A look at the health service in Northern Ireland. Seven-year-old Tyler is admitted to A&E in the Royal Belfast Hospital for Sick Children following an asthma attack.
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Good boy. This nurse is going to come and help hold, too, look.
He'll be wiped off his feet for a week, two weeks at a time.
He knows half of them in the ward by name, so he does,
because he's in here that often.
I hit the windshield and went up
the road with the bike.
See the blood lying in the road.
There was blood in my visor.
You are very afraid for your life, you know, you think that's it.
You know, you are disfigured.
It's a big scar.
I've measured out the amount of skin
that's required to match this breast.
This is a pretty serious syndrome and can cause a lot of problems,
and you can end up losing your leg.
To see her and to hold her, be able to walk again...
..it would be great.
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.
Statistics show that one in three people
will be diagnosed with cancer.
This is set to rise to one in two within 20 years.
Belfast City Hospital's Cancer Centre
is at the forefront of the fight against the disease.
Over the past ten years...
We do believe that we've got a technique now that
can cure more people and more effectively,
and deliver less in the way of side-effects.
With the advances in radiotherapy that we've seen,
it's changing everything.
The machine's called a linear accelerator
and it is a way of giving a very high-energy X-ray beam,
which we focus on to the tumour.
And the advantages with this machine,
are that we can be much more accurate
in targeting just the tumour.
The Cancer Centre treats 273 patients per day
using the linear accelerator.
Lung cancer patients now have a much better chance
of beating the disease.
And number threes, go.
Around 1,200 women are diagnosed with breast cancer
every year in Northern Ireland.
Swimming instructor, Rosaline Wray, was diagnosed in 2013 and
following extensive treatment, she now requires reconstructive surgery.
I just had a prosthesis.
So we're on the poolside and we're doing demonstrations all the time,
we're active. But you're always aware and you're always...
Sure it would be your worst nightmare standing on the poolside
or in the water and, you know, your prosthesis falling out.
It'd be, you know, your worst nightmare.
Today, she's in the plastic surgery ward of the Ulster Hospital,
waiting to have her breast reconstructed.
Losing the breast just was necessary.
Body image at that time wasn't an issue.
I was on my own, like, my marriage had broken down the year before.
And, you know, you are disfigured.
It's a big scar.
So the first time I looked at it I thought...
.."It's awful. You're deformed."
Her surgery's scheduled for tomorrow morning.
Nurses record Rosaline's obs regularly until then.
-And wait for it to go to zero.
-OK, just step on?
Perfect, that's you.
I really don't think that it's sunk in that,
you know, this is it now, I'm actually getting reconstruction.
I'm going to have something at the end of it.
They're not taking anything away this time.
Tomorrow evening I'm going to have two breasts!
Pop that on your finger.
It's going to be lovely being able to go out and, you know,
get nice wee string tops and, you know, that sort of just...
Although I didn't feel that I was missing out,
I think the closer it came to the operation,
and I was sort of thinking, you know, what the end result's
going to be and the more I realised,
well, actually, you know, I was very conscious.
very clearly the very first day I went back into a swimming pool
with a swimming costume on.
By that stage I'd been in and had a mastectomy.
I was very aware that everybody was very aware that...
You know, these two breasts...
There was only... One was, you know...
But nobody made any difference.
It was never an issue.
Slide in, reach.
The Royal Belfast Hospital for Sick Children cares for young patients
up to the age of 14.
Each year, 35,000 children attend its emergency department
and 10,000 are admitted for inpatient care.
Oh, sorry, darling.
OK. All righty.
The nurse in charge today is deputy ward sister Jenny Morrissey.
Her first patient is four-year-old Tyler Fisher,
who's suffered an asthma attack.
So we'll just connect the monitor up here and what we're looking for is
his oxygen levels,
and we'd like them above 95.
OK. You can see his wee breathing there is...
It's working a wee bit hard.
It's got to the stage he goes to the nursery,
he's hardly been at nursery because, you know,
he goes out and he plays and then
next thing he'll be wiped off his feet
for like a week, two weeks at a time.
OK, so we're at 92.
Can I have a wee look at your wee tummy just?
And I can see already that it's fast-ish rate.
So I'm just going to give that a wee count.
OK. I'm going to check if there's any rooms available.
-And then we'll get you straight in, OK?
That'll help him.
He knows half of them in the ward by name, so he does,
because he's in here that often.
Musgrave Park Hospital is one of
the leading orthopaedic centres in Europe.
In their limb fitting department,
they provide and maintain the latest in prosthetic technology.
27-year-old Tim Shields and his pregnant wife Jenna
have waited two long years for this day.
Tim's here to be assessed for a brand-new high-end prosthetic leg.
Bring your weight back a wee touch there. You can see it moves
and if you bring your weight forward a touch,
you'll see it moves the other way.
So you're just a wee bit heel heavy there.
-So go on to your right...
-The C-Leg prosthetic limb costs up to £30,000
and is only available to those who meet a strict physical criteria.
If Tim is deemed a suitable candidate for the new leg,
it will have a huge impact on him and his family's lives.
That's really good.
Tim has one young child already and with a second on the way,
the limited mobility with his current prosthesis
has been causing him real problems.
The limitations of this leg, you don't really want to take the chance
and walk with your 17-month-old baby in your arms
in case you trip on something.
This here is very limited in what you can do.
I have another baby due here in June
and I'm looking forward to having the C-Leg for that.
I'm looking forward to being able to walk about the house
with it in my arms, put it to sleep in my arms.
Them's the things I didn't get to do with Mason.
Put it back on.
A few months before his son Mason was born,
Tim was in a horrific motorbike accident.
I remember it all, I was conscious throughout the whole thing.
He caught me about the middle of the bike,
where this knee would have been.
I caught his front driver's headlight.
I'd hit the windshield and went up the road with the bike.
I finally landed about... I think they measured
about 300 yards from where the point of impact was.
While that had happened, this leg had got trapped in the foot peg,
which ripped the boot off the leg.
The boot actually didn't open,
it came off with that much of a force, the leg just came out.
At that stage, you know, you are very afraid for your life,
you know, you think that's it.
You know, you think you're tatty bread, lights out.
You know, you see the blood lying in the road,
there was blood in my visor.
My wife was heavily pregnant at the time,
that was going through my head too,
thinking of the child with no father. That was worrying me -
leaving her widowed after only two months of marriage.
The accident left him in hospital
for six weeks and although he lost his leg,
he was lucky to survive such a devastating impact.
But if things go well for him in today's assessment,
he could be a step closer to living the life he wants.
'I will be riding a bike again,
'which hasn't went down well with Jenna or my mum.'
But I think that's one of the hurdles in life, for me,
I have to get over.
We'll do a few wee tweaks.
In the orthopaedic ward of the Royal Victoria Hospital,
50-year-old Garvin Pollock is waiting for surgery.
He broke his leg after falling in his back garden.
This will be his fifth operation.
It became a complication after the first surgery
of compartment syndrome,
which is pressure within the leg, within the muscles.
To fix it they had to open my leg, both sides, to release the pressure.
This is a pretty serious syndrome,
it can cause a lot of problems
and you can end up losing your leg or your foot because of it.
Surgeon Chris Andrews will try to save Garvin's leg.
Today we're going to try to reconstruct his ankle as best we can
and he's had this CT scan done and it gives us an idea
of how many different parts the ankle joint has ended up in
and you can see several pieces.
So what we need to do
is open the front of his ankle here
to get in and actually physically put these bits back together
as best we can, like a jigsaw puzzle.
With the number of breaks in Garvin's ankle,
it's proving a more difficult case than most
and there's also a potentially life-threatening complication.
Garvin might have had an unusual reaction to an anaesthetic
about 15 years ago called malignant hypothermia,
and that's a really dangerous thing.
It can be fatal, so we've changed what we're going to do
in terms of the anaesthetic.
He's just going to be numbed with a spinal anaesthetic from
the waist down and we're just going to give him some light sedation
instead of a full general anaesthetic.
He's asleep, but if we speak to him,
he'll be able to wake up and answer appropriately.
This bit here, which is not very sterile,
because it's been on for several weeks.
Put a bit of iodine on it,
to make it as clean as we can to take it out.
Pull out now.
With Garvin developing compartment syndrome after his initial fall,
treating this became the priority
in order to prevent him losing his leg altogether.
While today's operation is to reconstruct his ankle,
the delay has brought its own complications.
The problem is, there's a fragment of bone here at the back and we're
trying to restore the natural arch by bringing it back down again.
And we're trying to do that with this lever, but unfortunately,
because we're three weeks down the line,
the bone's already started to heal.
I'm going to try to push the back of the tibia down
to get that step away, that you see in the foot surface.
This is the most important part of the operation,
because the joint is like the hinge of a door.
If the hinge works right, the whole door will work.
Show me that.
Garvin will have to spend four months in an Ilizarov frame
but surgeon Chris is confident of a positive outcome.
What we are going to do is
get an X-ray done and then he'll be starting to walk with full weight on
the leg starting tomorrow
and once he's able to walk with the aid of crutches
and manage stairs and things,
he'll be able to go home.
I would hope he'll get home maybe over the weekend,
depending on how well he does.
There are around 16 babies born every day
in Belfast's Royal Jubilee Maternity Service.
Leanne McDonnell is a maternity support worker.
I work on the ward
and my role is to support mums with their new babies
in the first stages of life.
'First-time mums are usually a wee bit afraid
'or conscious about working with a wee baby.'
And that's us done.
-Thank you very much, Leanne.
-No problem, thank you.
'So we sort of reassure them and, you know,'
help them any way we can.
BABY CRIES HEARTILY
Like showing them how to work with their baby,
you know, bathing their baby.
Our role also involves helping midwives,
supporting the midwives in their daily tasks.
Today, she's assisting midwife Fidelma Conway.
This wee one's just about to get a wee BCG.
And what I do is I will just assist the midwife in holding her.
This wee one's a day-old, Fidelma, is it?
-This wee one?
-Why don't you read the baby's notes?
-Yeah, born yesterday.
'Because these parents are from Nigeria,
'this baby is a candidate for the BCG vaccine.'
With the injections over, the sleepy baby is put down for a nap.
Back in the Ulster Hospital,
Rosaline's operation is about to begin.
I work as part of a team here, a breast team,
it's a very good team in the Ulster Hospital.
It's a big team, of breast surgeons, plastic surgeons, radiologists...
..oncologists, breast care nurses,
there's a never ending list of team members and we work well together.
The team begin by freezing
Rosaline's stomach with local anaesthetic.
Mr Sinclair then makes an incision for the placement of the new breast.
We're always a little bit short of skin at the top edge,
that's why we make that a wee bit wavy.
His team begin by removing the skin and fat
from Rosaline's stomach needed to create the new breast.
As the new breast will be made of living tissue,
he needs to remove a small piece of rib
to gain access to a blood supply.
I think we will go for...
We've created the pocket and we'll find the vessels that will drive the
tissue that we move up.
So we're going to dissect the blood vessels that
supply that skin and fat between the muscle and the nerves,
leave all the muscle behind, because this lady's a swimming instructor,
so there's lots of ways of reconstructing the breast.
This particular method preserves all your muscles,
which is important for her job.
Once the stomach tissue has been removed,
it is then placed on the breast cavity.
So this tissue has no blood supply going into it,
and we want to sort of re-establish that.
So the tissue has been raised on these blood vessels here...
..and we are now going to try and plumb them in
to the internal mammary or the blood vessels
just under the ribs.
He now connects it to a blood supply.
I'm already there now.
I suppose we could cut that, because we'll probably shorten that anyway.
The skin and tissue from Rosaline's stomach
can now be shaped to form her new breast.
'We've measured out the amount of fat that's needed'
and we've measured out the amount of skin that's required
'to match this breast, but we may in fact...
'..take some the skin out of this breast at a later date.'
Rosaline's stomach wound is then repaired,
effectively giving her a tummy tuck.
'As with many things - many hands make light work
'so everybody has a job.'
After six hours, surgery is complete.
Thanks very much, everyone.
Things went well. The vessels were mapped out
for us on the CT angiogram.
Once we had the flap elevated on the blood vessels,
everything else went very well.
The next morning, she's recovering in the ward.
I'm really pleased with the results.
It's lovely looking down and seeing two breasts!
It makes a big difference.
I think I'm only realising now just how much it impacted on me.
Going to check your... Do your... Check your flap.
-And your urine.
-So if you want to go around and check her urine and see what it is.
So, basically, you're looking for the colour,
making sure it's nice and warm.
-Can I feel it?
-Yeah. So if you put your hand down, you can feel.
-Oh, yeah. OK.
-Then you're looking for the return.
-That's doing really, really well. All right.
I think I just sort of had accepted and got on things, you know?
And now that, well, I'm looking down and seeing this breast and thinking,
"Goodness, I'm, like, normal again!"
So, it's good.
In Musgrave Park...
-This is class.
-..Tim and his wife Jenna have been amazed at the mobility that
the new C-leg has given him.
That's amazing, like.
Really amazing, like.
Big smile on his face. It's great to see.
Prosthetist Peter Taylor is happy that Tim
is a fitting candidate for the upgrade.
I think you're just more comfortable with it.
Take the phone out, answer it here, coming downhill
and everything here.
Huh? Order a pizza.
I'm putting my full weight on that leg and, you know,
you can feel it working away, like, it's amazing.
'With a new knee joint, when the person hits the ground with their heel,
'the knee will sense that.
'It knows that the leg is likely to leave the ground and then it has
'separate settings for the leg swinging back to straight again.'
There's modes on it, so you can put a cycling mode in it,
you can put a mode in it for playing sport, you know?
There's Bluetooth technology in it, so if I want to change a mode,
you can change it on your phone.
I want a motorbike mode!
At the children's hospital,
four-year-old Tyler has taken a turn for the worse.
The oxygen levels went dangerously low to 86,
so they put in the wee line in his hand
and that was just to get the medicine
straight into the IV so it speeds the whole process up.
So he's back on the oxygen now,
so he'll be on that for the next 20 minutes, half an hour.
He's going to need to stay in hospital now,
probably for about 48 hours to let the medicines do its work
and hopefully until he's better.
We're also going to do a wee X-ray of his chest to check and see
if there's any infection there that we need to treat.
Come on in.
Get a nice picture, will we?
Look, Tyler, this is just a picture.
That's all it is, just one picture.
All right? Right.
So... That's grand.
Just try and keep those straight, all right?
So he didn't really want to get his X-ray taken, but ideally...
See the way his head's turned here?
We ideally want the child's head straight
because with children,
when they turn their head, it rotates their chest.
So it's not really even on both sides,
so the doctor compares both sides, you see?
But obviously, with Tyler there, he wasn't really happy,
so you're just going to go with what you get, basically.
The results of his X-rays show that he has an infection.
So, at this stage, he's going to be transferred over to the ward for
further management and to continue his care.
And Mum and Dad obviously will be able to go with him
and stay with him.
Good boy, nearly done.
24-hours has made a remarkable difference to Tyler's condition.
He was treated overnight with nebulisers,
IV antibiotics and oxygen.
He was well this morning, so he's changed onto inhalers
and the medical staff are happy to discharge.
It's been ten days since Rosaline's reconstructive surgery.
She returns to the Ulster Hospital for a checkup with Mr Sinclair.
I'm very pleased with the breast.
It's so natural.
Possibly left a little bit of skin and make a nipple mound here
and then we'll tattoo some colour in to match the areola.
I think because they used the tummy fat,
it just has made the breast nice and soft, just like, you know,
a normal breast.
-I've already ordered...
..a couple of nice wee dresses with wee, thin straps, so, yeah,
it's... I'm feeling really, really good.
-Thank you very much.
-But take things easy for the next few weeks.
-Your muscles are all there...
-..the nerves are all there,
so you should get back to activities fairly quickly.
Yes, good, yes.
-Thank you very much.
-See you then. Bye-bye.
-Where's Daddy's bad leg?
There's been a new arrival in the Shields' household and Tim has
been feeling the benefits of his new prosthetic leg.
This is Madison, she's three and a half months old.
I had the other leg on with my first son, Mason,
and I wouldn't have even dared to have done this here, like.
So the confidence it gives me even just to be able to pick Madison up,
walk with her, I've no issues with doing it with this leg at all,
I don't even think about it.
Being able to look after his two young children
has changed Tim's life.
His new C-Leg has also allowed him to fulfil
one of his other ambitions.
Because I also ride the bike,
they also put a wee adapter in my leg
to make it easy to put the shoes on,
so I can flip it right up and it's easy for me to put it on.
You get an app that you can have on your phone
and it's able for me to set my leg up for riding the bike.
Whenever I want to go into motorbike mode,
I just select it, hit "OK", the leg beeps to let me know it's locked in.
And that will stay in that position until I change it.
Whenever Tim told me he was getting another bike after the accident,
I wasn't so sure about it.
I didn't really agree with it at the start,
because I was just scared of the same thing happening over again,
especially with another wee one.
Since he's been on the bike again though,
it's just really lifted him and with me seeing that
and seeing how happy and how much he enjoys it,
then it makes me feel a bit better about it.
They couldn't have done a better job, you know,
right from the get-go.
There's no doubt the NHS did save my life.
In Ballynahinch, it's just over a week since Garvin's last operation.
Having overcome some serious complications,
he's feeling positive about his recent progress.
Getting back on my feet is important with my newborn child.
Being able to do my normal duty of being a father and a husband,
getting back to work.
It sounds like a copout, smash your leg, you get out of nappy duty,
to see her and hold her... Whoo!
Being able to walk again...
..will be great.
-Yes, yes, here we go.
It's now been four months since Rosaline's surgery.
I think when I got out of hospital,
it took me a few good four or five weeks to get my strength back up.
Going through the surgery and getting the reconstruction,
it's just really closed that chapter.
I'm just looking ahead now.
Not having any impact of it on me any more, it's just...
You know, I'm back to...
you know, what I was.
I feel really privileged receiving the treatment.
The care's second to none.
She obviously had to go through a phase of being told
she was diagnosed with breast cancer and then had the treatment for that,
which included chemotherapy and radiotherapy,
so that was quite a process for her to get through.
Something like this can help just complete the process and help
her hopefully move on.
I'm really delighted with the results.
It's far better than I ever would have imagined.
And, yes, I'm glad I took that decision.
I think I would have regretted it if I hadn't.
You know, you don't know what might happen in the future.
You might meet someone.
Just go for it.
Rosaline Wray is having life-changing breast reconstruction surgery using a technique which involves the flesh from her abdomen. Seven-year-old Tyler is admitted to A&E in the Royal Belfast Hospital for Sick Children following an asthma attack. Tim Shields road tests a brand new state-of-the-art prosthetic C-Leg in Musgrave Park Hospital. Garvin hopes that surgeons can save his leg from amputation following compartment syndrome and that his surgery will allow him to be mobile enough to look after his newborn baby.