Episode 4 Hospital


Episode 4

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Where is he? I don't know. You need to shout for help. Where is he?

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Which way did he go?

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One of London's biggest hospital trusts...

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He's having a heart attack,

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but we'll get him in straightaway, and we'll get him sorted out.

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OK, on three. One, two, three.

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..treating more than 20,000 people every week.

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Flying over the enemy lines.

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This is a place with some of the best specialists in the world...

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I'm amazed he's alive. He had two blocked arteries.

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..where lives are transformed...

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Oh, thank you so much.

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..but it's under intense pressure...

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We have a financial deficit of 41 million.

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..with growing patient numbers...

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We are full. We're always full.

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How long has he been here?

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13 hours and 46 minutes.

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I don't think that's best patient care.

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..and higher expectations...

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There can't be nothing in this day and age.

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I want to look after him.

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First ambulance is on the rack.

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..at a time when the NHS has never been under more scrutiny.

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We are declaring a major incident at the St Mary's site.

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If this was my sister or a friend or anyone,

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this wouldn't be good enough.

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Week by week, we reveal the complex decisions the staff must make...

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Anybody else who hasn't gone knife to skin, they need to be sent home.

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..about who to care for next.

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Do you reach a point where you say enough is enough?

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Yes. The family may not like that,

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but we are stopping, and this is where it ends.

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PAGER BEEPS

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Emergency coming, five minutes, by a London Ambulance Service.

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So, what do we know? Who took the phone?

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Peri arrest, 50, hypotensive, bradycardic.

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56-year-old Edward, OK.

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Called about two o'clock. Yeah.

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He said he had a central chest pain. Yeah.

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He was in peri arrest, bradycardic. Around sort of 30-50.

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OK.

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56-year-old city worker Eddie is suffering a major heart attack.

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Oh, hello. HE GROANS

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All right, Edward?

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You're in hospital. HE GROANS

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After calling 999, Eddie collapsed at home alone.

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His heart is severely unstable and could stop at any time.

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It's all right, we've got some. Need some atropine, please. Quick, quick.

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What do you need? Atropine. Blood pressure, 125.

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What was the last heart rate?

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It's 35. OK, perfect.

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Yeah, atropine's in.

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Hammersmith is one of the UK's foremost heart attack centres,

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or HACs.

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Eddie will receive acute treatment

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only available in specialist hospitals.

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Mind your backs, please.

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The HACs are like a specialised A just for the heart.

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One, two, three.

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London ambulance bring us more and more patients,

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so probably double what we would have seen five years ago

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when we first started.

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Anna, have you got an ECG? Where's the ECG?

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Oh, dear, the ECG's showing that he's having a big heart attack.

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So, the team is going to intubate, cos he's so restless.

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He's got no forward output, really.

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Next stage, which is to get into his arteries and take a picture,

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find the blockage, fix the blockage.

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It's just making sure that he doesn't have a cardiac arrest

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before we get to that point.

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Pressure line on, please.

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The faster you are, the more muscle you save,

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and it's important, when someone's really sick,

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to get that artery open as fast as you can.

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So, we've got to get beyond this tricky leg.

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A catheter wire is inserted through Eddie's groin into his heart.

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Balloons and small mesh tubes called stents

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will then unblock his arteries in a procedure called angioplasty.

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This has got to be a big, big right.

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Must be a huge right. OK, we're in now.

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Yeah, look, a huge, great big clot that's just blown downstream.

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We'll see if we can't suck it out. OK.

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HEART MONITOR BEEPS

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No, I wouldn't call him stable.

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He's on blobs of adrenaline.

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So, let's just see if we've got a clot here.

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I don't have any big clots here. We're going to go back in again.

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We need to get rid of any clot that's sitting in this line.

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No point in taking the clot out of the coronary artery

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and then blowing it into his brain - that would be bad, wouldn't it?

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So...

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Now, that may have trapped something,

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cos that's not coming back.

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Yeah, yeah. Ah, it's opened up. Just leave it.

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This man had... I'm amazed he's alive.

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He had two blocked arteries.

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So, 40% of patients have two ruptured clots,

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but not two ruptured clots causing complete blockages, I have to say.

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OK. Good.

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The heart attack centre is one of seven set up in London

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within the last ten years

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to consolidate specialist skills and resources.

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He decided he wanted to live.

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Since they were established, survival rates in the capital

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for the most serious heart attacks have doubled.

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OK, let's see what we have.

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So, this is a nice story, yes? Yeah.

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Potentially.

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I'm very clear that today he was dead

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if he hadn't ended up with us and had gone to a smaller hospital

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where they didn't have a cath lab.

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Had he had a cardiac arrest in an A department

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without a cath lab facility,

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he would never have stabilised to come over to us

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to open up his arteries.

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There's no debate about it, he would be dead.

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INTERVIEWER: And where are you off to now?

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I'm into the next lab. So, we've just started another hot case -

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not quite as hot as him - this is a gentleman who's in his 80s,

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who's presented with a heart attack.

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Over the past decade,

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there's been a move to centralise NHS services

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in order to offer specialised care to more people

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in fewer, bigger hospitals.

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Charing Cross Hospital is the Trust's specialist centre

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for neurosurgery and the treatment of brain tumours.

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I'm off in to see my oncologist.

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She's asked me to come in quite urgently,

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just to have a chat about my recent MRI scan.

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28-year-old Ben had a brain tumour removed four years ago.

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I've been here a lot, cos this is where I was operated on

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to have my brain tumour taken out,

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and then also to have my follow-up radiotherapy and chemo.

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Since his operation,

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he's been monitored by consultant clinical oncologist Alison Falconer.

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He's been having scans every six months since he finished treatment.

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Over the last year, there's been a progressive change in his scans.

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Dr Falconer's called me in,

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but I don't think it's an official appointment,

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she said come in for 11:30.

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We've got the Grade 3 brain tumours, which Ben has.

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With these tumours, half the patients have died in five years -

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and it's four years since surgery.

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Hello. Hi, Ben. Hi, how are you?

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Good. Nice to meet you. So, I've heard your name a lot.

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Kevin O'Neill. Yeah. Did we meet before?

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I don't think I've ever actually met you,

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I just always hear Kevin O'Neill.

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Do you? That's strange. I think you're famous.

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Basically. So, we've been discussing you in our own big team,

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so we work altogether. Yeah, OK. So, how have you been?

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Have you been...? I've been fine, yeah.

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I've had absolutely no symptoms from my brain.

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No seizures? No seizures since the op.

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There's always a chance that things could change.

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Yeah, which I've always been aware of. Yeah.

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I think, if you look back, you can see a little ring

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that looks like maybe a residual bit of tumour.

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Looks like it's been very well-behaved,

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but in the last scan, it just...

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Part of it... Yeah. ..looks a little bit bigger.

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That would warrant us going in

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to remove that bit that's growing, and...

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Right. ..potentially threatening you. Mm-hm.

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OK. So, you're saying that you feel I should have a procedure...

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another operation.

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Well, we all feel that, you know,

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there is a risk of leaving you alone

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and the risk of treating you is less than the risk of leaving you alone.

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From my understanding of the tumour that I have had, blah, blah, blah,

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it was slow-growing? Relative to the fast ones, unfortunately.

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There's always a spectrum. OK. So there's barely growing,

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which are what we call benign - 1, 2.

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The Grade 3, which is what you had,

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means you can't just sit and watch it and observe it lifelong.

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Yeah, OK. Has to come out, have the chemotherapy, have the radiotherapy,

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as you did. Yeah. And the Grade 4 are the much more aggressive ones.

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In terms of timings, what are your thoughts, then, on...?

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When would it need to...? Probably in the next few weeks.

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Oh. Two or three weeks, we'd need to set it up.

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OK. Have you got plans?

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Well, yeah, I've always got plans, I'm really busy,

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but we have to work around those. Yeah.

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It's not going to be tomorrow. And, yeah, so...

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We've seen it grow, there's no point just sitting here, watching it,

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we need to do something about it. Yeah.

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Mm. Does that make sense?

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Yeah, it's making sense.

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It's just a pain in the arse.

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Basically.

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It's a tricky balance.

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Thanks very much.

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It's just a lot of stress and it's just annoying, isn't it?

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It's just...

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It is annoying. Yeah, it's annoying.

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It's just... That's nothing to what I said when I saw the e-mail.

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It really isn't fair.

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No, it's not fair, but it's happening, so get on with it,

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I guess. Right, so... Yeah.

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Great.

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SHE LAUGHS

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Why don't you get out into the sunshine? Yeah, exactly, exactly.

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It's fine. OK.

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Yeah, thank you very much.

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Oh. I know, what the hell?

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But it was going to happen at some point, I think. It's all right.

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Thank you. Right. Are we going, Ben?

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Yeah. Take care, see you soon.

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Oh, thank you.

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INTERVIEWER: Was it always going to come back? No.

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We always, always hope...

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There are patients whose tumours don't come back.

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He's been the unlucky one.

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So, this is Ben's story, basically.

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So, he had a tumour way back in 2012.

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This is my colleague, who did a very good resection,

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and got a lot of this out. You can see a big resection cavity here,

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but over the last few years, there's been something growing anteriorly.

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If we give it enough time to regrow, it can transform into something...

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high grade that will threaten him.

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It's very, very frustrating treating brain tumour patients like Ben

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where they've had a good surgery

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and, you know, his tumour's come back.

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The biggest problem with brain tumours

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is they have such poor survival rates.

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Many of them are very aggressive.

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For that reason, they cause the greatest reduction

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of life expectancy compared to any other cancer,

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because they can affect any one of us at any age.

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Most of them are fatal and under the age of 40,

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they're the greatest cancer killer.

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You know, you want to solve this problem

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and you want to make things better

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and that's what drives us on to try and research and develop,

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and design new technologies and new treatments.

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Kevin and his team are at the forefront of using new technology

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to understand more about brain tumours like Ben's.

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I didn't know exactly how my story would pan out,

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but I had a Grade 3 brain tumour, which had been treated,

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but there is the history that it does come back...

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..but the thing is, like, I've just got on with my life.

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I've enjoyed...I've enjoyed things

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and I've been, you know, living my life and getting on with it -

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and then, it has happened,

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and I just need to, erm...

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do it again.

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Any change from this morning here?

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It's 24 hours since Eddie arrived at the HAC,

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suffering a major heart attack.

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This came as quite a surprise.

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I would have expected there to be a feeling of panic,

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and something like that.

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For some reason, it was like...

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"I just hope that they get here with that ambulance quickly.

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"If not, then this could be it."

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That's all I felt.

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I hadn't really thought about it that hard up until then.

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So, that's quite...

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..quite heavy.

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But...I'm here.

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He's done pretty well, actually.

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He's come off the ventilator,

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he's come off all the drugs that were supporting the heart yesterday.

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So, for the extreme types of heart attacks that we see,

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that is a speedy recovery -

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and, hopefully, yeah, he'll be back at work within a few weeks.

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Hello, sir. Oh, hi, again.

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Right, how are you feeling compared to this morning?

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Much better. Does anything not make sense to you?

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Cos you've been through a lot in the last 24 hours.

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No. It has been literally 24 hours, this time yesterday.

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Yes, indeed. No, people have explained it very well.

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OK. Your heart tracings are good,

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your monitoring, your blood pressure and everything's been good.

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So, I think we can literally unhook you from all of this,

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make the next step and get you to the ward -

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and you'll find, as days go by, the heart gets stronger and stronger.

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That should make you feel better. Yeah. Cool. OK.

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Great. Thank you. Bye-bye.

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IQBAL: As a front line service for the heart,

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the HAC is incredibly successful.

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London is pretty well served,

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the rest of the country's following suit.

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These heart attack centres mean that there's a concentration of skills,

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a concentration of staff.

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These patients stay in the hospital for less days,

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and therefore not only does their life get saved,

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it's also cost-effective.

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OK, sir. Back in the ward now.

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HE HUMS TO HIMSELF

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Every division in the Trust must make significant cost savings

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to hit efficiency targets set by the Government.

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Morning. Morning.

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It's the job of general manager Steve Hart

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to oversee the Trust's cost saving plan

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for their cardiac services, including the HAC.

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Firstly, a sort of good news story for the team, so last year, '16/'17,

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challenged to deliver a ?2.3 million cost improvement programme.

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We actually achieved ?2.6 million,

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so surpassed what we're expected to do.

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What that doesn't mean is that '17/'18 is going to get any easier,

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unfortunately. So, last year, our challenge is ?2.3 million.

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This year, we've got a new challenge ?3 million.

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The plan is, basically,

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for us to either deliver

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more activity to a higher quality for the same money,

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or to deliver the same activity to a better quality for less money.

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I'm going to go through the plans now

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and, sort of, let's have the honest discussion

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around when are these likely to start?

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Be mindful of the fact that, at some stage,

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we may need to close beds - unless we expand the service.

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Every year, we're asked to make more and more savings,

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and it gets to a point where, actually,

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there is no more meat on the bone.

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What about seven-day working, then?

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Where's that rolling out?

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I think seven-day working is getting discussed

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as part of the chest pain pathway discussions.

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I'm hoping we don't need to do it

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and I'm conscious that we'll all be calling on the same group of staff

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that have already said, "We don't like working Saturdays and Sundays."

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Seven-day working, in principle, is an excellent idea.

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It doesn't matter what day or time you're admitted,

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you should get the same treatment.

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However, we cannot implement something

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when we don't have the infrastructure to do it.

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Is there a demand for a sixth cath lab to support growth

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in private patient activity?

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I'd just like it to be minuted that I am really, really nervous

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about this sixth cath lab that seems to be rolling on.

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It is impossible to have more cath labs than we have CCU beds.

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It cannot happen.

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So, at the minute, I think...

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I think this... The bed discussion is very much a pipeline discussion.

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What you need to do is see it in the business case,

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which is what I intend to allow you, enable you to see.

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PAGER BEEPS

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Heart valves is... Terminally in eight minutes.

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I've got a pericardial coming in with a GCS three.

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ETA's about five minutes.

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It is difficult -

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and it's continuing tension on a day-to-day basis.

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What is important from my perspective

0:17:340:17:36

is the quality of care delivered to our patients

0:17:360:17:38

and our patient safety isn't compromised in any way

0:17:380:17:41

as a consequence of any of the cost-improvement proposals.

0:17:410:17:44

As a specialist centre, in addition to treating heart attacks,

0:17:470:17:51

Hammersmith's cardiologists

0:17:510:17:52

deal with rare and complex heart conditions.

0:17:520:17:55

Sharp scratch.

0:18:000:18:01

I was...I was really, really healthy.

0:18:060:18:08

Like, at the peak of my health.

0:18:080:18:10

I was really into the gym and, like, fitness and everything.

0:18:100:18:13

We might need to keep it in, because you're having the procedure.

0:18:130:18:17

23-year-old teacher Rosa has a life-threatening infection

0:18:170:18:21

on the mitral valve of her heart called endocarditis.

0:18:210:18:24

Great, thank you. All right? That's you done.

0:18:240:18:29

Right.

0:18:290:18:31

Hello. Plan today is echo before lunch, scan this afternoon. Mm-hm.

0:18:310:18:36

She's got an infected heart valve, and that's called endocarditis.

0:18:380:18:42

It's the last thing you want to see in a young person.

0:18:420:18:44

It carries a high mortality.

0:18:440:18:47

Anywhere between 20-40%.

0:18:470:18:49

Though Rosa appears well, infected tissue from her heart is breaking

0:18:510:18:55

off and causing complications in her brain.

0:18:550:18:59

I was just, like, sending a text message

0:18:590:19:01

and then, I just suddenly couldn't...

0:19:010:19:04

couldn't type with my thumb and I was like, "This is weird,"

0:19:040:19:07

and then the next day, that happened again about five times,

0:19:070:19:09

and then, the last few times, it spread to my face and I, like,

0:19:090:19:13

couldn't move the left side of my face, so I couldn't smile.

0:19:130:19:17

They called it, like, mini strokes.

0:19:170:19:20

It's so weird to just sit here and feel completely normal...

0:19:200:19:24

and have major problems in your brain, and in my heart.

0:19:240:19:28

They said, "We need to speak to you,

0:19:300:19:33

"but," you know, "not here."

0:19:330:19:35

So, we knew. We knew.

0:19:350:19:36

We knew there was something very serious.

0:19:360:19:38

Yeah, in fact they phoned us, didn't they?

0:19:380:19:40

They asked us to come in, in fact.

0:19:400:19:42

All right, love. So, I can text you when I'm back.

0:19:420:19:44

Yeah, all right, sweetheart. Well, I'll make sure that I'm back.

0:19:440:19:46

OK. It takes you right back to when she was born, somehow.

0:19:460:19:50

You sort of go back into being needed as a parent,

0:19:500:19:54

whereas we sort of got used to not really being needed!

0:19:540:19:57

No, you just have this horrible feeling in the pit of your stomach

0:19:570:20:00

that you can't shift,

0:20:000:20:03

and it will be there until they tell us that everything's OK, basically.

0:20:030:20:07

I could see the fear in her parents' eyes,

0:20:080:20:11

and I could understand that because, you know, I'm a parent myself.

0:20:110:20:15

I have a young daughter, and isn't it every parent's worst nightmare?

0:20:150:20:18

This echo's from Friday afternoon

0:20:240:20:26

when I saw her in Charing Cross.

0:20:260:20:28

There's a...there's a big blob. Any leak?

0:20:280:20:31

Yeah, it is leaking.

0:20:310:20:32

Oh, yeah.

0:20:340:20:36

Every Wednesday, senior cardiologists and heart surgeons

0:20:360:20:39

come together to discuss their most complex cases.

0:20:390:20:43

Looking to operate as early as possible, I'd have thought, to...

0:20:430:20:46

That's what we were thinking on Friday.

0:20:460:20:48

So, that's why we had so much discussions with the neurology team,

0:20:480:20:51

the stroke team and neuroradiology.

0:20:510:20:55

The valve needs surgery.

0:20:550:20:57

She needs an operation.

0:20:570:20:59

So, it's one of the most challenging things we treat,

0:20:590:21:02

because the timing of surgery is crucial.

0:21:020:21:06

If you don't get the timing of surgery right, the patient will die.

0:21:060:21:09

I saw her on Saturday.

0:21:090:21:11

I explained that we don't know either the risk of spontaneous bleed

0:21:110:21:15

or going on bypass - and before talking to her,

0:21:150:21:18

I'd spoken to the neuroradiologist,

0:21:180:21:19

who actually said there is a very high risk of spontaneous bleed.

0:21:190:21:23

So, personally, I would wait longer. Yeah.

0:21:230:21:25

They did say that they didn't think that it would preclude

0:21:250:21:28

putting someone on bypass, they have written that.

0:21:280:21:30

We're are all strong minded individuals,

0:21:300:21:33

and we don't always agree,

0:21:330:21:35

but usually we can hammer it out.

0:21:350:21:38

There is a reason to just wait and not rush, so I think...

0:21:380:21:43

Is the neuroradiology MDT in Charing Cross?

0:21:480:21:51

Yeah. Yes. Quarter to 12, I can find out where it is.

0:21:510:21:54

Today? Yeah. It would be good if I could go down, wouldn't it?

0:21:540:21:56

OK. So, we got a plan.

0:21:560:21:58

Great. Right. Who's next?

0:21:580:22:00

There is no clear right or wrong here,

0:22:020:22:05

and you have to go on clinical judgment.

0:22:050:22:09

This grey area in medicine - but at the end of the day,

0:22:090:22:13

somebody has to make a decision.

0:22:130:22:17

It hasn't really hit home yet,

0:22:250:22:26

but I know that tomorrow it's, like, surgery time.

0:22:260:22:29

28-year-old Ben is at the neurosurgery centre in Charing Cross

0:22:290:22:34

for his brain tumour operation.

0:22:340:22:36

When this first happened to me, I was 24.

0:22:370:22:39

I moved down here to train in musical theatre,

0:22:390:22:44

which I'd worked in until this happened four years ago.

0:22:440:22:48

Last time, I was having visual problems, dizzy spells,

0:22:480:22:53

a couple of seizures, which I didn't realise were seizures.

0:22:530:22:57

Basically, blurred vision,

0:22:570:22:58

so I was rushed to A and they found the mass from an MRI scan.

0:22:580:23:03

It was found to be Grade 3.

0:23:030:23:05

I lost my left peripheral vision.

0:23:050:23:08

It was all pretty horrific.

0:23:080:23:10

Giving up dancing and going to dancing auditions was hard,

0:23:100:23:14

because that was my career path,

0:23:140:23:17

and I think I went through a sort of grieving process...

0:23:170:23:21

..and now that it's happening again, it's all a bit...

0:23:220:23:25

It's like going back to four years ago,

0:23:250:23:28

like, history repeating and it's bringing everything back.

0:23:280:23:31

Seventh floor.

0:23:320:23:34

To prepare for the operation,

0:23:360:23:38

the team creates a 3D map of Ben's brain.

0:23:380:23:41

This will help Kevin pinpoint Ben's tumour during the surgery.

0:23:480:23:52

These days, as opposed to his previous surgery, four years ago,

0:23:540:23:57

we now have more tools in the box,

0:23:570:23:59

so we now have quite useful intraoperative imaging,

0:23:590:24:03

which tells us where things are,

0:24:030:24:06

despite things moving around -

0:24:060:24:08

but we are also developing new tools.

0:24:080:24:11

Ben has consented for his operation

0:24:110:24:13

to be part of a pioneering research programme

0:24:130:24:16

which aims to change the way cancer is diagnosed and treated.

0:24:160:24:20

INTERVIEWER: Do you need people to, you know, guinea pig this?

0:24:220:24:24

We don't want anybody to be a guinea pig.

0:24:240:24:26

None of us wants to be a guinea pig,

0:24:260:24:28

but I think we are now starting to make advances.

0:24:280:24:30

You know, with innovations, it's going to open up a whole new world

0:24:300:24:34

of research and potential treatment options for these patients.

0:24:340:24:37

It's literally signing your life away, isn't it?

0:24:370:24:40

No. Hope not. All right. We'll see you soon. OK, yeah, yeah.

0:24:400:24:42

Thank you very much.

0:24:420:24:44

Hello, hello.

0:24:500:24:51

How are you doing, then?

0:24:510:24:53

Erm, yeah. You've had a little bit of a shave, there. OK.

0:24:530:24:55

Did you do that or did we do that? No, I didn't do that!

0:24:550:24:58

OK. OK. Well, look, Are you happy about tomorrow?

0:24:580:25:01

Tomorrow. Yes.

0:25:010:25:03

So, what we want to do is try and get you back... Yeah.

0:25:030:25:06

..to a point where you've got very little

0:25:060:25:08

or no discernible tumour on the imaging.

0:25:080:25:11

My main concern is my visual field -

0:25:110:25:13

and I know you can't promise that it won't be affected.

0:25:130:25:17

There is a small chance that...

0:25:170:25:18

There is a small chance that that could be affected.

0:25:180:25:21

How are your visual fields?

0:25:210:25:24

So, I've got no left peripheral from the last operation... Yeah.

0:25:240:25:27

..and a tiny bit hindered in the right.

0:25:270:25:30

Look me straight in the left eye and tell me when you can see my finger

0:25:300:25:32

coming, and I'll do the same. Can you see it coming in? Tell me.

0:25:320:25:35

Now. OK. I can see this way out here.

0:25:350:25:37

You can't see it till we get to... No, now. ..the midline.

0:25:370:25:39

You've got some deficit up there, but it's maybe the lower quadrant,

0:25:390:25:42

isn't it, on that left? Yeah. Is...? Yeah. We can't guarantee...

0:25:420:25:46

The vicinity that it's in is close

0:25:460:25:48

to where the connections from the eyeball

0:25:480:25:51

to where the brain perceives vision. Yeah, yeah.

0:25:510:25:54

Those radiations, it's...

0:25:540:25:56

They're going around that and have been stretched by that,

0:25:560:25:58

and they have been interfered with.

0:25:580:26:00

Obviously, every surgery we do... Yeah. ..has a certain risk to it.

0:26:000:26:03

I wish they'd do surgery sooner,

0:26:190:26:20

because I'm just sat here thinking at any point some of this infection

0:26:200:26:24

could come off again and cause another aneurysm.

0:26:240:26:27

What if an aneurysm happens in my brain and I'll just die?

0:26:270:26:31

23-year-old Rosa needs an operation to remove infected tissue

0:26:310:26:35

from her heart valve.

0:26:350:26:37

Due to complications in her brain,

0:26:370:26:39

the team must first decide if it's safe to go ahead.

0:26:390:26:43

Obviously, there is a risk of stroke for Rosa having surgery.

0:26:430:26:46

We are not risk averse,

0:26:460:26:48

but the right decision about timing is fundamental.

0:26:480:26:51

I went down to the neuro MDT in Charing Cross.

0:26:530:26:56

Her recent imaging from Tuesday hasn't changed,

0:26:560:27:01

and, actually, their concern over bleeding risk has gone down,

0:27:010:27:05

substantially, and they felt if she needed surgery,

0:27:050:27:08

from our point of view - we should just go ahead.

0:27:080:27:11

So, we were going to repeat the CTA brain on Tuesday,

0:27:110:27:16

and the transthoracic echo and we'll come back.

0:27:160:27:19

She's responding to antibiotics. She is. I think she is.

0:27:190:27:22

Yeah, yeah, yeah -

0:27:240:27:26

but if things change on Tuesday and it looks worse, we just regroup.

0:27:260:27:30

Good.

0:27:330:27:34

There are so many consultants involved with the decision,

0:27:350:27:38

but, eventually, there will be one name next to her bed

0:27:380:27:41

that is the name of the surgeon that operates on her,

0:27:410:27:43

and if things go well, it will be a great team effort.

0:27:430:27:48

If things don't go well, obviously,

0:27:480:27:51

the surgeon will be the first name to be on the spot.

0:27:510:27:54

You are a popular young woman.

0:27:560:27:58

So, we have talked and talked and talked. Yeah.

0:27:580:28:02

You have several small aneurysms in your brain.

0:28:020:28:06

These aneurysms are caused by infected material breaking off,

0:28:060:28:11

going up to the brain,

0:28:110:28:12

and it burrows through the wall of the artery.

0:28:120:28:15

So, I don't think we know yet when to operate.

0:28:150:28:18

I don't think we can decide now.

0:28:200:28:22

But, you know, know this -

0:28:220:28:23

we are not going to put you through surgery...

0:28:230:28:26

..that's going to cause you risk if we don't have to. Yeah. Yeah.

0:28:270:28:31

I'm just worried that with leaving it that, like...

0:28:310:28:33

I don't want any more aneurysms, especially in my brain.

0:28:330:28:36

But no new ones have formed. Yeah. Remember that.

0:28:360:28:38

OK. So, it's just a waiting game, in a way. Yeah.

0:28:380:28:43

OK, bye.

0:28:470:28:48

70-year-old retired railway worker Chhotalal

0:29:040:29:07

is waiting for an angioplasty

0:29:070:29:09

after arriving at the HAC complaining of chest pains.

0:29:090:29:13

My dad, he had a heart attack in January.

0:29:130:29:16

Over the weekend, he was just having a few pains

0:29:160:29:18

and, again, he wasn't saying exactly what was going on.

0:29:180:29:21

Because he was saying before it was indigestion,

0:29:210:29:23

and it wasn't indigestion, it was actually having a heart attack.

0:29:230:29:27

You just don't know when it comes to the heart, and men, especially,

0:29:270:29:31

don't like to admit that they might be dying, possibly. Yeah.

0:29:310:29:35

When did you come in here?

0:29:350:29:38

Yesterday, I came on the Tuesday.

0:29:380:29:41

And I've been kept prisoner since then.

0:29:410:29:45

So this lady is a PCI, to come into mine.

0:29:450:29:48

And this chap is the chap on HAC.

0:29:480:29:51

We've had a very busy night.

0:29:510:29:53

We've got lots of inpatients that need procedures,

0:29:530:29:56

we've got a busy elective list,

0:29:560:29:59

and we are going to get more admissions

0:29:590:30:00

and we are going to get more primaries.

0:30:000:30:03

Right, so what have we got now next?

0:30:030:30:06

So this is our...

0:30:060:30:09

Primary. Can we go through this case?

0:30:090:30:11

So, 70-year-old came in as a primary call.

0:30:110:30:15

Hypertensive, hypergastrinemia.

0:30:150:30:17

Just one stent.

0:30:170:30:20

Was rotablated, arm was heavily calcified.

0:30:200:30:22

He's under the care of consultant cardiologist Ghada Mikhail.

0:30:230:30:29

So we need to check the LAD first, don't we?

0:30:290:30:32

He has got ongoing chest pain

0:30:320:30:34

and he's got some disease left in the other arteries,

0:30:340:30:37

so that's what we're going to treat.

0:30:370:30:40

What we are seeing is increasingly patients with more complex coronary

0:30:400:30:44

disease. When I started training, we had what we call type A lesions,

0:30:440:30:48

very simple coronary disease. You put a balloon and a stent.

0:30:480:30:51

Now patients are living longer, they're getting older,

0:30:510:30:54

the disease is more complex.

0:30:540:30:56

Their arteries are calcified and hardened,

0:30:560:30:58

which can make angioplasty more complex.

0:30:580:31:00

BEEPING

0:31:000:31:02

I got a call from LAS about a gentleman -

0:31:110:31:13

and he's arrested in the community.

0:31:130:31:15

Downtown is five minutes.

0:31:150:31:16

He's on his way? He's on his way.

0:31:160:31:18

They're going to put a call out shortly.

0:31:180:31:19

So, you know what, we can't start this case now.

0:31:190:31:23

He's nearby. Let's talk to him, let's talk to him.

0:31:230:31:25

Hello. How are you?

0:31:330:31:36

OK. Listen, I don't have very good news at the moment.

0:31:360:31:39

We were about to start your procedure,

0:31:390:31:41

but we've just had an emergency call of a patient who's really unwell.

0:31:410:31:46

They're first. Quite good.

0:31:460:31:48

We just need to get the other patient done.

0:31:480:31:50

I'm really sorry about that.

0:31:500:31:51

It doesn't matter. I've got ten years to go.

0:31:510:31:52

Ha-ha! Fantastic, thank you so much.

0:31:520:31:56

OK, there's a cardiac arrest coming in.

0:31:560:31:58

We really don't like to do that type of thing,

0:31:580:32:01

but the other cath labs are being used.

0:32:010:32:03

This is a patient coming in in a cardiac arrest situation.

0:32:030:32:07

He's stable, so he can afford to wait, compared to the other patient.

0:32:070:32:14

I'm really sorry about that.

0:32:140:32:15

Any family, any family?

0:32:180:32:21

Hello. Just tell us what's going on.

0:32:210:32:24

Tell us, OK. Are you ready for a handover? Yes, please.

0:32:240:32:27

Just one second, sorry.

0:32:270:32:29

If he's got an output, we should take him to the lab, yeah?

0:32:290:32:32

Every day is unpredictable.

0:32:390:32:41

You plan for the day, but you could have a lot of emergencies

0:32:410:32:44

one after the other in one day,

0:32:440:32:46

or it could be a day where you have a couple of emergencies

0:32:460:32:49

and manage to get all the elective cases done.

0:32:490:32:51

Do you expect to be seen today?

0:32:570:32:59

I don't want to impose nothing.

0:32:590:33:02

I'm quite patient, because I'm retired.

0:33:020:33:04

What the hell am I going to rush it for?

0:33:040:33:07

I rushed enough for more than 50 years in the jobs I've done, so...

0:33:070:33:12

How are you feeling at the moment?

0:33:120:33:14

Oh, fine. Just as good as you.

0:33:140:33:16

It's just that the inside is not happy.

0:33:160:33:18

BEEPING

0:33:190:33:21

All right.

0:33:210:33:22

So this is another one. So it's going to be crazy today.

0:33:220:33:25

That is exactly how it happens.

0:33:290:33:32

You can be pootling along and then within sort of ten, 15 minutes

0:33:320:33:36

you've got two patients coming in.

0:33:360:33:38

I feel like I'm healthy enough to walk.

0:33:570:34:00

I'm going in for this major surgery,

0:34:030:34:06

but I feel fine, and it's really weird.

0:34:060:34:08

Last time, I was having seizures and a few blackouts.

0:34:080:34:12

I was on high medications, I was feeling like shit.

0:34:120:34:15

But this time, I'm feeling really fine, so it doesn't feel right

0:34:150:34:19

for me to be having surgery this morning.

0:34:190:34:21

It's the day of Ben's operation to remove his brain tumour.

0:34:220:34:26

Do we come up? No. No? OK, all right.

0:34:290:34:32

His family is here from Huddersfield to support him.

0:34:320:34:36

See you in a bit. See you in a bit.

0:34:360:34:38

It's just mixed emotions, you know.

0:34:380:34:40

You try to be positive for him and reassure him and everything,

0:34:400:34:43

but it's a bit surreal.

0:34:430:34:45

You just kind of... Can't imagine it.

0:34:450:34:50

Couldn't imagine it for myself.

0:34:500:34:51

What you want is it to be you.

0:34:510:34:55

You want it to be you, not him,

0:34:550:34:57

and that's the feeling I had, that it should have been me, not him.

0:34:570:35:00

Now, we're here today and he's having it done,

0:35:020:35:04

he's going through it all again and... It's just...

0:35:040:35:09

Well, he's going to come through it and he's going to be fine.

0:35:090:35:12

He's got loads of years ahead of him.

0:35:120:35:15

He's still got a lot to do in life. He's still got aims.

0:35:150:35:19

Oh, God, yeah. Always. Yeah.

0:35:190:35:22

We've created a three-dimensional image volume of Ben.

0:35:270:35:31

You can recognise that's Ben. These are the reference points,

0:35:310:35:34

these little markers we've put on his head,

0:35:340:35:35

which we use as reference points to correlate this virtual image

0:35:350:35:40

to the real Ben.

0:35:400:35:42

We can peel away the surface

0:35:420:35:44

and look at all the blood vessels that you need to avoid.

0:35:440:35:49

Years ago, without this sort of equipment,

0:35:490:35:52

it would be a lot harder.

0:35:520:35:54

I remember the days of putting a CT scan up

0:35:540:35:57

and marking on those lines where the tumour was

0:35:570:36:00

on the scout image to see where we would make our craniotomy.

0:36:000:36:03

We'd just had to hold it up and stand back

0:36:030:36:06

and look at the image on the wall.

0:36:060:36:09

Now, look where we are now.

0:36:090:36:11

You can see I'm pointing to this fiducial.

0:36:120:36:17

That machine is telling me where I'm pointing.

0:36:170:36:19

It even shows you my probe, look.

0:36:190:36:22

Beautiful.

0:36:220:36:24

During the operation, Ben could lose more of his peripheral vision.

0:36:240:36:28

There's also a risk of loss of sensation in his left side

0:36:280:36:32

and paralysis.

0:36:320:36:34

It's really that bit that we want take out, there.

0:36:340:36:36

Ultrasound probes will carry out live brain imaging,

0:36:380:36:42

guiding Kevin along the 3D map of Ben's brain,

0:36:420:36:45

helping him safely remove as much tumour as possible.

0:36:450:36:48

On the left-hand screen, you see the grey of the MRI,

0:36:480:36:51

and then on the ultrasound

0:36:510:36:53

you can see that bright signal in the cavity. Very clear cavity.

0:36:530:36:57

I can actually see it. There's the tumour there, look.

0:36:570:37:01

You can actually see it with your naked eye.

0:37:010:37:04

Amazing.

0:37:040:37:06

OK, so we've got to try and get that out.

0:37:060:37:08

That's Ben.

0:37:080:37:10

Emma. And that's Molly.

0:37:100:37:11

Yeah, happy-go-lucky. Yeah, always...

0:37:130:37:15

Bit bossy towards the other two.

0:37:150:37:16

Yeah, bossy. Always liked to have people around him.

0:37:160:37:19

His main thing were musical theatre.

0:37:190:37:22

He wanted to be in the West End.

0:37:220:37:24

Yeah, he wanted to be there. That was his dream. Yeah.

0:37:240:37:28

I just hope from today that they can do what they need to do to get

0:37:280:37:32

all the cancer out, all the tumour.

0:37:320:37:35

So he can move on, then, with his life.

0:37:350:37:37

Ben has agreed to be part of a research programme

0:37:390:37:42

testing a new diagnostic tool, the iKnife,

0:37:420:37:44

which is being pioneered at Imperial.

0:37:440:37:47

This is the iKnife, so you take tissue, you turn it on,

0:37:480:37:52

and it buzzes the tissue, coagulates it.

0:37:520:37:54

And you get some smoke being produced,

0:37:540:37:56

which then gets sucked up into this tube,

0:37:560:37:59

and that tube then goes into that machine.

0:37:590:38:02

And it tells you what the molecular make-up of that vapour is.

0:38:020:38:05

I'm going to get some iKnife samples here

0:38:070:38:09

and then at the boundary... So shall I take an iKnife sample?

0:38:090:38:13

As the iKnife heats and cuts the tissue,

0:38:130:38:16

it generates so-called surgical smoke.

0:38:160:38:20

It's basically like a sniffer knife.

0:38:200:38:21

It's smelling the vapour coming off the tumour.

0:38:210:38:24

Got something? OK, good.

0:38:240:38:28

Healthy tissue gives off a different molecular signature

0:38:280:38:30

to cancerous tissue.

0:38:300:38:32

The iKnife analyses the smoke

0:38:320:38:34

and transfers the data to its computer.

0:38:340:38:37

We've got a very, very early model, which is not...

0:38:380:38:41

We don't have a huge amount of data.

0:38:410:38:44

Usually, if you were going to have a robust database,

0:38:440:38:46

you would want thousands,

0:38:460:38:49

even tens of thousands, of bits of information to build it on.

0:38:490:38:52

So it is very early days.

0:38:520:38:55

The iKnife can already identify

0:38:560:38:58

the margin between healthy tissue and a number of different cancers,

0:38:580:39:02

but it's still in the training phase for brain tumours.

0:39:020:39:05

The thing about this is that it's bringing the lab into surgery,

0:39:070:39:10

giving us information very quickly. Maybe, possibly, in the future,

0:39:100:39:13

we'll have treatments that we can give locally as we're operating,

0:39:130:39:16

rather than then having to be closed up

0:39:160:39:17

and then wait for post-op chemotherapy and radiotherapy,

0:39:170:39:20

we can actually start giving treatments instantly

0:39:200:39:23

alongside surgery.

0:39:230:39:24

Perhaps, if we're lucky,

0:39:240:39:27

it'll give us some answers to a potential cure.

0:39:270:39:30

Let's see. Let's see.

0:39:300:39:32

I know you can see the tumour, and I am just now

0:39:320:39:35

pulling it away from more normal looking brain.

0:39:350:39:37

But it looks kind of greyish

0:39:370:39:39

and potentially a little bit more aggressive than it perhaps was.

0:39:390:39:43

So what I'm going to do is reset now.

0:39:430:39:45

Tumour.

0:39:500:39:51

Ben's tumour is sent to a lab,

0:39:540:39:56

where pathologists will determine

0:39:560:39:58

if it's more aggressive than his original cancer.

0:39:580:40:00

It'll be two weeks before he gets the results.

0:40:030:40:05

That tumour that was down there is all gone.

0:40:080:40:10

If this turns out to be slightly more aggressive,

0:40:120:40:15

then it was the best thing we could have done.

0:40:150:40:17

Right.

0:40:190:40:22

Good.

0:40:220:40:23

Want to check your temperature.

0:40:380:40:39

There was an emergency, they couldn't do it for me,

0:40:390:40:42

so I stayed all night long.

0:40:420:40:43

I couldn't say nothing.

0:40:430:40:45

Somebody might be in more dire trouble so...

0:40:450:40:50

I'm OK, I wasn't bad.

0:40:500:40:51

I wasn't feeling that bad anyway.

0:40:510:40:53

70-year-old Chhotalal

0:40:530:40:55

had his angioplasty cancelled yesterday

0:40:550:40:58

due to an emergency admission.

0:40:580:40:59

He's spent the night on the busy HAC Ward.

0:41:010:41:05

Current bed state is we're nearly at full capacity at the moment.

0:41:050:41:09

As it stands, if we have a primary come in that goes to the lab

0:41:110:41:14

and needs to go to the coronary care unit,

0:41:140:41:16

we don't have a bed to put them in.

0:41:160:41:18

How do you feel about that?

0:41:210:41:23

It makes me nervous. We are the primary service.

0:41:230:41:26

So anyone having a heart attack within north-west London

0:41:260:41:30

will come here via LAS.

0:41:300:41:32

I've got to do this because he's on HAC.

0:41:320:41:34

It needs to be done.

0:41:340:41:36

Yeah, no, do him... and then two coronaries.

0:41:360:41:38

And then whoever takes the other one with the pacemaker. Yeah? OK.

0:41:380:41:41

He got admitted with chest pain and he's been cancelled once.

0:41:410:41:46

So he needs to be done.

0:41:460:41:49

He wasn't on the elective list, he's come in with symptoms.

0:41:490:41:52

So you can't cancel him again

0:41:520:41:54

because patients can become unstable at any time.

0:41:540:41:57

Comfortable?

0:42:000:42:02

All right, happy for me to carry on?

0:42:020:42:04

Good.

0:42:040:42:05

This is Chhotalal's second angioplasty in three months.

0:42:070:42:12

Take a gentle breath in for me, gentle breath in.

0:42:120:42:16

So this is a very small balloon

0:42:160:42:19

that we're just going to use to inflate the narrowing.

0:42:190:42:23

Stents are inserted into his arteries

0:42:240:42:26

in an attempt to prevent him having another heart attack.

0:42:260:42:29

I'll try and crack that artery open.

0:42:320:42:34

Two, four, six, eight, ten.

0:42:340:42:37

BEEPING

0:42:370:42:38

That's better, and down.

0:42:380:42:41

Narrowing was quite resistant to cracking,

0:42:410:42:43

a lot of chalk in it, and calcium,

0:42:430:42:45

but with a small balloon, it's managed to crack it open.

0:42:450:42:48

How do you feel about the future of the HAC, with the current NHS cuts?

0:42:480:42:53

It's actually very frustrating and really quite depressing.

0:42:530:42:56

As a cardiologist, you want to do more for your patients.

0:42:560:42:59

But, you know, we're getting busier and busier, day by day, actually.

0:42:590:43:03

And the staff are extremely stretched,

0:43:030:43:05

but we have to keep going. Because you can't just walk out.

0:43:050:43:08

Fantastic. We're all done here. OK.

0:43:110:43:14

Good, all done.

0:43:150:43:16

All right? You all right? Yeah, it was very nice. You a bit emotional?

0:43:160:43:20

The benefit of having a centralised system for heart attacks

0:43:200:43:23

is well-proven. But the NHS is cost-constrained,

0:43:230:43:27

I think what's going to happen is that the emergency services,

0:43:270:43:30

as ever with the NHS, are going to be fantastic.

0:43:300:43:33

What might take the hit is the elective patients,

0:43:330:43:36

so when you're not acutely acutely unwell, you're going to wait longer.

0:43:360:43:39

And that is a reality of the modern NHS.

0:43:390:43:42

I is brand-new.

0:43:570:43:59

It feels like my life has just been put on hold.

0:44:030:44:06

Rosa is still waiting for major heart surgery

0:44:060:44:09

to remove infected tissue from her mitral valve,

0:44:090:44:13

but her brain aneurysms need to heal before it's safe to operate.

0:44:130:44:17

If I think about it too much, I'll just be, like, scared and miserable.

0:44:170:44:21

I think that's been one of the hardest things for her.

0:44:280:44:30

She looks around the ward,

0:44:300:44:32

and most people on the ward are kind of 60s, 70s, 80s.

0:44:320:44:38

And she... And that causes you to think a bit more, "Why me?"

0:44:380:44:42

I think the injustice of it all has got to her a bit.

0:44:420:44:46

Hi. Amrish, hi. Hi, Susan.

0:44:490:44:53

So, Rosa, the last time we spoke at the Neuro MDT,

0:44:530:44:57

we were down to one with a whiff of a second. Correct.

0:44:570:45:01

So there's just... A hint.

0:45:010:45:03

Only because you know that there was something there.

0:45:030:45:05

Had I not known, if I didn't have any of these,

0:45:050:45:07

I would have called this completely fine.

0:45:070:45:09

Oh. And the right frontal one is really inconspicuous, actually,

0:45:090:45:12

at this stage. That is just great news.

0:45:120:45:14

And I don't believe that there are any other new...

0:45:140:45:18

Lesions. ..lesions or septic foci, which I can't see on here.

0:45:180:45:23

This is a great result, isn't it? Yeah. Thanks very much.

0:45:230:45:27

No probs, thank you. All right.

0:45:270:45:29

Well, a lot happier.

0:45:290:45:32

Even to me, I'm a cardiologist, I can't read brain scans,

0:45:320:45:34

but even I can see that that looks a lot better.

0:45:340:45:37

Hello. Hello. Hi.

0:45:410:45:44

We had a look at your brain scan

0:45:450:45:47

and the brain scan looks a lot better.

0:45:470:45:49

In fact, if you weren't looking for it,

0:45:490:45:51

you probably wouldn't even see it.

0:45:510:45:53

This is a good outcome.

0:45:530:45:55

It doesn't mean the risk of bleeding is zero,

0:45:550:45:59

but I think it's as low as we're going to get.

0:45:590:46:02

So there's a window here, Rosa, and I think we're in it. Yeah, yeah.

0:46:020:46:07

But she's in good hands.

0:46:070:46:09

Yes. Oh, yeah. Yeah. Thank you.

0:46:090:46:12

I hope I'll get some sleep. I don't know if I will.

0:46:150:46:18

Hi, there. Hello.

0:46:400:46:42

How are you doing? You OK?

0:46:420:46:45

Yeah. Relief. Relief it's all over?

0:46:450:46:48

Feeling OK? I'm just relieved that my vision is here still.

0:46:480:46:52

Good. Still got your vision, yeah.

0:46:520:46:58

I was, I was, I was very worried

0:46:580:46:59

that I would wake up with no vision or less vision...

0:46:590:47:03

I just had nightmares that I would wake up to, or not wake up,

0:47:030:47:07

or have blackness... Yeah.

0:47:070:47:09

If I'm honest... It's a big relief, isn't it?

0:47:090:47:12

I'm sorry, I don't really know what to say. Don't worry.

0:47:120:47:16

You're going to have a bad headache because we took some pressure off

0:47:160:47:19

so it's going to be like the worst hangover you've had.

0:47:190:47:22

Very difficult. Of course it was, no. You've done really well.

0:47:220:47:26

You know, you couldn't almost see the tumour with the naked eye,

0:47:260:47:29

but we just confirmed it with everything

0:47:290:47:31

and it all correlated, and it's all gone. Oh!

0:47:310:47:35

What? Yeah. You've got it all out? Yeah, pretty much.

0:47:350:47:37

Oh, wow. Very happy.

0:47:370:47:40

OK? So you can relax now. Thank you.

0:47:400:47:42

You can relax.

0:47:420:47:44

OK? Wow. Thank you, thank you very, very, very, very, very, very much.

0:47:440:47:48

No problem. I'll see you later.

0:47:480:47:50

If anyone wants to ask what relief feels like, get into my body now.

0:47:500:47:55

OK. I'm going to have to go back to the next operation now.

0:47:550:47:57

Thank you. Good luck. See you. Thank you, well done, thank you.

0:47:570:48:00

He's had all that technology thrown at him

0:48:000:48:02

and he's come out the other side really well. So he will benefit,

0:48:020:48:06

but the real benefit will come for patients in the future,

0:48:060:48:09

when that technology is really well-developed and validated.

0:48:090:48:14

But without patients like Ben

0:48:140:48:16

who are willing to donate their tumour for analysis,

0:48:160:48:19

we're not going to make those steps forward.

0:48:190:48:21

This morning, we have got a big case. This young lady, Rosa.

0:48:320:48:38

You take care.

0:48:380:48:41

Up until now she's been incredibly lucky, really, health-wise.

0:48:520:48:56

In every regard.

0:48:560:48:58

She's very lucky to have landed in this hospital

0:49:020:49:06

with the right expertise.

0:49:060:49:08

I can't thank them enough. No, they've been brilliant.

0:49:090:49:12

Knife, please.

0:49:150:49:17

So we make an incision,

0:49:170:49:20

then we go underneath the breast

0:49:200:49:22

and we enter the chest in the fourth intercostal space.

0:49:220:49:28

Roberto is one of the only heart surgeons in the country

0:49:280:49:31

who performs this operation

0:49:310:49:33

using a minimally invasive technique without breaking the breast bone.

0:49:330:49:37

A traditional incision would be from here, the end of the bone,

0:49:370:49:40

to the beginning of the bone, so will cover all this

0:49:400:49:43

and will spread apart and then open it like this.

0:49:430:49:46

Only the noise makes me feel a little bit uneasy.

0:49:460:49:48

SQUEAKING

0:49:480:49:49

It looks like a Spanish Inquisition sort of tool.

0:49:490:49:53

I'm opening the pericardium, which is the sac around the heart.

0:49:530:49:59

You know, this is the heart.

0:49:590:50:02

The pericardium, the heart.

0:50:020:50:04

In order to operate on her mitral valve,

0:50:040:50:07

Rosa's heart must be stopped.

0:50:070:50:09

You happy there? Yes, we've got good line pressure.

0:50:090:50:12

First, her blood is diverted through a bypass machine

0:50:120:50:16

that takes over the work of her heart and lungs.

0:50:160:50:18

Full flow. Yes, that's full flow there.

0:50:210:50:24

Next, a solution of potassium slows then finally stops Rosa's heart.

0:50:240:50:29

Once it stops, the ECG will be flat.

0:50:310:50:33

We can work safely for an hour.

0:50:360:50:38

OK. Now I'm going to open the left atrium.

0:50:380:50:42

You see, there is a lot of blood here.

0:50:420:50:43

Within minutes, Rosa's heart valve is exposed.

0:50:450:50:48

It's not just the vegetation, there's a perforation in the valve.

0:50:480:50:52

Can you see the hole where I am putting my instrument,

0:50:520:50:55

but most of all, it's not just a hole.

0:50:550:50:56

All the valve here is so thin with infection,

0:50:560:50:59

it has to come out.

0:50:590:51:01

We can't compromise on this.

0:51:010:51:02

OK, one bit is coming off on its own.

0:51:070:51:09

At the moment, I just took out the infected part of the valve.

0:51:100:51:14

So I think that the amount of valve tissue left

0:51:140:51:17

is still good enough, with some work, for us to fix it.

0:51:170:51:22

That is really the best scenario.

0:51:220:51:24

Until I saw the valve, I didn't know we were going to be able to do it.

0:51:240:51:26

Can I have some water to test it?

0:51:260:51:28

In a patient like Rosa, who could have a life expectancy

0:51:300:51:34

of many, many decades, so is a long-term result.

0:51:340:51:39

Suction. Now we've got a pretty happy valve.

0:51:390:51:44

Can you see this, what we call the smiley face, yeah?

0:51:440:51:47

Once I'm out of here and we finish,

0:51:470:51:50

closing this incision will take five minutes.

0:51:500:51:54

So this minimally invasive technique has been proven

0:51:540:51:57

to let the patient recover much faster.

0:51:570:52:00

They are likely to be in hospital possibly two days less

0:52:000:52:03

than the normal traditional operation.

0:52:030:52:06

And so we're saving a lot of taxpayer money.

0:52:060:52:09

Now turn the red on, gently.

0:52:090:52:12

With her valve repaired, Rosa's heart is restarted.

0:52:140:52:17

Now let's have the facing.

0:52:190:52:21

The heart has been still for an hour,

0:52:210:52:23

so it is regaining its own rhythm which is becoming better and better,

0:52:230:52:27

now it's silence.

0:52:270:52:28

Rosa's got a normal heart rhythm.

0:52:300:52:33

The valve is looking very good.

0:52:330:52:34

There is no leak. As far as I'm concerned, it has been a success.

0:52:340:52:38

Hello. Good afternoon.

0:52:480:52:51

Hi, again.

0:52:510:52:53

You remember me, yeah? Yes, of course.

0:52:530:52:55

So, all good. All good.

0:52:550:52:57

Everything has been really, really straightforward.

0:52:570:53:00

Good news is that it's working well, and it's her own valve.

0:53:000:53:03

The heart is working on its own without any support.

0:53:030:53:06

Of all scenarios, this is really the best scenario.

0:53:060:53:09

Thank you very much. Thank you.

0:53:090:53:12

But we just have to wait until she wakes up and then assess her.

0:53:120:53:16

I have spoken to the intensive care last night,

0:53:520:53:54

but I haven't seen her since so...

0:53:540:53:56

She's here, behind these curtains.

0:53:580:54:00

Look at that.

0:54:000:54:02

Doesn't look like she went through much, huh?

0:54:020:54:04

Yes, isn't this wonderful?

0:54:040:54:07

Morning. Hello.

0:54:070:54:09

Look at you.

0:54:090:54:11

Hard to believe you had heart surgery yesterday.

0:54:110:54:14

So it went well?

0:54:140:54:17

Yes, absolutely. All perfect.

0:54:170:54:19

Here's the man. All perfect, so the valve looked like infected.

0:54:190:54:24

Yeah. And it looked like several weeks' infection, and it was,

0:54:240:54:28

it managed to produce a hole in the leaflet of the valve,

0:54:280:54:32

so all the tear has been taken out,

0:54:320:54:34

and we have managed to stitch it back in the normal position,

0:54:340:54:37

so we checked with the tube inside

0:54:370:54:39

and the valve looked absolutely perfect.

0:54:390:54:41

So that's my own valve?

0:54:410:54:43

You have got your own valve.

0:54:430:54:44

I think that is really the best scenario.

0:54:440:54:46

Am I going to have to have it replaced in ten years?

0:54:460:54:49

Probably not. With your valve working well now, we don't know,

0:54:490:54:51

we just have to check over the time.

0:54:510:54:53

Obviously, we need to hope that the infection is gone completely.

0:54:530:54:56

Yeah. Good.

0:54:560:54:57

You are happy? Very, very happy.

0:54:570:54:59

Thank you. I am very happy too.

0:54:590:55:01

I'm really delighted. This is just the best outcome

0:55:010:55:03

we could have hoped for, yeah. Yeah, really happy.

0:55:030:55:06

Thank you all so much. Great. I am just in awe of your work.

0:55:060:55:10

No, not at all, Rosa, it's a pleasure.

0:55:100:55:13

Talk soon, all right? All the best, yeah, bye-bye.

0:55:130:55:16

Thank you. Great.

0:55:160:55:18

See you later.

0:55:220:55:24

A thank you card doesn't really cover it, does it?

0:55:250:55:28

Yeah, I know, I'm really happy.

0:55:310:55:33

There has been a drive in the NHS,

0:55:450:55:47

and I think it's been the right one,

0:55:470:55:49

to concentrate services in specialist areas.

0:55:490:55:54

I think Imperial is probably unique,

0:55:540:55:56

in that it's such a large cardiac unit

0:55:560:55:59

but also has a very large neurology, acute stroke unit,

0:55:590:56:03

neurosurgical unit, so you have this confluence of expertise

0:56:030:56:07

which actually, when it came to Rosa's case,

0:56:070:56:09

was absolutely appropriate.

0:56:090:56:11

It's great, well done. This has been a long time coming.

0:56:150:56:17

It really has, you've been brilliant. Yeah.

0:56:170:56:20

OK? Mm-hm.

0:56:200:56:22

So it looks as though we've got a primary angioplasty that's just arrived.

0:57:090:57:13

Anterior hypokinesia, OK.

0:57:130:57:15

Anterior ST elevation and... OK.

0:57:150:57:17

Don't worry about him. He's having a heart attack

0:57:200:57:22

but we'll get him in straightaway and we'll get him sorted out.

0:57:220:57:25

Don't worry about him. You take a seat in the waiting room

0:57:250:57:28

and we'll get him sorted out quickly.

0:57:280:57:30

OK, and we'll come out and let you know. Thank you. All right.

0:57:300:57:33

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0:57:380:57:40

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0:57:400:57:42

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0:57:460:57:48

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