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00:00:00The clock is ticking.
00:00:04This is a serious life-saving operation.
00:00:08He's at risk of dying from this procedure.
00:00:14We can go from under control to emergency in the flutter of an eyelash.
00:00:20The beep means don't do that again.
00:00:24It is very personal for me.
00:00:30If you put a hole in here, he'd be at risk of dying on table.
00:00:35This is either life or death.
00:00:42Oh, there you go.
00:00:49I lost both my legs above the knee.
00:00:51I get pain, which is like electric shocks.
00:00:54Which, they're the ones that kill me.
00:00:57His kind of function is such that you wouldn't start out like this.
00:01:00The risks were probably too high.
00:01:02What's the chance of Luke's survival now?
00:01:05I mean, he's at risk of dying from this procedure.
00:01:10It's open a little bit for me.
00:01:12I'm going to have to relearn how to eat again.
00:01:15And there'll be problems with my speech.
00:01:17I'm just going to stab through the lip all the way.
00:01:21So that's in effect and the jaw will hopefully break.
00:01:29The biggest risk for dueling is an artery in the neck will burst.
00:01:33The last thing you want to do is to make a hole in the jugular vein.
00:01:36You've got the emergency list there.
00:01:37Do that one.
00:01:38Hold that one.
00:01:39Go away, it doesn't go anywhere.
00:01:40Today we're going to operate on Luke.
00:01:41So he's a chap who was injured in Afghanistan 15 years ago.
00:01:57Massive blast injury.
00:01:59He came through it, but he's got very high amputations.
00:02:02I don't know, he's going fast.
00:02:04Increased control.
00:02:06Yeah.
00:02:07So we first came in to contact with Luke immediately when he returned, actually with a number of
00:02:12his colleagues who'd been injured around that time.
00:02:16He's had some nerve pain which has been intractable.
00:02:19Operated on him in 2018.
00:02:21And then we just got some relief.
00:02:25And today we're hoping to really attack both the right and the left sides.
00:02:32Everybody's in.
00:02:33The burden of injury that these chaps had, it was phenomenal.
00:02:38The nurse would do it, wouldn't she?
00:02:40Oh, there you go.
00:02:41Oh, gosh.
00:02:42Gosh.
00:02:43There you go.
00:02:45There you go.
00:02:46And often this level of injury was unsurvivable.
00:02:52He's had nerve pain.
00:02:54His pain has really made him suicidal at times.
00:02:58He doesn't feel he has a quality of life.
00:03:00Good morning.
00:03:01Morning.
00:03:02My name's Heather.
00:03:03I'm one of the nurses here.
00:03:04So we'll just get on with the admission and get you ready.
00:03:05Is that okay?
00:03:06No, there you go.
00:03:11You've been getting lots of pain?
00:03:12Yeah.
00:03:13Bad.
00:03:14I was only young.
00:03:15I was 18 when I signed up.
00:03:19Instantly knew that I was a boy in the man's world when I rocked to the training.
00:03:27But it was what I needed.
00:03:29I think I needed a bit of discipline at that time of my life.
00:03:32So I was 20 when we just flew to Africa.
00:03:35It was in October 2011.
00:03:38I wasn't there long.
00:03:41I was only there six weeks before I got injured.
00:03:43My section in Afghanistan, there's me there, and there's the other lad that got injured.
00:03:56There's me, a young, fresh face bully.
00:04:01Some good legs, some big feet.
00:04:05Yeah, I was quite tall, I was six foot one.
00:04:08It was just a normal day, a normal foot patrol.
00:04:16We left our checkpoint quite early in the morning.
00:04:20We patrolled up to where the rest of our patoon was staying, trying to fight back where the Taliban had quite a stronghold.
00:04:29But as the lads started to search the compound, they cleared the compound, three of us got placed on overwatch, looking in, giving cover.
00:04:39And I just got up and walked around, and that's when I stood on the IUD.
00:04:46That's me there, and the IUD was around this area here.
00:04:50Unfortunately, the bloke who searched it missed it.
00:04:53Well, I think anyone who missed it is me, and you can't tell where it is.
00:04:56But I've got up and walked around, and stood on it and detonated it there.
00:05:00I lost both my legs above the knee straight away.
00:05:04I had damage to my left arm, and to my left hand as well.
00:05:09I broke my pelvis in three places, and then I suffered a cardiac arrest for nine minutes.
00:05:17It's weird talking about it in this much depth as well, but I haven't really spoke about it in depth like this before.
00:05:27I think if it was anywhere else in the world, I would have probably died, but I think it was the fact that it was in Camp Bastion that we had the best trauma doctors ever.
00:05:39There's not many people with my injury that survived.
00:05:44I just love normal life.
00:05:45I mean, it's never going to be normal.
00:05:46We've been amputee and that, but I love to be able to plan stuff and stick to it, and enjoy my life again.
00:06:05Since November last year, it's been the most challenging part of my life, because the pain has been pretty much constant from then.
00:06:19I've asked one of our peripheral nerve surgeons, Sam George, to help me with Luke's operation today.
00:06:26So, Luke was injured in, I think it was 2011.
00:06:29If you look at some of his original injuries from Camp Bastion, it was quite dramatic.
00:06:36Lots of the IED blast was pushed up into the pelvis and created a very difficult traumatic injury to treat.
00:06:48So, here we can see the right side of the pelvis with the nerves coming down.
00:06:53The pain is being driven by what we call a neuroma, so whenever a nerve end is cut, the nerve cells, they tend to form a chaotic ball of swelling of the nerve, which then produces a lot of pain.
00:07:09Whenever you tap or knock a neuroma, or you're obviously sitting on it, or it's on your prosthesis, that can just keep driving pain from it.
00:07:16What we do is we take this nerve end, after we've cut the neuroma out, and target it and direct it to another muscle nerve, going to a muscle that the person doesn't need.
00:07:29The nerve grows into the muscle to give it something to do, so it stops giving Luke pain.
00:07:33The risks for this surgery are fairly broad, and it's, one might say, fairly simple surgery techniques in a way that we're just going to connect up some small nerves together, or put small amounts of muscle around the nerve endings.
00:07:51But the challenges for us are that we're actually quite close to his bowel, we're quite close inside the pelvis.
00:08:01Got no blood pressure?
00:08:03And I think the other thing is that, unfortunately, as with quite a few of these guys, he's got cardiovascular ageing of his system, and he's got a very large heart that isn't beating as well as it might in someone of his age.
00:08:16It might not get rid of all his pain, it might not get rid of even a portion of his pain, there's always a possibility that there's no change.
00:08:36Arthritis?
00:08:37So, Luke's pain has been very intractable at times, I think it's really affected his dynamic at home.
00:08:46He's certainly been very close to suicide at times, has often come to me, to see me in clinic, often talking about suicide, that he can't go on, that he needs something done, because otherwise his life's not worth living at the moment, because his pain is so intractable.
00:09:01And even his daughter has sat with the clerk in tears, you know, it is quite hard for us to cope with in a way, because at times it's felt like there's not many options for us.
00:09:15I get two different types of pain, I get one background pain, which is sort of, if you imagine the static on the TV, if you imagine that as a feeling, that's what I seem to get, 90% of my life.
00:09:32And then I get another pain, which is like electric shocks, which, they're the ones that kill me.
00:09:39It stops my life, basically, I haven't got a life at the minute.
00:09:43It's what we live day to day, really.
00:09:46So yeah, it's crippling.
00:09:49Simple things that most people take for granted is something that we don't have at the moment, so this surgery hopefully is going to be the one that works and we can, we can just enjoy being married and being a family.
00:10:12If this don't ease today, I can't see the next phase of my life being, like, bright, to be honest.
00:10:22It's hard to hear them talk. If this doesn't work then, how would we, I don't know how we'd move forward, so.
00:10:43Hi, Luke, you all right? So, obviously we're going to address the two nerves that are causing problems on either side.
00:10:50What we're trying to do is we wrap a small piece of muscle around the end of the nerve and they really do seem to affect pain, particularly that's been caused by neuromas like this.
00:11:02It's a little bit controversial because with someone that's had his pain for such a long time, I think there's a belief that maybe this isn't going to work.
00:11:13So, what could, you know, the potential that one of the nerves is really close to the bowel, so it's a chance that we could damage the bowel, that's our concerns, I suppose.
00:11:30And I think for us sharing, you know, as partners in this, you know, something that we've spoken about quite a lot and, you know, you have to understand that because nothing is without risk.
00:11:42Yeah.
00:11:46Okie dokie.
00:11:48Rock and roll.
00:11:49Get the show on the road there, yeah?
00:11:50Yeah.
00:11:51Yeah, brilliant. Okay. Great. Is there anything else you want to talk to us about?
00:11:54There's always more pressure when you're treating someone that you know quite well for such a long time. And also there's this bond between us that you don't get elsewhere.
00:12:08I've been trained within the army, both in the UK and overseas, culminating in my time at Camp Bastion, treating soldiers like Luke.
00:12:19We all had this brother bond that we were looking after our team that were trying to do their thing.
00:12:30I've been fighting his corner for, you know, for such a long time. And that burden is not without some cost.
00:12:37Yeah, it's difficult, isn't it? You know, these things weigh on your mind all the time.
00:12:50Sorry.
00:12:57It's not without risk.
00:12:58I've carried through the responsibility of trying to bring everybody together to persuade them that this chap really has just one last chance for us to operate on him, to give him some level of normality that we all enjoy.
00:13:10I think as a family, we hope for relief for Luke.
00:13:12......
00:13:14......
00:13:22Can I just check in this family?
00:13:25Yeah.
00:13:30Is it a phone?
00:13:32Brilliant.
00:13:33I think as a family, we hope for relief for Luke.
00:13:36we hope for relief for Luke he's had such a rough ride the last few years
00:13:42really that my dream would be that this works and can give Luke relief of of the
00:13:48pain that'd be my dream
00:13:52in my eyes he's got the heart of a lion and he copes with the pain very well
00:14:08even though it's excruciating I'm so proud of him been a long long road to this
00:14:15day Luke's got every faith that Colonel Fosset he's put his life in his hands really pray to
00:14:21God that he'll come through it all over right here he is are you finally turned
00:14:28up then I thought you'd gone for a fag or something
00:14:44we're gonna do the right side first get so sorted and then we're gonna do the
00:14:49left side I think well they'll be fine way over the last few years his paint's
00:14:55got worse and he's been very close to suicide a number of times now I think
00:15:01his family have found extremely distressing I felt strongly that we we should have
00:15:06another try at this surgery where he would say to me even if I can get one
00:15:09more year of relief that would be better than you know my life at the moment which
00:15:13is which is not worth living
00:15:20if I didn't have the surgery today I think I would end up dead anyway it's
00:15:25like it's been the pain has been pretty much constant
00:15:29so Luke's heart is already weak because of his traumatic injuries that he sustained in the
00:15:39bomb blast so we're going to need to monitor him very closely to see how he copes with the
00:15:44anesthetic drugs what we may find is that his physiology is not coping and this will make the
00:15:50surgery more risky let me just get a little bit more information when we see what Damo's spoken to
00:15:58okay I've just spoken to the news test Luke's heart is not pumping very well
00:16:10has he reacted something then do you think he's now at serious risk of karniic arrest
00:16:17his karniic function is such that you wouldn't start out like this the risks were probably too high
00:16:25but the risks are already up now do we carry on we can then do the operation we promised Luke
00:16:31or are the risks of surgery now too great
00:16:34so today we're going to be operating on Julian who's got a tongue cancer going to be removing part
00:17:00of his tongue and reconstructing it with skin from his arm but because of the nature of the
00:17:06cancer and where it is we are going to have to split his jaw with what we call a mandibulotomy to
00:17:11gain access to the jaw morning Julian's cancer has been acting quite aggressively so therefore this
00:17:20is quite a radical operation if you leave these cancers they are ultimately life-threatening and
00:17:27you can die as a consequence
00:17:30so Julian's in this position where he's got this tongue cancer and this tongue cancer is right at
00:17:45the back it's at the junction of the front part of the tongue and the back we need to gain access to
00:17:52that area such that we can remove that tumor cleanly while at the same time allowing us to get in there
00:17:59to reconstruct the tongue that will be very difficult as you can imagine by just going through someone's
00:18:05mouth so while people can open very wide it can prove very difficult to get to the back from a visual
00:18:14perspective splitting someone's lip and then splitting the jaw even for us as in inverted commas season
00:18:21surgeons it is impressive so we will cut the jaw in front of this little hole here and then that will
00:18:30allow us to open the jaw so it's going to be opened up a bit like a book so the jaw is sitting there in a u
00:18:37shape shape and we will be able to swing this jaw out on the left hand side and it will pivot on the jaw
00:18:44joint here all the skin and the lip and the cheek comes out with it and then that will allow us to get
00:18:51a direct view into this area here so we do need to reconstruct this and we have to use this technique
00:18:59called microvascular surgery which is where we take skin from elsewhere in the body along with the blood
00:19:05supply that supplies that skin to reconstruct the defect and the blood vessels that supply that skin
00:19:12can then be plumbed into blood vessels that we've prepared in the neck but with all these operations there
00:19:18are going to be specific risks of what we're doing I think the biggest risk for Julian is infection or
00:19:28bleeding an artery in the neck will burst and consequently they'll either bleed externally
00:19:35or they'll bleed into the mouth
00:19:36morning morning how are you yeah all right thanks I'm Rachel hiya I'm just gonna do a nurse
00:19:51commission on you if that's okay just to get the pressure done a few details are you right or left
00:19:58handed right handed it's gonna be some radical surgery it's gonna be very weird having all this
00:20:06happen there's always be a chef in the navy your food's always been such an important part of my life
00:20:11you know I love food I love anything to do with it and so it's it you know to lose you know what your
00:20:17tongue does which you know you'll take for granted every day so I'm gonna have to relearn how to how to
00:20:23eat again and there'll be problems with my speech yeah so it's gonna be a bit of a journey and whatever happens
00:20:32afterwards when I come to you know I'll just deal with it
00:20:39it's all about getting back to my daughter and I love her very much and this has been tough for
00:21:06everyone and yeah this isn't just about me the wider family and the impact has on them which is
00:21:13dramatic even though I'm the one with cancer it doesn't matter everyone else is going through it
00:21:36that's lovely will his head go into there and I'll get my clothes on while you put the arm outside that's
00:21:49all right the main risks and is bleeding we're operating in the neck next to the carotid artery and
00:21:59jugular vein and you know you can make holes in these vessels and the bleeding can be significant
00:22:05so this is a complex operation I'm going to be working on removing the cancer from Julian's tongue
00:22:12while my colleague sat will be raising the flat from Julian's arm that will be used for reconstructing
00:22:18the tongue we're going to take the skin from the arm with the blood supply and with it will be two tiny
00:22:26veins so basically we're taking that skin and the nice thing is you've got a tattoo there it'd be nice
00:22:31not to disturb it so we'll just make a straight line incision so we can get it back together fairly
00:22:37accurately duration six hours antibiotics thank you very much thank you
00:22:46it's a massive operation for Julian and you always get a little bit nervous because you're putting the
00:22:57patient through something massive you always have that slight degree of anxiety which I like to think
00:23:06helps you perform better all right ready to start I'll have the lower premolar forceps
00:23:13to access Julian's cancer I need to get right to the back of his throat
00:23:18we don't want to take out any more teeth than we have to I'm going to give it a wobble
00:23:25we're just going to give it a little dab thank you
00:23:30so at the moment we're just cutting through fat in the neck
00:23:36what we find is that in this bit here between the underneath the chin and the neck if you do a
00:23:44straight line as it heals you end up with a tight scar band and so by throwing this little zed in it
00:23:52tends to be a bit less obvious I'm going to be really careful about the nerve which moves his lower lip
00:24:00it's only a little nerve so if we separate those like that that's lovely so the nerve which moves
00:24:08his lip is going to be down here somewhere and the facial nerve is a nerve which supplies movement to
00:24:14the face if I cut this nerve Julian could have permanent damage to his speech and swallowing so I'm
00:24:21coming onto the gland and then forward and this way I'll be protecting the nerve
00:24:28he's got a right plethora of veins here which is makes life a pain
00:24:38there's a 25% chance that Julian has cancer in his lymph nodes so we're going to remove them
00:24:45unfortunately I'm working down a big hole where at the base of that hole is the jugular vein
00:24:52it's a big vein it's usually about the diameter of your thumb it's a big blood vessel that drains
00:25:01blood from the head and neck so I'm just being a bit careful at the moment because he's got loads
00:25:09of little veins but clearly the last thing you want to do is to make a hole in the jugular
00:25:15vein if I damage that it could lead to a serious bleed which could be a risk to Julian's life
00:25:22I need to go and speak to the patient
00:25:36hopefully those are the haemophilters
00:25:43we just we need to make a decision but we need to make a decision quickly yeah okay so timelines do you think
00:26:03um 11 at the moment so I'll just have to sure okay if we don't try now I don't think he'll do very well afterwards because
00:26:14um he can't carry on with the pain uh like he is and he's been so close to suicidal a few times that he would want us to carry the risk with him
00:26:25Luke is now at significant risk of fatal cardiac arrest we need to have a chat with the medical director to see if we should proceed
00:26:32Hi Peter sorry I just wanted to sort of let you know that this was going on
00:26:39he's been anathetized but um we've now um he just wasn't responding very well there's a risk of death that there wasn't before
00:26:47and you know I know Luke really well you see he's been he's been with me for 10 years more than 10 years now
00:26:54so we've kind of gone through in our minds really that you know Luke want us to carry on
00:27:00and just wanted to make sure that you were aware rather than anything else rather than you know um you know so that you know what it's like with these decisions it's always a bit tough um
00:27:10um you know what I mean it's one of these things that um you know
00:27:17no
00:27:19yeah great no no okay yeah sure
00:27:25okay thanks thanks Pete okay cheers yeah okay bye bye
00:27:28okay cheers bye
00:27:30okay alright let me phone her then and let's just
00:27:39I'll put one speaker
00:27:41yeah yeah yeah
00:27:42I need to have a call with Luke's wife Abby
00:27:44I need to make her aware that the risk of Luke dying on the table is much more significant
00:27:48hi
00:27:49hi Abby
00:27:50hiya
00:27:51yeah and so you've got myself and Damien in the room we're just going to sort of talk to you
00:27:56um effectively we've not started his operation yet but we've we've come on to a few hurdles mainly around his cardiac functions
00:28:03his ejection fraction is probably you know if I'm being very optimistic 20% but running between 10 and 20% and we've got a lot of monitoring down to work that out
00:28:14um so in an in a ideal situation we'd cancel him now and we'd send him to the cardiologist
00:28:23um you know to work out what to do um and how we could optimize him but I think we all feel that the chances of us getting him back here in this state right now are next to nil
00:28:37um so this is this is where we are he he's I suppose the way to say I mean he's at risk of dying from this procedure more than we thought
00:28:49okay
00:28:51okay
00:28:52yeah
00:28:53so what what's the chance of Luke's survival now
00:28:57I don't know
00:28:58it's true you know we've never seen this you know this kind of case before I can't actually give you a number
00:29:04what I can tell you is it's not as good as it was before yeah
00:29:07no I mean I
00:29:08it's impossible for us to put your fingers on things that's not what we're after now we just
00:29:12you know what what we need to impart to you is that you know if this is what Luke would what
00:29:17yeah oh yeah I think Luke wants surgery he wants to try and get a normal life back we don't have a lot
00:29:26Luke doesn't have any form of life at the moment anyway
00:29:30and I think that's important for us to understand so that we can share this with the team so that the team will feel
00:29:35um it's the right thing to do
00:29:37yeah
00:29:38so Luke's new one is if surgery doesn't kill you the pain and the medication and will kill yourself
00:29:46yeah
00:29:47if he carries on like this
00:29:48go ahead I think that's the understanding it was kind of our decision to make and I think
00:29:53me and Mark have decided I think that's the way to go
00:29:57yeah
00:29:58given all the things we've said to you
00:30:00yeah
00:30:01alright
00:30:02yeah I'll erm
00:30:05you could drop me to give Gary a call I'll give Dad a call now
00:30:08yeah
00:30:09yeah okay and just try to keep yourself busy I'll give you a call
00:30:12yeah
00:30:13alright
00:30:14okay
00:30:15okay
00:30:16thank you
00:30:17bye
00:30:18are you going somewhere else or
00:30:28no I'm just hanging around for a couple of minutes I'm
00:30:31we have made a decision that um with knowing him and having a conversation with his wife that
00:30:43although he's under significant risk now I'm sure he would be telling us to carry on and to you know
00:30:51I certainly don't want to put him through anything that is unnecessary but of course now we feel that this
00:30:58is life sailing
00:31:00ready brace
00:31:01right down this way as well
00:31:10ready brace move
00:31:12and just someone grab the consent form for me
00:31:19and so plan procedure is that we're going to do this bilateral sciatic nerve explorations
00:31:24just to bring the team into the discussion
00:31:32I think beforehand we didn't think there was a significant risk of death as part of the procedure
00:31:37I think we now think there is a significant risk
00:31:40I've discussed this with his wife
00:31:43I've also spoken to the medical director as well who is supporting our proceeding
00:31:48based on the fact that this is probably the only time we're going to get Luke here in this position
00:31:53and he's already at significant risk but we feel that is worth it
00:31:57it's what he would want and that's what we've gone down
00:31:59is there anybody that really feels strongly about proceeding
00:32:03great
00:32:04I think it's important that we all feel together on this
00:32:10there's definitely a pressure that you know I do feel that making decisions for him have to be very circumspect
00:32:20which is completely why I've involved many other members of the team try not to allow any relationship that might have developed between us as friends to cloud what we are and what we're trying to do to help him
00:32:32well I think he's he's placing all of the success on this
00:32:38these are the point where he's willing to try anything
00:32:40yeah
00:32:41let's hope we can find the bloody nerves quickly
00:32:43as in when we make the first incision
00:32:47okay how are we doing then are we ready to
00:32:50the bone blast damage to Luke's thigh makes locating the nerves particularly challenging and we only have a limited amount of time under anaesthetic
00:32:57the neuroma is somewhere there
00:32:59yeah okay
00:33:00we go a bit like that
00:33:01yeah that's good
00:33:02we are going in at the top of Luke's thigh on the right side of his remaining pelvis
00:33:07great and knife please
00:33:08good
00:33:09I'm going to make it this big I think
00:33:11we don't want him under anaesthesia for too long
00:33:15time pressure acutely for the surgery now is more because of the anaesthetic risk
00:33:19and the longer he's under surgery the longer his body is experiencing trauma
00:33:28well the right leg is going to be is easier this is the right that we're doing now
00:33:32this is slightly easier as opposed as it is virgin territory
00:33:36the bigger the better
00:33:38yeah
00:33:39prior to this the risks were from the operation itself
00:33:42risks of his to his bowel risk of bleeding and things like that now it's
00:33:46risks to his actual whole body because of his heart
00:33:59I made the incision we've just gone through the skin and we're just into the circuitaneous fat now
00:34:03so we're now going to raise tissue to allow us to see the nerve
00:34:07I think we've got
00:34:09we might be close to the nerve we're just trying to orientate ourselves a little bit
00:34:13so we can feel
00:34:15we can feel the bone there
00:34:17is that nerve or the scar
00:34:21we need to find the nerve that has the neuroma on the end of it which is causing Luke's pain
00:34:25that's right how is it there
00:34:29yeah so we're just I'm just exposing the nerve now
00:34:32I think you can see it
00:34:34that's the neuroma
00:34:35yeah you can feel it
00:34:36yeah
00:34:37the body of the nerve is in the spinal cord
00:34:39or in your brain
00:34:40you know the cell body
00:34:42so the nerve doesn't die when the nerve gets cut
00:34:44it's like a starfish trying to regrow its legs
00:34:48so the when you cut the nerve
00:34:51the ends the nerve cells are still alive at the end of the nerve
00:34:54and they try to regrow
00:34:56but there's nothing to regrow to
00:34:58so they grow in a chaotic fashion and they
00:35:01and that causes a lot of pain
00:35:03Sam is going to give the nerve that is causing the pain something to do
00:35:07by stitching the freshly cut end into some muscle
00:35:10the hope is it will grow into the muscle
00:35:12and stop giving him pain
00:35:14and particularly these muscles that we're choosing aren't really doing very much now
00:35:19and so if we can give them something to do it will really help
00:35:23yeah we'll remove the neuroma
00:35:27cut it back to where the nerves healthy
00:35:29take a nice good chunk there
00:35:31make sure we're a couple of centimeters from the neuroma
00:35:33and then just make a nice clean sawing cut there
00:35:37cut them there
00:35:38and you can see how healthy the nerve fascicles are there
00:35:42yeah you can see this
00:35:47this lump that's formed
00:35:49where these fascicles at this end have tried to
00:35:52form new connections and not been able to
00:35:58and then that is very exquisitely sensitive
00:36:01so as soon as you bash on that a tiny little bit
00:36:03it will send big electrical signals down the nerve
00:36:05and cause him intense excruciating pain
00:36:10this is quite big so I'm going to just wrap it with muscle
00:36:12it's kind of a belt and braces type thing
00:36:14so microscope is it ready?
00:36:16I should get this answer
00:36:18you want to turn this to 62?
00:36:22the anaesthetist is especially important in this operation
00:36:24they're keeping a close eye on how Luke's heart is coping at every stage
00:36:30yep
00:36:35so we're just doing microsurgery just to join up that branch we found
00:36:41to the main sciatic nerve
00:36:44we really want to make sure that the cut nerve iron securely with the muscle
00:36:48to form a healthy connection that will grow
00:36:50otherwise there is a risk that Luke's pain comes back
00:36:53so it's tiny stitches
00:36:56that's why we need the microscope
00:36:57orientate it to the correct
00:36:59sort of fascicles as well
00:37:02oh we're going for the third one here
00:37:06yeah actually I like that idea
00:37:08yeah
00:37:10just to orientate it a little bit
00:37:12looks great Sam
00:37:15brilliant mate
00:37:17brilliant
00:37:18brilliant
00:37:19really good
00:37:20okay
00:37:22yeah we're done
00:37:24we're just going to close up
00:37:25back on
00:37:26back on please
00:37:27great
00:37:28so part one done
00:37:31we've done the right side
00:37:33yes we managed to excise the neuroma
00:37:36then now onto the left side
00:37:38the bigger challenge
00:37:39yeah
00:37:40we've successfully completed half the operation
00:37:44but now we're moving on to the more difficult left side
00:37:47where there are more risks
00:37:49it's very close to the parent to the end very close to the bowel
00:37:53so it mean us inadvertently tearing a bit of scar tissue that's attached to the bowel
00:37:58that would then open up the bowel which obviously is full of bugs
00:38:03this could cause a life-threatening infection like sepsis
00:38:07so we've been what have we been two in a
00:38:11we've been two hours haven't we really
00:38:15the longer he's under surgery it's a load on his heart which is already compromised
00:38:21I'm worried that Luke's heart could stop at any moment
00:38:24just as we're about to go into the most risky part of the operation
00:38:29is he okay
00:38:30if he did end up going into cardiac arrest we'd have to obviously stop what we're doing
00:38:38get the drapes off turn him onto his back as quickly as possible and start cardiac compressions
00:38:43just as possible and start limited to the second off
00:38:49the lunatic
00:38:51yep
00:38:54uh e park we've got two
00:38:56all right thanks h
00:39:06medium swap please
00:39:07We're trying to get low in the neck and access is always tight and difficult.
00:39:26Julian has a survival advantage by us removing the lymph nodes in his neck that may have
00:39:31cancer in them. So I'm just going to come on to the jug from above. We're avoiding all
00:39:38the named blood vessels but there are plenty of little blood vessels that don't have a name
00:39:43which are big enough to spoil your day in a way. Langdon bet please.
00:39:53So now I can finally get access to his lymph nodes and remove them as a whole.
00:40:01In the neck is all the fat and the glands that have got cancerous cells in there. We've
00:40:09removed all the lymph nodes in the neck and in doing so we've come down to the jugular
00:40:16vein. So we've separated the jugular vein and we've taken all the tissue out from around
00:40:21it. The first stage of the operation is over so now I need to split Julian's jaw to get
00:40:28to a cancer in his tongue. 15 platies and we're going to split the lip and do a mandibulotomy.
00:40:39I'm just going to stab through the lip all the way and then carve through the lip. Lovely.
00:40:47So squeezing the lip and pulling it up and out. And so I'm going to cut through that muscle
00:40:54in a minute and then come above it. Just going to go straight through the blade. So we're
00:41:00going to go straight down. Straight down the middle.
00:41:06And when we do our bone cuts we need to do our bone cuts such that we don't injure the teeth
00:41:19nerve. Soar into me please. So we're just completing the bone cuts now. So in a second the jaw will
00:41:42hopefully break. And a mallet please. So we're just doing some little tap taps and you can just
00:41:57see the beginning. It's beginning to open up. Now you've got good movement. So you've got to be
00:42:03careful that we don't tear this too much because obviously here it's all about preserving function.
00:42:10There will be a muscle on the inside called mylohyoid. Which we're going to need to cut as well.
00:42:16So you can see us opening the jaw.
00:42:29So I can cut through this now. And then we'll be able to swing the jaw out.
00:42:40Now I can get to the back of Julian's tongue where the cancerous tumour is. We want to make sure that as
00:42:49much of Julian's tongue as possible functions normally. Two forceps to me please. Could you grab hold of that bit there?
00:42:57So I must remove all of the cancer with a clear margin so it doesn't grow back.
00:43:05So now we're going into the tongue.
00:43:08So unfortunately the nerve which gives sensation to the tongue on that side is going to go.
00:43:21So it just means that the tip of his tongue is going to be numb. He's still going to have taste.
00:43:32Suction please. So I'm just going a little bit deeper here. So I'm going to come across the base now.
00:43:39Just coming right to the back.
00:43:54And it's right at the base of the tongue.
00:43:59So this is the base of the tongue.
00:44:02And that's where the positive margin was. And we need to get a centimetre on that. That's why
00:44:06we've had to go back as far. And so we've removed here almost half of Julian's tongue. And if we don't
00:44:12reconstruct this, he's going to find it very difficult to eat and speak again properly. And
00:44:17his quality of life would be intolerable. So basically I'm done. Sat's going to have a quick
00:44:24look at the blood vessels.
00:44:29So we're going to use a flap of skin from Julian's arm with its blood supply to reconstruct
00:44:35his tongue. Medium ligus please. So I've divided the two veins that travel with the artery.
00:44:43And then we'll divide the other major vein.
00:44:49When you're using muscle flaps, the amount of time you can survive without blood supply
00:44:55is markedly decreased.
00:44:56I'll just release this one vein.
00:45:06So here you can just see everything detached.
00:45:11We must connect with the flap as quickly as possible, as the longer it is without a blood supply,
00:45:16the more likely the flap will die. And then we may have to abort the reconstruction.
00:45:26Where is the patient going back to abscessing?
00:45:28Oh my God, we're looking full of facts.
00:45:42Obviously, I mean, his health concerns are there.
00:45:45Are there more now than now than now?
00:45:47Yeah, yeah, yeah.
00:45:47And so now we're going to do the more challenging side.
00:45:52Getting the nerve out is going to be a little bit more difficult.
00:45:55It's going to be close to big vessels within the pelvis and close to bowel,
00:46:00which is obviously one of our concerns.
00:46:03Luke's pain is unbearable and it's brought his life to a standstill.
00:46:07We need to locate the nerve at the top of the left thigh to give him the best chance of a life worth living.
00:46:12Are you okay?
00:46:13Yeah.
00:46:13Happy, everyone?
00:46:14All right.
00:46:14Yeah, we're doing the left side now.
00:46:17This side is slightly more complicated because we don't have the normal landmarks anymore
00:46:22in this side that we would normally follow to get to the nerve.
00:46:26So it's much more difficult to make things even more complicated.
00:46:30This is the area where the nerve is right in front of the bowel and all the big vessels as well.
00:46:39What's that rim?
00:46:40Is that?
00:46:40I'm not sure.
00:46:42So there's something sharp here.
00:46:44Can you feel that?
00:46:45Where are my fingers exactly?
00:46:48So you see that thing there?
00:46:49Can you see this?
00:46:49This is muscle.
00:46:50You see this here?
00:46:51Scarred.
00:46:52Yeah.
00:46:53I don't know what that is at the moment.
00:46:58The challenge is first finding the nerve.
00:47:01This all gets a bit red, doesn't it?
00:47:04You can't quite work out what's going on.
00:47:10The problem with all these things is that everything looks the same.
00:47:16I'm finding this quite hard now because I can't work out
00:47:23where it goes.
00:47:24Every time I do anything, it's just bleeding.
00:47:29That's the problem.
00:47:29Everything's at the same time.
00:47:31Yeah.
00:47:33Oh, it's just all red and horrible.
00:47:34There's some, there's a sort of something there.
00:47:38There's.
00:47:43And I think we've got to find some anatomy that we're familiar with at the moment because
00:47:48but we're making very slow progress at the moment.
00:47:50Um, I don't feel we're getting anywhere.
00:47:56Luke's anatomy is almost unrecognizable as a result of the bomb blast.
00:48:00We're struggling to identify the correct nerve to operate on.
00:48:05Oh my god.
00:48:06I might have to stop and look at the anatomy in a second, you know, on the scan again.
00:48:10I'm worried if we can't find the nerve on this left side,
00:48:14Luke's entire operation may have been wasted.
00:48:17I just can't get myself oriented at the moment.
00:48:19Do you want to have a little go and I'm going to just de-scrub a second because
00:48:22I want to have a look at the scan and get the scan out.
00:48:23All right.
00:48:27Can't find the nerve.
00:48:28Luke's been under anaesthetic for three and a half hours.
00:48:40Every minute puts more stress on his heart.
00:48:44Time pressure acutely to the surgery now is more because of the anaesthetic risk.
00:48:49There's a load on his heart which is already compromised.
00:48:52So the longer we take, the higher the risk is.
00:48:58I'm going to take a look at the patient in baby.
00:49:06Which theater was it?
00:49:0723.
00:49:26Thanks.
00:49:26The problem is it's just really difficult to identify the anatomy because he's only got a half of the pelvis.
00:49:38It all looks like scar tissue.
00:49:48I still think it's that.
00:49:50Do you think you've got it?
00:49:51It's not something I thought might be it, but I don't know if that's the stump there.
00:49:57I've tried cutting it, but...
00:50:01The one scanner I wanted to look at, I can't...
00:50:04It doesn't see.
00:50:05Well, you just can't see it properly.
00:50:07Yeah, I want to see the other graph.
00:50:09Let me re-scrub.
00:50:11The problem is the scar looks very much like nerve.
00:50:15It was there before, so it's quite hard at the moment.
00:50:21I'm cutting away at the scar tissue from Luke's injuries to give me a better view of the nerve that's causing him pain.
00:50:27I was just wondering if this is the stump of the nerve here, and this is the notch.
00:50:37I want to see what you mean, yeah, right there, yeah.
00:50:41Yeah.
00:50:42Yeah.
00:50:43You're right, aren't you?
00:50:44Can you see there?
00:50:45Yeah, yeah.
00:50:46There, that's it.
00:50:47The nerve is here.
00:50:48So, you could go around it a bit more, and then we could cut it then and put some, and just put some muscle around it.
00:50:58Yeah.
00:50:59I think we've got to go on this bit of bone as far as we dare.
00:51:04We can either put some muscle or something in there.
00:51:07A cat's paw, please.
00:51:08And then I think we've got right where it's all scarred up onto the bone.
00:51:15God, yeah.
00:51:16And the problem is now, is what I'm a bit nervous about, is that as I pull this, I'm feeling that there's stuck.
00:51:24You're pulling abdominal contents.
00:51:25I'm pulling abdominal contents this way, or certainly peritoneum, so.
00:51:28Yeah, yeah.
00:51:29Because we can't really free it up anymore here without damaging the peritoneum.
00:51:33No.
00:51:34And there's bowel there that is causing us, and lots of big veins.
00:51:37We are now operating deep inside Luke's pelvis, very close to his bowel.
00:51:43There's a risk that we can inadvertently put a hole in it, which could cause Luke lots of problems after surgery.
00:51:49There, look.
00:51:50There's some decent muscle there, look.
00:51:53Oh, yeah, yeah.
00:51:54Yeah.
00:51:55So, I think, take a bit of that muscle there.
00:51:58So, we're taking a small amount of piriformis to wrap around the end of the nerve that's quite scarred.
00:52:06We've freed it up as much as we can from the bone, but we can't really go any deeper without risking damage to bowel now.
00:52:13We want to try and minimize his time under anesthesia if we can.
00:52:17It's not too bad.
00:52:18What time are we on now?
00:52:19Half five.
00:52:20So, we've done five hours so far.
00:52:24What we're going to do next is we're just going to cut as much of the scarred nerve as we can, and then we're going to parachute around the end of the nerve this bit of muscle we've just taken.
00:52:36I mean, what we're trying to do is hopefully allow the nerve to have some muscle around it that is protecting it from scarring up to the bone again, and that will be really important.
00:52:51That looks great.
00:52:53There's a few little bits to do, but we're very close to starting to close.
00:52:58And that's it done.
00:53:02We're really hoping that it will get some relief from this, because at the moment, every time he jolts down onto his pelvis, remembering he's an amputee and has to sit, it jars the nerve, and hopefully this will then stop that cycle.
00:53:16We've got through it.
00:53:19It's really challenging surgery.
00:53:25I'm pleased that Luke's heart has managed to get him through this lengthy operation.
00:53:28This really is the last chance of improving Luke's pain.
00:53:31Hi.
00:53:32Abby, it's Mark Foster.
00:53:33Are you okay?
00:53:34Yeah.
00:53:35Yeah.
00:53:36Yeah, very good.
00:53:37Yeah.
00:53:38So we just finished.
00:53:39Everything's gone really well.
00:53:40He's fine.
00:53:41Hopefully you can rest a bit easier.
00:53:58He's not completely out of the woods as you can imagine.
00:54:01It will now be an eye to you, and he'll be able to keep everything very tight.
00:54:05From my perspective, I just think, you know, we've done exactly what we can.
00:54:09But yeah, it's taken its toll today, I have to say.
00:54:16The left side has caused us some, not problems so much, but I couldn't get as much around the nerve as I wanted to.
00:54:23It's just far too deep.
00:54:24So we've got onto the end, we think.
00:54:28I don't know how successful this will be, I have to say.
00:54:31I think we've not been able to see the nerve as clearly as we wanted to.
00:54:37We're really hoping that we'll get some relief from this.
00:54:53Yeah, go.
00:54:55Keep going.
00:54:56Okay.
00:54:57Stop it.
00:54:58What we'll do now.
00:55:00We're just going to move that loop, if we may.
00:55:03That's all right.
00:55:04Feel it.
00:55:13So this is going to be the front and the back.
00:55:15And these two blood vessels we're just going to lay into the neck.
00:55:18Like this.
00:55:19There.
00:55:20The skin that we've used to reconstruct the tongue is quite thick.
00:55:25The problem is it's so thick that it needs a blood supply.
00:55:29Without this blood supply, basically the flap would die within a number of hours.
00:55:35And it's got to have an inflow and an outflow.
00:55:37And we're just going to start insetting the skin here.
00:55:41Three ovicral, please.
00:55:43If we don't get this plumbed in in a timely manner, the skin will start to die off.
00:55:48If the skin flap dies, then the reconstruction wouldn't work.
00:55:51Well, that would mean that Julian would be left without a functional tongue,
00:55:54and this would affect his ability to speak and eat.
00:55:56A 9-0 stitch.
00:55:57So the stitch we use, as you'll see, is quite small.
00:56:01They're about one and a half, two mil.
00:56:04This is where you see how badly we all shake.
00:56:09We try and get a nice little stitch in.
00:56:12Got to be a bit careful.
00:56:14I've just lost where I am.
00:56:16There's one more, I think, just at the top.
00:56:19Just got to kind of pull that.
00:56:22There.
00:56:23That's it.
00:56:26It's all right.
00:56:27This is the last stitch.
00:56:29So that's just tying this off.
00:56:32And then I think, fingers crossed, we'll be done.
00:56:38It looks quite nice here, doesn't it?
00:56:40The important thing is the artery and the neck, you can see pulsating really well.
00:56:45So you've got a lovely pulse.
00:56:47You can see how you've got a good pulse going into the flap.
00:56:50Into the flap.
00:56:51I think, fingers crossed, so hopefully it'll be watertight.
00:56:56You'll be able to just lift it up.
00:56:58All we've got to do then is just close it.
00:57:01With the flap now in place, we can start putting Julian's jaw back together again.
00:57:06So we're going to be using metal plates and screws to hold the jaw in place.
00:57:10So we're not doing this rigid yet.
00:57:15We're just going to get these screws on.
00:57:17One more, thanks.
00:57:18We're going to plate it together and then I'll just try and get the stitching at the back.
00:57:22So, needle to you, thanks.
00:57:24Screw, please.
00:57:26Manipulate it into a good position and tighten up.
00:57:31So his teeth are in a good a bite.
00:57:36That's it.
00:57:37And you'll feel it lock.
00:57:39But the jaw is all together in one piece.
00:57:42And we've got that skin on the side of the tongue going right into the back.
00:57:49So what we need to do now is just a little bit more closing here.
00:57:53The skin stitches should really just be gently holding together what your deep stitches have done.
00:58:01The patients have no idea what you've done on the inside.
00:58:05They don't know if you've done a good job or a bad job.
00:58:07So all they see is the stitching that you've done.
00:58:11And if your stitching looks poor, then quite rightly, they've probably got to think to themselves,
00:58:17well, hold on.
00:58:18If they're not that bothered about what it looks like on the outside, what have they done on the inside?
00:58:23Happy guys?
00:58:29Ready, steady down type of thing.
00:58:31Yeah.
00:58:32Ready, steady, slide.
00:58:35I never say it on the down.
00:58:37Right, but before we come off the red, I want to come off the red.
00:58:41You just relax, Julian.
00:58:42Just let everyone do the work for you.
00:58:44You just lie there and relax.
00:58:46It's all gone well, okay?
00:58:48You just relax and let Yasmin do all the work for you.
00:58:52You walk away thinking there shouldn't be any problems.
00:58:59However, you never know.
00:59:01Really, until the patient goes home, which will be about ten days' time, you never truly relax.
00:59:22Good morning.
00:59:23Great.
00:59:24So we're going to see Luke today.
00:59:38He's two weeks following his surgery now.
00:59:41It's been a bit of a bumpy road, actually, following his surgery, certainly with lots of conditions that have kind of revealed themselves as we've gone on.
00:59:51But, yeah, we'll see how he is today.
00:59:54Knock, knock.
00:59:55Hello.
00:59:56How are we doing?
00:59:57Hello.
00:59:58Hiya.
00:59:59Wow.
01:00:00We've got everybody here today, including the frog.
01:00:02Excellent.
01:00:03Great to see you.
01:00:04Good to see you guys.
01:00:05Nice to see you again.
01:00:06Hello.
01:00:07You all right?
01:00:08Hi, Dad.
01:00:09You all right?
01:00:10Yeah, very good.
01:00:11Brill.
01:00:12So, I think we're two weeks down the line now.
01:00:15Yeah.
01:00:16It's been a rocky road with pancreatitis, PEs that we've had, and you've had some problems on one of the days of developing a chest infection as well.
01:00:26Yeah.
01:00:27And that really put you back a little bit.
01:00:29And your pain's been intermittent over that time.
01:00:32Yeah.
01:00:33But last day or two, I hear that things are getting a lot better.
01:00:36I'm good.
01:00:37How are you feeling?
01:00:38I'm good.
01:00:39The pain that I'm getting is more from the scar, I think.
01:00:44I am getting a bit of nerve pain on the right, but nothing drastic.
01:00:49No.
01:00:50So, I think it's more just from the wounds.
01:00:52Yeah.
01:00:53It's touch wood.
01:00:54Sure.
01:00:55And then the left side?
01:00:56The left side's fine.
01:00:57Yeah.
01:00:58That's quite surprising for me, actually, that the left side has been done so well.
01:01:02And because we've pulled quite a lot of the nerve away from bone and the scar, then that would probably explain why, actually, that's done okay.
01:01:10Yeah.
01:01:11Whereas the right side was very much a fresh cut through the nerve.
01:01:13Yeah.
01:01:14That's why it really does cause a bit of pain to start with.
01:01:16But then that's eased now.
01:01:17Great.
01:01:18We won't really know whether it's absolutely worked for a number of weeks yet.
01:01:23Yeah.
01:01:24Maybe for months.
01:01:25It's just to see how it goes.
01:01:26And I think, you know, as every week goes on, every month goes by, that's a good sign that we'll get things.
01:01:32And what happens is the nerve's got to grow down.
01:01:34It's got to re-innovate.
01:01:35Right.
01:01:36And that does take weeks to happen.
01:01:39It's early days.
01:01:40I don't want to give you any false hopes.
01:01:41Yeah.
01:01:42But I think, you know, we're going to go the right way.
01:01:45And then, you know, I think the hard work for you is now on as well.
01:01:48We want you to, you know, really get yourself as healthy as you can.
01:01:51Yeah.
01:01:52You know, because that will help everything settle down.
01:01:53Yeah.
01:01:54Help the pain that was happening not re-establish itself.
01:01:58Yeah.
01:01:59On behalf of my family and Abby and everybody else, I'd like to thank you and the team for the great job you've done with you.
01:02:06It's a team effort.
01:02:07Absolutely.
01:02:08I have to say, I felt I've earned my money with you.
01:02:11It's truly amazing, isn't it?
01:02:13We probably wouldn't have Luke if it worked for you guys.
01:02:15All right.
01:02:16Well.
01:02:17Thank you very much.
01:02:18It won't be goodbye.
01:02:19I know what this is like, Luke.
01:02:20So we'll see you in a few weeks in the clinic.
01:02:22Yeah.
01:02:23I think probably about the six-week point.
01:02:24Okay.
01:02:25Great.
01:02:26Catch me later.
01:02:27Cheers.
01:02:30I'm excited.
01:02:31Hopefully I can get back home today.
01:02:36There's good news about my surgery.
01:02:39I think this one might be the one that works.
01:02:44I've had about four or five days now where I've not really had any pain.
01:02:48It's like it's completely flipped it on its way.
01:02:50So it's quite mad to see.
01:02:55He's definitely turned the corner now as we hoped and predicted.
01:03:00Yeah.
01:03:01So he's doing much better.
01:03:03His pain is now really settling.
01:03:05And I think we, I would expect him now to have a good period of relief.
01:03:10You can see from him that he's dramatically different.
01:03:13This has made a massive difference in just in the short term now.
01:03:19I think we're all very cautious.
01:03:21I've been through this with Luke a few times now.
01:03:24I'm, I'm, yeah, I'm really pleased with how he is.
01:03:28I'm really pleased for him.
01:03:29We're always humbled at being in these scenarios.
01:03:32We don't really do it for, for the reward.
01:03:35We do it because it's the right thing.
01:03:40Hi Julian.
01:03:47If you come into my clinic over here,
01:03:51erm, I'll have a good look in your mouth
01:03:54and just touch base with you about where we stand.
01:04:01You did remarkably well.
01:04:03Obviously the scar line doesn't look particularly good at the moment
01:04:06because you've got hair growth around it.
01:04:08Erm, so, erm, you've got a little bit of, erm, you've probably seen yourself,
01:04:12that, erm, the skin is just overlying and overlapping a little bit underneath.
01:04:16Erm, all this neck is going to settle down.
01:04:19The bit that we really want to get right when we stitch it together
01:04:22is that little junction between your lip and the skin.
01:04:25And that's spot on.
01:04:27But should I have a look inside your mouth?
01:04:29So if you come and make yourself comfy, I'll put some gloves on.
01:04:35So I'll have a quick peek inside if I may.
01:04:37Just open a little bit for me.
01:04:38So we did go a long way back actually.
01:04:42You can let your tongue relax, let it all go soft and floppy.
01:04:45So I can see the flap at the back.
01:04:47You've got some purple stitches in there.
01:04:50We've got the skin there.
01:04:52Always swells up a bit.
01:04:53I'm just going to pull it right back.
01:04:55It's looking really nice.
01:04:57Everything's going the way it should be.
01:05:00Statistically, the most likely outcome is going to be,
01:05:04you know, all being well.
01:05:06No residual cancer.
01:05:07There are things you probably weren't expecting, erm,
01:05:10but this will go the right way.
01:05:12Lovely.
01:05:13Lovely.
01:05:14I'll let you go.
01:05:15You have done remarkably well.
01:05:16As I say, it is going to be peaks and troughs.
01:05:18It's all about regaining as much form and function of my tongue as I can.
01:05:22And you've done an amazing job on that.
01:05:24You know it's a team.
01:05:25Thank you so much.
01:05:26Cheers mate.
01:05:28Alright, I'll let you go.
01:05:29Cheers Julian.
01:05:30Thank you very much.
01:05:31I'll let you go.
01:05:33All the best.
01:05:34Cheers then.
01:05:35See ya.
01:05:36Bye now.
01:05:37The main thing for me was, quite simply,
01:05:41was how this graft took on my tongue.
01:05:46Taste is alright actually, amazingly.
01:05:48So it hasn't really impacted my taste, which is great.
01:05:51Tail down for you, okay?
01:05:53Oh, it's so good to get that off.
01:05:55I bet.
01:05:56It's all stepping stones for me.
01:05:59This now sets me off on my journey to getting back to health.
01:06:03Get through this major, major surgery,
01:06:05come out the other end okay.
01:06:07It's huge.
01:06:09Yeah, so I'm really happy with that.
01:06:12Okay.
01:06:19Not everyone will survive a heart operation,
01:06:21but this operation is really the only chance that Matt has.
01:06:24And the heart is out.
01:06:26All the breast has been replaced by the tumour itself.
01:06:31We are racing against time.
01:06:34It's possibly one of the most significant moments of her life.
01:06:39We are in the tumour now.
01:06:41This is inside the belly of the beast.
01:06:44Peace.
01:06:45Peace.
01:06:46Peace.
01:06:47Peace.
01:06:48Peace.
01:06:49Peace.
01:06:50Peace.
01:06:51Peace.
01:06:52Peace.
01:06:53Peace.
01:06:54Peace.
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01:06:57Peace.
01:06:58Peace.
01:06:59Peace.
01:07:00Peace.
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01:07:02Peace.
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01:07:07Peace.
01:07:08Peace.
01:07:09Peace.
01:07:10Peace.
01:07:11Peace.
01:07:12Peace.
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