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. You keep thinking,
if that was me, if that was my mum, that's not fair.
I've had a scan. They found, like, a brain tumour.
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.
We'll try and pull out all the stops
so that we don't have to cancel a patient on the clay.
When you finish surgery and it's gone well, it's great.
I love that feeling. How are you doing?
I'm alive.
We're OK? Yeah, it's all gone fine.
We're happy, aren't we? Yeah!
Right, my darling. See you soon. Yeah.
Champion.
I've checked this gentleman in already.
You're second on the theatre list.
Hello, morning, you all right?
The endocrine system is one of those things that actually plays
a really important role in the body.
It's like a messenger system.
You have areas in the brain which are then targeting certain glands.
They're releasing hormones, and then
that is keeping things running in the body.
Sheila Fraser is one of two endocrine surgeons
at Stjames's Hospital in Leeds.
She operates on the glands around the body that regulate hormones.
We see a lot of people who have both benign and cancerous conditions,
which have a massive impact on their life, both physically
but also massively psychologically and emotionally, as well.
What did you say your name was? So, it's David. OK? Yeah.
See you later.
The only patient on Sheila's operating list today
is 59-year-old solicitor David.
David has been prioritised for surgery after a scan showed a large
growth on one of his adrenal glands,
which is suspected to be cancerous.
Normally, I'm, you know, quite active,
enjoy life and no real physical disabilities at all.
Put this gown on with the opening down the back.
I started getting some quite severe pains in my upper body.
Ancl then I had a scan and, literally, within a few clays,
I received a telephone call from my GP saying that the scan had
revealed what he referred to as a mass in my upper right-hand side -
what they thought was a growth on my adrenal gland.
So I'll close the door and let you get changed.
The adrenal glands are glands which sit above the kidney towards
the back of the body.
And, again, they're glands that people often don't know
much about until they start causing problems.
The adrenal gland makes a range of hormones,
from steroid levels to ones that control your blood pressure,
to your adrenaline levels - which are the ones that you feel
if you're about to go for an exam or an interview, you can feel yourself,
heart pumping, on edge.
There's always a balance when we operate between
how much do you do, how far do you go, how much
do you push the patient?
So something like an adrenal cancer, where the only real way
of getting the best prognosis is surgery,
we're likely to be more aggressive.
You know, I haven't yet hit my 60s and, yeah,
I feel it's certainly come far too early.
Far too early, really, yeah. A bit of, you know, quite a shock.
I thought I was getting middle-aged spread, but I think actually
it's probably the lump is pushing everything out and, yeah,
so, er, yeah, probably a bit...
Yeah, I'm hoping to lose about six inches off my waistline.
He's been great.
Urn, I think he's gone from really dreading the operation to
being resigned that that's the only way he's going to get better.
And he's, um...
Yeah, no, he's done really well, actually, yeah.
We've tried to be very positive and upbeat about it all,
but, yes, it's worrying, it's worrying.
David's got two daughters,
and I think it's all come as a surprise because, you know,
David isn't very old and it all happened very quickly.
Knowing that it was a lump and it could be removed
didn't seem too bad at that time. Ha.
Um, once I'd got the scan, it had all moved very, very quickly.
In fact, you know, at times, a little bit alarmingly quickly.
One of the problems with the adrenals is that the glands
sit at the back of the body. So, because they sit above the kidney,
in what's called the retroperitoneum,
they don't impact on things like the bowel.
So they can actually grow to
a massive size before they start causing problems.
This is the CT scan. You can see a tiny, almost wishbone shape
there, which is the left adrenal.
On the right, this big thing here is liver,
which is what you expect to see.
But you can see here there's something different.
And, as you go down, you can see a huge mass.
This mass is the right adrenal gland,
which is massively enlarged.
Then you can see this man's poor kidney, on the right, has been
completely squashed and is almost in the pelvis.
So lemons are this big, grapefruits are this big.
This is more football. This is a football.
It's different from other types of cancers where you can confirm
it beforehand. Because, actually, if we stick a needle in
and did a biopsy and it is a cancer, we can do more harm than good.
Carrying out a biopsy could result in rupturing the growth,
enabling the cancer cells to spread.
The only way to confirm it's cancer is to remove
the whole mass in surgery and then test it.
But the operation is considered high-risk.
We have to take it intact.
If you break the capsule, as you shatter any
cells in the abdomen, the prognosis goes down dramatically.
So it's really important we get this out intact.
If David's tumour has invaded the liver or kidneys,
there's a chance he could lose part of both organs.
So the most important thing for us is to get the adrenal out intact
and to get the cancer out.
Ancl that gives people the best prognosis.
If that means that, to do it, we have to take part of the kidney out
and part of the liver out, we will do that,
because we're doing this for cancer
and we're doing it to give people the best chance of survival.
Sheila will carry out the operation with liver specialist Barbara Fiore.
The surgery is expected to take around 12 hours,
so David will be her only patient today.
He's got no other medical issues, but it is a big mass.
You can see the kidney really looks pushed down. It does.
It's just sort of sitting on the pelvis. Usually, you know,
it's not so... Big!
SHE LAUGHS
And, at the end of the clay, he's a fit man.
If he has to lose a kidney, he can lose a kidney.
He's not going to come to any long-term harm.
Whereas, if we don't get that out, he's... Yeah.
...he will come to harm.
Doing a complex case with another consultant gives you
more sets of eyes. It gives the patient a better experience,
because they're having two consultants.
It probably actually reduces operating time because you've got
two people making decisions rather than one, sometimes, on their own.
It also means you get less fatigue,
because you're not having to make every decision by yourself
during a sort of very long operation.
Morning. Hi.
Because this is a highly complex operation,
Sheila must make sure David understands the risks involved.
You've got this really big mass sitting here like this.
It is starting to push this kidney down,
and it's also pushing the liver up.
So the plan today is to take out this big mass,
which we strongly suspect is an adrenal cancer -
just because of the size of it, the look of it -
but we can never say 100% until we take it out.
One of our liver surgeons is coming
into theatre today to give me a hand.
Until we get in there, what we can't tell is
if it is pushing on the liver, or if it's actually what
we call invading the liver - if it's actually attached to the liver.
If it is attached to the liver,
then we would have to take some liver with it, because one thing we
want to do is make sure we've got the whole thing out.
The plan is to take the adrenal out,
but there is a small chance you may lose some liver, as well.
And, actually, the same applies to the kidney.
So I'm not going to lie - this is a fairly big cut.
I'm resigned to that. Yeah. Yeah.
We will only operate on people if we think we can do things
and we think there is a chance.
But we can do all the scans,
we can do all the blood tests in the world -
until we actually operate, you don't always know what
you're going to find until you get there.
As the operation is considered high-risk,
David has been prioritised a bed on the high-dependency ward.
So he's consented for right adrenal, possible nephrectomy,
possible liver resection, plus-minus.
After Sheila has finished her team briefing,
David will be called down to theatre.
Good morning. You're full at the moment? Yeah.
But discharge-wise? One this morning and one later, I think. OK.
I think there's no doubt that neurosurgery is a pretty
stressful speciality.
There is probably a slight misperception,
because people like to call neurosurgeons "brain surgeons".
But, actually, the spinal cord and the spinal column is a natural
extension of the skull and the brain.
Ryan Mathew is one of 13 neurosurgeons
at Leeds General Infirmary.
The brain and the spinal cord are all one organ.
And, therefore, we train to operate on the brain,
the skull, the spinal column, and the spinal cord.
Today, Ryan and his team have two patients on their surgery list.
One needs an operation on his spine, the other on his skull.
Hello there. Hi there. My name's Guy.
I'm one of the an aesthetic consultants. Hi there.
Can I just get you to tell me your name? Karl.
Karl needs part of his skull rebuilding after a fall
two years ago which caused a traumatic brain injury.
I was found at the bottom of the stairs in my house, unconscious,
and was taken into hospital.
I had a brain bleed and then I fell over.
Or I fell over and then I had the brain bleed.
We're not 100% sure which happened first.
Then they put me in intensive care,
so it was quite traumatic for the family.
At the time of the accident, Karl was taken to
Leeds General Infirmary, where he was under the care
of Ryan and his team.
Karl came in as an emergency.
He'd had a nasty, traumatic brain injury.
He came in in coma, with a shaken brain,
blood clot on the surface, and so we took him to
theatre as an emergency, opened his skull and removed the blood clot.
The brain was very swollen.
We were worried that the pressure within the skull,
clue to the swelling of the brain, will threaten his life over
the next few hours or clays.
And, at the end of the operation,
we made a decision not to put the skull back.
So this is a CT scan, which shows his bone very well.
And as we come up, we see large areas of Karl's brain
where there are old scars.
The skull is the bright white, thick layer on the outside.
And, up here, we can clearly see this is his original skull,
and this is the portion that's missing.
Ryan will attach a customised titanium plate to Karl's skull
to rebuild the missing section
and give him back a more regularly shaped head.
I went to a family party.
Pictures went round on Facebook.
And I looked at myself and thought, "God, you look weird."
Like, actually, yeah, the whole side of your head is just wrong.
And that was the reason that I sort of pushed a bit harder
to get this operation done.
In general day-to-day life,
we see no real evidence of significant trauma or
risk from them walking around with a portion of their skull missing.
But I think there can be effects on people's self-esteem,
confidence, clue to the appearance of their skull.
We do take into consideration those factors
if we think they're going to really impact someone's recovery.
Because cranioplasties are largely a cosmetic procedure,
then we would list them and schedule them as non-urgent.
And, therefore, patients do tend to wait a very long time
to have them put in.
Karl's operation was cancel led a week ago.
He has now waited more than 18 months for today's surgery.
Hello. Good morning. Hi.
I'm not sure if you remember me.
No!
So... I was otherwise engaged. Yes. So, Ryan Mathew,
consultant neurosurgeon.
So, obviously, I think the main thing to say about cranioplasties
are they're rarely as perfect as the original skull that you had.
It doesn't always become a perfect result.
There's always a risk of bleeding
and infection - probably the two biggest risks.
The worst-case scenario is that we
have to take the whole plate out again because it gets
infected or there's some problem with it after the operation.
But, fingers crossed, it all goes well, we'll get it clone,
and we'll keep an eye on you for 24 hours and, as long as everything's
OK, we'll let you go home tomorrow.
Well, we'll get you changed. You're first on the list, so...
Oh. Excellent. We'll just have to, fingers crossed, that there's a bed,
which, once I've seen all the patients,
we'll go down and check in theatre.
But I'm really hopeful we'll just get it sorted today.
Right. Thanks very much. Good, right. See you shortly. Cheers.
Karl's surgery can only go ahead
if there is confirmation a ward bed is available after his operation.
Second on Ryan's list today is Michael,
who needs surgery on his spine.
He's been suffering with spinal stenosis - a condition that
compresses the nerves in his spine, causing pain in his back and legs.
Was diagnosed in October 2020.
You can feel it coming on when the nerve actually gets really trapped.
It's like somebody's trying to pull the top of your head off.
It's causing me a lot of problems walking, lifting
and things like that.
Well, it could leave me paralysed from the waist down.
That's how big it is.
What he has are symptoms of what we call spinal stenosis.
So this is where wear and tear changes over many years.
Here, for example, is a nice, healthy disc, and you see the canal
is nice and open, with the fluid around it, which is the white stuff.
As we come down here, we see that it's more pinched.
Again, more pinched there, and really badly pinched there.
Ancl we can see that there's no fluid, really, there at all.
So he's been in agony for some time with that.
INDISTINCT
Michael and his wife have made
the 60-mile journey from their home today.
He's second on the list and will also have to
wait for a post-operative bed to become available.
I know, yeah.
I think all of our patients would love to be first on the list.
Ancl you can completely understand why,
because they've been fasting, they're travel led in,
they have anxiety around their operation being clone.
Then they might find out that there is a chance
they could get cancel led.
Then they sit there, waiting.
Ancl that's a really difficult, powerless time for them
where they just have no control over what's going to happen.
Ancl I can imagine that it's not particularly pleasant.
Sheila's patient, David, is on his way to theatre
to have his suspected adrenal cancer removed.
Let's go in this way, into six.
Come 'round this side, David. You're all right.
The surgery is quite lengthy, so a little bit scary.
But it's not really that we have much of an option.
The growth that I have is continuing to grow, so it'll just get worse,
and it's just hoped, really, that it hasn't spread anywhere else.
It just has to come out.
Sheila and liver specialist Barbara must remove the entire
growth in one piece.
If the tumour capsule is broken, the cancer cells could spread.
We're hoping this is just a big mass, and it is pushing on things.
But there is a risk it is invading liver, invading kidney,
so we'd rather be prepared for everything and not need it,
than end up in the difficult situation and need stuff.
So, adrenal cancer is very hard to treat.
The main thing is surgery.
We know that chemotherapy isn't particularly effective.
There are other treatments they can try,
which is specialised for adrenal cancer.
But the best treatment for it is surgery.
You can go on the side... Side.
...down, and then take it from the liver, last thing.
OK. You want to do the liver last?
Because that's where it's going to bleed.
Yeah, that's true.
I will give people a big cut.
Yes, they're at risk of hernias, so at risk of chest infections.
But, actually, compared to a recurrence of the adrenal cancer
or secondary disease, that is not so important.
I think that some of it is really playing it by ear, isn't it?
Yeah. See what we find.
We've been through the scans, we've emailed each other beforehand.
We've tried to make sure we've got everything possible.
We've spoken to the theatre team.
You prepare for everything,
but you can still find something on the day that catches you out.
First, they need to open the abdomen to see how the growth
has impacted the surrounding organs.
Shall we just get that muscle? Yeah, yeah, you're right.
It's been bleeding. Yeah.
This bit can go. This bit?
Yeah.
That's opening up.
OK, that's good.
Because of the size of David's growth,
his organs have been pushed out of position,
making the operation more of a challenge.
That's it. What's that? Is that appendix coming in?
Don't take his appendix. I'm not taking his appendix.
I was just thinking, what the hell is an appendix doing...?
Then he could bleed by pulling. Yeah.
It shows how low it's going.
Can you see?
So, what we've done is opened the abdomen,
and then you can see, here, a huge lump.
This is all the adrenal mass.
The adrenal gland is a really awkward gland.
It sits above the kidney.
It sits under the diaphragm.
And on the right-hand side, it can go under the liver.
And it also sits next to the big blood vessel that carries
blood back up from the lower half of the body to the heart.
And what we're trying to do is work our way
gently around the adrenal mass and work out the best way
of taking it out without, hopefully, causing any damage.
Right. Where's your kidney?
Here. Fine. Shall we take it...?
In there. So, we can take it here?
Yeah. Yeah, take it there.
Now, the adrenal is pushing the kidney right down.
So, this is the kidney, sitting right down here,
which is normally up here. Take this down here.
Yeah, yeah. And then around the kidney.
Yeah. We can make it more mobile.
That's what we need, no? Yeah, definitely.
Sheila detaches the growth from David's kidney
and the tissue surrounding it.
I'm just going. Yeah, yeah.
What... I can't actually see where... Oh, I can feel it.
I can't see it. Fine.
The only thing that you can hit there is the ribs.
Well, that's true. There we go.
Yeah, we're winning on the kidney.
With the kidney separated from the growth,
they can now move on to David's liver.
The adrenal gland sits in an awkward position.
And sometimes, to get to it, especially in these big open cases,
we always have to move the liver out of the way.
So, swabs under the liver. Yeah. It's bowed on the left.
If the tumour has invaded the liver, they will have no choice
but to remove a section of the organ,
making sure the tumour capsule does not break.
It's a huge lump.
I think we need to get this... There? Yeah, there.
As the team try to detach the growth from David's liver,
they find it's positioned dangerously close
to a major blood supply.
We're talking about millimetres.
And we're having to separate that from the vena cava,
the main vein that carries blood back to the heart.
So, if we accidentally nick the vein, tear the vein,
don't clip it off properly, or it's technically difficult or stuck,
then we can get dramatic blood loss in seconds.
OK. Exactly. Yeah, all right.
Suction, yeah.
It's not major, it's on the adrenal.
Yeah, that's why I'm like... Yeah. OK. That's fine. It's not the vein.
The team is able to separate the growth from the liver
and move it away from the major blood vessel.
Now they must lift it out.
Sorry, hang on a few secs.
So, we're pretty much under...
Here. Here, if you take...
Let me put my hand down. You put a hand down that side.
I think we can take it here. Yeah, you take it. Yeah.
That's good. Really good.
Yeah, I'm under it.
OK, sure. OK.
So, there, there, there.
Look at the size of that.
That is a good lump.
Can I just say that?
Can I have a large swab, please?
You can see the massive hole where it was.
So, from his point of view, this is the best result.
It's got... His kidney's still there, his liver's still there,
bowel's still there.
The capsule's completely intact.
So, from our point of view, it's about as good as it could be.
The growth weighs more than 2kg.
It will now be sent to the pathology lab to confirm the cancer
diagnosis and to decide if David will need further treatment.
That is the quickest weight loss ever. Yeah.
That is amazing.
Thank you very much.
Fab. I need a cup of tea.
So, what will happen now is we will send this off.
The main thing from our side is now to make sure he recovers well.
We can get him home.
Actually, we have to be a little bit cruel to be kind,
so we want to get him up. We want to get him going.
We don't want chest infections, we don't want anything like that.
Over the next few days, David will be closely monitored
while Sheila waits for the results from pathology.
Neurosurgeon Ryan is still waiting for confirmation on beds
for his patients Karl and Michael.
So, I don't know what's happening with anything
until I've seen everybody and gone down
and we just have a chat to the bed managers and the beds.
There is a critical shortage of beds.
There has been... Last week, we had to cancel patients.
There's somebody else listed first, anyway, so we'd let you have a
little drink once we know that they're on their way to theatre.
If we get it confirmed that there's definitely not going to be a bed,
we'll let you know as soon as possible, obviously, cos, you know,
you're going to need some drink ancl make arrangements to go home.
I won't have an idea for a little bit, probably another couple...
Two to three hours.
So, I'm sorry, that's just the way things are at the moment,
and I wish it was better.
But, as I say, the main thing is as soon as I know, we'll let you know.
All right? Any questions for me? No, that's fine. Right.
Good. OK? See you shortly. OK.
Well, yeah, I'm hoping that, you know, a little bit less pain.
I mean, this leg, from there to there, you start walking
from where I parked t'car, where disabled is,
to here, that's now numb.
My foot, that's the most I can bend that foot back.
I can move it that way, but that's it.
Ryan has received confirmation
there is a bed for his first patient, Karl.
Anything expected during the day that will affect the list?
Just beds.
Yeah, so we've got a confirmed bed for the first patient,
and we're waiting to hear for the second patient.
So, the first one can walk to theatre,
the second one will need a trolley.
Yeah. The first one's just going via scan.
So, he's just having a plain CT scan on his way down.
So, he'll go from there and come straight here, if that's OK.
Yeah, that's fine. Yeah.
After a cancellation last week,
Karl's operation to rebuild the shape of his skull can now begin.
So, we can get going, basically, on time, which is good.
At least if we're operating on somebody, then we've got that time
while we're operating on them to work out what's happening with beds.
The key outcome is to get the very best cosmetic result.
We want the patient to look as if they've never had
an operation in the past.
That's the ideal result.
Cranioplasty surgery is technically quite a straightforward
operation, but actually it carries considerable risk,
and it can be life-threatening, the operation itself.
So, just keep using the cutting, otherwise it burns the skin.
Forceps, please.
First, Ryan must peel back Karl's scalp.
This is the most dangerous part of the operation,
with a high risk of excessive bleeding.
The scalp bleeds a lot when you open it,
whether that being a first operation,
but certainly when you reopen it, because scar tissue always
bleeds a bit more and the tissue might all be stuck down.
He needs to remove any scar tissue between the scalp
and the protective layer of the brain.
That's the area that we want to put the implant back into.
So, we need to get that layer right.
Ancl when we do that, we want to make sure we're controlling any
bleeding along the way.
The risks are that you have this gap between the implant
and the sunken brain.
Anywhere where there's a gap in the skull, blood can accumulate.
Just try and get underneath that bit, yeah.
Ryan uses an instrument which sends an electrical current
to seal the blood vessels.
We have to stop any little bleeders
because they're the types of bleeders that can accumulate,
after we close the head, and cause life-threatening blood clots.
So, that's the customised plate.
Ancl it has his initials, his NHS number and his date of birth,
so we know that it's his and we double check that, so, yeah.
Titanium's fantastic because it's lightweight and very strong.
So, I think we need a bit more... That way? Yeah. That way. Yeah.
He needs to position the plate to fit the remaining bony edges
of Karl's skull.
One, two, three, four.
Probably at least four more.
If we think the plate's going to stick out in bits,
then it's best to secure it.
I'm just going to stop against the bone.
We can put one here, and it's fine, but it's equal. Yeah.
With Karl's plate successfully in place,
Ryan will now pull the scalp back into position.
Yeah. OK, two galeal stitches, please.
A call has come through from the theatre matron
about his next patient, Michael.
OK. I'll go and check.
I think there are lots of complex reasons around bed pressures.
There can be so many different elements of that,
which sometimes don't come to light until the morning of surgery
because there's been a busy night and, you know,
the emergency department has had pressures,
or we've not had as many discharges as we would hope on that morning.
So, these can all come to light on the clay of surgery.
Ancl I think that's really difficult to explain to patients sometimes.
We did get a bed confirmation and then
we got an update saying there might not be a bed, so I'm just waiting.
So, as soon as we know, we'll give you a ring back.
Five hours since arriving in hospital,
Michael is still waiting to find out
whether his surgery will happen today.
Nervous.
Uh, sick of waiting.
Tired.
Wanting to get it clone now.
Panicking a bit.
I'll see all the electives, essentially,
and then, trauma-wise, we'll just get through and see where we get to.
That's fine. Perfect. Great, thank you. Brilliant.
Can you bend your knees up? Oh, I bet you can.
There we go. Brilliant.
So, as an orthopaedic surgeon, there are often things that I do that
are fairly simple from an operation point of view,
but, actually, the transformative effect
that they have on people's lives is brilliant.
Colin Holton is an orthopaedic consultant
and clinical director of Leeds Children's Hospital.
So, we, on a daily basis, and sometimes
feels like on a minute-by-minute basis, make difficult decisions on
who to prioritise, who goes first, who gets seen first, who's treated.
Ancl that doesn't get any easier.
Morning.
How are we?
Shall we do a quick board round just now
so we can catch up about patients?
Today, Colin is the on-call consultant,
responsible for paediatric patients needing urgent orthopaedic surgery.
So, we need to do ward round, I'll do my clinic, and then I'll
speak to Bev about trying to get the cases clone in the afternoon.
That'd be great.
One patient Colin is hoping to add to his acute surgery list today
is seven-year-old Brooklyn.
Although Brooklyn is not considered clinically urgent,
Colin has chosen to prioritise his surgery.
Nine months ago,
Brooklyn and his family were involved in a car accident.
Brooklyn broke both of his legs
and had emergency surgery to fit pins into his thigh bones.
Today he is returning to hospital with his dad Craig,
to have the metal pins removed.
Let's find number 49.
Number 49, easy.
Down here, I think. Number 49. Number 49.
That's theatre.
He's got surgery today with Mr Holton. OK.
So, I met Brooklyn for the first time the morning after he'd come in.
They'd had a horrific and unfortunately fatal loss
of life at a crash on one of the motorways close to here in Leeds.
Brooklyn lost his mum and his brother and sister.
He had a head injury and he came to our intensive care unit.
So, he'd broken both his thigh bones,
so both his femurs he'd broken in that crash.
Ancl so, you know, big trauma.
Definitely right to come to us as a major trauma centre here in Leeds.
In the crash we had last year, I lost family members.
Ancl this place brings too many memories back.
I just want today to go well,
so we don't have to come back again.
I've only got him now.
So... Um...
It's just hard. Being here today is just...really hard.
He's not happy about being here today to have it clone,
but I've said it needs to be clone, and the sooner it's clone,
the better. Everything else... Trying to move forward.
Brooklyn's last stage in his treatment, for both
his thigh bone fractures that he had, is to take these rods out.
They can irritate the soft tissues and they can get in the way if he
was to break something again, then it obviously becomes problematic.
Brooklyn and Craig lost mum Shirley,
nine-year-old sister Ellie,
and five-year-old brother Oscar in a tragic accident
when a tyre blew out on their car on the motorway.
Brooklyn, in theory, could wait, but, obviously,
with the background history and the family story as well,
I'm keen to try to get them clone at all cost today, as well, to decrease
the time in hospital and, yeah, and look after them, really, honestly.
You've grown taller.
It's unbelievable.
But, yeah, he weren't supposed to be in, what, the 23rd ofjune.
That's when they sent it to me.
Ancl then I got a phone call yesterday. Oh, God, I threw up.
Just nervous. You can do it. I know.
What you've coped with in the last year, you...can do this.
We're here for you.
I think there's a juggling act of,
although it could wait, we don't want to prolong that...that, um,
you know, coming to hospital, potentially not getting clone,
going home. You know, you just want to provide the best possible care,
but that has to be balanced again to acute cases
and other surgical specialities as well, other cases to do.
Ancl that's a constant juggling act, both from the point of view
of clinical priority, as well as the whole picture of that patient
and family as well.
Ancl Brooklyn's a really good example of that.
As the on-call consultant today,
Colin is also in charge of prioritising the care
of children admitted overnight.
Hi, Mum.
I'm Colin Holton, I'm one of the orthopaedic consultants here.
This is Muhammad, isn't it? Yes, it is.
Two-year-old Muhammad has arrived from a local hospital with
a bacterial infection which Colin suspects could now have
caused him to have an infection in his left knee.
When we get to prioritise patients, there's the understanding,
obviously, it could just be led on what's most life-threatening.
Ancl the vast majority of time,
emergency case will always come first.
The plan today is to try and find out what's going on.
Because he is still spiking temperatures. Yeah.
Ancl it may well just all still be viral.
But the worry is whether or not he's got something in his joint or
things... Yeah. Um...
MUHAMMAD CRIES It's OK, it's OK.
Oh, I know, fella.
I know. He's got... He's got... Can't lift that foot.
Yeah, OK.
So, we're going to get an ultrasound scan of his hips and knees
and his ankle joints and see if there's any fluid in there.
We'll see what his ultrasound scan shows,
and then we'll make a plan from there.
It's a question of whether or not we're missing something else.
So has he got, you know, tonsils, lungs, tummy, or essentially...?
But we'll see. So, let's get this ultrasound scan
and then we'll make a plan from there. OK.
Any infected joint, be that in paediatric or,
or an adult patient, can be not only limb-threatening,
so the limb itself can be damaged,
but also sometimes life-threatening.
Colin will wait for Muhammad's test results before making
a decision about who to treat next.
If results show he needs urgent surgery,
Colin may have to cancel Brooklyn.
Ryan has received news from his team.
They have a bed for Michael after surgery,
and his spinal operation can now go ahead.
I think what we don't appreciate sometimes is we're busy doing
things, but some of these... You know, he's not eaten now for,
you know, the best part of ten hours.
Ancl I think it's the not knowing sometimes as well.
So, I'll just go and say hello to him,
tell him that we're all on to get clone and everything is usually fine.
Hello, sir.
Hello. Good news.
We have a bed.
It'd be good to get you walking, pain-free, wouldn't it?
If it's any better than what it is now, I'll be happy.
Good. Good.
All right? I'll see you down there.
Six hours after Michael arrived, he can now go to theatre.
I haven't been walking that much.
No. You'll have to take it easy for a while.
I actually... My wife can walk faster than me.
Physios will give you lots of advice from the ward
before you're discharged, yeah.
Hello.
Thank you.
The whole aim of the operation is to remove anything
that's squashing nerves.
Ancl that's what spinal stenosis surgery is about -
to create more space.
We're trying to cut out the bone
and the ligament that is squashing the nerves.
Ryan will be working millimetres away from Michael's spinal column.
Local going in.
OK, 20 mils in.
Shut that tube.
He lifts aside muscle to expose Michael's spine...
...then he starts to remove the bone and ligament squashing the nerve.
Self-retainers, please.
Thank you.
TUBE SUCKS BLOOD
The operation carries a risk of permanent paralysis
to Michael's lower body if any of the spinal nerves are damaged.
Quite difficult to see without a microscope, but that is the
thickened ligamentum flavum, and you see how thick that it is.
So, that's been squashing down on his nerve.
That's a great piece to take out.
The bone that we're removing is the bone overlying the nerves
at the point on the scan where we know they were most squashed.
So, all this time we're creating more space above
and 'round the sides of the sack that contains the nerves.
There you go. More ligamentum coming out.
You see that yellow stuff?
Yeah. That's fantastic.
More there. Yeah. Good. Look at that.
Really thick stuff just pressing down.
All along before here, there were big divots at certain points
where it was pinching in that you could see on the scan from earlier.
It's quite satisfying when you remove all that thick ligament
and you kind of... We call it a blow for freedom.
So, you feel that kind of, you know, release of pressure.
Pinch all the way down, all the way down.
Push all the way down, yeah, and cut.
Good.
Thank you.
Ryan must now wait until Michael's awake before he knows
whether the operation has been a success.
Immediately post op, we're looking for very clear
markers that the nerves are still working.
We just need to make sure that no damage has occurred.
So, we'll ask patients to move their legs,
move their foot up and down,
wiggle their toes, lift their knees off the bed.
Ancl that means that the nerves are working.
Everything's gone very well.
Very HAPPY-
Let's have a look, then.
Right, go on, then. Pull that towards you. Oh, wow.
That wasn't working very well before the operation.
Do you remember? You can pop it down now.
It's really good to have got it clone,
which is the most important thing today.
So, I think you always know...
You feel satisfied cos you actually feel quite
tired at the end of the clay, so, you know you've clone, you know,
a good amount of operating.
In the children's hospital, Brooklyn and his dad Craig
are still waiting for confirmation his operation will go ahead today.
If scans show Colin's other patient, Muhammad, needs urgent
surgery on his knee, Brooklyn's operation will be cancel led.
The ultrasound scan has revealed that he's actually got
an infection in his abdomen,
and that infection that's there is probably from a burst appendix.
So, Muhammad still needs to get clone, and he still is
a clinical priority, although he, you know, from my point of view,
he's handed over to a different clinical team,
he's still going to impact on the cases
that we need to do here within the children's hospital.
It's a constant juggling act.
There's competing demands at all times.
There's only so much resources that we've got here within the NHS,
and it's just trying to make sure we do the best with it, to be honest.
With Muhammad now under the care of another consultant,
Colin can go ahead with Brooklyn's surgery.
So, how are we doing, Brooklyn? Are you well?
Good.
Craig, lovely to see you.
Nice to see you again, too.
So, Brooklyn, can I put some marks on your legs?
Would that be OK? Brilliant.
So, I'm going to draw on this one. Oh, that's weird.
Does it feel weird, does it?
I'm going to draw a line on this one. Why?
So that we... Sometimes when we do operations, we just do one leg.
Ancl in that case, this is one of our checks.
But we're doing both your legs,
because you broke both of them before. I like drawing.
Do you? So, I can feel your nail there.
It feels weird.
So, we're going to take that out
so it stops irritating that soft tissues and that swelling.
This might be the last time we see each other face-to-face
in a good way. Yeah, I know. I understand that. In a good way.
So... I can't put it into words to thank you,
you know that, I've told you many times. I know.
Privilege. In all honesty, Craig, absolute privilege.
All right? Thank you. Brilliant. OK. So, we'll be back in touch with
the guy to take you for surgery and stuff. We'll get you sorted. OK?
All right. Thank you very much.
INDISTINCT Are you?
Ancl I want to see, by the time I come back,
when you come back from surgery, all these coloured in.
Do you reckon? I can do every single one.
Every single one?
I think it's very easy sometimes to forget the trust that parents
put in me as a surgeon.
The fact that they trust me
to make sure I get the best outcome for them is one that
I hopefully never lose sight of, and I'm very grateful for them.
Brilliant. Nice to see you guys, all right?
Nice to see you, too.
I'm scared, that's all.
No, I'm just...
Being away from him, that's all.
You're OK.
You are.
We're never away from each other. He don't give me...
You're not, are you? I can't...
Well, I can't even go to the toilet. Can't go anywhere.
So, he's always here.
Are you still snoring next to each other at night-time?
Oh, he won't let me...
I never snore.
LAUGHS I've heard you.
He won't let me sleep on my own.
He sleeps with me and cuddles me.
But I don't mind,
after all of that.
Like sleeping with a little octopus.
He's not ready yet. I know he's not.
He's told me he's not.
Brooklyn can now be taken down to theatre.
Why are you shaking?
Are you waiting for Brooklyn?
Have you had a little tour of downstairs?
Come in.
Wow.
You ready? What's that called?
That's the Spider-Man web shooter.
Why are you putting it on me? Does it hurt?
This is like a toilet. Will it hurt? Will it hurt?
No. just a bit cold.
You did so well there.
Ancl this is the magic milk that will send you...
Will it hurt? No, it just feels a bit cold.
You're doing really well.
Do you have to hold?
What are you going to dream about when you go to sleep?
I don't know. Will you dream about what you're going to eat?
Why does my mouth feel cold?
CRAIG LAUGHS That's normal. It's all right.
You're doing so well. So well.
I love you, just remember that, yeah? Aw, sweet dreams.
There you go. There you go. Well done, Brooklyn.
Dad, do you want to take your mask down and give him a big kiss?
You all right? He did so well.
Super brave. You all right? Go and get a hot drink.
Well clone, Dad.
NURSE SPEAKS INDISTINCTLY
Well clone.
CRAIG: I can't breathe.
Colin and his team will need to remove two metal rods
from each of Brooklyn's thighs.
Perfect.
Brooklyn, we put his nails on over nine months ago now
for his bilateral femoral shaft fractures,
which can be sometimes a bit of a challenge,
but it went very well for Brooklyn and he's got a really good outcome.
We're now planning to take them out because the metalwork can
get in the way of future operations as well as can irritate the skin.
But I would hope that we'll get these out without too much problems.
They can, you know, in theory, you can break around them
and you can cause more problems with injuring the bone and taking it out.
But I'm not expecting any, too many,
too much challenges with this case, anyway.
And he should get home today. I mean, he should be up and about.
He might need some crutches for a few clays and he'll be sore
but compared to, you know, breaking your thigh bones,
taking these out is minor stuff.
Colin makes an incision above Brooklyn's knee to extract
the first metal rod.
Ancl scissors now, thanks.
Perfect.
So, we could have the Nancy nail extraction device.
He must carefully extract the rod,
making sure not to damage the soft tissue surrounding the femur.
So, I can see the nail now here.
So, I'm just going to attach this device,
which just acts like a bit of pliers, in all honesty.
Ancl it'll hopefully be coming out shortly on one side.
So, I'll just...
So, this just clamps on to the nail.
That's all right, we're good, actually.
So, I'm going to... This is now, it's starting to come out,
hopefully, he says.
Here you go.
There you go.
It's as long as his femur.
Ancl you'll see it's curved.
It sits inside the bone and stabilises the fracture.
So, you'll see they bounce apart.
Ancl that means that they hold the fracture apart
and stabilise it on the inside, splinting it.
So, there we go. One side clone.
Yeah, good.
Brilliant. Excellent.
So, we'll have a bit of wash and we'll close this side up
and then we'll do the other side.
Dad's been sort of really desperate to have them out.
So, you're not unreasonably just wanting to move on.
With the final rod extracted...
Very good.
...Brooklyn's operation has taken less than an hour.
So, that's a bit of wash.
Let's get it closed and get out of here.
Brooklyn will be taken to Recovery,
where he'll be reunited with his dad Craig.
After three days on the ward, Sheila goes to check on David's recovery.
He's doing all right.
He's in a bit of pain,
but that's not unexpected from such a big operation.
To help him move forward, we want to get him moving,
want to get him up and about.
Ancl I want to check he's got all his lines out, catheter out,
to make it easier for him to get him going a bit quicker.
Sheila has received confirmation that David's tumour WAS cancerous.
But having successfully removed the whole tumour in one piece,
he won't need any further treatment. Hello.
I was coming up to check that you'd had everything taken out.
Catheter's out? Yes, it is. Yeah.
Lines all down? Yeah. Good.
Are you feeling better for it?
Uh-huh. Yes.
And have you managed to get up and about at a“?
Yeah, a little bit, yeah. Good.
Did you want to see a picture of what we took out or not?
Yes, I would, actually, yeah.
So...
So, this is, in the nicest way, your lump. God.
Wow.
So, I actually had that inside me.
Ancl we measured it, and it was over 2kg.
Yeah. So, it's instant weight loss for you as well.
Yeah, gosh.
Yeah.
Can't believe that was inside me.
Now you've got a bit of context... Yes.
...of what our fight was and what you needed out.
Yeah. So, I'll come in and see you tomorrow morning.
If you can manage to get up, walk around the ward,
I think that would be really good. Yeah.
But I have to say, you look like a different man.
Yeah. Good. Yeah. Yeah, I feel much better, actually.
And the pain? The pain is definitely easing.
And, actually, I think you might find, the more you try and
walk, the easier it gets as well. Yes. So, that's your mission.
Your first one was getting out of bed. Big rest.
Your next one is getting up, walking.
Yeah. I'll try. All right, good to see you.
See you later.
I mean, the reason we do surgery is because, ultimately,
we feel we're doing something that makes a difference.
So, when we do an operation and it goes well
and you feel it's gone to plan, it is such a great feeling.
Ancl then when you see the patient afterwards
and they've recovered, it just makes it all worthwhile.
So good to have such good news
that it had all come out very cleanly
and there was no sign of any spread.
Ancl the fact that it hadn't attached to the kidney or the liver, either.
Really didn't want to lose a kidney.
So, you know, that was a huge relief.
Ancl I've just got to start enjoying family life
and getting outside and walking and gardening and, you know,
doing all those nice things with family and friends.
Two days after his operation, Michael's pain has improved.
I mean, at the moment, if I lay and I get a nice,
comfortable position, my legs don't hurt.
Pains where I used to have them aren't there.
So, you know, it's... Hopefully, it'll mean a little bit better life.
I can walk.
Recovery is quite good for Michael.
He's very happy with how he's managing, and we're aiming home.
Just need to get you going again, don't we? Yeah.
Shall we have a little walk back, then? We can. Yeah.
Ryan checks on his other patient, Karl,
who's recovering from his skull surgery.
Hello.
Good afternoon. How do you feel?
Uh, all right, but...
Sore. It's sore, yeah.
Ancl I daren't touch anything, cos... No.
What looks really nice is there's the contour again which is... Yeah.
So, really pleased with how everything's gone.
So, we'll try and get you home.
Yeah. All right. Good. Good stuff. OK.
We'll see you in the clinic. OK? Thank you very much. Bye. Take care.
Well, I'm thinking of becoming a model.
Yeah. I think that, you know,
with this, I've got quite a unique selling point, you know?
It looks better than I thought, to be honest with you.
I'm sort of quite pleased with it.
It's just a self-confidence thing that I won't feel like I'm
different from everyone else.
The most rewarding part of my clay is that feeling,
after an operation that's gone well, and you see a patient wake up
in Recovery, just knowing that you fixed somebody,
you've managed to help somebody, and you've done a good job.
There is no feeling better than that,
and it is just a really rewarding part of my job.
In the children's hospital,
Colin is on his way to update Craig on Brooklyn's operation.
Hi, Craig. You all right?
So, all's gone absolutely per plan. All right?
So, he'll be waking up in Recovery in a bit,
and they'll have you round there before we know it. OK?
No, that's amazing. Thank you. Not at all.
Can't thank you enough, honestly. I know. I mean it.
I really do. Yeah. Thank you.
You've been through so much and, you know,
I don't know how you guys, you know, step forward each clay.
It's him that gives me the strength.
I think the pair of you are doing amazing, to be honest.
Hats off to you. You're doing brilliantly. All right?
Thank you. Um, stay in touch.
If there's any problems at all,
don't hesitate to get in touch with them.
But, you know, he's back to exactly how he should be.
Thank you. All right?
And I mean it from the bottom of my heart.
Thank you. I know. I know. Brilliant. Thank you. All the best.
Thank you. All right.
Hello...
Dad's come over. Yeah. Where is he?
Oh, he's sleeping.
He's absolutely fine. He has woke up. Come over, come over.
Has he? Yeah. Hello there.
Hello. Daddy's here. Brooklyn.
Oh.
You're OK.
He's been absolutely fine. The surgery's gone absolutely fine, OK?
Brooklyn, Daddy's here.
Mm.
Hello.
It's all gone good, hasn't it?
It's all gone really, really good.
OK? We'll move you a bit away from here.
You still tired, eh?
Right, yeah?
How are you feeling?
Good. Yeah?
CRAIG LAUGHS
You are my man, aren't you?
You are. Come here. Don't worry.
I'm going nowhere, mate.
I told you I'd be here, didn't I, eh?
Told you I'd be here.
Coming 'round now, aren't you?
I knew it wouldn't take long.
Ancl what's he going to have to eat, then?
It'll be Macca D's. I knew it. Cheeseburger.
The amount of children that go home after surgery and have a McDonald's.
Ah, but he's got... He has to ask them to put extra gherkin on.
Oh, extra gher...?! Usually they ask them to remove it, don't they?
Extra.
Knowing everything's back to normal with him and knowing he can carry on
doing what he can do, and being how he is, that's...
Makes me feel better.
Now I just want to make sure he's happy
and he's got everything he needs and...
...you know, that he's just safe.
It's all I want.
You're an amazing, man. You know that, don't you?
Some patients affect us more as clinicians.
There's no doubt that that bond becomes bigger.
Ancl in a good way, it affects us.
It's a privilege to be involved in that way.
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