This programme contains scenes of surgery
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, 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 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.
What are you doing? I'm alive!
I'm OK? Yeah, it's all gone fine.
We're happy, aren't we? Yeah!
All right, my darling. See you soon. Yeah. Champion.
Hello, it's recovery, Jubilee wing.
We can start this one late, or we can do a second case in here.
We're not going to be able to do both.
I think the public image of a plastic surgeon
and what the majority of us spend most of our time doing
is very different. Plastic surgery,
we're really interested in the way that things look
and the way things work.
We often get involved with other surgical specialties.
Chris West is one of 17 plastic surgeons at Leeds General Infirmary.
Most specialties in medicine are defined by a particular
organ system or an anatomical part of the body.
Plastic surgery, we get involved in any problem that needs us -
in any tissue, really.
Training alongside Chris is senior fellow Jill Baker.
Plastic surgery can sometimes be misunderstood, I suppose.
People expect breast enhancement, facial surgery.
However, the main part of plastic surgery
is mostly reconstructive surgery.
As well as that, we deal with a lot of different types of cancers
and we would operate to remove the whole tumour.
Chris and Jill are part of a specialist unit
dealing with a rare type of cancer called sarcoma.
This is the first one I saw about 12 months ago.
Yes, I saw that. She's got...fibromatosis.
So it was nowhere near that big when I saw her last time.
So sarcoma is a type of cancer.
It's a cancerous tumour of connective tissue, and particularly
the ones that I deal with are what we call soft tissue sarcomas,
and they tend to arise from things like fat and muscle, er, tendons.
We have connective tissue throughout the body.
Sarcomas themselves can arise anywhere.
It's 8am and Chris has a full list of sarcoma patients
to operate on today.
Hey, how are we doing? Hey!
Jill, if you start the brief in here...
Yeah, we have. Some patients, cool, and then I've got to see
this patient, and I'll come back. Very good. Cool.
Nice one. See you in a bit.
We're going to send for the first. Yeah, perfect. OK.
Chris is also the plastic surgeon on call, which means he must respond
to any emergency cases that come in from across the hospital.
LIFT: Doors open.
It's not unusual to have an elective list, but for there also
to be trauma that's come in,
and you can't always predict how busy it's going to be.
One patient on today's sarcoma list is retired plumber Leslie.
He has a five-centimetre sarcoma in his thigh,
which needs to be removed.
One of them will be with you shortly. Thank you.
Leslie first had his tumour operated on
ten years ago, but routine scans revealed that it has grown back,
so he needs more surgery.
Well, I've been through it before, so...
Apprehensive. You always are, aren't you?
I'm quite lucky, and I've got a lovely family.
I've got two lovely daughters. Grandchildren. They'll be probably
more concerned about it than what I am, because they're left
with the bits and pieces, aren't they?
Morning. Good morning.
How are you? I'm fine, thank you.
The tumour is buried deep in the fatty tissue of the thigh,
close to the bone.
You can see on the scan.
So the white stuff around the outside is the skin.
That black thing in the middle is the femur, the bone running
through the thigh. And then this
thing here, this whitish lump there, is the tumour.
Most lumps that we remove are this size or bigger.
We get worried at anything over five centimetres, but most present
10, 15 centimetres, sometimes more.
Thank you. Thank you.
Hello. Hi. Good morning.
Lovely to meet you. My name's Jill Baker.
I'm one of the senior plastic surgery fellows here.
I work alongside Chris West.
Looking at your scans,
we're removing...I'd say it's a fair-sized lump
we have to take away. The main thing that will be restricting you
will be discomfort. Yeah.
What we do know is these grade-one liposarcomas,
very small chance of any malignant potential. I think Mr West explained
that to you before. Yeah, yeah, yeah. No problem.
All sarcomas are graded.
The lower the grade, the less chance of spread throughout the body,
basically. So a grade-one sarcoma,
we wouldn't expect it to grow in other parts of his body.
May I have a little look, just to mark the area? Yeah. Is that OK?
Big arrow in your leg. I'm going to operate on this one.
Make sure! I have to make sure, yes, of course.
Even if they're grade one, they can sometimes press on nerves,
erm, even vessels at times,
so that's why we would quite often recommend surgery.
Have you any other questions for me? No, no.
It's very.... No, everything's straightforward. Fabulous.
These are the professionals. You do what they say, don't you?
The sooner it gets done,
the sooner I can start the road to recovery, hopefully.
Where do we have to go, then?
The next patient to arrive for sarcoma surgery
is 67-year-old Trevor.
We're down here, I think.
I think it's down here, I think.
His son Sam is bringing him in today
because Trevor has anxiety
and has discharged himself from hospital
on several previous occasions.
This is my son. Can he come with me now?
He can just come but then he'll have to go straight back out. Right.
Right. Thank you. Thanks.
My anxiety is horrendous.
Be brave.
I'm going to have to be, yeah. Calm down, be brave.
I think it was when we walked through the door.
My stress levels, it's... It's coming through my chest.
I think I'd have walked.
Six weeks ago, Trevor had an operation at another hospital
to remove what doctors thought was a cyst on his shin.
But a biopsy showed it was actually a high-grade sarcoma,
and he was referred to the specialist Leeds unit.
He needs another operation to remove any small bits of tumour
that might have been left behind.
The diagnosis of sarcoma is a challenge, partly
because they are rare.
The average GP will probably see about one sarcoma
in their entire career.
All right, good luck.
I'll be brave.
See you tonight. All right. Bye. See you later. Call me later, then.
Bye.
With Trevor's tumour, the type of sarcoma is a grade-two
fibromyxoid sarcoma, which is a challenge to treat.
We know that these fibromyxoid sarcomas often extend
way beyond what you can see or feel as a lump.
There is a chance that this may be life-threatening.
Covid restrictions mean Sam can't wait with Trevor on the ward.
People taking self-discharges, it's relatively common, you know,
and I get it, you know?
I'm used to being in a hospital. It's where I come to work,
and I think I become almost immune to the stress that just coming
to a hospital can invoke in a lot of people.
Ultimately, if they don't want to be there, I can't force them,
and that is their right.
My son's... We're very close.
He didn't want me to do a runner.
He knows I suffer from stress, terrible.
Can't wait for it to be over now, to tell you the truth.
Trevor's tumour is a higher grade, so his operation is more urgent
and the team would like him to go first. But he'll require a
high observation bed after surgery,
and at the moment, none are available.
Leslie, good morning. How are you doing?
Fine, thank you.
As the only beds available are standard ward beds,
Leslie will go first to theatre.
Next thing you know, you'll be waking up, it'll all be done. OK?
Thank you. Just a couple of nice big breaths for me.
Thank you.
How's it going?
Quite hard to find.
Is it? Yeah.
It's in there somewhere.
Jill is leading on Leslie's operation,
with Chris overseeing the surgery.
So this case we're doing now is a low-grade lump,
so we can take just the lump, really, and not much tissue
around the outside.
They're often quite deep down, so it takes a bit of finding.
Go through that bit of muscle there. You'll find it.
You can kind of see it.
There you go. Look, you can see it. Burst through.
Jill separates the tumour from Leslie's thigh and removes it.
Chris has received a call that a patient has arrived in A&E
after falling from a height.
He has a leg fracture that's punctured the skin.
As the surgeon on call, Chris will need to operate
and repair the open wound.
It was an open fracture where the bone sort of broke
through the skin, so it needs to be covered with some soft tissue.
So I'm just going to go and try and find out whether we've got
enough beds or if we need to juggle things around.
And then we need to work out
how we can kind of split our resources today.
Chris's priority now is to deal with the trauma patient,
which means Trevor will have to wait.
Beds are always an issue. You do feel that pressure -
"How am I going to get these cases done?"
John Davies is one of eight orthopaedic surgeons
at Leeds Children's Hospital.
You're almost like a little mouse in a wheel, constantly running.
The wheel is turning.
You're sprinting and running, just to try to keep going.
The orthopaedic department has
one of the longest waiting lists in the trust.
Right, you've got that kid there
and then you've got rather a large one there.
I think this one is...is a really big case. That one has to be done,
hasn't it? Because that one is going to breach.
We're really busy.
I have a lot of complex cases that I need to get done
and, unfortunately, the knock-on effect of that is the more
straightforward, simpler cases have to wait for longer.
Today, John hopes to operate on 13-year-old Ethan, whose tendons
on the back of his legs are so tight
his heels can't reach the ground when he walks.
After struggling with walking for more than a year, he was put
on the surgical waiting list ten weeks ago.
It all started in lockdown, 2020.
He grew really fast in, like, a short space of time.
And then he started to walk on his tiptoes,
but it was months before we really noticed that this was an issue.
I struggle to walk.
I'm in pain constantly.
Right there, on the sole,
and then up to here, and round.
And then, by the end of day, it'll be up here. I'm all tensed up.
We went to the doctors.
It took months to get in at the doctors, I'll be honest,
and then months to get a hospital appointment
on the back of the doctors.
It's been a bit of a fight to get here.
I do feel guilty that these kids are waiting a considerable amount
of time, a very long time to have their operation.
And where we can, we will try to fit these children in where possible.
How are you? Good.
Nice to see you. How are you? You all right?
Can I have a little look at your legs?
Oh, we've got some arrows. OK.
Is it all right if I just see you
do a quick walk in the corridor, actually? Is that OK?
That's brill. OK.
Just a little tiny walk, just down there for me.
Ethan has a condition where he's very high on his forefeet
and he's not able to get his feet flat to the floor.
So, oftentimes, children go through a period of rapid growth,
their bones are getting relatively longer in comparison
to the muscle tendon unit. They will then tighten up,
so you often find that it does have a dramatic effect
in terms of the quality of life of these children.
As we explained, we need to do the operation.
So three small incisions at the back of your calf.
If you imagine here, you've got your calf muscle, which goes
into that big tendon that goes to the heel bone.
So we're going to lengthen it to get your heel flat to the ground.
Obviously, any operation or procedure that we do,
there are risks associated with that.
There's a chance that you can damage a blood vessel or a nerve.
Overall, I think the main thing for you is that you're going to walk
with a comfortable walk, your heels flat to the ground.
OK, Mum? OK.
All right. I'll see you later. Thank you very much. OK.
It's a short but delicate procedure, and John has managed to get Ethan
on today's busy theatre list by fitting him in
before three longer operations.
On that day in particular, there are three urgent-need cases
that need to be done. We need to get on and get Ethan's operation done
as soon as possible because we've only got a certain window of time
to do him, and these other three knee cases are time-critical.
If we miss that window, then unfortunately he'll end up
getting cancelled and sent home.
Ethan and his mum Donna wait to be called for surgery,
but there's a last-minute delay.
They're taken to the admissions ward to wait.
If the operation doesn't start in the next hour,
Ethan will be sent home.
I don't know exactly what's happened.
All I know is that I've been told that we haven't got a bed,
so I just need to go and find out exactly what is the reason
and see if there's anything we can do to try and, you know,
help the situation.
I'm conscious that time is ticking.
Ay-up. Morning, morning!
So... What have you come to see?
I think the fascination with the brain
is that the more that we learn about it, the more we realise
that there's so much more that we don't know.
It's a level of complexity that I think none of us
can really understand.
Kenan Deniz is one of 13 consultant neurosurgeons
at Leeds General Infirmary.
Each surgeon in the team may only have one or two
operating days per week.
So I operate on tumours which tend to be localised in quite difficult
areas to access. They're big operations that take several hours,
such that you may only get one operation done a week.
You do feel like you're unable to make a huge impact
upon your waiting list because
all the while you're recruiting more patients.
Hello.
One of Kenan's specialisms is dealing with tumours that grow
between the ear and the brain, called acoustic neuromas.
An acoustic neuroma is a benign tumour
arising from...usually from the nerve of balance.
And so it's deep, deep to the ear,
and they're pretty rare.
These cases involve accessing the brain from just behind the ear,
so Kenan works alongside ear, nose and throat surgeon Sanjay Verma.
I think neurosurgeons are traditionally viewed as almost
otherworldly beings, and a lot of what they do is quite remarkable.
But I think, personally, I definitely prefer my specialty -
ENT. Myself and Kenan, we did train as junior doctors together
in Cambridge. It's quite supportive to have a colleague there
who you can bounce things off.
Second patient, 60-year-old.
On both sides, her hearing's a little bit reduced.
Kenan is the only neurosurgeon in the trust
who can operate on these tumours.
Surgery for those tumours is very specialised.
You're operating in difficult-to-access, tight spaces.
It's something that I trained additionally for
in order to be able to do.
All right, sweetheart, you'll be fine.
I'll speak to you later anyway.
One of Kenan's acoustic neuroma patients
is 63-year-old charity shop manager Maureen.
Sit there, and somebody will be with you shortly.
OK, thank you.
Her tumour was first discovered 14 years ago, and she was initially
treated with radiation therapy.
But recently it started growing, and now she needs surgery.
Sorry!
THEY LAUGH
Some people, when they have an acoustic neuroma discovered,
it's a tiny thing about the size of a grain of rice.
And when it's small, we don't really do anything about it.
We often just watch it - for at least ten years, maybe longer.
Are you OK if I check your temperature?
Yeah. Have you got your hearing aid in?
No, my hearing aid's on this side.
It may usually grow, a pretty slow rate, maybe a millimetre or two
a year. When they're big, they press on the brain stem and there's a lot
of very important complex structures around that area,
and that can become a real risk to life.
The only treatment that can relieve that pressure
and the compression is to remove the tumour.
Over the last few MRIs, it's grown every time.
The more it grows, the more it presses on different things.
You get different symptoms.
And then I totally lost the hearing in that ear.
My balance has been a lot worse.
I can't walk straight at all.
This is your personal disclaimer.
The surgery to remove Maureen's tumour will involve
11 theatre staff, split between an early and a late shift.
Sanjay will carry out the first part of the operation,
opening up the area behind the ear.
So this is a cross-section of Maureen's head.
You can see there's this white, enhancing, benign growth,
called an acoustic neuroma.
The problem with this is it's of a size that it's pressing
on her brain stem.
So if we were to do nothing, unfortunately, this would eventually
cause compression of the brainstem
and cause some fairly serious problems for her.
An acoustic neuroma surgery is obviously a major surgery.
Getting together two different surgical specialties, and all the
theatre staff involved in that as well, is quite an undertaking.
Given the number of different resources we have to pull together
to make this happen, it's something that you really don't want to cancel
unless you have no other option.
They may be able to go into our recovery area, post-operatively,
so we don't have to wait for definite confirmation of a
high-dependency bed before we can get started.
Maureen, hello. Hello.
How are you? All right, thank you.
Good. All set for today?
I am. Yeah. Good.
The operation is complicated and high-risk.
What I'm going to do, when you're asleep,
I'm going to make an incision behind your ear.
And then I'm going to use a drill to clear the bone from that area.
And that's to allow Mr Deniz to remove the acoustic neuroma. Yeah.
The acoustic neuroma surgery, like with any surgery, comes with risks.
The main risk after the operation is a full facial paralysis,
because the facial nerve is right up against the tumour.
And as the tumour grows,
that facial nerve splays over the tumour surface.
And preservation of that nerve is really quite challenging.
So, obviously, one of the risks of the procedure is that you can
have a weakness of your face afterwards, and that can be either
temporary or permanent if the nerve gets damaged.
Because Mr Deniz is operating around your brain, essentially,
there is a small risk of infection, meningitis.
There is a small risk of a stroke.
Even taking a small pinhead of tumour from someone's brain
can result in a devastating bleed if you happen to catch a vessel,
so that would be a risk to life.
Here's a consent form, then, that outlines what we've discussed.
If you're happy with it, we need you to pop a signature there,
print your name and a date next to it.
OK. OK. Any more questions at all, Maureen,
about today's proceedings?
No. The only thing I want to do is I want to write a quick thing
cos I didn't get to do a will. I mean, I know I'm not going to die.
Oh, gosh. That's a bit, er... No, no, I know I'm not going to die.
I know I'm not going to die,
but I just want to be prepared because no-one ever knows.
Do you know what I mean? It might be my time.
Well, I'll leave that to you, but we'll get into theatres
and we'll get started. All right. OK.
I'm a spiritual healer.
When you come into spiritualism,
it's not about finding a religion as such.
It's about finding yourself, finding that truth within.
You know, I do know that whatever way it goes,
that's my journey and it's my learning that I'm on.
And I accept that.
It's a big, big operation.
For somebody to allow you
to perform that type of surgery, where they've agreed to a risk
to their life with that operation,
erm, it's a huge privilege, really.
One that I struggle to understand sometimes, to be honest.
See you later!
That somebody will put their life literally in your...in your hands.
LIFT: Doors closing.
At Leeds Children's Hospital,
there are 31 patients listed for surgery today.
But due to a shortage of beds, all operations requiring an overnight
stay have been put on pause, including Ethan's.
Yeah, I'm good.
I'm just extremely tired.
Every single minute where that theatre is standing idle,
you know, we could be doing something. If we can try and
have a little chat, and hopefully
make something happen.
John has limited time available to operate on Ethan
at the start of his busy list.
If the theatres aren't reopened in the next 30 minutes,
he'll have to send Ethan home.
Tracey. How are you?
Erm, have we got no beds?
Sorry. Sorry. You carry on. I'll just stand here.
I'll just loiter.
"Loitering with intent" is where you're not trying to interrupt
people and stop them from getting on with their job,
but obviously you are trying to advocate for your patient.
So, at the moment, I've spoken to Sarah Fletcher...
Yeah.
Tracey Garner is a senior sister on the children's admissions ward.
So I'm just waiting on the matron making a decision.
And if they go to theatre, they're all going to need beds,
so 14 day-case admissions and five acutes
isn't going to fit into the ward. No, no.
There are no beds. Oh, right.
Ring Sarah if you want. Yeah, yeah.
Things might have changed in the last five minutes.
Sorry, Tracey. I know, I know you're doing everything that you can.
It's one of them mornings.
It is one of those mornings, isn't it?
Sarah Fletcher is one of the matrons in charge
of the Children's Hospital today.
She's working to free up beds so that theatres can be restarted.
Hi, Sarah, it's John Davies. How are you?
Yeah, yeah. Sarah, I've really got to get this kid done.
OK, I'll just hang fire. OK.
See you in a bit. OK. Bye. Bye. Bye.
Sarah's coming up - the matron in charge of the hospital -
so, hopefully, we can do a bit of arm-twisting.
60%. 60% hopeful.
65, 70%.
If you are met with the answer no,
if you are persistent, sometimes that no can become a yes.
Hey, how are you?
I think it's booked but he's actually a day case
because he would be able to go home later on.
Ethan has been booked as an overnight case, but John
decides to change him to a day case
in the hope that his surgery won't be cancelled.
Sometimes the decision-making that you have is based on
the child in front of you.
And sometimes you can...you get a feeling or you can tell
that if they're kind of bigger and more robust,
he's going to be OK to go home.
So we're just having a look at what we've got, bed-wise. Yeah.
So I've literally just come up to have a look at that.
Right.
I don't know where we are. Tracey's having a look. Yes.
Time is running out for John to fit in Ethan's operation today.
It's 9:20. We should have sent about half an hour ago. Just trying
to make sure that we're utilising the theatre time that we've got.
Let me ask him how long.
How long do you think he's going to be post-op?
I think he'll just be probably three or four hours.
Right. I think potentially, then,
it's going to be about three or four hours,
with what the acutes are going to be this morning...
Let's get on and get him done. Brill.
And then we'll work on everybody else!
Aw! Thanks, Sarah. Thank you. Really appreciate it.
Thank you so much.
Much appreciated. I'll tell them to send, then.
Tell them to send. You're a star.
Thank you so much, Sarah. I might need to do some juggling around.
OK. Really appreciate that. Thank you. See you later.
See you later. Bye.
With the go-ahead from the matron, Ethan can now be sent to theatre.
It's 11am, and plastic surgeon Chris West is meant to be operating
on his sarcoma list.
But the A&E patient with the serious leg wound is still waiting
for urgent reconstructive surgery.
Before he can go ahead with any operations, he'll need to find
the trauma patient a bed.
We are stretched in the NHS for beds. It's always a problem.
Myself and sometimes the team that I work with have to do a bit
of running around and phoning around, just to try and confirm
that we've got the beds. And I will fight as hard as I possibly can
for every single patient.
To secure another bed, Chris speaks to the bed manager.
Hi, it's Chris here, plastics consultant.
There is a patient who's got a nasty open fracture.
I've been to hubs, they're pretty full
and I'm wondering whether or not there's someone we could just do
a swap with or whether there's a spare bed.
Can I give you my mobile number to call me back on?
Meanwhile, Trevor - Chris's sarcoma patient -
is being prepared for surgery.
Keep getting a bit of pain in my chest. That's my anxiety, though.
That's what it is. Oh, OK.
But Trevor is a nervous patient, and is struggling to remain calm
while he waits for his operation.
I've had anxiety for the last 15 or 20 years, off and on, off and on.
Like, they diagnosed me with diazepam.
Right. Have you had any this morning?
A 2mg one at 11:00 last night.
Yeah.
Er, yeah.
So put half of a 2mg tablet of diazepam at 11:00 last night,
just so they know what he's had. All right? Yeah.
We've got to wait on beds, but hopefully you are having it done.
When you're struggling to get beds but you've managed to get an anxious
patient to the point of having an operation, you would worry
that if they didn't get the operation on that particular day,
you may have missed your opportunity to get that operation done at all.
While they wait for an answer on beds, Jill talks Trevor
through the details of the operation.
Hello, hello, sir. How are you?
Hello. I haven't met you before.
No. My name's Jill Baker.
I'm one of the senior plastic surgery fellows here.
Obviously, Chris West has discussed the operation with you.
Did it all come as a bit of a surprise, I presume,
after the original operation? It hit me like a wall.
I have been really bad... Yeah. ..distress and upset.
What I've been so nervous about,
and I haven't slept for a month...
I understand. I've just been, like, dreaming about you cutting my leg
and I've been waking up, "No!"
Mm-hm. I mean, like that.
So, what I was going to ask you,
you're not going to cut to my back leg, are you? Back in here?
We shouldn't need to go to the back, no. No.
So what we'll do - see this red area, here?
Yeah. We'll need to take that away.
Yeah. But we'll also need to take... A bit more.
..a little bit more away.
A lot of these surgeries are very daunting for patients.
Even when we talk to them about it, it's an awful lot to take in.
What we want to ensure that we do today is try our very best to get
it all out. Right.
If I didn't have it done, do you reckon it'd kill me, then?
If we left it, the likelihood is it will come back.
And obviously the concern is that it would come back
and perhaps even go somewhere else. Right.
Well, I'm worried, aren't I?
Between me and you and the gate post,
I've been thinking of not coming at all.
The concern with some of these sarcomas which are slightly
higher grade is that they can spread.
Say if it metastasises to the lungs,
it quite often cannot be operated on.
At some stages, it can spread.
So we have to... That's why we would definitely recommend... Right.
..to get this taken away. Right. Because this, this...
We're doing this with curative intent. Right.
I'll leave it up to you, then. OK, then, Jill.
OK. All right. Thanks. I'll see you shortly.
Bye. Take care.
The operation on the first sarcoma patient, Leslie, has gone smoothly,
so he's sent back to the ward.
But Chris still hasn't found a post-operative bed for the
trauma patient to allow him to carry out his surgery.
His last resort is to see if a consultant from another
department will free one up for him.
Tom, how are you doing, mate? You all right?
I was wondering whether or not someone could make a decision
on whether he can go to the ward, cos if he can go to the ward,
we can pinch that bed.
There's a lot of competition for beds, but there's a real
collaborative spirit within my department, and also within the
hospital itself, to ensure that we get as much work done as we can
in as timely manner as possible.
Awesome. Brilliant. Cheers, Tom. Appreciate it. Bye-bye. Bye.
CLAPS HANDS
We've got a bed.
We've got a bed. Yeah, we know.
Oh, you know! Well, fine, oh... Well, why didn't you tell me, then?
LAUGHTER
You came and told us!
It's good news. So we've got a bed for the trauma patient,
so we can start doing that.
The orthopaedic surgeons have finished their part of it,
which is to put a big sort of circular frame
to stabilise the bones.
It's been... What's that? About an hour and a half, two hours of trying
to sort out beds and the logistics, but we get to operate now,
and that's what I enjoy doing. That's why I'm here today,
so let's go and get started.
Can I shuffle these lights round a bit? Is that all right?
Chris must now carry out the surgery on the trauma patient.
If it takes too long, he could run out of time to operate on Trevor.
13-year-old Ethan is going for surgery
to lengthen the tendons in his legs.
Off to sleep now.
OK, Mum, you can take your mask down and give him a kiss...
Give me a kiss. ..and we'll take his mask off.
Thank you very much. See you soon, Mum.
Do you want to go with Alison? Well done.
INDISTINCT
It's a quick procedure, which maybe is only 10 or 15 minutes to do,
but it makes an immediate effect for that child to have a normal
appearance in terms of walking and your gait.
Can I grab...? 250? Yep.
Can I grab that blade?
I'm just going to quickly mark out the incisions.
So it's just going to be sort of nicks in the tendon
and I'm going to progressively lengthen it.
Try and not to overdo it.
Can you hold the knee for me, Sheila? I certainly can.
Have you got a swab, please, as well? Swab?
Swab. Yep.
Big one. OK. Blade.
A tendon is rather like a rope,
so if we come along and make little nicks in that tendon
and we can then stretch it out, once we put it into a cast,
it will then heal in a longer position.
It's pretty tight, so... It's extremely tight.
There we go.
So we've kind of got to 90 degrees.
So his foot is flat to the ground,
but we don't want to kind of overdo it.
This means he can walk with a normal foot position
and better quality of life, and just able to do the normal things
that other kids are doing, really.
With Ethan's surgery done,
John now hopes to complete the other operations on his list today.
Fantastic. Awesome.
Looks nice. Well done.
Thanks, everybody!
The surgery for Maureen's acoustic neuroma has started on time.
You'll get things in around there, won't you?
Yeah, that should be absolutely fine.
It could go on for around 14 hours.
Ear, nose and throat surgeon Sanjay will have to drill through the skull
behind the ear to provide access to the tumour.
You also have to drill through an area called the labyrinth,
which is a critical structure involved in balance and hearing.
You have to avoid the facial nerve,
the base of the brain, and a large vein called the sigmoid sinus.
So you have to be quite well versed in the anatomy of the ear.
These are facial nerve electrodes that we're using to monitor
the facial nerves. If one gets close to the facial nerve,
they'll make a noise.
But it just gives you some warning that the nerve's close by.
OK. We're going to do the bit now where I'm going to start to drill
through the bone.
DRILL WHIRS
Could you turn up the coagulation a bit, please? Certainly.
In order to be able to gain access to the tumour, you have to remove
the bone from what's called the dura, or the covering of the brain.
That needs to come across a bit more.
Once I've done that, then we're ready for the neurosurgeon
to come along and open up the dura and start removing the tumour.
He's been drilling and getting the access ready for me
since early this morning.
I can't hear any screaming and shouting,
so that must be a good sign!
LAUGHS
OK.
You ready for me, Mr Verma?
You're going to find this a real challenge. As you expected.
Yeah. Very prominent sigmoid sinus. OK.
The facial nerve is actually just here.
It is a priority, really, to preserve that nerve
because a facial nerve injury, which would result in a paralysis
of that side of the face, is a really disfiguring outcome.
So it has all the necessary ingredients to be one
of the more challenging ones.
Can I have the facial nerve stimulator?
It's about here.
They're big operations, they're prolonged operations,
they're complex operations.
Mentally, I've been building up to that operation for days or weeks.
It's over to Mr Deniz to work his magic.
Can I have a number seven?
Kenan's part of the operation is expected to last around eight hours.
And there's the tumour starting to come into view - there, that white
structure there. That's our tumour.
With most tumours like this, you tend to
core the centre of it out so that it collapses in on itself.
And as it collapses in on itself, you can then dissect it away
from the structures that are up against it and next to it.
Scissors, please.
The operations are very long and they can be quite gruelling.
But that said, the time flies past.
Thanks. Number seven, please.
Thank you.
When you're concentrating so hard,
minutes become hours in no time.
I don't tend to stop for a break,
so the team are very mindful of that,
so they'll often bring me a cup of tea or something.
Perfect. Thank you.
That was really good. Thanks, Em.
Really good.
INHALES, COUGHS
That was great.
Good to go.
SIGHS
We're onto brain stem there, and as I put the facial nerve
monitor into there...
There it is. There.
I use a facial nerve stimulator which starts to fire
when I'm touching the tip of that stimulator on the nerve,
so that helps me find the nerve.
The regular beat of the monitor indicates a healthy facial nerve.
That is where the facial nerve is taking off.
MONITOR BEATS
But Kenan now starts the riskier stage of the operation - removing
the parts of tumour stuck directly to the facial nerve.
MONITOR BLARES
When you're trying to remove the tumour, there will inevitably
be some stretching of the nerve, although you try to avoid that.
And you know that the nerve at times isn't particularly happy
because you can hear that on the facial nerve monitor.
MONITOR BLARES
Every time the facial nerve gets irritated or stimulated,
it sends impulses down that the monitor sounds on.
The fact it's groaning as it is at the minute would s...
Because the tumour is so stuck on to that particular part
of the nerve that the efforts to manipulate it off
are causing the nerve to be a little unhappy.
If the nerve gets transected, torn, then you get no noise whatsoever.
MONITOR BLARES
It is very stuck. Very, very stuck.
Any attempts to separate that nerve from the tumour,
by maybe putting some traction on the nerve, always runs the risk
of irreversible damage to the nerve.
Then you have difficult decisions to make.
Do we stop operating at this point, or do we say we need to be more
aggressive in making sure we get every last piece of the tumour?
Every time I have another go and the nerve grumbles like that,
it makes me think perhaps I should be stopping.
MONITOR BLARES
At Leeds Children's Hospital,
John is going to see Ethan's mum Donna after a successful surgery.
Hello.
Hi. Hey.
So it's all done. Oh, God. Everything OK?
Yeah, it's all gone fine.
It's all gone fine. I can breathe now.
HE CHUCKLES
So he's just... Yeah, it's all gone absolutely fine.
We got a good correction, foot's in a good position,
so it's about 90 degrees. That's fantastic.
As I said before, we try and be careful about how much
correction we get. So we don't want to overdo it
so that it kind of loses power.
So it should just be just about with his heels, you know,
flat to the ground. Any questions or...?
No, no, I'm happy.
No, I'm just happy it's done.
Yeah, I'm happy too. Yeah. I'm really grateful to you.
Being able to do an operation that helps a child
at a critical time of their life,
there's nothing better, really, I would say, in terms of
job satisfaction in things you can do as a career.
Relieved!
Just relieved that he's out.
Can you have a stand up?
Can you push yourself up?
And we'll be here.
When you're upright, are you there?
Six hours after the operation,
physios check that Ethan is safe to be discharged.
Bending those knees as much as you can.
Good job! Amazing. Well done.
Well done.
Feels very different.
Let go.
Take a step.
There you go.
INDISTINCT
I'm your anaesthetist.
Oh, pleased to meet you.
In Plastics, Trevor now has a bed confirmed for after his sarcoma
surgery, but he's getting more anxious as the wait continues.
I know if you say, "No, we're not doing it today, you can go home,"
and I went to the pub tonight, I'd be fine.
All being well, we'll get you up.
It shouldn't be too long a wait for you. Oh, right.
We'll look after you. No, you will. Yeah. Thanks very much.
OK. Nice one. Thank you. See you soon. Thank you very much.
Curved micro scissors, please.
Plastic surgeon Chris is still operating on the trauma patient
with the badly wounded leg.
He's already been in theatre for two hours.
Working out where to put your resources at any particular time
is always a challenge. You are busy,
but you try your best for every patient.
OK, that's flap on. 12.39.
Hi, Chris. We're just sending for Trevor.
But before his operation, Trevor wants to speak to him.
Hey, how are we doing? Hello, Mr West.
So you've got my full attention now.
So... I don't want you to take as much off
as what you said on that day.
I know what you're saying, but what we have to do... So that lump there
was cancerous, OK? Yeah. And it was a high-grade cancer.
So we have to make sure that we take away all the scar that's there
and also a little bit of normal tissue... Yeah.
..to make sure we've got it all away. Yeah.
You're not going to take that back muscle, are you?
We're not going to take the muscle, no.
We'll take as much as we think we need to. We won't take any more.
We want to get this away. We want to make sure that the cancer's gone.
So we take as much as we need to, to do that,
and then we borrow the tissue from this side to fill in the hole.
All right? All right, Mr West.
Thank you very much. We'll look after you. We'll look after you.
All right, Mr West. Thank you.
It's not unusual for patients to be anxious.
It's not unusual for people not to want to be there.
Again, part of our role is to try and provide as relaxed
an environment as we possibly can to get them the treatment they need.
And we'll get the tourniquet up on this side, please. 300.
Yeah.
These high-grade tumours, about 50% of them will spread elsewhere,
usually to the lungs, and that's kind of a terminal diagnosis.
So, ultimately, if he had no surgery and no treatment,
it's quite likely that eventually this disease would kill him.
You have a look, you see where the scar is.
You look for changes in the skin, and then you just go
as wide as you can until you feel like you've got normal tissue.
Chris will take out a 16cm-long section of tissue from Trevor's
calf in the hope that all the cancer cells will be removed.
We're going to peel all this tissue off, take the top layer of the bone
off here, and then keep peeling off that way.
So, hopefully, all this tumour comes off in one big block.
I can't see any tumour, you know, around the edges or in the middle.
So, to the best of my ability, you know, it's away, and then we send
it off to the lab and hopefully they can confirm that.
Only when we look under the microscope do we know
that actually that tumour went a lot further than you first
might have thought from looking at the scans or indeed feeling it.
And so taking that wider cuff of normal tissue allows us to try
and make sure that it doesn't come back.
Jill will now need to take tissue from the thigh on Trevor's other leg
so it can be transplanted over to where the tumour used to be.
Do we still have the template?
So, next thing we have to do is actually mark out exactly how much
tissue we need, which I believe to be this much.
Yeah. So, as you can see, we've taken an ellipse of tissue
and we've taken it with its own blood supply.
And then we'll take it off, give it to Chris down the bottom.
He will fit the blood vessels together.
You ready? Yeah.
It's very much time-critical.
We're stitching the arteries together.
Muscle doesn't survive very long without a blood supply.
Once you've disconnected it from one part of the body, you really do
want to get it reconnected and get that blood supply
re-established quite quickly.
If you can't connect it, then that tissue will die.
Flap on at 5.20. So there's blood getting in and out of it,
so when you press it, it should go white and the colour should come
back, and you can see that's exactly what's happening. It's white,
and the colour comes back.
Cool. Thanks, everybody. Thanks a lot.
MONITOR BEATS STEADILY
The operation to remove Maureen's tumour is still
in its most crucial stage.
It is very stuck to the brainstem, much more than you would expect.
Neurosurgeon Kenan is struggling to remove the last pieces of tumour
from her facial nerve without damaging it.
I'm not overly keen to take very much more of that because
we're talking millimetres here,
and I think whether I leave two millimetres or three millimetres
isn't really going to impact upon her.
There's a very thin rind of tumour on the nerve,
but the vast majority of the tumour is out.
We have a good nerve.
Concerned he could damage the nerve,
Kenan decides to leave some of the tumour intact.
So I think we...we accept that,
erm, and we start planning our exit.
Wash, please.
There are non-surgical options, like radiation treatment,
that can stop that small piece where it is
and prevent it from further growth.
It also looks nice and dry, which is really important.
Justin, are you going to challenge us?
Kenan asks the anaesthetist Justin to challenge him,
which means increasing Maureen's blood pressure.
This is to help him see if there are any undetected bleeds
in the blood vessels, which could be fatal.
I asked Justin for a challenge, because obviously when she's
waking up, her blood pressure will surge.
So there's no point being happy that it's dry when her
blood pressure's nice and low under anaesthetic.
So he gives us a surge to try to mimic what might happen
when she starts to wake.
Raising the blood pressure intensifies the flow of blood
in the vessels so any potential bleeds can be seen.
We don't normally have this, do we, Sanjay?
It's annoying.
With the blood pressure raised, Kenan has identified
she has a bleeding vessel.
The problem we have, Sanjay, is we've got a bleeder
and it's...and it's...it's somewhere we can't reach.
It's not what you need at the end of a long operation.
We can't really afford to leave that. If it doesn't stop
and she collects a big clot,
then she'd need an emergency operation.
Oh, for God's sake!
It's just annoying me now.
I want to be done with this.
A bit of wash in there.
Kenan inserts a mesh-like fabric into the surgical site.
This contains clotting agents that seek out ruptured blood vessels
to stem the bleeding.
It's one of the most important parts of my job, is being able to deal
with unexpected events and to be able to work under pressure.
Yep. You've got it.
That wasn't going to stop, I don't think.
HE SIGHS
Right. OK, that's good. OK.
Can you squeeze my hand if you can hear me, Maureen?
Wiggle your toes for us.
Fantastic! Yay!
Excellent.
Kenan has succeeded in avoiding permanent damage
to Maureen's facial nerve,
but it's likely she'll have some temporary damage.
Only when she wakes up will they know exactly
how she's been affected.
Five days after the operations on his sarcoma patients,
Chris is checking on their progress.
First he goes to see Trevor.
Good morning. How are you? Hello.
Are you doing well? Oh, you're Mr West.
I am, yeah. I am. I recognised your eyes straight away.
There we go.
LAUGHS
How are you doing? I believe I'm doing really well.
Well, everyone tells me you're doing really well.
I'm sorry I were panicking that bad. Not at all. I had to see you,
didn't I? You did. Listen, it's understandable.
It's a big operation that you went through.
You know, stressful situation. You know, lots of things happened
in the last few weeks.
There's lots of work that has to go on to make sure that they get
through that first 24, 48-hour post-operative period. To be able
to sit a patient down afterwards and say that the surgical plan
went well and the tumour is gone and that hopefully
is it gone forever, that's really satisfying.
I just heard this morning - I didn't know - that you made a special
effort or summat to get me an ICU bed or something.
He...he... One of your consultants said there were no bed for me
or summat. You made... You managed to find...
I didn't know anything about it.
I was on cloud nine for a couple of days.
We had to do a bit of juggling around. Thanks. But no, that's fine.
That's what we're here to do.
We had a number of patients that it was important we operated on
that day, and you were top of my list, so we just had to stand
your ground and dig your heels in.
There were challenges in getting Trevor to theatre.
Probably more challenges than we have on average
because of the type of surgery he was having and the complexity
of the care that he needed afterwards. That's our job.
Everybody's looked after me like God.
I've got a great team around me. Yeah, yeah. I'm very lucky.
Yeah, it really did. It's fantastic.
All right. Really good.
Well, it's a pleasure. Thank you, Mr West.
Pleasure. See you soon. Thank you.
Where's Leslie?
My man, how are you doing?
All right. So how are we doing?
You've still got the drain in, so... Still got the drain in. Yes.
That's going down as it should do. Good.
And obviously you've been up and about, mobilising, which is great.
Once the drain's out, that's you out of here
if you feel well enough, so, good stuff. I'll only go home and
start doing things like washing up. Oh.
Just stay here, then. Stay here!
You've done really well. You're done really well.
Thanks, Mr West. All right.
It's nearly a week since Maureen's operation, and John - a friend
from her spiritualist church - has come to give her some healing.
So what I'm going to do is put my hand on Maureen's shoulder,
and her wrist, just gently.
Maureen's going to relax and I'm just going to
whittle myself down and just allow the healing energies
to come through to Maureen.
Maureen does have a temporary facial paralysis on her right side.
You're looking great, aren't you?
I am. Absolutely great.
My face, I have a bit of a crooked smile.
I've decided we need to...
..we need to make a new emoji.
We need an emoji with a crooked smile.
HE LAUGHS
Because of the manipulation of the nerve that would
have inevitably have taken place during the surgery,
patients do wake up with a full facial palsy,
more often than not. This will recover, but it will take several
weeks, months, maybe up to a year, maybe longer.
I have got some drooping.
It's going to take time.
I've got speech and language therapists
that will be working with me.
Just have to take each day as it comes, really.
To save that facial nerve is amazing.
By removing the tumour and relieving the life-threatening
compression upon the brain, I would hope that she will have a full life
expectancy, and that's the best situation, really.
For Trevor, it's finally time to go home.
Often patients that come to me are, you know, in real states of distress
because of their recent diagnosis.
And to be a part of a team that can hopefully treat them
and take them through what is a really challenging part
of their life is really nice.
I have huge admiration for my patients when I see what they
go through and how they deal with it.
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