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00:00our job is hardcore it is life and it's death everything we do relies on this bond between us
00:17you're okay you're okay you have to be comfortable in high stress situations
00:32in this immersive series you're in the hospital how much do you want to tell me what drugs you want
00:37to win we take you into the theaters and wards of sydney's busiest hospitals
00:42and into the world of nurses nurses are the backbone of the hospital through their eyes
00:50you'll see life big deep breath in
00:56death unfortunately we can't save her
01:05and everything in between coughs colds and sore holes
01:08welcome to the front line
01:15of one of the world's toughest it's all right darling we're looking after you okay
01:20a most trusted professions
01:24was scary hey nurses are superheroes without capes just in scrubs
01:30this time on nurses an intoxicated patient jacob fights for his life jacob open your eyes you're in
01:46hospital mate a graduate midwife is put to the test hopefully we can break your waters so just going in
01:55now and a parkinson's patient in surgery and awake everything fine it's pretty awful actually
02:10st vincent's hospital has one of the busiest emergency departments in australia you're in the emergency
02:15department it's a vincent's over 50 000 patients come through its doors seeking urgent medical attention
02:23there is no such thing as a typical day in ed you see people with headaches you see people with
02:28injuries you see people have been in car crashes intoxicated people your drug affected people
02:35anything comes in the door head down bum up get in and get it done
02:43my name is carly and i'm a registered nurse in the ed department when i was younger i was the paper
02:49girl at the local hospital i was probably about eight or nine with the old cart
02:55and the whistle oh look who's here here we are i looked up to the nurses and i thought that's
03:00something i would like to do all right do you want a hand yeah sure all right i'll send these bloods
03:06where would you be without nurses up the creek without a paddle
03:10carly's shift is just beginning and a major trauma is on the way
03:23it's carly in ed can i have a major trauma recess two please thank you a 28 year old man has been
03:30discovered unconscious after a night of drinking recess three which is the lowest score you can get
03:36so it's the most unconscious you can be he's got an evident head injury so it doesn't sound good
03:42if he's not collared we'll collar him when he gets here
03:49it's a 28 year old male um history of going out last night drinking with a friend they came home
03:54around 2 a.m friend reports he fell to the floor all we can find is an abrasion on his left eye
04:00friend denies any drug use just says alcohol and doesn't have any other medical history on him
04:05where we're located we have a very big drug and alcohol catchment area he does have equal pupils
04:10they're about four meals he's just having a little vomit there just open up for me mate that's it the
04:15worst case scenario is that he could aspirate so he's going to vomit he's got no gag reflex it's going
04:20to go straight back into his lungs and give him ammonia and essentially he'll die from it jacob open your
04:27eyes jacob open your eyes you're in hospital mate jacob yeah very strong come on man open your eyes
04:38open your eyes buddy jacob hold on buddy yeah we'll have to flirt us today i think i've got i've got
04:47ketamine you want to ask yeah oh careful everybody please so we can get an arm so we can get a
04:57second line it's quite combative hold on buddy jacob 100 100 all right jacob
05:08the neurology department at st vincent's hospital treats an average of 1500 patients a year we're
05:22just being super super cautious the dedicated team performs complex brain surgeries you can see the
05:29brain pulsating away to improve the quality of life for those suffering from a number of debilitating
05:35conditions neurosurgery when it's successful it can be life-changing but we're working within
05:40millimeters and one wrong move can be disastrous
05:53this admissions
05:57ann is one of over 80 000 australians living with parkinson's disease
06:03a neurological movement disorder with symptoms including tremors rigidity and uncontrolled
06:09movements parkinson's to me is all the things i can't do like even getting dressed is difficult
06:15i can't write goodness me writing is terrible you know i don't like to go out walking very far by
06:22myself in case i fall over it sort of makes you feel incompetent
06:26today am will undergo a revolutionary surgical procedure called deep brain stimulation she will be
06:35awake during the entire operation
06:40for deep brain stimulation the idea is that we insert electrodes into the part of the patient's
06:45brain that is not conducting electrical signals correctly and we stimulate that area so the goals
06:51of deep brain stimulation for parkinson's is to improve our patient's quality of life by alleviating the
06:56symptoms that are hampering them doing their normal activities scrub nurse naomi has over 20 years
07:03experience i am in the specialized field of neurosurgery and has assisted in hundreds of deep brain
07:10stimulation procedures yeah you feeling okay yeah good okay if you need anything just yell out it's hard
07:16sometimes because you can see the fear on some patients faces and we try and make that a bit easier for
07:21them whilst naomi scrubs in anna is prepared for surgery which involves shaving her head a necessary
07:30step to minimize the risk of infection having the hair cut off it's daunting it's up there with all the
07:36things i'm not happy about but it's a small price to pay the mri that was done prior to surgery that looks
07:45nice ann has been fitted with a frame that will keep her head perfectly still during the delicate
07:52procedure principal neurosurgeon dr benjamin jonka and neurologist dr stephen tish will map the coordinates
08:00in her brain to precisely implant electrodes okay and let's scroll up from there by the way
08:08yeah it's still i think that's okay yeah it's still reasonably lateral over the next four hours a team
08:16of five doctors and four nurses will try to literally switch off the effects of parkinson's
08:24the surgery is unique in that the patient is awake for the majority of the procedure
08:28does your neck feel okay there ann yeah i think so yeah excellent can we get a swipe of prep and the local
08:34gloves and you're going to feel something cold on your head in the moment dr jonka will inject local
08:42anaesthetic into ann's scalp so that she won't feel the incision he needs to make in order to access her
08:49brain okay a little bit of a sting and i'm just going to put a little bit of extra local into your scalp
08:54now but the brain itself has no pain receptors so the implantation of the electrodes will be painless
09:01our patients awake for the procedure so that when we put the electrodes in we can test that they're
09:06actually a in the right place and that they're actually alleviating the patient's symptoms
09:13and real-time responses to questions and repetition of physical movements during the procedure will be
09:20crucial being awake while someone's drilling into your skull and putting electrodes into your brain
09:25it's pretty daunting how is that and a bit strange i think all of us imagine that the patient could be
09:33a family member or a loved one and we do try and make sure that we treat them as we would want our
09:37family members to be treated
09:47if we can make a patient more comfortable in any small way we'll go out of our way to doing that
09:52because it's such a strange and scary experience for patients being awake
09:59and have you got our cables dr yonker guides recording micro electrodes into the target positions
10:06which can be up to seven centimeters deep into ann's brain
10:13and that's the sound of your brain you can hear there and in a couple of minutes we'll hear some
10:17different sound as we enter the subthalamic nucleus it's the most perilous part of the procedure due to
10:26the risk of seizure brain bleed or even stroke the stakes are high one wrong move can have catastrophic
10:34consequences
10:47how is that and a bit strange in the surgical theater of st vincent's private hospital parkinson's patient
10:54ann is 90 minutes into a deep brain stimulation surgery during which she must remain awake
11:01and that's the sound of your brain you can hear there and once we've made the hole in the skull
11:07with the drill we're able to insert something called a micro driver into the brain which places
11:12the electrodes where we want them to if the surgery is successful the electrodes will override the
11:18malfunctioning part of ann's brain that is causing her parkinson's symptoms so i'm just going to take
11:24your right hand out just to check a few things and neurologist dr tish conducts physical tests to
11:31establish the baseline of her symptoms which include rigidity and tremors it's a bit restricted isn't it
11:38rigidities are two full range moderate severity but there is a tiny bit of tremor grade one
11:45so and we're going to do some test stimulation now what we're looking for is to see if it has any
11:59effect on that bit of rigidity that you still have and also to look and see if there are any side
12:04effects okay so 0.5 million very small amounts of electrical current are fed through the electrodes
12:13that are in place deep within ann's brain everything fine any pins and needles or numbers anything of
12:19that sort look left right still okay there's no more rigidity so we'll be mainly looking at side
12:30effects now 2.5 go to three smile big smile go to 3.5 the amount of electrical current is increased
12:41gradually it's a very fine line as too much current can result in difficulty speaking numbness and
12:48physical discomfort for ann sometimes there's complications that can occur straight to four
12:54oh it feels weird all over and look left right
13:09hold on babe in emergency jacob carly and the team have called in security to help manage an
13:20intoxicated patient with a suspected head injury who's becoming increasingly agitated jacob all that we
13:29know is that last night he's been drinking and then he was found on the floor this morning and he's
13:33quite combative and agitated and not waking up it looks like he's got some kind of head injury so
13:38it'll need to get sedated
13:43there's a hundred of ketamine just gone in so yeah lots of vomitus around the earway with the patient still
13:49vomiting seven hours after his last drink the decision is made to sedate and intubate him
13:56to prevent suffocation and allow the team to examine him safely
14:01when you guys are ready i think we'll make the tube 100 of rock yeah okay
14:12okay rock's going in right now the decision to intubate someone is never taken lightly because it is
14:18quite invasive procedure and there are a lot of risks involved you know trauma to the mouth trauma to the
14:23throat trauma to the chest cavity trauma to the lung you can cause someone to have an ammonia just by
14:28putting them on a ventilator so it's always a last resort can someone have a listen to the chest
14:38cure
14:42with jacob fully sedated and safely intubated he's sent for a ct scan to determine whether the fall he
14:50had in the early hours of the morning has resulted in a spinal injury or a bleed on the brain
14:56okay we're all ready to go yeah ready yeah
15:06he's acting like he does have a head injury he's at a decreased level of consciousness he's agitated
15:10he's not waking up he's doing non-purposeful movements so all of those signs of a head
15:15injury hence why we're going to scan his head and just see what's going on
15:19they're also going to scan his neck because he might have injured his neck at the same time as
15:25he fell okay so we're rolling on three one two three and down one two that's great yeah okay everyone ready
15:38it might just be a lot a lot a lot of alcohol but it'd have to be a very lot of alcohol for
15:42those symptoms
15:50in surgery at st vincent's private hospital
15:54go to 3.5 dr tish has been slowly increasing the intensity of electrical current through the
16:01electrode implanted deep into ann's brain that last little bit of testing was a bit unpleasant because
16:07we're just probing the level for where side effects occur okay
16:15do you feel fine you say the days of the week monday tuesday a bit louder so everyone can hear
16:25so ben there's a very good effect at target at 0.5 milliamps that's very loose can you see that
16:30rigidity is just about disappeared it's amazing seeing the instant impact i mean you can really
16:38see what we're doing what we're achieving
16:46see that yeah that's better yeah look at that that's a definite pop there isn't it very big
16:51so the tremor seems to have disappeared so tremors down to a zero does that feel looser that arm now
16:56does feel looser it feels like you've got more use of it yeah it's starting isn't it yeah it is
17:02so it's a lot looser than before we started the operation it's great it's definitely a source of
17:07hope for the patient they obviously notice the immediate effects of the stimulation while they're
17:12in theaters and it just i mean it's not a cure but it certainly improves their quality of life for
17:16hopefully many years both of those brain electrodes are now in and secured now we're just
17:22going to give everything a good clean and then close it all up the electrode stays in place after
17:37the operation because that's what actually overrides the electrical signals in the brain that are not
17:42firing correctly and it stays there permanently for the rest of their life it's always great to see the
17:48the patient responds so well it's a really rewarding experience for all of us the whole team
17:55after four hours of surgery am will now be transferred to the intensive care unit for
18:00monitoring and just brought you up to intensive care okay you've done very well although the surgery
18:07has been a success the care she receives in the coming days will be crucial to her recovery
18:13she's not out of the woods yet in emergency carly is anxiously awaiting the results of a ct scan for her
18:23patient who fell while intoxicated
18:27so we're all done okay thanks thank you
18:50a great outcome is someone will come in with an issue and it's not life-threatening and we can
18:55treat them and get them back home again that's good news for jacob his scans are all clear the best
19:01explanation for his deeply unconscious state would be alcohol consumption yeah that's better one two
19:08why were we ever trying to do it with two people in the first place he's at 230 pounds for women that
19:12can't i do think he'll be okay because you know his blood pressure is rising and his limbs are starting
19:17to move so they're all good signs that someone's trying to wake up
19:27jacob will be transferred to the intensive care unit for observation overnight
19:33whatever is the issue we greet everyone with open arms we're here to help
19:45our 30 minute drive from st vincent's is the maternity unit at the martyr hospital
20:02best sweethearty speaking there a roster of 90 nurses work around the clock in the specialized area of
20:10midwifery it's when things aren't going to plan particularly in labor if there's any complications
20:16baby's heart rate drops or we're in a bad position people appreciate you being there in those moments
20:22to support them and it reminds you again you know that you are making a difference
20:27my name is heidi and i'm a new graduate midwife it's cold and rainy out there so it's a good day to be inside
20:44i've started at the martyr at the beginning of the year
20:47morning susan i think it's a great career to be involved in because you're seeing start of life
20:57henry hello it's beautiful i would like to have a baby one day but for now i think i'll stick to my
21:04dog i'll wait a few more years
21:06i just put the stamps for the vitamin k and then as a first-year midwife heidi has been taken under
21:20the wing of senior midwife jeanette jeanette's beautiful she's been my preceptor since i started
21:28she's had so much experience in midwifery in chile and in australia you can tell she loves her job
21:34heidi is preparing the birthing suite for a third-time mum who was due to have an induction
21:45and within the light we have a powerpoint inside so an induction is bringing on labor artificially
21:53that means that if you don't want to listen music there's a few reasons why you might have an induction
21:57sometimes the placentas don't work as efficiently once a baby's overdue if the woman gets gestational
22:03diabetes or any other complications it's a big day for heidi laura how are you going we're just down
22:09here in um room four that's all good she'll take charge of laura's care while jeanette supervises
22:16when needed we'll monitor bub for the first bit and um then we'll get the induction started yeah
22:24and bub's been moving around a lot this morning yeah not heaps not heaps okay not heaps this morning
22:30not much room anymore and are you happy if i have a quick pout where he is sorry my hands are very
22:36cold there's a major emotional role that we play with people forming those relationships often quite
22:42quickly with people and who's looking after his little brothers today oh daycare hence why choosing
22:47today we're just trying to keep them in routine and yeah yeah that connection that you make with
22:53someone even in a short period of time is a special part of this job i think our three and a half
22:57year old gets it like i told him my baby has a present for them oh that's nice and our two-year-old
23:07laura's labor will be induced by breaking her waters
23:15so we'll put the monitor back on bub for about half an hour or so after we break the water and when we
23:20break the waters we'll give your cervix a nice sweep as well which will also probably irritate it a bit
23:25and yeah hopefully bring on some contractions heidi has watched jeanette perform the procedure
23:32but she's only done it herself twice before just check baby's trace and baby's heart rate's looking
23:37really good so we can go in and do an examination and hopefully break our waters just feel some cold
23:44jelly yeah and hopefully we can break your waters so just going in now yeah tickling bubba's little
23:55head heidi senses something isn't right
24:25graduate midwife heidi is preparing to induce a mother's labor by breaking her waters when something
24:37doesn't feel right heidi asks jeanette for a second opinion
24:46it's gonna be cold okay it's a little bit of pressure there
25:03heidi's instincts are right what happened at the moment i don't want to rupture the membrane
25:09because what i found the baby has a little hand here i can feel the little fingers in there saying
25:17hello so baby is basically sitting with their hand on our head if the cervix was here obviously that's
25:23not an ideal presentation we will just call your doctor and ask him what he wants to do
25:33laura's obstetrician is called in to check on whether the induction can proceed
25:37given the baby's position maybe i'll just do an examination and see if that hand's moved it
25:46looks like it's at least beside the head and when there's fingers in the front the pressure
25:58it can easily get through to the membranes
26:00the obstetrician confirms that heidi's hesitation to break laura's waters was right when there's
26:16something if you like in front of the head what the risk is things like cord prolapse
26:23the doctor is sending laura home in the hope that the baby moves on its own in the coming days if you've
26:29had a date set and they've been planning to come in and have their bob and have to go home it would
26:33be really difficult take your time okay it's not a new show the babies they can do it all the time
26:41but at the end of the day mum's safe and bob's safe so that's the most important thing for them yeah see you
26:47one in seven australians is over the age of 70. he is a lot more pale than normal
27:17the aging population's increasing need for healthcare has seen a rise in elderly patients
27:24requiring emergency medical attention do you want any blood killers every day can be a big challenge
27:30in the emergency department we certainly see a fair share of elderly patients it can be difficult
27:44so the lady in here 76 year old female she's been found at home really lying on the ground with like a
27:57magazine stuck to her legs her legs are really full of sores
28:01we can't feel the pulses in one of the leg because it's so necrotic looking there's actually some maggots crawling around her leg and she's now incredibly septic her blood pressure is really low she's really quite sick
28:15my name's iromi this is darren you're at st vincent's hospital can you try to sit up for me
28:37can you try to sit up for me
28:46is that sore
28:49is that painful
28:52she's not really following it no it's not following instructions
28:56she got probably something called a hypoactive delirium as well which is
29:00probably exacerbated with her infection so there's confusion acute confusion the patient's confusion
29:08is a serious symptom of sepsis a life-threatening bacterial infection that if not treated can lead
29:16to organ failure and death we're obviously incredibly concerned about the legs one of them is no pulse so
29:21she might end up having to go for an operation and you know she might end up losing the leg and so it's
29:26pretty serious i'll get the antibiotic started the patient is given iv antibiotics and fluids as the
29:33team races against the clock to try to save her legs and prevent her suffering septic shock a significant
29:40drop in blood pressure that can lead to heart failure so we're just trying to give her a fluid
29:45resuscitation but she's non-compliant with keeping her arm so that's why i'm kind of holding her arm to get
29:50these fluids in to try and improve that blood pressure you know 67 systolic's incredible long
29:57someone who's mid-70s female reasonable weight you're expecting about what 130 140 not that
30:06if she continues with her blood pressure that's only so long she can handle and then she'll crash
30:20on the 10th floor at st vincent's private hospital neurologist dr tish and neurosurgeon dr jonka are
30:30checking in on parkinson's patient anne following her deep brain stimulation surgery
30:36how are you going can't see it just stimulating sort of mid-array contacts one and nine with the
30:45electrodes now implanted in anne's brain the amount of current passing through them can be fine-tuned
30:52remotely rigidity at 0.3 i think it's clearly providing excellent benefit how do you feel your
30:59parkinson's is at the moment well it doesn't feel as though it's there actually that's good yeah it is
31:07this is not going to get good good stuff excellent the recovery is rapid it's actually amazing how
31:16quickly people can recover from this particular procedure given that it's brain surgery
31:24after seven days in hospital it's finally time for anne to go home to her husband henley
31:31you did very well no drains walking as what physio has recommended just take it easy for first two
31:38weeks two weeks naomi she might ring you like just to check on your mom when you've been settled yeah
31:45the reward of being a nurse for me is to make a difference i hope anne has a better quality of
31:50life and can go back to doing the things she loves doing having my hair shaved off was probably the most
31:57confronting thing of all although when i look back on it it doesn't really matter now i don't really
32:02care i quite like the feel of it i run my hands over it all the time and it's not so bad
32:10i wish you all the bad yeah thank you all right take care yeah i guess when i look back i wasn't very
32:19well when i first came in here i certainly feel quite well i feel i can get up and walk around easily
32:26and i don't think i'll get so tired i feel quite liberated actually i feel good i hope to feel a
32:36whole lot better for a whole long time now
32:39you're in the emergency department it's at vincent's in the emergency department darren is treating an
32:57elderly sepsis patient you've got the really bad infection in your legs the severe infection has
33:05caused confusion and delirium leaving the woman unresponsive hello yes first words you've said so far
33:16but after administering iv antibiotics the team finally has a breakthrough
33:21you've said so far where do you live about where do you live about where do you live
33:31in australia yeah
33:37well in darling point darling point that's good that's right
33:44and do you live alone at present at present yes okay
34:00it makes us feel better that she's certainly more alert despite that blood pressure
34:04and when i'm feeling her heart rate is it's strong so that's reassuring
34:08i'm feeling a lot better that you're talking to me now
34:14because you weren't talking at all for a good two hours
34:19so that means that something that we're doing is making you better i've worked with darren for
34:25just over a year and a half he really does care you can hold my hand if you want one there we go
34:32he wants the best for everyone can you move your toes move these toes for me are they sore
34:41yay no wonder i remember when i was a student nurse one of the nursing assistants back home
34:48in scotland she had said to me you know that woman over there and i looked over and it was like an old
34:54woman and she's like you treat her like it's your grand and you remember that throughout your career
34:59and you'll do well and i guess i've always kind of just kept at it
35:08this is in one leg or two days two i know
35:17they managed to contact the neighbor that's been looking after her she is a lady that lives alone
35:23she suffers from agoraphobia so doesn't leave the house normally the neighbor does all the care
35:28she's got sons overseas but i don't think there's good contact there at all and it sounds like
35:33she's just been left to on her own for quite a while with her blood pressure still dangerously low
35:39and the infection in her legs a serious cause for concern the decision is made to transfer the patient
35:45to the intensive care unit it's so lucky that the neighbor found her and she's going to need a lot of
35:50nursing care yeah she's going to need a lot of intervention this would probably be one of the
35:56worst dressings i've ever did a bit awkward though yeah it happens everywhere you know old people
36:03with no family around no one there for them it's just not the way it should be really but there is so
36:09many old people at home with no support now that we've got this patient with us we can really try
36:17and get her better because we've got her in the hospital system now we can try and get services there
36:22you know try and really support her so it doesn't happen again
36:39in the hospital
36:41february 2021 and it's a big day at st vincent's australia's covid 19 vaccination rollout has begun
36:50and frontline medical staff will be the first to get their jabs the registration process are we ready
36:56to go with that sitting up now lovely senior nurses danielle and rachel from the disaster management team
37:03are in charge of setting up the hospital staff vaccination program we've got the paper consent
37:09forms yes we'll write the temperature on those right let's go get the vaccine very exciting
37:18hopefully we'll do about 20 to 40 staff just as a bit of a soft launch while we get our processes in
37:24place danielle is miss corvid st vincent's and so between her and rachel i'm sure they'll kind of make
37:30sure everyone's vaccinated thank you to the vaccinations they're extraordinarily secure
37:36location in the bowels of the hospital to the point where we had to get the local police to come in and
37:42do a site security assessment it's danielle's job to collect the vaccine vials from the pharmacy
37:49are we ready i'm so ready oh my gosh my role is incident response and disaster management a historic
37:56moment the last 14 months it's really just been leading the hospital's response to covert
38:01think between our clinics and our amazing pathology team we've done over half a million covert tests
38:09i'm exhausted just talking about it here we've got a vial and now we're in covert vax
38:17the target today is 40 but danielle has enough to vaccinate a hundred members of staff to actually
38:27get to this point has required a lot of work from a lot of people hello everybody
38:35i have the vaccine oh it's here oh my gosh so in each one there's one vial and then the 10 labels
38:49it's a big event this is vaccination is gonna save the world so it's here obi-wan it's our only hope
38:57hope help me obi-wan is your help me astrazeneca you're my only hope rachel's hilarious she's my
39:08fellow master of disaster we're complete opposites but we complement each other we have worked together
39:15for 17 years now 17 years of marriage and we always say you know because we are very very different
39:26i she's slapping up sally on protocol patty i am very by the book and doing it properly
39:34just checking with me um yeah i'm shorter than you i can't oh sorry love
39:42first dose as our first patient here yeah there's all right good
39:47there you go ah there it goes we gave our first vaccination and you know it's a really special
40:05moment for the service but also personally for our team
40:13give us your vaccination it's so important for us to get the vaccination roll out really happening
40:20can i take a photo stephen the sooner we can get everybody vaccinated across the community not just
40:27across the health service the sooner you know the things that we used to take for granted can start up
40:32again we haven't socialized together forever because of covert i started drinking zero alcohol
40:38wine what's the point it's like going to maccas and having a salad it's been a hugely successful day
40:46for the team who've exceeded their target of vaccinating 40 staff i think we did 96 in total yes we
40:52will definitely be having a drink to celebrate our achievements today thank you we'll see you tomorrow
41:01i just need a gentle downward i'll push you in the pond please can you you're joking about the stairs
41:11i can't believe it was like seamless considering we thought maybe we do 20 to 50 vaccinations and we
41:17did nearly 100 like i'm pretty happy cheers love we did it
41:23patients aren't numbers we certainly treat everyone as if it was our loved ones lying in that bed space
41:39it's awesome at the end of the day the work that we've all done has helped and saved a life
41:42in surgeries where the brain is involved i think we make a huge difference and it's nice to feel
41:51like we have made a difference to someone's life that's pretty huge
42:00some aspects of nursing you're seeing a lot of death watching that moment of when baby's born
42:06it's beautiful it's beautiful just to see new life coming through
42:18you
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