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00:00Our job is hardcore, it is life and it's death.
00:15Everything we do relies on there's bond between us all.
00:19I've got secrets I can't tell.
00:24Just stay down, no, no, no. You're okay, you're okay.
00:26You have to be comfortable in high stress situations.
00:29In this immersive series.
00:34You're in the hospital.
00:36How much? Do you want to tell me what drugs you want to win?
00:39We take you into the theatres and wards of Sydney's busiest hospitals.
00:44And into the world of nurses.
00:47Nurses are the backbone of the hospital.
00:49Through their eyes, you'll see life.
00:52Big deep breath in. Push, push, push.
00:54Good girl!
00:56Death.
00:58Unfortunately, we can't receive her.
01:05And everything in between.
01:07Coughs, colds and sore holes.
01:09Take me to the fire burn.
01:12Welcome to the front line.
01:14Two, three.
01:15Of one of the world's toughest.
01:17It's alright darling, we're looking after you, okay?
01:20A most trusted profession.
01:25It was scary, hey?
01:26Good.
01:27Nurses are superheroes.
01:28Without capes.
01:29Just in scrubs.
01:30Just in scrubs.
01:39This time on Nurses.
01:41A patient with just days to live.
01:43Any time that you see a young person unwell, that's really hard to think about a life so short-lived.
01:49But will his last chance transplant go ahead?
01:53If there's a malignancy that's found, that could mean that these organs aren't viable for transplant.
01:58In emergency, something very simple.
02:01Bruce, is it okay if I have a little bit of that leg of yours?
02:04Yeah.
02:05It feels a lot hotter than normal.
02:06It's a clear indication that there's something wrong.
02:08Lee's a patient fighting for his life.
02:11I don't know what I'm doing.
02:13Just look at me, mate.
02:15Look at me.
02:16Plus, his symptoms are concerning, but he can't speak English.
02:21How old were you when you started to drink it, really?
02:32There are high stakes in organ transplant.
02:46Our job as transplant coordinators is to give patients on death's door a second chance at life.
02:53It is an immense responsibility.
03:02It's 3am, and while Sydney sleeps, the day is only just beginning for transplant nurse Holly.
03:12I'm Holly, and I'm one of the heart-lung transplant coordinators at St. Vincent's Hospital in Sydney.
03:18It's a team of seven of us nurses in the state, so it's a fairly niche role.
03:23Holly has been called to the heart-lung clinic after an urgent appeal was made for donor lungs,
03:31to save a young man's life.
03:34When you put out a compassionate listing, we put it out to all the other states in Australia and New Zealand
03:40to consider us and our patient that probably won't make it very long, more than a week.
03:46An interstate hospital has answered the call.
03:49Donor lungs have become available.
03:52The transplant that we're doing today is for a guy who's extremely unwell.
03:57The 39-year-old patient suffers from an irreversible lung disease.
04:02He's ended up intubated and on ECMO.
04:05Extracorporeal membrane oxygenation, or ECMO, takes over the work of the heart and lungs.
04:12Without it, the patient could not survive.
04:16Whichever part of nursing you're in, any time that you see a young person unwell,
04:20that's really hard to think about, you know, a life so short-lived.
04:25The retrieval mission will take Holly and a team of surgeons on a flight across the country.
04:31Okay. You ready?
04:36Happy leaving at 4am. Be back by 8.30.
04:40Time is off the essence with organ transplantation.
04:43Sometimes we go by road, sometimes we fly.
04:46A 4am flight time gives Holly just under 30 minutes to get everything prepared.
04:53In terms of, like, gear, we've got checklists and checklists,
04:59and there's one person who checks it, and there's another person who checks it.
05:02It's important that we just take everything with us.
05:05It pays to check, as Holly has discovered, they're missing something essential.
05:12Um...
05:13I just need to grab one more bag from the theatre.
05:16It's something as simple as, like, a plastic bag,
05:19but it's obviously what we packaged the organs up to bring them home in.
05:23So...
05:24I even take, um...
05:26So...
05:27I see you.
05:37Um...
05:38So that's the arrest alarm for I see you.
05:41Um...
05:42So our theatre team go to arrests.
05:45Um...
05:47As you can see behind me.
05:49So...
05:50But, yeah, it's like a chilling alarm.
05:52I hate that alarm.
05:54The surgeons that were about to embark on the organ retrieval with Holly
05:58have now been called to the intensive care unit
06:01to help the critical patient.
06:07The patient that's arresting at the moment is our first priority.
06:11I guess fortunate timing that our surgeons are on site
06:14cos we're about to head out.
06:16Unfortunately for me, that means that they're tied up.
06:18Without surgeons, the organ retrieval will be delayed.
06:22And there's another problem.
06:24A bit of a bugger because they've gone to that arrest
06:29and I needed one of those bags.
06:31Holly's on her own,
06:33with no surgical team and a plane to catch.
06:36It's, um, just over, like, the red line in theatres,
06:39which means that you have to be in scrubs.
06:41So I'm going to go chuck on a pair of scrubs
06:43and running at the back myself.
06:53Easy.
06:54I will dump these scrubs and we can get going.
07:00Alright.
07:02Take two.
07:04Get ourselves down to the ambulance bay
07:06and get ready to head out to the airport.
07:08Thanks.
07:12Thanks, H.
07:14We'll load up the car with all the gear.
07:17And then hopefully our surgeons aren't too far off.
07:20There are things that are completely out of our control.
07:27But it's a setback that could cost Holly's patient
07:32his chance of getting the life-saving transplant today.
07:36I mean, these are the things that you can't predict, right?
07:39We'll just hang tight.
07:44With the trajectory that he looks like he's on,
07:46yeah, it's a pretty dire-looking picture
07:49if he doesn't go on to get a lung transplant.
07:59In emergency, there's no rest
08:01for the 13 nurses on shift tonight.
08:04Briggle your toes for us.
08:07In emergency, you just never know
08:08what's going to come through that door.
08:10One, two, three.
08:16Well, we've got to be prepared for anything.
08:18He has fallen about three metres off of a building site.
08:22A second can be a difference between life or death.
08:25Hello, emergency doctor speaking.
08:27When the back phone goes off,
08:28with me being the operational nurse manager,
08:29I go to the phone.
08:30I want to hear the story.
08:31I want to know what's coming in.
08:32We are coming to you with a 63-year-old male bariatric patient.
08:34He's been complaining for approximately five days
08:35of abdominal pain on the right side,
08:36associated nausea or vomiting.
08:37And we'll see you in about five minutes.
08:38And based on that one-minute phone call, we have to assemble our team together.
08:45Things change from that phone call going off.
08:46And so we always go worst-case scenario.
08:52We'll need everyone in to help with this.
08:54Words when to recess please.
08:56Words when to recess please.
08:57Words when to recess please.
08:58Words when to recess.
08:59Words when to recess please.
09:13Words when to recess please, words when, thank you.
09:14So we've just got quite a large man coming in.
09:15He's a big boy.
09:20Quite a large man coming in. He's a below-the-knee amputee.
09:23He weighs 166 kilos, bed-bound.
09:29Bariatric patients have increased health complications
09:33with heart disease and stroke and blood pressure,
09:35and so obviously a lot of risk there with him coming in.
09:38So resuscitation nurse Youn is preparing for all possibilities.
09:44We just want all the airway equipment to be ready,
09:47just in case things go south.
09:49Even though we've got a little detail
09:51of what the patient's going to be like through the backbone,
09:53sometimes when they come in,
09:54if you're not prepared for the situation,
09:57things can get really stressful.
10:01So this is Bruce.
10:03He's 63 years old from a nursing home.
10:05He's been complaining about five days of right-sided abdominal pain.
10:09Bruce needs to be moved onto a resuscitation bed
10:13using an inflatable mattress.
10:17Just watch your backs.
10:18Thanks, Bruce.
10:20One, two, three.
10:21That's it, that's it.
10:22Perfect.
10:23Pull that board out.
10:24There it is.
10:25Thank you, everyone.
10:27You're all right?
10:28Oh, you're all right.
10:29Play four-way ambulance.
10:31Play four-way.
10:32Thank you very much.
10:33You're very welcome, Bruce.
10:35You're very welcome, Bruce.
10:36We'll get you sorted out, eh?
10:38With the patient safely moved,
10:40nurse Youn must now work out what's causing his severe abdominal pain.
10:46Do you want to point with your finger?
10:48Up there.
10:49OK.
10:50I've got this leg amputated four months ago.
10:53The skin feels a bit rough.
10:54Is that normally like that?
10:55No.
10:56No.
10:57It's hot as well.
10:58Well, that looks like it's angry, so I'll let Ed know.
11:01All right.
11:03Youn has serious concerns about Bruce's amputated limb.
11:07Ed, it looks like it's got some cellulitis on the amputation.
11:10OK.
11:11We'll have a look at that.
11:12Yeah.
11:13Cellulitis is a dangerous bacterial infection of the skin.
11:18If left untreated, the infection can spread and become life-threatening.
11:23Bruce, is it OK if I have a look at that leg of yours?
11:25Yeah, I meant to tell you, it feels a lot hotter than normal.
11:30But that just might be my imagination.
11:35It's certainly warm.
11:36Yeah.
11:37It's very red, and it's warm to touch.
11:41It's a clear indication that there's something wrong.
11:43The infection on Bruce's skin might have already spread to his bloodstream.
11:48You OK?
11:50We're worried about signs of sepsis.
11:53Septicemia.
11:54Septicemia, or sepsis, is a bacteria in your blood that's spreading amongst your organs.
12:00It does cause organ failure.
12:03So I've collected bloods.
12:04He'll just tell us pretty much what his organs are doing and how sick he is.
12:09Sepsis is a very time-critical thing.
12:11You're going to find the source of sepsis and treat it immediately, as soon as possible.
12:17It's potentially fatal.
12:19In the early hours of the morning, an organ retrieval mission to save a young man's life has suddenly come to a standstill.
12:34I see you.
12:36As you can see behind me.
12:38He was meant to be flying interstate to get the donor lungs.
12:42But the retrieval surgeons have been called to the intensive care unit for an emergency.
12:47It's a bit hard, like, with the surgeons not being here yet.
12:50Like, I mean, how long's a piece of string?
12:53I don't know if we're going to be an hour and a half behind or two hours behind.
12:56Yeah, it just gets all a bit tight.
12:59Transplant nurse Holly has been waiting in the car park for close to two hours and there's still no signs of the surgeons.
13:08The coordination role definitely challenges me.
13:12I don't think anything would prepare you for transplant coordination.
13:17I'm feeling pretty cold, pretty tired.
13:19Oh, come on, boys.
13:26Patience is a virtue.
13:29Oh, thank God.
13:33Seeing the surgeons, seeing the whites of their eyes.
13:35I'm pretty relieved that we can get this show on the road.
13:38All right.
13:40Three of us across the back.
13:42With the massive delay, it's now a race against the clock.
13:46It's just a lung transplant.
13:49We are about two hours behind schedule.
13:52Charles and Wen had to pop a patient onto ECMO in ICU.
13:55So we're just heading to the airport now.
14:00I have got the medical team here.
14:04I'll open the gate.
14:05Come on in.
14:08Thank you so much.
14:09As a transplant nurse, it's our goal to give critically ill patients a second chance at life.
14:16I think it's important to remember that for this to happen, there is a family at the other end who's saying goodbye to someone else.
14:23In emergency.
14:24Looks a bit red.
14:25Resuscitation nurse Yun suspects that bariatric patient Bruce may be suffering from sepsis, a life-threatening bacterial infection.
14:41It's all right, mate.
14:42You just relax.
14:43Okay.
14:44Bruce can deteriorate very quickly because the sepsis works very quickly on the body.
14:48Just look at me, mate.
14:49Look at me.
14:50He's very sick.
14:51They're waiting for the results of his blood tests when Bruce's condition suddenly worsens.
15:04Here, Bruce.
15:05Can you tell me?
15:06Yeah, I just want to have a funny rhythm there for a few days.
15:07I think I've got ventricular cycle down at the VT.
15:08So Bruce is having what we call conscious VT, and so his heart is slipping into this abnormal rhythm, which is probably related to his infection that he's got.
15:30Are you okay, Bruce?
15:32Yeah.
15:33With VT, ventricular tachycardia, if you have prolonged runs of this, you go into cardiac arrest.
15:39Bruce is going downhill fast.
15:42Do you know where you are?
15:44Yeah.
15:45Where are you?
15:46I'm from Australia Hospital.
15:48You think you're in South Australia?
15:50We really need to keep a close eye on Bruce at this stage.
15:53He's close.
15:54Hey, Bruce.
15:55You all right?
15:56Bruce has deteriorated.
15:58We're worried about his heart at the moment.
16:00We're worried that he'll go into a cardiac arrest until we put the defibs on.
16:04If we need a shock in, we will.
16:06Defibrillation is a procedure that provides an electric shock to the heart.
16:11It's a last resort.
16:13But where are you now?
16:14I don't think I am.
16:15Hello?
16:16Hey, man.
16:17Bruce?
16:18Hello?
16:19Bruce?
16:20Bruce?
16:21Just look at me, mate.
16:22Look at me.
16:23Look at me.
16:24On the other side of the country, Holly and the two surgeons have finally made it, retrieving
16:36the donor lungs.
16:37A chartered flight will get them back to Sydney for the transplant.
16:42But there's a major problem.
16:46Sometimes we do access the chest of the donor and there is something that is untoward.
16:54A lesion was found on the donor's liver and has been sent for urgent testing.
17:01If there's a malignancy that's found, I mean, that could have spread to other places in
17:07the body.
17:08We immunosuppress our patients afterwards.
17:10So you can imagine if you have a small lesion and then you're going to completely immunosuppress
17:16someone, that's just going to be like, you know, a wildfire throughout someone's body.
17:21That could mean that these organs aren't viable for transplant.
17:24At St Vincent's, the ICU team prepares the young patient for the worst.
17:33Even at the last minute, it seems to change.
17:36We're not happy with the quality of the violence.
17:39Yes.
17:40It seems to change.
17:42OK, OK.
17:47The retrieval team has landed in Sydney, and Holly is sweating on the results of the
17:53lesion test.
17:54Hey Shona, it's Holly.
17:55Just wondering if you've heard anything regarding the frozen section.
18:00OK.
18:03If the patient doesn't get his transplant today, he won't survive.
18:08There are times when you're so close to bringing home this transplant for this patient.
18:15You think you've got it all wrapped up with a bow and it just unravels in front of you.
18:31Bruce!
18:33In emergency, the team is closely monitoring bariatric patient Bruce as
18:38they suspect he has life-threatening sepsis.
18:43That's okay. That's just all your wires giving you all the good stuff.
18:47You're attached. There's so many different wires at the moment.
18:50Bruce is becoming increasingly disorientated,
18:54but it's his irregular heartbeat that is the most concerning.
18:58With ventricular tachycardia, you know,
19:01if you have prolonged runs of this, you go into cardiac arrest.
19:06Yeah, he's definitely got another run of it, doesn't he?
19:09Yeah, but he's having very short episodes at the moment,
19:12so we really need to get on top of that.
19:18Sudden heart failure is a real possibility.
19:22I think it's probably second year of your load, mate.
19:24You can get your normal lung.
19:27Let's get some potassium as well. Let's get my mini bag.
19:29Okay.
19:32They're going to give him some IV electrolyte replacement
19:34and see if that can flip his heart rate into a more normal rhythm.
19:39So you've started that potassium.
19:44Oh, whoa, whoa.
19:45Just look at me, mate. Look at me.
19:49I'm hoping this will be get this K and Mag into him.
19:52Make yourself.
19:52Let's settle down.
19:54The blood test results confirm their fears.
19:58The blood cultures have come back positive for sepsis.
20:00It's good that we found it.
20:01We just need to treat him with our antibiotics
20:03so he doesn't deteriorate any further.
20:07With the right medication, Bruce's condition should improve.
20:11Bruce, I'm just going to ask you again.
20:13Do you know where you are?
20:15Which hospital are you in?
20:20Oh, it's amazing.
20:22The early signs of the treatment are positive,
20:33but Bruce will still have a long recovery ahead.
20:37He sends Bruce to intensive care
20:38where he will be looked after closely
20:41from the nurses and the doctors up there
20:43and make sure the antibiotics and things are working for him.
20:45It's one of the nicest things when patients thank us
20:54and we certainly get a lot from that.
21:04Knowing that we've done our best for the patients
21:06is an amazing feeling.
21:08There is nothing better than being a nurse.
21:15Next door to St Vincent's emergency department
21:22is the PANDA unit,
21:24which treats patients with addiction
21:25and complex mental health issues.
21:29The six-bed specialty ward
21:31is the only one of its kind in Australia.
21:34PANDA is the psychiatric
21:37and non-prescription drug and alcohol assessment unit.
21:40You say the doctors?
21:41It's built as a safe space
21:43for people with psychiatric disorders
21:46or substance use disorders
21:47to seek assistance.
21:49You want some clean pyjamas?
21:51Yes.
21:52A staggering one in 20 Australians
21:54has an addiction or substance abuse problem.
21:58As a society,
21:59we see it as a failing or a downfall,
22:01but there's so many factors in someone's life
22:04that leads to them needing to use a substance.
22:07In a setting like PANDA,
22:09it's so important to treat them with kindness and respect
22:12and reduce barriers when people come in
22:14and not have them feel like they're going to be judged.
22:22I'm Allie.
22:23I'm one of the nurses.
22:24My name's Allie.
22:25I'm from Nelson,
22:26a small town in Canada.
22:28I moved to Australia two and a half years ago.
22:31Nurse Allie has received a call from emergency...
22:34Hi. Sorry.
22:35Who's the patient?
22:35...about a patient suffering abdominal pain.
22:38You said he's French-speaking?
22:40He's being transferred to the PANDA unit
22:43after revealing a history of alcohol dependency,
22:47which might be related.
22:49His English is limited.
22:51Are you feeling OK right now?
22:53So it sounds like he's come in
22:54with some quite severe abdominal pain.
22:57It sounds like he's homeless.
22:58Do you want some coffee or tea?
23:00It sounds like he's drinking a fair bit as well.
23:02You're in pain.
23:02It just seems quite vulnerable.
23:05He's not super great at English,
23:07so it would be really difficult
23:08to be in a health care setting,
23:09especially when you're in pain
23:10and you're trying to get support
23:12for whatever you're going through.
23:13I have some pain relief for you here.
23:16OK?
23:19Great.
23:20Thanks, Mohammed.
23:21I think we fail people in society so much
23:24who use substances.
23:25The last thing they need
23:26is to feel that you're
23:27kind of maybe looking down on them
23:28or taking a moral stance
23:30on their substance use.
23:31Relax.
23:33So I think as nurses,
23:35there's so many things we can do
23:36for people,
23:36making them feel like it's a safe space
23:38versus a space
23:39where there might be judgment.
23:41Are you shaky?
23:42Do you feel shaky?
23:43A little bit?
23:44If they can't understand him,
23:47it will be difficult
23:48to trace the problem.
23:50Ali organizes an interpreter.
23:52My name's Ali,
23:53and I'm his nurse today.
23:54I'm your nurse today.
24:00Welcome.
24:00I'm your nurse today?
24:01Yes.
24:02Hi, Mohammed.
24:03Can I just ask some questions
24:04about your alcohol?
24:06Yeah.
24:06What can you tell me
24:07about your alcohol?
24:10I drink every day
24:13a little bit of wine.
24:15A carton, 5 litres.
24:18I drink 5 litres of wine every day.
24:21OK.
24:22How old were you
24:22when you started to drink every day?
24:25What a dishonor.
24:26At the age of 10,
24:27I started drinking 5 litres of wine every day.
24:31When you hear that,
24:32it can be very shocking,
24:34but it also, I just think,
24:35gives you such a better picture
24:37of what his life might have looked like
24:39as a child and leading up to now.
24:41People don't just drink 5 litres a day for fun.
24:44and they're usually coping with something.
24:50For me, I find that really sad.
24:54Thinking about someone reaching out
24:55for a coping mechanism at 10 years old
24:57and alcohol being a coping mechanism,
24:59it really just hurts your heart.
25:02What's been happening for you recently, Mohamed?
25:06What's been happening for you recently, Mohamed?
25:08What's been happening for you recently, Mohamed?
25:09Oh, I was a little bit of blood.
25:13Spitting blood.
25:14How long have you been spitting blood for?
25:16Two days.
25:17Two days.
25:18Two days.
25:18Just try and relax your tummy a little bit more.
25:21Two days.
25:22It's been painful there?
25:27Have you had an injury to your chest recently?
25:31Wait.
25:32Can you tell me more about that?
25:36It's going to bug up.
25:39When did that happen?
25:40A month.
25:41A month ago.
25:43Yeah.
25:43When people have injuries to their ribs,
25:46sometimes it's hard to breathe,
25:49and then sometimes you can get an infection
25:51in your pneumonia because of that.
25:54Mohamed will be sent for an urgent CT scan
25:58to determine the cause of his abdominal pain.
26:03The CT scan is crucial right now
26:06to make sure that Mohamed doesn't have any sort of injury
26:08or underlying condition.
26:18In the Panda unit...
26:20I was crachy a little bit of blood.
26:22..a French-speaking patient's abdominal pain
26:25is cause for concern.
26:28It's done, we'll go.
26:32We've got Mohamed here from Panda.
26:34Nurse Ali is taking Mohamed for a CT scan
26:37to help find the source of his severe abdominal pain.
26:41Oh, I don't know how this will translate.
26:46Oh, beautiful.
26:48Do you have any?
26:48No.
26:49To help with the language barrier,
26:51the CT machine is set to speak in French.
26:54Inspirez, et retenez votre respiration.
26:59Respirez.
27:01We're done.
27:09Liver's fatty, isn't it?
27:10Jeez.
27:11That's not normal.
27:12The results show that Mohamed has signs of fatty liver disease,
27:17a condition that can progress to psoriasis and liver failure
27:21if not treated.
27:23Mohamed will stay in the Panda unit
27:25for treatment of his acute condition,
27:28but he also has a long-term goal.
27:30What would you like to do about the alcohol?
27:32Would you like us to help you stop?
27:34Would you like us to help you stop?
27:36Yeah, sit to play with me.
27:38Yes, please.
27:39Yeah, okay.
27:40Good.
27:42What if you could stay in the hospital with us
27:44so we can manage your alcohol withdrawal?
27:47He's keen to go to Gorman,
27:48which is the detox unit at St. Vincent's,
27:50and just have a supported medicated withdrawal.
27:53But he's been drinking since he was 10 years old.
27:56Recovery is a lifelong process,
27:59and relapse is often part of recovery.
28:03Bye.
28:05Nice to meet you.
28:07I love drug and alcohol nursing.
28:08See ya.
28:09I think the clients are the best part of my work.
28:12To be able to sit with people
28:14and hear those life experiences
28:16and what's maybe brought people
28:18to where they might be today
28:19is quite an honor, I think,
28:21and quite a privilege.
28:28There's your lips.
28:29The retrieval team has landed in Sydney
28:32and Holly is anxious for the results on the lesion.
28:38Hey, Shona, it's Holly.
28:40Just wondering if you've heard anything
28:42regarding the frozen section.
28:44Okay.
28:45If it is malignant,
28:47the transplant won't go ahead.
28:50Our superpower and our biggest weakness
28:53is being empathetic.
28:55I do believe that it obviously makes you a very good nurse.
28:58It's not just the clinical side that we do.
29:00It's all the little bits that stick it all together.
29:06No malignancy.
29:07Okay.
29:08Awesome.
29:09Okay, that's great.
29:11No malignancy.
29:12It's a biliary adenoma.
29:16That's really good news.
29:19It is such a relief to know that it isn't malignant
29:22and we can go ahead today
29:24and this is potentially the start
29:26of a really beautiful journey for this young patient.
29:28The transplant is on.
29:31Holly's patient will go straight from the intensive care ward
29:34to the operating theatre.
29:39For a patient pre-transplant,
29:41it's a bit like a pit stop before a Formula One.
29:45They come out from all angles.
29:47Anesthetic surgeons, cannulas are in, art lines are in.
29:50You know, we have them prepped, locked and loaded,
29:53ready to go
29:53because as soon as we get the green light
29:55from our retrieving team,
29:57it's all stations go.
30:01On arriving back to St. Vincent's,
30:03I go to the magical red line
30:05at the end of the theatre corridor
30:07and hand over the esky to our scrub team.
30:10Time to drop off the new set of lungs.
30:13That's got your cardioplasia and everything in it.
30:15They'll start implanting now.
30:20So Holly is the scrub nurse in this instance
30:23so she will get passed on the baton as such
30:26and take those lungs into the theatre to kick off.
30:35Obviously, surgery carries a risk.
30:37Transplant, a greater risk than some surgeries.
30:40Fingers and toes crossed that we've made it this far
30:43and there's been a few hiccups.
30:47Hopefully, it'll all go well today.
30:54Just do your best with your clothes.
30:56Yep.
30:57Scout nurse Holly is one of three nurses
31:00working alongside four surgeons
31:02for the complex operation.
31:04My name's Holly
31:05and I'm a perioperative scrub scout nurse.
31:09So today, I'm the hands for everybody that's scrubbed in.
31:11We're doing a bilateral single-squatural lung transplant.
31:16This patient has been on ECMO in ICU
31:19and this lung transplant is vital right now to save his life.
31:26The organs have just arrived into the theatre,
31:30which is really exciting.
31:32So from this point on, the clock is ticking.
31:34So I'm going to go on
31:38and then as soon as we're happy,
31:40I'm going to turn off the ECMO.
31:43For the last six weeks,
31:45the ECMO machine has kept the patient alive
31:48by taking over the function of his heart and lungs.
31:52Now they need to turn it off
31:54and transfer him onto another type of life support.
31:58It's a really critical moment of the surgery.
32:01We're actually taking the patient off ECMO.
32:04The patient's survival depends on this moment.
32:08So if anything goes wrong, the case can't go ahead.
32:19Australians love sport,
32:20which is why the waiting room of emergency
32:23is the busiest place in St. Vincent's on the weekend.
32:27I'm on my right arm.
32:28We see a lot of broken bones, you know,
32:30because we've just got kids off school,
32:31we've got sporting injuries.
32:33Accidents happen all the time.
32:35Stay nice and relaxed.
32:37Up to 60,000 Australians are hospitalised every year
32:41for sports-related injuries.
32:44The most common are fractures.
32:48I do feel for people who I see that have broken bones
32:50because you can just see how painful it is.
32:53There's no typical day in emergency.
32:55We're ready for whatever comes through those doors.
33:08My name is Carly,
33:10and I am a registered nurse in the emergency department.
33:13I'm normally stationed out the front as a triage nurse.
33:17Morning, 46-year-old Janet fell off the skateboard
33:21and he's had 10 of more with ambos and three of methoxy.
33:25Carly's first weekend warrior
33:27is probably feeling more embarrassed than in pain.
33:31Hello.
33:32Nicholas, is it?
33:33How are you going?
33:34I'm Carly, one of the nurses.
33:35Hi.
33:35What have you done?
33:37I just fell off on my side of the skateboard.
33:40All right, you're right to walk over there, mate.
33:41Yeah.
33:42Nicholas believes his elbow dislocated from the fall
33:45and then popped back into place.
33:50Lie down in there for us, if you can.
33:51I'm just going to have a quick look at it.
33:53Have you ever injured this elbow before?
33:54Not the elbow.
33:55No.
33:56Are you able to straighten it?
33:57No.
33:57No?
33:57OK.
33:59Back in.
34:00Ah!
34:00Sorry, mate.
34:02Do you want something else with pain at the moment?
34:04Yeah, maybe.
34:04Yeah?
34:05Yeah.
34:05All right.
34:07After administering some pain relief,
34:10Carly needs to organise an X-ray
34:12to see if the elbow is still dislocated or fractured.
34:19I used to skate when I was 15,
34:21and now my son's in skating,
34:22so he's at the park today.
34:24I was doing a few turns, it was all going fine.
34:27Of course, I fell off.
34:29I had a big pop.
34:30It came out, and then it popped.
34:32I went back in, and...
34:34So, yeah, misadventure.
34:39Hey, it's Carly in ED.
34:40I was just wondering if I could bring someone around for an X-ray.
34:43Oh, a legend.
34:43I'll bring him through.
34:44Thanks.
34:44Like, I think my son was begrudgingly quite impressed
34:48by his dad's skills,
34:50um, until I fell off.
34:53Now, X-ray's ready for you.
34:55Do you want me to get you a wheelchair?
34:57Oh, what?
34:58What, you a good skateboarder,
34:59or just an okay skateboarder?
35:02Just to be okay.
35:02Like, kickflips and stuff, are we talking?
35:04Growing up, my brother was a really good skateboarder.
35:07Obviously, I wanted to be just like my brother,
35:08so I used to skate as well.
35:10I used to be able to do, like, an ollie and a, you know, a few things.
35:13I really enjoy the patient interaction
35:15and meeting people from all walks of life,
35:17and I just love to chat to everyone as if they were my friends,
35:19so I really enjoy that part of the job.
35:22So no kickflips?
35:23No, no.
35:24Look, when I was that age,
35:26I only just meant to kickflips.
35:28Right, okay.
35:29X-ray.
35:33This is the sore part.
35:35Sorry.
35:37No, I can't turn it.
35:38As Nicholas waits to find out his fate,
35:41another patient has willed in with a skate park injury,
35:44except this one is a pro.
35:47This afternoon I was at a skate park.
35:49My foot's gotten slipped under the deck of my scooter,
35:52and it's twisted and cranked,
35:53and, oh, it's severely painful.
35:56While he waits in triage,
35:59Nicholas's X-ray results are in,
36:01and it's not good news.
36:04You all right, then?
36:06So it turns out he has fractured his elbow.
36:09He's done the radial head.
36:10Sounds like he won't need any theatre at the moment,
36:12so they're just going to put him in a sling,
36:13give him some good painkillers and send him home,
36:15and he'll go and see the orthopaedic doctors next week in the clinic
36:17just to make sure it's healing and they don't have to do anything.
36:20With the novice skateboarder on his way,
36:23Carly checks in on the pro rider.
36:25Hey, buddy, how are you going?
36:26I'm Carly, one of the nurses.
36:28How's your pain at the moment?
36:30It's probably about eight hours.
36:32You want something for it?
36:33Can you pop your leg down for me for a second
36:34or so I can have a quick look?
36:36Oh!
36:39Is there any pain in your foot there?
36:41All right, what about here?
36:43Sorry, here?
36:43Oh, yeah.
36:44He's hurt his right ankle.
36:46It may be fractured.
36:47He can't walk on it.
36:48It's very swollen, so I'm going to get an X-ray
36:50and see what injuries he has done, poor fella.
36:56Are you a good skateboarder?
36:57I've been a pro for 13 years.
36:59I've worked at Monster Skate Park for four and a half years
37:01and three tricks so far that I've got under my belt for world records.
37:05That's hectic.
37:06It's better than the guy before.
37:07Couldn't even do a kickflip.
37:09I could kickflip when I was four and a half.
37:11Oh, my God, that's so good.
37:12That's what I did today, that trick.
37:16Is that you?
37:17Yeah.
37:18And then my foot got caught under the deck.
37:21Oh.
37:22I'm going to go to room two.
37:23Room two.
37:24Room two.
37:25Roll.
37:27I love Santa Cruz.
37:29But the impressive move could be his last for a while.
37:32Lift the right leg for me.
37:34Good.
37:35Just the motherboard under there.
37:36Perfect.
37:36In the heart and lung theatre,
37:44the surgeons are facing the riskiest part of a lung transplant,
37:49temporarily turning off the patient's life support.
37:53Okay, lift the right leg.
37:54Now, they need to swiftly transfer him onto a heart and lung bypass machine.
37:59The bypass machine is taking over the functioning of the heart and the lungs.
38:04And if I know, it's on.
38:05It's really secure.
38:06With the bypass machine now keeping the patient alive,
38:10they can start the transplant.
38:13The patient's native lungs are going to come out.
38:16Two teams of surgeons will work simultaneously to get the timing exact.
38:23They'll separate the organs and get them ready to go into the patient.
38:27The first lung has been taken out and is ready to go into the patient.
38:32The other lung has been separated.
38:34It's pretty good.
38:39The first healthy lung is placed in his chest.
38:43We've got the surgical team working on getting one lung in,
38:46and we've got another part of the surgical team that are working on the other lung to get it ready.
38:51The new lung's in.
39:02What they'll do is connect the vessels from the donor lung up to the vessels of the patient.
39:08With the organs connected, the patient should be able to breathe on his own.
39:16The only way to find out is to switch off the bypass machine.
39:21We've just turned the patient's heart and lungs back on.
39:26We have a moment where everybody goes quiet,
39:28and we just wait to see how the lungs have taken to the patient's body.
39:33A minute has passed, and there's no sign that the lungs have taken.
39:42Lift the right leg for me.
39:57Good, just put the motherboard under there.
39:59Perfect.
40:00In emergency, a pro scooter rider is waiting to find out
40:04if a risky manoeuvre has broken his ankle.
40:07It's like Tyrone's got a fracture.
40:17Is it broken?
40:19Yeah.
40:20Sorry.
40:22This young man's got a broken ankle.
40:24Now I know what's swelled up so far.
40:26Yeah, yeah.
40:26So he'll go up to the physio room and get a half-cast put on,
40:30and next week he'll go to the orthopaedic clinic
40:32where they'll decide what treatment he needs from there,
40:34whether it's surgery or whether it's something that can be managed at home
40:36with a full cast and some crutches.
40:38We're going to probably go upstairs to the plaster room, I'm assuming.
40:42Oh, get out of the plaster room.
40:44The break means Tyrone won't be doing anything radical for a while,
40:49but the same can't be said for Carly.
40:51It is a pretty gory injury, but it has not put me off skating.
40:54I'll just stick to the ground and the little ramps.
40:59That's about as exciting as I'll do.
41:01Upstairs in the cardiothoracic theatre,
41:08Nurse Holly and the entire surgical team are holding their breath,
41:13waiting for their patient's new lungs to inflate.
41:17They've just turned the patient's heart and lungs back on.
41:21Pretty much now what they're waiting for
41:30is to see if the organs are working.
41:33Seeing the patient's new lungs inflate
41:54and get colour back for the first time
41:57has got to be one of the best parts of the procedure.
41:59After eight hours in theatre, the transplant is complete.
42:18And we're going to get the patient ready to go back to ICU.
42:21It's a moment of celebration for the 12-strong medical team
42:34who have worked tirelessly in the theatre
42:36to give the patient a new set of lungs.
42:40We've given the patient a new shot at life, which is amazing.
42:44I count myself very lucky every single day
42:49that I get to do this for a job.
43:00It's the end of a 12-hour shift for Carly,
43:03but before heading home,
43:05she wants to sweeten the night shift for the incoming team.
43:09Yum-o.
43:10This is my famous salted caramel fudge,
43:13which I've been making for a fair few years.
43:16I've made a batch tonight to bring to work,
43:18to give to everyone,
43:19to keep up their sugar and keep them going for the shift.
43:23I've only got many talents this one.
43:25Oh, yeah.
43:25Would you like some of my fudge?
43:28I want a big bit.
43:29Well, take two.
43:30Thanks, Holly.
43:31You're very welcome.
43:32That's delicious.
43:33Just a bit of a pick-me-up. You're welcome.
43:35Always brings a smile to people's faces.
43:37Homemade fudge.
43:38Oh, gosh. Is there a small one?
43:40Is there a big one?
43:41Yeah.
43:42That one in the middle has got your name all over it.
43:44It's very important to spread a bit of cheer where we work
43:47because it can be such a high-impact area
43:49that can cause a lot of stress and worry.
43:52Oh, thank you so much.
43:53It's beautiful.
43:55People always come back for more.
43:56Tony?
43:57Did you make it?
43:58Yeah.
43:58You got a mask on.
43:59I love it.
44:02Maybe I'll have one myself.
44:03Delicious.
44:09I think it's been a hit.
44:10It always is a hit, though.
44:12It's my one claim to fame.
44:14My fudge.
44:20See ya.
44:22Come.
44:23We have such great staff.
44:25We're all one big happy team.
44:27I love the work that I do.
44:28I love coming to work every day.
44:30Oh, happy birthday, Connor.
44:31And just, yeah, helping people.
44:36But, yeah, we'll get home and hopefully get a good sleep
44:39and do it all again tonight.
44:40I am done.
44:41When patients do get better, there's no better feeling
44:44because you know that you've done your bit for them
44:45and you've helped another human being
44:47and that's what I get out of this job.
44:49I'm so tired.
44:50I've just got the giggles.
44:52The greatest joy in this role, I think,
44:53is seeing when patients get back to a sense of normal.
44:57So...
44:57Get in sleep.
44:58I will.
44:59Enjoy.
44:59I will.
44:59I'll get out of here to know that...
45:01we have given patients on Death's Door
45:03another shot at life.
45:06When you were home for me
45:11I'll get you home for later, if you ever get back to a person,
45:16in a pocket, you know,
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