seem to be more or less resolved now.
0:55:09 > 0:55:12He seems to be back to his usual self.
0:55:12 > 0:55:14He is interested in the world again.
0:55:14 > 0:55:17We were having conversations about who his favourite prime minister was
0:55:17 > 0:55:21and who he thought was the worst prime minister he's ever witnessed in his lifetime.
0:55:21 > 0:55:23You're doing really well.
0:55:23 > 0:55:25- Thank you.- You're welcome.
0:55:25 > 0:55:26SHE CHUCKLES
0:55:26 > 0:55:29When I was training, 65 was the cut-off at older age.
0:55:29 > 0:55:31That's a young man these days.
0:55:31 > 0:55:34Yes, it's getting busier and the patients are getting older
0:55:34 > 0:55:36because they're surviving longer,
0:55:36 > 0:55:39which is a success story for the UK and the NHS.
0:55:41 > 0:55:44We've got all these amazing, pioneering techniques
0:55:44 > 0:55:46such as TAVI,
0:55:46 > 0:55:49but as the population ages, how sustainable is all of this
0:55:49 > 0:55:51within the current structure of the NHS?
0:56:05 > 0:56:07It was so worth it
0:56:07 > 0:56:09because I get to give her
0:56:09 > 0:56:12another fighting chance.
0:56:12 > 0:56:16Which is beyond something I could ever dream of doing.
0:56:18 > 0:56:22It's like a major beginning for me and my family.
0:56:22 > 0:56:25So...I'm very excited for the future.
0:56:36 > 0:56:40I think we did make the right decision, and his heart, apparently,
0:56:40 > 0:56:41is working beautifully.
0:56:41 > 0:56:45So...I think he has every chance now that he's had the TAVI of getting
0:56:45 > 0:56:49to 100, and if he does, my goodness, the party we'll have at that point.
0:56:49 > 0:56:51I can't wait.
0:56:53 > 0:56:54So, we've got a bit of a problem now.
0:56:54 > 0:56:56Next time...
0:56:56 > 0:56:58I've finished here at Charing Cross so I'm coming over.
0:56:58 > 0:56:59With more patients than theatres,
0:56:59 > 0:57:02surgeons struggle to get their operations started.
0:57:02 > 0:57:06We will talk about it when I've calmed down.
0:57:06 > 0:57:08- SIGHS - OK, um...
0:57:09 > 0:57:11I'll going to have to go and tell him.
0:57:11 > 0:57:14There's a drive to get obese patients treated.
0:57:14 > 0:57:16So that's ten cancellations on the list tomorrow already.
0:57:16 > 0:57:19I think there is a stigmatisation against obesity.
0:57:19 > 0:57:22I completely disagree with the opinion that
0:57:22 > 0:57:24obesity is self-inflicted.
0:57:24 > 0:57:27And the hospital joins forces with others across the country
0:57:27 > 0:57:29for a live kidney swap.
0:57:29 > 0:57:31Everything has to happen at the same time.
0:57:31 > 0:57:34One mistake can screw up the whole thing.
0:57:34 > 0:57:36Can we please all be quiet,
0:57:36 > 0:57:37just let me think a second.
0:57:42 > 0:57:43What choices would you make
0:57:43 > 0:57:46when faced with complex health-care decisions?
0:57:46 > 0:57:49Visit our interactive pages to find out how you would respond.
0:57:49 > 0:57:52Go to...
0:57:53 > 0:57:56And follow the links to the Open University.