- 3 tháng trước
Surgeons: Life in Their Hands - Season 2 Episode 8
Danh mục
😹
Vui nhộnPhụ đề
00:00Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
00:30Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
01:00Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
01:29Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
01:59Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:29Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:31Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:33Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:35Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:37Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:39Để không bỏ lỡ những video hấp dẫn
02:41Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:43Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:45Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
02:47Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
03:17Để không bỏ lỡ những video hấp dẫn
03:47Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
03:49Hãy subscribe cho kênh lalaschool Để không bỏ lỡ những video hấp dẫn
04:03So right now I am waiting anxiously for that call.
04:09Just once we need some good luck.
04:10Yeah, just a bit of good luck.
04:14Not many of us plan our day to include a pit stop at RPA's emergency department.
04:20And that's certainly true for 22-year-old geology student Grace,
04:25who's injured her ankle indoor rock climbing.
04:27Some of my uni friends and I went bouldering this afternoon after class.
04:32And it was my first time.
04:34And it's a bit lame.
04:38I was doing like one of the easiest climbs and I just kind of slipped.
04:41And I think I smacked my foot against the wall.
04:45Very obvious deformity there.
04:48Very weak pulse there.
04:50Pop this ice back.
04:51We're going to go to order x-ray now.
04:54It's very likely to be a fracture.
04:56Keep yourself and you not eating, drinking by mouth,
04:59just in case we need some procedure.
05:01OK.
05:01Jesus, OK.
05:02Yeah.
05:03Is it likely to need procedures?
05:05It will be very likely if it depends on the fracture.
05:08OK.
05:09Yeah, depends on the x-ray.
05:10OK.
05:11Don't be nervous.
05:12We'll be here to help you.
05:13OK.
05:14Thank you.
05:14Yeah.
05:15The x-ray soon confirms Grace's worst fears.
05:20I'm so broken.
05:22ED doctor Jane Ripley is called upon to examine Grace's injured ankle.
05:27Can you feel me touching her?
05:28Yes, I can.
05:29Yeah?
05:29Yeah, and I haven't lost any sensation.
05:30I can feel everything.
05:31Your foot feels nice and warm.
05:33That's good.
05:33Can you move your ankle?
05:34Not really.
05:35Oh, actually, I can get a little bit forward, backward.
05:38Yeah, you could.
05:39I fear you're about to tell me it's broken.
05:41It's very, very broken.
05:43It's the bottom of your ankle and your foot, the talus that's broken.
05:46Sorry.
05:47The talus is a small bone that sits where the foot and ankle come together.
05:52We're going to put your ankle back into the right position, which might be quite painful
05:56because it's in the wrong position at the moment.
05:58So we're going to do a lot of pulling.
06:00And obviously that's really sore and we need an operation, I think.
06:04OK.
06:05Oh, dear.
06:07OK.
06:08It's not the news Grace was hoping for.
06:14Professor Richard Scoglia has worked as a pathologist at RPA for 25 years.
06:20How are you going?
06:21Good to see you.
06:23The enthusiastic 56-year-old is also co-director of the Melanoma Institute
06:29with close friend and medical oncologist Dr Georgina Long.
06:34And so at this point you guys are practising the cutting of the blocks
06:39and then the IHC to get ready for the panel.
06:41They are world leaders in melanoma,
06:44responsible for halving death rates of the deadly cancer.
06:48It'll never be perfect, this sort of data.
06:50Does that mean you have to look at every...
06:52Yeah, and decide what are we going to do?
06:53I'm incredibly proud of what our team has done
06:57and contributed to melanoma,
07:01changed the field basically in many respects
07:04and some of our knowledge has been used
07:07and has transformed many other forms of cancer.
07:10Here's a good one to have a look at.
07:12Richard led the whole classification of the immune cells.
07:15What does it mean to activate your immune system?
07:18So our partnership is built on that working together,
07:23me being the drug doctor basically,
07:26thinking of the nuances, the side effects, the risks,
07:30and then Richard is the lead
07:32in terms of assessing whether it's working or not.
07:36Richard is invited to speak at medical conferences all over the world
07:41and recently took wife Katie to Poland with him when tragedy struck.
07:45We did this incredible walk, incredible scenery.
07:50The next day I came back down and had a headache,
07:54I was a bit vague, and then I had a seizure.
07:58If I'd have been travelling on my own,
08:00which now I go to a lot of conferences to lecture
08:03and usually I'm staying in the hotel room on my own,
08:05if I had a seizure on my own,
08:08I could well have died in that room.
08:11Rushed by ambulance to a hospital in Krakow,
08:14an MRI scan was done
08:16and the images immediately sent to Georgina back in Australia.
08:20When I first saw the scans,
08:22I thought, this is an unusual lesion in the brain.
08:29I need to ring Brinda Shivalingham.
08:31As soon as trusted colleague and respected RPA neurosurgeon,
08:36Dr Brinda Shivalingham, saw the scans,
08:38the worst scenario started to play out.
08:41I knew straight away what we were dealing with.
08:44It was devastating.
08:45The, you know, to look at that MRI of Richard's brain that night
08:51and knowing what it was, yeah, I felt awful.
08:57Everything she'd said absolutely happened, was true.
09:02I felt sick.
09:04Glyoblastoma is about the worst cancer you can get.
09:09So I knew what that meant and that meant certain death.
09:14In a cruel twist of fate,
09:16the man whose work had saved so many lives
09:19was now faced with losing his own.
09:21Basically, I'm stuffed with this tumour.
09:25I can't be cured from it with the standard treatment protocol
09:28that hasn't changed in 20 years.
09:30I'm likely to die in 12 months
09:33or maybe a little bit longer, a little bit shorter.
09:36But basically, I'm not going to survive.
09:39I just went into grief immediately
09:42and was more than just crying.
09:45It was like an ache, a screaming,
09:50not a scream, a hollow sound,
09:53like the air had just been punched out of me.
09:57But before the renowned pathologist
09:59was even back in Australia,
10:01Georgina had devised a radical plan to shake things up
10:04and Richard was on board to become a human guinea pig.
10:08We know from our melanoma work
10:09that giving immunotherapy while there's tumour still on board
10:13stimulates the immune system more
10:15to recognise and kill off tumour cells.
10:17So that was the idea what Georgina had.
10:20Let's give it a crack in brain cancer.
10:22Never been tried before
10:23with multiple immunotherapy drugs together
10:27and see if it worked.
10:30Richard, you're being summoned.
10:33Still reeling from Richard's diagnosis,
10:36his closest friends immediately flew in from around the world
10:39to join him, his wife and three teenage children
10:42and hear firsthand about his daring plan.
10:46Anyway, it's a long shot,
10:48but from my perspective, it's a shot I want to take.
10:50And a miracle might happen for me
10:54and if it does, it will then flow on for many other patients.
10:58There's a chance that I'll lose my faculties
11:03from having a bigger chunk of my brain chopped out.
11:07So it felt like a good opportunity
11:08to have a get-together tonight
11:10and to say thank you.
11:12Ultimately, you know, your family's the most important thing.
11:20I'm not ready to die.
11:22I love my life and to think that I may well not be around
11:29when they're still relatively young.
11:32It makes me feel really sad for me not to be there with Katie
11:39when, for, as we get older, I'm, yeah, I'm sorry.
11:48It makes me feel really sad.
11:5022-year-old geology student Grace
12:00is about to have her ankle bone realigned
12:02after a mishap rock-climbing with friends.
12:06Got fluids, running, got drugs.
12:10Kaz, I'm giving 50 mics of fentanyl.
12:12This is just pain relief, OK?
12:13Dr. Karan Sandhu is the orthopaedic registrar
12:20overseeing Grace's procedure.
12:22The priority is to get it back into place
12:24because if we don't, it can put pressure
12:25on the blood vessels, the nerves and also the skin
12:28and it can break down.
12:29The next one is going to be the medication
12:30to put you to sleep.
12:32Think happy thoughts.
12:33Think of a holiday, yeah?
12:35Just going to lift your jaw up a little bit, Grace.
12:37That's it. Nice bit grass.
12:39With Grace awake but sedated,
12:41Dr. Sandhu can begin repositioning her ankle bone.
12:45Ah, OK. You're OK. Deep breaths.
12:48I'm going to give another extra 20 of fentanyl coming in.
12:52Some more good pain drugs, yeah?
12:55You're doing really well, OK.
12:56We're just going to give you some more pain medication.
12:58Sometimes the medications that we give
13:00can drop the blood pressure,
13:02so we're just watching all of them
13:03to make sure that she's stable and has a safe airway.
13:08Grace. Grace.
13:09Yeah, you take big, deep breaths, OK?
13:14I'm going to try a little bit, see how she goes.
13:16She might still be a little sore, yeah.
13:19Nice big, deep breaths.
13:21Big, deep breaths.
13:22That's OK.
13:23Just focus on that breathing.
13:25That's OK.
13:25Good job.
13:27Well done.
13:28We're just doing an X-ray now.
13:30You've done such a good job.
13:32X-ray.
13:33Now back where it should be,
13:34the ankle bone's position is checked
13:36before fitting Grace with a plaster cast.
13:40Sorry.
13:41You're doing such a good job.
13:45Nice big, Grace.
13:45Are you itchy nose?
13:48Oh.
13:51You're OK, Grace.
13:52OK.
13:53Still just having your procedure, OK?
13:55Almost done.
13:56Almost done.
13:56Almost finished.
13:57Just putting the cast on now, OK?
13:59Bernie makes it for it before going in.
14:01It's OK.
14:02You're all right.
14:04You're OK.
14:08We're done, Grace.
14:10OK?
14:11So it's almost time to wake up anyway.
14:13Oh, thank you.
14:15You're welcome.
14:21That's good stuff.
14:23I was asleep.
14:25I didn't hear any of that.
14:28Oh, that's good.
14:28Having patients like Grace who appreciate what we do
14:32just brings a smile to my face
14:34and makes the shifts better.
14:37Feeling all right?
14:38I'm feeling good, thank you.
14:40So in terms of the fracture
14:42and the minor dislocations that you had,
14:44everything's back straight to where it should be.
14:47Oh, thank you.
14:47So it should help you with your pain as well
14:49now 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
14:57will not be happening today.
14:58So plan going forward is
15:00we're going to admit her to the ward,
15:01get a CT scan,
15:02and then we can plan her surgery accordingly.
15:04I worked as a seaman
15:15when I was at a private hospital
15:16when I was a registrar on camera for a while.
15:1956-year-old world-leading RPA pathologist Richard
15:23has been diagnosed with a catastrophic brain tumour.
15:27Life expectancy, 12 months.
15:31Thanks very much.
15:32It's all right.
15:33Yeah, good luck with your career.
15:34It'll be good.
15:35Richard and close friend,
15:37melanoma oncologist Dr Georgina Long
15:40are planning a world first to tackle his disease.
15:43The normal treatment for Richard's type of glioblastoma
15:48would be surgery,
15:49followed by radiotherapy for six weeks,
15:53combined 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.
16:04OK, I think we'll be starting.
16:07But this human guinea pig isn't starting with surgery
16:11to cut out his tumour.
16:13Rather, Richard's experimental treatment
16:15begins with immunotherapy drugs.
16:17These are drugs that are given through the vein,
16:20can take 30 minutes to 60 minutes,
16:21and 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,
16:35that invisible cloak is sort of taken away
16:38so that the T cells or the immune cells
16:41can become activated against the cancer.
16:44So we're away there.
16:47Thanks, guys, for setting that up.
16:49But the bulk of Richard's brain tumour
16:51will 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
17:01her surgical plans.
17:02It's going to get tricky.
17:05And that's because of these sort of the tentacles of cells
17:09that spread away from the main area of the tumour.
17:13That you can't see on radiology.
17:15Not really, yeah.
17:16You can't really see.
17:17They're so sneaky, these things.
17:18Interoperatively, you definitely can't see them.
17:21On MRI, we get a sense that there is a bit of a trail
17:26of something going down what we call the hippocampus,
17:29which is important for your memory function.
17:32I can safely remove all of this
17:36and I would not go back into the hippocampus,
17:41which 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
17:51or bring immunotherapy into the spectrum of glioblastoma
17:56for a long time because of what I saw in melanoma.
18:00and it's been very difficult to get a trial up and running.
18:04Brenda, there's no neurosurgeon I could trust more than you
18:07to be operating on my brain.
18:09and I feel very fortunate to have you as part of the team here looking after me.
18:13So, thank you so much.
18:15Hi, everyone.
18:16I 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
18:37and, yeah, just fingers crossed it all goes well.
18:42Thanks for listening in.
18:4332-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, 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.
19:17Oh.
19:18Hello, Jocelyn.
19:19Hi.
19:20I'm Susan.
19:21I'm the liver transplant coordinator.
19:23Thank 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.
19:30It's really rewarding.
19:32The reactions always vary, but in Jocelyn's case, there were a few tears
19:38and, you know, it was a really, really heartwarming time
19:41and she said, yes, I've been waiting for this for so long.
19:45Fingers crossed we go ahead.
19:47We're happy with the donor on paper.
19:50It looks good on paper means that the donor is a good match for her.
19:55So, the right blood group, they're also a good size match for her
19:59and there wasn't anything in the history that was very concerning medically.
20:03All right, come on through.
20:06We're just going to do your bloods, observations, do a checklist ready for theatre,
20:11some swabs.
20:12Yep.
20:13A chest x-ray and an ACG as well.
20:16It's going to be a long day, isn't it?
20:18Yeah.
20:19There's still a lot of jumping through hoops before anything can proceed.
20:23Still sort of pinching myself.
20:25At this point, nothing is certain.
20:3422-year-old Grace is about to have her ankle surgically repaired
20:39after breaking it yesterday whilst rock climbing.
20:42Hey, Grace. Morning. How are you?
20:44Oh, good. How are you?
20:45Good. All ready to go?
20:46Yep. Ready and ready.
20:48It was displaced beforehand.
20:51Yeah, it was.
20:52Dr Sandhu did an excellent job, along with the emergency staff,
20:56in putting the fracture back into a position
20:59that meant that her chance of getting long-term problems was very low.
21:04So, most of the hard work was done by him.
21:07Dr Sidhu will be assisted by Dr Sandhu
21:10as they repair Grace's badly broken bone.
21:13So, initially, we're just going to pin the Taylor fracture in the right position.
21:18You don't want it to be moving around, right?
21:20Mm, yeah.
21:21So, just getting x-rays to check the position of our wire.
21:25It's pretty central.
21:26Yeah. It's pretty good.
21:28So, now, because I've got it pinned,
21:30we're going to put a plate and screws on the lateral side of the fracture.
21:33We shouldn't need a big incision here.
21:35So, just exposing the lateral Taylor neck.
21:39I think there's a vessel there, and I don't really want to cut that.
21:42because that could be something important.
21:45So, that's our fracture down there.
21:47You have the small plate.
21:49It's a plate for the Taylor neck.
21:53Put the screws in.
21:55Okay, let's have a drill.
21:57So, this is the drill for the 2mm screw.
22:12Come on.
22:13That's looking better in terms of tight position.
22:15Yeah.
22:16Fracture reduction looks good, guys.
22:18Yeah.
22:19Let's get some x-rays to come out.
22:21X-ray.
22:28Looks great.
22:29And again, thanks.
22:31Shot there.
22:32The fracture's sitting in a good position.
22:35So, it's going to put a couple of more screws on,
22:37and then it should be done.
22:40Let's have a 28, thanks.
22:42Actually, make it a 30.
22:44Let's go for gold.
22:45While the surgery has been a success,
22:47a lengthy recovery process is expected for Grace,
22:51to give her fractured ankle time to heal.
22:53She'll have to stay off it for about eight weeks,
22:56but the whole recovery will take about a year.
22:59So, non-weight-bearing,
23:01and then she'll start physiotherapy,
23:02and then to get her strength back,
23:04coordination and movement will take up to a year afterwards.
23:0756-year-old RPA melanoma expert Richard Scoglia
23:25is creating medical history.
23:29In a world first, he was given immunotherapy drugs
23:32before having his own deadly brain cancer removed
23:35just over a week ago.
23:38Hi, everyone. It's Richard Scoglia here.
23:40Good to see you all.
23:41I'm now up to day nine postoperatively
23:44after my most recent craniotomy.
23:47Yeah, gradually getting my energy back
23:51and starting to feel better.
23:54Here you can see the scar.
23:56I had my sutures taken out today
23:59and things seem to be healing up well.
24:02Right by his side is trusted friend
24:04and colleague, Dr Georgina Long,
24:07who's mapped out a radical treatment plan
24:09based on the success they've had
24:11in treating melanoma cancers.
24:13So you had a biopsy,
24:14you had combination immunotherapy,
24:16you had resection of the tumour.
24:19And so that was delayed
24:20so that you could have immunotherapy
24:22and it could have an effect on the tumour.
24:24But people were a little bit nervous about delaying it
24:27because sometimes it can go bad in that short period of time.
24:30And we discussed at length delaying it further.
24:32We would have liked to have delayed a little longer
24:35but in the end we had a compromise.
24:37Yep.
24:38And then following that,
24:39more immunotherapy with radiotherapy.
24:43Just popping that on now and then coming down nice and snug now.
24:47Yeah, that's it.
24:48I like it.
24:49Yeah, beautiful.
24:50That's all in.
24:51Yeah, I really feel good about it when it's really tight.
24:53It sort of gives me confidence that those beams
24:56are going to be getting the exact part of my brain
24:59that the radiation oncologist has mapped out.
25:02It's all finished, Richard.
25:04I'll get the mask off.
25:06Following the radiotherapy, that will take six weeks.
25:09Richard will have more immunotherapy
25:12and we are going to give him a personalised vaccine.
25:16It's an incredibly gruelling treatment regime.
25:19But Richard is committed to his role as a human guinea pig.
25:23I accept that there are some risks associated with it.
25:27I could die sooner and I could live for the same amount of time
25:32but be left with some debilitation.
25:34That means I can't enjoy my life how I would.
25:38But, I don't know, weighing all those things up,
25:41it just feels right to me to go down this journey.
25:45With such a never-say-die attitude,
25:47Richard is soon back at work
25:49chairing meetings at the Melanoma Institute.
25:52So, welcome everyone to today's multidisciplinary team meeting.
25:55Jonathan, would you like to present your case?
25:58And more importantly for the fitness nut,
26:01back into training.
26:02Your body gets stressed by treatment,
26:05surgery, radiotherapy, drug therapy.
26:08And to have your body fit and healthy,
26:11it can, I think, I feel I can cope better
26:15with the stresses that I'm going through.
26:18People have told me, don't push it too hard
26:20because if your body temperature goes up too much,
26:24you can have another seizure.
26:29Hello.
26:30Despite undergoing surgery earlier today
26:33to fix her broken ankle,
26:35in the hospital.
26:3622-year-old Grace is already up to receiving
26:38visits from her nan and mum.
26:41Has the doctor come?
26:42No, so the doctor will come and see me at some point
26:46and sort of explain what they did.
26:49And then I think the physiotherapists will come in tomorrow.
26:52Okay.
26:53And then I think if I'm, yeah, stable on my crutches,
26:56they're happy for me to go home.
26:58Oh, that would be great.
26:59Yeah.
27:00Hard to believe that one day you're out having fun,
27:03and the next minute your fun's just taken away temporarily.
27:07Oh, no.
27:08Listen, I'm still having a good time.
27:10Yes, do we.
27:11This hospital's been very relaxing.
27:13It's just been a bit of an experience.
27:16Dr. Sidhu, Dr. Corinne, have all been so lovely.
27:19All the nurses have been beautiful.
27:21Oh, that's great.
27:22You're very lucky.
27:23I'm very grateful for everybody.
27:24That's wonderful.
27:25That's put me back together.
27:26That's wonderful.
27:27Yeah, yeah.
27:28No more bouldering.
27:29Yeah, stick to bowling.
27:30Yeah, stick to bowling rather than bouldering.
27:34All right.
27:35We'll make tracks now, my darling.
27:36Sounds good.
27:37Thank you for coming.
27:38Lovely to see you.
27:39Nice to meet you.
27:40Nice to meet you.
27:41Thank you.
27:42Yeah, that'll be lovely.
27:43God bless.
27:44Love you.
27:45I'll see you tomorrow.
27:46That'll be nice.
27:47Thanks, Mum.
27:48Thanks for coming to visit me.
27:49Bye-bye.
27:50No worries.
27:51Have a good night.
27:52You too.
27:53Be kind of those good-looking doctors.
27:54Okay?
27:55Bye.
27:56But Grace's Nan's not finished yet.
27:57I said he's all right.
28:0432-year-old Jocelyn has been waiting years for a new liver.
28:09Now more than eight nerve-wracking hours after receiving the call,
28:13is finally about to receive her life-saving gift.
28:16Ready 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.
28:28We'll know from the beginning, you know, from almost the skin incision with the blood loss.
28:33So we'll have a rough idea whether it's going to be straightforward or more like an eight-to-ten-hour case.
28:37As far as I know, the liver isn't here yet, but it's close to being on its way, so it's not that far away.
28:43The hardest part usually is removing the diseased liver, which often takes us two or more hours.
28:49So once we've got that diseased liver out, close to the sort of completion of that part,
28:54then often we try and time things so that the new liver has arrived and is prepared, ready for us to plumb in.
29:00So we're trying to minimise that storage time.
29:02So literally the new liver is stored in always as short a time as possible so we can put it straight into Jocelyn.
29:08Assisting Dr. Pless is fellow transplant surgeon Dr. Pram Siramana.
29:14She's had recurrent cholangitis.
29:17Okay.
29:18She's got an MRI.
29:19So she's got a big liver.
29:20That's inconvenient.
29:21Yeah.
29:22It's a massive.
29:23Huge left lateral.
29:24Massive.
29:25Left lateral, yeah.
29:27Big spleen.
29:28Yeah.
29:29Exhausted and emotional, Jocelyn's partner Michael is in for the long haul.
29:34I haven't slept since yesterday.
29:36Well, my biggest worry is that something in surgery doesn't go to plan.
29:41Yeah.
29:43I think it's going to be a long night.
29:48All we can do is our best, but you also need some luck in healthcare.
29:52I'm a great believer in feet, but we'll try and give her a good feet if you know what I mean.
29:56So we'll do our best.
29:57So are you happy for us to cut a hole?
30:00Yeah.
30:01Okay.
30:02Doctors Pless and Siramana have been notified the new liver is now en route, so they can prepare
30:08to remove Jocelyn's diseased liver.
30:10Well, we've come through the skin okay, but the liver, it's very enlarged, it's cirrhotic,
30:16and we've got these huge blood vessels, which we've sort of tied some of them off.
30:20Okay, 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.
30:42There's not usually too much preparation because it's actually already been split.
30:47So we know that part of the liver's been taken off for another patient in another hospital.
30:53Because they can regenerate, donor livers are sometimes divided into two, each part sent
30:59to a separate recipient.
31:01So today, two people will be given a second chance at life.
31:05Does it look like a nice liver, don't it?
31:07Yeah, definitely.
31:08How tiny is the artery?
31:10Artery.
31:14The donor liver artery is not the same size as Jocelyn's receiving artery.
31:20It's a complication that could spell disaster when Dr Pless tries to connect the new liver.
31:2756-year-old Richard, the world's leading melanoma pathologist and brain cancer patient,
31:38has just been rushed by ambulance to the ED.
31:42A training session on his treadmill at home appears to have triggered a seizure.
31:47My partner Katie came in and found me and said,
31:50you know, you're not righty, you don't look that good.
31:52There we go, that's a bit better.
31:54I must have passed out during that period.
31:57I don't remember exactly, but I remember her coming back in and waking me up.
32:00Yeah, I think your wife's had enough of you, so fair enough.
32:04While Richard gets an MRI scan...
32:07OK, the next scan will go for four minutes now.
32:09..fellow melanoma expert Dr Georgina Long
32:12and neurosurgeon Dr Shivalingham rush to the ED.
32:16Hey Brenda!
32:17How are you going?
32:19How are you?
32:20How are you?
32:21Why are you scaring us?
32:23We would not be happy if we saw bleeding, if we saw recurrence of the tumour,
32:28or if we saw swelling or a side effect from the combination of radiotherapy and immunotherapy.
32:35This is the space where the resection was.
32:38Yeah, yeah.
32:39And here there's absolutely nothing kind of enhancing anywhere.
32:44You know, the rest of your brain looks just normal.
32:48No swelling, nothing at all.
32:50So you're just tired and pushed yourself maybe?
32:52I think you just pushed yourself a little bit too hard.
32:54You may have had a tiny seizure.
32:57The relief is immediate, and not just for Richard.
33:00It keeps his experimental brain cancer treatment plan alive.
33:04I haven't shown you the data, have I?
33:06Have you seen the data?
33:07No.
33:08I've got it right here if you want to see it.
33:09OK.
33:10It's pretty amazing.
33:11OK.
33:12Amazing doesn't even start to describe it.
33:15Georgina shows Dr Shivalingham proof
33:18that only 12 days after Richard's first dose of immunotherapy drugs,
33:22his brain tumour was flooded with immune or T cells ready to do battle with his deadly cancer.
33:28We were not expecting that.
33:30We were so excited when we saw that influx.
33:3312 days after giving drug, we see the drug all bound to the immune cells.
33:37The red is the tumour and then the blue is the immune cells.
33:41So the first thing you can see is we see a lot more immune cells in ratio compared to the tumour.
33:47Gosh, that data is so impressive.
33:49It's amazing.
33:50Yeah, it's amazing.
33:51I've seen the immunotherapy effects in melanoma
33:55and how the treatment has changed vastly
33:59and patient outcomes have just considerably changed.
34:02And that is something that has been lacking in glioblastoma for 25 years.
34:07So I've been waiting for this.
34:10And so fingers crossed that we keep going on this path
34:13and things keep working for Richard because it will revolutionise what we do.
34:18Dr Shivalingham is happy for Richard to go home, but with a caution to monitor his exercise more closely and rest when he needs to.
34:28Well, thanks Brenda.
34:29Okay.
34:30Thanks Georgina.
34:31No problems.
34:32I'm glad you're feeling better.
34:33Yeah.
34:34And you can go home.
34:35Right.
34:36Yeah.
34:37Yeah.
34:38We will now continue the immune therapy and we will also be adding what we've termed at this point an immune kicker,
34:46like a vaccine personalised to the tumour.
34:49I could die earlier.
34:51I could get side effects that would make the rest of my life more miserable and less functional.
34:57But the upside is that I can make a difference.
35:02It may not make a difference to me personally, but we'll make research discoveries which will open the field up.
35:10And to be honest, I know we already have done that.
35:12Two hours into a six hour transplant operation, surgeons are close to removing Jocelyn's diseased liver.
35:27Oh, the liver is severely cirrhotic.
35:30It's massive.
35:31It's really stiff.
35:33We've actually, fortunately, despite struggling, made some good struggles.
35:38I promise we're doing a great deal, Piers.
35:40Thanks very much.
35:41Thank you.
35:42The contrast of the new pink healthy liver to Jocelyn's diseased one could not be any more stark.
35:49That's good.
35:50There's the liver.
35:51Oh, that was in the bucket.
35:5320 minutes later and it's out.
35:56It's like a baby basically.
35:59Yeah.
36:00Okay, so there's a big space now.
36:02There's no time to lose hooking up all the important veins and arteries to the new liver.
36:07And Dr. Pless has already discovered the size of one of the arteries is not a match.
36:12This is our artery.
36:13It's so small.
36:14Barely got a lumen, you see?
36:16That little tiny artery there.
36:18So that's what we've got.
36:19And that's a critical joint.
36:21So we'll be taking a lot of care on that one.
36:24For about three millimeters.
36:25Okay.
36:26That's ready.
36:27Go close.
36:28Yep.
36:29Liver out of ice just now.
36:30Liver out of ice.
36:31Whilst we're doing these joints, the liver has no blood supply, so it's getting damaged.
36:37So obviously, you're sort of under a lot of time pressure.
36:40So most of surgery, you're never operating under time pressure, but transplantation absolutely
36:44minutes matter.
36:45So we're really trying to do this joint as quickly as we can.
36:48If you spend hours, then the patient, you know, has a higher chance of dying.
36:52Okay.
36:53So cable clamp's off there.
36:54Cable clamp is off.
36:55So three hours after the transplant surgery began, and only 17 minutes after the new
37:05liver was taken off ice, Jocelyn's veins are now connected.
37:08So we're hopefully going to see the liver change color in another few seconds.
37:13And then portal venous clamp is off now.
37:15Reperfusing.
37:16Reperfusing.
37:17Reperfusing.
37:18Reperfusing.
37:19Reperfusing.
37:20Reperfusing.
37:21So you should see.
37:22That's the liver.
37:23Reperfusing.
37:24You should see the liver change color, you see.
37:25It's got a nice pink color there.
37:26Now everyone's attention switches to the mismatched artery.
37:31We're just trying to make the arteries reach each other because the donor artery is very
37:37short.
37:38How are we going to do that?
37:41After an illustrious career spent curing others of melanoma cancer, one of RPA's favourite
37:47sons, Professor Richard Scoglia, has a deadly brain tumor himself, diagnosed just three
37:54months ago.
37:55I'm just going to do a quick blood test for you.
37:57A 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.
38:06I've been tired, lethargic, just not the same energy level that I've had.
38:12So this is after I had a partial seizure a week or so ago and my anti-epileptic dose was
38:18increased and a variety of side effects you can get from me.
38:22So it could be related to that.
38:25Seven more to go.
38:27Despite the seizure, Richard is determined to hit their next experimental treatment
38:32milestone today.
38:33So, vaccine day.
38:34Yes.
38:35We've got the vaccine.
38:36It's been a bit of organising.
38:40You've had the blood tests?
38:42Yep.
38:43Blood tests, urine, we've had stool sample collected.
38:46Excellent.
38:47ECG.
38:48Okay.
38:49Excellent.
38:50Thank you.
38:51Now who's going to have the joy of popping the needle in?
38:54Maria.
38:55Here we go.
38:56It expires at 6.30 tonight.
39:02Dr Georgina Long and the team analyse the tumour removed from Richard's brain.
39:07And using the scientific data, a personalised vaccine has been developed to further boost
39:13the immune reaction against his cancer cells.
39:16So you've just had an intramuscular injection.
39:19Okay.
39:20So the needle went right deep into the muscle and the vaccine went into the muscle, which
39:25is how most vaccines are delivered.
39:27Human guinea pig Richard will be given a total of 10 personalised vaccines at varying intervals
39:33across the next 15 months.
39:35And continue with his immunotherapy.
39:38Bye.
39:39See you.
39:41What does success look like?
39:43If for 10 months we're seeing no recurrence on his scan, that's success.
39:48That's success.
39:50But we're not there yet.
39:51So.
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 and spend as much time as
40:05possible with his three kids, Emily, Lucy and Matt.
40:09Do you remember last time we played this game, Dad?
40:12You pretended not to know how to play and then you won.
40:15That was just luck.
40:16I'm sure the special times that come up will drag up some feelings that, you know, maybe
40:26this is the last time, but yeah, you know, that's life.
40:30You've got to make the most of the good times and celebrate and enjoy them.
40:35Unfortunately, my liver function tests have gone up a bit.
40:39So immunotherapy tomorrow has been deferred.
40:43We'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.
40:51Speak 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
41:04patients across the globe.
41:05Any other discussion about this particular case?
41:08No.
41:09Now, with Richard as the human guinea pig, the pair may not save his life, but their groundbreaking
41:15work with deadly brain cancers will save the lives of thousands more.
41:20I'm not going to go down without a fight.
41:22I think there definitely is a chance.
41:25And the data that we've generated so far gives me optimism.
41:30It's not proof, but it gives me optimism.
41:32And it'd be, wow, how fantastic would it be if I hadn't 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.
41:50Yeah, it's okay.
41:51The 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
42:06donor artery and the recipient artery.
42:09Fortunately, it's protocol that additional arteries from the donor are supplied along
42:14with the new liver.
42:16Does that scale reach?
42:17Maybe where we want it?
42:18Yeah.
42:19And like I said, we do it that way.
42:20We can do it that way, yeah.
42:21So we're just trying to prepare this length of artery that will fill the gap as it were.
42:26Despite a blood supply to the liver, they must attach the artery so the liver doesn't fail.
42:32All you can do is your best, and sometimes in health, sometimes your best isn't good enough.
42:37So I think you actually need some kind of good fortune.
42:40Things need to go well.
42:42We just have to hope that that's good enough for her.
42:45Well, I'm trying to see.
42:46Oh, it's horrible.
42:47The artery is like one of the smallest adult arteries I've ever seen.
42:52Um, okay.
42:53Well, we've redone all the blood vessel joints.
42:55Okay.
42:56Lots of wash, thanks.
42:57It wasn't easy, but the artery is now connected to Jocelyn's liver.
43:01Yeah.
43:02And then the guys are just finishing off the skin there.
43:06No, I mean, it's gone well.
43:08It's a tough case.
43:09I mean, that's what, seven hours?
43:11We've got evidence that the liver's working, so we're happy.
43:14Now, 2am, there's only one more important task left for Dr Pless.
43:20Hello?
43:21Hello, was that Michael?
43:24Yeah.
43:25Yeah, this is Henry Pless.
43:26I'm just one of the surgeons at RPA.
43:28Which is just to let you know that everything has gone well with Jocelyn.
43:31Great.
43:32Yeah.
43:33Okay.
43:34So, you know, it's taken us a while, but, you know, it could have been a lot worse.
43:38Okay?
43:39So, so far, so good.
43:40So good to hear.
43:41Thank you so much.
43:42No worries.
43:43Nice to talk to you.
43:45Two weeks after surgery.
43:50Bye, guys.
43:51See ya.
43:52Thank you so much for everything.
43:54So.
43:55Michael is thrilled his girlfriend can come home.
43:58I just can't believe how quickly she's recovered.
44:00It's only been a couple of weeks since the surgery, and 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
44:14for the rest of her life.
44:17I feel great.
44:19I got a new liver.
44:20I got a new life.
44:21I got a new future to look forward to.
44:24Couldn't be happier.
Bình luận