Episode 2 Saved: At the Heart of the Health Service


Episode 2

Four-part series filmed over a year, taking a look at the health service in Northern Ireland, showcasing the staff who dedicate their lives to saving others.


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Transcript


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This is all tumour. Worrisome. These are worrisome features.

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Scary to me.

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Probably scary for Raymond as well.

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But what's the other alternative?

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It's important to highlight, with this set of patients,

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the bravery of these people going through this type of procedure.

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This is new eye-gaze technology that I'm trying out.

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The new medication has really helped my muscles relax

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and it makes me feel good.

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It's normally a little tiny clot that really is the difference

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between life and death.

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I feel I'm one of the lucky ones, because I've had two friends,

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similar age to me, have died in the last two months.

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There's a very large team of people needed to make this all work.

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It's not just the doctors.

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Hopefully, everything goes well.

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On occasion, you may have a death

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and it's very hard to switch off then when you go home.

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You're only human, even though you are a nurse or a doctor

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or a radiographer, and you do feel the stresses and strains

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of events that happen.

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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 5,000 people in the UK are diagnosed with brain tumours every year.

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The neurology team in the Royal Victoria Hospital perform

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this life-saving brain surgery every day.

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55-year-old Raymond Killen is waiting for his surgery.

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As a porter in Musgrave, I like basically helping people,

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you know, be a part of that.

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Symptoms emerged seven years ago,

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when Raymond's partner began to notice changes in his personality.

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At the beginning, the way me and him have been,

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and have been together for such a long time,

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to me he just wasn't the same person.

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I had changed.

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The slightest wee thing, I was flying off the handle and, you know,

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couldn't understand why I was doing this, cos I've never done it before.

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It was just one of the wee sensations, lasted about five, ten seconds

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and the dog could sense that I was going into one of these.

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I thought to myself, "Well, it must be something,"

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but I honestly didn't think it was anything to do with his brain

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or anything like that, like.

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Just another normal day for neurosurgeon Tom Flannery,

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doing the school run before heading in to deal with Raymond's case.

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OK, see you later.

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Tom diagnosed Raymond with a glioma tumour in his brain.

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He's a guy in his mid-50s

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who's, basically, seven years of blank-out episodes

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and just really only presented to Neurology just towards

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the end of last year, when he had a more obvious seizure

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which seemed to have an effect on his speech.

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When I first noticed it...

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one minute he was talking and, the next thing, he just stopped.

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So a glioma's basically a tumour of the packing cells in the brain

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and there's a range, a spectrum, of different aggressiveness,

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but they eventually tend to progress to a higher grade -

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they become more aggressive.

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This is all tumour essentially here,

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but he has an area of contrast enhancement,

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so the dye is leeching across into the tissue in this area,

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indicating a more aggressive part of the tumour.

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Worrisome. These are worrisome features.

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Raymond urgently requires surgery.

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A brain operation.

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Scary to me.

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Probably scary for Raymond as well.

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But what's the other alternative?

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-Might we expect something on the face?

-I think so.

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Mr Flannery relies on the expertise of speech therapist Gillian Trimble.

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Well, speech and language therapy, it's an integral part

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of the neurosurgical team for this type of patient.

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Before this type of procedure being done awake, most of these

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patients would've been referred to my team with a speech problem.

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Anything ranging to speech absolutely gone altogether

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to a slight change in their speech or in their comprehension.

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Now, we're having almost 100% not with a problem.

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That's a massive change.

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So, Raymond, you're coming in for your operation on Monday.

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-Yeah.

-The point of this operation is that you're awake.

-Yes.

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-You will be as awake as you are now.

-Uh-huh.

-You won't be drowsy.

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If you're drowsy, we wait until you're fully awake.

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'Being able to monitor speech awake,

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'and that has to be done by a speech and language therapist,'

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'because any subtle change in language is what you're looking for

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'and it can't really be done by anyone else.'

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Whenever the surgeon is ready to take the part of your brain away

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that he needs to take away,

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that's whenever we start with language stimulation.

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We started using this procedure four years ago

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and I've done somewhere around about 100 patients.

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Before that, you know, patients would've been asleep.

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We'd have had no idea what the patient would be like when we woke them up.

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The bad part of the brain has no function in it,

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so when he touches it, there'll be no change to your speech,

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but when he goes to good brain, the speech will dip.

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He wants to take away without damaging any of the good brain -

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that's the theory behind all of this.

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Gillian needs to establish patterns in Raymond's speech to ensure that

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the surgeon removes tumour only.

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Are there a couple of really familiar dishes to you that would be

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something you'd make all the time?

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Er, yes, home-made soup.

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-OK.

-And stew.

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Now, what I want you to do, I want you to talk me through,

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from start to finish, how you'd make soup,

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and the reason for that is it's the construction of the sentences,

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it's how you find the words you're looking for,

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it's the pattern that you're using for your speech.

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I fill a pot with water,

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put the peas and barley in,

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and I cook the chicken.

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That I do for about an hour, an hour and a half, then put the veg in it,

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-slowly for about another couple of hours.

-OK.

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'I'm hoping this operation'

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returns me exactly the same to what I was before,

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and no more of these turns, and I'd be quite happy with that.

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It's important to highlight with this set of patients

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the bravery of these people

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going through this type of procedure, because normally,

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any of us that have gone for an operation, you're prepared for it,

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you hear all about it,

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and then you go to sleep and then you wake up when it's finished.

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In 2015, 11 people a day were admitted

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to hospitals across Northern Ireland with a heart attack.

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Catheter labs have transformed the way many of these patients

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are treated, dramatically improving outcomes.

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In Londonderry, at Altnagelvin Hospital,

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consultant cardiologist Aaron Peace prepares for another busy day.

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In global terms, we sit

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right up at the top,

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in the top three places in the world

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that suffer from heart attacks.

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Cardiovascular disease is still the number one cause of death

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in this society, surpassing all cancers combined.

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Every third person in our community will have cardiovascular disease.

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Billy has been admitted following a second heart attack.

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Just a usual Sunday, like, I am a shift worker,

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but I was off that Sunday.

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I had been to church

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and, when I came home, I made dinner for me and me girlfriend and my son.

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Er, it was after I had done the dishes that I felt

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a slight pain in my chest.

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You know, if I put it in, like, nought to ten,

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it would only be like a five pain.

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It was across here, but I also felt it there,

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on the insides of both arms.

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Like a numbness, like, you know.

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Dr Peace is going to be doing your procedure today.

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We're going to get you to sign the consent form now.

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-Right.

-As you know, there is a small chance of a complication.

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It is a very large team of people needed to make this all work.

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It's not just the doctors.

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Cath lab nurse, Christine McCrudden, plays a vital role in the team.

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So, basically, this is what we do before the procedure - we scrub up.

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We prepare the room in the morning

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and do all our checks to make sure our equipment's all safe

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and ready for use before the patient would come into the room.

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She prepares meticulously for the surgical procedure.

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So this is all sterile now, my gloves and my gown,

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and I'm going over to the trolley, which is sterile as well.

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Nothing's reusable that's on this at all.

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When the consultant needs it, we have it all prepped and ready to go.

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This is what we call our sheath.

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So this is actually entered just under the patient's arm.

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It is intense pressure and, especially if the patient's ill

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and you're running trying to get drugs, IV fluids,

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it's very hard when you go home to switch off

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if you've had somebody very ill in and, on the odd occasion,

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you may have a death and it's very hard to switch off then,

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when you would go home, you know, that you know that you've done

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everything to the best of your ability, but you know, you are only

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human, even though you're a nurse

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or a doctor or radiographer, you are still...

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You're only human and you do feel the stresses and strains of...

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of events that happen.

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Back at the Royal Victoria Hospital,

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neurosurgeon Tom Flannery is on his way to meet Raymond

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before his operation.

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I wish it was all over.

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I'm a bit nervous, but you know,

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it has to be done and I'm hoping that it goes through OK

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and, you know, I'll be happy when I'm on the recovery ward.

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You know, any brain surgery at all, we always mention to patients

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and the relatives that there is a risk of death,

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although that is very low, but it's there and we have to mention it.

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I just hope he gets through it all right and everything goes well.

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We will do our best.

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We've got an experienced team working on Raymond here,

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so I'll chat to you later on today, all right?

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OK. All right, we'll see you shortly, Raymond, OK?

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-Yeah.

-OK, thanks a million.

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Hopefully, everything goes well.

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In the Ulster Hospital, kitchen staff prepare meals

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for the 600 patients. That's an incredible 1,800 meals per day.

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Diet is very important.

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We cater all the people suffering from illnesses.

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Laarni Jamero is one of the 35-strong staff employed in the kitchen.

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Here in the kitchen, we used to be as one family.

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The Northern Irish cuisine is very, very simple.

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There are food are always potatoes,

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but in the Philippines, we always do, er, noodles.

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I miss working as a nutritionist dietician in the Philippines.

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I miss my work, especially counselling the patient,

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and making diets, special diets for the patients.

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We have the high protein and the strained one for the patient

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with difficulty of swallowing.

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This is very nutritious and delicious.

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Sometimes, it's hard work, especially if you're on 8-6 shift,

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because you do all the vegetables, lifting stuff,

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washing potatoes and doing the special diets.

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You need more muscles in lifting all the stuff.

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Raymond is now in theatre.

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Anaesthetist Catriona injects a local anaesthetic

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into his head to numb the area.

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OK, a little scratch here now.

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Just take nice, slow deep breaths. That's fine.

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He will be awake throughout the entire procedure.

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His head is clamped securely into place.

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'I certainly wouldn't like to have my head clamped and not being able

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'to move for three or four hours.'

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OK, Raymond?

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So it's going to start to get progressively tighter, all right?

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Your head will not be able to move much now

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for the rest of the operation.

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-Are you all right?

-Uh-huh.

-Good man.

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Mr Flannery uses the latest 3D technology,

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allowing him pinpoint accuracy for the removal of the tumour.

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The camera will match what it sees

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with the scans that have been done just preoperatively,

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so they're sort of merged.

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Raymond's eye on the left.

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Good.

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In the ear canal itself.

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That looks pretty good there, so...

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He begins by carefully cutting into Raymond's scalp.

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He then eases it away from the skull.

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These clips are very good at stopping any scalp bleeding.

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It's like a little clamp for the skin.

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Mr Flannery notices something unusual.

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It looks like you've got an old skull fracture here, Raymond.

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Um, Raymond, we're going to start drilling now, OK?

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So you will feel a pressure.

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It's almost time for speech therapist Gillian to begin her work.

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Using a powerful microscope,

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Mr Flannery peels back the membrane to access Raymond's brain.

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He can now begin to remove the tumour.

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Now, can you count from 20, please, back to one?

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Gillian covers some of the discussion topics

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she's prepped Raymond for prior to surgery.

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12, 11, 10, 9...

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'To have an operation on your brain is a massive thing.'

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When you're making soup. How do you make that?

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Well, er, overnight, I'd steep the...

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-soup veg...

-Mm-hm.

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The soup mixture and the peas, it'd help to soften them.

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'To know that you actually have to participate,

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'they know that everything they do is contributing to their outcome.'

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Well, then we add a bit of salt but not too much.

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Mr Flannery removes a large piece of tumour and, with Gillian's help,

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avoids good brain.

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'Um, I think it's important to get a handle on what the biology of

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'the tumour is, and we will get results on that in the weeks after

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'the operation, based on the tissue analysis.'

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After four hours in theatre,

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the surgeon has removed as much of the tumour as he can.

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The final task is to repair Raymond's skull and close the wound.

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So that's just the bone flap that was taken out in the craniotomy,

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so what we've done is, when we put it back,

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we've put it back together with

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what we call mini-plates and screws.

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These are titanium-based screws and plates.

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I've just put one across there. As you can see,

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there's a fracture line.

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Once the bone flap goes back in,

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we put three screws and tighten that to the edge of the bone.

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These stay in place to make sure there is enough cover.

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Well, I can only say I wouldn't like to feel it again,

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but it was a good job.

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Back at the Ulster Hospital,

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Laarni and her team are ready for a busy lunchtime.

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These are the menus. This will go to the wards

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and then the patients will choose what they want.

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So, after choosing it,

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somebody will collect them and bring them here in the kitchen.

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After that, we dish out each one onto a conveyor.

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Today, we're feeding 500 patients.

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Most of the patients chose stewed steak for their lunch.

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We served 100 patients for stewed steak

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and vegetable cheese bake for 60 patients.

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Minced chicken is for 63 patients,

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and then, 17 for grilled cod.

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And for our dessert, most of them get stewed fruit sponge,

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which is 176 patients, and the rest get jelly and ice cream.

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After putting all the food on to a plate, it goes to this trolley.

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This trolley will go to the wards.

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That's lovely. Thanks very much.

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The soup's nice. Very pleasant.

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Um...

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potato and leek probably.

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I've had hospital food before and

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haven't been able to eat it.

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This is very pleasant, so, um, top marks to the chef.

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In Altnagelvin's catheter lab,

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Dr Peace begins Billy's procedure for a second stent.

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So what we do is we just raise a wee bleb of

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local anaesthetic and just freeze up this wee spot

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above the pulse in your wrist.

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-Is that all right, Billy?

-Fine, that's OK.

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And then, this is the sheath that we use to allow us

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to put the little tubes up the arms,

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so that we can inject the dye, the contrast,

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and that allows us to see then the arteries in real-time

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on the screen here in front of us.

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We've seen progressively the mortality in patients,

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their chances of dying, decreasing and decreasing and decreasing

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over time with the implementation of a 24-hour service

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for our community when they have a heart attack.

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Now, unfortunately, there's still a very significant proportion

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of our patients die before they ever reach hospital,

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and that's something else that we really need to work on.

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But in patients who actually get here,

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being able to get rid of the clot that causes the problem,

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cos it's normally a little tiny clot,

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that really is the difference between life and death.

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But it blocks off the artery.

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That person then can just drop dead in the street.

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We pass this guide, this wire,

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up into the main blood vessel, the aorta,

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and then we pass the guide catheter

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and this acts as a tunnel, really,

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to allow us to pass equipment up through it.

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You'll see on the screen here now that, when I inject the dye,

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that the catheter becomes opacified with the contrast.

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The role of radiographer Paul is crucial for the success of this operation.

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My role here is I'm the eyes of the operation.

0:19:400:19:43

So, at the minute, I'm just keeping an eye on the X-ray camera here.

0:19:430:19:46

Moving it into different positions.

0:19:460:19:48

It's a visual examination.

0:19:480:19:51

RAO cranial.

0:19:510:19:53

30-30.

0:19:540:19:55

What I'm doing is just enabling him to see where the end of

0:19:550:19:58

the wire is going, where the catheter's going,

0:19:580:20:01

and then, in a wee minute, he's going to put that balloon in.

0:20:010:20:03

So what we're doing is taking pictures just to get measurements

0:20:030:20:06

for the size of stent that we're going to be placing.

0:20:060:20:08

-Can we go back to the RAO cranial, please?

-Yeah.

0:20:080:20:11

Just working on me now, you know it, but...

0:20:130:20:16

on the right arm and just along the chest.

0:20:160:20:19

I have my glasses on because I wanted to see the picture, what he's done.

0:20:220:20:26

So, between the two markers, we can see the stent, and so

0:20:260:20:29

what we'll do now is Patricia's going to inflate the stent.

0:20:290:20:32

Billy, are you OK?

0:20:320:20:34

-Yeah.

-Go, pick it up.

0:20:340:20:36

Then, really, we'll take a quick shot of it.

0:20:380:20:41

And you can see it's like a sausage inside the vessel

0:20:410:20:45

and the balloon expands

0:20:450:20:46

and pushes the stent into the wall of the vessel.

0:20:460:20:49

After 40 minutes, Billy's life-saving surgery is complete.

0:20:490:20:53

The fascinating thing about all of this is really that

0:20:560:20:59

we treat equivalent patients who would have otherwise had surgery

0:20:590:21:02

by just putting this little tube into their wrist.

0:21:020:21:06

You're sort of scared to move that much,

0:21:060:21:08

because you know it's something inside a vein the size of nothing.

0:21:080:21:11

Billy's going to go home today.

0:21:120:21:14

We're increasingly sending patients home.

0:21:140:21:17

And same-day discharge for these types of patient

0:21:170:21:19

is an extremely safe and effective thing to do.

0:21:190:21:22

Um, patients are happy,

0:21:220:21:24

because they'd rather go home and sleep in their own bed.

0:21:240:21:27

Domestic staff are an important part of the NHS team.

0:21:300:21:34

Working the hospital now nine years.

0:21:360:21:38

I've been up on this department, working now the past five years.

0:21:380:21:41

Stephen is responsible for cleaning the cath lab before and after every procedure.

0:21:410:21:47

Obviously, after the procedures,

0:21:470:21:49

you know, everything gets terminal cleaned.

0:21:490:21:51

Whether it be the cleaning team,

0:21:510:21:52

whether it be the person in the kitchen,

0:21:520:21:54

whether it be the clerical team,

0:21:540:21:56

everyone has got a massive part to play up here.

0:21:560:21:58

It's not just down to the doctor or the nursing staff as well.

0:21:580:22:01

Recently, he's found a greater appreciation for the team

0:22:010:22:04

that he's part of, as Billy is his father.

0:22:040:22:07

Well, Billy, how are you keeping?

0:22:070:22:08

I feel not too bad, doctor.

0:22:080:22:10

I've been down here many a times,

0:22:100:22:12

but whenever it's actually a relative, the feeling like it's...

0:22:120:22:15

because, when you see people coming in here,

0:22:150:22:17

you know that they're in safe hands and what not, and...

0:22:170:22:22

obviously, the nursing staff and the doctors and whatnot are very good

0:22:220:22:25

at their jobs, but obviously when your father or any relative gets

0:22:250:22:28

brought in, it's sort in the back of your mind, gosh,

0:22:280:22:31

you know, what's going on in there? How is he?

0:22:310:22:33

You know, how's he keeping? But it still sort of baffles me to the day,

0:22:330:22:36

like, cos my dad was sort of keeping himself active and he never smoked.

0:22:360:22:39

But there you are, hey, it just shows it could happen to any of us, you know.

0:22:390:22:44

In the Royal Victoria Hospital, Dr Claire Lundy,

0:22:520:22:55

a consultant specialist in paediatric neurodisability,

0:22:550:22:59

has an appointment with 13-year-old Patrick.

0:22:590:23:02

Patrick has a really very rare form of dystonia,

0:23:030:23:07

and that's a condition which is best described

0:23:070:23:11

as having uncontrolled, unwanted movements,

0:23:110:23:15

and it arises from a problem deep in the brain.

0:23:150:23:19

I see you've brought your new DynaVox.

0:23:190:23:21

So I'm dying to see how it works.

0:23:210:23:24

By focusing on the screen, Patrick is able to activate

0:23:240:23:27

pre-created sentences that he and his mum prepared last night.

0:23:270:23:31

My name is Patrick and I am 13 years old.

0:23:310:23:35

I live in Belfast with my mum and dad and two younger sisters.

0:23:350:23:39

My sisters keep me busy.

0:23:390:23:41

Patrick, that's brilliant!

0:23:410:23:43

It's really working very, very well.

0:23:430:23:46

'In Patrick's case, eye-gaze technology has been transformational,

0:23:460:23:50

'because of his movement disorder, and can't clearly articulate

0:23:500:23:53

'what he wants to say from a day-to-day,'

0:23:530:23:56

so this kind of device is life-changing,

0:23:560:23:58

not only for the child, but for the family and the carers

0:23:580:24:01

who are trying to support an individual like Patrick.

0:24:010:24:04

'The device has leads that are implanted with a stimulator box

0:24:040:24:08

'implanted in the chest and leads that track up

0:24:080:24:12

'into the brain to provide some more electrical stimulation,

0:24:120:24:17

'and the aim of the treatment, in Patrick's case, was to

0:24:170:24:20

'provide a little more control, particularly over his limbs.'

0:24:200:24:23

So that's perfect, OK?

0:24:230:24:26

So thank you very much for letting me take a look at that.

0:24:260:24:28

'There's a lot of work and preparation goes into using eye-gaze technology.

0:24:280:24:33

'Children will work with their speech therapist and their'

0:24:330:24:36

parents or carers to choose and plan sentences

0:24:360:24:41

or phrases that are important to them on a daily basis.

0:24:410:24:44

Everyone is very impressed with how well this works

0:24:440:24:47

and I love it.

0:24:470:24:48

It helps me so much in communicating with my family and friends.

0:24:480:24:53

This is so important to me.

0:24:530:24:55

-Thanks.

-Good man.

0:24:560:24:59

Well, it's my pleasure.

0:24:590:25:01

Through eye-gaze technology, for the first time for children

0:25:010:25:03

like Patrick, we're truly able to hear what THEY want to say.

0:25:030:25:07

It's been ten weeks since Billy had his stent fitted.

0:25:240:25:28

So, the same as before, we're doing that 10 to 15-minute warming up,

0:25:290:25:33

then we're going to do the circuits as normal,

0:25:330:25:35

and then your 10 to 15 minutes cooling down as well.

0:25:350:25:38

Today, Billy has a session with physiotherapist Margaret,

0:25:380:25:41

one of the team managing his post-operative care.

0:25:410:25:43

Oh, the health's now getting better, you know, the actual health side,

0:25:450:25:49

you know, getting stronger.

0:25:490:25:51

It's just, er, you get breathless easily, you know,

0:25:510:25:54

so you just try and keep within your limit.

0:25:540:25:57

Inside, your body's just that bit different, like, you know.

0:25:590:26:02

It's getting everything to talk together.

0:26:020:26:04

It's getting my mind, you know, that,

0:26:040:26:06

"You're good, you've got there," and get on with life.

0:26:060:26:10

Good, so now we've warmed up a little bit more

0:26:100:26:14

we're going to start shrugging the shoulders up.

0:26:140:26:16

I feel I'm one of the lucky ones, because I had two friends,

0:26:160:26:20

similar age to me, have died in the last two months.

0:26:200:26:23

I've got a son and a daughter

0:26:230:26:25

and they both went through the trauma too

0:26:250:26:27

with me in here, like, so...

0:26:270:26:30

Steve's a good lad.

0:26:300:26:31

When you're ill,

0:26:310:26:33

when a member of your family or a close friend is there for you,

0:26:330:26:36

it makes you feel good, but the staff were excellent anyway.

0:26:360:26:40

I've got the two stents in now and blood pressure seems to be good.

0:26:400:26:44

I'm able to do the exercises, get the rest of the body now in tune.

0:26:440:26:49

These stents have saved my life, I believe it.

0:26:490:26:52

You know, if they weren't cleared,

0:26:520:26:53

I would've sat on another so many hours, life might've been different.

0:26:530:26:58

Raymond is at home recovering from his surgery.

0:27:050:27:09

I got out of the hospital a week ago yesterday

0:27:130:27:16

and everything went according to plan.

0:27:160:27:18

I'm feeling pretty well, just the wound is sometimes a bit sore,

0:27:180:27:22

sometimes itchy - that's the way it's just... that's it healing.

0:27:220:27:25

That's the scar,

0:27:270:27:29

which I'm told will fade away and any stitches in there

0:27:290:27:32

are self-disposing. They'll just drop out.

0:27:320:27:35

Mr Flannery, as far as I'm concerned, he's an excellent surgeon.

0:27:370:27:41

Oh, he's brilliant.

0:27:410:27:43

It's a good job there's people like him.

0:27:430:27:45

I'm glad that we caught him at this stage.

0:27:480:27:50

I think maybe, a month, two months down the line,

0:27:500:27:53

it could've been a lot worse.

0:27:530:27:54

I just want me and him to be together...

0:27:560:27:59

..because we've been together a long time.

0:28:000:28:03

Well, he's my partner and I love him in my heart.

0:28:050:28:08

And I just don't know what I would do without him.

0:28:090:28:13

Consultant Tom Flannery of the Royal Victoria Hospital, with the assistance of speech therapist Gillian Trimble, performs an innovative, life-saving surgery on Raymond to remove a brain tumour.

Consultant Cardiologist Aaron Peace inserts a stent into Billy's heart following a heart attack in Londonderry's Altnagelvin.

We take a look behind the scenes of the kitchen in Dundonald Hospital as Filipino cook Laarni Jamero preps for 600 meals. And we meet inspirational 13-year-old Patrick Irvine, who uses eye-gaze technology to communicate.


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