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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. Already it's gonna make a difference for future
00:21pro-cancer patients. Give us a hug. Lifting patients up. Dirty. Very good.
00:26Okay. In their darkest hour. In that operating theatre, I was reborn.
00:31My little boy asked me if I was gonna die. I just told him that I'm gonna fight.
00:37You are so welcome. I feel like it's starting to become a bit more real.
00:41Getting ready for battle. I'm not ready to die. Welcome back to RPA.
00:47On this episode, a message we should all hear. Chris looked healthy, but it's split
00:56second. Your life can change, you know, or end. But he was living with a death sentence.
01:02I heard it as a time bomb in my chest. Now the race is on.
01:05He will be safe for 30 minutes of no blood flow. To save his life.
01:11Anything longer, there will be a problem. As she confronts her devastating diagnosis.
01:17Why me? I have not done anything bad to anyone. This mum of two has just one wish.
01:24Maybe like I'm strong enough that I can deal with this kind of surgery. But is it even possible?
01:30It's not easy giving bad news to a patient. And losing battery power is frustrating.
01:37But when it's your pacemaker. Adrian's heart had effectively stopped for about five seconds.
01:42There's no room for error. It's a life of death, isn't it? Really. So, very important.
01:5540-year-old Chris leads a busy life. By day, he's a lawyer.
02:01The thing that I love about the law is being able to help people through these problems that
02:08they come to you with. It's quite rewarding and fulfilling. And yeah, I really enjoy that.
02:15By night, you'll find him spinning the decks in Sydney's busy inner city clubs.
02:20There's nothing like the chemistry and energy between somebody who's performing music
02:27and someone on the dance floor. And that's what I love about it.
02:33But this frantic pace came to a screeching halt when a medical check revealed a life-threatening
02:39condition. It was described to me in a roundabout way that it was a time bomb. I heard it as a time
02:47bomb in my chest. Chris has an aneurysm in his aorta, the main artery delivering blood to the body.
02:54And it could burst and kill him at any moment.
02:57Each day that you hold a time bomb is a difficult day and it's an anxious day.
03:06And that had its difficulties because I stopped a lot of the things that I was enjoying.
03:13You know, little things. Some people may see it as little, but it was the outlets that I had
03:18to relax and or to look forward to. And a lot of that was taken away.
03:26How are you? Very well. How are you?
03:27Good, good. Thanks.
03:28RPA cardiothoracic surgeon Dr. Tristan Yan is overseeing Chris's case.
03:34How has this diagnosis impacted you?
03:38Greatly, greatly impacted me. I mean, there's so many questions, so many questions.
03:44During this vulnerable time, the trust between a patient and a surgeon becomes a keystone of the
03:50relationship. Where I can use my skills and experience to help the patients through this
03:58difficult time. So you have this aortic aneurysm. Here is your aorta. This is a cross-sectional image
04:08of your CT scan. Here is the ascending aorta that is grossly dilated. Over here is the descending aorta.
04:16This is supposed to be the size of your aorta. And it's twice as big in ascending portion. That's why
04:25we need to replace this segment of the aorta tomorrow.
04:32In simple terms, the aneurysm is a weakness in the tissue lining of the aorta.
04:36Chris's is now so big, there's no other option but to surgically remove it and replace it with a
04:43synthetic graft.
04:44You can just sit there without causing any problems when they're smaller size.
04:52But when it grows, it can cut off the circulation to the heart, causing heart attack. It can cut off
04:58the circulation to the brain and causing stroke.
05:01OK. Obviously, the biggest concern in this situation is the aortic aneurysm may dissect
05:11and may rupture.
05:13OK. You're quite lucky to have this found
05:17because a lot of patients don't know they have this aneurysm sitting on the side of their chest.
05:22Right.
05:22As you can imagine, people present with rupture, they don't lead to the hospital.
05:27I'm one of the lucky ones then.
05:28Yeah, well, what we're trying to do is prevent that from happening.
05:33What I want for every single patient to leave the consultation room with is a sense of
05:39clarity and confidence so they can move forward with their life.
05:42What's at stake for me?
05:46A lot. A lot.
05:51Indeed, my life.
05:58Mum of two, Jagrooty, enjoys posting dancing videos on Instagram.
06:02But this 38-year-old happy-go-lucky woman is facing the return of a malignant tumour in her pelvis.
06:17I was shocked. I was planning my daughter's first birthday. I was planning to go overseas
06:23because my family hasn't seen my second daughter, so they are waiting to see her.
06:28And all of a sudden, the doctor said that there is a lesion seen, so we have to operate.
06:36So that has scared me a lot. My daughter is just 11 months. She needs me. I'm not sure
06:43what will be the surgery this time, because I have gone through the first surgery and I know
06:49how scary it was.
06:50Last time, the tumour was attached to part of her rectum, so she had to have a temporary colostomy
06:56or stoma bag.
06:59It was hard for me. In the initial days, I was not even able to cope up with those bags.
07:05I had leakage. This time, I'm more scared because if the tumour is stuck with any of the organs,
07:11I may end up having permanent bags on my tummy.
07:14Jigrooty knows permanent bags will change her life drastically.
07:20With these young kids, it's going to be very hard for me.
07:23I'm not sure whether I will be able to work normally.
07:26I will be able to live a normal life with my husband and my kids. We don't know.
07:31Yes, there are people who are leaving.
07:34I am not ready with that thing.
07:37I don't deserve to live a life like that.
07:40I am in good hands. I know that. But then we don't know what is written in the destiny.
07:51For 40-year-old lawyer and DJ Chris, it's time to face the music.
07:56Today, he'll undergo surgery to check his deteriorating heart valve and also remove a deadly aortic aneurysm.
08:03I would be lying if I didn't say there's anxiety, there's nerves.
08:11Today is the day. Are you all set to go?
08:12Yeah, ready. Thank you.
08:14If you have a second thought, that's the door.
08:16This is the last moment before you can leave here.
08:18No, I know. I'm lucky to be here.
08:21One of the key elements in the relationship between a doctor and a patient is to provide compassionate care.
08:35Undergoing a major heart operation is probably the most vulnerable time for any human being.
08:43To give something back with compassion is why we do it at all.
08:49So this is the scan for Chris. It's a CT aorta scan that we do for all patients before aortic aneurysm operations.
08:59Basically, the CT scan picked up some calcium. It's quite a thickened calcium.
09:04So that's the thickened calcium. You can see that's just the white bit.
09:08But when we see calcification on the valve leaflets, that's a warning sign.
09:12The valve may not last for a long time.
09:15This image says to me that we will have to replace this valve.
09:20Yeah.
09:21So before even starting, Chris's surgery becomes more complex.
09:25Dr Yan must now perform two graft procedures to save Chris's life.
09:31The skin incision is five centimetres, as I'd outlined here.
09:35And through this incision, we'll be able to expose the aortic aneurysm.
09:39I've always been fascinated by the human heart. The human heart is dynamic, rhythmical and purposeful.
09:50It always reminds me that life is so precious. If I can in any way extend someone's life,
09:59it makes it worthwhile. Here's the aneurysm, the dilated bulge of ascending aorta.
10:07And down the bottom there, you can just see the heart is beating away down there.
10:12Ironically, to extend Chris's life, Dr Yan must first stop his heart from beating.
10:19The ventricular motion has ceased and the ECG is now flat.
10:23A heart-lung machine takes over pumping oxygenated blood to Chris's brain and vital organs,
10:29while Dr Yan operates to remove and replace the heart valve.
10:33This heart-lung machine is doing all the work for the heart and the lungs.
10:38What we're going to do next is remove these calcified leaflets. So this is the normal leaflet,
10:47it's more pliable, and this is the abnormal one. Calcified, heart nodule, like a rock here.
10:55This is the reason we can't save this valve, because this will progress.
10:59Chris is now given a new prosthetic heart valve.
11:03We're going to put valves in now, but we need to make sure it's the right size.
11:10Now, we are putting these sutures, the annular sutures, through the valve sewing ring.
11:16The new heart valve is stitched onto one of the two aortic grafts.
11:20Now, we're going to parachute this down. This valve and graft just big enough for this incision.
11:26So what we have done now is remove the aortic valve, the bypass valve which is calcified.
11:32We have implanted the new aortic valve. Still a fair way to go yet.
11:42With the new valve in position, Dr Yan now turns his attention back
11:46to removing the deadly aortic aneurysm. He'll replace it with the second aortic graft.
11:52So this graft is going to be attached to the bottom end of the aortic arch.
11:56But for this part of the operation, Chris's body is packed in ice.
12:01His temperature must be lowered to 23 degrees and the blood circulation to his vital organs
12:06completely cut off. Here's the line that we're going to use to perfuse the brain with.
12:12His brain will be the only organ receiving an oxygenated blood supply.
12:16It does carry risks. Prolonged period of circulatory arrest, that means no blood flow to the organ,
12:23can cause organ ischemia or damage. At a temperature of 23 degrees, he will be safe
12:29for 30 minutes of no blood flow. Anything longer, there will be a problem.
12:34CO2 is out? Yeah. Okay.
12:38Despite all the major advancements we have made in the field of cardiothoracic surgery,
12:45sometimes complex procedure has complications.
12:48Okay, Andy, are you ready? Yeah. Okay, flow down and off.
12:54Chris's blood supply is now cut. Okay.
12:58Arterial inflow is clamped. Drain the blood out.
13:02Not every single case will go well. There's one in a hundred patients
13:07who will not survive an operation. That's just reality.
13:1238-year-old Jagruti, her two little girls and hubby Jignesh have come to see RPA surgeon Dr Peter Lee
13:28to find out more about the operation to remove a cancerous tumour from her pelvis.
13:34Becoming a doctor wasn't my first choice. As a young adult or as a high school student,
13:41I had different aspirations. But after some convincing and some bribery from my mother,
13:50here I am today doing surgery. I really enjoy what I do and I feel blessed that I'm here today as a surgeon.
13:59Okay, thank you for coming to see me today and to discuss what we're going to do.
14:06The tumour is lying over her leg, bowel and bladder. She may lose both organs and be left with a limp.
14:13So this is the new one over here, over some important vessels. They're the vessels to your leg.
14:19The nerve is far away, so I'm not worried about the nerve that helps you lift up your leg.
14:24The tumour may be stuck to important blood vessels running to the leg. If that's the case,
14:30Dr Lee will need the help of a vascular surgeon to keep it functioning.
14:35Now let's see some other structures that are close.
14:38Bowel, uterus and bladder, which have been pushed to the right of the pelvis. If you see a brick wall,
14:45you see the bricks. That's the organs of your body, the structures that you can see that we know about.
14:51But then the whole of those structures need to be held together. And that's the cement going through
14:56all those little bricks. That's your soft tissue. Okay.
15:00This is where your tumour is coming from. So that cement there is attached to that brick,
15:04then we have to take a bit of that brick out or the whole of that brick. If the bowel is stuck,
15:09then if I have to take the bowel, you'll probably end up with a permanent bag for the bowel.
15:15In terms of the bladder, we can just take a bit of the bladder and reconstruct it by the look of that.
15:19Okay. But the worst case scenario, we have to also let you know, which is we might have to take the
15:24whole bladder and then give you a urine bag as well. That's the worst case scenario. I think the
15:30uterus we should remove too, if it is stuck. Okay. The extent of the surgery will only be known when
15:39Dr Lee opens her up and sees where the tumour has attached itself to her organs.
15:44I am scared now because I don't want any bag. I don't want any bag.
15:49Yes, I understand. It was so intense that she just didn't want stomas. That's all she didn't want.
15:58It's not easy giving bad news to a patient. It's never easy, even though I've been doing this for
16:04many years. It's difficult to give bad news because people are so different.
16:09Why me? I have not done anything bad to anyone. Yes, I am strong. Yes, I am a good mother. I want
16:17to give a better life to my daughters. But at the same time, I'm not sure that once my daughter is
16:23grown up, how are they going to, like, see that my mum is living with a permanent colostomy bag?
16:36Arterial inflow is clean. Drain the blood out.
16:4140-year-old lawyer Chris has just been put into circulatory arrest.
16:46His body temperature has been dropped to 23 degrees, and the only organ receiving blood is his brain.
16:55OK, cross clamp is released. Now there's no circulation to the rest of the body.
17:03Andy, increase the flow. Heart surgeon Dr Yan has just 30 minutes to replace the remaining aneurysm
17:10with the second aortic graft. This is absolutely crucial part of the operation.
17:18Prolonged period of deep hypothermic circulatory rest will lead to irreversible organ damage or even
17:24death. The surgical team has to be very focused. Everything comes to a standstill,
17:34except the clock is ticking on the wall.
17:35This is the distal portion of ascending aorta. Let's go to the specimen. A few minutes in,
17:44the aneurysm is removed. Andy, trichote arterial. But the difficult, more time-consuming part is still
17:53to come, implanting the new graft where the aneurysm was. So this graft is going to be attached to the
17:59bottom end of the aortic arch. Now this is the most critical part of this operation.
18:05It requires absolute focus. So this graft is sitting in there. So we're just doing one stitch at a time.
18:17I know we have 20 minutes, but we don't rush this. The more you rush, the worse it gets. So
18:24just trying to make sure all the stitches are nice and even. Make sure it's chemostatic.
18:29So when we take the clamp off, it's not going to lose blood. That's what we're hoping to achieve.
18:37Every single stitch counts. Going with the flow here.
18:41It's in my comfort zone to function, to operate, to perform difficult tasks under some sort of pressure.
18:5123 degrees. I think we're very safe for the brain. There hasn't been any changes, the cerebral set,
18:58since we start the circulatory rest. So what it means is that the brain is being protected.
19:0420 minutes down. And while Chris's brain remains protected, Dr. Yan has only 10 minutes to complete
19:12the graft implant before risking irreversible damage to Chris's other vital organs.
19:17I do this carefully. The bottom line is, if this layer of anastomosis is not done properly, we're not going anywhere.
19:27An aortic surgeon needs to have this sense of situational awareness, remain calm and collected,
19:35under stress, and also make a decisive decision, courage to act on it, courage to take the responsibility for it.
19:44Andy, what we're going to do is, uh, soon, we're going to come back on.
19:51With only minutes left on the clock, Dr. Yan has completed the riskiest part of Chris's operation.
19:58We're ready to resume the normal systemic circulation now.
20:04With great relief from the surgical team, full blood supply can now be restored.
20:09So now the two grafts are joined together with these little sutures. Everything is looking quite good at the moment.
20:16Yeah, we like this operation because, um, it's quite satisfying. Instantaneously, it will remove aneurysm.
20:24I'm a one member of the team, and everyone contributes in some way to the success of this operation.
20:33Whilst the early signs are looking good, the next few days will determine just how successful Chris's surgical procedure has been.
20:47At RPA's emergency department, 64-year-old carpenter Adrian has arrived with a very serious problem.
20:54The battery in his pacemaker is almost flat.
20:58I've been in on Friday for my scheduled check-up.
21:03Battery's a bit low. They switched me to emergency power.
21:07Everything was fine. They rang me this morning, asked me to come in as soon as possible, and here I am.
21:13They are the technology company that's been monitoring Adrian's pacemaker battery since he got the device 10 years ago.
21:20My pacemaker keeps my heart pumping. So it's like a little starter motor. If my pacemaker doesn't work, I'm dead.
21:30Hi Adrian. I'm Roslyn. I'm one of the emergency specialists. How are you?
21:34Good. I was getting a bit dizzy. Yeah.
21:37And a bit short of breath. Yeah.
21:39I couldn't train. Okay. What sort of training do you normally do?
21:42I do weights. Okay. Weight training and I run. Okay.
21:45So I couldn't do that. I actually struggled to catch my breath a bit. Okay.
21:48Hold your big breath.
21:52A pacemaker needs to be checked regularly, and you would expect that the technicians pick up on the battery's life.
21:59And if it's starting to fail, then they would need to plan for that battery to actually be replaced.
22:03Nothing is completely predictable.
22:05Until the new pacemaker is fitted, Adrian's heart could stop at any moment.
22:11So he'll have to stay at RPA and be closely monitored until then.
22:15It's the life of death, isn't it? Really. So, very important.
22:2038-year-old Jagruti is at RPA to have a pelvic tumour removed.
22:35Oh, I couldn't sleep. I couldn't even sleep because, oh, it was so...
22:39I was so much tense and worried because at the same time, I'm also...
22:43Something is running in my mind that whether my daughters will be able to cope up without me.
22:48It's hard, especially the 11 months old.
22:51This is the first time I'm leaving her.
22:53This mum of two is facing the possible loss of her bowel and bladder,
22:58leaving her with permanent colostomy bags to collect her bodily waste.
23:03It's her biggest fear.
23:05I worry if I'm getting permanent bags.
23:08I have no idea how am I going to live a life with two young daughters, with my husband.
23:16I'm not sure whether it's going to be the same life which I'm living right now.
23:22Jagruti tries to put on a brave face.
23:24Maybe I'll come out with a victory, V for victory.
23:27But is soon overwhelmed with what's to come.
23:32You're doing really, really well.
23:34I'm doing beautifully.
23:37Until he can see where the tumour is attached inside Jagruti's pelvis,
23:41Dr Lee can't make any promises.
23:45As we discussed, hope to do less than more.
23:49So we tend to prepare for the maximum invasive spectrum of the operation rather than minimum invasive.
23:56I want what they want, which is not having stomas.
24:01But I know as a surgeon we have to do the right thing and do what we call an oncological resection.
24:07So we get the clear margins for her so that she doesn't come back with a recurrence and
24:13going further surgery becomes more difficult.
24:15It's a tense wait for husband Jignesh.
24:18I was feeling nervous. We don't know what's going to happen because the doctor told us the
24:24precaution like what we need to do after the surgery and what might happen.
24:28So just a bit nervous.
24:30She's everything to me. She's like my life, wife, everything.
24:34You know, like without her, I can feel like the house is still empty, you know.
24:39So the ovaries on the right side are nice and free.
24:46There's the mass there.
24:48Once we set this a bit more and you can see the uterus is there.
24:52And we may have to take that looking like we'll probably have to take that.
24:57The bladder is free, which is great.
24:59You can see here there's no signs of stickiness to the tumour and the bowel.
25:07All right, so we've got some good news from the start.
25:10Okay.
25:10It looks like Dr Lee will be able to preserve Jagruti's bladder and bowel,
25:16so no stoma bags will be needed.
25:18This is the tumour, fallopian tube and ovary.
25:21It's good that the bowel has come off the tumour easily.
25:26So, so far, it looks like we're going to be able to preserve the bowel
25:30and not even dissect any of it, therefore avoiding a stoma for her.
25:38Ecstatic at the time of operating.
25:39Just you can't see my face because of the mask, but I'm smiling.
25:45It's the best news for Jagruti.
25:47Both her bladder and bowel can be left intact and she won't need stoma bags.
25:52But Dr Lee still needs to establish if the tumour is attached to the vessels
25:59leading to Jagruti's leg.
26:00So far, it's come off the artery.
26:03So I just need to know what's happening down here.
26:05But the other problematic part is deeper down where it's lying over the vein.
26:11If the tumour cannot be separated from the veins to her leg,
26:14she may end up with a limb.
26:2664-year-old Adrian's come to emergency because his pacemaker battery is going flat.
26:31Adrian, take a breath in.
26:33If it fails, his heart will stop beating.
26:35Breathe normally.
26:37That's the x-ray done all right.
26:38The best part is they don't alarm you.
26:41You know, you could be dying and it'd just be fine.
26:45Bring a cup of tea in a minute.
26:47Do you get chest pain when you're walking around?
26:49No, probably when I'm training.
26:52His case has been passed to Dr Yael Sellermeyer on the cardiology team.
26:57This is the pacemaker box.
26:59And then here's both leads coming down and they thread through one of the veins
27:04and then they separate, so this one goes into the right atrium
27:08and this one goes into the right ventricle,
27:10the two chambers of the right side of the heart.
27:13Adrian's pacemaker regulates the electrical impulses going to the heart,
27:17keeping it beating in a normal rhythm.
27:20Here's the pacemaker beat followed by the heartbeat
27:23and then the pacemaker beat followed by the heartbeat.
27:26So the concern is that if he missed out on this pacemaker beat,
27:30there would be no heartbeat that follows.
27:32That pacemaker beat could completely stop at any time,
27:37causing Adrian to go into cardiac arrest.
27:40I think because the result was so critically low, they wanted to keep him in.
27:45He'll have to stay put and be closely monitored
27:48until a replacement battery arrives.
27:5038-year-old mum of two, Jigruti, is having cancer removed from her pelvis.
28:03So far, Dr. Li has confirmed the tumour is not stuck to her bladder or bowel,
28:08so no stoma bags, her biggest fear.
28:13Now he's hoping to clear it without damaging the vein to her leg.
28:16So good, it looks like we're taking the tumour off the vessels, both the artery and the vein,
28:25quite easily, without any infiltration of the tumour into the wall of those vessels.
28:30So I'm very happy.
28:33So the leg is spared, but Jigruti's uterus and left ovary will need to be removed.
28:39That's the recurrence right there, still attached to the uterus.
28:44If the tumour is involving the whole of the uterus, then I have to remove all of it.
28:50So we need to have this clear margin when we're resecting tumours.
28:52After her first operation, she had a really bad prolapse of her pelvic organs,
28:57and the gynaecologist brought up everything back with sutures.
29:01And I'm thinking if I don't have to take the whole uterus,
29:06then at least there's a structure there preventing everything collapsing again.
29:12Dr. Li believes he can leave a clear margin around the tumour
29:16if he only removes the top part of the uterus,
29:19but needs to call in gynaecologist Selwyn Pather to help.
29:23So this is the beauty of RPA.
29:27Professor Pather wasn't aware of this case.
29:30I needed the expertise when we do what's called the subtotal hysterectomy.
29:35One phone call, Professor and Angelo dropped what they were doing and came to our aid.
29:41Thank you for coming on short notice.
29:42My pleasure to help you.
29:49And that's the mask came out completely intact.
29:52This is the best case scenario.
29:54So on the spectrum, good and maximally invasive, minimal and maximally.
29:58Yeah, the best that we could have done for them.
30:01So a very happy day.
30:03Happy to help because as much as we have work commitments and things,
30:07I think ultimately the most important thing is the patient needs your care at that point.
30:12And that's why we train to do what we do.
30:13The best part of my job is to see patient's outcome the best it could be.
30:18And to see the response and just the human side of it.
30:26They're smiling or crying and then they give you a hug.
30:30That's very rewarding.
30:33A groggy Jagruti has only one question for Dr. Lee.
30:39Dr. Lee, how are you?
30:46Dr. Peter Lee.
30:47Dr. Peter Lee.
30:48Can you see me?
30:50Yeah.
30:50Yeah?
30:52No bags.
30:52No bags.
30:54Okay.
30:56Good.
30:56All right.
30:57Best news.
31:00All right.
31:00Very good.
31:01Okay.
31:03Good.
31:04Okay.
31:05Rest now.
31:06Okay.
31:06Hopefully we can get that endone infusion off.
31:17You'll be able to sit out of bed.
31:19It's great.
31:20It's been 24 hours since 40-year-old Chris underwent surgery to replace an aortic aneurysm
31:26and a degenerated heart valve.
31:29What's difficult about this kind of operation is dependent on how meticulous we are
31:35with our stitching between the graft and the aortic arch component.
31:39It has to be watertight.
31:40If it doesn't work, patients may have a bleeding problem.
31:44Surgery was yesterday.
31:46Okay.
31:46So you recovered quite well now.
31:49Okay.
31:50The valve, the aortic valve had to be replaced.
31:55Okay.
31:56Because there was a thick bar calcium on one of the leaflets.
32:01And that valve itself will not last for a long time.
32:04Oh, okay.
32:05Absolutely, mate.
32:06Yeah.
32:07All the segments, the aneurysm has been resected, removed away.
32:11Great.
32:11That's what you wanted.
32:12Yeah.
32:12Exactly.
32:13And then replaced everything with the new graft.
32:16Everything from here onwards, it's on you.
32:19So you have to focus on recovery.
32:21Yeah.
32:22Okay.
32:22This is probably the most difficult part of your recovery.
32:27This is the start of your recovery.
32:29I think you are on the right track.
32:31But you need to have that faith in yourself.
32:35Yeah.
32:35I can't thank you enough to press in.
32:38Okay, mate.
32:38Okay.
32:39All the best.
32:39All right.
32:40We'll be in touch.
32:41And again, thanks for checking in.
32:43Okay.
32:44See you later, Chris.
32:45With Chris needing to remain under close scrutiny in ICU,
32:49he's not out of the woods just yet.
33:0064-year-old carpenter Adrian has a dodgy battery in his pacemaker
33:05that needs replacing immediately.
33:08Until that happens, he's being monitored in hospital.
33:13Overnight, it's stopped working along with his heart.
33:17People were panicking and they'd come from everywhere to help him with this situation.
33:22Luckily for Adrian, this was a brief blip.
33:25What we observed overnight was that Adrian's heart had effectively stopped for about five seconds.
33:31You can see on the screen that the pacemaker's functioning very normally.
33:36And then for a period of five seconds, we effectively have a blackout in his heart,
33:41where there's no electrical activity.
33:43And that's because the pacemaker's reached a critically low level of battery life.
33:47If this situation had have gone for even a couple of seconds longer,
33:50they could have had a cardiac arrest.
33:52And that could be a very difficult situation to salvage.
33:56This morning, Adrian's stabilised and impatient to get into the operating theatre.
34:02Today, I get a new battery for my pacemaker.
34:05So, I'm sedated.
34:08And when I wake up, I can have food.
34:14We're almost ready to get you off to sleep.
34:16Good.
34:18All right, medicine coming now.
34:22Surgeon Raymond Sy is getting straight to the heart of the matter.
34:26This is an example of a pacemaker.
34:28It's very similar to the version that we'll be putting inside Adrian.
34:31The pacemaker itself includes the battery and all the computer elements inside that box.
34:36It's very ingenious.
34:37Inside Adrian already, there will be a wire inside his heart, similar to this one.
34:42What we're going to do is disconnect the old pacemaker from the wire
34:46and then connect the existing wire to the new pacemaker and put it in and sew it up.
34:54The procedure is over in less than 30 minutes.
34:58So, we're all finished.
35:00That's the x-ray before the procedure with the pacemaker.
35:04You can see they're connected to the two wires which go into the heart.
35:08This is the pacemaker, his old pacemaker.
35:11So, we've made a cut through the skin, taken this old one out, connected the new one,
35:17sewed it back up and you just have to believe in the new pacemaker's in there
35:21and it's all working and his heart rate's back to normal.
35:23Can we bring the bed in?
35:26There's still a possibility of infection, swelling or blood clots where the device has been placed.
35:32Hi there, you're just wakeening up.
35:34Adrian won't be going home yet.
35:36Operation's all finished, you've got a new pacemaker there.
35:41Keep going, marching on the spot for me.
35:51Nice and slow.
35:53Perfect.
35:54Good. This is good.
35:5740-year-old Chris is at RPA after undergoing major surgery to remove a deadly aortic aneurysm
36:04and a degenerated heart valve.
36:08How are you feeling?
36:09On top of the world.
36:12Good.
36:12Chris's hospital recovery has taken longer than he'd hoped.
36:16I want to keep, you know, going through the recovery stages, but yeah, quicker than I am.
36:24That's why I'm glad that today went as well as he did in terms of the physio stuff.
36:29Fast forward five days and what a difference.
36:33Fully committed to his rehab, Chris has finally received the all clear to go home.
36:38Well, Professor Sian.
36:40Hi, Chris. How are you?
36:41I'm feeling amazing. Five days after a major operation. Cannot believe it.
36:45Yeah, so have you done the stairs with the physio today?
36:48Today I did a walk around with the physio. We went up to the one flight of stairs, did it by myself,
36:55came down, no dizziness, no issues.
36:58We did ultrasound at the heart and the heart is pumping rigorously, no fluid around the heart.
37:05So I'm very happy with the heart with the valve.
37:08So certainly, you know, 100% happy for you to go home today based on what you've said.
37:14Still can't believe it. Five days. I cannot believe it.
37:18Take it easy.
37:18Of course.
37:19You don't have to go running and start doing anything rigorous at the moment.
37:24No.
37:24Just take it easy. Take it slowly.
37:26Just focus on recovery and do it well. Eat well.
37:31Making that positive impact on someone's life now will just make my day.
37:37We'll catch up soon. Okay? You take care.
37:39Yes.
37:40Every single case I do, I do it with love. I do it with passion. And I don't have a bad day, to be honest.
37:50On RPA's cardiac ward, 64-year-old Adrian has made a remarkable recovery following surgery to replace his pacemaker.
38:02A bit sore, and I've still got all my wires and all my doodads.
38:07As soon as I take them out, I'm going.
38:09So much so, Dr. Poranik has given him the okay to go home.
38:14It may be a bit sore, so it'd be good to just expose that and have a look.
38:21You definitely have some really nice appearance of the wound. It looks like it's going to heal really well.
38:26I know you're a carpenter and you do a lot of exercise.
38:29Yeah.
38:30Can you just walk us through the kind of exercise that you'd normally do?
38:33Bench, about 70 kilos.
38:36We can't have you lifting your arm up above the horizontal for about six weeks, so we want that
38:41to set nicely in place.
38:43Yeah.
38:43And we'd definitely be avoiding any heavy lifting, so this bench pressing of 70 kilos, it's impressive,
38:49but I think we'd get you to give that a bit of a rest just for six weeks or so and build up really slow.
38:54I expected six weeks. Thanks very much. We'll be back in 10 years.
39:00A normal pacemaker will last about 10 years, but this is always dependent on how often the
39:05pacemaker needs to fire. In Adrian's case, he's actually pacemaker dependent. He doesn't have
39:10very much electricity generated out of his own heart, and so he may well use up the pacemaker
39:15faster than other people, and that's really important because regular checks of the pacemaker
39:20are therefore very important.
39:24It's four days since mother of two Jagruti had a recurring tumour removed from her pelvis,
39:33and she's making a good recovery.
39:35The tumour is out. No colostomy bags. I'm happy for that. And yeah, let's hope for the best that
39:43it doesn't come back again. The 38 year old will need scans every few months to check the tumour hasn't
39:50returned. But right now, she just wants to get back to her kids.
39:55This is the first time my daughters are left without me for this long.
40:00Knock, knock. So how are you feeling? Good.
40:07All right. Day four today. Is everything working in terms of your bowel and your bladder?
40:12Yep. Okay. Normal. Are you eating? I am eating. Eating? And would you like to go home soon?
40:19Yes. Yep. How's the pain control? I hear you're just taking some Panadol.
40:25Yes, I am. Fantastic. From my side, you're ready to go home.
40:29From my side, I'm also ready to go. Okay, good. That's good news. That's determination.
40:35And when you have determination, you'll do it. And thank you so much. My pleasure. Say hello to your
40:41family. Yes. And go back to your beautiful daughters. Thank you. Good. Okay. Thanks, Doctor.
40:46Oh, I love Dr. Peter Lee. I will never ever forget that person in my life. Even if I die,
40:53I will still remember Dr. Peter Lee. As a surgeon, just so happy for her, for what it means to the
41:01family, that she doesn't have to have bags. So happy that we could bring that smile to her face.
41:14With the all clear to go home, a few hours later, De Grootie's family arrived to pick her up.
41:22Baby, how are you?
41:26Yeah. Peek-a-boo. Peek-a-boo. Mummy coming home. Yeah. Mummy coming home. Yes.
41:37De Grootie can now put on her dancing shoes again and enjoy living life with her family.
41:43I'm very happy and excited to go home. Bye-bye, Arpia. I hope I don't have to see you again.
41:50Bye-bye. Slowly, slowly.
42:00It's now been five weeks since Lawyer and DJ Chris underwent double cardiothoracic surgery to remove
42:07a life-threatening aneurysm and a damaged heart valve. I didn't have any symptoms of that condition,
42:13but at a split second, your life can change, you know, or end.
42:21And it's fair to say he's getting his groove back.
42:24I'm fantastic. I really, truly am fantastic.
42:31The conversation about keys is not one of the happy.
42:34No, no.
42:36I have, I guess, a lust for life at the moment that I've never had.
42:42So we've got the night of the club coming up.
42:44Yeah.
42:45We have to make a set for it.
42:46Of course.
42:47As is always.
42:48It's going to be, yeah, good to be back.
42:50Yeah.
42:50This is a different life.
42:52This is a new life.
42:53I was reborn in that operating theater.
42:57I was reborn.
43:00And yeah, life better be ready for me.
43:05That's...
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