Episode 2 Scotland's Superhospital

Glasgow's skyline has changed.

Four of the city's oldest hospitals have closed their doors,

and Scotland's biggest and most talked-about hospital

has taken over.

Are you ready, my big girl? Up you get.

Three quarters of a million patients are treated here every year...

SCREAMING

I think it's quite fetching!

The scans are up, equipment's ready, the lucky socks are on.

..using state-of-the-art technology...

I've got the manoeuvrability down there with the robot.

..cutting-edge operations

and world-class scientific research.

He said it had been grown in a laboratory in America.

You know what I mean? Grown!

This massive building

is transforming health care in Scotland.

There is nowhere else in Scotland that could have done everything

that we've done.

But is big necessarily better?

I think we all have trackers now to see how many miles we do a day.

Am I in an airport or am I in a hotel?

It's a cross between the two.

And in a hospital this size,

are they in danger of losing the human touch?

You could go home irredeemably mad

if you spent all your time in a single room.

It's all technology in here now. I don't like it at all.

You're so grateful.

Can you hear me?

Since opening two years ago,

the Royal Hospital for Children in Glasgow

has treated 180,000 children.

With 256 beds,

it's the largest purpose-built children's hospital in Scotland.

GIGGLING

Today, four-year-old Charlotte

has come in with her mum and dad for an operation.

Do you want a chair over?

Charlotte spent four months in intensive care when she was born

premature at 23 weeks.

See what you can do. Oh, look!

She weighed one pound six ounce.

So she was like...

the size of your hand, really. As you can see, there's my...

that's my hand and this is the size of Charlotte.

A bit of a scare when she came out that size.

When she was first born, the only thing I kept saying to Richard was,

"I'm sorry. I'm sorry." He was like, "Why are you sorry?"

I was like, "I don't know."

The fact is she's here, she's fought all the way,

and, to be honest, still fighting.

OK, Charlotte. Do you want to come through?

-Are you taking Boo Boo?

-Oh, got to bring them along.

Charlotte is being admitted

for an operation with specialist surgeon Tash Kunanandam.

She's hoping to fix a problem caused

during Charlotte's time in intensive care.

Charlotte probably came to my clinic almost a year ago.

She was born early,

so she went to the neo-natal intensive care unit

and she had a period of intubation, so she was on the ventilator.

And we know that,

although it's life-saving at the time and absolutely necessary,

it can actually lead to some problems with swelling and scarring

in the windpipe just under the voice box, and later on in life

that scarring can give rise to a narrowing in their airway.

As a result, Charlotte is susceptible to croup,

a condition that causes swelling in her windpipe and makes it difficult

to breathe.

She's required numerous hospital admissions so they've never been

mild enough episodes that she gets one dose of steroids

and everything's fine.

If you speak to the family, you know it does impact on their life,

they're almost scared of this happening

and the numerous trips to hospital.

Mum Charlene has had some scary times.

Croup, it doesn't sound as serious but when Charlotte's to the point

where she's barely breathing, that's when I feel myself it is serious.

There was a point where...

I was taking her to the hospital

and she actually turned blue and passed out in the car.

She was barely breathing when we got to the hospital.

And the fact that I've heard stories of people dying with the croup,

which I don't know if it is true, but I have heard,

and I just think that puts the fear through me even more -

that after her fighting for as long as she did, that I might actually

lose her through something silly like the croup.

With winter approaching, the dangers of croup increase,

so Tash is going to carry out a complex operation to permanently

enlarge Charlotte's airway, using a piece of her own rib cartilage.

We will make a cut into the airway,

going through all the tissue in the neck,

and divide the airway

-so we can open up and see the area that's narrowed.

-OK.

-OK?

We can just then measure the area that's needed to be grafted. OK?

So we take a nice bit of rib tissue,

carve it out and pop it into the airway.

-Are you all right?

-I don't know if I want to hear any more.

You've been through a lot with her. I know it's a big operation

but we're doing it with the aim that we can try to get things better

-for her.

-I know that, and that's what we want done, but it's just

hearing the actual procedures...

It is a big operation

but it is something that we do lots of in this hospital.

You know, it's a specialised area.

That's why you've come to us.

There's a whole team of people.

They'll all be absolutely looking to do the best for you.

Glasgow's adult neurology department has been here for 44 years.

Beside it stands the new hospital and a cutting-edge research centre.

Here, teams are working on one of the most complex

but least understood parts of the human body - the brain.

For neurosurgeon Roddy O'Kane it's his passion.

It's one of the fields of medicine, I suppose, one of the last areas

that we don't really know much about, to some degree.

And in that, that makes it an exciting field because things

are changing all the time.

51-year-old Peter is in for a scan

before a potentially life-changing operation.

This is the new winter range,

courtesy of Greater Glasgow Health Board.

Wrap round for the winter, keep you nice and warm.

There you go, have a nice day now!

Peter is having surgery to remove a tumour deep within his brain.

It's been increasing in size and causing him regular epileptic fits.

One seizure that I did have recently

lasted for 6.5 hours, I've been told.

I have no recollection of it.

Peter found out he had the tumour a week after meeting his partner, Sam.

I get told I had a brain tumour - I never had one until I met you.

At least I didnae run!

-I know you didnae run, hen.

-I know.

OK, thank you.

Roddy O'Kane is Peter's surgeon.

-Now! How are you?

-Fine, how are you?

-Hi, folks.

So people always say, "What are you going to chop out of me?"

I'm going with this...

Peter's tumour has grown to six centimetres.

All of this white stuff, OK?

Roddy suspects it's cancerous.

So he has proposed an operation

the team only attempt on around ten patients a year.

When Roddy first told me about the procedure for the operation, right,

eh, I wasn't too impressed.

It's a case of awake surgery, right?

And for people that don't know what that is, they sedate you,

cut the top of your head off, or part of your skull off,

then wake you up again.

When Roddy first told me this, I had visions of them standing,

having a talk, having a fag and using my head as an ashtray!

Roddy's going to perform what is called an awake craniotomy.

The operation that we're planning to do then is to put you asleep,

open up the head, then wake you up,

which allows us to take as much away

as possible without causing you damage.

This is a very important part of the brain.

This lies in what is called your primary motor strip.

If I chop that out in anybody, I paralyse them.

OK? So in your right side

-I would paralyse your left, and you are left-hand dominated?

-Yes.

It's a big surgery,

and you've got to appreciate that comes with risks.

So whilst you have walked into hospital,

you may have problems getting out. That is a possibility.

We could change your seizures, so we could make your seizures different

or more frequent or more intense, OK?

And everything I do carries a risk of death.

OK? Small it may be, it's there.

-In Rod I trust! Right?

-OK.

Right, the way I've got it in my head just now is that I'm going to

-lose power on the left-hand side.

-Uh-huh.

If it turns out that I don't lose the power and I get recovery,

it's a bonus. It's a Brucie Bonus.

I've got the worst-case scenario now, if I lose power altogether.

-So if you do a good job, happy days.

-That's it. You're just

-batting the pressure back to me.

-Aye.

-Good man.

-OK.

-See you Monday.

OK, good, good. Well done.

-OK, folks, see you, then.

-Thank you.

-All right.

Because of the risks involved,

not all surgeons would choose to operate on Peter's tumour.

What we're embarking on is not a black and white area.

It's an opinion-based area.

I have a more aggressive mind-set

to deal with this here, without a shadow of a doubt, yeah,

but I freely admit that.

He's young. He's fit, he's healthy, he's engaging,

he's the right type of patient to undergo an awake craniotomy

and he, I think, has fully taken on board

the different options that we have,

weighed them up and made his decision,

which, if he feels is right, it's the right decision for Peter.

Very brave. I think anybody going under surgery is brave.

-So, it's Peter Fury, is that correct?

-Yes.

-Can you tell me

in your own words what you are getting done today?

-Brain tumour removed.

-OK.

-I cannae remember...

-Yep, so it's an awake right frontal craniotomy.

-Aye.

-OK. So you're going to be awake during this procedure.

-Yes.

-Okey dokey? Now, are you allergic to anything at all?

-Ex-wives!

-None of them are surgeons, are they?

-No.

-OK.

Going ahead with this operation

is a big undertaking for both Peter and Roddy.

I'd like to pretend I'm calm and collected. I'm not. There is a joke

about why surgeons wear theatre masks,

that's cos we're screaming underneath it.

At any one time in the hospital,

there are over 500 trials taking place,

testing new treatments to help advance medical care.

The renal and vascular departments

in the adult hospital are world leaders

in specialist procedures for patients on dialysis.

Surgeon David Kingsmore is leading this work.

We've got the best facility in the world in cutting-edge research

and it's here in Govan. It's fantastic.

Today's a big day for him, with an exciting arrival from America.

This is science fiction being brought to the real world.

This package contains a 40-centimetre-long blood vessel,

or vein, grown entirely in a laboratory from human cells.

If you went back to 1985

and you said in a few decades

we would be able to grow something in a test tube to implant,

people would have thought you were mad.

Its arrival here marks the start of a clinical trial to find out if this

laboratory-grown blood vessel can help patients on dialysis.

The hospital is the first place in Europe to take part in the research.

In terms of cutting edge, this is on the front edge of science,

not just medicine.

One of Mr Kingsmore's dialysis patients is 47-year-old Dougie.

There she goes.

Dialysis is a life-saving treatment

that cleans the blood of patients with kidney failure.

I get it done three times a week,

eight o'clock at night till one o'clock in the morning.

Basically, I'm on dialysis until I get a transplant. That's...

That's cast iron. It's not as if you get dialysis one week,

miss it for a month and then come back,

if I don't come back here for the dialysis,

there is every chance they'll be phoning an undertaker.

Dougie has had a lot of problems connecting to the machines because

long-term dialysis weakens the veins and they become blocked.

34-year-old David is also struggling with dialysis.

I currently am dialysing through a line in my chest,

connected to the arteries. It's not working so well at the moment.

I'm pretty lethargic and pretty tired

with not getting a great dialysis.

Three quarters of patients will never get a kidney transplant,

so dialysis is their only option.

If you don't have a good, reliable system for doing that,

your life is really tough.

You'd never get your blood filtered,

your fluid builds up and you are in and out trying to get

lines and things working and it dominates your life.

Your life is about staying alive.

The next stage for patients like David and Dougie is to have

a plastic vein or graft implanted

in their arms, but plastic grafts have their problems.

We have had plastic tubes and grafts for 20 years.

They get blocked once or twice a year,

they get infections which can be up to 5% to 10%,

in which case they have to come out.

They are in hospital for a period of time. And they are very footery.

The new laboratory-grown blood vessel could be the answer.

David and Dougie have agreed to be part of the trial to test it.

He said it had been grown in a laboratory in America.

You know what I mean? Grown! So...

Aye, something different!

Dr Jeff Lawson, who pioneered this research,

is here from America to oversee the trial.

One of the things that brought us here to Glasgow is Dr Kingsmore.

He's an internationally recognised vascular access surgeon who cares

for these dialysis patients.

This is Dr Jeff Lawson from the States, he's across here.

Dougie is getting fed up getting recurrent operations

-and wants something that's going to work.

-It's nice to meet you.

And you're part of the cutting edge of all this tissue engineering.

It's exciting times.

Well, it's exciting but we really respect you helping out.

Hello? This is Dr Lawson from the States.

-All the way across.

-How are you, sir? Nice to meet you...

But there's a catch.

In this clinical trial, a computer will decide whether a patient

receives the new lab-grown vein or the plastic tube.

No-one will know until surgery begins tomorrow.

-Right, see you in the morning, then.

-It's nice to see you.

-Right, buddy, you take care.

-Thanks.

-See you in the morning.

-Have a good night yourself.

Get a good night's sleep.

Over in the children's hospital,

it's the morning of four-year-old Charlotte's operation.

Take a deep breath for us, darling.

That's it.

I'll lift you up to this trolley.

-This is the trolley?

-This is the trolley. We ready, my big girl?

Up you get. Good girl. I'll put this side up.

How comfy is that? Is that comfy?

Charlotte is having an operation to enlarge her airway

to try to prevent dangerous bouts of croup.

So if you think of your airways as a tube here, we make a cut

into the very front end, so that opens up and then we use a bit of

cartilage to plug that gap

and stitch it in, allowing it to heal up.

But it will have made the overall size of the airway much bigger.

You singing? Oh, she's giving us a song.

You can only hope it goes the way we want it to and she doesn't

get the croup any more. We're hopeful. Really hopeful, so...

Knowing Charlotte and her family for a little while now,

I'm hoping, very much like them,

that they will find this life-changing.

I would like to think that although this is something that technically

I enjoy, that this would be a fantastic result for the family.

I think once you start operating

you're always aware of who it is but it's much easier just to be focused

on the area that you are working on.

So I don't tend to have pictures

of Charlotte running round in my head at that point.

This is the only hospital in Scotland where this complex

operation takes place, so Tash has medical students observing.

So, we're starting with the chest area to get our rib graft material.

So we're going to find a nice cartilage bit of it,

which is softer, and put that safely to one side.

The first stage of the operation

is to remove a piece of Charlotte's soft rib cartilage.

Tash will work on it later.

-Knife, please.

-Obviously, because she's smaller, we need to just be

careful that we're not affecting her vocal cords.

Now she opens up Charlotte's windpipe.

-A little bit of bleeding there.

-Yeah, we'll just...

You know, if you stay in the lower half of it,

-you're going to be safe, aren't you?

-Yeah.

Knife, please.

The operation takes at least three hours.

A long wait for Charlotte's mum and dad.

I'm hoping it goes well.

I just try not to think about it too much.

I just hope she gets through it.

Tash now needs to shape the piece of soft cartilage

they took out earlier.

It must be the right size to fill the gap they've created

in Charlotte's windpipe.

So, using a piece of your own body

is always going to reduce the problems that you can get with

the area healing up, and in children particularly they have nice soft

cartilage, in adults this is calcified and hard,

so soft cartilage we can carve into a nice shape

to fit into the airway to expand it.

Tash is working the soft cartilage into place.

I can actually feel it click in just at the top now.

-I think it's looking in place, isn't it?

-It looks good, doesn't it?

After three and a half hours of surgery,

Charlotte is on the intensive care ward.

The next few days are critical.

Her airway must heal before she can breathe for herself.

The superhospital has the largest square footage of any hospital

in the UK. With 10,000 staff, and at any one time over 2,000 patients,

it has the population of a small town.

Down in the basement, robots have taken over.

I've been with them for over a year

and they have got their own wee kind of quirks.

It's like you maybe send one to do a job and it decides

it's no' going to do it, it'll go to charge.

They just do whatever they want sometimes.

The 26 robots find their way using sensors

and are each capable of lifting half a tonne.

'Attention: vehicle changes direction.'

If it wasn't for the robots, we wouldn't be able to run the hospital

because of the sheer size of it.

We're doing something like 900 jobs every 24 hours.

They cover an average of 225 miles a day.

When it suits them!

Well, the other smart thing they do

is they basically chuck you out of the lift!

There it goes. It stole the lift off me.

I'm stuck here at the moment.

'Attention: automatic transport.'

On the second floor of the hospital,

a ground-breaking human graft trial is under way.

15 years ago they didn't exist.

-That's correct.

-And it's science fiction, really,

what we are talking about!

Dialysis patient David needs a new blood vessel.

For the first time in Western Europe,

he may be about to get one grown from human cells in a laboratory.

Let's just put that on. Have you got everything you need? You are OK?

But it's a lottery.

Following strict trial conditions, a randomising computer programme

will decide whether David will get the new blood vessel or the standard

plastic tube.

This is the standard comparator, and this is the vessel.

It's sterile in here, that's actually the vessel itself.

The team have both options standing by.

David Kingsmore has performed over 230 graft operations

in the last five years but today is different.

Any time you do an operation you run things through your mind,

what you might anticipate. There is always a bit of uncertainty.

But this, it's all heightened for several reasons, but, one, you are now

involved in something that's new, that's different,

it's a first procedure.

You want to make sure that everything is set up,

that it runs smoothly and well.

So, yes, that is ramped up by quite a considerable amount.

This is prestigious and really very exciting for the hospital,

something to be really proud of that we've got enough of a reputation to

be wanted to be included and asked to participate in this.

It's a real honour. It's a real honour. It certainly is.

The first step is to open David's arm to find the right kind of vein.

It's got to be big enough to carry the blood,

soft enough to sew onto and deal with.

If there are narrowings or kinks or blockages, it won't work.

So when looking at the vein, that's what we're looking for, the size,

the calibre and whether it's nice and soft if we can use it to take

back blood to the heart.

-I think it'll be OK.

-Do you think?

-Yeah.

Mr Kingsmore finds a suitable vein.

Beautiful. Wonderful.

Hayley, we have a suitable vessel,

so can we now randomise, please?

It's 40 centimetres long...

Only the computer can decide

if David is getting the radical new blood vessel.

The suspense is killing me here.

We have it. We have the HAV,

the treatment arm, so this patient will get it. So congratulations.

It's been worth the wait.

David is receiving the laboratory-grown vein.

This ground-breaking blood vessel is the culmination of 20 years of

research by 12 medical centres around the world.

It's nice to be part of something which isn't just one to one but has

implications, not just for here or Scotland, but actually

its worldwide implications of helping people all around the world

who are in the same situations, who are suffering, and advancing

that knowledge a wee bit further, making their treatment a bit better,

giving them another option, so it means a lot to be a part of that.

INDISTINCT CHATTER

-Does that feel OK?

-Yeah. Yeah.

-Good.

Jeff's keen to find out what Mr Kingsmore thinks of

the lab-grown vessel.

So from a handleability?

It's easy. It's lovely. It's just like a nice, lovely bit of vein.

In some ways I think it has a little more structure than a vein.

-Absolutely.

-So it's easier to handle.

-Oh, absolutely.

And to be the first people in the UK, never mind mainland Europe,

is just fantastic, it's just brilliant. I'm very excited.

It's hard not to get excited about the new graft.

It really is very, very good to use.

It's like a perfect blood vessel. It's hard to go back to a cheaper

car when you've been in a very, very expensive one.

The surgical step of the trial has been a success.

But David Kingsmore had two patients today.

For Dougie, it's been a disappointment.

I didn't get the one that was coming from America,

neither I did.

I got the bit of plastic!

But...not to worry.

Not to worry.

Dougie may not have made medical history but the standard plastic

tube that he's had implanted in his arm should mean a better connection

for dialysis and there's always

the hope that he'll get a kidney transplant.

In adult neurology theatre two,

the operation to remove Peter's brain tumour is under way.

We do a sweep like that, an S line.

Surgeon Roddy O'Kane suspects that it's cancerous

so the aim is to remove as much of it as possible.

The risk is I'm going to paralyse him,

I'm going to paralyse his face and he won't recover,

so he will have a slumped, drooped face.

He will have a weak arm and potentially a leg.

That could be a complete paralysis -

an arm that does no activity whatever.

It might do some but not have fine dexterity.

And, of course, if he has a paralysed leg,

which is a bit further, but we could still damage it in the fibres coming

down, he wouldn't be able to walk.

To minimise the risks, Roddy will wake Peter up

when he reaches the deepest section of his tumour.

But while Peter's fully anaesthetised,

Roddy's first step is to remove a section of his skull.

Primary brain tumours tend to be mixed into brain.

So there is normal brain mixed in where the tumour is.

It's a mixed bag.

So in taking tumour you're going to damage brain, and depending on which

part of the brain that is,

that can have very profound consequences to patients.

A team of neurophysiologists

have helped wire Peter up with electrodes to help pinpoint

which tumour-affected areas of his brain control which parts

of his body.

-Happy?

-Yep.

They help identify a small piece of tumour Roddy can safely remove while

Peter is asleep.

I think the next part is just to wake him up.

Because that's what's going to aid what's going to go.

Now he's deeper into the brain,

it isn't safe to continue without waking Peter up.

Peter, Peter...

Some patients are too groggy to rouse during surgery but Roddy

can't continue with this operation unless Peter comes round.

Not only are you nervous for the patient waking up,

cos you want them to wake up, but you're nervous because there can be

problems with brain swelling.

So you're concentrating on multiple different events at that time.

That is always anxious.

Peter?

Peter?

Good afternoon, ward 3A, Debbie speaking, how can I help you?

Next door in the children's hospital,

it's seven days since Charlotte's airway operation.

Her ventilator tube has been removed and she's back on the ward.

You get your own room!

How good's that?!

And this is Mummy's bed. Your own space! Yes!

Where are the toys?

Where are the toys?

There is a playroom where you can go

play with the toys but once you're a wee bit better.

Now that she's got the tube out

we can actually have a conversation with her and see her

-a little bit more alert.

-She's a wee battler.

She always has fought, ever since she was born, so...

Nothing's going to stop her. It just seems like she's back to normal,

bossing everybody around.

-One...

-One...

-Two... Three...

-Ah!

Obviously you still worry about your kids but...

at least we can see forward.

So I just kind of hope with the winter coming around now

that there will be no more croup.

That's all I can hope for.

In the next couple of days,

Charlotte should have her feeding tube removed and she'll be able to

go home.

Cold winter weather will be the real test to find out if she avoids any

further life-threatening bouts of croup.

Where did it go?

In neurology, it's two hours into Peter's open brain operation.

Try this one...

You are. You are.

Peter, how are you doing?

Don't nod your head. Remember, you can't nod it.

The brain is unique in every individual.

We don't know exactly how it works in every individual.

The only way we know it is to have the patient do the tasks that we

want them to do, and so you have to wake them up.

Squeeze hard. Hard.

That's as hard as you can do it?

Speech and language specialist Jennifer Bowers

is assessing his hand strength and facial movements,

so she can feed back any changes to surgeon Roddy.

So I'm going to need you to just keep on and off squeezing my hand

like this. OK?

Can you wiggle your ankle for me?

Yeah. Yeah.

-Can he smile?

-Open wide and do a big cheeser.

Yeah, no. Upper and lower quadrants weaker.

Some weakness in Peter's face is not too much of a concern.

Facial muscles are controlled by both sides of the brain,

so there's good potential for recovery.

Peter's been awake for 15 minutes.

But something isn't quite right.

He's started to twitch uncontrollably.

Yeah, a good bit of facial twitching.

-We're not doing anything.

-OK. OK.

He's having an epileptic fit.

You're all right, Peter. It just feels a bit funny.

-Just keep looking at me.

-You're doing really well.

Are we having a seizure?

You're all right, Roddy's doing something about it, don't worry.

Just keep looking at me.

The only way to stop it

is to pour ice-cold water directly onto his brain.

Maybe about the last 30 seconds.

I still see some twitching here.

You're all right. Give me a big squeeze in this hand.

Yeah, you're feeling stronger again.

You're doing really, really well.

By slowing down the misfiring electrical activity

in Peter's brain, the icy water has stopped his fit.

-OK, I'm going to carry on.

-Are you feeling quite calm?

Good. Calmer than you thought you would?

Of course, of course.

Good.

OK.

How do you feel? Can you feel anything in your face?

Let me just check your mouth again.

Spread and forward like this.

OK, and spread and forward.

No, you've still got that pout, good stuff!

So, what do you prefer,

is it a different kind of holiday if you go to Turkey or Benidorm?

Benidorm is just a big party!

Along with Jennifer's observations,

Roddy continues to rely on the neurophysiologists' electrical readings

and Peter himself.

Getting twitching in the hands.

You OK?

Oh, we got another twitch there.

The signs are that Roddy is in an area of brain that could leave Peter

paralysed if too much tumour is taken out.

I'm starting to get a bit nervous to take that one.

There is a fight in your own ego.

You can't help but want to do more

but you've got to do that sensibly and you've got to know...

Training when to stop is probably a very big thing about training.

And that's what you gain with experience, it's about when to stop.

I think I'm done. I think I'd rather preserve more hand than take

the extra 6% of normality.

Pieces of the tumour are sent to the lab.

Only when Roddy gets the results back

will he know how serious Peter's cancer is,

and whether it's treatable.

Before an operation, we can have a guess from what we see on the scans

but we don't ultimately know what we're going to get.

And it takes a week for that result to come through.

So it's about getting them over the operation before we deal with the

pathology we're going to deal with.

Over in the renal department,

it's the next stage of the clinical trial.

David is the first person in Western Europe to have a laboratory-grown

blood vessel implanted into his arm.

This is obviously the implant here.

I can feel it, the blood rushing through.

It was once described to me as like a racetrack, with a racing car,

very high flow, high volume of blood that will go through it.

Two weeks on from the operation,

David's new implant has had time to heal

but it hasn't yet been tested on the dialysis machine.

It's the moment of truth for Mr Kingsmore.

-No pressure now, hey?

-I know.

-Did you find that quite soft going in there?

-Really soft. It just felt

-like a normal human vein.

-This is everything that we would hope for

and the proof of the pudding is somebody who's experienced,

and I actually felt quite straightforward and surprised

as to how easy it is and how good to use it is,

it is just everything. For a difficult health problem,

this makes it a lot easier.

This is the cutting edge of where technology is at. You've heard all

-of this technology in the past from Dolly the sheep onwards.

-Yeah.

This is the practical result of all that.

Now it's coming through and it's taken 20 years for that.

-MACHINE BEEPS

-That means something.

The machine has identified an issue.

The pressure is too low.

It means it's working too well!

Usually with grafts,

you have to pump quite hard to drive the blood through.

The fact this is going straight through, the machine goes,

"I think there's a problem here."

It doesn't recognise that that's really, really good.

That is absolutely fantastic. Absolutely brilliant.

Over in the children's hospital there's another trial taking place.

The paediatric renal department is the largest in Scotland and they're

piloting a new programme to help children on dialysis.

Going to hospital three times a week means children on dialysis can miss

out on as much as 60% of school.

But the new pilot could change that.

Seven-year-old Milo is first to take part.

He's come to the hospital with dad Kevin from their home in Fife.

That's a dialysis machine.

-What's it do?

-It sends blood into me, I think.

Cos my kidneys are going and it works the exact same as a kidney.

Most parents would say the same thing about their children but Milo

is a lovely character. Really, he's very chilled out, he's always happy.

He just kind of gets on with things,

nothing ever really seems to bother him.

He's a lovely boy, quite an obliging little soul, bless.

We often call him a little Tonka truck, because he just seems to,

whatever comes his way, he just seems to deal with it

and get on with it.

Three years ago, Milo was diagnosed with a rare and advanced form of

kidney cancer.

His treatment resulted in him having both kidneys removed.

Milo's family now have to make a 110-mile round trip to hospital

three days a week.

It's boring at dialysis sometimes.

And I'd rather be at school.

Life on dialysis is difficult.

And it leaves most patients feeling very unwell.

But a new portable machine could transform Milo's life.

It's exciting to have this new dialysis machine.

They can get the dialysis at home.

This means that they can socialise with their family and friends more.

They can attend school on a daily basis and they won't have as many

restrictions when it comes to their diet and fluid.

They'll have more energy

and in general just feel much better about themselves.

It will just change the family's life completely.

Another advantage is that Milo can get dialysis more frequently,

which should mean a big improvement in how he feels.

First, Zoe must train up Kevin

so that the family will be able to use the machine by themselves.

Make sure you clamp.

If you didn't clamp, you would very soon remember to clamp.

Because of the blood pouring out.

It is probably the most intense thing I've ever done, actually.

Because I'm used to, you know, if you go on a course through work,

whatever, you come out and you don't understand and you miss a bit,

in the work that I do,

no-one dies because of it or no-one becomes unwell because of it.

So we're very much aware the stakes are really, really high in this.

After a week of theory,

Kevin is going to attempt to put Milo onto the machine himself.

-What are you doing?

-I'm getting you ready.

My lines! My lines!

He's following Zoe's newly created step-by-step guide.

-So there's how many steps?

-114...

114 steps of "Attach this to this. Clamp."

So it's a bit of a foolproof

idiot's guide to setting up this machine.

Halfway through, Kevin hits a problem.

Zoe, this bit, where I went to unclamp this one...

So I touched it with my hands.

Oh, did you? We should start again.

Touching the end of a tube means

there's a risk of giving Milo an infection.

-So we need to start again.

-Good practice!

Right!

There are many complications and dangers of dialysis in general.

So for the parents to be doing this dialysis at home,

obviously if something is to go wrong,

then it would be them dealing with the situation, be it an infection

or a drop in blood pressure or a problem with the line.

There's lots of complications

that they need to be taught how to deal with

in case any of these problems do arise.

Getting the next step right is critical for Milo's health.

-Then just take this one out?

-Yeah.

Yeah, you feel it? So just push that one back in.

Just leave it about a mil there.

And then we'll see what his next line's like.

Yeah.

We're actually sucking all the blood out of his body,

putting it through the machine that we've set up,

and hopefully giving it back to him in a correct manner

based on our calculations of how much we should be giving him.

It is a responsibility.

Perfect. All connected, so clamp off, clamp off.

Best, green for go.

That's only three hours it's taken me to do a 20-minute process!

In just a week,

the family will take the portable machine home and Milo will depend on

his mum and dad for his life-saving dialysis.

One benefit of the superhospital's design is that all ages can be

looked after on the same site,

from premature babies to the elderly.

In Scotland, the number of people over 90 has increased by 20%

in the last five years.

I think it's fair to say that as the population ages that it does put a

pressure within the hospitals

and we are finding that we are getting busier.

Hello...

At the superhospital, the first port of call for emergency

elderly patients is a new specialist acute receiving unit.

88-year-old Rose was brought in last night by ambulance

after she collapsed at home.

Oh, it was awful. The next thing, I thought I was

going to die. I thought it was my time, I was going to go.

I was so frightened.

-Hello, Rose.

-Hello, Doctor.

Nice to see you again.

So, I suppose first of all, how are you feeling now?

I feel good, Doctor.

Good. So we want to do an ultrasound scan of your tummy,

just to see what's going on there

and make sure there's no inflammation going on.

As long as you keep me living for another wee while.

-Absolutely, that's what we're here for.

-I don't want to die yet.

-OK. See you later.

-OK.

The staff here focus on finding out about their patients' circumstances

outwith the hospital.

Do you want to try and stay at home? Is that what you want?

-Mm-hm.

-That's what you'd like. OK.

I think it would be fair to say that the vast majority of elderly

patients who come into hospital want to be at home, and often as soon as

possible. So one of my jobs as an elderly-care physician

is to try and get them back home to living within the community

ideally in their own home as soon as that's safe to do so.

I hope I'll go home soon.

It's nice to get into hospital

and to go home when you're well.

Whatever happens this time,

whether I stay on my own again, or with one of my daughters...

One of my daughters has stairs to the bathroom,

which is no good to me.

Rose has spent all her time here

in one of the new hospital's single rooms.

I'd rather the old hospital,

because you would have patients next to you.

See, at this hospital, you're on your own.

You know, the likes of me anyway.

And you have nobody to talk to. You know, when you get older,

we like to have a wee gossip

or something, but we can't have everything, can we?

No, we can't have everything.

Just along the corridor, John, who's been in with a chest infection,

can't help but agree.

There is a lot to be said for single rooms

but it's a lonely, lonely wait.

I'm only here for a couple of days

but if you're stuck in hospital for three months because you're unwell,

you know,

you could enter with a twisted ankle

and go home as irredeemably mad...

if you spent all your time in a single room!

On the adult neurology ward,

Peter's recovering in his own room.

It's been 18 hours since his awake brain surgery.

I was thinking you were going to be

sleeping and tubes everywhere

and not being able to talk and, of course,

not being able to move your arm,

so when you waved to me,

I was in total shock!

You're absolutely amazing.

I know I am, I telt you that.

That's how you fell for me in the first place.

Peter's six-hour operation has left its mark.

Surgeon Roddy wants to know how it's affected him.

-Well, my man?

-Still got a bit of brain freeze with you throwing ice

-on me.

-Is that right? Still a bit cold in the head.

What about this arm, then, how has it been doing today?

-Are you able to squeeze it?

-A wee bit.

-That's way better.

Squeeze it again. That's even better than yesterday.

Yesterday you had nothing on it at the end of the operation.

Looking good. OK.

A bit of physio. A bit of rehab, you'll be doing the Riverdance soon.

-I'd like to try it.

-OK, the new Michael Flatley.

Put it there.

-You're a grand man. See you later. Thank you.

-See you later.

Performance surgery like this is kind of strange.

This morning when I see him moving his hand a lot more,

I always have that negative thought of, "I haven't taken enough."

Whereas alternatively when I see patients afterwards and they are

very weak, I think,

"I've taken too much."

You always have the balance of trying to justify what you're doing

but there's never a happy feeling afterwards.

Yeah? It's either I've taken too much and damaged them

or I've taken too little and they're intact.

But we'll see what the diagnosis is and what I've done on the scale.

Roddy has left Peter with no paralysis but he won't know

how serious his cancer is until the results come back from the lab.

Up on the children's renal ward,

it's an important day for seven-year-old Milo and his family.

Get him off the machine,

close his lines then he's finished and that's it.

Simple as that!

What are you laughing at?

After two weeks of intensive training,

Milo's mum is taking home the portable dialysis kit.

Milo will be the first child in Scotland

to use this new machine at home.

I'm clamping blue.

Now you're still bleeding him back the same.

-This is where you're going to get confused.

-This is...

You're still bleeding back exactly the same,

-it's when you come to locking his lumens that it'll be different.

-OK.

-Right, OK.

-Yeah?

-Yeah.

Today has been quite stressful, just making sure that I've asked Zoe,

our nurse, everything that I need to know and just make sure that we're

organised and that we're ready for it.

All done, dude.

If the trial works, it will be rolled out to other children

across Scotland.

I feel like it's on my shoulders a little bit, that if it doesn't work,

obviously it's not just me in the team, there are other people

in the team as well, but if it wasn't to be successful, then, yes,

I would feel that it was on my head.

Milo will be able to go to school every day by using the machine

at home.

I think because Milo loves school

and he's looking forward to going back to school

and seeing all his friends,

I definitely think you're not going to miss us, are you?

I'm going to miss you!

Right, don't lose this folder.

Don't go too fast, we don't want to damage the machine, it's precious.

Over the last year, three times a week

the family have been travelling from Fife to get Milo on dialysis.

I feel the wind in my hair!

Yeah, it's good. We're free!

With Milo being younger, I think he kind of just takes it all in his

stride that now his mum and dad will do it and doesn't quite

understand the burden that his mum and dad are taking on in performing

this treatment for him.

A life being tied to the hospital may be coming to an end.

The Queen Elizabeth University Hospital

has a pathology department on site.

It's the largest in the UK and employs just under 200 staff.

They deal with an average of 7,000 samples every week.

This is where Peter's brain tumour has been analysed by specialists.

Ten days after his operation, he's back for the results.

-This was the hardest bit, waiting.

-I know. It is.

It is common for us to explain that tumours are incurable and the

survival might be anything from weeks to months.

We can never actually tell how long somebody is going to survive.

But we can break pretty... tragic news to people

that ultimately is telling them that they're not going to survive

for very long and that they may not have any treatments available.

That's part of the job.

But it happens.

Thought this was a brain tumour. It is a brain tumour.

It is a low-grade tumour called oligodendroglioma.

This is probably the best of the selection box of different types

of tumours that you can get, OK?

It has probably the best favourable prognosis.

When I heard it, knowing that all the things that you can get,

I had a big smile on my face.

Yes. It was all good.

-Does that make sense?

-All good.

-Fantastic.

They do impact your overall survivability

in terms of life expectancy,

it is reduced compared to somebody without one

but I think we can be optimistic that,

you know, we're in years, not months in that type of picture, OK?

-Good man.

-Happy days.

All right.

You get to know your patients quite well,

you kind of nearly become their friend in one sense, so...

you can't help but be a wee bit emotional with them.

It might sound stupid but in one sense there's a happiness with me

that he is able to do everything

and is recovering well and that his diagnosis is...

favourable in the spectrum of where it could be.

I had my consultation, it's a year of chemotherapy

and five weeks' intensive radiation.

We'll just see what happens from there.

But I'm feeling really fantastic.

You cannae take the smile aff my face.

And there's some great news on the renal ward.

47-year-old Dougie is back.

He wasn't picked for the pioneering laboratory-grown blood vessel

in the trial, but 48 hours ago he got something better.

Saturday morning I was getting ready to go out to work

and then I got the phone call to come to the Queen Elizabeth

because they'd...

got me a kidney.

So I come up here on Saturday morning and...

everything was good to go. They done the tests and...

they operated on Saturday night...

and Bob's your uncle.

The kidney is working well,

the stress of life on dialysis for Dougie looks like it's over.

So what are you looking forward to most?

A fish supper.

The finer things in life. Just a fish supper.

Since it opened two years ago, Scotland's supersized hospital

has witnessed the transformation of lives every day.

Charlotte had her operation six months ago.

She's had her first winter without any croup.

It's been a great thing.

No more midnight rushes to hospital for medicine.

It's good to actually see her being a child and getting out to play.

Peter's had his first two rounds of chemotherapy.

Medication is keeping his epileptic fits under control.

And after three months of home dialysis,

Milo has seen much more of his friends and school

and his overall health has improved.

Other families have now moved on to doing this.

I think Zoe's now trained... I think she's on her fourth family,

which is a massive difference.

It's going to make such a difference to everyone's lives.

KIDS SHOUT