He had some heart conditions,
which made us worry about the risk of him suddenly dying.
It's mind boggling, really,
that somebody's willing to place their life in your hands.
These poor patients are waiting and waiting and you keep thinking,
"If that was me, that was my mum, that's not fair."
I've had a scan. They find, like, a brain turn our.
There's a chance that I can make things a lot worse
if I'm not choosing the right patient at the right time.
We've got a finite amount of resource and a growing backlog
of patients, and that's difficult. My first patient is losing vision,
so she's going to be the priority patient. Going to try and pull out
all the stops so that we don't have to cancel a patient on the day.
When you finish surgery and it's gone well, it's great,
I love that feeling.
How are you doing? I'm alive.
Everything OK? Yeah, it's all gone fine.
We're happy, aren't we? Yeah.
Right, my darling. See you soon. Yeah. Champion.
SIRENS WAIL IN DISTANCE
It's the calm before the storm.
She's an inpatient as well.
So a little bit of grit and determination. We're good to go.
Despite the issues we have with our resources and the frustrations
we have, we're able to do amazing things for our patients.
And it makes you feel really good when your patients do well.
Kenan Deniz is one of 13 neurosurgeons
at Leeds General Infirmary.
These are the patients which tend to take lower priority anyway.
We've listed her, we've listed him. He's not urgent.
If you've got a growth inside your head that's pressing
on your brain, then you would want to have that surgery straight away.
If your waiting list is so long, you've got 10 or 12 patients,
all of whom need their surgery as soon as possible,
it's a case of making sure that those patients
are at the front of the queue.
One patient who may need to be added to the surgery list is Karen.
Three months ago, a growth was discovered on her brain.
Today, she will find out if she needs surgery to remove it.
I've come today because I've had a scan
and they, find, like a brain tumour on the left-hand side.
Karen had a brain scan after she had a blackout whilst driving her car.
Quite near home, actually.
Just went off a long road and I just veered off
and there was a gentleman behind me with a dashcam.
Luckily there were no cars coming the other way
at the point of I went off the road, but I went into a field.
I can't remember any of it.
I keep losing what to say and what I'm wanting to say
and stumbling on my words a lot. I have brought me husband,
so hopefully we'll get some answers today.
Take a seat. Thank you.
I've got some scans for you here.
All this grey structure is your brain.
This is the abnormality here. Oh, wow.
Can you see that? Yeah. Really bright. Wow.
It is bigger than I thought. It's nearly as big as her eyeball.
And has your speech been affected by this at all,
word finding or slurring? Yeah, word finding, that's right, yeah.
Sometimes she'll... She can speak to you,
and it's...it's just made-up words,
basically. I might not know the last word.
In terms of what we do about it, I think that there's enough...
...diagnostic uncertainty, I would probably have it removed. Yeah.
I'm sorry to have upset you.
Obviously a lot of information for you to take on.
VOICE OVER: If you think someone's got a possibility that they have got
a cancerous tumour,
then ideally you would operate as soon as possible.
Thanks a lot. You're very welcome. Take care now. Thank you.
Tumours can progress pretty fast over a matter of weeks.
The deterioration can be rapid.
Due to the potential risks with Karen's tumour,
she will now be prioritised for surgery.
Gobsmacked, to be honest. I didn't want surgery at all.
I don't like having a needle, I don't like having a Covid jab, so...
There's too much at home to lose
to not go down that avenue and get it clone now.
Well, I've got a 22-year-old, but I've got a 12-year-old
and I've got a three-year-old granddaughter.
It happens to us all eventually and we've all got to...
But not yet. So.
I think for a lot of people, having brain surgery
is probably one of your worst nightmares, to be honest.
They've built themselves up to this moment.
People are very anxious.
Morning. Morning. Do we have Karen?
Morning, Karen. Morning.
Keep going, right to the end, into the first bay.
Karen is one of 18 patients
who have arrived at the surgical admissions ward
hoping to have an operation later today.
Jean is going to bed number four. OK.
Another patient on Kenan's surgery list is jean.
A bit more comfortable for you, ain't it?
A swelling inside a weakened blood vessel, known as an aneurysm,
was found in her brain a year ago.
A recent scan has revealed it is at risk of bursting.
I had double vision.
I went to the optician and they couldn't find any reason for it.
I went to the GP and she organised a brain scan, found this aneurysm.
They said they thought it should be operated on.
Are you allergic to anything?
Not that I know of. Not that you know of.
They sorted the double vision out with just prisms on my glasses.
SHE LAUGHS
Thank you very much.
An aneurysm is like a blow out on a tyre.
It's a bubble on the side of the blood vessel.
The concern with aneurysms is that they can rupture, they can bleed.
Have you been abroad in the last ten clays? No. No?
The worst-case scenario of an aneurysm rupture is that...
Is that you die from it.
Before Kenan can operate on Karen and jean,
they both need to be allocated a ward bed for after surgery.
Without one, their operations can't go ahead.
It'll be quick, I think it's just, it's just here,
it'll be a quickish procedure. Fingers crossed we get some. Yeah.
I did say to the manager, I said,
"Well, actually, Karen needs a ward bed.
"Usually ward beds are easier to come by." And he said,
"Well, actually, it's the ward beds that are the problem."
But overnight, a number of patients have arrived in A&E
who need to be admitted.
This will impact on the beds available to Kenan.
So we're in 14... Yeah. This is jean. And then...
INDISTINCT CHATTER Wonderful. Thank you very much.
I need to talk to you about beds today.
We have a number of patients that have come in
to the emergency department and are currently on trolleys downstairs.
Until we know where they're going... Yeah.
...we can't commit any beds to you and to the other patient. Right.
So that does mean there's a chance we may not get you done today.
Right. I'll be honest with you. I'll be honest. OK.
It's frustrating for me,
and it must be ten times more frustrating for you
and I'm sorry about that.
If there's a chance that I'm not going to be able to operate
on my patient, then I feel like I've let them down.
I shall come back to you when I know a bit more.
If you see me coming, it probably won't be good news.
But if we get the green light and we've got a bed for you,
then we'll probably just send for you and we'll get going.
In the majority of cases, they're very understanding and...
And it's... But I still dread doing it because I... Because I hate it.
|-|-| feel... I feel like
we're not providing the service that we should be able to provide.
OK? Thank you. You're welcome. Bye.
The list has been put on hold. Completely? Yes. OK.
Do we have priority? Well, that's a tricky one.
If we have to choose between the two, it's going to be a difficult
decision. We'll have to have a think about that, to be honest. OK.
It's not an uncommon situation -
you have two patients with two very different pathologies,
both of which pose a significant risk to them.
You have to make a difficult decision as to which one
is your priority, particularly if it's looking like
you're only going to have a bed for one of them.
The concern is the patient that you haven't prioritised
will have an event of some sort or be a risk to their life.
You just don't know that.
It's very, very difficult and it weighs heavily on you
cos whilst you make a decision,
you're never entirely sure whether you've made the right decision.
Plastic surgery is about reconstruction.
The human body in its anatomy is wonderful.
Being able to do something physical and manual
that improves the well being of your patients is a joy.
Professor Simon Kay is a world leader in hand transplants
and part of a team of 17 specialist plastic surgeons.
We're the busiest unit in the world for hand transplantation.
We did our first transplant in 2012.
Since then, we've clone 14 transplants in eight patients.
Leeds is the only hospital in the UK to specialise in this surgery.
For every patient who's listed for a transplant,
it comes down to the likelihood of them getting an immunological match.
We're going to go up to the ward now.
Everybody is equal on the waiting list and the transplant goes to
the most suitable.
A possible match has been identified for Jamie, who has been waiting
for a double hand and forearm transplant for more than two years.
On the 19th of December 2016 I had a near-fatal work accident,
getting electrocuted on overhead power lines
when I was building a scaffold.
Morning. Are you all right?
33,000 volt electricity shock.
It did feel like it liquefied my insides at the time.
Surprised it didn't kill me, to be honest. But here I am.
All I want you to try and do is try and relax as much as you can.
Just imagine you're somewhere else.
So I've always been a fighter. If I didn't have my kids
maybe I wouldn't be so willing, but I certainly am for their futures.
Morning, Jamie. Morning. How are you? Yeah, good.
Woken you up? Yeah, kind of. Sorry about that. No problem.
Good to see you.
Can I move your legs? Yeah, of course. OK.
Cardiac are still on hold.
Theatre four can start... PHONE RINGS
OK. Excuse me.
For the transplant to go ahead,
the team will need not one but two theatres,
so both Jamie and the donor limbs can be prepared simultaneously.
Theatre three? No, the patient is still on hold in theatre three.
Eight patients' operations will now need to be cancel led.
Four of them are children.
They can go ahead in theatre four
and we gave them the early go-ahead at quarter to eight.
The gift of getting a patient who's donating some organs
and then a patient receiving them,
we cannot stop that type of procedure going ahead.
Thanks, Alice. Thank you. Bye.
So, the cut-off for theatre three, Vicky, is ten o'clock.
10am. If we don't have a crit care bed by then,
we won't have enough time.
I feel for the patients who are postponed,
but would it be justifiable to say, "Jamie, I can't do your surgery
"because I can't cancel patients"?
I think if they metjamie and saw what a life-changing event this was,
they'd understand how difficult it is to say to a donor family,
"No, your gift's really generous, but we don't want it."
So, probably going to shorten the bone to about that level.
That's because the more of the donor bone you have,
the better the function of the donor muscles.
Although a donor has been found for Jamie,
the procedure is very rare and extremely high risk.
In hand transplantation, the risk is suppressing your immune system,
and that immune system fights infection, cancers and tumours.
A patient has to be able to balance the risks and benefits
of a hand transplant,
and they have to have the right stability and understanding.
This will be replaced with a patch of donor skin,
so we will kind of zigzag it in for you.
The donor skin contrasts with yours, Jamie,
because you're very dark skin.
The donor's very pale. Yeah.
If we wait a long time for a person with exactly your skin tone,
we could be waiting another ten years. Yeah, exactly right.
From a physical point of view, Jamie has a real need
and he's a coper - he gets on with it.
Ancl that's a really positive attitude.
They've got no tattoos, but you can soon change that.
JAMIE LAUGHS
We need to leave you enough length that, if it fails,
you can still use your split hook.
Nothing you want to ask? No, nothing. Thank you so much.
See you later. Cheers.
OK, all go.
I'm quite excited actually.
I've been waiting for years for a hand transplant.
It'll make my life so much easier,
as I'm a single parent with twin girls.
They were five months old when I lost all my limbs.
They don't know any different. But, yeah,
I've always explained to them that I've been on a waiting list.
So, yeah, they see me as normal like this.
But...hopefully, one day, life will be a lot easier for Daddy
with his hands!
Hello there!
Whilejamie has surgery, his mum Carla is looking after
his twin daughters, Savannah and Isabella.
I got a call,
and I think a lot of it went over my head
because it was such a shock.
Oh, please be careful.
They were putting, like, large...
You know those wriggly tin sheets on a roof?
Ancl he went like that, and the tin didn't actually touch the cables.
But of course, electricity can jump.
He managed to get off the roof and get down,
but he said to the lad, "You better call an ambulance.
"I am going to die."
You know...
Oh, they're lovely. Thank you.
Aren't they beautiful?
They smell like lavender.
This is a nice smell.
The surgeons thought that he might last a week, if he was lucky,
but, of course, they didn't know my Jamie.
He was determined. He had those little girls at home.
Ancl he loves those little girls so much.
It's so important for Jamie to have hands.
He'll be able to hold his daughters' hands again.
It's a really physical job being in orthopaedics.
It's physical cos we're dealing with the strongest structure
in the body, and we're effectively breaking them
and re-orientating and moving them around.
Adelle Fishlock is one of eight paediatric orthopaedic surgeons
at Leeds Children's Hospital.
We are definitely adding patients a lot quicker
than we're crossing off.
At the minute, I feel like it's very much
we're firefighting.
The patients that I mainly see
are children with neuromuscular problems,
neuro disabilities, mainly children with cerebral palsy.
Morning.
So we're doing a joint list today.
Declan... You can see that the right hip is reduced in the socket.
On the left side, his left hip is dislocated.
What we're seeing post-Covid is children that potentially
could have had smaller operations have now deteriorated.
We think we're possibly going to have to open this to get it back in.
We're now needing to do much bigger surgery, which means longer time
in theatre, a longer time to recover, bigger blood losses,
so it all has this big knock-on effect.
So the plan today is to hopefully get this hip back in.
His hip's been out for quite a while.
Declan has cerebral palsy,
a neurological condition
which impacts his mobility.
He's been waiting 12 months for an operation on his hip.
You've got to be careful when you're hoisting him
you're not knocking that hip.
He doesn't like, obviously, being sat in his chair,
so he gets a little bit tetchy.
It'll make such a big difference for him.
His brother plays rugby on a Sunday
and I haven't been able to put him in the wheelchair
to go and watch his brother because of how much it hurts.
Like, he loves being moving
and he loves being in a crowd and he loves noise.
It's not fair for him. It's not.
Cerebral palsy in itself can affect children in multiple ways -
problems with their arms, problems with their hips, knees, feet.
So it's about being very specific on the surgery that you're doing
for that patient.
That is a beautiful smile, young man.
I always smile.
You're always smiling?
Another child on Adelle's surgery list for today is Hamza.
Hamza's cerebral palsy has caused a problem with his hip,
and over the last year his condition has deteriorated.
So, this is Hamza.
So you can see he's got really valgus femoral necks.
So, he had a...X-ray back in August of last year.
Ancl you can see that hip didn't look too bad. Yeah.
Certainly, if you look between the two of them,
it's changed quite considerably.
So that's the plan for today. Busy clay.
Definitely have some breakfast and some coffee!
HE MURMURS
Morning. All good?
Yeah. Smile. That's good!
Morning, Declan. How are you?
Due to the complexity of the operations,
Adelle will work with fellow surgeon john Davies.
All set?
Is there any questions that you've got for us?
No.
OK. Yeah, yeah, I'm all right.
Third time lucky, this one!
I'm so sorry that we couldn't do it before.
We didn't have the bed,
and we're keeping everything crossed. Absolutely.
It's our next port of call. They just need to do a ward round
and have a bed made. And then we're going straight there. Yeah.
Declan's cerebral palsy has impacted his lungs, so after surgery,
he will need a bed in the high dependency unit.
As Hamza doesn't require specialist care,
he needs a standard ward bed.
See you soon. We'll let you know as soon as we know anything.
OK. Thank you. All right. Speak to you soon. Take care.
The type of bed that becomes available first will determine
which child goes into theatre next.
The team involved in hand transplant surgery is huge.
Morning. Morning.
You got it? Yeah.
Beautifully clone. Perfect. Thank you very much.
Do you know what we're going to do for you?
Bilateral hand transplant and forearm.
A team of around 40 theatre staff
are preparing for Jamie's hand and forearm transplant.
For a double hand transplant, you need four operating teams,
one for each limb, and then as the limbs come together,
they become two teams.
Do you have any more questions before we put you to sleep?
No, I'd like to see the hands, but I can't, can I? No, you can't.
You'll see them shortly.
Surgeons, trainees, nurses, anaesthetists,
theatre staff, theatre technicians - it's huge.
When Grainne and Waz get back with donor one and donor two,
hopefully Rob or I will be relatively free by then.
The whole transplant could take around 14 hours.
Let's get you down.
Whoa. Lovely.
Feel nervous? No.
Excited? Yeah. Yeah. Excited. Sounds good.
Brilliant.
The really critical thing is for the donor limb
we like to reduce the time it has no blood supply,
that the longer it's lacking oxygen, the more likely it is to suffer
episodes of rejection,
and the poorer the function and the less long-lasting it will be.
So we try and keep that to an absolute minimum.
OK, go to it. Let's make it work.
Thank you.
I promise we are waiting for you.
Hi there. How are you doing? Hello.
OK? OK.
Good man. Thank you very much. Cheers. Sleep well.
Yeah, I will do.
I'll see you again in the morning.
Are you comfy like that? Yeah.
Thanks. Right. You're welcome.
Right.
Progress.
I kind of feel if you put one of those lie-detector
stress testers on me, it'd be going off all the way through!
Have we got transport? Have we got enough team?
Are the drugs ready? ls the anaesthetist happy?
You know, everything can go wrong.
Ancl that's a big responsibility to shoulder.
You just want to know when they're on the way back?
I want to know when they're on the way back. Yeah. OK.
Simon needs to closely co-ordinate with his team in a hospital
almost two hours away who are operating on the donor limbs.
Um... Well, the first part of the process
is to identify the key structure in the arm.
Julie, who is one of the team, they're all scrubbed.
Julie is going to text me as soon as there's skin.
I don't want to go beyond the point of no return until we know
we're getting this limb.
Once you're committed to the transplant,
you've removed his own muscles,
you've shortened his own skeleton.
You've now clone him damage
if you don't restitute by completing the transplant.
Ancl then that's the point we don't want to abandon him at.
Can I have a sling, please?
As soon as they get confirmation that the donor limbs are en route,
the team must work quickly to finish preparing Jamie's limbs.
In neurosurgery,
Kenan and his team have been waiting to start operating
for more than an hour,
but he still needs confirmation on whether his patients,
Karen and jean, have ward beds for after surgery.
There's time pressure to get an answer about a bed early.
Ancl so we...we have to set a...a cut-off.
I need to know by nine o'clock,
because even then, by the time the patient's down,
they're in the an aesthetic room, they're put to sleep,
it's going to be 11 o'clock before we start.
The ups and downs, the emotional ups and downs!
It's a very, very frustrating situation,
where you have...
"all the resources that you need
in order to perform the surgery, apart from the bed.
PHONE RINGS Hello?
It's Mr Deniz.
Yeah, thanks for letting us know.
Cheers, Vicky. Bye. Bye.
After some moving of patients,
we've got a bed.
But Kenan only has one bed confirmed.
He needs to decide which of his two patients in the admissions ward
will go first.
It's an uncomfortable decision to have to make.
Ancl Karen, clinically, is the higher priority.
The reason why we've prioritised the tumour today
is because it has some unusual features.
Ancl I'm just anxious to know that we're not dealing
with something more aggressive.
It remains to be seen whether we're going to have a bed for jean.
I'm not hugely confident at the moment.
Ancl her aneurysm is of a size
where the risk of haemorrhage is by no means insignificant.
This is one of the most difficult situations to have to deal with,
and you question yourself afterwards.
By deciding Karen, there was anxiety that I'm going
to make somebody with quite a big aneurysm a ticking time bomb
and wait longer than I would have wanted,
and knowing that if she bleeds from her aneurysm,
that would potentially be a threat to her life.
Jean will only get her operation today if she's allocated a ward bed
and if there are no complications with Karen's surgery.
We're going to need the staples, I think, for this one.
I just need to exclude all that away.
The most important trait to have as a neurosurgeon
is to not allow yourself to get flustered
in the face of adversity, because when you lose your focus,
that's when things go very badly wrong.
We will access the tumour just in front of her ear.
We should hopefully be able
to separate the tumour from the brain
and remove it in its entirety.
I hope.
OK. Forceps, please.
The team remove a few small sections of the tumour
which are sent to the lab for a biopsy.
I need a pattie handy.
Removing the rest of the tumour will be a challenge
as it's full of tiny veins and there's a risk of heavy bleeding.
Can I have another pattie, please?
There's an area that I'm skirting around
because the base of the tumour,
where the blood supply is coming in,
it really does growl at me.
In neurosurgery, if you encounter a tumour
with a very rich blood supply,
then you run the risk of quite a significant haemorrhage.
You worry about the volume of blood that you're losing.
Suction's a little bit high, I think
Never a good thing when it bleeds a lot,
when you're trying to remove it, it just makes life more difficult.
Anticipating we may have
some more turbulence.
Scissors, please.
Thanks.
Scissors, please.
Funny, when the thing's out, the bleeding stops.
It's good. All right, we'll have the top lights in, please.
Ah! It's a feeling of relief when you've removed the tumour.
You can tell the patient that's what's happened, which is great,
but you never know for sure
until you've got the results back.
Steady. Slide.
So that does make for an anxious wait.
Kenan calls Karen's husband to give him an update.
Hi, is that Michael? It is. Hi, it's Kenan Deniz here,
neurosurgeon at the LGI. Hi, you all right?
I'm good, thank you, yeah, I'm just phoning... Good, good.
I'm just phoning to let you know that Karen's operation is all clone.
Right. The surgery went as well as could be expected, at the end,
I was happy that... That the tumour was all out.
So... Yeah. So far, so good.
Right, brilliant. Can I just say thank you very much?
You're more than welcome. It's my pleasure.
Right. OK. Take care now.
OK, cheers, bye. Bye.
Good. Excellent.
While Karen recovers, Kenan's next priority is jean
and seeing if a ward bed has become available so he can operate.
SIREN WAILS IN DISTANCE
Three hours into Jamie's hand transplant surgery,
the donor limbs have arrived.
It's a long-awaited day for Jamie and his family.
I can remember him ringing me up and saying,
"Mum, I found this professor and he's doing hand transplants."
He got a lovely reply back from Simon and Simon said,
"Yes, OK, we'll take you on, Jamie."
As a mother, you have a child and you could imagine donating
a heart or a liver or something like that.
But to actually let somebody cut the limbs off your child,
I think that's a gift.
So...
Sorry. It's just so remarkable
that they would give that gift of hands.
With the donor limbs now in theatre,
Simon and his team need to work against the clock to prepare them
so they can be joined to Jamie's.
Now we turn our attention to the donor limbs,
where we'll do the mirror image of what we've clone with his limbs.
And, luckily, of course, in the donor limbs, the anatomy is normal.
So they haven't been subject to trauma,
scarring, healing, distortion.
So that's radial...
This is... That, I think, is biceps.
There's no blood supply so the tissues all look pale
and hard to differentiate one from the other.
This is the most stressful part of the whole procedure.
There's a vein and an artery.
Every minute the limbs are without oxygen,
the tissues will deteriorate, increasing the risk of rejection.
In theatre one, the orthopaedic team work quickly to fix metal plates
into Jamie's bones so the new arms can be attached.
The idea is to keep the plates quite flexible
so when we put the donor limb on, we can really compress the bones hard
because what we want is really good bone healing
cos the last thing that Prof Kay and his team want
is us to have to go back in
when he's clone all the nerves and the vessels and the tendons.
We have to be quick because the bit that's going to keep the limbs alive
is the plastics bit.
The donor arms are now ready to be attached.
We're going to fix it now. OK.
INDISTINCT CHATTER
Does it look like it's going to fit? Yeah. Looks good now.
The limbs will now be screwed into the metal plates
anchored in Jamie's bones.
How long...now?
This arm, 12:25.
So four hours, 20 minutes. Ancl a lot of that was cold.
The donor limbs have now been without oxygen
for more than four hours. To prevent further deterioration of tissue,
they urgently need to connect the new arms
to Jamie's blood vessels.
Once the skeleton is stable, then we go in and start repairing
first the muscles
and then the blood vessels and then the nerves.
There's a vein there.
Ancl there's a big vein there. That'll be a good start, won't it?
As the veins are connected, they need to test to see if blood
is flowing through the donor arms.
Nicely clone. I don't think that is twisted, is it? No.
OK. There's that really heart-in-mouth moment
when you've got the bone fixation clone,
the skeleton is joined,
and then at that point I like the blood supply to be restored.
Can I have a pack for here to clean the hand?
That's the moment you hope it goes pink.
Everybody's quiet. We all watch.
Go pink!
Come on.
Just give me a 15 blade.
A bleeding finger
shows the intricate network of blood vessels is working.
Do I love surgery? I absolutely love surgery.
I think I've got the best job in the world.
Being able to do something that improves the well being
of your patients is a joy.
Cheers, guys. Bye. This is a good one.
After ten hours of surgery,
Jamie's arms are bandaged in casts.
The next few days will be critical
to see if his body rejects his new donor limbs.
So the plan, hopefully, is Hamza first.
Yeah...
Unless there's definitely a HDU bed ready for Declan.
On Adelle's theatre list today are Declan and Hamza,
two children with cerebral palsy.
Both need reconstructive surgery on their hips.
She's just come back from the bed meeting. Sorry to gang up on you.
We're just wondering, have you been to the bed meeting? Yes.
We're just wondering about the state of beds for the two we've got.
One's for HDU. HDU is OK.
Amazing.
I'm not too sure... So we start with Declan... Start with Declan.
Brilliant. That's a great plan.
Oh, Tracy. Yeah. So kind of you. Thank you. Thank you so much.
Much appreciated. OK, thank you.
Who goes first on the list,
I often feel at the minute it's down to luck.
It depends if your bed is there for you.
So it is, it's a lottery.
Another patient has left the High Dependency Unit,
freeing up a bed for Declan,
who takes the first slot in theatre,
while Hamza must wait.
INDISTINCT CHATTER
Is he a Paw Patrol? Oh, he is. He is? Yeah.
What's his favourite pup, then? Who is his favourite pup?
Chase. Chase? Oh, very good. Mine is Marshall.
LAUGHTER
If we're operating on hips,
biggest joint in your body, it is heavy work.
Declan - ouch, OK? Ouch.
Can I remove it?
Sorry.
When my son was 18 months,
he had surgery to wash out an infected hip.
Ancl for me, I think that was a real turning point to realise
what it's like to be on the other side of it.
Mummy's going to lift you up and we're going to go on that bed
and then guess what's going to happen. We're going to get fixed.
We are.
Ancl I think it's really important that I never forget
what that felt like.
Go sleepies, and when you wake up,
it'll all be so over and it'll all be different.
I've been on the other side of the bed.
I've stood in that an aesthetic room and laid my son on the table
and walked out. And it's hard. It's really hard.
You did really well, Mum, well clone. Thank you. Thank you.
We'll look after him. Thank you.
Have you got some long forceps?
Just a self retainer, please.
Thank you.
Adelle attempts to move Declan's hip back into its socket.
INDISTINCT CHATTER
Do you have a bigger...? Bigger than that? Yeah.
The delay in waiting for a date for his operation
means Declan's surgery is now more of a challenge.
At the minute, his femoral neck is sat like that, what we call valgus,
and the hip is dislocated, so it's out of the socket.
But, at the minute, we still don't know whether the...
It looks like it's not going to reduce closed at the minute.
I just get a feeling it's... Everything looks really tight,
contracted and shortened. So no matter how hard you try
and pull that hip down, cos their muscles are so tight,
they're just trying to pull it back.
So this is why, ideally, you want to do them before the hip
is actually dislocated because it's just...
Dealing with a dislocated hip is so much more difficult.
The complications mean that Declan's surgery
is taking longer than expected.
Although Hamza has now been allocated a bed,
if the operation overruns,
there is a risk he won't make it into theatre.
How are we doing?
With Karen recovering after surgery,
Kenan can now operate on Jean's aneurysm and seal off the swelling
in the weakened blood vessel in her brain.
We have had a patient in the past who was...
Who'd waited for some time and had been cancel led as well,
went home, and then the following clay
suffered a bleed and unfortunately passed away.
They were cancel led because of prioritisation of other patients
on the clay.
Oh...
PHONE RINGS
H ello?
Hello, who's that?
Becky. Hi.
Oh, go on. Tell me.
We've got a bed for the aneurysm.
Excellent. That's really good news.
So just need to close A&E now for the next three hours, don't we?
Somebody doesn't steal our bed.
Despite the issues we have
with our resources and the frustrations we have,
well, once the bed's confirmed, it tends to then fade away
into the background and you can just focus on
what you're trying to achieve.
So we've got bed for the clipping. Better late than never, indeed.
So we'll come at it through this fold in the brain here.
Ancl then we know, once we're at that branching point,
we know that the aneurysm is right next to it.
The aim of the surgery will be to seal off the bulge in the vein
with a metal clip.
We'll place across the neck...
...here because the blood's coming in here and then passing out here.
But at the moment, it's sort of going into the aneurysm.
So we need to place the clip across there
to exclude the aneurysm from the circulation.
I feel that I age several years
every time we operate on an aneurysm.
There's the added stress
of accessing something that could rupture, that could burst.
If something was to go wrong,
then it can be catastrophic.
We're just starting to come to the aneurysm. There it is.
We're starting to see it now.
So the neck of the aneurysm, the blood's coming in here.
At the moment, it's filling the aneurysm here as well.
With a risk of a bleed on the brain,
a dye is fed into the vessels around the aneurysm
to identify exactly where the clip should be placed.
This should cut off the blood flow to the bulge
in the weakened blood vessel.
Branch one, branch two. Big aneurysm there.
So let's go with a seven, I would go.
Pretty small, really.
But that should be big enough to get all the way across the neck,
get right down each gutter.
The mistake is to not go far enough.
Nice control. That's good.
Nice job.
Here it comes.
So, that lights up nicely.
There's nothing in the aneurysm - it's dead.
That's good.
There you go, job clone.
Yeah, well, you know...
It's brain surgery, isn't it?
Not rocket science!
When you've got that number of people waiting for beds, it normally
doesn't happen like that, so, yeah, pleasantly surprised.
But just goes to show that work was going on in the background
to make things possible. It's been a good clay.
Until next week.
HE LAUGHS
With both patients now through surgery - next, Kenan must wait
for the results of the biopsy on Karen's tumour.
Yeah, X-ray there, please.
Adelle has been in theatre now for more than two hours.
Declan's hip surgery has been more complex than expected.
Been for a walk, and I had to walk...
I happened to have been just walking round in a circle to myself!
The wait, every minute is like an hour. It's...
It's awful, especially when you don't know how long and...
It's like, how long is a piece of string?
Can I have another swab, please?
It's that... Can I have a bit of bone wax, please?
The team have cut out a section of bone from Declan's femur,
which has caused heavy bleeding.
So, it's kind of bleeding from the bone surface.
Sometimes it's actually really, really vascular.
We keep having to sort of just slow down and make sure we get control
of all the bleeding.
So, another swab's going in.
How many's in at the minute? Three.
Thank you. You're welcome.
So, we're getting there. Yeah, we're definitely getting there.
The hip looks like it's reducing.
It's just that typical thing, we're just running out of time.
We're just cutting the graft up to put inside the pelvis.
The bone is placed into a cut made in the pelvis
to anchor the hip into its new position.
OK. Propper, please.
Oh, that looks loads better. Oh, that's amazing.
Fantastic. Well clone.
That is really good, isn't it? Yeah, that's mint, actually. Yeah.
With the hip now in place, john gives the good news.
Hey.
How are you? All right.
So, it's all gone fine, it's all gone fine.
Just... Yeah. Thank you.
It's all right. It's OK. Thank you.
So, he's... We're just finishing now, OK?
Ancl then you can see him, then. Thank you.
Pleasure. Thank you so much.
Thank you. I can't believe it...
Thank you so much. Thank you. OK.
You're a diamond. OK, no worries. Pleasure.
Now the tears start. Yeah.
You don't know how much we appreciate this. OK.
Thank you. All right. Thank you. No worries.
It's been a year and a half waiting for this, waiting for this day,
and now that waiting is done and I know he's OK, then...
I can breathe!
It's a shame I'm in the hospital, because it'd be a stiff drink!
Although Declan's surgery has been a success,
the operation has overrun.
John's going to go speak to the last family. We're just not going
to have enough time. By the time we get him off the table,
it's going to be 3:00, I think, realistically.
He's older, it's dislocated,
so it was always going to be a tough clay at the office today.
John needs to let Hamza's family know they've run out of time
to do his surgery.
I'm really, really sorry,
but we're not going to be able to do the operation today.
Still find it really difficult telling a patient
that we've cancel led them.
We've said we're going to do this operation.
The emotional build-up to the surgery.
It's that trust that they've built in me, and I've broken that trust.
The first case that we did, a lot of blood loss,
so we've taken longer than we were expecting
and we've run out of time.
I'm so, so sorry.
I'm really sorry.
HE SPEAKS TO TRANSLATOR
TRANSLATOR: He says it's fine. It's out of our hands.
Happy to... Yeah. He just wants to know the next date.
Yeah. For us, you're a priority.
And, you know, I'm really sorry that it's happened.
Show us your muscles next time. Yeah.
You come back and see us later. OK.
Say bye to the camera, then.
THEY LAUGH
Hamza has been given a new date for surgery in four weeks' time.
I'm just so excited to get these off today.
It's been five days since Jamie's hand and forearm transplant.
I've come in today, because I'm the only one here,
and I'm on leave, but I am a bit clingy.
HE LAUGHS
I really need to know that he's OK every clay.
Hiya. How are you doing? I'm doing good, thanks. You? Yeah.
Right.
You good at bum shuffling? Yeah.
Today, Jamie's bandages will be removed,
so his new hands and forearms can be examined.
After surgery, there are a number of challenges for his body -
one is to heal, and then his regeneration starts.
What's all this whoa-ing about? Not sure.
Heaviness.
Right, don't worry.
Just let me move you around.
With Jamie, we joined up something like 10, 12 nerves a side,
and we will see those start to regenerate in the first six to nine months,
and they'll go on improving for at least three years.
Just feel like today's... A little worse? Yeah.
Well, we'll have a look at that.
I think it might just be me not having any sleep, feeling a bit...
Yeah, I didn't sleep that well last night.
Partly worrying about you.
They've stuck it on very carefully.
The biggest thing to avoid in the early post-operative period
is injuring your hands before the sensation recovers.
So, burning them under hot water, and so on.
So, Jamie, are you all right? Do you want me...
You don't want me to do anything? No, I want you just to relax. OK.
You can moan a bit, if you like. Yeah, yeah...
What's that one say?
Oh, that says, actually, "Tiger".
It's, like, a nickname I used to have for an ex-girlfriend.
She called you Tiger? Yeah!
Easy, tiger. Yeah!
How's it feel to get them off?
Oh, a bit of a relief, mate, yeah.
I can't wait to see it again.
Just, I don't feel much in my arms, so... Yeah.
Don't worry, don't worry. I've got you, Jamie.
Simon needs to examine Jamie's new arms before they are re-bandaged.
The swelling's going down. Yeah.
Looking good.
I would love to say I feel euphoric, but it bloody hurts!
Cos it's healing now. But I do. No, I feel blessed.
I really do feel blessed and lucky...
JAMIE WINCES Oh, sorry, Jamie.
Ow...
Going to be a hard first year, I think,
with the nerves growing back for me to feel them.
I've got to be super careful. They feel super heavy.
Actually, if you lose your suntan, they're going to match more.
Yeah, yeah, yeah.
Yeah, it's strange they're just on you, and even though they might look
different to what you had before, they're attached to you,
so it's hard to not think that they're not yours.
Oh...
It's going to be tough, but I'm well up for it.
I've always liked the challenge, and this is just another one
of these small challenges in my life.
I'm not going to pretend I know what that says across there.
I know, but I thought you might be a man who speaks Latin.
"My children..." Yeah.
Uh... "..empower me...
"..sempiternum."
I don't know what sempiternum...
"Forever in my heart." Perfect.
See you later. Right, I will do.
We're just trying to call Daddy.
RINGING TONE
Daddy, I can't see you!
Hiya...
How are you doing? Oh, hi, Daddy.
I made a card for you.
Look, read all that.
"Welcome, Daddy.
"Love, Bells."
Awesome. That's a really good, Bells. I like it.
I want real Daddy.
I'm coming home...
Say bye-bye to Daddy.
I I ove you. Bye-bye! Mwah! BYe-bye!
Bye-bye!
I've had a bit of feedback from the team this morning,
so we can go and have a quick look.
Kenan has come to check in on his patients.
Hi, jean. Hi. How are you doing?
You had such a late do yesterday.
Well... My husband said it went on quite late.
No, not at all. I was just relieved to get you clone, to be honest.
So was I. I was pleasantly surprised. No, it was good.
It was a good clay yesterday, and everything went really well. Good.
That was a great clay, that was a really good clay.
That's the great thing about my job.
That's a real high.
That's really good.
Ancl it makes up for all the lows, really.
So, yeah, I was really pleased with that.
I'm very relieved, you know.
I mean, it's funny, you don't look forward to this surgery,
but on the other hand, you don't look forward to it being cancel led.
It's all good. We got it clone, and it all went very well.
Thank you very much, and thank you for your expertise.
You're more than welcome.
With the aneurysm under control, jean is now out of danger.
And Kenan has the biopsy results of Karen's tumour.
How are we doing? Not bad. Good. Nice to see you.
We sent a specimen to the lab for what's called a frozen section,
and the pathologist was very definite in saying that they thought
it was a meningioma without any concerning features of cancer.
So, you know, that's really good news. Yeah.
You put up with the downsides in order to have the positives.
Ultimately, we're able to do amazing things for our patients.
Do you think I could ever get another one?
It's unlikely, but not impossible.
But hopefully not.
Get to your main question. I've done it.
No, your main one. Oh...
When can I go to the hairdressers to deal with my grey hairs?
That's a really common question, actually. I would...
Not with men, though. No. No! No, not so much.
Despite the issues we have with our resources
and the frustrations we have,
ultimately, our patients do well.
Ancl so, I suppose you focus on that,
and you put up with the other side of it.
OK, thank you very much. Thank you very much.
You're welcome. Nice to see you. Take care. Thank you.
You're very welcome. Well done. OK!
Taxi coming at 12:00, did you say? Yeah.
There you go.
Six weeks after arriving at hospital, Jamie can finally go home
with his two new hands.
The girls have missed him so much.
Savannah said the other day she's never letting him go again.
My goodness. Bless you!
Carefully, carefully. O h...
Good to see you.
Aw! My goodness. Oh!
Oh, you're home. Thank you so much for looking after the girls.
Bless you. Yeah, you haven't had the bill yet.
Oh, I know.
They are amazing.
They're heavy, then, are they?
Well, they were, yeah, when I first had them clone.
Bit cold... No, they're warm.
Yeah? They're warm.
Isn't that a wonderful gift you've been given? Yeah.
I remember the time when I was holding a hand
that wasn't going to make it. Yeah. If you remember.
It's funny to hold your hand again. I know. Crazy, isn't it? Yeah.
Hands are what make us human.
We do many things with our hands that other animals don't do.
We point, we indicate, we gesticulate, we caress.
We care.
I feel normal again now, instead of, like you say, where I didn't...
When I looked in the mirror, like you say, having my arms cut off.
Like you say, they say about that big picture, don't they?
Like being a whole, as a person, when you look at yourself.
Yeah. Ancl I've started to feel whole again now, do you know what I mean?
Can't wait for all the nerves to start regenerating into my hands
and I can move them around. That's...
Ancl then, the girls are giving me loads of stuff to do.
Hello! Oh, my God! Daddy!
Oh, my goodness. Daddy's here!
Daddy...
Daddy, you've got real fingers.
I know. Do you want to hold them?
Hold my hand?
We'd never expect a patient to say, "You know, I feel complete again."
It's not about what somebody else looks at you and thinks.
It's not cosmetic or aesthetic.
It's what you yourself see as being complete.
It feels weird!
Your finger's just touched mine!
Don't worry, it's my finger. My finger. No!
Remember, I'm going to tickle you severely when they start working.
I can't wait until the fingers move. You're so ticklish, aren't you?
Beep, beep!
That's still tickly, Daddy!
But aren't they lovely?
That's so nice.
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