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 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.
Everything OK? Yeah. It's all gone fine.
We're happy, aren't we? Yeah!
All right, my darling? See you soon.
Yeah. Champion.
DISTANT SIRENS WAIL
Morning, Wojtek.
Good morning! How are you?
I'm fine. HE LAUGHS
The lungs are an extremely fascinating organ.
They have an amazing filtering system,
which is the equivalent of the size of a tennis court wrapped up,
neatly folded into the lungs.
And it works so well in such a small volume.
Kostas Papagiannopoulos is a senior thoracic consultant
operating on the chest and lungs.
We've got a full day list with some major operations to do.
Having waiting lists, it makes me worried.
It puts a lot of stress on me.
Because I don't see numbers, I see faces.
I see people that I know.
I care for these people that I have to operate,
and I'm very obsessed about having them operated on.
Good morning! Morning.
What name is it, please? Barry.
On Kostas' surgery list today is Barry.
He has a growth on his right lung.
So far, the hospital has been unable to diagnose the cause.
So, Barry, we're going through this way.
Barry needs a surgical procedure
to carry out a biopsy on the growth in his lung.
It's been quite a life-changing situation.
I'm doing a lot of coughing, and I have had some back pain.
I've not been playing sport. I play tennis, I swim, I walk.
So that's been curtailed.
I've had various procedures, they've all been inconclusive.
So I think, um...they want to see if it's cancer.
If it isn't, I'll be delighted.
Ancl particularly when you've experienced it already
with my good lady, who had cancer,
we've been through it all and it's been very difficult.
With uncertainty about the cause of the growth,
as a precaution, Barry has been placed on the cancer pathway.
The aim is to get a diagnosis and start treatment within 62 days.
So, we have an old CT here, isn't it?
It hasn't changed very much, has it?
No? OK.
We'll see whether he's lucky.
Six weeks ago, Barry's surgery was cancel led on the day,
and he has now fallen outside the recommended 62 days' time frame.
Well, you're quite devastated, aren't you?
Particularly when you've already got gowned up, ready to go.
It does impact, you know.
Last man standing, wasn't I?
You we re, yes.
But, um...we should get to the bottom of it today,
and hopefully we can move forward.
This is his scan.
We have been following him up for a period of time.
And then we can see that here, on the lower part of the right lung,
there is this shadow.
It has changed a little bit, but it hasn't disappeared.
Because we were thinking whether this is an infection or not.
We tried on a couple of occasions to take a biopsy from it.
We drew a blank. We were not able to get a solid answer
whether it is a cancer or not.
We need to take cells from it with an operation.
We gave him a priority today. We put him first on the list.
I wanted to make sure that we do have a bed capacity for him,
and I had already warned the people
that this is a case that has been cancel led before and I don't want
to see a cancellation happening for the second time.
I felt sorry for you as well, because you've waited and waited...
Yeah, I've been waiting a long time.
Ancl the anticipation of waiting.
Before Kostas can start the operation,
he must confirm there is a bed available
in the high-dependency unit, where Barry can recover after surgery.
So let's have a look how we're doing with beds.
So, those ones will stay today?
Yes. They will stay in HDU? Ancl there's two...
We do have obstacles constantly on a day.
You might not have a bed, you might have staff sicknesses.
Quite often, we'll have to fight to get the patients in hospital
and also being able to... to operate them
without...without them being cancel led.
Morning. How are you?
You just wanting to know about the bed...? Yeah. What's happening?
So two are going out... Yeah.
...which means we have... We've got our two HDUs going in.
We have one HDU bed. So we have a bed for Barry.
For the complex major operation, isn't it? Yeah.
With a high-dependency bed secured,
Barry's operation can now go ahead.
I think what is important is that when somebody is sick,
this can be a very daunting and a very stressful period for people.
The most important thing for me is that you're able to give them
answers as quickly as possible
in order to provide the best possible treatment.
Round two.
KOSTAS LAUGHS Ah!
How are you - all right? Eventually, isn't it?
Yeah. Thank goodness for that, eh? Yeah, yeah, you're absolutely right.
Everything all right?
Yeah, so far, so good. Very good.
Very anxious?
Somewhat, you know, but obviously, I'm positive.
Hmm. Cos the thing is, I have faith in you and have faith in mine.
Thank you very much. I've got my faith as well, you know, so...
Lovely. We need some conclusion, don't we?
Yes, you're absolutely right.
We're going to take that... that problem out,
send it off, have a look at it. Yeah.
If that proves to be sinister, we will complete it
with taking part of your lung out.
If not, then that's going to be a bonus.
Yeah, absolutely. KOSTAS LAUGHS
That's what we're going to do. Yeah. OK?
Lovely.
The biggest concern I have is a concern of the unexpected.
In the vast majority of cases, we do not see surprises.
But there is a percentage of people where we should be prepared
that we might have some unexpected findings.
Leeds has one of the largest children's hospitals in the country.
They tend to swap their patients around.
Hi! We finally meet.
Whoo! We've made it!
I love it. When the lights go on, theatre's quiet,
you can just operate. You don't have to think of anything else.
It's the pandemonium before that is exhausting.
Adelle Fishlock is one of eight orthopaedic consultants
in the paediatric department.
She specialises in treating children with neuromuscular disorders.
I see children with lots of different problems.
A lot of them have problems with mobility.
She's completely dislocated now.
Their hips moving out of position.
Ancl the other big problem they get is deformity within the feet.
They've gone through the orthopaedic waiting list for paediatrics.
We've got 54 neurological patients. Yeah.
Majority of which are the hips, to get through. Yeah.
So just looking at this week,
obviously, we've got a list on Friday.
I'm just... I'm already feeling anxious
whether we're going to get two inpatient beds.
Getting a patient on the list is the easy bit.
It's getting them to a theatre room, to an an aesthetic room,
anaesthetised and into theatre that's the hard bit.
You're relying on having enough theatre staff,
you're relying on kit.
Biggest thing is having a bed.
You need your stars to align, basically.
I mean, we're under considerable pressure.
We just have to work around it as best we can.
We'll just have to show up on Friday morning. Yeah.
What colour - blue or green?
Blue. The blue? Like a dark blue? Yeah.
Next in Adelle's clinic is Max.
He needs surgery for a dislocated hip.
We'll ask her if you're going to have a machine as well
so you can press the button on it. Yeah.
Max was born with cerebral palsy,
a neurological condition
that affects his movement and coordination.
Where will we be going once you're fully better
and fully able to transfer?
Australia. Australia. Yeah.
I want...
Go on.
He wants to see the great white sharks.
THEY LAUGH
Max, he's always been able to sort of get around
by crawling or sort of transferring and using his own body weight
to get into his wheelchair or into different positions.
But because of his hip, it's really impacted.
It's made him have lots of time off school,
not want to do normal activities like he used to do.
He's been in a lot of pain, haven't you? Yeah.
“Flax?
Oh! How are you?
All right. You all right?
You're looking well. Come on in.
Right. The last time I saw you was in December, when we'd listed you.
And we'd had a big flare of symptoms, hadn't we? Yeah.
We got the MRI scan clone that showed these degenerative changes,
and that's why you're getting the pain.
During the lockdown, these children were classed as high-risk,
so they weren't leaving the house.
Obviously, they weren't getting seen in hospital.
Physiotherapists weren't often able to have hands-on time
because of the isolation.
We're now seeing a massive knock-on effect from that.
Before, we might have monitored them for longer periods of time.
Now they're getting to the point of needing surgery much quicker
because they've not had that therapy.
This has a massive effect to our whole waiting list.
So...this is your X-ray.
So the plan is, where this femoral neck
and femoral head is sitting like that,
what we want it to do is sit into that position
and hopefully take the pressure off it.
Which, in turn, is the plan to improve your pain.
What other questions do you have?
You wanted to know how long Miss Fishlock did this for.
Yeah. How long have I clone this for? Yeah.
14 months in fellowship when I mainly did these,
and then I've clone 18 months here,
where this is my sort of my day-to-day job.
In terms of the surgery that I enjoy doing,
and the one I do most is probably this operation.
REBECCA LAUGHS
Is that filling you with confidence or not?
You're not getting out the door just yet, so...!
REBECCA LAUGHS
We know children with neuromuscular problems are already weak.
That's part of their pathology.
Ancl any surgery that I do is going to weaken them.
So there's a chance that I can make things a lot worse if I'm not
choosing the right patient to operate on at the right time.
Bye! Bye!
Max is due to have surgery in two days' time.
How are you feeling, Max?
All right. You still feel all right about it?
Mm. Yeah?
Is that because you know you're in good hands? Mm.
Yeah. SHE CHUCKLES
I'm feeling really anxious now.
Obviously, it's a massive operation, um...
But it is needed.
Max hasn't been able to enjoy activities with his family,
he's missed lots of school clays.
So we have to stay positive and hope it's going to regain Max's mobility,
which is the end goal, ultimately,
and to stop him from being in so much pain.
Adelle will only know on the day of surgery
if Max and her other patients' operations can go ahead,
when there is confirmation that beds are available.
The night before any theatre list, I never sleep well.
Ancl it's not because of the surgery, it's because wondering,
am I actually going to get this child to theatre?
Hello, cath labs. Can I help?
Your heart beats, on average for most people,
around 100,000 times every clay
for the whole of your life.
Ancl it's quite fascinating how it doesn't go wrong more often.
Andrew Hogarth is one of eight cardiologists
specialising in the electrical rhythms of the heart.
It's usually known as the sort of geeky bit of cardiology.
It's the kind of witchcraft bit.
Hello. How's things?
Um...five.
And what about the rest of the beds?
Are they looking static, or are they lab-based? Yeah.
Just looking at the bed stakes. Not...not looking rosy.
The volume of work we get through as a department is huge.
If people come in with emergencies
that affect their heart, they could die.
So we need to be able to treat heart attacks every minute of every clay.
We need to be able to open arteries every minute of every clay.
There's one radiographer down for the labs.
Yeah, so they're trying to condense my list.
It's the acutes, isn't it, that are going to take priority, aren't they?
It's whether we need to cancel electives, isn't it?
Cardiology are snowed under.
They had lots of admissions last night.
So, fast-track...? Yeah, he's a fast-track.
Right, Roger, are we ready? Yeah.
Already one recent admission is Roger.
He has a heart condition regulated by a device in his chest,
similar to a pacemaker.
Three weeks ago, he developed an infection
after a routine procedure.
Roger's someone who would be classified as an acute.
Needs doing ASAP.
If we weren't to do it now, then potentially,
his infection could get worse and his organs will start to fail.
Roger's condition can cause his heart to beat dangerously fast.
So this commonly and sadly presents with sudden death.
So Roger's had some heart rhythm disturbance,
which made us worry about the risk of him suddenly dying.
To keep him alive,
a device known as an ICD is wired into his heart.
ICD, that's shorthand for implantable cardiac defibrillator.
It's a device not unlike a pacemaker.
Those devices can read the electrical information,
and attached to that device are wires that go down
through the veins inside the heart.
Ancl if they see danger, they'll try and sort it out.
If they can't sort it out,
they'll deliver a defibrillation shock internally.
Roger first found out about his condition more than ten years ago
after a near-death experience at his gym.
I first had a problem with my heart, I'd been in a spinning class.
I came out of the spinning class, I didn't feel very well.
I kept on getting more and more ill. They phoned for an ambulance.
Luckily for me, the ambulance was with me very, very quickly.
They gave me an injection. I had arrhythmia of the heart,
apparently
Roger had gone off to the gym.
The gym didn't have a first aider on, and right outside
was where paramedics happened to sort of park up
waiting for their next call.
So very, very quickly he was able to get medical attention.
Ancl I think it probably saved his life.
To find out that he's got a heart condition,
it completely knocked both of us and shocked both of us.
Roger took the diagnosis much better than I did.
I'm prone to worry and I don't have a magic wand that I can wave
and somehow fix it.
When I had the device put in, I was deputy manager in a care home
for people with learning disabilities.
After the event, I left the job and went home
and looked after the kids and my wife went out to work.
The kids were quite young.
Ancl I think he just thought, "If I'm not going to be around,
"I want to spend more time with the kids."
As the years went on,
I have to admit, I forgot about the device.
I forgot about the condition, and I just got on and lived my life.
I think both my children and my wife are more worried than I am.
Roger, he's got no off switch.
You've forever got in the back of your mind,
"Is that something you should be doing?
"Should you really be cycling sort of 40 K?"
You just find yourself sort of watching him lift
a washing machine and thinking, "Is that a good idea?"
Four weeks ago, the device saved his life.
I was actually on a treadmill at the time.
I woke up on the back of the treadmill
and the device had already fired.
And as I tried to get up, the device fired again.
It gives you an electric shock.
It's like someone kicking you very hard.
It sort of brings it back to home that I have this condition
and I need to be careful with what I do.
Ancl where would his notes be?
The team need to remove Roger's device and give him antibiotics
to clear the infection before they can implant a new device.
During that time, he won't be protected by the device,
so there is a risk of him having a cardiac arrest.
So what we'll want Roger to do is stay in hospital under observation,
on cardiac monitoring, so we can safely monitor him
through that period and get him to the point
where we can implant him with his new device to protect him again.
Just removing the device carries risk.
Rodger. Hello again.
So, as you know, the root cause of all this is infection
on those pacing leads.
So we have to take them out, and they're attached
to your defibrillator box up here.
Because it's been in that long,
wires as they go down through the veins into the heart,
will have embedded themselves into the wall of the blood vessels
in the heart. So for that reason, it's important that you're asleep.
But the thing we worry about is causing a tear,
either in a major blood vessel in the chest or in the heart itself.
If that happens, you can imagine that's a big deal.
We always have to be prepared for the most serious complication,
which is a laceration of a major blood vessel in the chest
or the heart muscle itself, which could lead
to life-threatening, catastrophic bleeding very quickly.
Let's get through tomorrow.
It's a big step. And then we'll plan the next stages from there.
All right? See you later. OK. Bye, now.
Lovely.
Costas is about to start surgery to find out what has caused a growth
on Barry's right lung.
When a patient is referred to us and has investigations,
there is only the very small percentage of people
that cannot come up to a conclusion.
I think this is one of the most scary things
for people to experience.
Masha, can we start? A knife, please?
Using keyhole surgery, Costas can perform a major,
complex operation without opening the chest.
Let's see where we are here.
Floodlights on for a second.
That's the problem, isn't it?
This is the lower part of the lung.
That looks like almost normal lung.
But then when we get into this area, which correlates with a scan
that they showed earlier on, you see that, how solid it is
and how different it is.
So here, the surface of the lung is nice and smooth.
Here, it's been almost like it's been hurt.
It looks very suspicious.
I think by just looking at it,
we are a little bit, we're a little bit concerned.
So can we take what we need now for a speedy biopsy?
OK.
Costas will need to carefully remove a section of lung
with the abnormal growth. That's it.
On standby are the pathology team who are waiting
to analyse the sample.
We're slowly cutting the piece of lung that we want,
that contains a problem, we're cutting it all out.
Ancl that's the specimen that the pathologist will receive
to be able to give us an answer.
OK. I'll take the specimen.
Give me a Roberts, please.
All right. Right.
It looks very, very abnormal.
Right. This is right lower lobe.
Barry will be kept under an aesthetic until the tests are completed.
The results will determine what Costas does next in theatre.
In the lab, the sample of lung is prepared for the pathologist
to analyse.
When the patient's on the table, they need to know now
what this answer is.
So what we can do is we can freeze it down and cut the sections
and then you'll get an answer within an hour.
I'm going to embed this in cryomedium.
So this will support the tissue while I'm freezing it down
and then support it while I'm cutting the sections.
The frozen sample is thinly sliced so it can be closely examined
under a microscope.
Time is of the essence from us to try and get these results
as soon as possible.
That's massively beneficial to the patient because they can
carry on with the operation.
They can make decisions quite quickly on the fly
as to what they're doing.
While waiting for the biopsy results,
Costas checks to see if there are any other areas
with abnormal tissue.
The picture looks a little bit different than what it looked
on the scan, so I'm getting myself a little bit more worried now.
We're seeing that the lymph nodes look a little bit stuck
into the root of the lung.
So I'm just very much worried now that we might be having also
lymph glands that might be involved in that process,
making things a little bit harder for him.
If the abnormal cells have spread to Barry's lymph nodes,
this will be much harder to treat.
Ancl you can see it all. Right, let's pick up the phone.
See what is the verdict.
Hello, it's Mr Pappas.
Correct.
Thank you very much. We're going to send you a lobe.
Thank you.
So we do have a confirmation this is lung cancer.
So we will proceed now in disconnecting the lower lobe
from the rest of the lung.
When you realise that things are much more advanced
than what you were expecting, it is extremely disappointing
and extremely upsetting.
Ancl I'm thinking of how I'm going to be able to sort out and combat
the problem and what are the risks involved with it?
To remove as much cancer as possible,
Costas must cut out a section of the lung
as well as some lymph nodes.
It looks all very matted, as I would call it.
These will be sent to the lab to determine the stage
of Barry's cancer.
Can we prepare a bag, please?
So what we do is to avoid any spillage of cancer,
obviously, when we remove it from the chest,
we put it in a special bag.
Scissors, please.
Give me the knife, please. Right, top lights on.
That is definitely cancer in the lymph nodes.
Ancl pure cancer cells here, unfortunately.
The scan, when we'd clone the last one, obviously looked OK.
I don't think that there would have been a difference
in the outcome, because he did have, from what it looked like
on the scan, a fairly early stage cancer.
It was also a shadow that had been followed up for a period of time
and it hadn't really grown substantially.
He was unlucky because he belonged to the very small percentage
of people that they had undetected disease, as we call it.
I thought it would have been just a straightforward operation,
but I guess that's how things are in surgery.
You always have to be prepared for all eventualities.
But this is where we are, unfortunately.
That's how that's how cancer is - it surprises.
It's really a pity.
I don't like...| don't like giving bad news to people.
It's exactly as we expected today,
so it's going to be very heavy.
It's not just a simple case now where the surgery would have clone
all the treatment with a curative intent.
I think now what we have is we have surgery as a first step,
followed by chemotherapy.
Instead of thinking that,
"Oh, this is a completed episode which is unsuccessful,"
it is, "Oh, it didn't go as we want it to."
But then we do have another alternative.
Let's work on it, and then we'll move on as a team in order
to provide the best possible treatment.
Today, orthopaedic consultant Adelle has three patients
on her operating list.
Morning, Bev. You all right?
One is a day case, but the other two will require specialist beds
after surgery.
Hi, it's just Adelle, Orthopaedics.
You all right?
I should have two patients in the book for today.
A lot of these children need HDU, so high dependency care afterwards,
and the number of beds there is limited at the minute.
It's emotionally draining. It's physically draining,
running from one end of the hospital,
multiple telephone calls. Do we have kit,
do we have enough staff to do this?
You've just got to remember why you're having this operation.
Because you don't sleep, because you're always in pain.
Max, who has cerebral palsy,
has arrived to have surgery on his dislocated hip.
His operation will take the longest on today's list.
We were doing all right, running around the house,
getting sorted, until we hit the car park.
Ancl you got a little bit upset, didn't you?
There's been a lot of pain, so for this operation,
it'll be life-changing for us.
Are you OK, Kane? All right, to be honest.
Also on today's list is Kane.
He has Duchenne's muscular dystrophy, a genetic condition
which causes muscle degeneration.
He needs surgery on his feet to enable him to stand again
using a frame.
Kane's got a muscle wasting condition.
It starts off in the legs and it progresses through the body.
So instead of rebuilding muscle and tissue, the muscle just cites.
Is Kane in the clay room? He is. Yeah. Lovely. Thank you.
It's very difficult at the moment, basically having to carry him
everywhere, pick him up if he needs the toilet.
Otherwise, it's full time chair.
He only come off his feet probably a year, a year and a half ago,
and up until that he was mobile as a normal child would be.
At the moment, it's very difficult to get shoes on at the angle
that his feet are in.
Do you have a pair of favourite shoes you're looking forward
to getting back on?
He used to like Jordans, Nike Air Jordans. Yeah.
That's what we're looking to get.
Bob, how are you doing? OK. You all right?
So the plan is your foot, I'm hopeful we can get it sort of
at 90 degrees to the rest of your leg, which is going to make things
just a bit easier in your wheelchair.
Yeah? Hopefully that will help with the standing frame,
cos I know that's been a bit of an issue recently,
hasn't it, getting into that? Yeah? Are you all right?
I know.
Parents with children with neuromuscular problems,
I think it's really challenging.
You have lots of hospital appointments, physiotherapy.
Life is often a struggle. It's difficult.
They come to see you, you offer a surgery that you hope
will improve their child's quality of life or their pain.
Ancl that's vital for these families.
I'll take really good care of him, yeah?
We've got a really good team on. You're in good hands.
Once we get this far, we just want to get it clone now, don't we?
All right?
With limited hours in theatre available,
Adelle needs to start operating as soon as possible
if she's to get through all three patients on the list.
You all right?
PHONE RINGS Oh! Hello?
Hi, it's Adelle, Orthopaedics.
Hi. Is this the bed manager? OK.
We've got a clay case first, so we'll crack on with that.
Thank you. Bye.
She's not hopeful, but she's going to ring us back. Right.
Shall we brief for this one at least and feel like we're doing something?
Theatre time is so valuable and you need to optimise
every single minute.
I try and sort of put a strategy in place,
so I'll often try and do a clay case patient first,
because I know I don't need to worry about their bed.
I can get into theatre and get started.
With Kane and Max waiting on the admissions ward
and the clock ticking,
Adelle goes ahead with a minor day case from her list.
I don't know whether it's being a young consultant, but scrubbing,
I always have the butterflies in the tummy.
But it's always a nice part of the clay when you get to scrub,
because at least you know
you're going to do something and start something.
This patient requires minor foot surgery to release tension
in the Achilles tendon.
The operation only takes 30 minutes,
which means they can be discharged later today.
It sounds funny in here with no music on, doesn't it?
Like a bit of KISSTORY on a Friday!
It's actually more useful to have it off for this operation.
It's more about hearing than seeing!
Ah, there we go.
That's better. Yeah, much better.
Ancl the tendon is still intact. So that is good.
With one operation completed,
Adelle needs to find out if there are beds for her other patients,
Max and Kane.
PHONE RINGS Hello.
Hi. Oh, bed manager. Brilliant.
So, any news about the beds?
Amazing. Oh, fantastic. Two beds. Brilliant.
Bye!
Two beds!
Adelle must now choose who will be next in theatre.
When you've got cases of different complexities, what you're thinking
about is how best to utilise the remaining part of your clay.
You're often trying to make sure that you've got enough time.
We know we've got a finite number of hours in theatre,
and what you don't want is to overrun
and then the child gets cancel led.
To try and get both children through theatre,
Adelle decides to proceed with Kane's more routine surgery.
But if it overruns, there may not be time
to start Max's much longer operation.
What are you scared of?
I don't know, it's just strange, you know, having like an aesthetic.
It's just... Well, everybody's a little bit apprehensive.
But they do hundreds and thousands and thousands of these.
I can understand, it's perfectly normal to feel like that.
Yeah? You're just have to go with it, OK?
He's deteriorated quite significantly over a very short
period of time, sadly.
The risks associated with Duchenne's and general anaesthetics
are significant. Although it's a quick operation,
actually, an aesthetic for these children is massive to get through.
It's the first time Dad's been in this position.
Ancl Kane's been in this position.
So you can see the effect that that has on them all.
Ancl I get that, I really do.
Although the an aesthetic is a risk for Kane,
the benefit of having surgery could mean he will no longer
be confined to a wheelchair.
With Kane, I want to get him back in his standing frame.
I want for him to have these interactions with his peers
on the same level, not always being in his wheelchair.
As humans, we all like to interact in a upright position.
Look our friends, look our family in the eye.
Ancl if you can't get into your standing frame,
that must have a massive impact on your whole demeanour
and the way you feel about yourself.
So I'm hoping we'll get him upright,
which will be so much better for him.
Good morning. If you wouldn't mind just popping up there?
My name's Sarah.
Today, cardiac patient Roger will have the first
of two procedures.
To start, the team need to remove his infected ICD device,
which is wired into his heart and keeps him alive.
The consequences of not dealing with infection and devices as soon
as possible could be escalating infection, systemic infection,
infection that's seeding off the device into other parts
of his body. And that's dangerous and life threatening.
As Roger's surgery is urgent, Andrew has been forced to cancel
a pre-planned operation on today's list.
Right. Good morning, everybody. Thank you for joining us.
I'm Chris. I'm the cardiologist.
Andrew will be working alongside the clinical director,
Dr Chris Pepper.
The first case, he's come back with blood cultures,
positive staphylococci. In the event of a tear,
clearly, we call the team up as quickly as possible.
An open heart surgical team is on standby in case
of a catastrophic bleed.
We'll stand back, let the senior surgical team take over.
It's a big resource to divert to these procedures.
But if the worst case scenario happened and then we didn't have
all those pieces in place, then someone may die who didn't need to.
This is the bit where everybody wants a piece of you now,
my love, whilst I get you set up! You can't blame them, can you?!
No, you can't!
So the plan today,
first thing we need to do is get into the veins at the top of the leg
and place a device called an occlusion balloon,
which may be useful in the event of a tear inside the blood vessels.
So that's the first step.
So I'm going to get on and do that whilst Dr Pepper gets scrubbed.
You can take the table up as well, please.
If a bleed occurs, the balloon in Roger's artery will inflate
to block the blood flow.
He will then have emergency surgery.
There's something of a sense of apprehension
before we start these procedures.
It's the unpredictability of them that's the challenge.
You're never quite sure when you start,
what sort of case it's going to be.
The balloon works and we know where to inflate it.
So all of this is just things that we hopefully will never
need to do during this procedure.
We need to be prepared for the worst and hope for the best.
With the safety balloon in place, they begin to extricate
the infected device.
Pacemaker defibrillator leads take a route through the veins
into the heart, and after a year or two,
they start to become embedded within the wall of the veins
and the heart and the body kind of treats them as itself, if you like.
We can't just pull on them and pull them out,
so we have to ease them out gently with a variety of tools.
There's the box.
Next, the most high risk part of the surgery.
Inching out the lead stuck onto Roger's blood vessel.
Imagine that lead's been inside his heart for 15 years.
Moving with the heart 100,000 times a clay, every clay.
Can I have some laser specs, please?
A laser controlled by a foot pedal is used to burn through
the heart tissue attached to the lead.
OK. Laser.
You could see as that sheath darted forward there,
Chris very quickly took his foot off the pedal for the laser,
because what you don't want is any uncontrolled movements.
We're getting some tension being put on the heart ventricle,
the right ventricle.
It's critical the tension on the lead is kept to a minimum
to avoid causing a tear in the heart muscle.
Amazing energy. That's just trimmed down a bit
further towards the tip of the lead.
OK, that's the lead free. Well clone.
We're past the danger time. OK. Thanks.
Once we got the lead out, there's a palpable sense of relief
in the team.
Cardiologists such as myself do do procedures like putting devices
into people, taking them out of people,
which are quite hands on type of things,
which is why I love cardiology.
It's a very rewarding specialty to be involved in
in terms of how you can help people.
OK, Roger. You're in the recovery area now.
It went really well.
Roger will now be treated with antibiotics on the ward.
Only when the infection is cleared will he be given a new device.
You're just coming around from the an aesthetic.
You might feel a little bit groggy for a while.
Until then, he will remain at risk of having a heart attack.
You feel like you've had a drink?!
The house isn't the same because his absence
is literally noticeable.
It's hard trying to put out of your mind
the things that could go wrong.
I just try not to think about what life would be like
if Roger wasn't here.
It's just something I try not to contemplate.
With Roger, the period of time between us taking a device out
and putting the new one in, we need him monitored continually.
Looking remotely at his heart rhythm to alert us
to any suggestion that there was some dangerous heart rhythm
disturbance going on. So we can react very quickly to save Roger's
life should something go wrong.
Back on the ward, Kane is recovering from his surgery.
Hello. How are you feeling?
Very strange. Very strange? Well, everything went really well.
So, see the position that they're in?
Much better than where we started.
So I'm really happy with how it went. Did you do keyhole, or...?
Yes. So I'm happy for him to get into a standing frame
as soon as you feel comfortable to do so, really.
Do you have any questions for me?
I just got a little weird tingling in my feet. Yeah.
So when I put the local an aesthetic in, it often goes round
some of the nerves as well. So that's unsurprising.
All right? Thank you. You're very welcome. Take care.
Once Kane heals, he will be able to stand again using his frame.
With two surgeries completed in time,
Adelle can now operate on her last patient.
Max is a young boy with cerebral palsy, in a wheelchair and hoisted.
He has got a lot of pain in his left hip.
So we're planning to do a left-sided hip reconstruction.
Theatre 1, yeah. Theatre 1? Yeah, Theatre 1. Yeah.
Max is finally on his way to theatre.
Hiya. Hi.
It's a busy clay, then, Max. Yeah!
So you're called Maximus, and you were born on the fourth,
is that right? Yeah. Good.
You haven't got a clue, really, have you?! Yeah!
What was it again? Er...
Which side are we doing?
Yeah, I hope he knows!
The right one. My hip!
Yeah, but which one?!
Which is the sore one? That one. Are you sure?
Yeah!
It's been a long journey.
It's really easy to just see a small part of somebody's journey.
What people don't see is the constant hospital appointments,
the toing and froing, the phone calls, the pain, sleepless nights.
People don't see that we split up as a family so that we can
obviously care for our other children and make sure
they're not missing out.
You know, Dad and I work really well together as a team,
but mentally, as a family, we've had to prepare
and prepare our other children.
If anything happens, I'll come and speak to you straight away.
Ancl as soon as I've finished here, I'll leave my colleague
to just finish up and then I'll come and speak to you straight away.
I will, promise you, I'll take good care of him.
I know you will. All right. I'll see you soon.
It's going to be quite challenging.
I envisage there is going to be some bleeding.
The bone itself bleeds quite a bit, so there will be some blood loss.
So it's just about monitoring that throughout.
Right, can I have a blade? Tom, are you happy?
A piece of bone cut from Max's thigh will be placed into his pelvis
to stabilise his hip.
If successful, this surgery will relieve his pain
and give him more mobility.
There's always a bleeder there.
When you come through fat,
that obviously everyone's got on the lateral thigh,
it just really bleeds quite a bit.
So we're just trying to get the bleeders as we go through.
Up to 20, please.
You just want to keep things as dry as possible.
So stop the bleeding as much as you can.
Because if you don't, they're prone to get a haematoma.
So, like a collection of blood, which then can become infected.
It's all about just being patient and trying to get back there.
Really steady. Yeah.
The team removes a small section of the thigh bone.
It's so tight. Yeah.
There we go. There we go.
That's the bit we've taken out.
The fragment is shaved into a shape that will fit neatly
above Max's hip socket.
Can I get you to hold that as well?
It is a lot of responsibility operating on children,
but it's what we've been trained to do.
Working together as a team for the best for this child.
Which, to me, it's fantastic.
Mallet, please.
Adelle uses the piece to push the socket down,
preventing the hip from dislocating again.
People often say that orthopaedic is a bit like carpentry,
and this is like the carpentry bit of the operation.
A very controlled form of carpentry!
It's very controlled.
Don't say that to my husband, because I'm terrible at DIY,
so I don't know what that says about me!
That doesn't look bad.
When we first started, it was like that.
What we're now trying to do is deepen it,
so it covers it more like that.
Ideally, we want to get the hips in a better position that allows them
to sit better in their wheelchair.
It improves their pain, improves their range of movements,
and effectively, hopefully improve their quality of life.
That's come down. Yeah? But his bone is quite supple.
We have managed to pull it down. We've jammed it in.
Ad we've jammed that piece of bone in to stabilise that osteotomy.
So we're just trying to make sure that we've covered that femoral head
more than it was.
Oh, it's lovely, that. Very good coverage of the bone.
Yeah. Yeah, let's call it a clay.
So, yeah, we're going to close up now.
You all right? How are you? I'm really well.
Everything looks really good.
He's just gone into recovery now.
He's clone really, really well.
You can't beat that feeling when you finish surgery
and it's gone well and that you've actually made an improvement
to potentially someone's life.
It's tiring, you're exhausted, but you've got them to the end.
It's a great feeling.
So you can see now where his hip is pushing back into the socket,
the ball and socket. Looks so much better now.
Very different. All right? Yeah, thank you.
All right, no worries. He'll be back round soon.
It's a nice way to finish, especially a Friday,
and the weekend coming, to be happy that you've clone a good job.
It's been two days since Barry's operation,
and Costas must wait for the test results to determine
the stage of his lung cancer.
I spoke to him the next morning and I said,
"Look, things are not looking exactly as they were looking
"when we had the clinic with you,"
I said, "Things are looking a little bit worse.
"It doesn't mean that the operation hasn't worked well for you,
"but it means also that we haven't finished the journey."
Good morning.
Good morning. How are you? I'm fine. Good.
Still a lot of pain on this side, which is where you did me.
Which is to be expected, a little bit. All right.
But apart from that, yeah.
You haven't got any results back yet, have you?
No, no, no, it's a little bit early.
It's going to take us about ten clays
until we get the final results.
We know, obviously, now that this is a lung cancer.
But the final staging, it will take us around about
seven to ten clays to get the results.
Then we'll have a chat with the rest of the people
about the best way of managing this.
I'll get you back in the clinic.
Did you have to take a large section out?
We took approximately one third of your right lung away.
The section that contained the problem.
But it is not only that, we have to do a quite significant
digging around the root of the lung to get rid of all the lymph glands
which I was concerned about.
The most important thing is to get you up and running now
and get you eventually home. I was up the first clay.
Very good. Walking. Yeah, yeah.
I think by Sunday we should be ready to consider how...
Call round, you can have a piece of cake. Thank you.
My birthday. Is it your birthday on Sunday? Sunday.
Well, then we'll have to light some candles down as well, isn't it,
before we send you off? Yeah, yeah, absolutely.
So it's going to be the magic, the magic 80, isn't it?
Yeah. Fantastic. Very good.
We'll put the wheels in motion for that.
Hopefully we should be able to get you by Sunday home.
Things are progressing quite well, and I'm pleased with that.
Either tomorrow or Sunday, we're going to be looking
at taking the tube out, celebrate the birthday,
get some cake. OK. And then home. Thanks very much.
All right. Good to see you, sir. OK? Bye for now.
We finally got to the bottom of it.
It's not what you want to hear, but we've now got a conclusion.
There's no point in sitting down and, you know,
crying spilt milk.
You're dealt a blow and that's it.
Life deals you all kinds of blows throughout your lifetime.
But I think I'm lucky that I've got to 80,
hopefully on Sunday.
I've already told the... asked one of the nurses to get me
a birthday cake.
Ancl I'll give them a piece. You know, celebrate.
What is the most important thing for me as a surgeon and as a doctor?
I'm not interested in treating only people's disease.
I'm interested to probe a little bit further and see how much
that disease might have affected their mind, how stressed they are,
how upset they are, how optimistic they are.
Barry, he's got his 80th birthday on Sunday.
Perhaps, if he's well enough, we can send him home on Sunday.
Ancl I think a large part of our conversation
after the treatment has been clone is about lifting off
the negative thoughts that they might have.
For me, it is not about treating the body only and the disease
that they might have, but it's also treating the mind.
After six more days on the ward, Roger, is infection free.
Now the team must implant a new ICD device into his chest.
I'm feeling more anxious than I was last time.
I don't know why I'm feeling anxious.
Maybe it's just because I'm quite looking forward to getting home.
The device will be fitted, which is like an insurance package for me.
You know, if something does go wrong,
it means that I won't end up dead!
Cardiologists Chris and Andrew need to keep Roger awake
to check the device is fully operational.
The first stage is making the pocket,
which Roger's tolerating very well with a bit of sedation,
local an aesthetic.
It's always a slightly odd feeling doing them the wrong way around.
With the device now in his chest,
the lead is fed directly into Roger's heart.
From the right side, it is quite tricky to steer the lead across
into the right ventricle, which way we need it to be.
May feel some jumps and bumps there.
Got to make sure it's perfect, Rogen
With the device connected, the team must test its life-saving function
by delivering a 50 hertz volt directly into Roger's heart.
For this, he is given heavier sedation.
R0ger?
Roger, can you hear me?
So we're going to try and induce dangerous cardiac arrest type rhythm
disturbance by effectively replicating what happens
if you stick your fingers in a plug socket.
The device should detect a fast heartbeat and shock the heart back
into normal rhythm.
You all good? Let's run your checks, then.
Yeah.
Yeah, I think we're good to go if you guys are ready.
OK, so it's going to be 50 hertz coming on now.
One, two, three, four, five. On.
Device is detecting arrhythmia, it's slowed and terminated itself.
Let's just go again, please. Five seconds, coming on now.
One, two, three, four, five.
Ancl off.
Device detecting arrhythmia. It's good detection.
Device is charging.
30 joules shock coming from the device.
It'll be a little jump.
Ancl a clean termination, we're back to 8/10 beep.
Lovely. Thank you. Well clone, Roger.
Sorry you woke up with a bit of a jump there.
You just drift off back to sleep. Everything's absolutely fine.
The successful test means Roger's heart is now protected again.
Previously, he'd already had a life-saving shock from his device.
So we know he's at risk of further problems that could kill him
from a heart rhythm point of view.
So that device will give us the protection,
give Roger the protection to potentially save his life
should that happen again.
Roger, good evening. How are you feeling?
A bit sore, bit tired.
Yeah. I'm sure all those things will pass. Good.
It all went absolutely to plan.
So the device is implanted with nice result,
and the test fire was seamless. CooL
So I guess you'd like to go home? I would like to go home, yes!
Is your wife picking you up? She's coming to meet me, yeah.
Thank you very much. Bye-bye. Take care. Bye, now.
I don't just see the heart as a muscle.
The heart is a vital organ to keep that person alive.
Ancl I see it as something very precious.
So when I see those waiting lists going up,
you've got to pick that up and turn it around.
You get a fire in your belly to make things better, to improve them.
Are you going to carry my bag? Or do you want me to carry it?
I'll carry your bag.
There's been people on these wards waiting a lot longer than I have
for operations, and I think I've just been incredibly lucky
to get in and get sorted.
Thanks very much, everyone. Take care. See you later, thank you.
Bye now. See you later, bye.
Max has returned to Adelle's clinic for the first time
since his hip operation.
How are we getting on? Apart from the tantrums when he's really
felt fed up, he's generally been really well. Good.
Haven't you? So we're normally managing? Yeah. Well clone.
So, yeah, that pain that was deep in your groin,
has that got any better? Yeah.
Good.
Ancl it's not unsurprising to have pain after the surgery,
but the fact that that pain has got better is really reassuring for me.
Yeah, definitely.
How's the physio been? All right. Have you been doing your physio?
Yeah. Yeah, he's been doing it. It's fine.
The X-ray that we did today, I can't see anything
that's worrying on it.
I'm happy at the six-week mark for him to start
getting into a standing frame. Have you got it at home? Yeah.
Yeah, so I think we start trying.
Yeah. All the things he couldn't do before, which now, hopefully...
Give it to the 12-week mark before we go and do that, please!
Yeah, we will! I don't want to hit you!
Well, yeah. No, that's all the things I'm hopeful
he'll be able to get back to. Absolutely.
I'm really impressed with how much the pain has settled.
Having a child come back and they're doing much better
after you've operated on them is a lovely feeling.
It's a win for them. They've got their surgery.
It's a win for me as I've got them through that surgery,
and I still get that real feeling of joy from it.
Any problems in the meantime, let us know. Yeah. All right.
Perfect. Take care. Bye.
See ya. He's clone really well.
Haven't you? Yeah. Superstar!
We'll start to plan for the bigger holiday later in the year,
when he can cope with that flight. Cos obviously it's a long flight.
How long does it take, Max, to Australia? 24 hours. 24 hours.
Every case that you do manage to get through the doors and into recovery
and onto the ward, it does keep you going.
It does. Something has to.
At the end of the clay, you've all achieved this,
this big thing that at the beginning of the clay
we thought was potentially insurmountable.
So it's great. I love that feeling.
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