Episode 2 Saved: At the Heart of the Health Service

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

Scary to me.

Probably scary for Raymond as well.

But what's the other alternative?

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

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

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

The new medication has really helped my muscles relax

and it makes me feel good.

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

between life and death.

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

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

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

It's not just the doctors.

Hopefully, everything goes well.

On occasion, you may have a death

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

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

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

of events that happen.

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

focusing on the large team of people

who dedicate their lives to saving ours.

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

The neurology team in the Royal Victoria Hospital perform

this life-saving brain surgery every day.

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

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

you know, be a part of that.

Symptoms emerged seven years ago,

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

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

and have been together for such a long time,

to me he just wasn't the same person.

I had changed.

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

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

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

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

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

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

or anything like that, like.

Just another normal day for neurosurgeon Tom Flannery,

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

OK, see you later.

Tom diagnosed Raymond with a glioma tumour in his brain.

He's a guy in his mid-50s

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

and just really only presented to Neurology just towards

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

which seemed to have an effect on his speech.

When I first noticed it...

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

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

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

but they eventually tend to progress to a higher grade -

they become more aggressive.

This is all tumour essentially here,

but he has an area of contrast enhancement,

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

indicating a more aggressive part of the tumour.

Worrisome. These are worrisome features.

Raymond urgently requires surgery.

A brain operation.

Scary to me.

Probably scary for Raymond as well.

But what's the other alternative?

-Might we expect something on the face?

-I think so.

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

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

of the neurosurgical team for this type of patient.

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

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

Anything ranging to speech absolutely gone altogether

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

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

That's a massive change.

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

-Yeah.

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

-Yes.

-You will be as awake as you are now.

-Uh-huh.

-You won't be drowsy.

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

'Being able to monitor speech awake,

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

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

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

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

that he needs to take away,

that's whenever we start with language stimulation.

We started using this procedure four years ago

and I've done somewhere around about 100 patients.

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

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

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

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

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

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

that's the theory behind all of this.

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

the surgeon removes tumour only.

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

something you'd make all the time?

Er, yes, home-made soup.

-OK.

-And stew.

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

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

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

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

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

I fill a pot with water,

put the peas and barley in,

and I cook the chicken.

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

-slowly for about another couple of hours.

-OK.

'I'm hoping this operation'

returns me exactly the same to what I was before,

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

It's important to highlight with this set of patients

the bravery of these people

going through this type of procedure, because normally,

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

you hear all about it,

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

In 2015, 11 people a day were admitted

to hospitals across Northern Ireland with a heart attack.

Catheter labs have transformed the way many of these patients

are treated, dramatically improving outcomes.

In Londonderry, at Altnagelvin Hospital,

consultant cardiologist Aaron Peace prepares for another busy day.

In global terms, we sit

right up at the top,

in the top three places in the world

that suffer from heart attacks.

Cardiovascular disease is still the number one cause of death

in this society, surpassing all cancers combined.

Every third person in our community will have cardiovascular disease.

Billy has been admitted following a second heart attack.

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

but I was off that Sunday.

I had been to church

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

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

a slight pain in my chest.

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

it would only be like a five pain.

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

on the insides of both arms.

Like a numbness, like, you know.

Dr Peace is going to be doing your procedure today.

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

-Right.

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

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

It's not just the doctors.

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

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

We prepare the room in the morning

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

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

She prepares meticulously for the surgical procedure.

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

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

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

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

This is what we call our sheath.

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

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

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

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

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

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

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

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

human, even though you're a nurse

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

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

of events that happen.

Back at the Royal Victoria Hospital,

neurosurgeon Tom Flannery is on his way to meet Raymond

before his operation.

I wish it was all over.

I'm a bit nervous, but you know,

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

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

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

and the relatives that there is a risk of death,

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

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

We will do our best.

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

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

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

-Yeah.

-OK, thanks a million.

Hopefully, everything goes well.

In the Ulster Hospital, kitchen staff prepare meals

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

Diet is very important.

We cater all the people suffering from illnesses.

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

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

The Northern Irish cuisine is very, very simple.

There are food are always potatoes,

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

I miss working as a nutritionist dietician in the Philippines.

I miss my work, especially counselling the patient,

and making diets, special diets for the patients.

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

with difficulty of swallowing.

This is very nutritious and delicious.

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

because you do all the vegetables, lifting stuff,

washing potatoes and doing the special diets.

You need more muscles in lifting all the stuff.

Raymond is now in theatre.

Anaesthetist Catriona injects a local anaesthetic

into his head to numb the area.

OK, a little scratch here now.

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

He will be awake throughout the entire procedure.

His head is clamped securely into place.

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

'to move for three or four hours.'

OK, Raymond?

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

Your head will not be able to move much now

for the rest of the operation.

-Are you all right?

-Uh-huh.

-Good man.

Mr Flannery uses the latest 3D technology,

allowing him pinpoint accuracy for the removal of the tumour.

The camera will match what it sees

with the scans that have been done just preoperatively,

so they're sort of merged.

Raymond's eye on the left.

Good.

In the ear canal itself.

That looks pretty good there, so...

He begins by carefully cutting into Raymond's scalp.

He then eases it away from the skull.

These clips are very good at stopping any scalp bleeding.

It's like a little clamp for the skin.

Mr Flannery notices something unusual.

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

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

So you will feel a pressure.

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

Using a powerful microscope,

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

He can now begin to remove the tumour.

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

Gillian covers some of the discussion topics

she's prepped Raymond for prior to surgery.

12, 11, 10, 9...

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

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

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

-soup veg...

-Mm-hm.

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

'To know that you actually have to participate,

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

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

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

avoids good brain.

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

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

'the operation, based on the tissue analysis.'

After four hours in theatre,

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

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

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

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

we've put it back together with

what we call mini-plates and screws.

These are titanium-based screws and plates.

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

there's a fracture line.

Once the bone flap goes back in,

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

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

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

but it was a good job.

Back at the Ulster Hospital,

Laarni and her team are ready for a busy lunchtime.

These are the menus. This will go to the wards

and then the patients will choose what they want.

So, after choosing it,

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

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

Today, we're feeding 500 patients.

Most of the patients chose stewed steak for their lunch.

We served 100 patients for stewed steak

and vegetable cheese bake for 60 patients.

Minced chicken is for 63 patients,

and then, 17 for grilled cod.

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

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

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

This trolley will go to the wards.

That's lovely. Thanks very much.

The soup's nice. Very pleasant.

Um...

potato and leek probably.

I've had hospital food before and

haven't been able to eat it.

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

In Altnagelvin's catheter lab,

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

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

local anaesthetic and just freeze up this wee spot

above the pulse in your wrist.

-Is that all right, Billy?

-Fine, that's OK.

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

to put the little tubes up the arms,

so that we can inject the dye, the contrast,

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

on the screen here in front of us.

We've seen progressively the mortality in patients,

their chances of dying, decreasing and decreasing and decreasing

over time with the implementation of a 24-hour service

for our community when they have a heart attack.

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

of our patients die before they ever reach hospital,

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

But in patients who actually get here,

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

cos it's normally a little tiny clot,

that really is the difference between life and death.

But it blocks off the artery.

That person then can just drop dead in the street.

We pass this guide, this wire,

up into the main blood vessel, the aorta,

and then we pass the guide catheter

and this acts as a tunnel, really,

to allow us to pass equipment up through it.

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

that the catheter becomes opacified with the contrast.

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

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

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

Moving it into different positions.

It's a visual examination.

RAO cranial.

30-30.

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

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

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

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

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

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

-Yeah.

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

on the right arm and just along the chest.

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

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

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

Billy, are you OK?

-Yeah.

-Go, pick it up.

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

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

and the balloon expands

and pushes the stent into the wall of the vessel.

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

The fascinating thing about all of this is really that

we treat equivalent patients who would have otherwise had surgery

by just putting this little tube into their wrist.

You're sort of scared to move that much,

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

Billy's going to go home today.

We're increasingly sending patients home.

And same-day discharge for these types of patient

is an extremely safe and effective thing to do.

Um, patients are happy,

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

Domestic staff are an important part of the NHS team.

Working the hospital now nine years.

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

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

Obviously, after the procedures,

you know, everything gets terminal cleaned.

Whether it be the cleaning team,

whether it be the person in the kitchen,

whether it be the clerical team,

everyone has got a massive part to play up here.

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

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

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

Well, Billy, how are you keeping?

I feel not too bad, doctor.

I've been down here many a times,

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

because, when you see people coming in here,

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

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

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

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

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

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

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

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

In the Royal Victoria Hospital, Dr Claire Lundy,

a consultant specialist in paediatric neurodisability,

has an appointment with 13-year-old Patrick.

Patrick has a really very rare form of dystonia,

and that's a condition which is best described

as having uncontrolled, unwanted movements,

and it arises from a problem deep in the brain.

I see you've brought your new DynaVox.

So I'm dying to see how it works.

By focusing on the screen, Patrick is able to activate

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

My name is Patrick and I am 13 years old.

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

My sisters keep me busy.

Patrick, that's brilliant!

It's really working very, very well.

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

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

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

so this kind of device is life-changing,

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

who are trying to support an individual like Patrick.

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

'implanted in the chest and leads that track up

'into the brain to provide some more electrical stimulation,

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

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

So that's perfect, OK?

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

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

'Children will work with their speech therapist and their'

parents or carers to choose and plan sentences

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

Everyone is very impressed with how well this works

and I love it.

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

This is so important to me.

-Thanks.

-Good man.

Well, it's my pleasure.

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

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

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

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

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

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

Today, Billy has a session with physiotherapist Margaret,

one of the team managing his post-operative care.

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

you know, getting stronger.

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

so you just try and keep within your limit.

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

It's getting everything to talk together.

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

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

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

we're going to start shrugging the shoulders up.

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

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

I've got a son and a daughter

and they both went through the trauma too

with me in here, like, so...

Steve's a good lad.

When you're ill,

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

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

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

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

These stents have saved my life, I believe it.

You know, if they weren't cleared,

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

Raymond is at home recovering from his surgery.

I got out of the hospital a week ago yesterday

and everything went according to plan.

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

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

That's the scar,

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

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

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

Oh, he's brilliant.

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

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

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

it could've been a lot worse.

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

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

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

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