Episode 1 Saved: At the Heart of the Health Service


Episode 1

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Transcript


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I mean, you always hear about people's families and you don't

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really think about it until it comes to your own door.

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To have been told that you could survive and get new life

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from a new kidney was the only hope I was living on.

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Truly, our donors are our heroes.

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They put themselves on the line for the love of another human being.

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Just got a call from ICU. Told us that they might have a body.

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It's hard, you know, moving a child or baby.

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They haven't really lived a life.

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So, this gentleman's coming with a wound to the back of his head

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and a sore-looking eye but we don't know why.

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He doesn't speak any English at all.

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The first two nights, I cried myself to sleep.

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My husband was murdered during the Troubles,

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so I've sort of never got over that, like.

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There are times when I would go away and I would weep,

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because, yeah, some of the things are very difficult.

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We've spent a year looking under the skin of the health service,

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focusing on the large team of people

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who dedicate their lives to saving ours.

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Around 1,700 people in Northern Ireland

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are living with end-stage renal failure.

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800 patients are on dialysis.

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Last year, the Belfast team performed

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a record-breaking 115 kidney transplants.

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We're now number one in the world

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and this makes the whole unit feel immensely proud.

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I'm William Spiers.

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I'm from Killyleagh.

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I discovered that I took a cyst in my belly button.

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The doctors rang me to say they'd found something in my blood.

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They discovered that my kidney function was only working at 15%.

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So whenever they scanned my kidneys, they could hardly see them at first,

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because they were that small and they'd shrivelled up.

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It's difficult for me to convey how dangerous kidney failure is.

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Your life expectancy is halved.

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It's got a worse survival than most cancers.

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My brother Jonny here is going to give me his kidney on Wednesday,

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so if all goes well, it'll be life-changing for me.

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Even a blood test, I would get worried about going to the hospital

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for that and that's only a simple thing,

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so, nervous but still excited at the same time.

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Hopefully it'll not be too bad for me.

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It'll be nothing compared to what my brother has to go through anyway.

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So, anybody in the same situation would do it, so they would.

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No, but he's very brave, too.

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He's a hard nut, like.

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You always hear of it in other people's families

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and you don't really think about it until it comes to your own door.

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When it does, it definitely hits you, like, so it does.

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It hits everybody.

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Dialysis can only work for so long, for some people,

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and, you know, whenever I was told all this, it didn't really...

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You know, it was really hard to take in.

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It does make you a wee bit emotional,

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so it does.

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You know, to have been told that you could survive and

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get new life from a new kidney was the only hope I was living on.

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It was just the relief that he got a kidney,

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so it was. It just happened to be mine.

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I'd have been happy if it had have been my sister or my brother's

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but it just turned out that mine was the best match available.

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At the Royal Belfast Hospital For Sick Children,

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paediatric neurodisability consultant Claire Lundy

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and occupational therapist Julia Maskeray

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have an appointment with three-year-old Aoife.

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Aoife's case would be fairly typical of a child presenting

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with hemiplegia which have resulted in a problem

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with moving the right arm.

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I know.

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We need our marbles.

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We need to open our bottle

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and pour them into our saucepan to make our soup.

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You do it. Aoife do it.

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Good girl. So, holding.

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One hand to hold.

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Yes.

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Clever, clever girl.

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Today, Julia will focus on Aoife's right hand.

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Oh, Mummy, wait till you see.

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The assessment is play based but it really does assess how effectively

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a child uses their two hands through play.

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What about this hand?

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Can you put a bracelet on this hand?

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One, two. Or will we tidy up?

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What do you think? Do you want it on?

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Oh, lovely.

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Gorgeous.

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They are actually trying to elicit certain behaviours with the upper

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limb and it can be to see whether they can actually grasp

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and stabilise an object, so it does look like I'm playing but we

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are actually looking to see is what it is that's

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limiting that child's function.

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Aoife did really well there, didn't she?

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-She did, didn't she?

-You're a wee star, aren't you?

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One of the things that we noticed is

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that her grip is limited by her thumb being stuck across the hand.

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One of the treatments that can be very helpful is using botulinum toxin,

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a day case procedure up in Musgrave Park.

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And the aim of the botulinum treatment is to improve her grip

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and hopefully the functional use of her right hand.

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The botulinum toxin gives us a window of opportunity but what

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actually has to come is a lot of activity.

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It is the activity that creates the change.

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-Good girl. Well done.

-Super-duper.

-Smart lady.

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In Craigavon, hospital porter Paul Anderson starts his shift.

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Porters.

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A typical day of our porter is transfers from ward to ward.

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Blood units. They bring all the linen up to the wards.

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Then there's security too.

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If any people's kicking off, or anything, we just go up

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and try to calm them down and put them back to bed.

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Usually on the weekends, it'll all kick-off.

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Giving abuse out all the time to nurses, so they phone us.

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Sometimes we see it on the camera before the nurse even says.

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You can even tell who's coming to the door,

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who's going to kick off, the state of them. They're drunk.

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Part of Paul's job is looking after the car park.

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I'm just out here studying cars,

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cars that are not supposed to be parked here.

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It's not right on disabled people. We have to go out and put these

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stickers on them just to warn them to not park there again.

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I had to sticker a man's car there, so I did.

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It was in a disabled spot, so I had to put a sticker on it.

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They're a bit hard to get off, so they are, so I don't like doing it,

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like, but it has to be done.

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Maybe it'll give him a hint not to park there again.

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The day has finally arrived for Jonathan

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to donate his kidney to his brother William.

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There's nothing routine about living donor surgery.

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The stakes are so high in terms of outcomes.

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When these things go well, it's fantastic, but

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when things go wrong, you really feel it.

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Reality is just kicking in for William and his girlfriend Joanna.

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There's no turning back now, so there's not.

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The nerves is kicking in...

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..but, sure, it has to be done.

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Yeah, I'm really excited that he's finally getting a kidney.

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Like, people don't really realise how much it changes your life being

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on dialysis. I feel like I'm going to cry now talking about it...

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It's been a tough year, like, for us.

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So it has.

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Very nervous. I'll be happy when it's over and he's back up here.

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The Spiers family have had their fair share of heartache this year.

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We're a very close family, like,

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especially this year has brought us all together, real close.

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It'll be strange now whenever I get home, so it will,

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because I have two kids at home.

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They're staying with their granny, so they're all excited about that.

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I had three kids but one of them unfortunately passed away last year.

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Kayla passed away at the end of August.

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She lived for four days and...

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It just wasn't meant to be.

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Truly, our donors are our heroes, they really are.

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They put themselves on the line for the love of another human being.

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Whether it's their brother, whether it's their sister, mother, father,

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they've put themselves at risk

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and the risks are significant.

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Right, then.

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It's definitely a good thing he's doing, like.

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I'll see you later on. Right, Vanessa.

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At the A&E in the Royal,

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triage nurse Jane Wilson has an interesting day ahead.

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So, this gentleman's come in with a wound to the back of his head and a

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sore-looking eye but we don't know why.

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He doesn't speak any English at all. Could you interpret for me, please?

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Could you ask this gentleman what's brought him up to A&E?

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All right.

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IN OWN LANGUAGE:

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Thank you.

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A fall? When did that happen?

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Did he tell you anything about the fall?

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It's really, really important that I know, was he knocked out or not?

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I need you to ask him, did he get knocked out?

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Was he unconscious?

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I need that answer. And I also need to know why is he on warfarin?

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Here you go.

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-Mr Lin produces a hospital letter.

-Thank you.

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I think, roughly, he fell this morning and he doesn't know why.

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So, he just woke up on the floor so we'll have to just treat it like it

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was some sort of heart collapse or something severe and work back.

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After consulting with the interpreting service,

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it appears that Mr Lin lost consciousness

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whilst sitting on the toilet.

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Apparently he fell, resulting in a head injury.

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Further tests are now needed to rule out anything more sinister

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than just a cut to his head.

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In Belfast City Hospital,

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Mr Tim Brown and his team prepare donor Jonathan for his surgery.

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All William can do now is wait.

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Mr Brown will perform keyhole surgery to remove Jonathan's kidney.

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He begins by making two incisions in Jonathan's side and inserting a

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camera to help him navigate his way through

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the vital organs to reach the kidney.

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So, we just put some gas into the tummy to make sure that we can see

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what's what, so that it gives us some room to operate.

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And that's hopefully what we'll be able to use to take this kidney out,

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so, what we've got to do is move a few things out of the way

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to get to the kidney. We've got the colon here

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which we're going to have to move out of the way.

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It's got natural adhesions to the tummy wall,

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which we'll have to take down first of all.

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I'm using an instrument that cuts with ultrasound,

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so what it does, it cuts and seals any blood vessels,

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because it's nice not to operate with any blood around.

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After two and a half hours, Jonathan's kidney is removed.

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We're going to disconnect the kidney from the blood supply.

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Just come back.

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So, this bit is the time-crucial bit.

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We want to try to minimise the time at all because when the kidney

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is warm and not getting a blood supply,

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then that's when the damage to the tissue is done.

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A larger cavity is needed to retrieve the kidney.

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So the problem is we've made a hole in the lining of the tummy in order

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to get the bag in but we need to still keep operating with

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the gas inside the tummy,

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so this is what this elaborate sort of situation is about now.

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Gas on, please.

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Jonathan's kidney is now ready for retrieval.

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And then what we do is we put the kidney in the bag.

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There we go. Scoop it up.

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Lovely. Lovely.

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OK. Top lights on, please.

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Very good. And that goes over to get nice perfusion.

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When the kidney comes out,

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we need to make sure that all the blood vessels are suitable for

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transplantation, so there's a bit of tidying up on the back bench when

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the blood is flushed out of the kidney

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and it's cooled down to stop the metabolism of the kidney

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in order to preserve it while it's not being perfused with blood.

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So, it looks like a nice kidney. Very pleased with that.

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Just give it a bit of a tidy up.

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Make it look pretty. Very, very pleased with that.

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In Craigavon, porters Paul and Raymond are on the night shift.

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Tonight, they face one of the tougher parts of the job.

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Dealing with death is a big part of hospital life.

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You soon get used to it, like, it's just part of the job.

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You don't even think about it after a while.

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Sometimes three or four a day, so...

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So it's a right few over the year, like.

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When I first started,

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if I had to move the body, it was tight enough.

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I didn't really like doing them.

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It's hard. Especially, I've got a child and all, so it's hard,

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you know, moving a child or a baby or anybody under a certain age.

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I've a child myself, like, so I don't really like doing them.

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Like Raymond was saying, young ones are hard to do,

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but you soon get used to it. It's part of the job.

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You don't even think about it after a while.

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You just get on with it and that's it, really.

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Jonathan's surgery is over and he's taken to recovery.

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Are you feeling all right?

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Just tired. A wee bit of pain but nothing...

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I've felt worse, like.

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That was a very long day, waiting for him.

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It's now William's turn for surgery.

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So this morning's operation was keyhole.

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This is definitely not a keyhole operation.

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This'll be what we call an open operation.

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Mr Brown begins by opening an area of tissue

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just above William's groin.

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The new kidney is placed in this area

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and connected to the main artery in William's leg.

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-So can you see in the screen yet?

-Yes?

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Yeah, so that's the blood supply to the leg.

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That's the external iliac artery.

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So what we've got to do is prepare these vessels to accept the kidney,

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so that means getting rid of some of the tissue surrounding them.

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Yeah, this way.

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Right, so now we've got the kidney

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that Jonathan so kindly donated this morning.

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So we got the ureter, we've got the artery here sitting behind them.

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So what we've got to do is join, put the ureter onto the bladder.

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OK, so what we want to do now, see how he wants to sit.

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That looks like he wants to sit there very nicely.

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In order to get the kidney connected,

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we need to make a hole in the vein

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and to do that, we need to get control of it,

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so we've closed off the vein on one side and to the other.

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Can I get a knife, please? Thank you.

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So now we're going to make a hole in this vein and hope that

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the instrument has connected it properly, which it hasn't.

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Suddenly, the clamp fails but within seconds,

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he has the bleed under control.

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The team can now transplant Jonathan's kidney into William.

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The moment of truth is when the grey kidney plumps up and turns pink.

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So you can see, it's all white, so what we're going to do

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is let the artery in and that'll go pink,

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hopefully, and swell up.

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That's exactly what we want to see.

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and then let the vein in and that's the kidney back to life again.

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So what we're looking for now is the ureter.

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I want to see clear liquid coming out of here, so we'll see...

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Oh, and there we go. So the kidney's started to pass water already,

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so that's really good.

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The transplant is almost complete.

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So you can see the artery joined there

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onto to the external iliac artery,

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a nice pulse and the vein in front of him here

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just going on the iliac vein in front of it.

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A nice pink kidney and then the ureter's

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going in there into the bladder there.

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It's nice.

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Very pleased.

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It's been two days since William received Jonathan's kidney.

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He's waiting for his creatinine test results

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to see how well it's performing.

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-Well, William, how's it going?

-All right? Not too bad, thanks.

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-Good. Feeling OK?

-Yes, feeling brilliant.

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Wonderful, wonderful.

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The numbers have come way down so, before we started,

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-your creatinine was over 600...

-Yes.

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..and today it's 200, so...

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-That's very good.

-Over 48 hours, that's superb.

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So, great. Yeah, you look fantastic. I'm delighted, really delighted.

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-Thanks so much.

-OK, all right, see you later.

-Thank you.

-OK.

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A significant decrease in creatinine levels indicates

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that the new kidney is functioning as normal.

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-Good, all right, so you're feeling OK, not too sore?

-Not too bad.

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-Good. Have you been up and around?

-I've been up.

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I went for a walk earlier and got washed all by myself.

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-Good man.

-Glad it's over.

-Glad it's over, absolutely.

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-You and me both.

-Thank you.

-You're very welcome. Right, OK.

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-All right.

-See you in a bit.

-Thank you very much.

-All right, OK.

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I was sick, yesterday.

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It was rough with all the stitching and all that.

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Then I felt all right after that, like.

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People say he's looking worse than me!

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So, I don't know.

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But, no, I think he's doing all right, like.

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He'll soon recover and the surgeon said he'll be out

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in a few days' time and all, so.

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Did you get a drop of dinner, did you?

0:20:460:20:49

Aye, smoked fish or something.

0:20:490:20:51

Are you getting the hell out?

0:20:510:20:53

I'll say it's lovely as we're on camera, but it's not really.

0:20:530:20:57

-Are you feeling well anyway?

-Oh, aye.

0:20:570:21:00

It's good to see him up and about, like.

0:21:000:21:02

That's what it was all for, like, so it was.

0:21:020:21:06

Definitely.

0:21:060:21:08

Having that kidney, that doubles his life expectancy

0:21:080:21:13

immediately compared to being on renal dialysis

0:21:130:21:18

and he will be able to lead a normal life.

0:21:180:21:21

Two months after her assessment, Aoife returns

0:21:280:21:31

to Musgrave Park Hospital for her botulinum toxin injection.

0:21:310:21:36

Ideally what we'd like to do today is to do two injections,

0:21:360:21:39

one in her little thumb to help bring the thumb position out

0:21:390:21:44

and help improve...

0:21:440:21:45

Just like that, angel, just like that. OK?

0:21:450:21:47

Well, that'll be good, won't it, darling?

0:21:470:21:49

It's going to help your hand, isn't it?

0:21:490:21:51

Well, I just do that with my thumb

0:21:510:21:53

with the other thumb, that's why.

0:21:530:21:56

Like this.

0:21:560:21:58

Can we do high-fives?

0:21:580:22:01

Good girl!

0:22:010:22:03

'The medication itself is a very small volume'

0:22:030:22:06

and we use very fine needles but children who're old enough

0:22:060:22:09

and can tell us, say that some of the injections in the upper limb,

0:22:090:22:12

there's a slight sting but that's about it.

0:22:120:22:15

For young children, even the process of coming up to hospital

0:22:150:22:18

can sometimes cause distress and I think in Aoife's case,

0:22:180:22:22

one of the things that bothered her

0:22:220:22:24

was actually the jelly that we need to use for ultrasound scanning.

0:22:240:22:30

In the end, Dr Lundy decides to give Aoife her injection a bit later

0:22:300:22:34

but she's able to give Eva, who's in the next bed, her injection.

0:22:340:22:38

Eva has been born with cerebral palsy

0:22:380:22:42

affecting her left side.

0:22:420:22:45

Her left arm, she has very little use of it at all

0:22:450:22:49

and she can't hold anything in it, she's no grasp.

0:22:490:22:52

So we're hoping that these injections today can maybe just

0:22:520:22:55

loosen her arm up a wee bit and give her a wee bit more use of it.

0:22:550:22:59

Who's going to sit beside you of these guys?

0:22:590:23:02

-Both.

-Both of them, OK.

0:23:020:23:04

'The families that I work with are just incredible.'

0:23:040:23:08

They constantly surprise me with, you know,

0:23:080:23:13

their level of commitment to their children.

0:23:130:23:16

You're OK, pet, you're all right.

0:23:160:23:20

-A little jag, pet.

-It's going to take two seconds.

-Superstar.

0:23:200:23:24

You are super.

0:23:240:23:26

Good girl.

0:23:260:23:28

Brilliant. Good girl.

0:23:280:23:30

That's a big smile.

0:23:300:23:31

'For many families, their children are in daily pain

0:23:310:23:35

'and those would be the children that we really try and prioritise

0:23:350:23:40

'as best we can'

0:23:400:23:42

and I don't know that I could ever do what they do.

0:23:420:23:45

So stretch your arm out this way.

0:23:450:23:48

In Belfast's Mater Hospital,

0:23:510:23:53

Chaplain Rosie Morton begins her rounds.

0:23:530:23:56

Being a chaplain is a distinct ministry.

0:23:590:24:01

It's different to being in a parish or a church

0:24:010:24:04

and it's different because you are part of a team.

0:24:040:24:07

There are times when I would go away and I'm not so brave faced,

0:24:070:24:10

I would weep, because some of the things are very difficult.

0:24:100:24:13

'It's not a role for the faint-hearted.'

0:24:130:24:16

Hello, Ann. It's lovely to see you.

0:24:170:24:19

-Nice to see you, too.

-Now, I haven't seen you for...

0:24:190:24:23

-Since last week.

-It was. Last time I was in a different ward.

0:24:230:24:27

The first two nights, I cried myself to sleep,

0:24:270:24:28

I couldn't sleep.

0:24:280:24:30

-Yeah.

-But thank goodness now I can.

0:24:300:24:32

'Ann is quite a sad story.'

0:24:320:24:36

She has lost touch with some of her family.

0:24:360:24:40

-And, Ann, would you like me to say a wee prayer with you?

-I would.

0:24:400:24:43

Well, you could pray for my son who I haven't seen for about 16 years.

0:24:430:24:47

-Just that he's fine and I hope he keeps well, you know?

-OK.

0:24:470:24:52

And he's two children, so I don't see them, you know?

0:24:520:24:56

And, it's hard to... I know it's a long time ago,

0:24:570:25:01

but it's hard to sometimes cope with it, you know?

0:25:010:25:05

Do you have any other family?

0:25:050:25:08

No, I have two brothers but we don't bother...

0:25:080:25:12

And my sister died about a year and a half ago

0:25:120:25:14

and I just read that in the paper.

0:25:140:25:17

Oh, goodness.

0:25:170:25:18

And my husband was murdered during the Troubles, so...

0:25:180:25:22

I've sort of never got over that, like.

0:25:220:25:25

You've had an awful lot of hard things.

0:25:250:25:28

I have but people don't...

0:25:280:25:29

-don't realise, you know what I mean?

-No.

0:25:290:25:33

-Well, will I say a prayer?

-Yes.

0:25:330:25:36

Gracious God, we come as we are

0:25:360:25:40

because we can do no other than be ourselves.

0:25:400:25:44

'Clearly there's been stuff...'

0:25:440:25:47

A really difficult number of things in her life.

0:25:470:25:50

But today and every day be close to Ann.

0:25:500:25:53

Amen.

0:25:530:25:55

-Thank you very much indeed.

-Thank you.

0:25:550:25:57

-That was lovely.

-Thank you.

0:25:570:25:59

-Well, it's been good seeing you today.

-It's good seeing you.

0:25:590:26:02

-Thank you.

-Thank you very much.

0:26:020:26:05

It's very humbling, meeting somebody and listening to that.

0:26:050:26:09

It's been over three months since

0:26:140:26:16

Jonathan donated his kidney to William.

0:26:160:26:18

Life has changed dramatically.

0:26:180:26:20

Obviously, after the operation it takes a bit of time

0:26:210:26:25

for all the healing process and all to take place.

0:26:250:26:28

Just waking up and feeling healthy and strong,

0:26:290:26:33

you know, being able to eat my steak again, is...

0:26:330:26:36

is mighty.

0:26:360:26:38

We are a close family, like, but Johnny,

0:26:390:26:42

when I look at him now, like, he's definitely...

0:26:420:26:45

You know, for him to do that for me was amazing, like,

0:26:450:26:49

and I just think the world of my brother.

0:26:490:26:53

Well, I'm keeping well now, like!

0:26:530:26:56

The first few days was a bit tough.

0:26:570:27:00

Well, I wouldn't say tough, just a bit...

0:27:000:27:02

I was maybe a bit sicker than I thought I was going to be but just

0:27:020:27:06

everyday after that, gradually you could feel yourself getting better.

0:27:060:27:10

Now I wouldn't even know I've had the op, whereas for William there,

0:27:100:27:14

he's just totally, totally changed.

0:27:140:27:16

It's like the difference between night and day.

0:27:160:27:18

It makes me feel that it was worth it, so it was.

0:27:180:27:22

The wife, she's expecting again now, which is sort of like

0:27:240:27:29

a bit of sunshine in the bit of bad weather,

0:27:290:27:33

you could call it, that we had.

0:27:330:27:35

-Go ahead.

-Pull.

0:27:390:27:42

By receiving that kidney, I would hope that that kidney would last,

0:27:450:27:51

on average, at least 25 years

0:27:510:27:53

and give William a successful life for 25 years,

0:27:530:27:57

and our record in Belfast

0:27:570:27:59

for length of graft function is 40 years and still going.

0:27:590:28:02

'It feels amazing just to be out and about again

0:28:070:28:10

'and enjoying each other's company again

0:28:100:28:14

'now we're all fit and well.

0:28:140:28:16

'I think people take life for granted, sometimes.

0:28:180:28:22

'It is a pretty amazing thing what the doctors

0:28:220:28:24

'and all can do for you and I can't be more thankful for it.'

0:28:240:28:27

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