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've 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 to 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.
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, Take Heart Suite, can I help?
I've got a patient in here, waiting to go to theatre.
I love cardiac surgery because the amazing thing
about the heart is that it is an ingenious piece of engineering.
And despite what we do to it as cardiac surgeons,
once you recover the heart from the operation and allow it to have blood
going back into it, it wakes up again
often as if nothing has happened to it.
Betsy Evans is one of six consultant cardiac surgeons
at Leeds General Infirmary.
She's fine, so she's on a bit of NORAD.
Who's looking after her?
Are you, Carol? Yeah. Good.
What gets me up and out of bed, ready to work in the morning,
it has to be the surgery.
It's a feeling of great joy, seeing patients, how their life
has been transformed by the procedures
that we're able to perform.
Many patients on Betsy's waiting list are at such risk of further
heart attacks that they must remain in hospital until surgery.
Andy is one of seven in-patients on the ward.
After a recent heart attack,
a scan revealed he has a hereditary heart condition
and needs an urgent triple bypass.
Hello. Morning!
Should have this operation tomorrow.
Second on the list.
Waited a long time.
I had a very, very minor warning.
It was a breathing complication and it built up over seven clays.
I had no pain.
No symptoms of any heart attack at all.
None. Nothing.
Just a brief, uncomfortable breathing.
Ancl then, came in,
and then they told me, "Oh, you've had a heart attack."
And I was like, "No!" Then I got admitted.
Have you signed a consent form yet? Yes, all clone.
As soon as I saw the guy coming, the consent form, I was like...
He's an in-patient on Ward 16, type two diabetes.
He's just 49.
So he'll need three bypass grafts, OK?
So there are three vessels that have got narrowed routes
and therefore you haven't got enough blood going to that particular bit
in your body, which is your heart muscle.
If a patient warrants triple bypass surgery, they've basically reached
the last point in the treatment line, if you like,
for ischemic heart disease.
So it's major.
It's my mum.
Hiya, Mum. How you doing? You OK?
Got my family around me.
My daughter, her mother, my mum, my clad,
brother, sister.
So I've got people to go home to,
to look after me and, you know, take care of me.
So...
Really lucky there.
Andy has a diabetic condition that affects the nerves
around his heart, which meant he had no pain
during his heart attack.
The sort of pain that you'd typically describe
with a heart attack doesn't always occur in diabetic patients,
and they can have what we call silent heart attacks.
They're not aware of the classic symptom of central,
crushing chest pain.
They could drop dead.
From all the scans they've clone since,
to find out the condition and what it's in,
you know, it's been extremely lucky to have that minor blip
which has shown it up.
16,17,18,19.
Patients who aren't at immediate risk of another heart attack
are able to wait at home until they're called in for surgery.
I'm going to ask this guy over here to find out where I need to go.
65-year-old Sandra is currently Betsy's longest waiting patient,
having been on her list for almost eight months.
She needs an operation to replace a valve and has been allocated
the first slot on tomorrow's surgery list.
Come in, don't be scared.
All right.
I've got my room now.
I'll just press the bell when I want someone.
I think you press these, don't you, this one.
Bing, hing: hing"
Sandra was diagnosed with mixed mitral valve disease
after starting to suffer symptoms a year ago.
Breathlessness and it was just hard doing tasks,
walking, making your bed and things like that.
It's just so tiring.
I can only walk like, 20, 30 metres
and then I have to stop.
So it's led to here.
They're going to fix me, aren't they?
Hopefully.
Her heart valve that we're operating on is the mitral valve,
which you can see with colour flow across it.
This colour flow is because the valve is abnormal.
She's got what we call a regurgitant valve.
It's leaking as well as it doesn't open properly.
So it's stenotic as well.
So it's what we call mixed mitral valve disease.
So what I'm going to do is take away the diseased valve and then replace
the valve leaflets with a new valve.
So, symptoms can be extremely debilitating.
If Sandra doesn't have an operation, the risk is that the heart function
can start to deteriorate
because blood is in the abnormal position at each heartbeat.
So this valve then has to be adjusted in order for the patient
to have a good quality of life and for life survival.
That feel all right? Yeah, yeah. Champion.
Just relax.
I'd just be happy if I can take my dog out for a nice, long walk,
up onto the tops, see all the scenery, and just get back
to my normal life.
Ancl hopefully I will do.
Do you want to see him?
There we go.
My little boy, Benji.
I lived with my husband, but I lost him two years ago.
Ancl I thought, "I can't do this on my own."
So I went and bought Benji, and he's made it a lot better.
It's hard.
I miss him.
I didn't want to leave him today.
No, I didn't.
He'll be able to walk a lot further, won't he?
It'll make life a lot better.
You can sit back down if you're ready, thank you.
Can I have a badge?
Yeah, you can have all the badges you like! Or a sticker!
Both of Betsy's patients, Sandra and Andy,
must wait on the ward in the hope that tomorrow,
they both get intensive care beds so their surgery can go ahead.
When patients are admitted to hospital for an operation,
that's the sort of first hurdle in their journey.
But getting the date isn't the end.
Everybody finishes their operation on a breathing machine,
a ventilator.
So we can't proceed without intensive care.
One of the things that's nice about surgery is the difference
is almost immediate.
It's not gradual.
It doesn't occur over a year or two.
I can't imagine not operating and not having that wonderful moment
where you dive into the human body and make something right.
That's just magical.
So, I love it.
Professor Simon Kay is part of a team of 17 plastic surgeons
at Leeds General Infirmary.
A world-renowned hand specialist,
he works with both adults and children.
Children are a joy to operate on, they heal quickly.
They get over things. They adapt immediately.
But it's a big responsibility
when a parent hands their child over to us.
It's a big thing.
Actually, we start to take responsibility of that child
the first time we meet them.
If I can just give you both a mask.
16-year-old Caitlin has been waiting for an operation on her hand
for more than seven months.
She was born with a rare and incurable joint condition
ca lled a rth rog rypos is.
Occurring in just one in 3,000 births,
it particularly affects Caitlin's left arm.
Arthrogryposis is a Greek word, meaning bent joints, basically.
It's a cover all because the causes
of the condition may be many and lead to muscles being weak
in some groups or wrongly attached
or anatomically different.
When she was a baby,
it was just like, just simple things, like, she couldn't crawl,
so she missed out on things like that.
It affects like, doing your everyday tasks
and I can't really do my hair.
Can't cut up food.
Can't find my back, really.
Just hurts my joints.
When I look at other people,
I think. "Oh, I wish I could do that," but I can't.
So we've just got some questions, all right?
Simon first operated on Caitlin eight years ago
and while there is no cure, treatment can improve
symptoms and movement.
There's no magic bullet, no magic drug, no magic injection.
She's had a number of operations, including muscle transplants
and realignments of muscles.
She's had an improvement in function.
And now we're going to address the fact that the middle two fingers
are bent on her wrist and we're going to try
and straighten them for her.
They're going to loosen up my, like, tendons
and that, but in my fingers to work and, like...
Grab? Grab stuff.
Ancl a bit more function. Yeah, so it's not feeling tight.
I'll come around this side, Caitlin.
Then I can see you better.
How are you?
A few things have changed since I last saw you.
I see your hair and your eyelashes.
Let's have a look at this hand, sweetheart.
Roll over.
OK.
So we're just releasing these fingers to come more straight.
Yeah?
She'll have an improved posture of the hand, improved appearance.
It'll make a big difference the way she perceives her hand.
You're still hiding it.
She just covers herself up all the time.
Do you? It could be 30 degrees outside, she'd wear a jumper.
Right.
Ancl is that getting worse?
As she's getting older.
Is it?
All differences in children growing up are a burden
and they're particularly difficult when you become self aware.
Ancl then when you start to compare yourself to others.
So that's bound to be an issue for Caitlin with her peer group.
Obviously, getting bullied,
it's changed my behaviour.
I feel well lonely, it genuinely did make me feel, like,
I didn't want to go in school at one point and I was scared
to tell my mum and dad.
People are cruel, aren't they?
I'm going to get upset.
They're just cruel.
So...
I do relate to Caitlin.
You know, in my own case, I was bullied at school a lot
about my hand.
I became a hand surgeon because I had a hand injury
as a child.
I had a bad hand burn and I was burnt on the palm of the hand.
Ancl my parents took me to great experts who went to quite
considerable lengths and did quite considerably complex surgery
to preserve part of my hand and little finger.
And that was at the age of about five.
I am empathetic to my patients
and I think it's made me a different doctor, I'm sure.
A little dressing on the hand for a week, ten clays.
Is that OK?
Do you want to ask me anything?
OK.
As Caitlin waits on the ward, her surgery isn't guaranteed
until she gets the call to theatre.
We came in last week.
We were all ready to, well, ready to go down.
And then, unfortunately, it did get cancel led.
It does have an effect when it's cancel led.
It really does.
I do sometimes have to cancel patients.
The most common reason for that is there is no bed
and I feel quite strongly about that, actually.
The purpose of the hospital is to bring me and the patient
together in a safe environment for me to help them.
It can be very difficult, even if the patient is in hospital,
to get them to theatre promptly or to get them treated at all.
Cardiac surgeon Betsy has two planned operations on today's list.
On an operating clay,
ideally we'd just want to be going to theatre to do a procedure
that was listed.
But inevitably there's challenges.
We have to ensure that there is a bed for these patients
to decant from the operating theatre into.
One patient is Andy, who's been waiting
four weeks for a triple heart bypass.
He also has bipolar disorder.
So the delay has been an added challenge for his mental health.
I suffer from bipolar.
Ancl eight years ago, it destroyed my health, my mental health.
And I just didn't cope and I ended up having a breakdown
at the end of it.
I just, just got in a mess.
To be honest with you, it's scary.
It's scary seeing the juggling that they're doing with the ward.
It's just an eye opener.
Everything I've gone through, my family,
I can't let this hold me back.
I have to be better.
Ancl I will be better from this.
Return to work,
have some health and fitness back and enjoy my time.
Andy has the second slot on Betsy's list today, as Sandra will go first.
She's waited eight months for her valve replacement
and has already been cancel led once before.
All right? Yeah.
So, we're all set, hopefully.
You got a bit further this time.
Yeah. Got the bed.
Have you got any questions for me, just before we...
It is what it is, isn't it? It is what it is, yes.
All right? Yeah. Thank you. All right.
See you in a bit, then. Yes.
Ideally, patients should not have to wait more than about
three months for heart surgery.
So even saying that they are stable on a waiting list
is quite uncomfortable.
Nine months is pushing it because they're waiting
in an uncontrolled environment, really in their home.
An intensive care bed and nurse has been secured.
Sandra's surgery has been given the go ahead.
It's lovely, that blanket.
My name's Henry, I'm part of the an aesthetic team, we'll get going.
OK? Yeah.
We'll just start by getting some cannulas and an arterial line
in your left arm, OK? Yeah, champion.
The mitral valve sits in the middle of the left side of the heart,
and it controls the blood flow through that side of the heart.
In order to perform a mitral valve replacement operation,
you need to have access to the heart.
So usually the route for this is through the mid line,
through the sternotomy, which is the sternum.
DRILL WHIRS
Back on.
So now, we're just getting things ready to go
on the heart-lung machine.
This key piece of equipment will keep Sandra alive while Betsy
stops her heart for surgery.
So what we say is that full flow means that the whole
of the circulation is being managed, effectively,
by the heart-lung machine.
So we're on full flow.
Yeah.
Good. Right, flat line.
Just remind me at 20 minutes, please, john. Yes, will do.
It is amazing that the body will tolerate its entire circulation
going through a machine and, sitting at the end of the bed the next clay,
the patient seems to be totally normal.
It is quite phenomenal the tolerance of the human body.
With Sandra's heart stopped, Betsy now needs to remove the damaged
mitral valve, located deep at the back of the heart.
There.
So that's just coming out now, the anterior bit,
to make room for the new valve.
So that's that. Highly abnormal.
After removing the damaged valve, Betsy is ready to fit
the new carbon replacement.
The sutures that are down there are orientating where the valve
will sit, and it's got, like, what we call a sewing ring
on this valve, which is this white felt bit that I can put sutures in.
OK. Should slide down now.
There we go.
Relax.
Permanently altering the heart doesn't come without risks.
In changing the structure of the heart by putting a new valve in,
there's an area between the atrium and the ventricle, where
the valve sits.
Ancl in some patients, this can be weakened by the replacement.
Ancl the riskiest part is that that bit can be weakened
to a point where it can separate.
So that's the dread of mitral valve surgery.
And, in fact, we don't talk about it when we're in theatre.
Now we have to tie it in.
So each stitch needs to be untied.
If this situation does happen, where the atria and the ventricle
separate, it's almost irretrievable.
Patients die.
OK.
Betsy successfully secures the new valve into position.
Volume away. Lungs off.
Flow right down.
Next, she needs to restart Sandra's heart.
So, we'll just give it a chance to get used to its own blood now
going into the coronary circulation.
So it will wake up in a minute.
The team must wait to see if the heart responds and the surgery
has been a success.
Just give it time, basically.
Starting to wake up.
Wiggly line, as opposed to a flat line.
Ancl then it'll start beating, hopefully.
78 minutes.
Starting to beat.
The riskiest part of the operation is over.
The structure of the heart has remained intact,
and it's now beating independently.
Are you happy with the valve, yeah? Yes. Good.
OK. Two dry swabs.
I'm happy she's had a nice placement, and the heart's
responding well to it.
After three hours, Sandra's surgery is nearly finished.
Om Right.
Have we heard anything about the situation for the next patient?
0|<. Right.
Andy has been waiting on the ward all morning for the call
to go to theatre.
We normally know about 11.30 whether there's a yes
to the second patient's bed...in ICU. We'll proceed automatically.
It hasn't?
INAUDIBLE
Right. So that's bad news. I'm going to have to go and see him,
and I think it's... I think it's a confirmed no.
I assume it's that there's no staff in ICU.
Yeah. It's been made at a higher level than critical care.
OK. Now we're stopped.
This is the most frustrating bit of my job, basically. To be prepared
to perform an operation on somebody and then to not be able to progress
with that plan is extremely frustrating and demoralising
to the team as well.
The staffing issue in intensive care means that Andy's operation
has been cancel led.
That's... It's rubbish, isn't it? But I can't help it, unfortunately.
No, you can't. It could be worse.
It could be sort of a bit longer. I understand.
Sol hope... I hope that on Friday morning we'll be not
having this conversation at all.
I really do understand. Your hands are tied.
OK. Thank you so much. No problem.
Obviously disappointed. Not with any of the staff.
But it's just disappointing not getting a surgery today,
because I've had such a good clay, mentally prepared for it,
and I'm just relaxed. it just couldn't be better,
but it's that thing
where now, it's like, "Oh, I better unpack my bags," you know?
Ancl just fingers crossed for Friday.
I think people really do get anxious because they've prepared themselves
for their operation.
So, at the last minute, to be informed that that's not going to
proceed is devastating.
So the patient on the ward is going first, and then the lady
on bay one is second.
Ancl then when the other 7.00 comes in, she is going third.
I've always really liked orthopaedic surgery.
It's a very practical discipline.
I've always liked using my hands to build things -
I've done so since I was a child - and ultimately decided
to be a doctor.
Ancl once I made that decision, I never really looked back.
Hi, C3. Trevor Wilson...
joe Aderinto is one of 15 orthopaedic surgeons
at Chapel Allerton Hospital, part of the Leeds Trust.
He specialises in joint replacements.
What I really love about hip and knee replacement surgery
is that from beginning to end of the operation, you change the
joint that's worn out and isn't functioning to one
that functions, hopefully, normally.
So you get almost immediate results.
On Joe's operating list today is 70-year-old jean.
She's been waiting for a new hip for the last five months
after being diagnosed with severe arthritis.
I hope it's got an en-suite.
It started last year when I went to the doctor's
because I couldn't walk. I was like a tin woman.
And they sent me for X-rays.
Ancl when I went for the X-rays, they said I'd got series four,
I think, arthritis.
So there's nothing much more they could do for me but operate.
I'm not really bothered. Any one. Yeah, this is fine.
Osteoarthritis is the most common joint disease worldwide,
with more than 8.5 million sufferers in the UK.
Physically, it doesn't look like there's
anything wrong with me, except I do limp.
But if I'm working around the house, or if I walk, anything, by the end
of the night, I'm in severe pain.
Arthritis can be a real problem for many of my patients.
It can also have a psychological effect.
Thank you very much indeed.
Pain is unpleasant.
Disability is unpleasant.
Waking up every clay in pain, unable to do the things
that we would normally do.
I really see it as my responsibility to treat those patients, to get rid
of the pain that they're suffering and improve their mobility
and quality of life.
Can I just check your blood pressure? Is that OK?
Yeah. Have you got any allergies?
No. No? No.
Jean has one daughter and used to work in admin, but has been
caring for her mother for the last 18 months.
My mother is 94 and, bless her, she can't walk because she's
got arthritis in her knees.
I'm 70, and I class myself as a young 70, and I'd like to be able
to do the things that I couldn't do before.
I have the best group of friends.
We usually go for a coffee, and they'll probably go for a walk
around the park.
I can't go because I can only walk so fast.
I feel as if I'm hampering them.
Although they keep saying to me, "|t don't matter."
But I'm sure it does.
So I'm hoping the hip is going to help me get back
to have a better life.
So you can see both of the hips on this X-ray, and we're doing
the right one.
There is normally a space between the ball and the socket,
but it's completely gone.
You've got bone literally rubbing on bone, because the normal, smooth
white cartilage has been completely worn away to nothing, essentially.
As a result of that,
the hip becomes very, very stiff and uncomfortable.
Ancl that obviously causes pain and difficulty walking.
Jean's already had one last-minute cancellation due to ill health.
I should have come on the 31st of March, but unfortunately I got
Covid, and so then they've postponed it
and I managed to get it for today.
So I'm hoping nothing else goes wrong.
Could I have a look at that, that sheet there, to see
where...? You're in bay one.
OK, that's great. Thank you.
Hi there. How are you? I'm fine, thank you. How are you? OK.
Excellent. Thanks for asking.
So, obviously, we cancel led your operation a few weeks ago,
didn't we, because you had Covid? Yeah.
So have you recovered from that OK? I have, yeah.
So we're doing your right hip, as you know. We talked about that in some detail.
Yeah. Previously. Any questions?
No, I'm fine. Nervous, but fine.
OK. I'm in your hands. You'll be absolutely fine. OK.
All right. OK. I'll see you later. OK. Bye. Thank you.
If I was to get cancel led today, I'd be disappointed, but hopefully
they'll get me in.
Joe has nine and a half hours of theatre time today, but with jean
and two other cases on his list, it's important he gets the go-ahead
to start surgery as soon as possible.
Who sent for Caitlin?
I haven't evaluated.
She might be better prone, because her arm is very twisted.
OK.
Simon and his team have been given the go ahead to operate on
16-year-old Caitlin's hand.
Why don't we get her now in case? Yeah.
Do you like the way I'm thinking?
Perfect. Stick that in place for you.
You rest your hand down there for me for a second.
Are you feeling OK? Yeah?
Have they always just been known as Teddy? Yeah.
I mean, it's a strong name, to be fair.
There's no point complicating things. Yeah.
Sometimes a little bit cold on the back of your arm, OK?
You'll be asleep within seconds. That's normal.
Think of somewhere nice. We'll take very good care of you, OK?
It is hard. It upsets me a lot.
Every time I come to hospital, I'm always in tears
because it just...
I just wish that it didn't affect her, you know, but
it's life. It's how things are.
And we've been dealt those cards and we get on with it as best
6S we can.
For a minor operation, Caitlin's had to wait more than eight months,
much longer than more critical cases.
I feel once something's no longer life-threatening,
it's difficult to say,
"I think this surgery is more urgent or less urgent."
Obviously, if you're curing a cancer or preventing a bowel
obstruction or returning somebody to work, there are social arguments.
But if you're restoring self-esteem, or even actually just treating
somebody, so you don't even have to focus on the outcome,
you focus on the care, then that has its own effect.
Ancl I think it's very difficult to say one example is worth
more, or more urgent than another.
In theatre, Simon and colleague Ibrahim must carefully plan
where to make the incision.
Where would you release it?
The main tightness is just along there.
The tightness in Caitlin's hand is caused by both the skin
on her palm and the fibrous tissue - or gristle structure - beneath it.
While skin can stretch over time, the gristle is inflexible
and must be cut in order to release her bent fingers.
That will also address her pseudosyndactyly.
It will push the web space back.
The hand is absolutely full, crammed full of clockwork
that you mustn't damage.
It's a technique that has to be learnt and requires meticulous
attention to detail.
I don't know if this will work. Let's try it.
Let's have a suture. Do you want to take me a skin graft?
As part of the surgery,
the team also need to take a piece of skin from Caitlin's upper arm.
So what we're doing here is two fingers.
We've... We haven't got enough skin.
So we've released the skin.
Which is demonstrating how much is missing.
Thank you.
She's posturally had a flexed hand, and the skin is therefore short
because skin doesn't...
As you grow, the skin doesn't grow with you if you don't straighten.
So now Rob's kindly raised a skin graft for us,
the donor site, which he's just closing. Can I have the graft?
That transplanted skin has only 48 to...
...72 hours to take. That is to survive.
Ancl in that time, it has to gain nourishment from the wound bed
and have new microscopic vessels grow into it.
The wound bed has this miraculous process where every microscopic
vessel starts budding out and looking for other vessels
to join up with.
Ancl they go "plonk", join up to it, and then blood starts to flow.
Ancl if that's not a miracle, what is?
Ancl if you look at a skin graft as it's healing, it's deathly white.
Ancl within 48 hours, it's pink, as the blood starts to flow.
Astounding phenomenon.
Once Simon aligns the skin with the gap on Caitlin's fingers,
he hands over to his team to finish.
Right, if you do that, Bobby, I'll go and see next case.
Yeah. So we can just crack straight on.
Thanks.
Two days after Andy's cancellation, Betsy is on her way to the cardiac
ward to prepare for a full day of theatre.
So, hopefully do a briefing with the patient already
in the an aesthetic room.
There are concerns that any further cancellations might affect Andy's
bipolar condition, as he continues to wait for news that his surgery
will go ahead. Yeah, of course, yeah.
If I'm focused on one thing, life is easier.
If that makes sense. It's when too much comes in,
then I start to struggle.
I know that the team has got to get bodies through. The Ward's full.
You know, there's people queueing up to get in.
So they've got to get operations clone.
Betsy has a second in-patient booked for this afternoon.
She and the team are once again waiting for the go-ahead
from intensive care.
Good morning, Lucy speaking.
Hi.
Yeah.
Oh, wow.
Bye.
That was the ICU.
Every bed space needs a nurse, and at the moment, they're down,
apparently, eight nurses.
So it's going to be a tight squeeze to find anybody.
When I'm arriving for an operating clay, you get a feeling,
as you're walking down the corridor, how people are.
Have we heard anything? No. Oh! Absolutely nothing.
You know, if the heads are held high, that means that we've got
the beds and we've proceeded with sending for the patient.
As Betsy arrives at the an aesthetic room outside her theatre,
there is news about bed availability.
There's no patient here. No.
Oh! Oh, Sarah. They're on hold.
These patients are already in hospital, so they're not
going anywhere without an operation.
So it just logjams everything,
if we can't get the go-ahead to start with these.
With staff shortages and no ward beds available to transfer improving
patients out of intensive care,
Betsy joins a video call with teams across the city
to discuss the situation.
We need to try and move them, don't we?
So how's that going to be improved on then, James,
if we've got eight nurses short?
It's almost an impossible task, isn't it?
Oh! Lots of crosses.
Oh, clear.
OK. Right. Well, I think we're clone, then.
Bye-bye.
Oh.
OK.
SHE CHUCKLES
Oh. Fed up.
This is worst-case scenario, where we are now.
Because I don't think we can match it up. When it's sort of that number
of nurses short,
I'm not sure they can magic up some sort of solution to that.
That's the issue.
Ultimately, if you haven't got staff to staff your facility,
you really are scuppered.
Intensive care is impacted at the moment
because it's been highly utilised in the recent
past with regards to Covid.
So there's been a major requirement for intensive care beds.
There's been a loss of staff because of the workload
that they've been put through.
In addition, the nurses that perform the role in intensive care
have been specially trained to perform that role.
So there's not usually an excessive pool of nurses that can step
in to meet the need of staff shortages.
Unable to operate, Betsy has no choice but to cancel everyone
on her list, including Andy.
I didn't actually think it would come to this extent of cancellation.
I thought we'd be able to do it in one place.
100% cancellation is pretty grim.
As a surgeon, your safe and great place of work
is the operating room. I think that's fair to say.
That's why we become surgeons.
So it is terrible to not perform your operations.
Andy's been waiting in hospital for four weeks for urgent surgery,
and has now been cancel led for a second time.
You know, then, basically? And, unfortunately, I really didn't
anticipate this for today.
We are stretched.
And, unfortunately, Andrew, today is playing out in a negative
way for you. I was thinking. "Yes! Because I'm first...
I know. "..the delay won't be long."
No, thank you. I know you are holding out and you're all sat
waiting and waiting. Yeah.
So what will happen now is next week, the next available slot
will become yours, all right? OK. OK.
Thank you. Sorry. I hope you have a good weekend.
I'm on call. I'll see you. All right. OK.
Thank you. Bye.
It does feel very personal because we're dealing with people,
and having to then go and tell these people that their big operation
that they're planning for to happen today is not going to happen.
You do inevitably take the personal side of it.
Andrew has bipolar, which is well controlled.
But, you know, obviously, each time he's getting this enormous stress
from having his operation cancel led, there's a risk
that we might just destabilise him from a sort
of psychological perspective.
Hiya.
I know, I know, I know.
But, fingers crossed, I can get in Tuesday or Wednesday.
Currently, he seems to be coping very well, but there's only so many
ups and downs an individual who DOESN'T have bipolar
can cope with.
You know, don't stress. Whatever, we'll get something sorted.
But if it's Tuesday, then fingers crossed it'll all go well.
Obviously, it's a bit of burying your head in the sand.
I sent a message to everyone, and I say, "Look, guys,
"it's all cancel led."
Ancl then I get, you know, two messages back.
They'll all be like, "Bummer, it must be horrible."
But I don't want to answer that. I don't want to be negative.
I'm just like, "No, it's fine."
It's just with the outside life carrying on. You know, it's starting
to build up and you start to realise everyone else is having to cope
and there's other things going on.
That's where it starts to encroach on you.
Ancl you're starting to think, "I need to be out."
With a backlog of patients building up on the ward, the team decide
to trial a new system, which will ensure some intensive care beds
are always available for cardiac surgery patients.
Next week, we are trialling a three-week plan that four patients,
every clay, will be assigned an intensive care bed, counting
these as automatically needing an intensive care nurse.
So as soon as we can get this sort of established, we can con...
We can control the flow through our cardiac bed space.
Andy has been rescheduled to next week and will now be part
of the trial of the new system.
Back at Chapel Allerton,
Joe's orthopaedic theatre day is well under way.
He's finished the first of his three operations on schedule,
and jean is next on the list.
All right, jean. I'm going to lock your bags away because
we'll be taking you in shortly, love.
Do you need to go to the bathroom? I've been. OK. That's good.
I've been. Yeah.
Most hip and knee replacements at the trust are done without general
an aesthetic, so jean will be sedated and have spinal anaesthesia,
similar to an epidural.
I'll tell you what. They could do with getting bigger knickers.
I won't need an epidural
because I think I'm dead from waist down, anyhow,
they're that tight.
LAUGHTER
Yeah, it's one size fits all, but they don't fit me.
Have they rung? Yes, we're going to theatre, jean.
Right. So we're going this way, love. Right, OK.
Joe performs around 240 hip and knee replacement surgeries every year,
which all require an extra high level of protective equipment.
Well, we have an artificial joint.
You've got metal in there. You've got plastic in there.
So there's a risk that if bacteria were to get into the body,
or contaminate the implant,
it would be a major issue for us.
So we take all these precautions to reduce the risk of infection.
The problem with infections, particularly with implants,
is that they're very hard to treat, because when they're on the implant,
the antibiotics often can't access them effectively.
On some occasions, to get rid of the infection, you have to remove
the implant altogether.
The ultimate problem, if the infection isn't treated,
could actually be the patient succumbs to that,
and could result in death.
In the an aesthetic room, jean is being prepared for theatre.
Is this going to hurt? No. Right. 0|<.
Here we go. just look after me. Oh, we will do.
Look after me.
I think with spinal, the advantage is the recovery is enhanced.
Good pain relief, postoperatively.
With spinal, you just go a few millimetres deeper
than an epidural would.
When I speak to my patients before a surgery and explain
they're going to have a spinal an aesthetic,
the first thing they worry about is they're going to be completely awake
during the procedure, and that is going to be very, very stressful.
But when I explain that they don't have to be aware and can have some
sedation, that usually reduces the anxiety.
With jean anaesthetised and sedated, joe can begin the replacement.
The key start is the approach, is the first.
So how do you get into the hip? Finding the right planes to do so.
There's a layer of fat just over the front of the hip,
which I'm just removing that layer of fat to get over the front
of the hip joint.
Joe's first task after accessing the hip is to remove the damaged
arthritic head of jean's thigh bone.
I'm just going to cut the neck of the femur to relieve
that, to release the head. Saw, please.
DRILL WHIRS
And that's the head.
Ancl this is usually covered in smooth cartilage,
but the cartridge is worn out.
So this is the part that was flattened,
that showed on the X-ray. There's the exposed bone.
Ancl that's where you have so much pain, really.
You have to understand the significance
of what you're doing. These are invasive procedures.
You know, you're changing people's anatomy.
It has to be perfect. It has to be.
Now he can begin to attach the artificial joint.
A plastic cup needs to be fixed to jean's pelvis.
So this is the socket that we have to put in.
It's made of high-density polyethylene.
It's got a wire marker so we can see it on the X-rays.
The other half of the joint will be a ball, attached to a metal
stem fixed deep into jean's thigh bone.
Both the stem and socket must be cemented into place.
A process which is highly time-sensitive.
Because the cement starts to go off.
As time goes on, it gets warmer and it starts to cure.
Ancl if you don't get it in on time, you'll just be too late.
It's like cement going off, as in real cement going off.
It starts off very, very fluid, and it goes very, very hard.
When it's fluid, you can press it into the bone, and then it will
harden and the bones will be stuck to the bone, because the bone
is like a Crunchie bar almost. It's got little, porous holes in it.
So you push it into the bone, and then it goes off really hard.
So it sets.
Three minutes now.
The final step is to attach the metal ball
to the newly-cemented stem.
Ancl that head will articulate with the socket.
This is the head.
We can knock it on.
After just over an hour in theatre, Jean's surgery is almost complete,
and the operating list for the day stays on schedule.
Final skin stitch.
So after this, we will still be calling for the next...
Our next patient.
I love the operating theatre environment.
I love performing the procedures.
I'm in a speciality which is associated with, generally speaking,
good results, which also helps as well.
So you have that sort of positive reinforcement of what you do.
In the cardiac department,
the new trial is under way of allocating a set number
of intensive care beds and nurses for cardiac patients each day.
Hopefully, with this plan put in place for this week and the next
three weeks, we'll see a real difference
to our patient throughput.
So this is hope on the horizon.
In order to ensure at-risk patients are operated on as soon as possible,
the six cardiac surgeons at the trust share their lists,
and today, Andy's been given a confirmed slot
with another surgeon.
Andrew was my patient.
However, another colleague will take on his care to ensure
that he gets his operation clone as quickly as possible.
I wouldn't want him to wait until my next available operating slot.
You see how busy they are, what's going on.
You're like, "OK, they haven't been for me by this time."
But this morning, it's Monday morning, first thing.
Unless the doctor's got serious hangover -
my surgeon, sorry - I'm good to go.
Right, your chariot's here. Thank you. Cheers, thank you.
See you. See you in a bit. See you.
Elsewhere on the ward, nine days after her valve replacement surgery,
Sandra is nearly ready to be discharged.
I want to go home now.
I'm missing Benji.
Before cardiac surgery patients can leave hospital,
there are several criteria they need to meet, including
having stable blood pressure, heart rhythm and oxygen levels.
OVER PHONE: Here's Benji. Hello, Benji.
Hello, Benji Boo.
When I'm better, I can go out for a walk with the dog,
and it'll be the dog that's stopping, not me.
The dog will be saying, "Stop, Sandra, you're going too fast," won't it?
I can't wait to go for a walk, like I used to do.
You know...
She's changed my life.
That's all I can say.
Yeah, I can't speak now.
But everything will be fine.
I'm soft, really.
You look good, seeing as you've had surgery.
It's been nearly four hours since Caitlin left theatre.
And as a day case, she will soon be discharged.
I'm relieved that it's all clone with.
Yeah. NURSE: No worries. just tired now.
I can't wait to get home. I'm a lot better now.
I feel a lot better now than I did this morning.
Yeah, just relieved that it's sorted, and she's all right.
Yeah. just can't wait to get home now.
Home comforts.
SHE LAUGHS
There are a number of both tangible, measurable benefits, mechanically.
She'll be able to straighten more, which is important.
So, for instance, when you have a hand that can't straighten,
you can't put on a glove, it's difficult to put it flat to get
into a small space or whatever.
Ancl also you can't encircle a larger object.
So those are benefits.
They're small benefits, but they're real benefits.
What's the plan when you go home, then?
Eating. Eating.
What's on the cards, then? McDonald's.
Oh, it's always McDonald's. Yeah.
Proper little trooper. A real little trooper.
I don't think I could handle what she goes through.
We're always proud of Caitlin.
Always.
Everything that matters in a child or an adult is between the ears.
It's all in the mind and the way they react.
But, of course, if you make her more able and less unusual,
that has both mechanical and psychological benefits.
So I'm just going to rest it, crack on with my GCSEs,
and then prom. Hopefully, I won't have it on for prom.
If I do, I'll just put glitter all over it!
LAUGHTER
Are you going as well? Yeah, we're going now.
Oh, it's been lovely meeting you. Thank you so much. See you later.
Thank you. Thanks.
The day after her hip replacement, Jean's up and out of bed.
Hi there. How are you recovering from your surgery?
Yes, very well. They've just checked my...
Good. Good to see you sitting out. Yeah.
Ancl how's your mobility been, walking-wise?
Not too bad. Painful, but not too bad.
I've managed to walk to the toilet and back with me Zimmer
and me crutches. Good.
Tomorrow, they are going to show me how to walk up and down steps.
All right.
So, yeah, it's painful. It's like sitting on a brick.
But, yeah, all right. I'm sure that will settle down.
Potentially home tomorrow, or the clay after.
Depending on how you are. Yeah. Depending on how you feel.
Do you remember much of it? I don't remember a thing.
Yeah.
For joint replacement surgery, relieving all the pain
that the patient had before and restoring function to normality,
the reality is that isn't always achievable.
But that's what perfection is to me.
Thank you very much. No, not at all.
It's been brilliant. Well... OK.
SHE LAUGHS
The EXPERIENCE has been brilliant.
I'll catch up with you tomorrow. All right.
Thank you very much, indeed. Thank you.
We'll see what happens for the next 12 weeks.
Because it's going to be a fair recovery.
I am looking forward to driving, gardening, walking...
...and just generally the things I haven't been able to do for well
over a year. In fact, I might even take up bowls.
You never know. The world is my oyster.
Zero three...
I think the NHS is under an incredible amount of strain
at the moment.
Yes, there are pressures and there are challenges, but ultimately,
you have to want to do the job.
I love getting up in the morning to go to work.
On the cardiac ward, it's been two days since Andy had his triple heart
bypass, and he's back from intensive care.
Here he is.
Success! You had it clone. Yes. Fantastic.
My little guardian angel over there. Michelle. Yes.
She's keeping a close eye on you, yeah? Good.
Well, I didn't succeed, but others have. No, I know, but
you gave a nudge, but thank you. All right. Good.
Much appreciate it. No problem.
Oh, it's nice to see he's smiling, and that's always good.
Ta-da! You know how important it is to make progress
with these patients, to get on with their life, really.
So this is the first time I've seen my wound.
Brilliant.
I mean, the leg wound looks much worse.
Raring to go.
You know, they've extended my life,
and they've just said, "Here you go, we've given you everything back.
"Go...go do something with it."
Thank you very much.
My Rolls-Royce.
Home sweet home. Ready?
Ready. Steady. Go.
After two weeks in hospital, Sandra has finally been discharged
after her valve replacement.
Take care, darling. You as well. I will do.
It's been a good start for the trial of the new system.
This is genuinely making things better because the theatre team
are no longer in this sort of inertia
at the beginning of the clay, not knowing.
The patients know that if they are listed,
they're going to have their procedure, and also
that you then can start to reduce the patient's time
that they're waiting, and, obviously, your numbers on the waiting list.
Hello, handsome boy. Hello.
I can't take him out for 12 weeks, but at least we can have some fun.
Thank you. Bye-bye.
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