0:00:03 > 0:00:05This is all tumour. Worrisome. These are worrisome features.
0:00:05 > 0:00:07Scary to me.
0:00:07 > 0:00:09Probably scary for Raymond as well.
0:00:09 > 0:00:12But what's the other alternative?
0:00:12 > 0:00:15It's important to highlight, with this set of patients,
0:00:15 > 0:00:19the bravery of these people going through this type of procedure.
0:00:19 > 0:00:22This is new eye-gaze technology that I'm trying out.
0:00:22 > 0:00:26The new medication has really helped my muscles relax
0:00:26 > 0:00:28and it makes me feel good.
0:00:28 > 0:00:32It's normally a little tiny clot that really is the difference
0:00:32 > 0:00:33between life and death.
0:00:33 > 0:00:37I feel I'm one of the lucky ones, because I've had two friends,
0:00:37 > 0:00:41similar age to me, have died in the last two months.
0:00:41 > 0:00:45There's a very large team of people needed to make this all work.
0:00:45 > 0:00:47It's not just the doctors.
0:00:47 > 0:00:49Hopefully, everything goes well.
0:00:53 > 0:00:54On occasion, you may have a death
0:00:54 > 0:00:57and it's very hard to switch off then when you go home.
0:00:57 > 0:01:00You're only human, even though you are a nurse or a doctor
0:01:00 > 0:01:03or a radiographer, and you do feel the stresses and strains
0:01:03 > 0:01:05of events that happen.
0:01:14 > 0:01:18We've spent a year looking under the skin of the health service,
0:01:18 > 0:01:20focusing on the large team of people
0:01:20 > 0:01:23who dedicate their lives to saving ours.
0:01:25 > 0:01:31Around 5,000 people in the UK are diagnosed with brain tumours every year.
0:01:31 > 0:01:34The neurology team in the Royal Victoria Hospital perform
0:01:34 > 0:01:36this life-saving brain surgery every day.
0:01:38 > 0:01:4255-year-old Raymond Killen is waiting for his surgery.
0:01:45 > 0:01:51As a porter in Musgrave, I like basically helping people,
0:01:51 > 0:01:53you know, be a part of that.
0:01:53 > 0:01:56Symptoms emerged seven years ago,
0:01:56 > 0:01:59when Raymond's partner began to notice changes in his personality.
0:01:59 > 0:02:03At the beginning, the way me and him have been,
0:02:03 > 0:02:07and have been together for such a long time,
0:02:07 > 0:02:10to me he just wasn't the same person.
0:02:10 > 0:02:12I had changed.
0:02:12 > 0:02:15The slightest wee thing, I was flying off the handle and, you know,
0:02:15 > 0:02:19couldn't understand why I was doing this, cos I've never done it before.
0:02:21 > 0:02:25It was just one of the wee sensations, lasted about five, ten seconds
0:02:25 > 0:02:28and the dog could sense that I was going into one of these.
0:02:28 > 0:02:31I thought to myself, "Well, it must be something,"
0:02:31 > 0:02:35but I honestly didn't think it was anything to do with his brain
0:02:35 > 0:02:38or anything like that, like.
0:02:40 > 0:02:44Just another normal day for neurosurgeon Tom Flannery,
0:02:44 > 0:02:48doing the school run before heading in to deal with Raymond's case.
0:02:48 > 0:02:49OK, see you later.
0:02:55 > 0:02:59Tom diagnosed Raymond with a glioma tumour in his brain.
0:02:59 > 0:03:02He's a guy in his mid-50s
0:03:02 > 0:03:06who's, basically, seven years of blank-out episodes
0:03:06 > 0:03:10and just really only presented to Neurology just towards
0:03:10 > 0:03:13the end of last year, when he had a more obvious seizure
0:03:13 > 0:03:16which seemed to have an effect on his speech.
0:03:16 > 0:03:19When I first noticed it...
0:03:19 > 0:03:22one minute he was talking and, the next thing, he just stopped.
0:03:24 > 0:03:28So a glioma's basically a tumour of the packing cells in the brain
0:03:28 > 0:03:31and there's a range, a spectrum, of different aggressiveness,
0:03:31 > 0:03:35but they eventually tend to progress to a higher grade -
0:03:35 > 0:03:37they become more aggressive.
0:03:37 > 0:03:40This is all tumour essentially here,
0:03:40 > 0:03:43but he has an area of contrast enhancement,
0:03:43 > 0:03:47so the dye is leeching across into the tissue in this area,
0:03:47 > 0:03:50indicating a more aggressive part of the tumour.
0:03:50 > 0:03:52Worrisome. These are worrisome features.
0:03:52 > 0:03:56Raymond urgently requires surgery.
0:03:56 > 0:03:57A brain operation.
0:03:57 > 0:03:59Scary to me.
0:04:00 > 0:04:03Probably scary for Raymond as well.
0:04:04 > 0:04:07But what's the other alternative?
0:04:08 > 0:04:11- Might we expect something on the face?- I think so.
0:04:11 > 0:04:15Mr Flannery relies on the expertise of speech therapist Gillian Trimble.
0:04:15 > 0:04:19Well, speech and language therapy, it's an integral part
0:04:19 > 0:04:21of the neurosurgical team for this type of patient.
0:04:21 > 0:04:26Before this type of procedure being done awake, most of these
0:04:26 > 0:04:29patients would've been referred to my team with a speech problem.
0:04:29 > 0:04:32Anything ranging to speech absolutely gone altogether
0:04:32 > 0:04:36to a slight change in their speech or in their comprehension.
0:04:36 > 0:04:39Now, we're having almost 100% not with a problem.
0:04:39 > 0:04:41That's a massive change.
0:04:42 > 0:04:45So, Raymond, you're coming in for your operation on Monday.
0:04:45 > 0:04:48- Yeah.- The point of this operation is that you're awake.- Yes.
0:04:48 > 0:04:52- You will be as awake as you are now. - Uh-huh.- You won't be drowsy.
0:04:52 > 0:04:55If you're drowsy, we wait until you're fully awake.
0:04:55 > 0:04:57'Being able to monitor speech awake,
0:04:57 > 0:05:00'and that has to be done by a speech and language therapist,'
0:05:00 > 0:05:03'because any subtle change in language is what you're looking for
0:05:03 > 0:05:05'and it can't really be done by anyone else.'
0:05:05 > 0:05:08Whenever the surgeon is ready to take the part of your brain away
0:05:08 > 0:05:10that he needs to take away,
0:05:10 > 0:05:12that's whenever we start with language stimulation.
0:05:12 > 0:05:15We started using this procedure four years ago
0:05:15 > 0:05:17and I've done somewhere around about 100 patients.
0:05:17 > 0:05:20Before that, you know, patients would've been asleep.
0:05:20 > 0:05:23We'd have had no idea what the patient would be like when we woke them up.
0:05:23 > 0:05:25The bad part of the brain has no function in it,
0:05:25 > 0:05:27so when he touches it, there'll be no change to your speech,
0:05:27 > 0:05:30but when he goes to good brain, the speech will dip.
0:05:30 > 0:05:34He wants to take away without damaging any of the good brain -
0:05:34 > 0:05:35that's the theory behind all of this.
0:05:36 > 0:05:40Gillian needs to establish patterns in Raymond's speech to ensure that
0:05:40 > 0:05:42the surgeon removes tumour only.
0:05:42 > 0:05:46Are there a couple of really familiar dishes to you that would be
0:05:46 > 0:05:47something you'd make all the time?
0:05:47 > 0:05:50Er, yes, home-made soup.
0:05:50 > 0:05:51- OK.- And stew.
0:05:51 > 0:05:54Now, what I want you to do, I want you to talk me through,
0:05:54 > 0:05:57from start to finish, how you'd make soup,
0:05:57 > 0:06:01and the reason for that is it's the construction of the sentences,
0:06:01 > 0:06:03it's how you find the words you're looking for,
0:06:03 > 0:06:05it's the pattern that you're using for your speech.
0:06:05 > 0:06:07I fill a pot with water,
0:06:07 > 0:06:09put the peas and barley in,
0:06:09 > 0:06:12and I cook the chicken.
0:06:12 > 0:06:16That I do for about an hour, an hour and a half, then put the veg in it,
0:06:16 > 0:06:20- slowly for about another couple of hours.- OK.
0:06:20 > 0:06:22'I'm hoping this operation'
0:06:22 > 0:06:26returns me exactly the same to what I was before,
0:06:26 > 0:06:29and no more of these turns, and I'd be quite happy with that.
0:06:29 > 0:06:33It's important to highlight with this set of patients
0:06:33 > 0:06:34the bravery of these people
0:06:34 > 0:06:37going through this type of procedure, because normally,
0:06:37 > 0:06:40any of us that have gone for an operation, you're prepared for it,
0:06:40 > 0:06:42you hear all about it,
0:06:42 > 0:06:45and then you go to sleep and then you wake up when it's finished.
0:06:52 > 0:06:55In 2015, 11 people a day were admitted
0:06:55 > 0:06:59to hospitals across Northern Ireland with a heart attack.
0:06:59 > 0:07:03Catheter labs have transformed the way many of these patients
0:07:03 > 0:07:06are treated, dramatically improving outcomes.
0:07:06 > 0:07:09In Londonderry, at Altnagelvin Hospital,
0:07:09 > 0:07:13consultant cardiologist Aaron Peace prepares for another busy day.
0:07:14 > 0:07:17In global terms, we sit
0:07:17 > 0:07:18right up at the top,
0:07:18 > 0:07:20in the top three places in the world
0:07:20 > 0:07:22that suffer from heart attacks.
0:07:22 > 0:07:26Cardiovascular disease is still the number one cause of death
0:07:26 > 0:07:31in this society, surpassing all cancers combined.
0:07:31 > 0:07:37Every third person in our community will have cardiovascular disease.
0:07:40 > 0:07:43Billy has been admitted following a second heart attack.
0:07:43 > 0:07:46Just a usual Sunday, like, I am a shift worker,
0:07:46 > 0:07:48but I was off that Sunday.
0:07:48 > 0:07:49I had been to church
0:07:49 > 0:07:53and, when I came home, I made dinner for me and me girlfriend and my son.
0:07:53 > 0:07:56Er, it was after I had done the dishes that I felt
0:07:56 > 0:07:59a slight pain in my chest.
0:07:59 > 0:08:02You know, if I put it in, like, nought to ten,
0:08:02 > 0:08:04it would only be like a five pain.
0:08:04 > 0:08:06It was across here, but I also felt it there,
0:08:06 > 0:08:08on the insides of both arms.
0:08:08 > 0:08:10Like a numbness, like, you know.
0:08:12 > 0:08:14Dr Peace is going to be doing your procedure today.
0:08:14 > 0:08:16We're going to get you to sign the consent form now.
0:08:16 > 0:08:19- Right.- As you know, there is a small chance of a complication.
0:08:19 > 0:08:23It is a very large team of people needed to make this all work.
0:08:23 > 0:08:25It's not just the doctors.
0:08:27 > 0:08:31Cath lab nurse, Christine McCrudden, plays a vital role in the team.
0:08:33 > 0:08:36So, basically, this is what we do before the procedure - we scrub up.
0:08:36 > 0:08:38We prepare the room in the morning
0:08:38 > 0:08:42and do all our checks to make sure our equipment's all safe
0:08:42 > 0:08:45and ready for use before the patient would come into the room.
0:08:45 > 0:08:49She prepares meticulously for the surgical procedure.
0:08:49 > 0:08:51So this is all sterile now, my gloves and my gown,
0:08:51 > 0:08:54and I'm going over to the trolley, which is sterile as well.
0:08:54 > 0:08:56Nothing's reusable that's on this at all.
0:08:58 > 0:09:02When the consultant needs it, we have it all prepped and ready to go.
0:09:02 > 0:09:04This is what we call our sheath.
0:09:05 > 0:09:08So this is actually entered just under the patient's arm.
0:09:08 > 0:09:11It is intense pressure and, especially if the patient's ill
0:09:11 > 0:09:13and you're running trying to get drugs, IV fluids,
0:09:13 > 0:09:16it's very hard when you go home to switch off
0:09:16 > 0:09:20if you've had somebody very ill in and, on the odd occasion,
0:09:20 > 0:09:22you may have a death and it's very hard to switch off then,
0:09:22 > 0:09:24when you would go home, you know, that you know that you've done
0:09:24 > 0:09:27everything to the best of your ability, but you know, you are only
0:09:27 > 0:09:29human, even though you're a nurse
0:09:29 > 0:09:31or a doctor or radiographer, you are still...
0:09:31 > 0:09:35You're only human and you do feel the stresses and strains of...
0:09:35 > 0:09:36of events that happen.
0:09:41 > 0:09:43Back at the Royal Victoria Hospital,
0:09:43 > 0:09:46neurosurgeon Tom Flannery is on his way to meet Raymond
0:09:46 > 0:09:47before his operation.
0:09:47 > 0:09:50I wish it was all over.
0:09:50 > 0:09:51I'm a bit nervous, but you know,
0:09:51 > 0:09:54it has to be done and I'm hoping that it goes through OK
0:09:54 > 0:09:58and, you know, I'll be happy when I'm on the recovery ward.
0:10:01 > 0:10:05You know, any brain surgery at all, we always mention to patients
0:10:05 > 0:10:07and the relatives that there is a risk of death,
0:10:07 > 0:10:11although that is very low, but it's there and we have to mention it.
0:10:11 > 0:10:14I just hope he gets through it all right and everything goes well.
0:10:14 > 0:10:16We will do our best.
0:10:16 > 0:10:18We've got an experienced team working on Raymond here,
0:10:18 > 0:10:21so I'll chat to you later on today, all right?
0:10:21 > 0:10:23OK. All right, we'll see you shortly, Raymond, OK?
0:10:23 > 0:10:25- Yeah.- OK, thanks a million.
0:10:29 > 0:10:31Hopefully, everything goes well.
0:10:39 > 0:10:42In the Ulster Hospital, kitchen staff prepare meals
0:10:42 > 0:10:46for the 600 patients. That's an incredible 1,800 meals per day.
0:10:46 > 0:10:48Diet is very important.
0:10:48 > 0:10:53We cater all the people suffering from illnesses.
0:10:54 > 0:10:58Laarni Jamero is one of the 35-strong staff employed in the kitchen.
0:10:58 > 0:11:02Here in the kitchen, we used to be as one family.
0:11:05 > 0:11:09The Northern Irish cuisine is very, very simple.
0:11:09 > 0:11:11There are food are always potatoes,
0:11:11 > 0:11:15but in the Philippines, we always do, er, noodles.
0:11:18 > 0:11:21I miss working as a nutritionist dietician in the Philippines.
0:11:21 > 0:11:25I miss my work, especially counselling the patient,
0:11:25 > 0:11:29and making diets, special diets for the patients.
0:11:29 > 0:11:33We have the high protein and the strained one for the patient
0:11:33 > 0:11:37with difficulty of swallowing.
0:11:37 > 0:11:39This is very nutritious and delicious.
0:11:41 > 0:11:44Sometimes, it's hard work, especially if you're on 8-6 shift,
0:11:44 > 0:11:48because you do all the vegetables, lifting stuff,
0:11:48 > 0:11:53washing potatoes and doing the special diets.
0:11:54 > 0:11:58You need more muscles in lifting all the stuff.
0:12:01 > 0:12:02Raymond is now in theatre.
0:12:04 > 0:12:07Anaesthetist Catriona injects a local anaesthetic
0:12:07 > 0:12:09into his head to numb the area.
0:12:11 > 0:12:13OK, a little scratch here now.
0:12:13 > 0:12:15Just take nice, slow deep breaths. That's fine.
0:12:15 > 0:12:18He will be awake throughout the entire procedure.
0:12:20 > 0:12:23His head is clamped securely into place.
0:12:23 > 0:12:25'I certainly wouldn't like to have my head clamped and not being able
0:12:25 > 0:12:27'to move for three or four hours.'
0:12:29 > 0:12:30OK, Raymond?
0:12:30 > 0:12:33So it's going to start to get progressively tighter, all right?
0:12:33 > 0:12:35Your head will not be able to move much now
0:12:35 > 0:12:37for the rest of the operation.
0:12:38 > 0:12:40- Are you all right? - Uh-huh.- Good man.
0:12:40 > 0:12:44Mr Flannery uses the latest 3D technology,
0:12:44 > 0:12:48allowing him pinpoint accuracy for the removal of the tumour.
0:12:48 > 0:12:50The camera will match what it sees
0:12:50 > 0:12:53with the scans that have been done just preoperatively,
0:12:53 > 0:12:55so they're sort of merged.
0:12:55 > 0:12:58Raymond's eye on the left.
0:12:58 > 0:12:59Good.
0:12:59 > 0:13:01In the ear canal itself.
0:13:01 > 0:13:04That looks pretty good there, so...
0:13:06 > 0:13:09He begins by carefully cutting into Raymond's scalp.
0:13:12 > 0:13:15He then eases it away from the skull.
0:13:16 > 0:13:21These clips are very good at stopping any scalp bleeding.
0:13:21 > 0:13:24It's like a little clamp for the skin.
0:13:28 > 0:13:31Mr Flannery notices something unusual.
0:13:31 > 0:13:34It looks like you've got an old skull fracture here, Raymond.
0:13:35 > 0:13:38Um, Raymond, we're going to start drilling now, OK?
0:13:38 > 0:13:41So you will feel a pressure.
0:13:48 > 0:13:52It's almost time for speech therapist Gillian to begin her work.
0:14:01 > 0:14:02Using a powerful microscope,
0:14:02 > 0:14:06Mr Flannery peels back the membrane to access Raymond's brain.
0:14:10 > 0:14:12He can now begin to remove the tumour.
0:14:16 > 0:14:19Now, can you count from 20, please, back to one?
0:14:19 > 0:14:21Gillian covers some of the discussion topics
0:14:21 > 0:14:24she's prepped Raymond for prior to surgery.
0:14:25 > 0:14:2712, 11, 10, 9...
0:14:27 > 0:14:30'To have an operation on your brain is a massive thing.'
0:14:30 > 0:14:32When you're making soup. How do you make that?
0:14:32 > 0:14:36Well, er, overnight, I'd steep the...
0:14:36 > 0:14:39- soup veg...- Mm-hm.
0:14:39 > 0:14:43The soup mixture and the peas, it'd help to soften them.
0:14:43 > 0:14:46'To know that you actually have to participate,
0:14:46 > 0:14:50'they know that everything they do is contributing to their outcome.'
0:14:52 > 0:14:55Well, then we add a bit of salt but not too much.
0:14:55 > 0:14:59Mr Flannery removes a large piece of tumour and, with Gillian's help,
0:14:59 > 0:15:01avoids good brain.
0:15:01 > 0:15:04'Um, I think it's important to get a handle on what the biology of
0:15:04 > 0:15:08'the tumour is, and we will get results on that in the weeks after
0:15:08 > 0:15:11'the operation, based on the tissue analysis.'
0:15:13 > 0:15:15After four hours in theatre,
0:15:15 > 0:15:18the surgeon has removed as much of the tumour as he can.
0:15:21 > 0:15:25The final task is to repair Raymond's skull and close the wound.
0:15:28 > 0:15:32So that's just the bone flap that was taken out in the craniotomy,
0:15:32 > 0:15:34so what we've done is, when we put it back,
0:15:34 > 0:15:36we've put it back together with
0:15:36 > 0:15:38what we call mini-plates and screws.
0:15:38 > 0:15:41These are titanium-based screws and plates.
0:15:41 > 0:15:43I've just put one across there. As you can see,
0:15:43 > 0:15:45there's a fracture line.
0:15:45 > 0:15:47Once the bone flap goes back in,
0:15:47 > 0:15:51we put three screws and tighten that to the edge of the bone.
0:15:51 > 0:15:55These stay in place to make sure there is enough cover.
0:15:59 > 0:16:01Well, I can only say I wouldn't like to feel it again,
0:16:01 > 0:16:03but it was a good job.
0:16:05 > 0:16:07Back at the Ulster Hospital,
0:16:07 > 0:16:09Laarni and her team are ready for a busy lunchtime.
0:16:11 > 0:16:14These are the menus. This will go to the wards
0:16:14 > 0:16:16and then the patients will choose what they want.
0:16:16 > 0:16:19So, after choosing it,
0:16:19 > 0:16:23somebody will collect them and bring them here in the kitchen.
0:16:23 > 0:16:26After that, we dish out each one onto a conveyor.
0:16:31 > 0:16:34Today, we're feeding 500 patients.
0:16:34 > 0:16:38Most of the patients chose stewed steak for their lunch.
0:16:38 > 0:16:41We served 100 patients for stewed steak
0:16:41 > 0:16:44and vegetable cheese bake for 60 patients.
0:16:44 > 0:16:48Minced chicken is for 63 patients,
0:16:48 > 0:16:51and then, 17 for grilled cod.
0:16:51 > 0:16:57And for our dessert, most of them get stewed fruit sponge,
0:16:57 > 0:17:03which is 176 patients, and the rest get jelly and ice cream.
0:17:06 > 0:17:12After putting all the food on to a plate, it goes to this trolley.
0:17:12 > 0:17:14This trolley will go to the wards.
0:17:14 > 0:17:18That's lovely. Thanks very much.
0:17:18 > 0:17:21The soup's nice. Very pleasant.
0:17:21 > 0:17:24Um...
0:17:24 > 0:17:26potato and leek probably.
0:17:27 > 0:17:31I've had hospital food before and
0:17:31 > 0:17:33haven't been able to eat it.
0:17:33 > 0:17:38This is very pleasant, so, um, top marks to the chef.
0:17:44 > 0:17:46In Altnagelvin's catheter lab,
0:17:46 > 0:17:50Dr Peace begins Billy's procedure for a second stent.
0:17:52 > 0:17:56So what we do is we just raise a wee bleb of
0:17:56 > 0:17:59local anaesthetic and just freeze up this wee spot
0:17:59 > 0:18:02above the pulse in your wrist.
0:18:02 > 0:18:06- Is that all right, Billy? - Fine, that's OK.
0:18:06 > 0:18:10And then, this is the sheath that we use to allow us
0:18:10 > 0:18:12to put the little tubes up the arms,
0:18:12 > 0:18:15so that we can inject the dye, the contrast,
0:18:15 > 0:18:20and that allows us to see then the arteries in real-time
0:18:20 > 0:18:22on the screen here in front of us.
0:18:25 > 0:18:29We've seen progressively the mortality in patients,
0:18:29 > 0:18:33their chances of dying, decreasing and decreasing and decreasing
0:18:33 > 0:18:37over time with the implementation of a 24-hour service
0:18:37 > 0:18:40for our community when they have a heart attack.
0:18:40 > 0:18:43Now, unfortunately, there's still a very significant proportion
0:18:43 > 0:18:46of our patients die before they ever reach hospital,
0:18:46 > 0:18:49and that's something else that we really need to work on.
0:18:49 > 0:18:52But in patients who actually get here,
0:18:52 > 0:18:56being able to get rid of the clot that causes the problem,
0:18:56 > 0:18:59cos it's normally a little tiny clot,
0:18:59 > 0:19:02that really is the difference between life and death.
0:19:02 > 0:19:04But it blocks off the artery.
0:19:04 > 0:19:07That person then can just drop dead in the street.
0:19:09 > 0:19:11We pass this guide, this wire,
0:19:11 > 0:19:15up into the main blood vessel, the aorta,
0:19:15 > 0:19:18and then we pass the guide catheter
0:19:18 > 0:19:21and this acts as a tunnel, really,
0:19:21 > 0:19:24to allow us to pass equipment up through it.
0:19:24 > 0:19:28You'll see on the screen here now that, when I inject the dye,
0:19:28 > 0:19:33that the catheter becomes opacified with the contrast.
0:19:35 > 0:19:40The role of radiographer Paul is crucial for the success of this operation.
0:19:40 > 0:19:43My role here is I'm the eyes of the operation.
0:19:43 > 0:19:46So, at the minute, I'm just keeping an eye on the X-ray camera here.
0:19:46 > 0:19:48Moving it into different positions.
0:19:48 > 0:19:51It's a visual examination.
0:19:51 > 0:19:53RAO cranial.
0:19:54 > 0:19:5530-30.
0:19:55 > 0:19:58What I'm doing is just enabling him to see where the end of
0:19:58 > 0:20:01the wire is going, where the catheter's going,
0:20:01 > 0:20:03and then, in a wee minute, he's going to put that balloon in.
0:20:03 > 0:20:06So what we're doing is taking pictures just to get measurements
0:20:06 > 0:20:08for the size of stent that we're going to be placing.
0:20:08 > 0:20:11- Can we go back to the RAO cranial, please?- Yeah.
0:20:13 > 0:20:16Just working on me now, you know it, but...
0:20:16 > 0:20:19on the right arm and just along the chest.
0:20:22 > 0:20:26I have my glasses on because I wanted to see the picture, what he's done.
0:20:26 > 0:20:29So, between the two markers, we can see the stent, and so
0:20:29 > 0:20:32what we'll do now is Patricia's going to inflate the stent.
0:20:32 > 0:20:34Billy, are you OK?
0:20:34 > 0:20:36- Yeah.- Go, pick it up.
0:20:38 > 0:20:41Then, really, we'll take a quick shot of it.
0:20:41 > 0:20:45And you can see it's like a sausage inside the vessel
0:20:45 > 0:20:46and the balloon expands
0:20:46 > 0:20:49and pushes the stent into the wall of the vessel.
0:20:49 > 0:20:53After 40 minutes, Billy's life-saving surgery is complete.
0:20:56 > 0:20:59The fascinating thing about all of this is really that
0:20:59 > 0:21:02we treat equivalent patients who would have otherwise had surgery
0:21:02 > 0:21:06by just putting this little tube into their wrist.
0:21:06 > 0:21:08You're sort of scared to move that much,
0:21:08 > 0:21:11because you know it's something inside a vein the size of nothing.
0:21:12 > 0:21:14Billy's going to go home today.
0:21:14 > 0:21:17We're increasingly sending patients home.
0:21:17 > 0:21:19And same-day discharge for these types of patient
0:21:19 > 0:21:22is an extremely safe and effective thing to do.
0:21:22 > 0:21:24Um, patients are happy,
0:21:24 > 0:21:27because they'd rather go home and sleep in their own bed.
0:21:30 > 0:21:34Domestic staff are an important part of the NHS team.
0:21:36 > 0:21:38Working the hospital now nine years.
0:21:38 > 0:21:41I've been up on this department, working now the past five years.
0:21:41 > 0:21:47Stephen is responsible for cleaning the cath lab before and after every procedure.
0:21:47 > 0:21:49Obviously, after the procedures,
0:21:49 > 0:21:51you know, everything gets terminal cleaned.
0:21:51 > 0:21:52Whether it be the cleaning team,
0:21:52 > 0:21:54whether it be the person in the kitchen,
0:21:54 > 0:21:56whether it be the clerical team,
0:21:56 > 0:21:58everyone has got a massive part to play up here.
0:21:58 > 0:22:01It's not just down to the doctor or the nursing staff as well.
0:22:01 > 0:22:04Recently, he's found a greater appreciation for the team
0:22:04 > 0:22:07that he's part of, as Billy is his father.
0:22:07 > 0:22:08Well, Billy, how are you keeping?
0:22:08 > 0:22:10I feel not too bad, doctor.
0:22:10 > 0:22:12I've been down here many a times,
0:22:12 > 0:22:15but whenever it's actually a relative, the feeling like it's...
0:22:15 > 0:22:17because, when you see people coming in here,
0:22:17 > 0:22:22you know that they're in safe hands and what not, and...
0:22:22 > 0:22:25obviously, the nursing staff and the doctors and whatnot are very good
0:22:25 > 0:22:28at their jobs, but obviously when your father or any relative gets
0:22:28 > 0:22:31brought in, it's sort in the back of your mind, gosh,
0:22:31 > 0:22:33you know, what's going on in there? How is he?
0:22:33 > 0:22:36You know, how's he keeping? But it still sort of baffles me to the day,
0:22:36 > 0:22:39like, cos my dad was sort of keeping himself active and he never smoked.
0:22:39 > 0:22:44But there you are, hey, it just shows it could happen to any of us, you know.
0:22:52 > 0:22:55In the Royal Victoria Hospital, Dr Claire Lundy,
0:22:55 > 0:22:59a consultant specialist in paediatric neurodisability,
0:22:59 > 0:23:02has an appointment with 13-year-old Patrick.
0:23:03 > 0:23:07Patrick has a really very rare form of dystonia,
0:23:07 > 0:23:11and that's a condition which is best described
0:23:11 > 0:23:15as having uncontrolled, unwanted movements,
0:23:15 > 0:23:19and it arises from a problem deep in the brain.
0:23:19 > 0:23:21I see you've brought your new DynaVox.
0:23:21 > 0:23:24So I'm dying to see how it works.
0:23:24 > 0:23:27By focusing on the screen, Patrick is able to activate
0:23:27 > 0:23:31pre-created sentences that he and his mum prepared last night.
0:23:31 > 0:23:35My name is Patrick and I am 13 years old.
0:23:35 > 0:23:39I live in Belfast with my mum and dad and two younger sisters.
0:23:39 > 0:23:41My sisters keep me busy.
0:23:41 > 0:23:43Patrick, that's brilliant!
0:23:43 > 0:23:46It's really working very, very well.
0:23:46 > 0:23:50'In Patrick's case, eye-gaze technology has been transformational,
0:23:50 > 0:23:53'because of his movement disorder, and can't clearly articulate
0:23:53 > 0:23:56'what he wants to say from a day-to-day,'
0:23:56 > 0:23:58so this kind of device is life-changing,
0:23:58 > 0:24:01not only for the child, but for the family and the carers
0:24:01 > 0:24:04who are trying to support an individual like Patrick.
0:24:04 > 0:24:08'The device has leads that are implanted with a stimulator box
0:24:08 > 0:24:12'implanted in the chest and leads that track up
0:24:12 > 0:24:17'into the brain to provide some more electrical stimulation,
0:24:17 > 0:24:20'and the aim of the treatment, in Patrick's case, was to
0:24:20 > 0:24:23'provide a little more control, particularly over his limbs.'
0:24:23 > 0:24:26So that's perfect, OK?
0:24:26 > 0:24:28So thank you very much for letting me take a look at that.
0:24:28 > 0:24:33'There's a lot of work and preparation goes into using eye-gaze technology.
0:24:33 > 0:24:36'Children will work with their speech therapist and their'
0:24:36 > 0:24:41parents or carers to choose and plan sentences
0:24:41 > 0:24:44or phrases that are important to them on a daily basis.
0:24:44 > 0:24:47Everyone is very impressed with how well this works
0:24:47 > 0:24:48and I love it.
0:24:48 > 0:24:53It helps me so much in communicating with my family and friends.
0:24:53 > 0:24:55This is so important to me.
0:24:56 > 0:24:59- Thanks.- Good man.
0:24:59 > 0:25:01Well, it's my pleasure.
0:25:01 > 0:25:03Through eye-gaze technology, for the first time for children
0:25:03 > 0:25:07like Patrick, we're truly able to hear what THEY want to say.
0:25:24 > 0:25:28It's been ten weeks since Billy had his stent fitted.
0:25:29 > 0:25:33So, the same as before, we're doing that 10 to 15-minute warming up,
0:25:33 > 0:25:35then we're going to do the circuits as normal,
0:25:35 > 0:25:38and then your 10 to 15 minutes cooling down as well.
0:25:38 > 0:25:41Today, Billy has a session with physiotherapist Margaret,
0:25:41 > 0:25:43one of the team managing his post-operative care.
0:25:45 > 0:25:49Oh, the health's now getting better, you know, the actual health side,
0:25:49 > 0:25:51you know, getting stronger.
0:25:51 > 0:25:54It's just, er, you get breathless easily, you know,
0:25:54 > 0:25:57so you just try and keep within your limit.
0:25:59 > 0:26:02Inside, your body's just that bit different, like, you know.
0:26:02 > 0:26:04It's getting everything to talk together.
0:26:04 > 0:26:06It's getting my mind, you know, that,
0:26:06 > 0:26:10"You're good, you've got there," and get on with life.
0:26:10 > 0:26:14Good, so now we've warmed up a little bit more
0:26:14 > 0:26:16we're going to start shrugging the shoulders up.
0:26:16 > 0:26:20I feel I'm one of the lucky ones, because I had two friends,
0:26:20 > 0:26:23similar age to me, have died in the last two months.
0:26:23 > 0:26:25I've got a son and a daughter
0:26:25 > 0:26:27and they both went through the trauma too
0:26:27 > 0:26:30with me in here, like, so...
0:26:30 > 0:26:31Steve's a good lad.
0:26:31 > 0:26:33When you're ill,
0:26:33 > 0:26:36when a member of your family or a close friend is there for you,
0:26:36 > 0:26:40it makes you feel good, but the staff were excellent anyway.
0:26:40 > 0:26:44I've got the two stents in now and blood pressure seems to be good.
0:26:44 > 0:26:49I'm able to do the exercises, get the rest of the body now in tune.
0:26:49 > 0:26:52These stents have saved my life, I believe it.
0:26:52 > 0:26:53You know, if they weren't cleared,
0:26:53 > 0:26:58I would've sat on another so many hours, life might've been different.
0:27:05 > 0:27:09Raymond is at home recovering from his surgery.
0:27:13 > 0:27:16I got out of the hospital a week ago yesterday
0:27:16 > 0:27:18and everything went according to plan.
0:27:18 > 0:27:22I'm feeling pretty well, just the wound is sometimes a bit sore,
0:27:22 > 0:27:25sometimes itchy - that's the way it's just... that's it healing.
0:27:27 > 0:27:29That's the scar,
0:27:29 > 0:27:32which I'm told will fade away and any stitches in there
0:27:32 > 0:27:35are self-disposing. They'll just drop out.
0:27:37 > 0:27:41Mr Flannery, as far as I'm concerned, he's an excellent surgeon.
0:27:41 > 0:27:43Oh, he's brilliant.
0:27:43 > 0:27:45It's a good job there's people like him.
0:27:48 > 0:27:50I'm glad that we caught him at this stage.
0:27:50 > 0:27:53I think maybe, a month, two months down the line,
0:27:53 > 0:27:54it could've been a lot worse.
0:27:56 > 0:27:59I just want me and him to be together...
0:28:00 > 0:28:03..because we've been together a long time.
0:28:05 > 0:28:08Well, he's my partner and I love him in my heart.
0:28:09 > 0:28:13And I just don't know what I would do without him.