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Where is he? I don't know. You need to shout for help. Where is he? | 0:00:03 | 0:00:06 | |
Which way did he go? | 0:00:06 | 0:00:08 | |
One of London's biggest hospital trusts... | 0:00:08 | 0:00:10 | |
He's having a heart attack, | 0:00:10 | 0:00:11 | |
but we'll get him in straightaway, and we'll get him sorted out. | 0:00:11 | 0:00:14 | |
OK, on three. One, two, three. | 0:00:14 | 0:00:16 | |
..treating more than 20,000 people every week. | 0:00:16 | 0:00:20 | |
Flying over the enemy lines. | 0:00:20 | 0:00:22 | |
This is a place with some of the best specialists in the world... | 0:00:22 | 0:00:26 | |
I'm amazed he's alive. He had two blocked arteries. | 0:00:26 | 0:00:28 | |
..where lives are transformed... | 0:00:28 | 0:00:30 | |
Oh, thank you so much. | 0:00:30 | 0:00:32 | |
..but it's under intense pressure... | 0:00:34 | 0:00:36 | |
We have a financial deficit of 41 million. | 0:00:36 | 0:00:39 | |
..with growing patient numbers... | 0:00:39 | 0:00:41 | |
We are full. We're always full. | 0:00:41 | 0:00:43 | |
How long has he been here? | 0:00:43 | 0:00:44 | |
13 hours and 46 minutes. | 0:00:44 | 0:00:47 | |
I don't think that's best patient care. | 0:00:47 | 0:00:49 | |
..and higher expectations... | 0:00:49 | 0:00:50 | |
There can't be nothing in this day and age. | 0:00:50 | 0:00:53 | |
I want to look after him. | 0:00:53 | 0:00:55 | |
First ambulance is on the rack. | 0:00:55 | 0:00:57 | |
..at a time when the NHS has never been under more scrutiny. | 0:00:58 | 0:01:02 | |
We are declaring a major incident at the St Mary's site. | 0:01:02 | 0:01:04 | |
If this was my sister or a friend or anyone, | 0:01:04 | 0:01:07 | |
this wouldn't be good enough. | 0:01:07 | 0:01:08 | |
Week by week, we reveal the complex decisions the staff must make... | 0:01:08 | 0:01:13 | |
Anybody else who hasn't gone knife to skin, they need to be sent home. | 0:01:13 | 0:01:18 | |
..about who to care for next. | 0:01:18 | 0:01:20 | |
Do you reach a point where you say enough is enough? | 0:01:22 | 0:01:25 | |
Yes. The family may not like that, | 0:01:25 | 0:01:27 | |
but we are stopping, and this is where it ends. | 0:01:27 | 0:01:30 | |
PAGER BEEPS | 0:01:35 | 0:01:37 | |
Emergency coming, five minutes, by a London Ambulance Service. | 0:01:40 | 0:01:44 | |
So, what do we know? Who took the phone? | 0:01:44 | 0:01:46 | |
Peri arrest, 50, hypotensive, bradycardic. | 0:01:46 | 0:01:50 | |
56-year-old Edward, OK. | 0:01:52 | 0:01:55 | |
Called about two o'clock. Yeah. | 0:01:55 | 0:01:57 | |
He said he had a central chest pain. Yeah. | 0:01:57 | 0:01:59 | |
He was in peri arrest, bradycardic. Around sort of 30-50. | 0:01:59 | 0:02:03 | |
OK. | 0:02:03 | 0:02:05 | |
56-year-old city worker Eddie is suffering a major heart attack. | 0:02:05 | 0:02:09 | |
Oh, hello. HE GROANS | 0:02:12 | 0:02:15 | |
All right, Edward? | 0:02:15 | 0:02:16 | |
You're in hospital. HE GROANS | 0:02:16 | 0:02:17 | |
After calling 999, Eddie collapsed at home alone. | 0:02:17 | 0:02:21 | |
His heart is severely unstable and could stop at any time. | 0:02:21 | 0:02:25 | |
It's all right, we've got some. Need some atropine, please. Quick, quick. | 0:02:27 | 0:02:30 | |
What do you need? Atropine. Blood pressure, 125. | 0:02:30 | 0:02:34 | |
What was the last heart rate? | 0:02:34 | 0:02:35 | |
It's 35. OK, perfect. | 0:02:35 | 0:02:37 | |
Yeah, atropine's in. | 0:02:38 | 0:02:41 | |
Hammersmith is one of the UK's foremost heart attack centres, | 0:02:41 | 0:02:45 | |
or HACs. | 0:02:45 | 0:02:46 | |
Eddie will receive acute treatment | 0:02:46 | 0:02:49 | |
only available in specialist hospitals. | 0:02:49 | 0:02:51 | |
Mind your backs, please. | 0:02:51 | 0:02:53 | |
The HACs are like a specialised A just for the heart. | 0:02:59 | 0:03:02 | |
One, two, three. | 0:03:02 | 0:03:04 | |
London ambulance bring us more and more patients, | 0:03:04 | 0:03:06 | |
so probably double what we would have seen five years ago | 0:03:06 | 0:03:09 | |
when we first started. | 0:03:09 | 0:03:12 | |
Anna, have you got an ECG? Where's the ECG? | 0:03:12 | 0:03:14 | |
Oh, dear, the ECG's showing that he's having a big heart attack. | 0:03:16 | 0:03:19 | |
So, the team is going to intubate, cos he's so restless. | 0:03:19 | 0:03:23 | |
He's got no forward output, really. | 0:03:23 | 0:03:26 | |
Next stage, which is to get into his arteries and take a picture, | 0:03:26 | 0:03:30 | |
find the blockage, fix the blockage. | 0:03:30 | 0:03:32 | |
It's just making sure that he doesn't have a cardiac arrest | 0:03:32 | 0:03:35 | |
before we get to that point. | 0:03:35 | 0:03:37 | |
Pressure line on, please. | 0:03:40 | 0:03:41 | |
The faster you are, the more muscle you save, | 0:03:43 | 0:03:46 | |
and it's important, when someone's really sick, | 0:03:46 | 0:03:49 | |
to get that artery open as fast as you can. | 0:03:49 | 0:03:52 | |
So, we've got to get beyond this tricky leg. | 0:03:52 | 0:03:56 | |
A catheter wire is inserted through Eddie's groin into his heart. | 0:03:56 | 0:04:00 | |
Balloons and small mesh tubes called stents | 0:04:00 | 0:04:03 | |
will then unblock his arteries in a procedure called angioplasty. | 0:04:03 | 0:04:07 | |
This has got to be a big, big right. | 0:04:07 | 0:04:09 | |
Must be a huge right. OK, we're in now. | 0:04:09 | 0:04:11 | |
Yeah, look, a huge, great big clot that's just blown downstream. | 0:04:14 | 0:04:18 | |
We'll see if we can't suck it out. OK. | 0:04:18 | 0:04:20 | |
HEART MONITOR BEEPS | 0:04:20 | 0:04:22 | |
No, I wouldn't call him stable. | 0:04:24 | 0:04:27 | |
He's on blobs of adrenaline. | 0:04:27 | 0:04:29 | |
So, let's just see if we've got a clot here. | 0:04:29 | 0:04:32 | |
I don't have any big clots here. We're going to go back in again. | 0:04:32 | 0:04:36 | |
We need to get rid of any clot that's sitting in this line. | 0:04:36 | 0:04:40 | |
No point in taking the clot out of the coronary artery | 0:04:40 | 0:04:43 | |
and then blowing it into his brain - that would be bad, wouldn't it? | 0:04:43 | 0:04:46 | |
So... | 0:04:46 | 0:04:48 | |
Now, that may have trapped something, | 0:04:48 | 0:04:49 | |
cos that's not coming back. | 0:04:49 | 0:04:51 | |
Yeah, yeah. Ah, it's opened up. Just leave it. | 0:04:51 | 0:04:54 | |
This man had... I'm amazed he's alive. | 0:04:54 | 0:04:56 | |
He had two blocked arteries. | 0:04:56 | 0:04:58 | |
So, 40% of patients have two ruptured clots, | 0:04:58 | 0:05:01 | |
but not two ruptured clots causing complete blockages, I have to say. | 0:05:01 | 0:05:04 | |
OK. Good. | 0:05:06 | 0:05:08 | |
The heart attack centre is one of seven set up in London | 0:05:08 | 0:05:11 | |
within the last ten years | 0:05:11 | 0:05:13 | |
to consolidate specialist skills and resources. | 0:05:13 | 0:05:17 | |
He decided he wanted to live. | 0:05:17 | 0:05:18 | |
Since they were established, survival rates in the capital | 0:05:21 | 0:05:24 | |
for the most serious heart attacks have doubled. | 0:05:24 | 0:05:27 | |
OK, let's see what we have. | 0:05:27 | 0:05:31 | |
So, this is a nice story, yes? Yeah. | 0:05:31 | 0:05:34 | |
Potentially. | 0:05:34 | 0:05:36 | |
I'm very clear that today he was dead | 0:05:36 | 0:05:39 | |
if he hadn't ended up with us and had gone to a smaller hospital | 0:05:39 | 0:05:41 | |
where they didn't have a cath lab. | 0:05:41 | 0:05:43 | |
Had he had a cardiac arrest in an A department | 0:05:43 | 0:05:45 | |
without a cath lab facility, | 0:05:45 | 0:05:47 | |
he would never have stabilised to come over to us | 0:05:47 | 0:05:49 | |
to open up his arteries. | 0:05:49 | 0:05:51 | |
There's no debate about it, he would be dead. | 0:05:51 | 0:05:54 | |
INTERVIEWER: And where are you off to now? | 0:05:55 | 0:05:57 | |
I'm into the next lab. So, we've just started another hot case - | 0:05:57 | 0:06:02 | |
not quite as hot as him - this is a gentleman who's in his 80s, | 0:06:02 | 0:06:05 | |
who's presented with a heart attack. | 0:06:05 | 0:06:07 | |
Over the past decade, | 0:06:16 | 0:06:17 | |
there's been a move to centralise NHS services | 0:06:17 | 0:06:20 | |
in order to offer specialised care to more people | 0:06:20 | 0:06:23 | |
in fewer, bigger hospitals. | 0:06:23 | 0:06:25 | |
Charing Cross Hospital is the Trust's specialist centre | 0:06:30 | 0:06:33 | |
for neurosurgery and the treatment of brain tumours. | 0:06:33 | 0:06:36 | |
I'm off in to see my oncologist. | 0:06:44 | 0:06:47 | |
She's asked me to come in quite urgently, | 0:06:47 | 0:06:50 | |
just to have a chat about my recent MRI scan. | 0:06:50 | 0:06:54 | |
28-year-old Ben had a brain tumour removed four years ago. | 0:06:57 | 0:07:01 | |
I've been here a lot, cos this is where I was operated on | 0:07:03 | 0:07:07 | |
to have my brain tumour taken out, | 0:07:07 | 0:07:10 | |
and then also to have my follow-up radiotherapy and chemo. | 0:07:10 | 0:07:14 | |
Since his operation, | 0:07:16 | 0:07:18 | |
he's been monitored by consultant clinical oncologist Alison Falconer. | 0:07:18 | 0:07:23 | |
He's been having scans every six months since he finished treatment. | 0:07:23 | 0:07:27 | |
Over the last year, there's been a progressive change in his scans. | 0:07:27 | 0:07:30 | |
Dr Falconer's called me in, | 0:07:32 | 0:07:34 | |
but I don't think it's an official appointment, | 0:07:34 | 0:07:36 | |
she said come in for 11:30. | 0:07:36 | 0:07:38 | |
We've got the Grade 3 brain tumours, which Ben has. | 0:07:38 | 0:07:41 | |
With these tumours, half the patients have died in five years - | 0:07:41 | 0:07:45 | |
and it's four years since surgery. | 0:07:45 | 0:07:47 | |
Hello. Hi, Ben. Hi, how are you? | 0:07:50 | 0:07:52 | |
Good. Nice to meet you. So, I've heard your name a lot. | 0:07:52 | 0:07:55 | |
Kevin O'Neill. Yeah. Did we meet before? | 0:07:55 | 0:07:58 | |
I don't think I've ever actually met you, | 0:07:58 | 0:07:59 | |
I just always hear Kevin O'Neill. | 0:07:59 | 0:08:01 | |
Do you? That's strange. I think you're famous. | 0:08:01 | 0:08:03 | |
Basically. So, we've been discussing you in our own big team, | 0:08:03 | 0:08:06 | |
so we work altogether. Yeah, OK. So, how have you been? | 0:08:06 | 0:08:09 | |
Have you been...? I've been fine, yeah. | 0:08:09 | 0:08:11 | |
I've had absolutely no symptoms from my brain. | 0:08:11 | 0:08:13 | |
No seizures? No seizures since the op. | 0:08:13 | 0:08:16 | |
There's always a chance that things could change. | 0:08:16 | 0:08:18 | |
Yeah, which I've always been aware of. Yeah. | 0:08:18 | 0:08:21 | |
I think, if you look back, you can see a little ring | 0:08:21 | 0:08:23 | |
that looks like maybe a residual bit of tumour. | 0:08:23 | 0:08:26 | |
Looks like it's been very well-behaved, | 0:08:26 | 0:08:28 | |
but in the last scan, it just... | 0:08:28 | 0:08:30 | |
Part of it... Yeah. ..looks a little bit bigger. | 0:08:30 | 0:08:32 | |
That would warrant us going in | 0:08:32 | 0:08:34 | |
to remove that bit that's growing, and... | 0:08:34 | 0:08:36 | |
Right. ..potentially threatening you. Mm-hm. | 0:08:36 | 0:08:39 | |
OK. So, you're saying that you feel I should have a procedure... | 0:08:39 | 0:08:43 | |
another operation. | 0:08:43 | 0:08:45 | |
Well, we all feel that, you know, | 0:08:45 | 0:08:47 | |
there is a risk of leaving you alone | 0:08:47 | 0:08:49 | |
and the risk of treating you is less than the risk of leaving you alone. | 0:08:49 | 0:08:53 | |
From my understanding of the tumour that I have had, blah, blah, blah, | 0:08:53 | 0:08:57 | |
it was slow-growing? Relative to the fast ones, unfortunately. | 0:08:57 | 0:09:01 | |
There's always a spectrum. OK. So there's barely growing, | 0:09:01 | 0:09:04 | |
which are what we call benign - 1, 2. | 0:09:04 | 0:09:06 | |
The Grade 3, which is what you had, | 0:09:06 | 0:09:08 | |
means you can't just sit and watch it and observe it lifelong. | 0:09:08 | 0:09:11 | |
Yeah, OK. Has to come out, have the chemotherapy, have the radiotherapy, | 0:09:11 | 0:09:14 | |
as you did. Yeah. And the Grade 4 are the much more aggressive ones. | 0:09:14 | 0:09:17 | |
In terms of timings, what are your thoughts, then, on...? | 0:09:17 | 0:09:21 | |
When would it need to...? Probably in the next few weeks. | 0:09:21 | 0:09:23 | |
Oh. Two or three weeks, we'd need to set it up. | 0:09:23 | 0:09:25 | |
OK. Have you got plans? | 0:09:25 | 0:09:27 | |
Well, yeah, I've always got plans, I'm really busy, | 0:09:27 | 0:09:29 | |
but we have to work around those. Yeah. | 0:09:29 | 0:09:33 | |
It's not going to be tomorrow. And, yeah, so... | 0:09:33 | 0:09:37 | |
We've seen it grow, there's no point just sitting here, watching it, | 0:09:37 | 0:09:40 | |
we need to do something about it. Yeah. | 0:09:40 | 0:09:42 | |
Mm. Does that make sense? | 0:09:43 | 0:09:45 | |
Yeah, it's making sense. | 0:09:45 | 0:09:47 | |
It's just a pain in the arse. | 0:09:47 | 0:09:49 | |
Basically. | 0:09:49 | 0:09:51 | |
It's a tricky balance. | 0:09:51 | 0:09:53 | |
Thanks very much. | 0:09:53 | 0:09:55 | |
It's just a lot of stress and it's just annoying, isn't it? | 0:09:59 | 0:10:03 | |
It's just... | 0:10:03 | 0:10:05 | |
It is annoying. Yeah, it's annoying. | 0:10:05 | 0:10:07 | |
It's just... That's nothing to what I said when I saw the e-mail. | 0:10:07 | 0:10:10 | |
It really isn't fair. | 0:10:10 | 0:10:11 | |
No, it's not fair, but it's happening, so get on with it, | 0:10:11 | 0:10:14 | |
I guess. Right, so... Yeah. | 0:10:14 | 0:10:16 | |
Great. | 0:10:18 | 0:10:19 | |
SHE LAUGHS | 0:10:19 | 0:10:20 | |
Why don't you get out into the sunshine? Yeah, exactly, exactly. | 0:10:20 | 0:10:23 | |
It's fine. OK. | 0:10:23 | 0:10:25 | |
Yeah, thank you very much. | 0:10:25 | 0:10:27 | |
Oh. I know, what the hell? | 0:10:27 | 0:10:29 | |
But it was going to happen at some point, I think. It's all right. | 0:10:29 | 0:10:33 | |
Thank you. Right. Are we going, Ben? | 0:10:33 | 0:10:36 | |
Yeah. Take care, see you soon. | 0:10:36 | 0:10:38 | |
Oh, thank you. | 0:10:38 | 0:10:40 | |
INTERVIEWER: Was it always going to come back? No. | 0:10:41 | 0:10:45 | |
We always, always hope... | 0:10:45 | 0:10:46 | |
There are patients whose tumours don't come back. | 0:10:46 | 0:10:50 | |
He's been the unlucky one. | 0:10:50 | 0:10:52 | |
So, this is Ben's story, basically. | 0:10:53 | 0:10:55 | |
So, he had a tumour way back in 2012. | 0:10:55 | 0:10:59 | |
This is my colleague, who did a very good resection, | 0:10:59 | 0:11:02 | |
and got a lot of this out. You can see a big resection cavity here, | 0:11:02 | 0:11:05 | |
but over the last few years, there's been something growing anteriorly. | 0:11:05 | 0:11:09 | |
If we give it enough time to regrow, it can transform into something... | 0:11:09 | 0:11:13 | |
high grade that will threaten him. | 0:11:13 | 0:11:15 | |
It's very, very frustrating treating brain tumour patients like Ben | 0:11:15 | 0:11:19 | |
where they've had a good surgery | 0:11:19 | 0:11:21 | |
and, you know, his tumour's come back. | 0:11:21 | 0:11:23 | |
The biggest problem with brain tumours | 0:11:23 | 0:11:25 | |
is they have such poor survival rates. | 0:11:25 | 0:11:26 | |
Many of them are very aggressive. | 0:11:26 | 0:11:28 | |
For that reason, they cause the greatest reduction | 0:11:28 | 0:11:30 | |
of life expectancy compared to any other cancer, | 0:11:30 | 0:11:33 | |
because they can affect any one of us at any age. | 0:11:33 | 0:11:36 | |
Most of them are fatal and under the age of 40, | 0:11:36 | 0:11:39 | |
they're the greatest cancer killer. | 0:11:39 | 0:11:40 | |
You know, you want to solve this problem | 0:11:40 | 0:11:42 | |
and you want to make things better | 0:11:42 | 0:11:44 | |
and that's what drives us on to try and research and develop, | 0:11:44 | 0:11:47 | |
and design new technologies and new treatments. | 0:11:47 | 0:11:50 | |
Kevin and his team are at the forefront of using new technology | 0:11:51 | 0:11:55 | |
to understand more about brain tumours like Ben's. | 0:11:55 | 0:11:58 | |
I didn't know exactly how my story would pan out, | 0:11:58 | 0:12:01 | |
but I had a Grade 3 brain tumour, which had been treated, | 0:12:01 | 0:12:05 | |
but there is the history that it does come back... | 0:12:05 | 0:12:09 | |
..but the thing is, like, I've just got on with my life. | 0:12:11 | 0:12:13 | |
I've enjoyed...I've enjoyed things | 0:12:13 | 0:12:15 | |
and I've been, you know, living my life and getting on with it - | 0:12:15 | 0:12:19 | |
and then, it has happened, | 0:12:19 | 0:12:22 | |
and I just need to, erm... | 0:12:22 | 0:12:24 | |
do it again. | 0:12:24 | 0:12:26 | |
Any change from this morning here? | 0:12:42 | 0:12:45 | |
It's 24 hours since Eddie arrived at the HAC, | 0:12:45 | 0:12:48 | |
suffering a major heart attack. | 0:12:48 | 0:12:51 | |
This came as quite a surprise. | 0:12:51 | 0:12:53 | |
I would have expected there to be a feeling of panic, | 0:12:53 | 0:12:57 | |
and something like that. | 0:12:57 | 0:13:00 | |
For some reason, it was like... | 0:13:00 | 0:13:03 | |
"I just hope that they get here with that ambulance quickly. | 0:13:03 | 0:13:07 | |
"If not, then this could be it." | 0:13:07 | 0:13:11 | |
That's all I felt. | 0:13:11 | 0:13:12 | |
I hadn't really thought about it that hard up until then. | 0:13:22 | 0:13:25 | |
So, that's quite... | 0:13:25 | 0:13:27 | |
..quite heavy. | 0:13:29 | 0:13:31 | |
But...I'm here. | 0:13:34 | 0:13:36 | |
He's done pretty well, actually. | 0:13:38 | 0:13:40 | |
He's come off the ventilator, | 0:13:40 | 0:13:42 | |
he's come off all the drugs that were supporting the heart yesterday. | 0:13:42 | 0:13:45 | |
So, for the extreme types of heart attacks that we see, | 0:13:45 | 0:13:47 | |
that is a speedy recovery - | 0:13:47 | 0:13:50 | |
and, hopefully, yeah, he'll be back at work within a few weeks. | 0:13:50 | 0:13:54 | |
Hello, sir. Oh, hi, again. | 0:13:54 | 0:13:56 | |
Right, how are you feeling compared to this morning? | 0:13:56 | 0:13:58 | |
Much better. Does anything not make sense to you? | 0:13:58 | 0:14:01 | |
Cos you've been through a lot in the last 24 hours. | 0:14:01 | 0:14:03 | |
No. It has been literally 24 hours, this time yesterday. | 0:14:03 | 0:14:06 | |
Yes, indeed. No, people have explained it very well. | 0:14:06 | 0:14:09 | |
OK. Your heart tracings are good, | 0:14:09 | 0:14:11 | |
your monitoring, your blood pressure and everything's been good. | 0:14:11 | 0:14:14 | |
So, I think we can literally unhook you from all of this, | 0:14:14 | 0:14:17 | |
make the next step and get you to the ward - | 0:14:17 | 0:14:19 | |
and you'll find, as days go by, the heart gets stronger and stronger. | 0:14:19 | 0:14:22 | |
That should make you feel better. Yeah. Cool. OK. | 0:14:22 | 0:14:25 | |
Great. Thank you. Bye-bye. | 0:14:25 | 0:14:28 | |
IQBAL: As a front line service for the heart, | 0:14:31 | 0:14:33 | |
the HAC is incredibly successful. | 0:14:33 | 0:14:35 | |
London is pretty well served, | 0:14:35 | 0:14:37 | |
the rest of the country's following suit. | 0:14:37 | 0:14:39 | |
These heart attack centres mean that there's a concentration of skills, | 0:14:39 | 0:14:43 | |
a concentration of staff. | 0:14:43 | 0:14:45 | |
These patients stay in the hospital for less days, | 0:14:45 | 0:14:47 | |
and therefore not only does their life get saved, | 0:14:47 | 0:14:50 | |
it's also cost-effective. | 0:14:50 | 0:14:51 | |
OK, sir. Back in the ward now. | 0:14:53 | 0:14:55 | |
HE HUMS TO HIMSELF | 0:14:57 | 0:14:59 | |
Every division in the Trust must make significant cost savings | 0:15:01 | 0:15:05 | |
to hit efficiency targets set by the Government. | 0:15:05 | 0:15:08 | |
Morning. Morning. | 0:15:08 | 0:15:10 | |
It's the job of general manager Steve Hart | 0:15:10 | 0:15:13 | |
to oversee the Trust's cost saving plan | 0:15:13 | 0:15:15 | |
for their cardiac services, including the HAC. | 0:15:15 | 0:15:18 | |
Firstly, a sort of good news story for the team, so last year, '16/'17, | 0:15:18 | 0:15:24 | |
challenged to deliver a ?2.3 million cost improvement programme. | 0:15:24 | 0:15:29 | |
We actually achieved ?2.6 million, | 0:15:29 | 0:15:31 | |
so surpassed what we're expected to do. | 0:15:31 | 0:15:34 | |
What that doesn't mean is that '17/'18 is going to get any easier, | 0:15:35 | 0:15:38 | |
unfortunately. So, last year, our challenge is ?2.3 million. | 0:15:38 | 0:15:42 | |
This year, we've got a new challenge ?3 million. | 0:15:42 | 0:15:45 | |
The plan is, basically, | 0:15:45 | 0:15:47 | |
for us to either deliver | 0:15:47 | 0:15:49 | |
more activity to a higher quality for the same money, | 0:15:49 | 0:15:51 | |
or to deliver the same activity to a better quality for less money. | 0:15:51 | 0:15:55 | |
I'm going to go through the plans now | 0:15:55 | 0:15:57 | |
and, sort of, let's have the honest discussion | 0:15:57 | 0:16:00 | |
around when are these likely to start? | 0:16:00 | 0:16:02 | |
Be mindful of the fact that, at some stage, | 0:16:02 | 0:16:04 | |
we may need to close beds - unless we expand the service. | 0:16:04 | 0:16:07 | |
Every year, we're asked to make more and more savings, | 0:16:07 | 0:16:10 | |
and it gets to a point where, actually, | 0:16:10 | 0:16:13 | |
there is no more meat on the bone. | 0:16:13 | 0:16:14 | |
What about seven-day working, then? | 0:16:14 | 0:16:16 | |
Where's that rolling out? | 0:16:16 | 0:16:18 | |
I think seven-day working is getting discussed | 0:16:18 | 0:16:20 | |
as part of the chest pain pathway discussions. | 0:16:20 | 0:16:23 | |
I'm hoping we don't need to do it | 0:16:23 | 0:16:24 | |
and I'm conscious that we'll all be calling on the same group of staff | 0:16:24 | 0:16:27 | |
that have already said, "We don't like working Saturdays and Sundays." | 0:16:27 | 0:16:31 | |
Seven-day working, in principle, is an excellent idea. | 0:16:31 | 0:16:35 | |
It doesn't matter what day or time you're admitted, | 0:16:35 | 0:16:39 | |
you should get the same treatment. | 0:16:39 | 0:16:41 | |
However, we cannot implement something | 0:16:41 | 0:16:43 | |
when we don't have the infrastructure to do it. | 0:16:43 | 0:16:46 | |
Is there a demand for a sixth cath lab to support growth | 0:16:46 | 0:16:51 | |
in private patient activity? | 0:16:51 | 0:16:53 | |
I'd just like it to be minuted that I am really, really nervous | 0:16:53 | 0:16:57 | |
about this sixth cath lab that seems to be rolling on. | 0:16:57 | 0:17:00 | |
It is impossible to have more cath labs than we have CCU beds. | 0:17:00 | 0:17:05 | |
It cannot happen. | 0:17:05 | 0:17:07 | |
So, at the minute, I think... | 0:17:07 | 0:17:09 | |
I think this... The bed discussion is very much a pipeline discussion. | 0:17:09 | 0:17:13 | |
What you need to do is see it in the business case, | 0:17:13 | 0:17:15 | |
which is what I intend to allow you, enable you to see. | 0:17:15 | 0:17:17 | |
PAGER BEEPS | 0:17:17 | 0:17:19 | |
Heart valves is... Terminally in eight minutes. | 0:17:19 | 0:17:21 | |
I've got a pericardial coming in with a GCS three. | 0:17:21 | 0:17:24 | |
ETA's about five minutes. | 0:17:24 | 0:17:26 | |
It is difficult - | 0:17:29 | 0:17:31 | |
and it's continuing tension on a day-to-day basis. | 0:17:31 | 0:17:34 | |
What is important from my perspective | 0:17:34 | 0:17:36 | |
is the quality of care delivered to our patients | 0:17:36 | 0:17:38 | |
and our patient safety isn't compromised in any way | 0:17:38 | 0:17:41 | |
as a consequence of any of the cost-improvement proposals. | 0:17:41 | 0:17:44 | |
As a specialist centre, in addition to treating heart attacks, | 0:17:47 | 0:17:51 | |
Hammersmith's cardiologists | 0:17:51 | 0:17:52 | |
deal with rare and complex heart conditions. | 0:17:52 | 0:17:55 | |
Sharp scratch. | 0:18:00 | 0:18:01 | |
I was...I was really, really healthy. | 0:18:06 | 0:18:08 | |
Like, at the peak of my health. | 0:18:08 | 0:18:10 | |
I was really into the gym and, like, fitness and everything. | 0:18:10 | 0:18:13 | |
We might need to keep it in, because you're having the procedure. | 0:18:13 | 0:18:17 | |
23-year-old teacher Rosa has a life-threatening infection | 0:18:17 | 0:18:21 | |
on the mitral valve of her heart called endocarditis. | 0:18:21 | 0:18:24 | |
Great, thank you. All right? That's you done. | 0:18:24 | 0:18:29 | |
Right. | 0:18:29 | 0:18:31 | |
Hello. Plan today is echo before lunch, scan this afternoon. Mm-hm. | 0:18:31 | 0:18:36 | |
She's got an infected heart valve, and that's called endocarditis. | 0:18:38 | 0:18:42 | |
It's the last thing you want to see in a young person. | 0:18:42 | 0:18:44 | |
It carries a high mortality. | 0:18:44 | 0:18:47 | |
Anywhere between 20-40%. | 0:18:47 | 0:18:49 | |
Though Rosa appears well, infected tissue from her heart is breaking | 0:18:51 | 0:18:55 | |
off and causing complications in her brain. | 0:18:55 | 0:18:59 | |
I was just, like, sending a text message | 0:18:59 | 0:19:01 | |
and then, I just suddenly couldn't... | 0:19:01 | 0:19:04 | |
couldn't type with my thumb and I was like, "This is weird," | 0:19:04 | 0:19:07 | |
and then the next day, that happened again about five times, | 0:19:07 | 0:19:09 | |
and then, the last few times, it spread to my face and I, like, | 0:19:09 | 0:19:13 | |
couldn't move the left side of my face, so I couldn't smile. | 0:19:13 | 0:19:17 | |
They called it, like, mini strokes. | 0:19:17 | 0:19:20 | |
It's so weird to just sit here and feel completely normal... | 0:19:20 | 0:19:24 | |
and have major problems in your brain, and in my heart. | 0:19:24 | 0:19:28 | |
They said, "We need to speak to you, | 0:19:30 | 0:19:33 | |
"but," you know, "not here." | 0:19:33 | 0:19:35 | |
So, we knew. We knew. | 0:19:35 | 0:19:36 | |
We knew there was something very serious. | 0:19:36 | 0:19:38 | |
Yeah, in fact they phoned us, didn't they? | 0:19:38 | 0:19:40 | |
They asked us to come in, in fact. | 0:19:40 | 0:19:42 | |
All right, love. So, I can text you when I'm back. | 0:19:42 | 0:19:44 | |
Yeah, all right, sweetheart. Well, I'll make sure that I'm back. | 0:19:44 | 0:19:46 | |
OK. It takes you right back to when she was born, somehow. | 0:19:46 | 0:19:50 | |
You sort of go back into being needed as a parent, | 0:19:50 | 0:19:54 | |
whereas we sort of got used to not really being needed! | 0:19:54 | 0:19:57 | |
No, you just have this horrible feeling in the pit of your stomach | 0:19:57 | 0:20:00 | |
that you can't shift, | 0:20:00 | 0:20:03 | |
and it will be there until they tell us that everything's OK, basically. | 0:20:03 | 0:20:07 | |
I could see the fear in her parents' eyes, | 0:20:08 | 0:20:11 | |
and I could understand that because, you know, I'm a parent myself. | 0:20:11 | 0:20:15 | |
I have a young daughter, and isn't it every parent's worst nightmare? | 0:20:15 | 0:20:18 | |
This echo's from Friday afternoon | 0:20:24 | 0:20:26 | |
when I saw her in Charing Cross. | 0:20:26 | 0:20:28 | |
There's a...there's a big blob. Any leak? | 0:20:28 | 0:20:31 | |
Yeah, it is leaking. | 0:20:31 | 0:20:32 | |
Oh, yeah. | 0:20:34 | 0:20:36 | |
Every Wednesday, senior cardiologists and heart surgeons | 0:20:36 | 0:20:39 | |
come together to discuss their most complex cases. | 0:20:39 | 0:20:43 | |
Looking to operate as early as possible, I'd have thought, to... | 0:20:43 | 0:20:46 | |
That's what we were thinking on Friday. | 0:20:46 | 0:20:48 | |
So, that's why we had so much discussions with the neurology team, | 0:20:48 | 0:20:51 | |
the stroke team and neuroradiology. | 0:20:51 | 0:20:55 | |
The valve needs surgery. | 0:20:55 | 0:20:57 | |
She needs an operation. | 0:20:57 | 0:20:59 | |
So, it's one of the most challenging things we treat, | 0:20:59 | 0:21:02 | |
because the timing of surgery is crucial. | 0:21:02 | 0:21:06 | |
If you don't get the timing of surgery right, the patient will die. | 0:21:06 | 0:21:09 | |
I saw her on Saturday. | 0:21:09 | 0:21:11 | |
I explained that we don't know either the risk of spontaneous bleed | 0:21:11 | 0:21:15 | |
or going on bypass - and before talking to her, | 0:21:15 | 0:21:18 | |
I'd spoken to the neuroradiologist, | 0:21:18 | 0:21:19 | |
who actually said there is a very high risk of spontaneous bleed. | 0:21:19 | 0:21:23 | |
So, personally, I would wait longer. Yeah. | 0:21:23 | 0:21:25 | |
They did say that they didn't think that it would preclude | 0:21:25 | 0:21:28 | |
putting someone on bypass, they have written that. | 0:21:28 | 0:21:30 | |
We're are all strong minded individuals, | 0:21:30 | 0:21:33 | |
and we don't always agree, | 0:21:33 | 0:21:35 | |
but usually we can hammer it out. | 0:21:35 | 0:21:38 | |
There is a reason to just wait and not rush, so I think... | 0:21:38 | 0:21:43 | |
Is the neuroradiology MDT in Charing Cross? | 0:21:48 | 0:21:51 | |
Yeah. Yes. Quarter to 12, I can find out where it is. | 0:21:51 | 0:21:54 | |
Today? Yeah. It would be good if I could go down, wouldn't it? | 0:21:54 | 0:21:56 | |
OK. So, we got a plan. | 0:21:56 | 0:21:58 | |
Great. Right. Who's next? | 0:21:58 | 0:22:00 | |
There is no clear right or wrong here, | 0:22:02 | 0:22:05 | |
and you have to go on clinical judgment. | 0:22:05 | 0:22:09 | |
This grey area in medicine - but at the end of the day, | 0:22:09 | 0:22:13 | |
somebody has to make a decision. | 0:22:13 | 0:22:17 | |
It hasn't really hit home yet, | 0:22:25 | 0:22:26 | |
but I know that tomorrow it's, like, surgery time. | 0:22:26 | 0:22:29 | |
28-year-old Ben is at the neurosurgery centre in Charing Cross | 0:22:29 | 0:22:34 | |
for his brain tumour operation. | 0:22:34 | 0:22:36 | |
When this first happened to me, I was 24. | 0:22:37 | 0:22:39 | |
I moved down here to train in musical theatre, | 0:22:39 | 0:22:44 | |
which I'd worked in until this happened four years ago. | 0:22:44 | 0:22:48 | |
Last time, I was having visual problems, dizzy spells, | 0:22:48 | 0:22:53 | |
a couple of seizures, which I didn't realise were seizures. | 0:22:53 | 0:22:57 | |
Basically, blurred vision, | 0:22:57 | 0:22:58 | |
so I was rushed to A and they found the mass from an MRI scan. | 0:22:58 | 0:23:03 | |
It was found to be Grade 3. | 0:23:03 | 0:23:05 | |
I lost my left peripheral vision. | 0:23:05 | 0:23:08 | |
It was all pretty horrific. | 0:23:08 | 0:23:10 | |
Giving up dancing and going to dancing auditions was hard, | 0:23:10 | 0:23:14 | |
because that was my career path, | 0:23:14 | 0:23:17 | |
and I think I went through a sort of grieving process... | 0:23:17 | 0:23:21 | |
..and now that it's happening again, it's all a bit... | 0:23:22 | 0:23:25 | |
It's like going back to four years ago, | 0:23:25 | 0:23:28 | |
like, history repeating and it's bringing everything back. | 0:23:28 | 0:23:31 | |
Seventh floor. | 0:23:32 | 0:23:34 | |
To prepare for the operation, | 0:23:36 | 0:23:38 | |
the team creates a 3D map of Ben's brain. | 0:23:38 | 0:23:41 | |
This will help Kevin pinpoint Ben's tumour during the surgery. | 0:23:48 | 0:23:52 | |
These days, as opposed to his previous surgery, four years ago, | 0:23:54 | 0:23:57 | |
we now have more tools in the box, | 0:23:57 | 0:23:59 | |
so we now have quite useful intraoperative imaging, | 0:23:59 | 0:24:03 | |
which tells us where things are, | 0:24:03 | 0:24:06 | |
despite things moving around - | 0:24:06 | 0:24:08 | |
but we are also developing new tools. | 0:24:08 | 0:24:11 | |
Ben has consented for his operation | 0:24:11 | 0:24:13 | |
to be part of a pioneering research programme | 0:24:13 | 0:24:16 | |
which aims to change the way cancer is diagnosed and treated. | 0:24:16 | 0:24:20 | |
INTERVIEWER: Do you need people to, you know, guinea pig this? | 0:24:22 | 0:24:24 | |
We don't want anybody to be a guinea pig. | 0:24:24 | 0:24:26 | |
None of us wants to be a guinea pig, | 0:24:26 | 0:24:28 | |
but I think we are now starting to make advances. | 0:24:28 | 0:24:30 | |
You know, with innovations, it's going to open up a whole new world | 0:24:30 | 0:24:34 | |
of research and potential treatment options for these patients. | 0:24:34 | 0:24:37 | |
It's literally signing your life away, isn't it? | 0:24:37 | 0:24:40 | |
No. Hope not. All right. We'll see you soon. OK, yeah, yeah. | 0:24:40 | 0:24:42 | |
Thank you very much. | 0:24:42 | 0:24:44 | |
Hello, hello. | 0:24:50 | 0:24:51 | |
How are you doing, then? | 0:24:51 | 0:24:53 | |
Erm, yeah. You've had a little bit of a shave, there. OK. | 0:24:53 | 0:24:55 | |
Did you do that or did we do that? No, I didn't do that! | 0:24:55 | 0:24:58 | |
OK. OK. Well, look, Are you happy about tomorrow? | 0:24:58 | 0:25:01 | |
Tomorrow. Yes. | 0:25:01 | 0:25:03 | |
So, what we want to do is try and get you back... Yeah. | 0:25:03 | 0:25:06 | |
..to a point where you've got very little | 0:25:06 | 0:25:08 | |
or no discernible tumour on the imaging. | 0:25:08 | 0:25:11 | |
My main concern is my visual field - | 0:25:11 | 0:25:13 | |
and I know you can't promise that it won't be affected. | 0:25:13 | 0:25:17 | |
There is a small chance that... | 0:25:17 | 0:25:18 | |
There is a small chance that that could be affected. | 0:25:18 | 0:25:21 | |
How are your visual fields? | 0:25:21 | 0:25:24 | |
So, I've got no left peripheral from the last operation... Yeah. | 0:25:24 | 0:25:27 | |
..and a tiny bit hindered in the right. | 0:25:27 | 0:25:30 | |
Look me straight in the left eye and tell me when you can see my finger | 0:25:30 | 0:25:32 | |
coming, and I'll do the same. Can you see it coming in? Tell me. | 0:25:32 | 0:25:35 | |
Now. OK. I can see this way out here. | 0:25:35 | 0:25:37 | |
You can't see it till we get to... No, now. ..the midline. | 0:25:37 | 0:25:39 | |
You've got some deficit up there, but it's maybe the lower quadrant, | 0:25:39 | 0:25:42 | |
isn't it, on that left? Yeah. Is...? Yeah. We can't guarantee... | 0:25:42 | 0:25:46 | |
The vicinity that it's in is close | 0:25:46 | 0:25:48 | |
to where the connections from the eyeball | 0:25:48 | 0:25:51 | |
to where the brain perceives vision. Yeah, yeah. | 0:25:51 | 0:25:54 | |
Those radiations, it's... | 0:25:54 | 0:25:56 | |
They're going around that and have been stretched by that, | 0:25:56 | 0:25:58 | |
and they have been interfered with. | 0:25:58 | 0:26:00 | |
Obviously, every surgery we do... Yeah. ..has a certain risk to it. | 0:26:00 | 0:26:03 | |
I wish they'd do surgery sooner, | 0:26:19 | 0:26:20 | |
because I'm just sat here thinking at any point some of this infection | 0:26:20 | 0:26:24 | |
could come off again and cause another aneurysm. | 0:26:24 | 0:26:27 | |
What if an aneurysm happens in my brain and I'll just die? | 0:26:27 | 0:26:31 | |
23-year-old Rosa needs an operation to remove infected tissue | 0:26:31 | 0:26:35 | |
from her heart valve. | 0:26:35 | 0:26:37 | |
Due to complications in her brain, | 0:26:37 | 0:26:39 | |
the team must first decide if it's safe to go ahead. | 0:26:39 | 0:26:43 | |
Obviously, there is a risk of stroke for Rosa having surgery. | 0:26:43 | 0:26:46 | |
We are not risk averse, | 0:26:46 | 0:26:48 | |
but the right decision about timing is fundamental. | 0:26:48 | 0:26:51 | |
I went down to the neuro MDT in Charing Cross. | 0:26:53 | 0:26:56 | |
Her recent imaging from Tuesday hasn't changed, | 0:26:56 | 0:27:01 | |
and, actually, their concern over bleeding risk has gone down, | 0:27:01 | 0:27:05 | |
substantially, and they felt if she needed surgery, | 0:27:05 | 0:27:08 | |
from our point of view - we should just go ahead. | 0:27:08 | 0:27:11 | |
So, we were going to repeat the CTA brain on Tuesday, | 0:27:11 | 0:27:16 | |
and the transthoracic echo and we'll come back. | 0:27:16 | 0:27:19 | |
She's responding to antibiotics. She is. I think she is. | 0:27:19 | 0:27:22 | |
Yeah, yeah, yeah - | 0:27:24 | 0:27:26 | |
but if things change on Tuesday and it looks worse, we just regroup. | 0:27:26 | 0:27:30 | |
Good. | 0:27:33 | 0:27:34 | |
There are so many consultants involved with the decision, | 0:27:35 | 0:27:38 | |
but, eventually, there will be one name next to her bed | 0:27:38 | 0:27:41 | |
that is the name of the surgeon that operates on her, | 0:27:41 | 0:27:43 | |
and if things go well, it will be a great team effort. | 0:27:43 | 0:27:48 | |
If things don't go well, obviously, | 0:27:48 | 0:27:51 | |
the surgeon will be the first name to be on the spot. | 0:27:51 | 0:27:54 | |
You are a popular young woman. | 0:27:56 | 0:27:58 | |
So, we have talked and talked and talked. Yeah. | 0:27:58 | 0:28:02 | |
You have several small aneurysms in your brain. | 0:28:02 | 0:28:06 | |
These aneurysms are caused by infected material breaking off, | 0:28:06 | 0:28:11 | |
going up to the brain, | 0:28:11 | 0:28:12 | |
and it burrows through the wall of the artery. | 0:28:12 | 0:28:15 | |
So, I don't think we know yet when to operate. | 0:28:15 | 0:28:18 | |
I don't think we can decide now. | 0:28:20 | 0:28:22 | |
But, you know, know this - | 0:28:22 | 0:28:23 | |
we are not going to put you through surgery... | 0:28:23 | 0:28:26 | |
..that's going to cause you risk if we don't have to. Yeah. Yeah. | 0:28:27 | 0:28:31 | |
I'm just worried that with leaving it that, like... | 0:28:31 | 0:28:33 | |
I don't want any more aneurysms, especially in my brain. | 0:28:33 | 0:28:36 | |
But no new ones have formed. Yeah. Remember that. | 0:28:36 | 0:28:38 | |
OK. So, it's just a waiting game, in a way. Yeah. | 0:28:38 | 0:28:43 | |
OK, bye. | 0:28:47 | 0:28:48 | |
70-year-old retired railway worker Chhotalal | 0:29:04 | 0:29:07 | |
is waiting for an angioplasty | 0:29:07 | 0:29:09 | |
after arriving at the HAC complaining of chest pains. | 0:29:09 | 0:29:13 | |
My dad, he had a heart attack in January. | 0:29:13 | 0:29:16 | |
Over the weekend, he was just having a few pains | 0:29:16 | 0:29:18 | |
and, again, he wasn't saying exactly what was going on. | 0:29:18 | 0:29:21 | |
Because he was saying before it was indigestion, | 0:29:21 | 0:29:23 | |
and it wasn't indigestion, it was actually having a heart attack. | 0:29:23 | 0:29:27 | |
You just don't know when it comes to the heart, and men, especially, | 0:29:27 | 0:29:31 | |
don't like to admit that they might be dying, possibly. Yeah. | 0:29:31 | 0:29:35 | |
When did you come in here? | 0:29:35 | 0:29:38 | |
Yesterday, I came on the Tuesday. | 0:29:38 | 0:29:41 | |
And I've been kept prisoner since then. | 0:29:41 | 0:29:45 | |
So this lady is a PCI, to come into mine. | 0:29:45 | 0:29:48 | |
And this chap is the chap on HAC. | 0:29:48 | 0:29:51 | |
We've had a very busy night. | 0:29:51 | 0:29:53 | |
We've got lots of inpatients that need procedures, | 0:29:53 | 0:29:56 | |
we've got a busy elective list, | 0:29:56 | 0:29:59 | |
and we are going to get more admissions | 0:29:59 | 0:30:00 | |
and we are going to get more primaries. | 0:30:00 | 0:30:03 | |
Right, so what have we got now next? | 0:30:03 | 0:30:06 | |
So this is our... | 0:30:06 | 0:30:09 | |
Primary. Can we go through this case? | 0:30:09 | 0:30:11 | |
So, 70-year-old came in as a primary call. | 0:30:11 | 0:30:15 | |
Hypertensive, hypergastrinemia. | 0:30:15 | 0:30:17 | |
Just one stent. | 0:30:17 | 0:30:20 | |
Was rotablated, arm was heavily calcified. | 0:30:20 | 0:30:22 | |
He's under the care of consultant cardiologist Ghada Mikhail. | 0:30:23 | 0:30:29 | |
So we need to check the LAD first, don't we? | 0:30:29 | 0:30:32 | |
He has got ongoing chest pain | 0:30:32 | 0:30:34 | |
and he's got some disease left in the other arteries, | 0:30:34 | 0:30:37 | |
so that's what we're going to treat. | 0:30:37 | 0:30:40 | |
What we are seeing is increasingly patients with more complex coronary | 0:30:40 | 0:30:44 | |
disease. When I started training, we had what we call type A lesions, | 0:30:44 | 0:30:48 | |
very simple coronary disease. You put a balloon and a stent. | 0:30:48 | 0:30:51 | |
Now patients are living longer, they're getting older, | 0:30:51 | 0:30:54 | |
the disease is more complex. | 0:30:54 | 0:30:56 | |
Their arteries are calcified and hardened, | 0:30:56 | 0:30:58 | |
which can make angioplasty more complex. | 0:30:58 | 0:31:00 | |
BEEPING | 0:31:00 | 0:31:02 | |
I got a call from LAS about a gentleman - | 0:31:11 | 0:31:13 | |
and he's arrested in the community. | 0:31:13 | 0:31:15 | |
Downtown is five minutes. | 0:31:15 | 0:31:16 | |
He's on his way? He's on his way. | 0:31:16 | 0:31:18 | |
They're going to put a call out shortly. | 0:31:18 | 0:31:19 | |
So, you know what, we can't start this case now. | 0:31:19 | 0:31:23 | |
He's nearby. Let's talk to him, let's talk to him. | 0:31:23 | 0:31:25 | |
Hello. How are you? | 0:31:33 | 0:31:36 | |
OK. Listen, I don't have very good news at the moment. | 0:31:36 | 0:31:39 | |
We were about to start your procedure, | 0:31:39 | 0:31:41 | |
but we've just had an emergency call of a patient who's really unwell. | 0:31:41 | 0:31:46 | |
They're first. Quite good. | 0:31:46 | 0:31:48 | |
We just need to get the other patient done. | 0:31:48 | 0:31:50 | |
I'm really sorry about that. | 0:31:50 | 0:31:51 | |
It doesn't matter. I've got ten years to go. | 0:31:51 | 0:31:52 | |
Ha-ha! Fantastic, thank you so much. | 0:31:52 | 0:31:56 | |
OK, there's a cardiac arrest coming in. | 0:31:56 | 0:31:58 | |
We really don't like to do that type of thing, | 0:31:58 | 0:32:01 | |
but the other cath labs are being used. | 0:32:01 | 0:32:03 | |
This is a patient coming in in a cardiac arrest situation. | 0:32:03 | 0:32:07 | |
He's stable, so he can afford to wait, compared to the other patient. | 0:32:07 | 0:32:14 | |
I'm really sorry about that. | 0:32:14 | 0:32:15 | |
Any family, any family? | 0:32:18 | 0:32:21 | |
Hello. Just tell us what's going on. | 0:32:21 | 0:32:24 | |
Tell us, OK. Are you ready for a handover? Yes, please. | 0:32:24 | 0:32:27 | |
Just one second, sorry. | 0:32:27 | 0:32:29 | |
If he's got an output, we should take him to the lab, yeah? | 0:32:29 | 0:32:32 | |
Every day is unpredictable. | 0:32:39 | 0:32:41 | |
You plan for the day, but you could have a lot of emergencies | 0:32:41 | 0:32:44 | |
one after the other in one day, | 0:32:44 | 0:32:46 | |
or it could be a day where you have a couple of emergencies | 0:32:46 | 0:32:49 | |
and manage to get all the elective cases done. | 0:32:49 | 0:32:51 | |
Do you expect to be seen today? | 0:32:57 | 0:32:59 | |
I don't want to impose nothing. | 0:32:59 | 0:33:02 | |
I'm quite patient, because I'm retired. | 0:33:02 | 0:33:04 | |
What the hell am I going to rush it for? | 0:33:04 | 0:33:07 | |
I rushed enough for more than 50 years in the jobs I've done, so... | 0:33:07 | 0:33:12 | |
How are you feeling at the moment? | 0:33:12 | 0:33:14 | |
Oh, fine. Just as good as you. | 0:33:14 | 0:33:16 | |
It's just that the inside is not happy. | 0:33:16 | 0:33:18 | |
BEEPING | 0:33:19 | 0:33:21 | |
All right. | 0:33:21 | 0:33:22 | |
So this is another one. So it's going to be crazy today. | 0:33:22 | 0:33:25 | |
That is exactly how it happens. | 0:33:29 | 0:33:32 | |
You can be pootling along and then within sort of ten, 15 minutes | 0:33:32 | 0:33:36 | |
you've got two patients coming in. | 0:33:36 | 0:33:38 | |
I feel like I'm healthy enough to walk. | 0:33:57 | 0:34:00 | |
I'm going in for this major surgery, | 0:34:03 | 0:34:06 | |
but I feel fine, and it's really weird. | 0:34:06 | 0:34:08 | |
Last time, I was having seizures and a few blackouts. | 0:34:08 | 0:34:12 | |
I was on high medications, I was feeling like shit. | 0:34:12 | 0:34:15 | |
But this time, I'm feeling really fine, so it doesn't feel right | 0:34:15 | 0:34:19 | |
for me to be having surgery this morning. | 0:34:19 | 0:34:21 | |
It's the day of Ben's operation to remove his brain tumour. | 0:34:22 | 0:34:26 | |
Do we come up? No. No? OK, all right. | 0:34:29 | 0:34:32 | |
His family is here from Huddersfield to support him. | 0:34:32 | 0:34:36 | |
See you in a bit. See you in a bit. | 0:34:36 | 0:34:38 | |
It's just mixed emotions, you know. | 0:34:38 | 0:34:40 | |
You try to be positive for him and reassure him and everything, | 0:34:40 | 0:34:43 | |
but it's a bit surreal. | 0:34:43 | 0:34:45 | |
You just kind of... Can't imagine it. | 0:34:45 | 0:34:50 | |
Couldn't imagine it for myself. | 0:34:50 | 0:34:51 | |
What you want is it to be you. | 0:34:51 | 0:34:55 | |
You want it to be you, not him, | 0:34:55 | 0:34:57 | |
and that's the feeling I had, that it should have been me, not him. | 0:34:57 | 0:35:00 | |
Now, we're here today and he's having it done, | 0:35:02 | 0:35:04 | |
he's going through it all again and... It's just... | 0:35:04 | 0:35:09 | |
Well, he's going to come through it and he's going to be fine. | 0:35:09 | 0:35:12 | |
He's got loads of years ahead of him. | 0:35:12 | 0:35:15 | |
He's still got a lot to do in life. He's still got aims. | 0:35:15 | 0:35:19 | |
Oh, God, yeah. Always. Yeah. | 0:35:19 | 0:35:22 | |
We've created a three-dimensional image volume of Ben. | 0:35:27 | 0:35:31 | |
You can recognise that's Ben. These are the reference points, | 0:35:31 | 0:35:34 | |
these little markers we've put on his head, | 0:35:34 | 0:35:35 | |
which we use as reference points to correlate this virtual image | 0:35:35 | 0:35:40 | |
to the real Ben. | 0:35:40 | 0:35:42 | |
We can peel away the surface | 0:35:42 | 0:35:44 | |
and look at all the blood vessels that you need to avoid. | 0:35:44 | 0:35:49 | |
Years ago, without this sort of equipment, | 0:35:49 | 0:35:52 | |
it would be a lot harder. | 0:35:52 | 0:35:54 | |
I remember the days of putting a CT scan up | 0:35:54 | 0:35:57 | |
and marking on those lines where the tumour was | 0:35:57 | 0:36:00 | |
on the scout image to see where we would make our craniotomy. | 0:36:00 | 0:36:03 | |
We'd just had to hold it up and stand back | 0:36:03 | 0:36:06 | |
and look at the image on the wall. | 0:36:06 | 0:36:09 | |
Now, look where we are now. | 0:36:09 | 0:36:11 | |
You can see I'm pointing to this fiducial. | 0:36:12 | 0:36:17 | |
That machine is telling me where I'm pointing. | 0:36:17 | 0:36:19 | |
It even shows you my probe, look. | 0:36:19 | 0:36:22 | |
Beautiful. | 0:36:22 | 0:36:24 | |
During the operation, Ben could lose more of his peripheral vision. | 0:36:24 | 0:36:28 | |
There's also a risk of loss of sensation in his left side | 0:36:28 | 0:36:32 | |
and paralysis. | 0:36:32 | 0:36:34 | |
It's really that bit that we want take out, there. | 0:36:34 | 0:36:36 | |
Ultrasound probes will carry out live brain imaging, | 0:36:38 | 0:36:42 | |
guiding Kevin along the 3D map of Ben's brain, | 0:36:42 | 0:36:45 | |
helping him safely remove as much tumour as possible. | 0:36:45 | 0:36:48 | |
On the left-hand screen, you see the grey of the MRI, | 0:36:48 | 0:36:51 | |
and then on the ultrasound | 0:36:51 | 0:36:53 | |
you can see that bright signal in the cavity. Very clear cavity. | 0:36:53 | 0:36:57 | |
I can actually see it. There's the tumour there, look. | 0:36:57 | 0:37:01 | |
You can actually see it with your naked eye. | 0:37:01 | 0:37:04 | |
Amazing. | 0:37:04 | 0:37:06 | |
OK, so we've got to try and get that out. | 0:37:06 | 0:37:08 | |
That's Ben. | 0:37:08 | 0:37:10 | |
Emma. And that's Molly. | 0:37:10 | 0:37:11 | |
Yeah, happy-go-lucky. Yeah, always... | 0:37:13 | 0:37:15 | |
Bit bossy towards the other two. | 0:37:15 | 0:37:16 | |
Yeah, bossy. Always liked to have people around him. | 0:37:16 | 0:37:19 | |
His main thing were musical theatre. | 0:37:19 | 0:37:22 | |
He wanted to be in the West End. | 0:37:22 | 0:37:24 | |
Yeah, he wanted to be there. That was his dream. Yeah. | 0:37:24 | 0:37:28 | |
I just hope from today that they can do what they need to do to get | 0:37:28 | 0:37:32 | |
all the cancer out, all the tumour. | 0:37:32 | 0:37:35 | |
So he can move on, then, with his life. | 0:37:35 | 0:37:37 | |
Ben has agreed to be part of a research programme | 0:37:39 | 0:37:42 | |
testing a new diagnostic tool, the iKnife, | 0:37:42 | 0:37:44 | |
which is being pioneered at Imperial. | 0:37:44 | 0:37:47 | |
This is the iKnife, so you take tissue, you turn it on, | 0:37:48 | 0:37:52 | |
and it buzzes the tissue, coagulates it. | 0:37:52 | 0:37:54 | |
And you get some smoke being produced, | 0:37:54 | 0:37:56 | |
which then gets sucked up into this tube, | 0:37:56 | 0:37:59 | |
and that tube then goes into that machine. | 0:37:59 | 0:38:02 | |
And it tells you what the molecular make-up of that vapour is. | 0:38:02 | 0:38:05 | |
I'm going to get some iKnife samples here | 0:38:07 | 0:38:09 | |
and then at the boundary... So shall I take an iKnife sample? | 0:38:09 | 0:38:13 | |
As the iKnife heats and cuts the tissue, | 0:38:13 | 0:38:16 | |
it generates so-called surgical smoke. | 0:38:16 | 0:38:20 | |
It's basically like a sniffer knife. | 0:38:20 | 0:38:21 | |
It's smelling the vapour coming off the tumour. | 0:38:21 | 0:38:24 | |
Got something? OK, good. | 0:38:24 | 0:38:28 | |
Healthy tissue gives off a different molecular signature | 0:38:28 | 0:38:30 | |
to cancerous tissue. | 0:38:30 | 0:38:32 | |
The iKnife analyses the smoke | 0:38:32 | 0:38:34 | |
and transfers the data to its computer. | 0:38:34 | 0:38:37 | |
We've got a very, very early model, which is not... | 0:38:38 | 0:38:41 | |
We don't have a huge amount of data. | 0:38:41 | 0:38:44 | |
Usually, if you were going to have a robust database, | 0:38:44 | 0:38:46 | |
you would want thousands, | 0:38:46 | 0:38:49 | |
even tens of thousands, of bits of information to build it on. | 0:38:49 | 0:38:52 | |
So it is very early days. | 0:38:52 | 0:38:55 | |
The iKnife can already identify | 0:38:56 | 0:38:58 | |
the margin between healthy tissue and a number of different cancers, | 0:38:58 | 0:39:02 | |
but it's still in the training phase for brain tumours. | 0:39:02 | 0:39:05 | |
The thing about this is that it's bringing the lab into surgery, | 0:39:07 | 0:39:10 | |
giving us information very quickly. Maybe, possibly, in the future, | 0:39:10 | 0:39:13 | |
we'll have treatments that we can give locally as we're operating, | 0:39:13 | 0:39:16 | |
rather than then having to be closed up | 0:39:16 | 0:39:17 | |
and then wait for post-op chemotherapy and radiotherapy, | 0:39:17 | 0:39:20 | |
we can actually start giving treatments instantly | 0:39:20 | 0:39:23 | |
alongside surgery. | 0:39:23 | 0:39:24 | |
Perhaps, if we're lucky, | 0:39:24 | 0:39:27 | |
it'll give us some answers to a potential cure. | 0:39:27 | 0:39:30 | |
Let's see. Let's see. | 0:39:30 | 0:39:32 | |
I know you can see the tumour, and I am just now | 0:39:32 | 0:39:35 | |
pulling it away from more normal looking brain. | 0:39:35 | 0:39:37 | |
But it looks kind of greyish | 0:39:37 | 0:39:39 | |
and potentially a little bit more aggressive than it perhaps was. | 0:39:39 | 0:39:43 | |
So what I'm going to do is reset now. | 0:39:43 | 0:39:45 | |
Tumour. | 0:39:50 | 0:39:51 | |
Ben's tumour is sent to a lab, | 0:39:54 | 0:39:56 | |
where pathologists will determine | 0:39:56 | 0:39:58 | |
if it's more aggressive than his original cancer. | 0:39:58 | 0:40:00 | |
It'll be two weeks before he gets the results. | 0:40:03 | 0:40:05 | |
That tumour that was down there is all gone. | 0:40:08 | 0:40:10 | |
If this turns out to be slightly more aggressive, | 0:40:12 | 0:40:15 | |
then it was the best thing we could have done. | 0:40:15 | 0:40:17 | |
Right. | 0:40:19 | 0:40:22 | |
Good. | 0:40:22 | 0:40:23 | |
Want to check your temperature. | 0:40:38 | 0:40:39 | |
There was an emergency, they couldn't do it for me, | 0:40:39 | 0:40:42 | |
so I stayed all night long. | 0:40:42 | 0:40:43 | |
I couldn't say nothing. | 0:40:43 | 0:40:45 | |
Somebody might be in more dire trouble so... | 0:40:45 | 0:40:50 | |
I'm OK, I wasn't bad. | 0:40:50 | 0:40:51 | |
I wasn't feeling that bad anyway. | 0:40:51 | 0:40:53 | |
70-year-old Chhotalal | 0:40:53 | 0:40:55 | |
had his angioplasty cancelled yesterday | 0:40:55 | 0:40:58 | |
due to an emergency admission. | 0:40:58 | 0:40:59 | |
He's spent the night on the busy HAC Ward. | 0:41:01 | 0:41:05 | |
Current bed state is we're nearly at full capacity at the moment. | 0:41:05 | 0:41:09 | |
As it stands, if we have a primary come in that goes to the lab | 0:41:11 | 0:41:14 | |
and needs to go to the coronary care unit, | 0:41:14 | 0:41:16 | |
we don't have a bed to put them in. | 0:41:16 | 0:41:18 | |
How do you feel about that? | 0:41:21 | 0:41:23 | |
It makes me nervous. We are the primary service. | 0:41:23 | 0:41:26 | |
So anyone having a heart attack within north-west London | 0:41:26 | 0:41:30 | |
will come here via LAS. | 0:41:30 | 0:41:32 | |
I've got to do this because he's on HAC. | 0:41:32 | 0:41:34 | |
It needs to be done. | 0:41:34 | 0:41:36 | |
Yeah, no, do him... and then two coronaries. | 0:41:36 | 0:41:38 | |
And then whoever takes the other one with the pacemaker. Yeah? OK. | 0:41:38 | 0:41:41 | |
He got admitted with chest pain and he's been cancelled once. | 0:41:41 | 0:41:46 | |
So he needs to be done. | 0:41:46 | 0:41:49 | |
He wasn't on the elective list, he's come in with symptoms. | 0:41:49 | 0:41:52 | |
So you can't cancel him again | 0:41:52 | 0:41:54 | |
because patients can become unstable at any time. | 0:41:54 | 0:41:57 | |
Comfortable? | 0:42:00 | 0:42:02 | |
All right, happy for me to carry on? | 0:42:02 | 0:42:04 | |
Good. | 0:42:04 | 0:42:05 | |
This is Chhotalal's second angioplasty in three months. | 0:42:07 | 0:42:12 | |
Take a gentle breath in for me, gentle breath in. | 0:42:12 | 0:42:16 | |
So this is a very small balloon | 0:42:16 | 0:42:19 | |
that we're just going to use to inflate the narrowing. | 0:42:19 | 0:42:23 | |
Stents are inserted into his arteries | 0:42:24 | 0:42:26 | |
in an attempt to prevent him having another heart attack. | 0:42:26 | 0:42:29 | |
I'll try and crack that artery open. | 0:42:32 | 0:42:34 | |
Two, four, six, eight, ten. | 0:42:34 | 0:42:37 | |
BEEPING | 0:42:37 | 0:42:38 | |
That's better, and down. | 0:42:38 | 0:42:41 | |
Narrowing was quite resistant to cracking, | 0:42:41 | 0:42:43 | |
a lot of chalk in it, and calcium, | 0:42:43 | 0:42:45 | |
but with a small balloon, it's managed to crack it open. | 0:42:45 | 0:42:48 | |
How do you feel about the future of the HAC, with the current NHS cuts? | 0:42:48 | 0:42:53 | |
It's actually very frustrating and really quite depressing. | 0:42:53 | 0:42:56 | |
As a cardiologist, you want to do more for your patients. | 0:42:56 | 0:42:59 | |
But, you know, we're getting busier and busier, day by day, actually. | 0:42:59 | 0:43:03 | |
And the staff are extremely stretched, | 0:43:03 | 0:43:05 | |
but we have to keep going. Because you can't just walk out. | 0:43:05 | 0:43:08 | |
Fantastic. We're all done here. OK. | 0:43:11 | 0:43:14 | |
Good, all done. | 0:43:15 | 0:43:16 | |
All right? You all right? Yeah, it was very nice. You a bit emotional? | 0:43:16 | 0:43:20 | |
The benefit of having a centralised system for heart attacks | 0:43:20 | 0:43:23 | |
is well-proven. But the NHS is cost-constrained, | 0:43:23 | 0:43:27 | |
I think what's going to happen is that the emergency services, | 0:43:27 | 0:43:30 | |
as ever with the NHS, are going to be fantastic. | 0:43:30 | 0:43:33 | |
What might take the hit is the elective patients, | 0:43:33 | 0:43:36 | |
so when you're not acutely acutely unwell, you're going to wait longer. | 0:43:36 | 0:43:39 | |
And that is a reality of the modern NHS. | 0:43:39 | 0:43:42 | |
I is brand-new. | 0:43:57 | 0:43:59 | |
It feels like my life has just been put on hold. | 0:44:03 | 0:44:06 | |
Rosa is still waiting for major heart surgery | 0:44:06 | 0:44:09 | |
to remove infected tissue from her mitral valve, | 0:44:09 | 0:44:13 | |
but her brain aneurysms need to heal before it's safe to operate. | 0:44:13 | 0:44:17 | |
If I think about it too much, I'll just be, like, scared and miserable. | 0:44:17 | 0:44:21 | |
I think that's been one of the hardest things for her. | 0:44:28 | 0:44:30 | |
She looks around the ward, | 0:44:30 | 0:44:32 | |
and most people on the ward are kind of 60s, 70s, 80s. | 0:44:32 | 0:44:38 | |
And she... And that causes you to think a bit more, "Why me?" | 0:44:38 | 0:44:42 | |
I think the injustice of it all has got to her a bit. | 0:44:42 | 0:44:46 | |
Hi. Amrish, hi. Hi, Susan. | 0:44:49 | 0:44:53 | |
So, Rosa, the last time we spoke at the Neuro MDT, | 0:44:53 | 0:44:57 | |
we were down to one with a whiff of a second. Correct. | 0:44:57 | 0:45:01 | |
So there's just... A hint. | 0:45:01 | 0:45:03 | |
Only because you know that there was something there. | 0:45:03 | 0:45:05 | |
Had I not known, if I didn't have any of these, | 0:45:05 | 0:45:07 | |
I would have called this completely fine. | 0:45:07 | 0:45:09 | |
Oh. And the right frontal one is really inconspicuous, actually, | 0:45:09 | 0:45:12 | |
at this stage. That is just great news. | 0:45:12 | 0:45:14 | |
And I don't believe that there are any other new... | 0:45:14 | 0:45:18 | |
Lesions. ..lesions or septic foci, which I can't see on here. | 0:45:18 | 0:45:23 | |
This is a great result, isn't it? Yeah. Thanks very much. | 0:45:23 | 0:45:27 | |
No probs, thank you. All right. | 0:45:27 | 0:45:29 | |
Well, a lot happier. | 0:45:29 | 0:45:32 | |
Even to me, I'm a cardiologist, I can't read brain scans, | 0:45:32 | 0:45:34 | |
but even I can see that that looks a lot better. | 0:45:34 | 0:45:37 | |
Hello. Hello. Hi. | 0:45:41 | 0:45:44 | |
We had a look at your brain scan | 0:45:45 | 0:45:47 | |
and the brain scan looks a lot better. | 0:45:47 | 0:45:49 | |
In fact, if you weren't looking for it, | 0:45:49 | 0:45:51 | |
you probably wouldn't even see it. | 0:45:51 | 0:45:53 | |
This is a good outcome. | 0:45:53 | 0:45:55 | |
It doesn't mean the risk of bleeding is zero, | 0:45:55 | 0:45:59 | |
but I think it's as low as we're going to get. | 0:45:59 | 0:46:02 | |
So there's a window here, Rosa, and I think we're in it. Yeah, yeah. | 0:46:02 | 0:46:07 | |
But she's in good hands. | 0:46:07 | 0:46:09 | |
Yes. Oh, yeah. Yeah. Thank you. | 0:46:09 | 0:46:12 | |
I hope I'll get some sleep. I don't know if I will. | 0:46:15 | 0:46:18 | |
Hi, there. Hello. | 0:46:40 | 0:46:42 | |
How are you doing? You OK? | 0:46:42 | 0:46:45 | |
Yeah. Relief. Relief it's all over? | 0:46:45 | 0:46:48 | |
Feeling OK? I'm just relieved that my vision is here still. | 0:46:48 | 0:46:52 | |
Good. Still got your vision, yeah. | 0:46:52 | 0:46:58 | |
I was, I was, I was very worried | 0:46:58 | 0:46:59 | |
that I would wake up with no vision or less vision... | 0:46:59 | 0:47:03 | |
I just had nightmares that I would wake up to, or not wake up, | 0:47:03 | 0:47:07 | |
or have blackness... Yeah. | 0:47:07 | 0:47:09 | |
If I'm honest... It's a big relief, isn't it? | 0:47:09 | 0:47:12 | |
I'm sorry, I don't really know what to say. Don't worry. | 0:47:12 | 0:47:16 | |
You're going to have a bad headache because we took some pressure off | 0:47:16 | 0:47:19 | |
so it's going to be like the worst hangover you've had. | 0:47:19 | 0:47:22 | |
Very difficult. Of course it was, no. You've done really well. | 0:47:22 | 0:47:26 | |
You know, you couldn't almost see the tumour with the naked eye, | 0:47:26 | 0:47:29 | |
but we just confirmed it with everything | 0:47:29 | 0:47:31 | |
and it all correlated, and it's all gone. Oh! | 0:47:31 | 0:47:35 | |
What? Yeah. You've got it all out? Yeah, pretty much. | 0:47:35 | 0:47:37 | |
Oh, wow. Very happy. | 0:47:37 | 0:47:40 | |
OK? So you can relax now. Thank you. | 0:47:40 | 0:47:42 | |
You can relax. | 0:47:42 | 0:47:44 | |
OK? Wow. Thank you, thank you very, very, very, very, very, very much. | 0:47:44 | 0:47:48 | |
No problem. I'll see you later. | 0:47:48 | 0:47:50 | |
If anyone wants to ask what relief feels like, get into my body now. | 0:47:50 | 0:47:55 | |
OK. I'm going to have to go back to the next operation now. | 0:47:55 | 0:47:57 | |
Thank you. Good luck. See you. Thank you, well done, thank you. | 0:47:57 | 0:48:00 | |
He's had all that technology thrown at him | 0:48:00 | 0:48:02 | |
and he's come out the other side really well. So he will benefit, | 0:48:02 | 0:48:06 | |
but the real benefit will come for patients in the future, | 0:48:06 | 0:48:09 | |
when that technology is really well-developed and validated. | 0:48:09 | 0:48:14 | |
But without patients like Ben | 0:48:14 | 0:48:16 | |
who are willing to donate their tumour for analysis, | 0:48:16 | 0:48:19 | |
we're not going to make those steps forward. | 0:48:19 | 0:48:21 | |
This morning, we have got a big case. This young lady, Rosa. | 0:48:32 | 0:48:38 | |
You take care. | 0:48:38 | 0:48:41 | |
Up until now she's been incredibly lucky, really, health-wise. | 0:48:52 | 0:48:56 | |
In every regard. | 0:48:56 | 0:48:58 | |
She's very lucky to have landed in this hospital | 0:49:02 | 0:49:06 | |
with the right expertise. | 0:49:06 | 0:49:08 | |
I can't thank them enough. No, they've been brilliant. | 0:49:09 | 0:49:12 | |
Knife, please. | 0:49:15 | 0:49:17 | |
So we make an incision, | 0:49:17 | 0:49:20 | |
then we go underneath the breast | 0:49:20 | 0:49:22 | |
and we enter the chest in the fourth intercostal space. | 0:49:22 | 0:49:28 | |
Roberto is one of the only heart surgeons in the country | 0:49:28 | 0:49:31 | |
who performs this operation | 0:49:31 | 0:49:33 | |
using a minimally invasive technique without breaking the breast bone. | 0:49:33 | 0:49:37 | |
A traditional incision would be from here, the end of the bone, | 0:49:37 | 0:49:40 | |
to the beginning of the bone, so will cover all this | 0:49:40 | 0:49:43 | |
and will spread apart and then open it like this. | 0:49:43 | 0:49:46 | |
Only the noise makes me feel a little bit uneasy. | 0:49:46 | 0:49:48 | |
SQUEAKING | 0:49:48 | 0:49:49 | |
It looks like a Spanish Inquisition sort of tool. | 0:49:49 | 0:49:53 | |
I'm opening the pericardium, which is the sac around the heart. | 0:49:53 | 0:49:59 | |
You know, this is the heart. | 0:49:59 | 0:50:02 | |
The pericardium, the heart. | 0:50:02 | 0:50:04 | |
In order to operate on her mitral valve, | 0:50:04 | 0:50:07 | |
Rosa's heart must be stopped. | 0:50:07 | 0:50:09 | |
You happy there? Yes, we've got good line pressure. | 0:50:09 | 0:50:12 | |
First, her blood is diverted through a bypass machine | 0:50:12 | 0:50:16 | |
that takes over the work of her heart and lungs. | 0:50:16 | 0:50:18 | |
Full flow. Yes, that's full flow there. | 0:50:21 | 0:50:24 | |
Next, a solution of potassium slows then finally stops Rosa's heart. | 0:50:24 | 0:50:29 | |
Once it stops, the ECG will be flat. | 0:50:31 | 0:50:33 | |
We can work safely for an hour. | 0:50:36 | 0:50:38 | |
OK. Now I'm going to open the left atrium. | 0:50:38 | 0:50:42 | |
You see, there is a lot of blood here. | 0:50:42 | 0:50:43 | |
Within minutes, Rosa's heart valve is exposed. | 0:50:45 | 0:50:48 | |
It's not just the vegetation, there's a perforation in the valve. | 0:50:48 | 0:50:52 | |
Can you see the hole where I am putting my instrument, | 0:50:52 | 0:50:55 | |
but most of all, it's not just a hole. | 0:50:55 | 0:50:56 | |
All the valve here is so thin with infection, | 0:50:56 | 0:50:59 | |
it has to come out. | 0:50:59 | 0:51:01 | |
We can't compromise on this. | 0:51:01 | 0:51:02 | |
OK, one bit is coming off on its own. | 0:51:07 | 0:51:09 | |
At the moment, I just took out the infected part of the valve. | 0:51:10 | 0:51:14 | |
So I think that the amount of valve tissue left | 0:51:14 | 0:51:17 | |
is still good enough, with some work, for us to fix it. | 0:51:17 | 0:51:22 | |
That is really the best scenario. | 0:51:22 | 0:51:24 | |
Until I saw the valve, I didn't know we were going to be able to do it. | 0:51:24 | 0:51:26 | |
Can I have some water to test it? | 0:51:26 | 0:51:28 | |
In a patient like Rosa, who could have a life expectancy | 0:51:30 | 0:51:34 | |
of many, many decades, so is a long-term result. | 0:51:34 | 0:51:39 | |
Suction. Now we've got a pretty happy valve. | 0:51:39 | 0:51:44 | |
Can you see this, what we call the smiley face, yeah? | 0:51:44 | 0:51:47 | |
Once I'm out of here and we finish, | 0:51:47 | 0:51:50 | |
closing this incision will take five minutes. | 0:51:50 | 0:51:54 | |
So this minimally invasive technique has been proven | 0:51:54 | 0:51:57 | |
to let the patient recover much faster. | 0:51:57 | 0:52:00 | |
They are likely to be in hospital possibly two days less | 0:52:00 | 0:52:03 | |
than the normal traditional operation. | 0:52:03 | 0:52:06 | |
And so we're saving a lot of taxpayer money. | 0:52:06 | 0:52:09 | |
Now turn the red on, gently. | 0:52:09 | 0:52:12 | |
With her valve repaired, Rosa's heart is restarted. | 0:52:14 | 0:52:17 | |
Now let's have the facing. | 0:52:19 | 0:52:21 | |
The heart has been still for an hour, | 0:52:21 | 0:52:23 | |
so it is regaining its own rhythm which is becoming better and better, | 0:52:23 | 0:52:27 | |
now it's silence. | 0:52:27 | 0:52:28 | |
Rosa's got a normal heart rhythm. | 0:52:30 | 0:52:33 | |
The valve is looking very good. | 0:52:33 | 0:52:34 | |
There is no leak. As far as I'm concerned, it has been a success. | 0:52:34 | 0:52:38 | |
Hello. Good afternoon. | 0:52:48 | 0:52:51 | |
Hi, again. | 0:52:51 | 0:52:53 | |
You remember me, yeah? Yes, of course. | 0:52:53 | 0:52:55 | |
So, all good. All good. | 0:52:55 | 0:52:57 | |
Everything has been really, really straightforward. | 0:52:57 | 0:53:00 | |
Good news is that it's working well, and it's her own valve. | 0:53:00 | 0:53:03 | |
The heart is working on its own without any support. | 0:53:03 | 0:53:06 | |
Of all scenarios, this is really the best scenario. | 0:53:06 | 0:53:09 | |
Thank you very much. Thank you. | 0:53:09 | 0:53:12 | |
But we just have to wait until she wakes up and then assess her. | 0:53:12 | 0:53:16 | |
I have spoken to the intensive care last night, | 0:53:52 | 0:53:54 | |
but I haven't seen her since so... | 0:53:54 | 0:53:56 | |
She's here, behind these curtains. | 0:53:58 | 0:54:00 | |
Look at that. | 0:54:00 | 0:54:02 | |
Doesn't look like she went through much, huh? | 0:54:02 | 0:54:04 | |
Yes, isn't this wonderful? | 0:54:04 | 0:54:07 | |
Morning. Hello. | 0:54:07 | 0:54:09 | |
Look at you. | 0:54:09 | 0:54:11 | |
Hard to believe you had heart surgery yesterday. | 0:54:11 | 0:54:14 | |
So it went well? | 0:54:14 | 0:54:17 | |
Yes, absolutely. All perfect. | 0:54:17 | 0:54:19 | |
Here's the man. All perfect, so the valve looked like infected. | 0:54:19 | 0:54:24 | |
Yeah. And it looked like several weeks' infection, and it was, | 0:54:24 | 0:54:28 | |
it managed to produce a hole in the leaflet of the valve, | 0:54:28 | 0:54:32 | |
so all the tear has been taken out, | 0:54:32 | 0:54:34 | |
and we have managed to stitch it back in the normal position, | 0:54:34 | 0:54:37 | |
so we checked with the tube inside | 0:54:37 | 0:54:39 | |
and the valve looked absolutely perfect. | 0:54:39 | 0:54:41 | |
So that's my own valve? | 0:54:41 | 0:54:43 | |
You have got your own valve. | 0:54:43 | 0:54:44 | |
I think that is really the best scenario. | 0:54:44 | 0:54:46 | |
Am I going to have to have it replaced in ten years? | 0:54:46 | 0:54:49 | |
Probably not. With your valve working well now, we don't know, | 0:54:49 | 0:54:51 | |
we just have to check over the time. | 0:54:51 | 0:54:53 | |
Obviously, we need to hope that the infection is gone completely. | 0:54:53 | 0:54:56 | |
Yeah. Good. | 0:54:56 | 0:54:57 | |
You are happy? Very, very happy. | 0:54:57 | 0:54:59 | |
Thank you. I am very happy too. | 0:54:59 | 0:55:01 | |
I'm really delighted. This is just the best outcome | 0:55:01 | 0:55:03 | |
we could have hoped for, yeah. Yeah, really happy. | 0:55:03 | 0:55:06 | |
Thank you all so much. Great. I am just in awe of your work. | 0:55:06 | 0:55:10 | |
No, not at all, Rosa, it's a pleasure. | 0:55:10 | 0:55:13 | |
Talk soon, all right? All the best, yeah, bye-bye. | 0:55:13 | 0:55:16 | |
Thank you. Great. | 0:55:16 | 0:55:18 | |
See you later. | 0:55:22 | 0:55:24 | |
A thank you card doesn't really cover it, does it? | 0:55:25 | 0:55:28 | |
Yeah, I know, I'm really happy. | 0:55:31 | 0:55:33 | |
There has been a drive in the NHS, | 0:55:45 | 0:55:47 | |
and I think it's been the right one, | 0:55:47 | 0:55:49 | |
to concentrate services in specialist areas. | 0:55:49 | 0:55:54 | |
I think Imperial is probably unique, | 0:55:54 | 0:55:56 | |
in that it's such a large cardiac unit | 0:55:56 | 0:55:59 | |
but also has a very large neurology, acute stroke unit, | 0:55:59 | 0:56:03 | |
neurosurgical unit, so you have this confluence of expertise | 0:56:03 | 0:56:07 | |
which actually, when it came to Rosa's case, | 0:56:07 | 0:56:09 | |
was absolutely appropriate. | 0:56:09 | 0:56:11 | |
It's great, well done. This has been a long time coming. | 0:56:15 | 0:56:17 | |
It really has, you've been brilliant. Yeah. | 0:56:17 | 0:56:20 | |
OK? Mm-hm. | 0:56:20 | 0:56:22 | |
So it looks as though we've got a primary angioplasty that's just arrived. | 0:57:09 | 0:57:13 | |
Anterior hypokinesia, OK. | 0:57:13 | 0:57:15 | |
Anterior ST elevation and... OK. | 0:57:15 | 0:57:17 | |
Don't worry about him. He's having a heart attack | 0:57:20 | 0:57:22 | |
but we'll get him in straightaway and we'll get him sorted out. | 0:57:22 | 0:57:25 | |
Don't worry about him. You take a seat in the waiting room | 0:57:25 | 0:57:28 | |
and we'll get him sorted out quickly. | 0:57:28 | 0:57:30 | |
OK, and we'll come out and let you know. Thank you. All right. | 0:57:30 | 0:57:33 | |
What choices would you make | 0:57:38 | 0:57:40 | |
when faced with complex health care decisions? | 0:57:40 | 0:57:42 | |
Visit our interactive pages to find out how you would respond. | 0:57:42 | 0:57:46 | |
Go to... | 0:57:46 | 0:57:48 | |
..and follow the links to the Open University. | 0:57:50 | 0:57:53 | |
Sometimes... | 0:58:26 | 0:58:28 |