Episode 8 Keeping Britain Alive: The NHS in a Day


Episode 8

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Transcript


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MAN SCREAMS

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18th October, 2012.

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Across Britain, 100 cameras are filming the NHS on a single day.

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MAN VIA LOUDSPEAKER: This change will be a disaster.

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CHEERING

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On this day, more than 1.5 million of us will be treated.

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Three days ago, you had a stroke.

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1,500 of us will die.

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2,000 will be born.

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WHISTLE BLOWS

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The NHS is the largest public healthcare system in the world.

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We want that to be in your voice all the time.

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Hi, we're going to help you.

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We rely on it...

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-Be really brave.

-..complain about it...

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In the bin. That's because of you.

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..often, we take it for granted.

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Lucas, Lucas!

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What we expect from the NHS is ever-increasing.

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The money to pay for it isn't.

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If we could see what this institution does in a single day...

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..what would it make us think?

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This entire series tells the story of one day.

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So, why isn't she waking up?

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100 cameras...

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capturing the NHS, as you've never seen it before.

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Baby born at 2.55.

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RADIO: Good morning, everyone!

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-RADIO:

-This day, 18th October. It's...

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BABY CRIES

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-Good morning.

-Morning.

-Morning, Collette. Any drama?

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-RADIO:

-..West Yorkshire, overturned lorry at...

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-Could you come and see a patient?

-Yeah, of course.

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-PATIENT:

-Oh, the pain's getting worse, Doctor.

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Dial 2222 for me, please. Is it...? What medication is he on?

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All right, there's no...

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PATIENT GROANS

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What happened, Doctor?

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Oh, what's going on?

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Oh-h!

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You've had a bit of a heart attack again, it looks like.

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A bit of a what?

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Manchester Royal Infirmary -

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final-year medical students role-play heart attack scenarios.

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Not another one! Oh-h!

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The patient is Bob, a £33,000 dummy.

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OK, guys, we'll stop there.

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Thank you so much.

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You saved my life!

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Bob's alive.

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Bob lives again! Right, marvellous. Let's go round the other side and...

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Around 282 people will have heart attacks in Britain today.

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200 will die.

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Dr Ordoubadi is a heart specialist.

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He's about to start one of his regular 24-hour shifts.

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Hi, guys!

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-Oh, hi!

-Yeah, you've got a heart attack case?

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Just waiting for the ECG.

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He's got previous bypass, extensive cardiac history.

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AMBULANCE SIRENS BLARE

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Dr Ordoubadi heads up the cardiac cath lab,

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a specialist unit that deals with emergency heart problems

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from across Greater Manchester.

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A 77-year-old man has been rushed in by ambulance, after collapsing at home.

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-Hello. You've had a bypass operation, when?

-1997.

-1997.

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-Had you had previous heart attacks?

-Yes, the first one was in '92.

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MACHINE BEEPS

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-Sorry.

-It's all right, don't worry.

-We won't be able to...

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I had a stent fitted and it was during the stent-fitting that I had a heart attack.

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-Do you still have the chest pain?

-Yes.

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-It looks as though you might be having a heart attack.

-Oh!

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The cath lab aims to treat all patients within an hour

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of their heart attack. The sooner Clifford gets treated,

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the better the chances that doctors can prevent long-term damage.

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If there's a blockage, we'll try to unblock it.

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The longer that artery remains blocked,

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the more muscle that actually dies,

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so we need to unblock that as soon as possible, to save more heart muscle.

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Are we ready?

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That's why we want to get him in as soon as possible,

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because the best way to unblock the artery is by putting

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the wire down and doing angioplasty.

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'And the sooner we get him on the table,

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'the sooner we know where the blockage is and the sooner we can open it up.'

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What a pain.

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Damp, clammy...

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Not very nice, no.

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Access time now.

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OK, all set.

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OK, can I have the camera in, please?

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Dr Ordoubadi guides a tiny catheter from Clifford's groin,

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so the artery is feeding the heart, in an attempt to free the blockage.

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It's, kind of, like fishing...

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Fishing, fishing, fishing.

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So, in a minute, you're going to get this hot flush. Ready?

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Stop breathing, sir.

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Make it start.

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Clifford has had 20 years of heart problems,

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but it's only in the last five that this technique has been available.

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This artery is very degenerative.

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It's, kind of, got massive amounts of clots in it.

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It's just full of clots, full of clots.

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Below it, haemorrhaging.

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We found the problem.

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Where they put the stent in, inside your chest,

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-that's blocked off.

-Ah-ha.

-Mm.

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Outside the operating room, the cath lab is starting to fill up.

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As well as six patients booked in for pre-planned treatments,

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there are more emergency cases coming in.

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PHONE RINGS

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Hello, primary PCI, Justine speaking.

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OK, where is he coming from?

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Just blue-light him straight over, don't worry.

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-RADIO:

-Both directions between the M6...

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-Put an arrow there, if that's all right?

-Yeah!

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I'd love to go on Bake Off.

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HENS CLUCK

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GEESE SQUAWK

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Morning, Basil.

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Morning, Paddy.

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Sit!

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Morning, Mother.

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25-year-old Ciaran has an extremely rare genetic disorder called Prader-Willi.

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He just licked my ear!

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The rabbit's just licked my ear.

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Pardon!

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Are you all right?

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He's a bit irregular.

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Mostly, that's what I hold, is the wee bunny rabbits.

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That's all you do, put them towards your heart and hold them tightly,

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but not too tight.

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One of the main symptoms of the condition is an insatiable hunger,

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for which there is no effective treatment beyond careful supervision around food.

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GOOSE SQUAWKS

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I am throwing this to Basil, the goose.

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SQUAWKING CONTINUES

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-My, he loves the tomatoes! Aye, doesn't he?

-Yeah.

-Yeah.

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Since leaving home at 18, Ciaran,

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who also suffers learning difficulties, has been

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in and out of community placements and secure institutions.

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For the last three weeks,

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the NHS have been helping to fund a place in supported accommodation.

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-DIRECTOR:

-So this is your palace, then?

-Yes, this is my palace.

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My palace.

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At Kilcreggan, Ciaran has his own house, but for his own safety,

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his access to food is carefully controlled.

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It's thought that as many as one in 35 people with Prader-Willi die as a result of overeating.

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Does it frustrate you having the fridge locked and everything locked up?

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It does, yeah. It doesn't feel like a normal person.

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Like, yourself, your fridge is not locked.

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If they didn't lock your fridges, would you eat the stuff in it?

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No, I won't, but other Prader-Willis would eat themselves to death.

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Overeat, overeat, you put on a lot of weight,

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and then the wee heart stops and that will be the end of them - dead.

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I'm still alive...

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because I just watch what I eat, sometimes.

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KNOCK ON DOOR

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-Hi, Ciaran, how are you doing?

-Hello, Damian.

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Damian is the manager of the home.

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He knows that today, like every day, he'll need to watch Ciaran closely.

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Ciaran is going to be a difficult proposition.

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He feels hungry all the time.

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That urge to quench that hunger is on him all the time,

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irrespective of how much he eats.

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To complicate it further, he has diabetes.

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When you factor in his constant desire to have food

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and how he can manage to manipulate situations

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and get food in other ways that you are not aware of,

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it makes it an extremely difficult condition to work with.

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Can you sometimes be manipulative to get food?

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Mmmm, if I was hungry, yes.

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-Are we nearly ready to rock?

-Yes.

-Yes, you done?

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'An hour delay on the train's northern route.'

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Um, I was close to pigeons a few weeks ago.

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-But not regularly close to pigeons?

-No.

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-He is such a happy boy.

-What time are you taking him in?

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-I'm not too sure.

-Has he not said yet?

-No.

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Tell me about Kyran's heart operation today.

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They are going to be opening him up from the chest

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and then they are going to be fixing his aortic artery.

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It's not a small operation.

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There's nothing you can do about it though, is there? He has to have it.

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Oh, dear.

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Baby Kyran is six months old.

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He was born with an abnormally small main artery to the heart

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and, at ten-days-old, had his first open heart surgery.

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Today is his second operation and, if all goes well,

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it should be his last.

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We need to stop the heart to go in and do this operation.

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This is a complex procedure.

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We need to put him on a heart-lung machine which takes

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all of the blood, mixes with oxygen and pumps back into the body.

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Getting into the chest a second time is always a difficult problem.

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There's a bit of risk involved with this operation,

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but I'm quite confident and optimistic that Kyran

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-will do very well.

-Yes.

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Parents Michael and Gemma separated before Kyran was born,

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but attend all his medical appointments together.

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What's that big smile, mate? Look at that big, lovely smile!

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Here you go.

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Is that better, eh, mate? It's cold on them corridors.

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You don't have a clue, do you?

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He's so happy.

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-I know.

-It's the best way.

-I know.

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Is that nice?

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Hello, gorgeous. He's gorgeous, isn't he?

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-Is he always this well behaved?

-Yeah.

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BABY WHIMPERS

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I'm sorry, sweetie. Oh, dear.

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BABY CRIES

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-Oh, sorry. Oh!

-OK, sh, sh, sh.

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That's it now. Big kiss and we'll look after him for you, OK?

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Did you see his eyes!

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Bye now.

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Did you see his eyes?

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His eyes were just like, up like that.

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I'm just a bit shocked because he...

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He still had his eyes open as he was falling asleep,

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so his eyes were like, going up.

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The operation to repair Kyran's heart is expected to take 4.5 hours.

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I'll try and get some sleep.

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I wouldn't be able to go to sleep.

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See the dots? Those dots are all clots.

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It doesn't look that big,

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but you only need that much to cause a complete blockage.

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In the cath lab, Dr Ordoubadi has been working for over an hour

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on Clifford's blocked arteries.

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We have done a bit of fishing, we're going to do more fishing.

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-What does the ECG doing?

-'It's on slow motion.'

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-Thank you very much.

-What does that mean?

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That means that what we were doing is working.

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Simple as that.

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Yes.

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Yes.

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Come in.

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You can see the white bit is the clot,

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we have actually managed to catch the clot.

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Taking everything out...

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This is the moment of truth. Let's get rid of this clot.

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So this is it.

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Open it up, that red bit at the bottom

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is all of the clot that we captured.

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That is what I found here.

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OK, good. So, I think our job is done.

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Clifford's procedure has been a success.

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He'll be taken to recovery

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while Dr Ordoubadi moves straight on to his next heart-attack patient.

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You've got to treat her condition, so we just put it on, anyway.

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The other one is already coming, isn't it?

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It's coming from Hull, but I think that would be more suited to Bernard.

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-Tell me what to do, I'll do it.

-Dance!

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What would we do without the NHS, eh?

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Hmm?

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-What was the question?

-Show them what they get in a pack.

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I could rip open the pack!

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Are we allowed to rip it open?

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There is a science behind what's in the pack.

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Absolutely...

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What we came across in the evidence is that,

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if you quit for 28 days, you're actually five times more likely to quit

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for good and so that is what we focused on with this campaign,

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so it is a start to stopping, as it were.

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At one point on Monday, 1 October when we launched,

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we had 50 tweets a minute.

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One, two, three, four, five. Yeah?

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10, 11, 12, 13, 14, 15, 16.

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So I would be lying to you if I said that I'm not nervous

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or I'm not anxious or anything like that.

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Most of the cases, when they are straightforward,

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we don't think twice about it, but today's case, Kyran,

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being a second operation, there is a certain element of risk.

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-Testing the saw.

-Testing.

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This is where things can go wrong while opening the breastbone

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we can straight enter into the heart,

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so we make sure that everybody's available in the theatre.

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We have the perfusionist and the heart-lung machine ready

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and set up, in case if we need to go on bypass.

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Gently.

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Are you OK?

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Is everybody all right?

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SAW WHIRRS

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It's always in my mind, what they think they might be doing

0:17:450:17:49

and... I have visions in my head and...

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I just don't think about it.

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I don't know how you can do that. How can you not think about it?

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It's mine now.

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Hello, mate. What's been happening?

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That's good news, Dad.

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Look at the camera. Smile for the camera.

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I know you haven't done your hair yet, but, hey!

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You're still beautiful, you get me?

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A true teenager.

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Genieva was diagnosed with early stage kidney failure.

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That's my girl.

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Oh, it tastes nasty.

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Yeah, but you know it's not about the taste,

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it's about what it's going to do for your body.

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All right there?

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-Are you Genieva's sister?

-Yes.

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Give her a kiss, then.

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Do you love her?

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Oh, cuddle time.

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The Yorkshire air ambulance is one of 35 helicopters on stand-by

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today across the UK.

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'Ambulance, tell me exactly what's happened?'

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'I've had a mechanic doing some work and I think he's had a heart attack.'

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A call has come from a farm outside Ripon.

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'OK, I'm organising help for you now.

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'Stay on the line and I'll tell you how to do resuscitation.

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-'Listen carefully.'

-Yes.

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'Pump the chest hard and fast at least twice a second.

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'We're going to do this 600 times or until help can take over.'

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Paramedics have been dispatched by road.

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The helicopter has been scrambled to get the 80-year-old mechanic

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to hospital as fast as possible.

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-'Is that the right pace?

-Yep. Keep going for me.'

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'11, 12, 13, 14, 15...

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'..55, 56, 57, 58, 59...

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'..90, 91, 92, 93...

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'96, 97, 98, 99...'

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'Don't give up, this will keep him going

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'until the ambulance gets there.'

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'98, 99, 100. I think the ambulance is here.'

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'OK, keep going for me until they're ready to take over.'

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'I don't how long he was down. I literally...'

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Paramedics are on the scene, trying to resuscitate the mechanic.

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It's now 15 minutes since the 999 call was made.

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Found collapsed, was blue, I got here CPR was in progress

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when I got here. Arrest could have happened at any time.

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He has got a bit of a cut on his head.

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OK. Just stop.

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Carry on. Tell me if you want to swap.

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See if you can gather any information off the other guy,

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-age and that type of thing.

-Yes, sure.

-Cheers.

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Is it a relative or...?

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No, he's a friend from the village. He does a bit of mechanicing.

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He could be hypothermic. It's unlikely.

0:21:010:21:05

At the moment, he's not responding to anything we're doing.

0:21:050:21:08

-No, I didn't like the look of him when I found him.

-Yes.

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Probably not going to be here.

0:21:110:21:13

He's not got any bruising where he's fallen or anything like that?

0:21:130:21:16

No. There is one cut here. He could've clouted it on the way.

0:21:160:21:20

He was saying to the chap it was a bit of a bugger as a job,

0:21:200:21:24

when he was doing this vehicle, so he could've got himself worked up.

0:21:240:21:28

Liz Shade.

0:21:280:21:29

-She's going to be absolutely mortified.

-Of course she is.

0:21:290:21:32

Why don't you hang fire a minute and let's see what happens.

0:21:320:21:35

Let's see if...

0:21:350:21:36

Yes, I don't want to hide it from her either, do you know what I mean?

0:21:360:21:39

I didn't know whether to call her first or the ambulance, but it was ambulance.

0:21:390:21:43

Yes, yes.

0:21:430:21:45

Pupils are fixed and dilated.

0:21:480:21:50

All right,

0:21:510:21:53

I think we're going to get to the point of calling this.

0:21:530:21:55

Is everybody happy that we call this?

0:21:550:21:57

All right, we've done ALS, we've done BLS.

0:21:570:22:00

-All his reversible causes.

-All his reversible causes.

0:22:000:22:02

Maintained asystole throughout.

0:22:020:22:05

-Right, stop here then, yes?

-Yes.

0:22:050:22:07

Tell this gentleman.

0:22:090:22:11

Yes, as we suspected, we've given him all the drugs we can

0:22:170:22:21

so far and, there's nothing.

0:22:210:22:22

I think Mark's just gone to...

0:22:240:22:26

I mean, great stuff for doing what you did.

0:22:280:22:31

I mean, certain cardiac events, certain things,

0:22:310:22:33

there's just no coming back from.

0:22:330:22:35

-Right, I better go up and see Liz then, hadn't I?

-OK.

0:22:440:22:47

Husband, father and grandfather

0:22:480:22:51

Jim Shade had no previous history of heart trouble.

0:22:510:22:54

We cut here. Press it and cut there.

0:23:000:23:03

Just leave it there.

0:23:030:23:05

Having reached baby Kyran's heart,

0:23:060:23:09

surgeon Ram is ready to cut into the artery.

0:23:090:23:11

Kyran's heart problems, this part of the aorta was quite small

0:23:110:23:16

when he was born, so, initial operation,

0:23:160:23:19

we made this bigger and now he came back with narrowing in here,

0:23:190:23:23

right in the root of this great vessel,

0:23:230:23:26

so we had to enlarge that wall,

0:23:260:23:29

make it bigger, as well as this part of the great artery.

0:23:290:23:32

To widen the valve, Ram has to painstakingly stitch

0:23:320:23:36

a six-millimetre skin graft into the artery,

0:23:360:23:39

but he can't operate with the heart beating.

0:23:390:23:41

-Are you happy?

-Yes.

0:23:410:23:43

-On bypass please.

-OK.

0:23:430:23:46

The bypass machine will take on the job of the heart.

0:23:480:23:51

So now, the heart-lung machine is taking over the circulation

0:23:560:23:59

and the heart will become empty now.

0:23:590:24:01

-We are about to stop the heart.

-We are about to stop the heart.

0:24:100:24:13

It has actually stopped.

0:24:380:24:40

If you see the ECG monitoring line there,

0:24:400:24:42

which has completely gone flat.

0:24:420:24:45

The white at the top and the heart rate is zero.

0:24:450:24:47

Gemma first found out there was a serious problem with Kyran's heart

0:24:530:24:57

during a routine pregnancy scan.

0:24:570:24:59

Doctors couldn't tell whether the defect was treatable

0:24:590:25:03

and weren't able to give a clear prognosis until he was born.

0:25:030:25:06

I was 32 weeks pregnant and they actually said to me

0:25:060:25:11

that I could actually terminate my pregnancy then.

0:25:110:25:13

For someone to say that you could terminate your baby at 32 weeks

0:25:130:25:18

is, it's very hard to take.

0:25:180:25:21

I couldn't.

0:25:210:25:23

I know they have to give you that opportunity

0:25:230:25:25

to have a termination but...

0:25:250:25:27

No, I couldn't.

0:25:270:25:29

Because of all the stress, me and Michael have split up.

0:25:300:25:34

Michael couldn't take it, so he went to live with his mum.

0:25:340:25:38

I think he just wanted to be on his own.

0:25:400:25:42

For Michael not being there, it was a lot harder to...

0:25:450:25:50

Because I was, I just got all of that information about Kyran

0:25:520:25:56

and all I wanted to do was just cuddle up to Michael,

0:25:560:26:00

you know, like you do, and he weren't there.

0:26:000:26:04

You're too busy worrying to think about each other. It's quite...

0:26:060:26:10

It very difficult.

0:26:110:26:13

He'll be all right.

0:26:170:26:18

Genieva, roll your window.

0:26:200:26:22

Thank you.

0:26:220:26:24

Where are you going, Genieva?

0:26:240:26:26

-Look in the camera, please. Where are you going?

-Hospital.

0:26:260:26:29

Which hospital?

0:26:290:26:30

Evelina.

0:26:300:26:32

Guys Children's Hospital.

0:26:320:26:34

-How do you feel about going there?

-OK.

0:26:340:26:38

You feel OK?

0:26:380:26:39

Cheese, Mum!

0:26:390:26:40

-Why do you have to go there?

-To have dialysis.

0:26:400:26:43

-Look into the camera, please.

-Cheese!

0:26:430:26:46

-To have dialysis.

-Three times a week.

-Yes.

0:26:460:26:49

Cheese!

0:26:490:26:50

'A very important date in the calendar of Welsh music today...'

0:26:500:26:54

My friend, Louisa, the blonde.

0:26:550:26:59

Very good. What lovely teeth.

0:27:010:27:03

Stigmatise the cigarette, rather than the smoker.

0:27:160:27:18

We want the smokers to feel we are on their side.

0:27:180:27:22

OK, let me show you again. This is our dominant image.

0:27:220:27:26

It's a cigarette with a fleshy, red, cancerous tumour.

0:27:260:27:31

Oh, I could never be a heroin addict!

0:27:340:27:37

'We are talking about the cost of celebrity gone wrong.

0:27:370:27:40

'Plebgate, it's not going away, you know.

0:27:400:27:43

'Gary Barlow is off on a solo tour. Would you pay to see him

0:27:430:27:47

'without the rest of the Take That lads?

0:27:470:27:49

Under the watchful eye of Kilcreggan care home staff,

0:27:490:27:52

Ciaran is making his favourite egg and onion sandwiches for lunch.

0:27:520:27:56

Ciaran does like onions,

0:27:560:27:58

absolutely no problem to him.

0:27:580:28:00

Eats them like apples. It's an acquired taste, that's for certain.

0:28:000:28:04

There is no medication to ease Ciaran's constant urge to eat.

0:28:040:28:08

All staff can do is make sure he maintains a healthy lifestyle

0:28:080:28:12

with exercise and strict meal rotas.

0:28:120:28:14

You go swimming today, yes?

0:28:140:28:17

No. Go on Sunday.

0:28:170:28:18

-It's under swimming.

-Zumba.

0:28:180:28:22

Zumba.

0:28:220:28:24

-Zumba.

-Zumba today.

-Yes.

0:28:240:28:27

-OK.

-I know what my days, I know my schedule, blah blah blah.

0:28:270:28:32

That's what I'm looking for.

0:28:360:28:39

You don't have soup today.

0:28:400:28:42

Yes, I have soup with my sandwich.

0:28:420:28:44

It's all right.

0:28:440:28:46

Go on, make a big fuss of it.

0:28:570:28:58

Go on! Make a big fuss of it! Go on!

0:28:580:29:01

-Make a big fucking fuss of it!

-I just want to...

0:29:010:29:04

Go on, make a big fuss of it, go on.

0:29:040:29:06

-I just want to talk to him.

-Go on, make a big fuss of it.

0:29:060:29:09

You see that there. I can crumple it up. I can put it in the bin.

0:29:090:29:14

-That's because of you.

-No, I just explained to you.

0:29:140:29:17

I've put it in the bin.

0:29:170:29:19

-You can read. Today...

-Fuck away off! Fuck away off!

0:29:190:29:23

Calm down, Ciaran.

0:29:230:29:25

I'm going to see him.

0:29:250:29:27

I'm not staying in this fucking Kilcreggan.

0:29:270:29:30

I'm telling you, I'm telling my mother.

0:29:300:29:32

Calm down, calm down.

0:29:320:29:33

Fuck away off. Fuck away off!

0:29:330:29:36

You are driving me in-fucking-sane, man.

0:29:360:29:39

He's over limit on his food budget,

0:29:390:29:42

because the soup is tomorrow's lunch.

0:29:420:29:45

Being in this place makes me so popping mad sometimes.

0:29:450:29:48

Ciaran, did you read this?

0:29:480:29:50

Get the saucepan out of his hands.

0:29:500:29:52

I'm sure you read that, Ciaran.

0:29:520:29:54

I always have a soup along with my sandwich.

0:29:540:29:56

So is the thing for you and me to do

0:29:560:29:59

-to have a conversation with Sandra later on?

-Yes.

0:29:590:30:01

OK, that's the thing we'll do then.

0:30:010:30:03

Mealtimes will, nine times out of ten, will be challenging.

0:30:060:30:09

What he was after, was he'd seen the cup-a-soups sitting there

0:30:090:30:12

and that's what he wanted.

0:30:120:30:13

That was part of his menu yesterday and part of his menu tomorrow

0:30:130:30:16

and he knows his menu, you can be absolutely sure of it,

0:30:160:30:19

but that was an opportunity that he'd seen to get something extra.

0:30:190:30:24

Anybody else, it's not a problem,

0:30:270:30:29

but, you know, he's limited to an amount of calories.

0:30:290:30:31

His metabolism burns off food a lot slower than we do

0:30:310:30:36

and that's where the real risk is.

0:30:360:30:38

It seems like such a simple thing to turn around and say,

0:30:380:30:41

"Yeah, go ahead and have that,"

0:30:410:30:42

and the next time, "Go ahead and have that."

0:30:420:30:45

Then you come back four weeks later and allow him to have all that

0:30:450:30:48

and you're looking at a stone weight on as fast as that.

0:30:480:30:51

And that continues to multiply

0:30:510:30:53

and that's where the real danger in his health comes to.

0:30:530:30:56

54 minutes, coming up to an hour now.

0:31:150:31:17

OK, now let me assess that other side once again to see...

0:31:240:31:28

No, stop.

0:31:280:31:29

He is given? OK, we will try and do our best to...

0:31:310:31:34

Ram has successfully sewn the tiny graft into baby Kyran's heart valve.

0:31:340:31:38

But in doing so, he has discovered another problem.

0:31:400:31:43

These are called the leaflets of the valve, they are supposed to be

0:31:430:31:47

very thin, but in Kyran's case they are a bit thicker now.

0:31:470:31:52

What looks like instead of having three leaflets out of three doors,

0:31:520:31:56

-surprisingly he has got only two doors.

-Did you know that?

0:31:560:31:59

Sometimes with the scans you can't exactly see,

0:31:590:32:02

but what we know is that it will cause problems to him

0:32:020:32:07

later on because it's not a normal valve.

0:32:070:32:10

The newly discovered defect means Kyran may well have to undergo

0:32:120:32:15

more open heart surgery.

0:32:150:32:17

What we need to do now is to expel all the air.

0:32:180:32:23

If air travels to the brain, it causes brain damage.

0:32:230:32:26

Is the vent sucking OK?

0:32:260:32:28

OK, clamp off, lungs off, please.

0:32:310:32:34

The heart has started beating happily which is a good sign.

0:32:420:32:46

You can see the ECG has returned.

0:32:460:32:48

The heart is contracting,

0:32:480:32:50

so now we are ready to take Kyran off the heart-lung machine.

0:32:500:32:53

-Are you happy?

-Happy.

0:32:530:32:54

Are you ventilating a bit? Come off bypass, please. Go on.

0:32:540:32:59

-A little bit of volume, please.

-OK.

0:33:010:33:04

Ram can only be sure this operation has worked

0:33:040:33:07

when the heart is beating independently

0:33:070:33:09

and the scan shows the artery is working.

0:33:090:33:13

I am happy.

0:33:240:33:26

With the scan we have done

0:33:260:33:27

and with the result, we are sure that the operation is a success.

0:33:270:33:30

-Hello.

-Hello.

-Everything went fine.

0:33:370:33:40

-We did what we planned to do.

-Yes.

0:33:400:33:43

There were a couple of things that we hadn't been expecting.

0:33:430:33:48

Normally in every person the valves should contain three doors,

0:33:480:33:51

open and closed. Normal people.

0:33:510:33:54

So what Kyran has got is he has got only two doors

0:33:540:33:57

and the two doors are not equal.

0:33:570:33:59

So the problem now is that since his valve is not normal,

0:33:590:34:03

-it might require another operation later on.

-OK.

0:34:030:34:05

-He hopefully won't need another one after that.

-Hopefully not.

0:34:050:34:08

-Hopefully not.

-So...

-Everything went well.

0:34:080:34:10

We'll give him some more time

0:34:100:34:12

so that he'll settle and then wake up properly.

0:34:120:34:14

Yay!

0:34:140:34:16

-I'm going to cry. I am just so happy.

-Yes, he is fine.

-Good.

0:34:160:34:21

Thank you very much. Yes. I'm just so happy.

0:34:210:34:25

Everything were good, everything were successful, yes.

0:34:250:34:28

I'm just so happy. Yes.

0:34:280:34:31

At the cath lab,

0:34:420:34:43

73-year-old Noel has come in to have his arteries examined.

0:34:430:34:47

I seem to be, you know,

0:34:490:34:52

if I'm walking any distance, I seem to get breathless very easily.

0:34:520:34:57

And I get tired very, very easily.

0:34:570:35:00

So they just want to sort of check to see basically

0:35:000:35:05

what's causing this problem.

0:35:050:35:08

-What do you think it might be?

-Who knows?

0:35:080:35:11

Just have to wait and see.

0:35:130:35:15

Bit of pushing in the arm now, sir, a bit of pushing in the arm.

0:35:170:35:20

-Right, sir, we're done.

-Lovely.

0:35:290:35:30

We're going to take this tube out of your arm now,

0:35:300:35:32

if you just hold onto this, sir.

0:35:320:35:34

-We are done.

-Glad it's over.

0:35:340:35:36

-Right, so I'm just going to...

-Pretty boring just lying here.

0:35:370:35:40

All I'm thinking now is a nice cup of coffee.

0:35:400:35:43

And a cigarette. I shouldn't say that, should I?

0:35:490:35:54

Your arteries, although there are certain blockages here and there,

0:35:540:35:57

they're not severe enough to require any intervention,

0:35:570:36:00

be it stents or bypass surgery or anything like that.

0:36:000:36:02

The other thing to say is that the pumping function of your heart

0:36:020:36:05

is actually not bad.

0:36:050:36:06

So why does my body feel as if it's out of oxygen after about 100 metres?

0:36:060:36:13

-You know, remember you are a smoker, aren't you?

-Yes.

0:36:130:36:16

So it's not necessarily your heart that's to blame for all of this.

0:36:160:36:20

He does have clinical signs of smoking-related lung disease

0:36:200:36:23

and he's promised he's going to stop, gradually.

0:36:230:36:26

-Yes, the willpower is what you need now.

-Yes, I do.

0:36:260:36:28

Say to yourself, "Look, it's not too bad,

0:36:280:36:30

-"I've been given reasonably good news..."

-Right.

0:36:300:36:33

-"..let's consolidate that and build on it."

-Yes.

-OK?

0:36:330:36:36

-See you later on on the ward, then.

-Yes.

0:36:360:36:38

Smoking is a big part of his problem

0:36:380:36:40

and his main problem is breathlessness.

0:36:400:36:42

A proportion of his breathlessness will be down to his lungs

0:36:420:36:45

because when I did examine them, he does have wheezy lungs,

0:36:450:36:48

he's got expanded lungs and it's probably all smoking-related

0:36:480:36:50

so a lot of his breathlessness will be down to smoking.

0:36:500:36:53

Does it frustrate you that people carry on smoking after you see them?

0:36:530:36:56

It can be, but you know, you do your best to improve their health

0:36:560:37:01

and as frustrating as it may be, there is nothing I can do

0:37:010:37:03

to force him to stop. All we can do is just keep advising.

0:37:030:37:06

It's good news but I still haven't got sort of... How can I put it?

0:37:060:37:12

..something that I can do which actually can give me an improvement.

0:37:120:37:18

-If you understand me.

-They said if you cut down on smoking...

0:37:180:37:22

Yes, yes, yes. Well, I'm on ten.

0:37:220:37:24

Ten a day.

0:37:260:37:28

Instinctively I feel that that's not the problem.

0:37:300:37:33

Oh, well.

0:37:330:37:35

-How are you feeling?

-Anxious.

0:37:470:37:49

-Nervous?

-Yes.

-Excited?

-Excited, nervous.

-Can't wait?

0:37:490:37:53

-How old are you?

-Me, I'm 39 now,

0:37:530:37:57

I had a heart attack when I was 37.

0:37:570:37:59

And since I've had my bypass I've been back here 44 times

0:37:590:38:05

-with the same problem.

-That's crazy, isn't it?

-Yes.

0:38:050:38:08

I used to think it was down to being a little bit overweight,

0:38:080:38:12

but the time when I had my last heart attack,

0:38:120:38:15

there was a person in there who was on my ward, in my cubicle,

0:38:150:38:18

and by looking at him you could see that he was really fit,

0:38:180:38:22

he goes to the gym and everything and he had a bypass

0:38:220:38:25

so it could happen to anybody, really.

0:38:250:38:27

Right hand, quickly, quickly.

0:38:330:38:35

HE RETCHES

0:38:360:38:39

This is the hand that I used to use.

0:38:390:38:42

I had a stupid idea this, three months ago, I said,

0:38:460:38:50

for my 77th birthday, which was last week, to celebrate it...

0:38:500:38:55

..in Croatia. Dear! Did we?

0:38:560:38:59

Any heart problems prior to last week?

0:38:590:39:02

-I have had a heart attack when...

-July, 1996.

0:39:020:39:06

David and Josie have been married for 53 years.

0:39:060:39:09

On holiday in Croatia last week, David was rushed into hospital.

0:39:090:39:14

He spent three days on a coronary care ward in Dubrovnik

0:39:140:39:17

where he was diagnosed with a heart murmur.

0:39:170:39:19

He flew home, but today his symptoms have returned.

0:39:190:39:23

At least they all speak English, don't they?

0:39:240:39:26

David can communicate with people and you couldn't there,

0:39:260:39:29

and they were lovely, but it was very hard work, wasn't it?

0:39:290:39:32

Oh, yes, wonderful, wonderful doctor.

0:39:320:39:34

It was very traumatic for me in Dubrovnik.

0:39:340:39:36

They put him in a place like this,

0:39:360:39:38

"Well, we will keep him in. You go, we will keep him in."

0:39:380:39:42

I thought, "Oh, thanks."

0:39:420:39:44

So at twenty to four in the morning,

0:39:440:39:46

I was left in a very, very dark corridor with just little...

0:39:460:39:52

Nothing like these, nothing at all like that, just little lamps.

0:39:520:39:56

So how do you get out of there? You know?

0:39:570:39:59

"How do I get out of there?"

0:39:590:40:02

I thought "Well, I think I've done the easy bit,

0:40:020:40:04

"the easy bit is I've got David looked after,

0:40:040:40:07

"I could do with someone to look after me,"

0:40:070:40:09

because, you see, all the signs are in Croat. You just...

0:40:090:40:15

It's not something that I would recommend to anybody,

0:40:150:40:19

but we got through it.

0:40:190:40:22

Anyway, I found my way out with the help of a...gorgeous man.

0:40:220:40:26

Clogs and all. White clogs and everything on. You know?

0:40:280:40:32

We did want to come home, yes.

0:40:340:40:36

David more than me, because the food was, it was fed in steel bowls.

0:40:360:40:42

You know, like you give dogs.

0:40:420:40:45

It was, well, I don't know if it was soup or Ready Brek.

0:40:450:40:50

I don't know what it was. It was indescribable.

0:40:500:40:53

The food was terrible.

0:40:530:40:55

He said, "Look at my lunch!"

0:40:550:40:57

But he's not right, my David, you know, he's not right.

0:41:050:41:08

They'll get him right, hopefully.

0:41:080:41:11

Kyran is back from theatre and he is stable,

0:41:320:41:36

but since he's come onto the unit he has started bleeding

0:41:360:41:38

more and more.

0:41:380:41:40

We are on top of it, but his body is fighting us so we need to keep him...

0:41:400:41:46

There's been an unexpected complication.

0:41:480:41:51

Kyran's suddenly losing a lot of blood.

0:41:510:41:54

I can see his heart beating.

0:42:000:42:03

Yes, because it's beating so hard, so fast, the heart.

0:42:030:42:06

-He's not going into cardiac arrest or anything?

-No, as long as we...

0:42:060:42:09

Ram is going to reopen Kyran's chest to find out why he's bleeding so heavily.

0:42:090:42:14

If he is bleeding excessively...

0:42:140:42:16

When he initially came in here, it wasn't much,

0:42:160:42:19

he was extubated, everything was good, we thought.

0:42:190:42:21

But then he suddenly started bleeding.

0:42:210:42:24

We interfered with the clotting mechanism of the blood, so

0:42:240:42:28

we keep it very thin and sometimes it doesn't thicken very well.

0:42:280:42:31

It is always safer to have a look.

0:42:310:42:34

Hopefully we can fix it.

0:42:340:42:36

Will someone ring us?

0:42:370:42:39

Can I give him a quick kiss?

0:42:390:42:41

Ram needs to operate immediately and so closes the intensive care ward.

0:42:490:42:54

I thought that were it, I thought he were going to be fine and then...

0:42:550:42:58

Everything's changed.

0:43:000:43:02

I'm confident in everything what they're doing, but it's...

0:43:030:43:06

At the end of the day, it's still my baby and there's still,

0:43:060:43:09

something, you know, serious happening.

0:43:090:43:12

He's got an emergency on and there's one treat and return.

0:43:250:43:28

-And there's another one going in.

-There's another one after this one.

0:43:280:43:31

It looks like we going to be busy already, so...

0:43:310:43:34

I know, that's why I want to create as much capacity.

0:43:340:43:36

The cath lab is having a run of emergency cases.

0:43:360:43:40

When you say extensive, have you got a measurement?

0:43:400:43:43

OK, all done! Good news.

0:43:430:43:46

-One in, one out.

-One in, one out.

0:43:460:43:48

ETA, when, sorry?

0:43:480:43:51

Ten minutes, OK. Thank you very much.

0:43:510:43:53

There is a shortage of beds and procedure rooms.

0:43:540:43:57

Five minutes, thank you. All right, thanks, love. Bye. Five minutes.

0:43:570:44:02

With another emergency case about to arrive, the team have to make

0:44:020:44:06

a difficult decision about a female patient from another hospital,

0:44:060:44:09

who's been waiting for her planned operation.

0:44:090:44:12

She won't have a bed to go into because they're all male beds.

0:44:140:44:17

I'm not arguing who should be done, but there is still two to do.

0:44:170:44:20

Don't you agree with that, though?

0:44:200:44:22

Don't you think that's a wise decision?

0:44:220:44:23

If we can't do it, we can't do it.

0:44:230:44:25

-We're just moving, so there should be a bed.

-Right, lovely.

0:44:270:44:30

She's crying.

0:44:300:44:31

She's not happy.

0:44:320:44:33

It's quite sad really, because she's been waiting for a few days.

0:44:330:44:36

She's got a complex case and you want to do her procedure

0:44:360:44:39

but you can't right now, because we've got an emergency coming in.

0:44:390:44:42

If it's up to you, you'd stick around after five o'clock

0:44:420:44:45

and do it at six or seven, but it's not up to you

0:44:450:44:47

and we've got nowhere to put her after we do her procedure.

0:44:470:44:50

The latest emergency patient is 74-year-old Rita.

0:44:500:44:54

When did the chest pain start?

0:44:580:44:59

I've had an aching chest all week.

0:44:590:45:02

-Have you got chest pain now?

-Yes.

-ECG, please.

0:45:020:45:07

The ECG shows you're having a heart attack.

0:45:090:45:11

In that case we're going to take you straight to the lab

0:45:110:45:15

to unblock the artery to stop the heart attack.

0:45:150:45:18

-Is that OK?

-Yes.

-Let's go.

0:45:180:45:20

What's happened to the ECG?

0:45:350:45:37

INAUDIBLE SPEECH

0:45:370:45:39

Right, OK, so that means that we need to be acting more quickly.

0:45:390:45:44

-If you hear extensive ST changes...

-It sounds bad.

-It sounds bad, yeah.

0:45:440:45:48

I've just walked into the dialysis room.

0:45:530:45:56

This is the machine that Genieva's going to be plugged into.

0:45:560:46:00

My precious baby will not be on dialysis for ever,

0:46:000:46:05

because there's nothing God cannot do, amen.

0:46:050:46:08

Some saline.

0:46:100:46:12

When you found out I was sick, like, how did you feel?

0:46:120:46:16

When I found out you were sick I was heartbroken,

0:46:160:46:20

because...this was the last thing I expected to hear.

0:46:200:46:25

'See how it is out there on the water...'

0:46:280:46:31

THEY GIGGLE

0:46:370:46:39

-How are you feeling over there?

-All right.

-OK. Any chest pain?

0:46:440:46:48

-How is the chest pain?

-It's got a lot easier.

0:46:480:46:51

We can see why, because we managed to open the artery for you. It's open.

0:46:510:46:56

So you're getting blood back to your heart, which is good news.

0:46:560:46:59

That is the artery now.

0:46:590:47:02

That's what it was before. And here, the blood flow stops completely.

0:47:020:47:07

The edge of the heart is there,

0:47:070:47:08

so that portion of the heart is not getting any blood here.

0:47:080:47:11

And now, we put a stent here

0:47:110:47:15

and now we know that the blood flow is going back to where it should be.

0:47:150:47:18

Good.

0:47:180:47:20

-Are you a smoker?

-Yes.

0:47:200:47:21

One artery was fully blocked today.

0:47:210:47:24

The tablets that you're going to be on are very important to protect you,

0:47:240:47:27

but stopping smoking is absolutely vital here.

0:47:270:47:29

I only smoke about five a day.

0:47:290:47:32

My husband smokes three times as much.

0:47:320:47:35

Mind you, I hope he doesn't end up with the same thing.

0:47:350:47:41

-I never buy them. I won't buy them.

-You just smoke his?

0:47:410:47:45

I just smoke his!

0:47:450:47:47

Rita has no history of heart problems.

0:47:500:47:52

Well, we'd just had a cup of coffee and...

0:47:550:47:58

Rita said that she had pains here. She said, "It's like indigestion."

0:48:010:48:05

And it gradually got worse,

0:48:050:48:07

and I said, "This is more than indigestion."

0:48:070:48:11

And she was grey, her face was grey,

0:48:110:48:14

and her hands were clammy and then she started to vomit.

0:48:140:48:17

I said, "This is more than indigestion, this,

0:48:170:48:20

"let me get an ambulance."

0:48:200:48:21

She wouldn't let me get an ambulance at first.

0:48:210:48:23

-She wouldn't let you get one?

-No.

-Why not?

-Not at first.

0:48:230:48:25

Well, she doesn't like the fuss and things like that.

0:48:250:48:28

But she didn't tell me that she'd had this ache all week. Did you?

0:48:280:48:34

-No.

-Naughty girl.

0:48:340:48:36

Well, now I'm worried.

0:48:360:48:37

If I do have a smoke, it's not going to be in her vicinity.

0:48:370:48:40

-It's going to be outside. Away from her.

-Oh, no...

0:48:400:48:43

It will be, it will be. You watch.

0:48:430:48:46

I've always smoked, a good many years, you know.

0:48:460:48:50

-I enjoy a cigarette.

-Have you ever had any problems with your heart?

0:48:500:48:54

Touch wood, no.

0:48:540:48:56

HE COUGHS

0:49:070:49:08

Do you like smoking?

0:49:080:49:10

I do, yes.

0:49:100:49:12

Because I like working...

0:49:120:49:14

I like something working to do with my hands. I don't like...

0:49:140:49:20

I don't like my hands just lying flat.

0:49:200:49:25

Just the way I go.

0:49:250:49:28

That's what I do during the day - smoke.

0:49:280:49:31

During the night - smoke.

0:49:310:49:35

That's just one of my leisures.

0:49:350:49:39

Keeps you calm.

0:49:390:49:41

Does smoking take your mind off the food?

0:49:430:49:47

Erm, not really.

0:49:470:49:49

What happened, James?

0:49:520:49:53

Stabbed.

0:49:530:49:55

I'm looking to retire. I feel cheated at the moment

0:49:550:49:58

because the government's upped the retirement age,

0:49:580:50:01

so I've got to stay on an extra two years, so I feel very cheated.

0:50:010:50:04

'..Chelsea defender says he wanted to apologise to everyone...'

0:50:060:50:09

That's us leaving now after a long day at dialysis.

0:50:110:50:14

She's so tired and fed up.

0:50:140:50:17

Her room is damp, so we are all sleeping in one bedroom.

0:50:170:50:22

It's ridiculous, really.

0:50:220:50:25

But I love her courage, I love her strength.

0:50:250:50:28

If her dad was alive, I'm sure he'd be proud of her,

0:50:280:50:32

she's a beautiful daughter.

0:50:320:50:35

My beautiful Genieva.

0:50:350:50:36

-Hello.

-Hello.

-How's things?

-Not too bad.

-Hello, how are you?

-All right.

0:50:460:50:51

You're looking very smart.

0:50:510:50:55

So what's your plans the rest of the day, Ciaran?

0:50:550:50:58

Well, I don't know.

0:50:580:51:00

Since Ciaran moved in to the Kilcreggan Care Home

0:51:000:51:03

three weeks ago,

0:51:030:51:04

his mum, Angela, has been coming to check on him

0:51:040:51:06

as often as she can.

0:51:060:51:08

-We talk about it quite a lot, don't we, Ciaran?

-Yeah.

0:51:080:51:10

Yeah, just to make sure

0:51:100:51:12

you're on the same wavelength as everybody else, aren't we?

0:51:120:51:15

And that you've got the correct food and stuff,

0:51:150:51:17

that you're making the right choices to keep yourself alive, isn't it?

0:51:170:51:24

Because we wouldn't want anything less for you, would we? No.

0:51:240:51:28

We wouldn't. We wouldn't want anything less.

0:51:280:51:31

Have to be careful.

0:51:330:51:35

-What have you found?

-No, it's just sugar-free.

0:51:350:51:37

We were just checking to make sure it was the right stuff

0:51:370:51:39

that he should be drinking. But it is.

0:51:390:51:42

I'm not buying any stupid stuff.

0:51:420:51:44

No, I know you wouldn't buy stupid stuff, I'm just saying.

0:51:440:51:48

'If Ciaran wants food, he's going to get it anywhere.

0:51:480:51:50

At home we call Ciaran Houdini,

0:51:500:51:52

because he was able...

0:51:520:51:54

We were convinced he floated about the house,

0:51:540:51:56

because we never heard him.

0:51:560:51:57

You wouldn't know until the wrappers

0:51:570:52:00

or the bottles or whatever were sitting.

0:52:000:52:02

He was able to get tins of beans and things, even, out.

0:52:020:52:04

I lifted it out of his bedroom one time.

0:52:040:52:07

The food part of it is quite extreme with Ciaran.

0:52:070:52:11

This is my bathroom, my shower and that.

0:52:110:52:15

And my Home Changing Room sign.

0:52:150:52:19

'Independence to Ciaran is very much top of the agenda.

0:52:190:52:23

'We're hoping that this is the place for Ciaran,

0:52:230:52:27

'but, obviously, being out in the community,

0:52:270:52:29

'it's always at the back of your mind

0:52:290:52:31

'when you're going to get the phone call'

0:52:310:52:33

to say something's happened,

0:52:330:52:35

or he's gone into a diabetic coma, or...

0:52:350:52:37

Yeah, you're just waiting for that phone call, you know?

0:52:370:52:39

All Ciaran's previous attempts to live independently have failed.

0:52:390:52:45

The NHS found him a place at a residential college,

0:52:450:52:47

but it was only weeks before his behaviour deteriorated

0:52:470:52:51

and he was sectioned back to a secure hospital.

0:52:510:52:53

'Ciaran obviously was buying the wrong types of food,

0:52:540:52:57

'wasn't taking his insulin.'

0:52:570:52:59

He threatened a couple of the teachers down there

0:52:590:53:01

who were more than good to him.

0:53:010:53:03

The different bodies were all brought in, social services, doctor.

0:53:030:53:07

Ciaran was put in the back of the ambulance

0:53:070:53:11

and, for his own safety, Ciaran was then handcuffed,

0:53:110:53:14

because obviously he tried to jump out,

0:53:140:53:16

and he was taken up to a secure accommodation

0:53:160:53:20

on the outskirts of Belfast.

0:53:200:53:22

But, yeah, the worst day of our lives, that was. It was awful.

0:53:240:53:28

'We're obviously sceptical

0:53:370:53:39

'of what way things are going to go for Ciaran,

0:53:390:53:41

'but he's trying, and we're hoping that it'll be'

0:53:410:53:46

the place for him to stay and make a life for himself,

0:53:460:53:49

and hopefully live as long as he can, you know?

0:53:490:53:53

'I'm a 25-year-old man, I don't need to be treated like a two-year-old.'

0:53:530:53:58

I just want to get on with my normal life, before...

0:53:580:54:02

Like the rest of people do, like yourself. I just love independence.

0:54:020:54:07

'The freedom now that he's got out in the community is still worrying,

0:54:080:54:12

'because we know he can still

0:54:120:54:14

'do his wee Houdini tricks and get the food.'

0:54:140:54:17

We spend as much time as we can with him.

0:54:170:54:20

As much as he'll let us - because he's independent now!

0:54:200:54:25

-I was in that bar last weekend.

-Is it any good?

0:54:250:54:28

How the hell did you get home from that?

0:54:280:54:30

Doesn't take long to get up home.

0:54:300:54:32

You walked all the way up there on your own?

0:54:320:54:35

THEY LAUGH

0:54:350:54:36

Ram has managed to stem baby Kyran's bleeding

0:54:430:54:46

and he is now stable.

0:54:460:54:48

All went well.

0:54:510:54:53

We opened the chest

0:54:530:54:54

and then... There were tiny little holes, which were bleeding actually,

0:54:540:54:58

where we took the needles through the patch we used to repair.

0:54:580:55:01

What we did is, we reinforced all those tiny little holes

0:55:010:55:04

and then we put some material and stuff to help it seal up.

0:55:040:55:08

So, as you can see, there's not much coming out through the drains,

0:55:080:55:11

and earlier on there was blood all over, which is all gone now.

0:55:110:55:15

So hope that we're on top of things.

0:55:150:55:19

OK. Yeah. Good, yeah.

0:55:190:55:21

'Surgery today has saved my son's life.

0:55:320:55:35

'If it weren't for people like Ram, he wouldn't be here now.'

0:55:350:55:39

'We don't know what the future holds for Kyran.

0:55:410:55:44

'After a few months he might need another operation.

0:55:440:55:47

'It's going to be very stressful for all of us,

0:55:470:55:53

'but we are lucky, because Kyran did pull through today.

0:55:530:55:57

'That's a lot for a little baby to go through. So proud of him.'

0:55:570:56:03

-HE LAUGHS

-Part-timer!

0:56:120:56:14

Eight o'clock to eight o'clock in the evening. Still a part-timer.

0:56:140:56:18

Yeah, I'm in a hotel tonight

0:56:240:56:25

because I'm on call for the hospital patients.

0:56:250:56:29

It's 11 o'clock at night, we've just had a call.

0:56:290:56:32

Someone coming from one of our district hospitals.

0:56:320:56:35

He's having a heart attack now.

0:56:350:56:38

He should be with us any minute.

0:56:380:56:41

-It's a wonderful place.

-It is.

0:56:520:56:55

MUSIC: "Gimme Some Lovin'" By The Spencer Davis Group

0:56:550:57:00

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0:57:370:57:40

Working To Save Lives, which accompanies this series, call...

0:57:400:57:44

..or go to...

0:57:480:57:50

..and follow the links to the OU.

0:57:520:57:54

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0:58:080:58:11

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