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0:00:06 > 0:00:11- Bangor's Ysbyty Gwynedd - is a busy yet homely place.
0:00:13 > 0:00:16- Its 530 beds and 3,500 staff...
0:00:16 > 0:00:21- ..serve the people - of North West Wales.
0:00:22 > 0:00:24- Every aspect of life is seen here.
0:00:25 > 0:00:29- Excitement at the Accident Unit, - joy at the Maternity Unit.
0:00:29 > 0:00:33- They treat sick children - and care for the elderly.
0:00:34 > 0:00:38- Operations, deaths and births...
0:00:38 > 0:00:41- ..cleaners, chefs, - maintenance workers...
0:00:42 > 0:00:44- ..and laughter.
0:00:44 > 0:00:48- This and more in Ysbyty Gwynedd.
0:01:10 > 0:01:16- The Special Care Baby Unit treats - the youngest, most fragile patients.
0:01:17 > 0:01:21- This Unit - cares for tiny newborn babies.
0:01:21 > 0:01:26- The consultant does a formal ward - round on Tuesdays and Thursdays.
0:01:26 > 0:01:29- The rest of the time, - a doctor does the round.
0:01:30 > 0:01:33- It's a Tuesday morning, - so here I am.
0:01:36 > 0:01:40- Usually, the babies are premature.
0:01:40 > 0:01:46- Premature babies get problems - with their lungs and stomachs.
0:01:46 > 0:01:51- They're unable to digest food - like a normal baby.
0:01:52 > 0:01:57- We slowly sift through the problems - we'd expect from a premature baby.
0:01:58 > 0:02:02- We try to anticipate the problems. - He hasn't had caffeine yet?
0:02:03 > 0:02:08- He isn't breathing much, - except for ventilation breaths.
0:02:08 > 0:02:12- He's awake, - but he seems comfortable.
0:02:12 > 0:02:14- Just lying there!
0:02:15 > 0:02:19- We're fairly busy. - A baby was born last night.
0:02:19 > 0:02:22- I'll tell - his mother how he's doing...
0:02:22 > 0:02:26- ..and explain what - we hope to do today and tomorrow.
0:02:26 > 0:02:30- He was ten weeks early. - He's not meant to be here yet.
0:02:30 > 0:02:33- We'll see what his mother will say.
0:02:43 > 0:02:48- Terrence Channing from Holyhead - is having an MRI scan.
0:02:48 > 0:02:50- He has throat cancer.
0:02:52 > 0:02:55- We're scanning his throat.
0:02:55 > 0:02:58- He's had a diagnosis from a biopsy.
0:02:59 > 0:03:02- The doctors will study the scan...
0:03:03 > 0:03:05- ..and decide on treatment.
0:03:06 > 0:03:10- It'll be difficult for the patient - because he can't lie flat.
0:03:10 > 0:03:15- He can't swallow - or breathe properly.
0:03:16 > 0:03:18- We need to take care.
0:03:21 > 0:03:25- How are you doing? - Have a cough and then swallow.
0:03:26 > 0:03:27- We'll start again when you're ready.
0:03:27 > 0:03:29- We'll start again when you're ready.- - PATIENT COUGHS
0:03:32 > 0:03:35- It can be a terrifying experience.
0:03:36 > 0:03:41- They don't understand the situation.
0:03:41 > 0:03:45- Once they see the scanner - and talk to the staff...
0:03:45 > 0:03:49- ..they accept it has to be done, - for their own good.
0:03:53 > 0:03:55- This is the sound the patient hears.
0:03:56 > 0:04:00- LOUD TONE
0:04:01 > 0:04:06- They have headphones - to listen to the radio.
0:04:07 > 0:04:11- They can bring their own CD - and we play that for them.
0:04:12 > 0:04:14- It's a horrible sound.
0:04:20 > 0:04:22- OK, how are you feeling now?
0:04:22 > 0:04:23- OK.
0:04:23 > 0:04:25- You're struggling a bit, are you?
0:04:25 > 0:04:26- You're struggling a bit, are you?- - Yeah, just a bit.
0:04:26 > 0:04:28- Can I do anything to help?
0:04:28 > 0:04:31- Can I do anything to help?- - No, there's nothing you can do.
0:04:32 > 0:04:34- OK. Are you ready to start again?
0:04:34 > 0:04:35- OK. Are you ready to start again?- - OK.
0:04:47 > 0:04:50- All set for today? - Which knee are we doing?
0:04:50 > 0:04:53- Rheinallt Jones - is having a new knee.
0:04:53 > 0:04:57- It's the second - he's received in Ysbyty Gwynedd.
0:04:58 > 0:05:01- You had the MRI scan - a few weeks ago.
0:05:02 > 0:05:04- I'm looking forward - to having it done.
0:05:05 > 0:05:10- I had the same surgery - on the other leg eight years ago.
0:05:10 > 0:05:13- I've been through it.
0:05:13 > 0:05:16- They are made to measure.
0:05:16 > 0:05:19- I hope they get the right joint.
0:05:19 > 0:05:24- I wouldn't want to get - somebody else's knee!
0:05:26 > 0:05:30- Rheinallt Jones - is Mr Muthu Ganapathi's patient.
0:05:31 > 0:05:35- He uses the latest technology - for the task.
0:05:36 > 0:05:40- I've used computer guided surgery - for almost four years.
0:05:40 > 0:05:44- It's more precise - than manual instrumentation.
0:05:44 > 0:05:46- But it takes longer.
0:05:46 > 0:05:50- We get an MRI scan of the patient's - hip, knee and ankle.
0:05:51 > 0:05:56- That goes through a software and - I get a 3D model made of his knee.
0:05:56 > 0:06:00- I plan the whole - knee replacement in the computer.
0:06:00 > 0:06:03- I do a virtual replacement, - planning the cuts...
0:06:03 > 0:06:06- ..what size prosthesis - I need to use.
0:06:06 > 0:06:09- It makes surgery much, much easier.
0:06:09 > 0:06:11- My surgical time is reduced by half.
0:06:12 > 0:06:15- Generally it takes about - one hour, 20 minutes.
0:06:15 > 0:06:20- But now I'm doing the majority - of the surgery in 35-45 minutes.
0:06:27 > 0:06:32- In the Baby Unit, it's a busy - but enjoyable day for Dr Mair Parry.
0:06:34 > 0:06:39- The birth of a child is the best day - of most people's lives.
0:06:40 > 0:06:44- I've shared that day with hundreds - of families, which is lovely.
0:06:45 > 0:06:48- It's an honour and privilege.
0:06:48 > 0:06:52- But sadly, I wouldn't be - there if everything was OK.
0:06:53 > 0:06:56- But I do enjoy it. - I like seeing the little babies.
0:06:57 > 0:06:59- Shall we give him a fluid bolus?
0:06:59 > 0:07:05- We need to try to get the rate down - and maybe reduce the morphine.
0:07:05 > 0:07:08- We'll try to reduce the rate.
0:07:08 > 0:07:10- OK, happy?
0:07:11 > 0:07:14- The nurses specialize - in premature babies.
0:07:15 > 0:07:19- They tend to just work here.
0:07:20 > 0:07:23- Looking after a premature baby...
0:07:24 > 0:07:28- ..is unlike - caring for a 10-year-old.
0:07:28 > 0:07:31- They are specialist nurses.
0:07:31 > 0:07:35- The middle room is like - an Intensive Care unit for babies.
0:07:35 > 0:07:39- They need different skills.
0:07:39 > 0:07:44- It's quite technical - and more than just feeding babies.
0:07:49 > 0:07:51- A new patient arrives for a scan.
0:07:52 > 0:07:55- Are you OK?
0:07:57 > 0:08:00- Are you comfortable?
0:08:01 > 0:08:04- We're doing the head and throat.
0:08:04 > 0:08:07- They've found something.
0:08:07 > 0:08:13- The X-ray was inconclusive - so they sent him for an MRI scan.
0:08:14 > 0:08:17- It provides - a clearer view of the throat.
0:08:17 > 0:08:19- He's a broad man.
0:08:20 > 0:08:24- They usually find - it more difficult to go in...
0:08:25 > 0:08:29- ..because of the scanner's size, - so it's not always the weight.
0:08:30 > 0:08:34- It's more difficult - when patients are short and broad.
0:08:35 > 0:08:38- We like people - who are tall and thin!
0:08:39 > 0:08:41- But a scan can be dangerous.
0:08:41 > 0:08:45- The scanner is a big magnet, - so metal is prohibited.
0:08:46 > 0:08:51- The most serious problem - is pacemakers.
0:08:51 > 0:08:57- We change the patients here - and ensure their pockets are empty.
0:08:58 > 0:09:03- A patient insisted - on wearing his own dressing gown.
0:09:04 > 0:09:08- I could see a metal object - in his pocket.
0:09:09 > 0:09:13- He denied there was anything - in his pocket.
0:09:14 > 0:09:17- There was a nail in his pocket.
0:09:25 > 0:09:28- The technology is amazing.
0:09:30 > 0:09:34- We get brilliant images.
0:09:35 > 0:09:39- It's great to know that these images - are helping the patients.
0:09:45 > 0:09:48- Rheinallt Jones - is under the anaesthetic.
0:09:49 > 0:09:52- He's ready - for his knee replacement surgery.
0:09:55 > 0:09:59- The surgery is performed - 300 times a year in Ysbyty Gwynedd.
0:10:00 > 0:10:03- The continuously - evolving techniques...
0:10:03 > 0:10:06- ..shorten the recovery period.
0:10:07 > 0:10:12- Most patients walk the same - day they've had a knee replacement.
0:10:13 > 0:10:15- Some even go home that day.
0:10:15 > 0:10:17- OK, starting!
0:10:20 > 0:10:25- Rheinallt Jones's new knee - was designed for him on a computer.
0:10:26 > 0:10:29- The surgery itself - takes less time...
0:10:30 > 0:10:35- ..the surgeon's work is easier - and it makes better use of his time.
0:10:36 > 0:10:40- The new pieces fit perfectly - without having to reshape.
0:10:40 > 0:10:46- The treatment, designed beforehand, - will save time under the knife.
0:10:46 > 0:10:49- Now we can see - that it's fitting the bone.
0:10:49 > 0:10:51- The holes are made already.
0:10:51 > 0:10:55- I just need - to make some holes and do the cuts.
0:11:27 > 0:11:29- The leg is almost ready - for the new knee.
0:11:30 > 0:11:34- Incredibly, Rheinallt Jones - will be on his feet...
0:11:34 > 0:11:39- ..and walking in a few hours.
0:11:40 > 0:11:44- In part two, - will the new knee impress?
0:11:45 > 0:11:48- A race to find a bed for this baby.
0:11:48 > 0:11:50- And rather unusual training.
0:11:50 > 0:11:52- And rather unusual training.- - Gary! It's time to wake up!
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0:11:57 > 0:11:57- Subtitles
0:11:57 > 0:11:59- Subtitles- - Subtitles
0:12:08 > 0:12:13- In the boiler room, - a machine gets an annual service.
0:12:14 > 0:12:15- Alright?
0:12:20 > 0:12:22- It's a yearly on the boiler.
0:12:23 > 0:12:25- We open it up...
0:12:26 > 0:12:29- ..clean out the tubes, - test the gas...
0:12:29 > 0:12:32- ..test the gas pressure...
0:12:33 > 0:12:36- ..and we'll reassemble it...
0:12:36 > 0:12:40- ..to make sure it's burning - properly, that the CO is correct.
0:12:41 > 0:12:45- These boilers heat the water...
0:12:46 > 0:12:50- ..and power the central heating.
0:12:51 > 0:12:54- The water - goes through heat exchangers...
0:12:54 > 0:12:59- ..which provide domestic hot water - for baths and sinks.
0:13:00 > 0:13:06- We also send steam to the kitchen - for the hospital's food.
0:13:11 > 0:13:14- The hospital couldn't carry on - without this place.
0:13:15 > 0:13:20- They'd freeze in the winter - and roast in the summer!
0:13:20 > 0:13:24- Everything here - has to be in working order.
0:13:24 > 0:13:29- It doesn't matter if a bulb fuses, - there are half a dozen of them.
0:13:29 > 0:13:35- But if one of these boilers go, - they'd soon run out of hot water.
0:13:36 > 0:13:41- Very few people know what - happens in here. They've no idea!
0:13:43 > 0:13:47- We're sweated buckets - in here over the years.
0:14:01 > 0:14:04- Things are hotting up - in the theatre, too.
0:14:04 > 0:14:10- Surgeons prepare to put the new - knee in Rheinallt Jones's leg.
0:14:12 > 0:14:17- A special cement is used on the - bone to hold the new piece in place.
0:14:19 > 0:14:25- It's a perfect fit, but - it'll take an effort to position it.
0:14:27 > 0:14:28- Stop.
0:14:30 > 0:14:32- Make the knot, please.
0:14:40 > 0:14:41- It's good.
0:14:42 > 0:14:46- You can see the knee - is straight and it moves nicely.
0:14:46 > 0:14:50- The kneecap is tracking, - and that's one of the problems.
0:14:50 > 0:14:52- It's precise.
0:14:53 > 0:14:57- It's balanced nicely. - I'm just going to close it now.
0:14:58 > 0:15:00- Chlorhexidine, please.
0:15:10 > 0:15:13- He's settling, - he's back on the vent.
0:15:14 > 0:15:20- In the Special Baby Care Unit, - a baby gives cause for concern.
0:15:20 > 0:15:22- De-sat first?
0:15:23 > 0:15:26- The sat goes down.
0:15:28 > 0:15:33- The baby isn't coming off - the ventilator as well as we'd hope.
0:15:33 > 0:15:37- He was born at 30 weeks, - and not 40 weeks.
0:15:37 > 0:15:40- His lungs - aren't working as they should.
0:15:41 > 0:15:44- We can keep babies - here for 24 hours.
0:15:44 > 0:15:48- But after that, their needs - become more serious and complex.
0:15:49 > 0:15:53- We move them to a bigger Unit, - usually to Glan Clwyd.
0:15:54 > 0:15:59- But Glan Clwyd and Wrexham are full. - Arrow Park is the next hospital.
0:16:00 > 0:16:05- I need to contact Arrow Park - to see if they can come and get him.
0:16:05 > 0:16:08- He'll be treated for longer there.
0:16:08 > 0:16:11- I'm trying to find a bed for him.
0:16:12 > 0:16:13- OK?
0:16:15 > 0:16:16- OK, lovely.
0:16:17 > 0:16:19- Great, thank you. Bye-bye.
0:16:20 > 0:16:22- There's a bed in Arrow Park.
0:16:22 > 0:16:26- They have a special ambulance - for premature babies.
0:16:27 > 0:16:30- The sooner the better they arrive.
0:16:30 > 0:16:35- No-one wants to move babies late at - night. It's easier during the day.
0:16:35 > 0:16:38- The next step is to tell his mother.
0:16:38 > 0:16:42- I've told her the baby - might go to Glan Clwyd or Wrexham.
0:16:42 > 0:16:45- I didn't mention - he might go further.
0:16:53 > 0:16:55- It's a staff training day.
0:16:59 > 0:17:03- The Clinical Skills Lab - is part of our training.
0:17:03 > 0:17:07- We practise on the mannequins. - There are three adults and a baby.
0:17:08 > 0:17:11- They move and breathe.
0:17:12 > 0:17:16- They can open and shut their eyes. - Some can bleed and sweat.
0:17:16 > 0:17:21- We can give them fluids and drugs.
0:17:22 > 0:17:28- Today's scenario is that - a patient has arrived in Recovery...
0:17:28 > 0:17:30- ..and everything goes wrong.
0:17:30 > 0:17:32- ..and everything goes wrong.- - Hi, Glen.
0:17:32 > 0:17:36- Gary Wright has had - an arthroscopy on his right knee.
0:17:37 > 0:17:40- He's fit, doesn't smoke - and has no allergies.
0:17:41 > 0:17:44- He regularly takes Co-codamol.
0:17:45 > 0:17:46- Thank you.
0:17:46 > 0:17:48- You're welcome.
0:17:48 > 0:17:49- Are you going back to theatre?
0:17:49 > 0:17:50- Are you going back to theatre?- - Yes.
0:17:52 > 0:17:54- Are you alright?
0:17:58 > 0:18:00- Things usually go smoothly.
0:18:01 > 0:18:03- If things go wrong...
0:18:03 > 0:18:07- ..we practice so we know - how to deal with emergencies.
0:18:09 > 0:18:12- Gary, Gary, it's time to wake up!
0:18:13 > 0:18:18- Gary, open your mouth for me.
0:18:22 > 0:18:26- We trying to get him - to react as if he's lost blood.
0:18:27 > 0:18:30- I've entered his pulse rate.
0:18:31 > 0:18:36- I change his blood pressure - to reflect the blood loss.
0:18:37 > 0:18:40- When they do the right things, - I reverse things.
0:18:41 > 0:18:44- If they are incorrect, - I can worsen his condition.
0:18:53 > 0:18:56- The on-call anaesthetist, please.
0:18:56 > 0:18:57- Can you phone Theatre 4?
0:18:57 > 0:18:58- Can you phone Theatre 4?- - Yes.
0:19:00 > 0:19:02- His blood pressure is lowering.
0:19:03 > 0:19:05- Gary, everything's fine, OK?
0:19:06 > 0:19:09- I'm just checking your leg dressing.
0:19:13 > 0:19:16- It's still low.
0:19:24 > 0:19:27- It went quite well.
0:19:28 > 0:19:31- I take the patient - to Glenys in Recovery.
0:19:31 > 0:19:34- I left - but was told something was wrong.
0:19:34 > 0:19:37- I went back - before the anaesthetist arrived.
0:19:38 > 0:19:41- Glenys was in charge of the patient.
0:19:42 > 0:19:44- I was there to help her.
0:19:45 > 0:19:48- It proves we can work as a team. - We know what we can do.
0:19:49 > 0:19:51- Sometimes we overstep the line.
0:19:58 > 0:20:02- Surgery is finally over - for Rheinallt Jones.
0:20:02 > 0:20:05- He's now half an hour in Recovery.
0:20:05 > 0:20:07- How are you feeling, sir?
0:20:08 > 0:20:10- Not too bad, thank you.
0:20:10 > 0:20:12- Not too bad, thank you.- - Can you lift your leg up, please?
0:20:13 > 0:20:16- OK. Can you bend the knee, please?
0:20:16 > 0:20:20- Bend it as much as you can. - OK, straighten the knee, please.
0:20:20 > 0:20:22- Yes, you can straighten the knee.
0:20:23 > 0:20:27- Well done, sir. - I'll see you in the ward later.
0:20:28 > 0:20:33- Once he's feeling better, - he'll change to his normal clothes.
0:20:33 > 0:20:38- Within a couple of hours, if he's up - for it, he'll be sitting in a chair.
0:20:38 > 0:20:43- They'll make him walk, using - a zimmer frame and then crutches.
0:20:43 > 0:20:48- If he's fine, he'll do stairs, - depending how he's progressing.
0:20:48 > 0:20:52- If he's fine, he'll - be able to do the stairs today.
0:21:07 > 0:21:11- This mother receives bad news. - He has to travel for treatment.
0:21:12 > 0:21:15- He'll need the ventilator - for longer than 24 hours.
0:21:16 > 0:21:19- It's not that he isn't coping - with the ventilator.
0:21:19 > 0:21:22- His numbers are absolutely perfect.
0:21:22 > 0:21:27- He's not able to maintain - that without the ventilator.
0:21:27 > 0:21:31- But there is one problem. - Ysbyty Glan Clwyd is full.
0:21:32 > 0:21:35- The next one is Wrexham, - which is also full.
0:21:35 > 0:21:38- The next one after that - is Arrow Park on the Wirral.
0:21:38 > 0:21:41- They've got a bed - and they can come for him.
0:21:42 > 0:21:44- I'm sorry it's a long way.
0:21:44 > 0:21:48- But if that's where the expertise - is, that's where he's got to go.
0:21:48 > 0:21:52- If he was my baby, - I'd want him to go there as well.
0:21:52 > 0:21:55- I'll leave you to your lunch, - sorry to interrupt.
0:21:57 > 0:21:58- Years ago...
0:21:59 > 0:22:04- ..I decided I couldn't spend my life - crying over other people's babies.
0:22:04 > 0:22:08- It sounds hard, - but it's for my own sanity.
0:22:08 > 0:22:12- I'd be good for nothing - if I kept getting upset.
0:22:13 > 0:22:19- If I cried everytime, - I couldn't do my job.
0:22:20 > 0:22:26- It's a skill doctors learn, - how to separate work from home.
0:22:34 > 0:22:35- On the next programme...
0:22:36 > 0:22:39- ..the pleasure and pain - of being a midwife...
0:22:40 > 0:22:43- ..a prescription's journey, - the hospital DJs...
0:22:44 > 0:22:47- ..and will she recover - in time for her holiday?
0:23:03 > 0:23:05- S4C Subtitles by Gwead
0:23:05 > 0:23:05- .