Episode 4 Saved: At the Heart of the Health Service


Episode 4

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This man's had a previous stroke,

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which makes things a bit more complicated in assessing him.

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In - one, two, three.

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Out - one, two, three.

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Cough, come on, cough.

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HE COUGHS

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I think you brought it up.

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It all started with a pea size

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that lived in my right sinus.

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Then it began to grow

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and it came out almost like half a golf ball on my face.

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'You get trained on how to break bad news...'

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We're in to do the bloods, is that OK?

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'..but sometimes you find yourself getting too close to patients,

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'so it's is about finding that balance.'

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Fat grafting is actually pretty simple.

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This is how we harvest it, with this cannula,

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so we're going to start now and harvest some fat.

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There is a risk of bleeding in your brain.

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-Are you able to understand that?

-Help.

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Can we try to get a relative on the phone?

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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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In the Royal Victoria Hospital,

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Doctor Enda Kerr is treating 67-year-old James McCabe,

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who he suspects has had a stroke.

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My name is Doctor Kerr,

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one of the doctors from the stroke unit.

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This is Maria Kinnaird, our stroke specialist nurse.

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All right, pet?

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T-t-t...

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HE WAILS

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Are you able to lift your arm up?

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Good. Can you keep it up?

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Keep it up for ten seconds.

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Ten, nine, eight, seven,

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six, five, four,

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three, two... Right.

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That is a typical drift.

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Can we try to get a relative on the phone

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to establish what his baseline language was like?

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Mr McCabe, he was already in the hospital,

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he was having a procedure done on his heart

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called a coronary angiogram, or a dye test of his arteries, and...

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not an uncommon complication of that procedure

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would be to develop a small clot

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to go up into the brain

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and present as having a stroke.

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Try to point to the ceiling with your finger.

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Is that...?

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It's hard to understand that one, is it? OK.

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We talk about time as brain,

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the quicker you get to us,

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the quicker we give you the treatment,

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the more likely it's going to be effective

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and, really, you need to get to us within three or four hours.

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We're literally talking about a five to ten-minute assessment

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of the patient to clarify the diagnosis.

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Have any double vision?

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'Figure out how bad the stroke is

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'and then get them urgently to the CT scanner.'

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Don't worry.

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James is showing some of the symptoms associated with a stroke

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but, as he was already in hospital when it began,

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time should hopefully be on his side.

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Are you able to lift that leg at all? Not at all.

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While most of us will only need the care and support of the NHS

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a few times in our lives,

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there are some who will need much more.

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Well, Grace has been coming to the School of Dentistry

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for probably about ten years now

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and has had a variety of treatments done over the years.

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Grace Smith was a keen socialite

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and captain of the local golf club.

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At the age of 46,

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she was struck by cancer.

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It all really started with a pea size

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that lived in my right sinus,

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then it began to grow and it came out

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almost like half a golf ball on my face.

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Grace had an aggressive cancer of the salivary glands.

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She has had to have her upper jaw bone,

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lower eye socket

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and most of the right side of her face removed.

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Over the last 12 years,

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a team of experts have used the latest pioneering technology

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to gradually reconstruct her face.

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I had three very young children at the time.

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I knew that I had no alternative.

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I had to go through with it

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or I wasn't going to be here.

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That was really how I felt.

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Anything I had...

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thought of doing or any plans that I had made

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really all just...

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disappeared

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cos nothing matters any more

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and your main thought is,

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"I have cancer and I have to fight it, and I have to get through."

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I would say, in my own small way,

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I was maybe a little vain in life.

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I wouldn't have gone to work without my make-up on

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and I wouldn't have gone out without make-up and nails done,

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so it really hit hard.

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It hit home very hard that,

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all of a sudden,

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I'd gone from being

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a bubbly, outward-looking person

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to living life behind dark glasses

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for 11, 12 years.

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Scalpel blade.

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I'm just going to cut away a wee bit of this as well.

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Grace lost all of her top teeth and upper jaw bone

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as a result of the cancer.

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But today, specialist dental surgeon Dr Simon Killough

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is taking a mould of her reconstructed hard palate

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so she can be fitted for a permanent bridge.

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Really, to get the teeth back in

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will restore her...

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cosmetic appearance, first of all,

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and then also her function.

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She'll be able to eat and drink much more easily.

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The teeth and the smile is such an important part of who we are

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and that's one of the aspects of head and neck cancer,

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it can take that away.

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And it is such a nice part of the job

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to be able to give that back to the patient,

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to give them back their smile.

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Can't smile really without upper teeth,

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so I'm really looking forward

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to being able to smile.

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Also, I have a granddaughter

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and I can't give her a kiss on the cheek

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because I can't do the kissing

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formation with no teeth.

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It's taken 14 surgeries over 12 years

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to get Grace to where she is today -

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the most complex of which was to replace her entire upper jaw bone.

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In 2014,

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a team of surgeons at the Ulster Hospital

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were able to make use of some cutting-edge technology,

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recently pioneered in Belgium,

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which allowed them to make a precise 3-D representation

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of Grace's original jawbone.

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They then replicated it

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using the fibula from her leg.

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The main difficulties with this reconstruction -

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the fibula bone is used routinely here and elsewhere

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to reconstruct the lower jawbone,

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quite a straight bone in a way,

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but trying to do that with the upper jawbone,

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the maxilla, is much more complex

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and that's where the 3-D planning technology came into play.

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It basically uses the image data on the CT scans

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and you can do the virtual surgical planning,

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pre-plan where you're going to cut the bone,

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and generate a template like this.

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These slots are all appropriately angled

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so that, when you make all those cuts,

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it will all piece together

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in a jigsaw fashion, like that.

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It was very, very precise

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and there's no wastage at all

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because you know exactly

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at what millimetre you have to cut.

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While in the old days, if you wanted to do something similar,

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you'd be guessing that, "I need this to be 7-8 millimetres,

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"I need this to be that angle,"

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and if it doesn't fit, you have to trim a bit.

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The Macmillan Unit is located in the grounds of Antrim Area Hospital.

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It's a specialist palliative care facility

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for those in the advanced stages of progressive illnesses,

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such as cancer, motor neurone disease and heart failure.

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23-year-old junior doctor Conal Corr begins his rounds.

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I'm currently a foundation year one doctor.

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My first rotation is up here, in the Macmillan Unit,

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to start off my first job as a doctor.

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-Hello, Maureen.

-Hello.

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-How are you?

-Not so bad.

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Are you OK sitting forward?

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You're not sore or anything, are you?

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-My stethoscope might be a wee bit cold, all right?

-That's all right.

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Maureen was a really, really fit and healthy individual.

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She was a horse riding trainer

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and a gymnast,

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and I think that's why she's managed to get to the age that she is

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without any problems.

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And I think that's why the cancer that she does have

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has been allowed to grow and to spread

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without her really noticing it until a very late stage, unfortunately.

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That's you, all right?

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SHE COUGHS

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-Is that cough still bothering you, is it?

-No, it's not bothering me.

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-Are you sure now? Are you just being a trooper?

-No, no.

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THEY LAUGH

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I'll leave you in peace now, anyway.

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-All right?

-Thank you very much.

-See you soon.

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You have to be a people person.

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You have to be able to talk to people.

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There has to be a relationship.

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And I think that's why I'm interested in palliative care

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and end of life care,

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because there's so much...

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It's SO patient-centred.

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The nurses are brilliant.

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Really, really lovely, lovely nurses -

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every one of them.

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Doctors, everything, staff, the lot.

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Could not get better.

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I have a few, like, non-medical friends,

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and when I started the job,

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I was maybe a month or two in,

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and they'd have said, "Oh, Conal, how many lives have you saved?"

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I sort of said, "Well, none,

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"because I don't work in that setting."

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But psychologically

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that's difficult because you're not actually treating people.

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You're not able to fix things and that has been challenging.

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But, apart from that, I love it.

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I couldn't see myself in any other career.

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In Lurgan hospital,

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the Acute Care at Home Team are having their morning meeting.

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Gentleman came on Friday evening,

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MS man, he's in bed at the minute.

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He remained quite chesty over the weekend.

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What fluids is he having, Ann?

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'This is a very unique team.'

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We're the first team within Northern Ireland

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to actually act within this model.

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You'll hopefully see him this afternoon.

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Paul will start cough assist

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and whatever nurse...

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If you can do a joint visit with the nurse this afternoon.

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So, it's a multidisciplinary team

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made up of specialist nurses, physio,

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pharmacist and our consultant doctors.

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It's hospital at home.

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We're doing all the care and intervention that a hospital can do.

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The idea of our service is to cut out hospital admission,

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where they'll be treated within the home.

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Maybe a doctor has been called out,

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our team will come into play

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and we will go and see them and see if they are appropriate

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for the Acute Care at Home Team.

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The acute care service also has big benefits for patients,

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who can be treated in the comfort of their own homes,

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and their families,

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who can avoid the hassle and expense of repeated hospital visits.

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Anne Graham's husband, Billy, has MS...

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Hello, Anne. Hello.

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..and was referred to the team last week

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as he's currently suffering from pneumonia.

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We'll explain everything to you.

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Take a nice, deep breath when you're ready again.

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-Go, a big one.

-HE EXHALES

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BILLY COUGHS

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That's OK. That's OK.

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The team that come out

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are really, really good.

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And there is a nurse comes three times a day,

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and does all the injections and things.

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Breathe in with the machine.

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In - one, two, three. Rest.

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It's great because

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you don't have to be tied to a time

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to go and see him,

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you can see him at any time,

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and you know what's going on all the time,

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instead of going into the hospital and being told.

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You know at the time what's happening.

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It's much better, so it is.

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In - one, two, three.

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Out - one, two, three.

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In - one, two, three. Cough.

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Come on, cough.

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-HE COUGHS

-Very good. Very good.

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'Cough assist is one of the best options

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'to help him clear the secretions.'

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Clearing secretions are going to help improve the infection

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-as early as possible.

-HE COUGHS

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Good, strong cough there.

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Well done.

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He's quite well this afternoon.

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He will still need quite a few more days of intensive physio

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and intravenous antibiotics.

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We'll also be taking blood samples

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to check the effectiveness of the treatment.

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Well done. Well done.

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We could take most of our pneumonias back into the home

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and we could look after them if we have a good team down.

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Most of the pneumonias can be looked after at home.

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You don't really need hospital admission,

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unless they are critically unwell.

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I haven't been well myself,

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which means I can't drive all the time.

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I couldn't get down to see him if he was in hospital.

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At least, if I have him at home, I can see what's going on.

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It's great.

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They even come out here to the house...

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instead of having me go into hospital,

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in which they are more packed.

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Better for them to come here.

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At Craigavon Area Hospital,

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their always-busy laundry department

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has become a integral part

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of the Southern Trust's domestic services,

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with the staff here managing the laundry

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for eight separate hospitals.

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It opened back in 1972

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and head of linen services, Anne Forbes,

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has been at the helm for the past 15 years.

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That's the Belfast linen being sent out.

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Going out, yeah.

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In this laundry, we employ 52 staff.

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We process about 100,000 pieces of linen a week

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and we service up to 1,600 beds.

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All the linen that comes within the health service

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must be washed at a thermal disinfection temperature

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and that's to ensure that all infections are destroyed

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and the linen is safe, at point of use, for the patient.

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Every delivery of dirty laundry

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must first pass through the sorting room,

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where the team takes special care

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to ensure that no unwanted items

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end up in the wash.

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We get phone calls here to watch out for mobile phones

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and iPods,

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false teeth...

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You're never surprised what you're going to find

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when you open a bag in here, you know? It could be anything.

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The only thing we haven't found is a patient.

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There's times that there's stuff comes in here

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and the smell is overpowering.

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You have to have a really, really strong stomach sometimes, you know?

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But you get used to it in the end, you know.

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Back at the Royal, it's 30 minutes

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since James McCabe's started showing signs of a stroke

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and the team are ready to begin his CT scan.

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We want to see if we can identify any large arteries that are blocked,

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in this man's brain,

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that seem to be causing this sudden speech problem

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and visual problem that he's developed.

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But as the results start coming in,

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a diagnosis could prove trickier than expected.

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This is complicated cos this man's had a previous stroke

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in the right side of his brain,

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causing left-sided weakness,

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which makes things a bit more complicated in assessing him.

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A major riddle...

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'The most exciting treatments

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'that people talk about for acute stroke are...'

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One is an intravenous drug, that we call thrombolysis,

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that helps to dissolve clots.

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There's some risk, with that drug, of causing bleeding -

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so selecting a patient for that treatment is really important.

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The second real major advance in stroke treatment in recent years

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is a thing called clot retrieval,

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where we have colleagues in our hospital here

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who can go into your arteries, in your brain, with little fine tubes,

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find the clot and physically pull it out.

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It's remarkable when you see someone with a dense stroke

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going from unable to speak, unable to move, to -

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within minutes or hours after that treatment -

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standing up and walking out.

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We're trying to figure out

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whether you've had a stroke or not this morning.

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Another stroke.

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OK?

0:16:270:16:28

You're large arteries in your brain are OK.

0:16:280:16:31

It might be that there's a small artery in your brain

0:16:320:16:35

that's blocked by a clot.

0:16:350:16:39

The treatment for that is a clot-busting drug

0:16:390:16:41

that we call thrombolysis,

0:16:410:16:43

but there is some risk with doing that,

0:16:430:16:46

in giving you that treatments.

0:16:460:16:48

It's about one in 50,

0:16:490:16:51

2% risk,

0:16:510:16:54

of bleeding in your brain.

0:16:540:16:56

That could make you worse.

0:16:560:16:58

Do you understand that?

0:16:580:17:00

Are you able to understand that?

0:17:000:17:02

Help.

0:17:020:17:03

OK. Oh, it's frustrating,

0:17:050:17:07

it is frustrating.

0:17:070:17:08

OK.

0:17:080:17:10

I think what we'll do is we'll give him thrombolysis.

0:17:100:17:14

I can't exclude that he's not had a stroke

0:17:140:17:16

-and he has severe speech problems.

-OK.

0:17:160:17:18

OK, sir, I'm going to give this clot-busting medication now, OK?

0:17:220:17:25

I have some suspicion

0:17:270:17:28

that there may be something else going on other than a stroke

0:17:280:17:31

but, at the moment, it's impossible to tell for sure

0:17:310:17:34

whether it was or was not a stroke.

0:17:340:17:36

I'm just going to flush through a bit of water.

0:17:360:17:38

The scans are good, there's no major artery occlusion,

0:17:380:17:42

so this thing seemed to happen very suddenly.

0:17:420:17:45

It is in keeping with a stroke

0:17:450:17:46

and he seems to have right-sided weakness

0:17:460:17:49

along with a loss of language,

0:17:490:17:50

which is very much in keeping with a stroke.

0:17:500:17:52

Just the way he's behaving.

0:17:520:17:54

He seems a bit frustrated with it

0:17:540:17:55

and that's making me wonder, you know, for sure.

0:17:550:17:58

But, if it is a stroke, then we only one option

0:17:580:18:01

and the option is to get rid of this clot

0:18:010:18:03

and the only way we can do that now

0:18:030:18:05

is by giving him the clot-busting drug.

0:18:050:18:07

Tough calls like these are part of everyday life for doctors.

0:18:080:18:12

Mr McCabe will be kept under close observation

0:18:120:18:15

to see how he responds to the treatment.

0:18:150:18:17

At the Ulster Hospital,

0:18:220:18:23

cancer survivor Grace Smith

0:18:230:18:25

is in for yet another operation.

0:18:250:18:27

Plastic surgeons Chris Hill and Declan Lannon

0:18:270:18:31

want to close a hole in her upper palate

0:18:310:18:33

as well as taking fat from her stomach

0:18:330:18:35

to help rebuild her face.

0:18:350:18:38

Grace, I haven't seen you since we did the last fat grafting,

0:18:380:18:41

so I know that your tummy was quite sore afterwards

0:18:410:18:44

and I'm afraid it probably will be again but,

0:18:440:18:48

just looking, it has added a bit more volume in here,

0:18:480:18:50

but there's still this contour deformity in your cheek

0:18:500:18:53

and we'll really aim to try and fill that out this time.

0:18:530:18:55

..but despite undergoing numerous surgeries,

0:18:570:19:00

it still doesn't get any easier for Grace.

0:19:000:19:03

Apprehensive, nervous,

0:19:030:19:05

but I'm in the very best of hands.

0:19:050:19:07

So, looking forward to getting another stage

0:19:070:19:09

in the journey completed and one more move towards the end.

0:19:090:19:13

There are two parts to today's procedure.

0:19:190:19:21

We're going to do some fat grafting to her cheek

0:19:210:19:23

and we're going to then try to close

0:19:230:19:25

the palatial fistula in her mouth.

0:19:250:19:28

What I'm doing now is I'm just looking at her face,

0:19:280:19:31

at the side that's unaffected,

0:19:310:19:32

and I'm just trying to decide...

0:19:320:19:34

We're looking at the contours here on the right side

0:19:340:19:36

to decide where I'm going to put the most fat.

0:19:360:19:41

The sorest bit of the fat grafting procedure is her abdomen.

0:19:410:19:44

It will feel a bit...

0:19:440:19:46

I tell patients it feels a bit like being punched in the tummy,

0:19:460:19:50

so it's not agony, but it's still uncomfortable.

0:19:500:19:53

Fat grafting is actually pretty simple.

0:19:550:19:58

This is how we harvest it,

0:19:580:19:59

with this cannula.

0:19:590:20:01

When it sucks the fat in,

0:20:010:20:02

the idea is to try and not damage the fat

0:20:020:20:05

cos we want the fat to be viable

0:20:050:20:06

so that it will survive when we transfer it to her face.

0:20:060:20:09

So, we're going to start now and harvest some fat.

0:20:090:20:13

So, I'm just making a little stab incision

0:20:130:20:15

through the skin into the fat here

0:20:150:20:18

and then, that's now sitting in the subcutaneous fat.

0:20:180:20:20

I can feel where the tip of the cannula is

0:20:200:20:23

and I've got the suction now on this

0:20:230:20:24

and you can see the fat starting to come into the syringe.

0:20:240:20:28

It'll be quite watery because of the local anaesthetic.

0:20:280:20:31

It's a bit repetitive, but...

0:20:310:20:33

it's fine when we're not trying to harvest too many syringes,

0:20:330:20:37

but, if you're harvesting 20 or 30 ten-mil syringes,

0:20:370:20:40

it becomes quite hard work.

0:20:400:20:43

So, you can see that's a syringe of harvested fat.

0:20:430:20:46

Once Mr Hill has harvested a sufficient amount of fat,

0:20:480:20:51

it then has to be centrifuged and separated

0:20:510:20:54

before being re-injected into her face.

0:20:540:20:56

OK.

0:20:560:20:58

The centrifuge has stopped

0:20:580:20:59

and we're just going to lift these out...

0:20:590:21:01

You grab the other two, Chris.

0:21:010:21:02

..and you can see, it's quite colourful, actually.

0:21:020:21:05

This is the fluid layer, with the blood.

0:21:050:21:07

There's a little patch at the bottom.

0:21:070:21:09

This is the viable fat and, at the top, you can see the oil.

0:21:090:21:12

Now, clearly here, you need to be careful

0:21:120:21:14

that the fat doesn't actually start to run out.

0:21:140:21:17

It's, sort of, held in by the suction at the minute,

0:21:170:21:19

but it will fall out, eventually.

0:21:190:21:21

And that is the fat that we're going to use.

0:21:210:21:24

And that's it...clean now.

0:21:240:21:25

Just let it slide back down the tube.

0:21:270:21:29

So, we're going to infiltrate the fat now with this.

0:21:310:21:33

This is a blunt cannula,

0:21:330:21:35

so through this tiny, little incision

0:21:350:21:38

I'm just going to advance this cannula under the skin.

0:21:380:21:40

You can see it moving down.

0:21:400:21:43

Now, the idea is to infiltrate the fat

0:21:430:21:45

as you withdraw and you can see, look.

0:21:450:21:47

You can see the little ridge of fat that's been left behind.

0:21:470:21:51

So, you just keep doing that until the area is filled.

0:21:510:21:54

Each layer of fat that's placed

0:21:550:21:57

will be close to her blood supply.

0:21:570:21:59

If you put it all in the same place,

0:21:590:22:00

if you just keep injecting and blow one area up,

0:22:000:22:02

the innermost layer of fat,

0:22:020:22:04

or the inner layers of fat,

0:22:040:22:05

will be too far from the blood supply to actually take as a graft.

0:22:050:22:08

After about four months,

0:22:100:22:12

the fat is felt to be stable,

0:22:120:22:13

so the patient, the volume that they gain

0:22:130:22:16

will remain and really will remain indefinitely.

0:22:160:22:19

So, it's a permanent fix

0:22:190:22:21

and we've certainly significantly improved the contour.

0:22:210:22:24

This fat grafting is only the first part of today's surgery -

0:22:240:22:28

Grace lost most of her upper palate due to the cancer -

0:22:280:22:31

but after this dual operation,

0:22:310:22:33

it should be restored to normal function.

0:22:330:22:36

This lady has a large fistula,

0:22:360:22:37

a large hole in the roof of her mouth,

0:22:370:22:39

connecting into what would have been her sinus and her nose,

0:22:390:22:43

her nasal cavity.

0:22:430:22:45

So, that's giving her nasal speech

0:22:450:22:47

and it can cause a certain amount of nasal regurgitation,

0:22:470:22:50

where food and fluid can pour out of the nose.

0:22:500:22:53

We're trying to close that.

0:22:530:22:55

Declan has raised this oral flap

0:22:550:22:57

and it's going to swing back the way

0:22:570:23:00

and stitch across that, like that.

0:23:000:23:02

We'll be using the front of her palate

0:23:020:23:04

to try to close the back of the palate.

0:23:040:23:07

The front of her palate will then be a raw area.

0:23:070:23:09

It will be a raw, unclosed wound

0:23:090:23:11

that will have to heal itself over the coming weeks.

0:23:110:23:15

Back at the Macmillan Unit...

0:23:210:23:23

We need a blood sample on Jacqueline in room 12.

0:23:230:23:26

..junior doctor Conal Corr is finishing his rounds.

0:23:260:23:29

Unfortunately, it has been tried a few times

0:23:290:23:32

and it's been really difficult to get it,

0:23:320:23:34

so we're going to have another go on her, just to see.

0:23:340:23:37

I will have two goes. Two goes is quite reasonable.

0:23:370:23:39

Three's pushing it.

0:23:390:23:40

Then you might want to just refer on to somebody else who can do it,

0:23:430:23:46

who's maybe more experienced.

0:23:460:23:47

ALARM BEEPS

0:23:470:23:50

'Jacqueline is a new lady that was just brought down to us yesterday.

0:23:530:23:56

'She's a young lady with breast cancer

0:23:560:23:59

'and she's had chemo, she's had the surgery, she's had everything,

0:23:590:24:03

'but unfortunately the disease has come back.

0:24:030:24:06

'So now it is all about supportive measures,

0:24:060:24:08

'but she has a really good family support,

0:24:080:24:10

'which is so lovely to see and it's...

0:24:100:24:12

'It makes our job a lot easier when the family are there,

0:24:120:24:14

'helping them through.' Hello, Jacqueline.

0:24:140:24:16

-Hiya.

-Morning.

-We're in to do the bloods, is that OK?

0:24:160:24:19

Sometimes you find yourself getting too close to patients.

0:24:210:24:24

You know, you get trained on how to break bad news

0:24:240:24:26

and how to tell somebody that somebody's died.

0:24:260:24:29

But I was on a night shift,

0:24:290:24:30

'and there was a patient of ours recently

0:24:300:24:33

'who I was a very close with, and I thought I'd pop down...'

0:24:330:24:35

That's going to be really tight, OK?

0:24:350:24:37

But it'll help. The tighter, the better.

0:24:370:24:39

I went into the main office and her name wasn't on the board any more,

0:24:390:24:44

and that was how I found out.

0:24:440:24:45

And that...

0:24:450:24:47

You know, that was no-one's fault,

0:24:470:24:48

but that wasn't a nice way to find out.

0:24:480:24:51

And, in that way, it is difficult,

0:24:510:24:53

so it's about finding that balance.

0:24:530:24:55

Stop.

0:24:550:24:56

Sometimes it does that.

0:24:560:24:58

That's what Gordon said.

0:24:580:24:59

Every person that's passed away in this unit

0:25:030:25:06

has done so comfortably,

0:25:060:25:08

peacefully and surrounded by their families, every time.

0:25:080:25:11

That, for me, has been...

0:25:130:25:15

It's really helped me deal with it in my own head and say,

0:25:150:25:17

"Yes, these patients are dying,

0:25:170:25:19

"but it's a successful death."

0:25:190:25:21

We're all going to die someday and I think, if I did,

0:25:210:25:23

that's how I'd want it.

0:25:230:25:24

I'd want to be peaceful and comfortable

0:25:240:25:26

and surrounded by my family, so, you know,

0:25:260:25:28

you can't really ask any more than that.

0:25:280:25:30

At the Royal Victoria Hospital,

0:25:390:25:41

67-year-old James McCabe has responded well

0:25:410:25:44

to his clot-busting medication.

0:25:440:25:46

Mr McCabe has had a fantastic outcome

0:25:470:25:49

after getting the clot-buster drug,

0:25:490:25:50

which was given to him really very quickly

0:25:500:25:53

after onset of the stroke.

0:25:530:25:55

And I suppose that's the thing about stroke,

0:25:550:25:57

it can be really devastating

0:25:570:25:59

and, hopefully, you can see

0:25:590:26:01

that the systems we have set up in our hospitals

0:26:010:26:04

allow us to try to respond to people having a stroke urgently.

0:26:040:26:08

We get there as quickly as we can.

0:26:080:26:11

I can't thank Doctor Kerr and the medical team enough.

0:26:110:26:15

They explained everything, bit by bit,

0:26:150:26:19

because, at the time, it was frightening.

0:26:190:26:22

You couldn't get the words out.

0:26:220:26:24

You had them in your brain, but they wouldn't come out.

0:26:240:26:28

With the care of Doctor Kerr and his team,

0:26:280:26:31

it was bloody marvellous.

0:26:310:26:33

You couldn't be in a better place than it actually happened.

0:26:330:26:37

It's now been seven weeks since Grace's surgery.

0:26:450:26:48

And it's improving the shape of my face,

0:26:490:26:52

and it's giving me the symmetry with the other side

0:26:520:26:55

and I feel that that in itself

0:26:550:26:58

is helping me feel a lot more confident going out and about

0:26:580:27:01

when people aren't just staring at me

0:27:010:27:02

the same as they were in the past.

0:27:020:27:04

Each surgery that has taken place

0:27:060:27:07

has really improved my inner feeling about myself

0:27:070:27:11

and I definitely feel a lot more confident.

0:27:110:27:14

And with her oral surgery now complete...

0:27:140:27:17

We've got your bridge back from the laboratory.

0:27:170:27:20

..Grace is finally able to be fitted with a permanent bridge.

0:27:200:27:23

So, what do you think, Grace? What you think of them?

0:27:230:27:26

I think they're wonderful. Thank you. Yeah.

0:27:260:27:28

-Really pleased with them.

-It's looks lovely.

0:27:280:27:30

-I love them.

-Yeah?

0:27:300:27:32

It's lovely just to think now that I have permanent teeth.

0:27:320:27:36

They're absolutely wonderful and I'm delighted with them.

0:27:360:27:38

And it's a new smile,

0:27:380:27:40

a new chewing technique

0:27:400:27:42

and everything's great.

0:27:420:27:44

She really thinks it looks really good and I'm really pleased.

0:27:450:27:49

It's very rewarding sort of work, this, and such a good result.

0:27:490:27:52

Everything is moving forward,

0:27:530:27:55

and I'm delighted with it and I feel that I'm really getting there now.

0:27:550:27:59

One thing it's given to me, as I've said before

0:27:590:28:02

and will continue to say for the rest of my days,

0:28:020:28:05

is that they've given me quality of life

0:28:050:28:08

and they've given me my life back

0:28:080:28:10

and I never will be able to thank them enough for that.

0:28:100:28:13

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