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Surgeons Life in Their Hands Season 2 Episode 8
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00:00Our cameras have been capturing the incredible teamwork of the Royal Prince
00:08Alfred Hospital for decades. Oh gosh, it's happening as the future of medicine
00:16unfolds before our very eyes. You know already it's gonna make a difference for
00:21future pro-cancer patients. Give us a hug. Lifting patients up in their
00:28darkest hour. In that operating theatre, I was reborn. My little boy asked me if we're
00:33gonna die. I just told him that I'm gonna fight. You are so welcome. I feel like it's
00:40starting to become a bit more real. Getting ready for battle. I'm not ready to die.
00:44Welcome back to RPA. On this episode, he's the world-leading cancer expert. People who
00:54previously were all gonna die. We're curing 50% of them. Dedicated to saving other
01:00people's lives. Our discoveries have changed care around the world. But this
01:05time, it's his life he'll be saving. Basically, I'm likely to die in 12 months.
01:12Jocelyn finally gets the call she's been waiting for. I just got the call for my
01:17liver transplant. But a last-minute hitch threatens everything. How are we gonna do
01:24that? And how climbing to the top. Some of my uni friends and I went bouldering. It was
01:30my first time. Put Grace under pressure. It's so broken.
01:36Today, we welcome Jocelyn from Chile, who is to be granted Australian citizenship. Many, many
01:53congratulations. 32-year-old Jocelyn has been waiting for this day since she arrived from
02:00Chile seven years ago. I fell in love with this country the moment I landed. Then, she fell
02:07in love with Michael. I'm so excited. I'm feeling Aussie.
02:13Becoming an Australian was one of my biggest dreams. And now, I've done it. And now, I'm
02:19just thinking about trying to spread. That's all I'm thinking about.
02:22Jocelyn lives with a rare liver disease which, without a transplant, will kill her.
02:28The name of my condition is primary sclerosis and cholangitis. So, most commonly known as
02:34PSC. PSC attacks the bile ducts in the liver. There's no cure. And in Jocelyn, it's so aggressive,
02:42her liver is failing fast. You usually get infections every now and then. But, last year, I had nine
02:51infections. All of which required hospitalisation. IV antibiotics and pretty much it's three to
02:58four weeks to recover from one. And I had nine of them in nine months. So, it's pretty much
03:03the whole year. These ones are gorgeous. That one. That one there. We talk about the future
03:09a little bit. I'm tired. Yeah, I know. But, not too much. A true superhero. And Michael has
03:17gone from partner to carer. Michael is my everything. She means so much to me. Since
03:23we've met, we've barely ever been apart. Like, so, for the last almost seven years, we've been
03:30inseparable. And it's hard to imagine being anywhere without her now. Jocelyn is at the
03:35top of the list for donation if a suitable liver becomes available. But, it's a big if.
03:41A transplant is a hope for life. But, at the same time, you know it comes at the cost of
03:47someone else's passing. And, that is a sad thought. That's the conflicting part that something
03:58so beautiful can come out of something, you know, so sad. So, right now I am waiting anxiously
04:08for that call. Just once we need some good luck. Yeah, just a bit of good luck.
04:15Not many of us plan our day to include a pit stop at RPA's emergency department. And,
04:21that's certainly true for 22-year-old geology student Grace, who's injured her ankle indoor
04:27rock climbing. Some of my uni friends and I went bouldering this afternoon after class.
04:32And, it was my first time. And, honestly, it's a bit lame. I was doing,
04:38like, one of the easiest climbs. And, I just kind of slipped. And, I think I smacked my foot
04:42against the, um, the wall. Very obvious deformity there. Very weak cross there. Pop this iceberg.
04:50Thank you. We're going to go to order x-ray now. Okay.
04:53Um, it's very likely to be a fracture. Oh. And, keep yourself a new, not eating,
04:58drinking by mouth, just in case we need some procedure. Okay? Jesus, okay. Yeah.
05:03Is it likely to need procedures? It will be very likely, if it depends on the fracture. Okay.
05:09Yeah. Depends on the x-ray. Okay. Don't be nervous. We'll be here to help you. Okay?
05:13Okay. Thank you. Yeah.
05:14The x-ray soon confirms Grace's worst fears. I'm so broken. ED Dr. Jane Ripley is called upon to
05:24examine Grace's injured ankle. Can you feel me touching it? Yes, I can. Yeah. Yeah,
05:29I haven't lost any sensation. Good. I can feel everything. Your foot feels nice and warm. That's
05:33good. Can you move your ankle? Not really. Not really. Actually, I can get a little bit forward,
05:37backward. Yeah, good. I fear you're about to tell me it's broken. It's very, very broken. It's the
05:43bottom of your ankle and your foot, the talus that's broken. Sorry. The talus is a small bone
05:49that sits where the foot and ankle come together. We're going to put your ankle back into the right
05:53position, which might be quite painful because it's in the wrong position at the moment. So,
05:58we're going to do a lot of pulling and obviously that's really sore and we need an operation,
06:03I think. Okay. Oh dear. Okay. It's not the news Grace was hoping for.
06:13Professor Richard Scoglia has worked as a pathologist at RPA for 25 years. How are you going?
06:21Good to see you. The enthusiastic 56-year-old is also co-director of the Melanoma Institute
06:30with close friend and medical oncologist Dr Georgina Long. And so at this point you guys are
06:37practicing the cutting of the blocks and then I actually need to get ready for the panel. Perfect.
06:41They are world leaders in Melanoma, responsible for halving death rates of the deadly cancer.
06:47It'll never be perfect, this sort of data. So does that mean you have to look at every...
06:51Yeah and decide what are we going to do? I'm incredibly proud of what our team has done
06:58and contributed to Melanoma, changed the field basically in many respects and some of our knowledge
07:06has been used and has transformed many other forms of cancer. Yeah. Here's a good one to have to look at.
07:12Richard led the whole classification of the immune cells. What does it mean to activate your immune system?
07:18So our partnership is built on that working together, me being the drug doctor basically,
07:26thinking of the nuances, the side effects, the risks and then Richard is the lead in terms of assessing
07:34whether it's working or not. Richard is invited to speak at medical conferences all over the world
07:41and recently took wife Katie to Poland with him when tragedy struck. We did this incredible walk,
07:48incredible scenery. The next day I came back down and had a headache, I was a bit vague and then
07:56and then I had a seizure. If I'd have been traveling on my own, which now I go to a lot of conferences to
08:02lecture and usually I'm staying in the hotel room on my own. If I had a seizure on my own,
08:06I could well have died in that room. Rushed by ambulance to a hospital in Krakow,
08:14an MRI scan was done and the images immediately sent to Georgina back in Australia. When I first
08:21saw the scans, I thought this is an unusual lesion in the brain. I need to ring Brinda Shivalingham.
08:31As soon as trusted colleague and respected RPA neurosurgeon, Dr Brinda Shivalingham, saw the scans,
08:38the worst scenario started to play out. I knew straight away what we were dealing with. It was
08:44devastating. The, you know, to look at that, that MRI of Richard's brain that night and knowing what it
08:53was, um, yeah, I felt awful. Everything she'd said absolutely happened was true. I felt sick.
09:03Glyoblastoma is about the worst cancer you can get. So I knew what that meant and that meant certain death.
09:13In a cruel twist of fate, the man whose work had saved so many lives was now faced with losing his own.
09:21Basically, I'm stuffed with this tumour. I can't be cured from it with the standard treatment protocol
09:28that hasn't changed in 20 years. I'm likely to die in 12 months or maybe a little bit longer,
09:34a little bit shorter. But basically, I'm not, I'm not going to survive.
09:38I just went into grief immediately and was, uh, more than just crying. It was
09:47like an ache, a screaming, not a scream, a hollow sound like the air had just been punched out of me.
09:56But before the renowned pathologist was even back in Australia, Georgina had devised a radical plan to
10:03shake things up and Richard was on board to become a human guinea pig. We know from our melanoma work
10:09that giving immunotherapy while there's tumour still on board stimulates the immune system more
10:15to recognise and kill off tumour cells. So that was the idea what Georgina had. Let's give it a crack
10:21in brain cancer. Never been tried before with multiple immunotherapy drugs together and see if it worked.
10:29Richard, you're being summoned. Still reeling from Richard's diagnosis, his closest friends
10:37immediately flew in from around the world to join him, his wife and three teenage children and hear
10:43first hand about his daring plan. Anyway, it's a long shot, but from my perspective, it's a shot I
10:50want to take and, um, and a miracle might happen for me. And if it does, it will then flow on for,
10:56for many other patients. There's a chance that I'll, um, you know, I'll lose my, um, my faculties from,
11:04from having a bigger chunk of my brain chopped out. So it felt like a good opportunity to have a get
11:09together tonight and, and to say thank you. Ultimately, you know, your family's the most important thing.
11:17I'm not ready to die. Um, I love my life and to, to think that my, that I may well not be around when,
11:30when they're still relatively young. Um, it's, makes me feel really sad and for me not to be there with
11:38Katie when, for, as we get older. Yeah. Sorry. Makes me feel really sad.
11:5722 year old geology student Grace is about to have her ankle bone realigned after a mishap,
12:04rock climbing with friends. Got fluids, running, got drugs.
12:10Kaz, I'm giving 50 mics of fentanyl. This is just pain relief, okay?
12:17Dr. Karan Sandhu is the orthopedic registrar overseeing Grace's procedure.
12:22The priority is to get it back into place, because if we don't, it can put pressure on the,
12:26the blood vessels, the nerves and also the skin and it can break down.
12:29The next one is going to be the medication to put you to sleep. Oh, cool.
12:32Think happy thoughts. Think of a holiday. Yeah.
12:35I'm just going to lift your jaw up a little bit, Grace. That's it. Nice bit of grass.
12:39With Grace awake, but sedated, Dr. Sandhu can begin repositioning her ankle bone.
12:45Ah, okay. You're okay. Deep breath.
12:47Ah, ah, ah, ah, ah. I'm going to give another extra 20 of fentanyl coming in.
12:52Some more good pain, pain, pain drugs, yeah?
12:55You're doing really well, okay. We're just going to give you some more pain medication.
12:58Sometimes the medications that we give can drop the blood pressure,
13:01um, so we're just watching all of them to make sure that she's stable, um, and has a safe airway.
13:07Grace. Grace.
13:11Yeah, you take big deep breaths, okay?
13:14I'm just going to try a little bit, see how she goes. She might still be a little sore.
13:17Oh, oh, oh. Nice big deep breaths.
13:20Oh, big deep breaths. That's okay. Just focus on that breathing. That's okay.
13:25Good job. Good job. Well done.
13:28You're just doing an x-ray now. You've done such a good job.
13:32X-ray. Now back where it should be, the ankle bone's position is checked
13:36before fitting Grace with a plaster cast.
13:40Oh, sorry.
13:41You're doing such a good job. Nice big breaths.
13:45Are you itchy nose?
13:51You're okay, Grace.
13:53Okay, still just having your procedure, okay? Almost done.
13:56Almost done. Almost finished.
13:57Just putting the cast on now, okay?
13:5920 minutes of prayer before going in.
14:01It's okay. You're all right.
14:04You're okay.
14:08We're done, Grace, okay?
14:11So it's almost time to wake up anyway.
14:13Yeah.
14:13Oh, thank you.
14:14Yeah.
14:15You're welcome.
14:21That's good stuff. I didn't hear any of that.
14:27Oh, that's good.
14:29Having patients like Grace who appreciate what we do
14:32just brings a smile to my face and makes the shifts better.
14:37Feeling all right?
14:38I'm feeling good, thank you.
14:40So in terms of the fracture and the minor dislocations that you had,
14:44everything's back straight to where it should be.
14:46Oh, thank you.
14:47So it should help you with your pain as well now that you're in the plaster
14:50because things won't be moving around like how they were.
14:52Yeah.
14:53While the realignment is done,
14:55surgery to repair the damaged joint will not be happening today.
14:58So plan going forward is we're going to admit her to the ward,
15:01get a CT scan and then we can plan her surgery accordingly.
15:09I worked as a CMO at a private hospital when I was a registrar on camera for a while.
15:19Yeah.
15:1956-year-old world-leading RPA pathologist Richard has been diagnosed with a catastrophic brain tumour.
15:27Life expectancy, 12 months.
15:31Thanks very much.
15:32That's all right.
15:32Yeah, good luck with your career.
15:34Yeah, good luck with your career.
15:36Richard and close friend, melanoma oncologist Dr Georgina Long,
15:40are planning a world first to tackle his disease.
15:43The normal treatment for Richard's type of glioblastoma would be surgery,
15:49followed by radiotherapy for six weeks, combined with chemotherapy for six weeks,
15:56and then ongoing chemotherapy for another four and a half months.
16:00And chemotherapy is not good for the immune system.
16:04Okay, I think we'll be starting.
16:08But this human guinea pig isn't starting with surgery to cut out his tumour.
16:13Rather, Richard's experimental treatment begins with immunotherapy drugs.
16:17These are drugs that are given through the vein, can take 30 minutes to 60 minutes.
16:22And what they do is they uncover the cancer to the immune system.
16:27Think of the cancer as having an invisible cloak over it.
16:32And with these immune drugs, that invisible cloak is sort of taken away.
16:39So that the T cells or the immune cells can become activated against the cancer.
16:44So we're away there. Thanks guys for setting that up.
16:48But the bulk of Richard's brain tumour will still need to be surgically removed.
16:54So a few days after his first dose of immunotherapy drugs,
16:58he's discussing with neurosurgeon Dr Shivalingham her surgical plans.
17:02It's going to get tricky.
17:05And that's because of these sort of the tentacles of cells that spread away from the main area of the tumour.
17:13That you can't see on radiology.
17:14Not really.
17:15Even intraoperatively, you can't really see.
17:17They're so sneaky, these things.
17:18Intraoperatively, you definitely can't see them.
17:21On MRI, we get a sense that there is a bit of a trail of something going down,
17:28what we call the hippocampus, which is important for your memory function.
17:32I can safely remove all of this.
17:37And I would not go back into the hippocampus, which is likely to cause you problems.
17:43We want Richard to say Richard, you know.
17:46It's very exciting because I've been wanting to do this or bring immunotherapy into the spectrum
17:54of glioblastoma for a long time because of what I saw in melanoma.
18:01And it's been very difficult to get a trial up and running.
18:04Brenda, there's no neurosurgeon I could trust more than you to be operating on my brain.
18:08I feel very fortunate to have you as part of the team here looking after me.
18:13So thank you so much.
18:15Hi, everyone.
18:17I thought I'd give you an update of where things are up to with me.
18:20Hey there.
18:21From day one, Richard has chosen to share his brain cancer journey on social media,
18:26including the terrifying moments pre-surgery.
18:29I guess in truth, I'm anxious and nervous about how it's going to turn out.
18:34But I know I'm in great hands with a great team of people and yeah, just fingers crossed it all goes well.
18:42Thanks for listening in.
18:4632-year-old Jocelyn is dying from liver failure.
18:51At 4am, the call she and partner Michael had been waiting for came through.
18:56It's been a long wait. It's felt really, really long.
19:01A donor liver has been found and not a moment too soon.
19:06I just got the call for my liver transplant.
19:09She said there will be a bed for me just to come to this level, but I don't know.
19:13But before they get too excited, the organ must be a perfect match.
19:18Hello, Jocelyn. Hi.
19:20I'm Susan. I'm the liver transplant coordinator. Thank you for coming in.
19:24It was Susan Virtue who made the phone call.
19:27It is the best phone call I get to make. It's really rewarding.
19:32The reactions always vary, but in Jocelyn's case, there were a few tears and, you know,
19:38it was a really, really heartwarming time. And she said, yes, I've been waiting for this for so long.
19:45Fingers crossed we go ahead. We're happy with the donor on paper.
19:50It looks good on paper means that the donor is a good match for her. So the right blood group,
19:57they're also a good size match for her. And there wasn't anything in the history that was very
20:02concerning medically. All right, come on through.
20:06You're just going to do your bloods, observations, do a checklist ready for theatre, some swabs.
20:12Yep. A chest x-ray and an ACG as well. It's going to be a long day, isn't it?
20:20There's still a lot of jumping through hoops before anything can proceed.
20:24Still sort of pinching myself. At this point, nothing is certain.
20:2822-year-old Grace is about to have her ankle surgically repaired after breaking it yesterday
20:41whilst rock climbing. Hey, Grace. Morning. How are you?
20:44I'm good. How are you? Good. All ready to go? Yep. Ready and ready.
20:50It was displaced beforehand. Dr. Sandhu did an excellent job, along with the emergency staff,
20:56in putting the fracture back into a position that meant that her chance of getting long-term
21:02problems was very low. So most of the hard work was done by him. Dr. Sidhu will be assisted by Dr.
21:10Sandhu as they repair Grace's badly broken bone. So initially, we're just going to pin the Taylor
21:16fracture in the right position. You don't want it to be moving around, right? So just getting x-rays to
21:23check the position of our wire. It's pretty central. It's pretty good. So now, because I've got it pinned,
21:30we're going to put a plate and screws on the lateral side of the fracture. We shouldn't need a
21:34big incision here. So just exposing the lateral Taylor neck. I think there's a vessel there and I
21:41don't really want to cut that because that could be something important. So that's our fracture down
21:46there. If you have the small plate, it's a plate for the Taylor neck. Put the screws in. Okay, let's have a drill.
21:58The two mil screws.
22:13That's looking better in terms of plate position. Fracture reduction looks good, guys.
22:19Let's get some x-rays to come out. X-ray.
22:26Looks great. And again, thanks. Shot there. The fracture's sitting in a good position.
22:35Just going to put a couple of more screws on. And then it should be done. Let's have a 28,
22:42thanks. Actually, make it a 30. Let's go for gold. While the surgery has been a success,
22:48a lengthy recovery process is expected for Grace to give her fractured ankle time to heal.
22:54She'll have to stay off it for about eight weeks. But the whole recovery will take about a year.
23:00So non-weight bearing and then she'll start physiotherapy. And then to get her strength back,
23:04coordination and movement will take up to a year afterwards.
23:0956-year-old RPA melanoma expert Richard Scoglia is creating medical history.
23:27In a world first, he was given immunotherapy drugs before having his own deadly brain cancer removed
23:36just over a week ago. Hi, everyone. It's Richard Scoglia here. Good to see you all. I'm now up to day nine,
23:43postoperatively after my most recent craniotomy. Um, yeah, gradually getting my energy back and
23:52starting to feel better. Um, here you can see the scar. I had my sutures taken out today and
24:00things seem to be healing up well. Right by his side is trusted friend and colleague, Dr. Georgina
24:07Long, who's mapped out a radical treatment plan based on the success they've had in treating
24:12melanoma cancers. So you had a biopsy, you had combination immunotherapy, you had resection of
24:18the tumour. And so that was delayed so that you could have immunotherapy and it could have an effect
24:24on the tumour. But people were a little bit nervous about, um, delaying it because sometimes it can go
24:29bad in that short period of time. And we discussed at length delaying it further. We would have liked
24:34to have delayed a little longer, but in the end we had a compromise. Yep. And then following that,
24:40more immunotherapy with radiotherapy. Just popping that on now and then coming down nice and snug now.
24:47Yeah, that's it. That's how I like it. Yeah, beautiful. That's all in. Yeah, I really feel
24:52good about it when it's really tight. It sort of gives me confidence that those beans are going to
24:57be getting the exact part of my brain that the radiation oncologist has mapped out. That's all
25:04finished, Richard. I'll get the mask off. Following the radiotherapy, that will take six weeks.
25:10Richard will have more immunotherapy and we are going to give him a personalised vaccine.
25:17It's an incredibly gruelling treatment regime. But Richard is committed to his role as a human
25:23guinea pig. I accept that there are some risks associated with it. I could die sooner and I could
25:31live for the same amount of time but be left with some debilitation. That means I can't enjoy my life
25:37how I would. But, um, I don't know, weighing all those things up, it just feels right to me to go down
25:44this journey. With such a never-say-die attitude, Richard is soon back at work chairing meetings
25:51at the Melanoma Institute. So welcome everyone to today's multidisciplinary team meeting. Jonathan,
25:56would you like to present your case? I don't know how to function. And more importantly for the fitness
26:00team members, if you're not back into training. Your body gets stressed by treatment, surgery,
26:06radiotherapy, drug therapy. And to have your body fit and healthy, it can, I think, I feel I can cope
26:15better with the stresses that I'm going through. People have told me, don't, don't push too hard
26:21because if your body temperature goes up too much, you can have a, have another seizure.
26:29Hello. Despite undergoing surgery earlier today to fix her broken ankle,
26:3622-year-old Grace is already up to receiving visits from her nan and mum.
26:41Has the doctor come? No, so the doctor will come and see me at some point and sort of explain
26:48what they did. Um, and then I think the physiotherapists will come in tomorrow.
26:53Okay. Uh, and then I think if I'm, yeah, stable on my crutches, they're happy for me to, to go home.
26:58Oh, that'd be great. Yeah. Hard to believe that one day you're about having fun,
27:03and the next minute you're, the fun's just taken away temporarily.
27:07Ah, no. Listen, I'm still having a good time. This hospital's been very relaxing.
27:13It's just been a bit of an experience. Dr. Sidhu, Dr. Corinne have all been so lovely.
27:20All the nurses have been beautiful. Oh, that's great. You're very lucky.
27:23I'm very grateful for everybody. That's wonderful.
27:26Put me back together. That's wonderful. Yeah.
27:28Yeah. No more bouldering. Yeah, stick to bouldering.
27:30Yeah, stick to bouldering rather than bouldering.
27:32Yeah. All right. We'll, we'll make tracks now, my darling. Sounds good.
27:37Aw, thank you for coming. Lovely to see you.
27:38Nice to see you. Nice to see you.
27:39This hospital in your home. Thank you. Yeah, that'd be lovely.
27:43Good. Thanks, Nan. All right, my darling. Love you.
27:45I'll see you tomorrow. Yeah, that'd be nice. Thanks, Ma. Thanks for coming to visit me.
27:48Bye-bye. No worries. Okay, have a good night. You too.
27:50Be kind of those good-looking doctors, okay? Bye.
27:53Bye. But Grace's Nan's not finished yet. I've finished, I'm all right.
28:0432-year-old Jocelyn has been waiting years for a new liver. Now more than eight nerve-wracking
28:10hours after receiving the call, she's finally about to receive her life-saving gift.
28:17Ready to work late into the night, Dr Henry Pless leads a large surgical team.
28:22The average is about five and a half hours if it goes well and it's straightforward, but
28:26yeah, you could be eight hours easily. We'll know from the beginning, you know,
28:30from almost the skin incision with the blood loss, so we'll have a rough idea whether it's going to
28:35be straightforward or more like an eight to ten hour case. As far as I know, the liver isn't here yet,
28:40but it's close to being on its way, so it's not that far away. The hardest part usually is removing
28:47the diseased liver, which often takes us two or more hours. So once we've got that diseased liver out,
28:52close to the sort of completion of that part, then often we try and time things so that the
28:57liver, the new liver has arrived and is prepared, ready for us to plum in. So we're trying to minimise
29:02that storage time. So literally the new liver is stored in always as short a time as possible,
29:07so we can put it straight into Jocelyn. Assisting Dr. Pless is fellow transplant surgeon Dr. Pram
29:14Siramana. It's an octo. She's had recurrent cholangitis. Okay. She's got an MRI. So she's got a
29:20big liver. That's inconvenient. Yeah. It's a massive huge left lateral section. Massive left lateral,
29:27yeah. Big spleen. Yeah. Exhausted and emotional, Jocelyn's partner, Michael, is in for the long
29:34haul. I haven't slept since yesterday. Well, my biggest worry is that something in the surgery
29:40doesn't go to plan. Yeah. I think it's going to be a long night.
29:45All we can do is our best, but you also need some luck in healthcare. I'm a great believer in feet,
29:54but we'll try and give her a good feet, if you know what I mean. So we'll do our best.
29:58So are you happy for us to cut a hole? Yeah. Okay. Doctors Pless and Siramana have been notified the
30:05new liver is now en route, so they can prepare to remove Jocelyn's diseased liver. Well, we've come
30:11through the skin okay, but the liver, it's very enlarged, it's cirrhotic, and we've got these huge
30:17blood vessels, which we've sort of tied some of them off. Okay, guys, liver is here.
30:25Still divided the bowel back.
30:31With all the inflammation, it's all distorted.
30:35The liver's just arrived, they're just preparing it. There's not usually too much preparation,
30:44because it's actually already been split. So we know that part of the liver's been taken off for
30:49another patient in another hospital. Because they can regenerate, donor livers are sometimes divided into
30:57two, each part sent to a separate recipient. So today, two people will be given a second chance at life.
31:05Does it look like a nice liver, don't it? Yeah, it's a nice liver. How tiny is the artery?
31:14The donor liver artery is not the same size as Jocelyn's receiving artery. It's a complication that
31:22could spell disaster when Dr Pless tries to connect the new liver.
31:3256-year-old Richard, the world's leading melanoma pathologist and brain cancer patient,
31:38has just been rushed by ambulance to the ED. A training session on his treadmill at home
31:45appears to have triggered a seizure. My partner Katie came in and found me and said,
31:50you know, you're not right or you don't look that good. There we go. That's a bit better.
31:54I must have passed out during that period. I don't remember exactly, but I remember her coming back
31:59in and waking me up. Yeah, I think your wife's had enough of you, so fair enough. While Richard gets
32:06an MRI scan... Okay, the next scan will go for four minutes now. ...fellow melanoma expert Dr Georgina
32:12Long and neurosurgeon Dr Shivalingham rushed to the ED. Hey, Brenda. How are you? How are you?
32:22Why are you scaring us? We would not be happy if we saw bleeding, if we saw recurrence of the tumour,
32:29or if we saw swelling or a side effect from the combination of radiotherapy and immunotherapy.
32:35This is the space where the resection was, and here there's absolutely nothing kind of enhancing
32:44anywhere. You know, the rest of your brain looks just normal. No swelling, nothing at all.
32:51So you're just tired and pushed yourself maybe? I think you just pushed yourself a little bit too
32:54hard. You may have had a tiny seizure. The relief is immediate, and not just for Richard. It keeps his
33:01experimental brain cancer treatment plan alive. I haven't shown you the data, have I? Have you
33:06seen the data? No. I've got it right here, if you want to see it. It's pretty amazing. Amazing
33:13doesn't even start to describe it. Georgina shows Dr Shivalingham proof that only 12 days after Richard's
33:20first dose of immunotherapy drugs, his brain tumour was flooded with immune or T cells, ready to do battle
33:27with his deadly cancer. We were not expecting that. We were so excited when we saw that influx.
33:3312 days after giving drug, we see the drug all bound to the immune cells. The red is the tumour,
33:39and then the blue is the immune cells. So the first thing you can see is we see a lot more immune cells
33:45in ratio compared to the tumour. Gosh, that data is so impressive. It's amazing. Yeah, it's amazing.
33:51I've seen the immunotherapy effects in melanoma and how the treatment has changed vastly and patient
34:00outcomes have just considerably changed. And that is something that has been lacking in glioblastoma
34:06for 25 years. So I've been waiting for this. And so fingers crossed that we keep going on this path
34:14and things keep working for Richard because it will revolutionise what we do. Dr Shivalingham is
34:20happy for Richard to go home, but with a caution to monitor his exercise more closely and rest when
34:26he needs to. Well, thanks, Brenda. Thanks, Georgina. No problems. I'm glad you're feeling better.
34:33And you can go home. We will now continue the immune therapy and we will also be adding
34:43what we've termed at this point an immune kicker, like a vaccine personalised to the tumour.
34:50I could die earlier. I could get side effects that would make the rest of my life more miserable and
34:56less functional. But the upside is that I can make a difference. It may not make a difference to me
35:04personally, but we'll make research discoveries which will open the field up. And to be honest,
35:11I know we already have done that.
35:20Two hours into a six hour transplant operation, surgeons are close to removing
35:26Jocelyn's diseased liver. Oh, the liver is severely cirrhotic. It's massive. It's really stiff.
35:34We've actually, fortunately, despite struggling, made some good struggles.
35:38I just promise we're doing a great deal, Piers.
35:41Thanks very much. Thank you.
35:42The contrast of the new pink healthy liver to Jocelyn's diseased one could not be any more stark.
35:50That's good. There's the liver. Oh, that's in the bucket.
35:5520 minutes later and it's out. It's like a baby basically.
36:00OK, so there's a big space now. There's no time to lose hooking up all the important veins and
36:05arteries to the new liver. And Dr. Pless has already discovered the size of one of the arteries
36:11is not a match. This is our artery. It's so small.
36:15Barely got a lumen, you see that little tiny artery there. So that's what we've got.
36:20And that's a critical joint. So we'll be taking a lot of care on that one.
36:24What about three millimeters? OK.
36:30Liver out of ice just now.
36:34Whilst we're doing these joints, the liver has no blood supply, so it's getting damaged. So
36:37obviously you're sort of under a lot of time pressure. So most of surgery,
36:41you're never operating under time pressure, but transplantation absolutely minutes matter.
36:46So we're really trying to do this joint as quickly as we can. If you spend hours,
36:50then the patient, you know, has a higher chance of dying.
36:55So cable clamp's off there. Cable clamp is off.
36:59So three hours after the transplant surgery began, and only 17 minutes after the new liver
37:06was taken off ice, Jocelyn's veins are now connected. So we're hopefully going to see the
37:11liver change colour in another few seconds. And then portal venous clamp is off now.
37:16So you should see the liver change colour, you see. It's got a nice pink colour there.
37:26Now everyone's attention switches to the mismatched artery.
37:30We're just trying to make the arteries reach each other because the donor artery is very short.
37:39How are we going to do that?
37:42After an illustrious career spent curing others of melanoma cancer, one of RPA's favourite sons,
37:48Professor Richard Scoglia has a deadly brain tumour himself, diagnosed just three months ago.
37:55I'm just going to do a quick blood test for you. A quick blood test.
37:58His treatment has never been tried before anywhere in the world.
38:02The last week's probably been the toughest for me so far during my cancer journey.
38:07I've been tired, lethargic, just not the same energy level that I've had. So this is after I had a
38:13partial seizure a week or so ago and my anti-epileptic dose was increased and
38:20a variety of side effects you can get from these, so it could be related to that.
38:26Seven more to go. Despite the seizure, Richard is determined to hit their next
38:31experimental treatment milestone today. So vaccine day. Yes. We've got the vaccine.
38:38It's been a bit of organising. You've had the blood tests.
38:42Yes. Blood tests, urine. We've had stool sample collected.
38:46Excellent. So... ECG.
38:48OK. Excellent. Thank you.
38:51Now, who's going to have the joy of popping the needle in?
38:54Maria.
38:58There we go.
38:59It expires at 6.30 tonight.
39:02Dr Georgina Long and the team analysed the tumour removed from Richard's brain.
39:07And using the scientific data, a personalised vaccine has been developed to further boost the
39:14immune reaction against his cancer cells. So you've just had an intramuscular injection.
39:20OK. So the needle went right deep into the muscle and the vaccine went into the muscle,
39:25which is how most vaccines are delivered. Human guinea pig Richard will be given a total of 10
39:30personalised vaccines at varying intervals across the next 15 months and continue with his immunotherapy.
39:38Bye. See you.
39:41What does success look like if for 10 months we're seeing no recurrence on his scan? That's success.
39:48That's success. But we're not there yet. So...
39:52Oh!
39:53Does that mean I won?
39:54Nah.
39:55I put heart.
39:56You have to put green.
39:57Green!
39:58In the meantime, Richard wants to enjoy each day as it comes
40:03and spend as much time as possible with his three kids, Emily, Lucy and Matt.
40:09Do you remember last time we played this game, Dad? You pretended not to know how to play and then you won.
40:14That was just luck.
40:16I'm sure the special times that come up will drag out some feelings that, you know,
40:26maybe this is the last time, but yeah, you know, that's life. You've got to make the most of the
40:32good times and celebrate and enjoy them. Unfortunately, my liver function tests have gone up a bit,
40:39so immunotherapy tomorrow's been deferred. We'll do the blood tests again next Wednesday.
40:46And if they're good, you go ahead?
40:47Yep, on Thursday.
40:48And if they're bad, how long do you have to wait again?
40:50I don't know. Speak to that. World expert in immunotherapy, Georgina.
40:54We got this one, Dad.
40:55Yeah!
40:58The dynamic duo of Richard and Georgina have already saved the lives of thousands of melanoma patients across the globe.
41:06Any other discussion about this particular case? No.
41:09Now, with Richard as the human guinea pig, the pair may not save his life,
41:14but their groundbreaking work with deadly brain cancers will save the lives of thousands more.
41:20I'm not going to go down without a fight. I think there definitely is a chance. And the data that
41:26we've generated so far gives me optimism. It's not proof, but it gives me optimism. And it'd be,
41:34wow, how fantastic would it be if I'd beat this wretched cancer?
41:44Surgeons are six hours into a liver transplant to save the life of 32-year-old Jocelyn.
41:49I think it's okay, actually. Yeah, it's okay.
41:52The new liver is in, but Dr Pless is struggling to connect an important artery.
41:57So we're going to have to use some extra vessels from the donor to bridge the gap between the donor
42:07artery and the recipient artery.
42:10Fortunately, it's protocol that additional arteries from the donor are supplied along with the new liver.
42:15Do you feel a scale reach? Maybe where we want it to be?
42:19Yeah. And I guess if we do it... We could do it that way, yeah.
42:21So we're just trying to prepare this length of artery that will fill the gap as it works.
42:26Despite a blood supply to the liver, they must attach the artery so the liver doesn't fail.
42:33All you can do is your best and sometimes in, you know, health, sometimes your best isn't good enough.
42:37So I think you actually need some kind of good fortune. Things need to go well.
42:42We just have to hope that that's good enough for her.
42:45Wow, it's hard to see. Oh, it's horrible.
42:48The artery is like one of the smallest adult arteries I've ever seen.
42:52Um, okay. So we've redone all the blood vessel joints.
42:55Okay, lots of wash, thanks.
42:57It wasn't easy, but the artery is now connected to Jocelyn's liver.
43:01Yeah, I mean, the guy, they're just finishing off the skin there.
43:07No, I mean, it's gone well. It's a tough case. I mean, that's, what, seven hours?
43:11We've got evidence that the liver's working, so we're happy.
43:15Now, 2am, there's only one more important task left for Dr Pless.
43:22Hello?
43:23Hello, is that Michael?
43:24Yeah.
43:25Yeah, this is Henry Pless. I'm just one of the surgeons at RPA.
43:29Just to let you know that everything's gone well with Jocelyn.
43:33Great.
43:33Okay. So, you know, it's taken us a while, but, but, you know,
43:37could have been a lot worse. Okay. So, so far, so good.
43:41So good to hear. Thank you so much.
43:43No worries. Nice to talk to you.
43:48Two weeks after surgery.
43:51Bye guys.
43:51See ya.
43:52Thank you so much for everything.
43:55Michael is thrilled his girlfriend can come home.
43:58I just can't believe how quickly she's recovered.
44:01It's only been a couple of weeks since surgery,
44:04and already she's looking so much better.
44:06It's hard to imagine just how much things could change so quickly.
44:09There's still a long road ahead, and Jocelyn will remain on anti-rejection medication
44:15for the rest of her life.
44:16I feel great. I got a new liver. I got a new life. I got a new future to look forward to.
44:26Couldn't be happier.
44:27Tell me.
44:35I'm
44:38Mom.
44:38I want to say that.
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