- 13 hours ago
Surgeons: A Matter of Life or Death - Season 3 Episode 1
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00:00:00It's a serious life-saving operation.
00:00:03He's at risk of dying from this procedure.
00:00:09We can go from under control to emergency in a flutter of an eyelash.
00:00:16The beep means don't do that again.
00:00:23It is very personal for me.
00:00:26If you put a hole in here, he'd be at risk of dying on table.
00:00:31This is either life or death.
00:00:38Oh, there you go.
00:00:44I lost both my legs above the knee.
00:00:46I get pain, which is like electric shocks.
00:00:49Which, like, they're the ones that kill me.
00:00:52His kind of function is such that you wouldn't start out like this.
00:00:55The risks were probably too high.
00:00:57What's the chance of Luke's survival now?
00:01:00I mean, he's at risk of dying from this procedure.
00:01:05It's open a little bit for me.
00:01:07So I'm going to have to relearn how to eat again.
00:01:10And there'll be problems with my speech.
00:01:12I'm just going to stab through the lip all the way.
00:01:16So that, in a second, the jaw will hopefully break.
00:01:18The biggest risk for Julian is an artery in the neck will burst.
00:01:28The last thing you want to do is to make a hole in the jugular vein.
00:01:31You've got the emergency list there.
00:01:32Do that one.
00:01:33Don't worry, it doesn't go anywhere.
00:01:34Today we're going to operate on Luke.
00:01:35So he's a chap who was injured in Afghanistan 15 years ago.
00:01:52Massive blast injury.
00:01:54He came through it, but he's got very high amputations.
00:01:57I don't know, he's going fast.
00:02:00Increased control.
00:02:01Yeah, yeah.
00:02:02So first came in to contact with Luke immediately when he returned,
00:02:06actually with a number of his colleagues who'd been injured around that time.
00:02:10He's had some nerve pain which has been intractable.
00:02:14Operated on him in 2018, and then we just got some relief,
00:02:20and today we're hoping to really attack both the right and the left sides.
00:02:27Everybody's in.
00:02:28The burden of injury that these chaps had, it was phenomenal.
00:02:33The nurse would do it, wouldn't she?
00:02:35Oh, there you go.
00:02:36Oh, gosh.
00:02:38Gosh.
00:02:39There you go.
00:02:40And often this level of injury was unsurvivable.
00:02:47He's had nerve pain.
00:02:49His pain has really made him suicidal at times.
00:02:53He doesn't feel he has a quality of life.
00:02:55Good morning.
00:02:56Morning.
00:02:57My name's Heather, I'm one of the nurses here.
00:02:58So we'll just get on with the admission and get you ready.
00:03:00Is that okay?
00:03:01No, thank you.
00:03:05You've been getting lots of pain?
00:03:07Yeah.
00:03:08Bad.
00:03:09Good morning.
00:03:10I'm not going to be so.
00:03:13I was only young.
00:03:14I was 18 when I signed up.
00:03:16Instantly knew that I was a boy in a man's world when I rocked up to the training.
00:03:21But it was what I needed.
00:03:23I think I needed a bit of discipline at that time in my life.
00:03:27So, I was 20 when we deployed to Afghanistan. It was in October 2011. I weren't there long.
00:03:36I was only there six weeks before I got injured. My section in Afghanistan. There's me there,
00:03:44and there's the other lad that got injured. There's me, a young, fresh face bully. Some
00:03:56good legs, some big feet. Yeah, I was quite tall. I was six foot one.
00:04:07It was just a normal day, a normal foot patrol. We left our checkpoint quite early in the morning.
00:04:15We patrolled up to where the rest of our platoon was staying, trying to fight back where the Taliban
00:04:22had quite a stronghold. But as the lads started to search the compound and clear the compound,
00:04:29three of us got placed on overwatch, looking in, giving cover. And I just got up and walked around,
00:04:36and that's when I stood in the IED.
00:04:41Last meet there, and the IED was around this area here. Unfortunately, the bloke who searched it missed it.
00:04:47Well, I think anyone would miss it. I mean, you can't tell where it is. But I've got up and walked around,
00:04:53and stood on it and detonated it there. I lost both my legs above the knee straight away.
00:04:59I had damage to my left arm and to my left hand as well. I broke my pelvis in three places,
00:05:07and then I suffered a cardiac arrest for nine minutes.
00:05:17It's weird talking about it in this much depth as well. I haven't really spoke about it in depth like this before.
00:05:26I think if it was anywhere else in the world, I would have probably died.
00:05:29But I think it was the fact that it was in Camp Bastion that we had the best trauma doctors ever.
00:05:35There's not many people with my injury that survived.
00:05:40I just love normal. It's a normal life. I mean, it's nothing going to be normal.
00:05:52We've been amputee and that, but I'd love to be able to plan stuff and stick to it,
00:05:57and enjoy my life again. It's been, since November last year,
00:06:03it's been the most challenging part of my life.
00:06:06It's been, the pain has been pretty much constant from then.
00:06:14I've asked one of our peripheral nerve surgeons, Sam George,
00:06:16to help me with Luke's operation today.
00:06:21So, Luke was injured in, I think it was 2011.
00:06:24If you look at some of his original injuries from Camp Bastion,
00:06:28it was quite dramatic.
00:06:31Lots of the IED blast was pushed up into the pelvis
00:06:36and created a very difficult traumatic injury to treat.
00:06:43So, here we can see the right side of the pelvis with the nerves coming down.
00:06:48The pain is being driven by what we call a neuroma.
00:06:51So, whenever a nerve end is cut, the nerve cells,
00:06:55they tend to form a chaotic ball of swelling of the nerve,
00:07:01which then produces a lot of pain.
00:07:04Whenever you tap or knock a neuroma or you're sitting on it
00:07:08or it's on your prosthesis, that can just keep driving pain from it.
00:07:12What we do is we take this nerve end after we've cut the neuroma out
00:07:16and target it and direct it to another muscle nerve
00:07:20going to a muscle that the person doesn't need.
00:07:24The nerve grows into the muscle to give it something to do,
00:07:27so it stops giving Luke pain.
00:07:30The risks for this surgery are fairly broad
00:07:34and it's, one might say, fairly simple surgery techniques
00:07:40in a way that we're just going to connect up some, you know,
00:07:43small nerves together or put small amounts of muscle around the nerve endings.
00:07:47But the challenges for us are that we are actually quite close to his bowel.
00:07:53We're quite close inside the pelvis.
00:07:55Got no blood pressure.
00:07:58And I think the other thing is that, unfortunately,
00:08:00as with quite a few of these guys,
00:08:02he's got cardiovascular ageing of his system
00:08:05and he's got a very large heart that isn't beating as well as it might
00:08:10in someone of his age.
00:08:13Cloth I am.
00:08:15That's good, 4.3.
00:08:18Sweet.
00:08:22It might not, A, get rid of all his pain,
00:08:25it might not get rid of even a portion of his pain.
00:08:28There's always a possibility that there's no change.
00:08:31Arthritis.
00:08:32No.
00:08:34So, Luke's pain has been very intractable at times.
00:08:37I think it's really affected his dynamic at home.
00:08:41He's certainly been very close to suicide at times,
00:08:44has often come to me, to see me in clinic,
00:08:47often talking about suicide,
00:08:49that he can't go on, that he needs something done
00:08:52because otherwise his life's not worth living at the moment
00:08:54because his pain is so intractable.
00:08:57And even his daughter has sat with him in clinic in tears.
00:09:01You know, it is quite hard for us to cope with in a way
00:09:06because at times it's felt like there's not many options for us.
00:09:11I get two different types of pain.
00:09:17I get one background pain, which is sort of,
00:09:21if you imagine the static on the TV,
00:09:23if you imagine that as a feeling,
00:09:25that's what I seem to get, 90% of my life.
00:09:27And then I get another pain, which is like electric shocks,
00:09:30which, like, they're the ones that kill me.
00:09:33It stops my life, basically.
00:09:35I haven't got a life at the minute.
00:09:37It's what we live day to day, really.
00:09:41So, yeah, it's crippling.
00:09:49Simple things that most people take for granted
00:09:52is something that we don't have at the moment,
00:09:55so this surgery, hopefully, is going to be the one that works
00:09:59and we can just enjoy being married and being a family.
00:10:08If this don't ease today,
00:10:10I can't see the next phase of my life being that bright, to be honest.
00:10:17It's hard to hear them talk.
00:10:20If this doesn't work, then how would we...
00:10:23I don't know how we'd move forward, so...
00:10:29Hi, Luke, you all right?
00:10:39So, obviously, we're going to address the two nerves
00:10:42that are causing problems on either side.
00:10:44What we're trying to do is we wrap a small piece of muscle
00:10:48around the end of the nerve
00:10:50and they really do seem to affect pain,
00:10:53particularly that's been caused by neuromas like this.
00:10:56It's a little bit controversial because
00:10:59with someone that's had this pain for such a long time,
00:11:02I think there's a belief that maybe this isn't going to work.
00:11:08So, what could...
00:11:11You know, the potential that...
00:11:16One of the nerves is really close to the bowel.
00:11:18So, there's a chance that we could damage the bowel.
00:11:21That's our concerns, I suppose.
00:11:25And I think for us sharing, you know, as partners in this,
00:11:30you know, it's something that we've spoken about quite a lot
00:11:33and, you know, you have to understand that
00:11:35because nothing is without risk.
00:11:37Yeah.
00:11:41Okie dokie.
00:11:43Rock and roll.
00:11:44Get the show on the road there, yeah?
00:11:45Yeah.
00:11:46Yeah, brilliant.
00:11:47OK. Great.
00:11:48Is there anything else you want to talk to us about?
00:11:53There's always more pressure when you're treating someone
00:11:55that you know quite well for such a long time.
00:11:57And also, there's this bond between us that...
00:12:00that you don't get elsewhere.
00:12:03I've been trained within the army,
00:12:07both in the UK and overseas,
00:12:10culminating in my time at Camp Bastion,
00:12:13treating soldiers like Luke.
00:12:17We all had this brother bond
00:12:20that we were looking after our team
00:12:22that were trying to do their thing.
00:12:25I've been fighting his corner for, you know,
00:12:28for such a long time.
00:12:29And that burden is not without some cost.
00:12:34Yeah, it's difficult, isn't it?
00:12:36You know, these things weigh on your mind all the time.
00:12:45Sorry.
00:12:46Sorry.
00:12:52It's not without risk.
00:12:53I've carried through the responsibility
00:12:55of trying to bring everybody together
00:12:57to persuade them that this chap
00:12:59really has just one last chance
00:13:01for us to operate on him,
00:13:02to give him some level of normality
00:13:04that we all enjoy.
00:13:19Can I just check in this family?
00:13:20Yeah.
00:13:21I think as a family we hope for relief for Luke.
00:13:34He's had such a rough ride the last few years really
00:13:38that my dream would be that this works
00:13:40and can give Luke relief of the pain.
00:13:44That would be my dream.
00:13:46Give Luke a love then.
00:13:51Love you.
00:13:52I love you.
00:13:53See you later.
00:13:54All right.
00:13:55Love you.
00:13:56Love you.
00:13:58In my eyes he's got the heart of a lion.
00:14:01And he copes with the pain very well
00:14:03even though it's excruciating.
00:14:06I'm so proud of him.
00:14:08It's been a long road to this day.
00:14:11Luke's got every faith that Colonel Fasset
00:14:13has put his life in his hands really.
00:14:15Just pray to God that he'll come through it all all right.
00:14:21Here he is.
00:14:22Oh, you've finally turned up then.
00:14:25I thought you'd gone for a fag or something.
00:14:27Friendly.
00:14:29The head's going to be there.
00:14:35Any nose will crack back in?
00:14:37Yeah.
00:14:38Canyon lines will be flushed.
00:14:39Yes.
00:14:40We're going to do the right side first.
00:14:42Yeah.
00:14:43Get ourselves sorted.
00:14:44And then we're going to do the left side up.
00:14:46Well, he'll be fine.
00:14:49Over the last few years his pain's got worse.
00:14:52He's been very close to suicide a number of times now.
00:14:56I think his family have found it extremely distressing.
00:14:58I felt strongly that we should have another try at this surgery
00:15:02where he would say to me,
00:15:04even if I can get one more year of relief,
00:15:06that would be better than my life at the moment,
00:15:08which is not worth living.
00:15:16If I didn't have the surgery today,
00:15:18I think I would end up dead anyway.
00:15:20The pain has been pretty much constant.
00:15:23So Luke's heart is already weak because of his traumatic injuries
00:15:33that he sustained in the bomb blast.
00:15:35So we're going to need to monitor him very closely
00:15:37to see how he copes with the anaesthetic drugs.
00:15:40What we may find is that his physiology is not coping,
00:15:44and this will make the surgery more risky.
00:15:49Let me just get a little bit of information
00:15:51when we see what Damo's spoken to.
00:15:53I've just spoken to...
00:15:59Okay.
00:16:00Okay.
00:16:01I've just spoken to the anaesthetist.
00:16:03Luke's heart is not pumping very well.
00:16:07Has he reacted to something then, do you think?
00:16:10He's now at serious risk of cardiac arrest.
00:16:15His cardiac function is such that you wouldn't start out like this.
00:16:18The risks were probably too high,
00:16:20but the risks are already up now.
00:16:22Do we carry on?
00:16:24We can then do the operation we promised Luke,
00:16:26or are the risks of surgery now too great?
00:16:30It was tough.
00:16:31Hello there, you've got some CD drugs.
00:16:40I've just seen the anaesthetic, didn't you?
00:16:42Yeah.
00:16:43Perfect, thank you.
00:16:50So today we're going to be operating on Julian,
00:16:52who's got a tongue cancer.
00:16:54We're going to be removing part of his tongue
00:16:56and reconstructing it with skin from his arm.
00:16:59But because of the nature of the cancer and where it is,
00:17:02we are going to have to split his jaw
00:17:04with what we call a mandibulotomy
00:17:06to gain access to the jaw.
00:17:09Morning.
00:17:11Julian's cancer has been acting quite aggressively,
00:17:14and so therefore this is quite a radical operation.
00:17:18If you leave these cancers,
00:17:20they are ultimately life-threatening
00:17:22and you can die as a consequence.
00:17:29So Julian's in this position where he's got this tongue cancer,
00:17:38and this tongue cancer is right at the back.
00:17:41It's at the junction of the front part of the tongue and the back.
00:17:45We need to gain access to that area,
00:17:48such that we can remove that tumour cleanly,
00:17:51while at the same time allowing us to get in there
00:17:54to reconstruct the tongue.
00:17:57That will be very difficult, as you can imagine,
00:17:59by just going through someone's mouth.
00:18:01So while people can open very wide,
00:18:05it can prove very difficult to get to the back.
00:18:09From a visual perspective, splitting someone's lip
00:18:11and then splitting the jaw,
00:18:14even for us as, in inverted commas, seasoned surgeons,
00:18:17it is impressive.
00:18:20So we will cut the jaw in front of this little hole here,
00:18:24and then that will allow us to open the jaw.
00:18:28So it's going to be opened up a bit like a book,
00:18:30so the jaw is sitting there in a U-shape,
00:18:32and we will be able to swing this jaw out on the left-hand side,
00:18:38and it will pivot on the jaw joint here.
00:18:42All the skin and the lip and the cheek comes out with it,
00:18:45and then that will allow us to get a direct view
00:18:49into this area here.
00:18:51So we do need to reconstruct this,
00:18:53and we have to use this technique called microvascular surgery,
00:18:56which is where we take skin from elsewhere in the body,
00:18:59along with the blood supply that supplies that skin
00:19:03to reconstruct the defect,
00:19:05and the blood vessels that supply that skin
00:19:08can then be plumbed into blood vessels
00:19:10that we've prepared in the neck.
00:19:12But with all these operations,
00:19:14there are going to be specific risks to what we're doing.
00:19:21I think the biggest risk for Julian is infection or bleeding.
00:19:25An artery in the neck will burst,
00:19:27and consequently they'll either bleed externally
00:19:30or they'll bleed into the mouth.
00:19:31Morning.
00:19:32Morning.
00:19:33Morning.
00:19:34How are you?
00:19:35Yeah, all right, thanks.
00:19:36I'm Rachel.
00:19:37Hiya.
00:19:38I'm just going to do a nurse commission on you, if that's okay.
00:19:39Yeah, yeah.
00:19:40Just to get your blood pressure down, a few details.
00:19:41Are you right or left-handed?
00:19:42Right-handed.
00:19:44It's going to be some radical surgery.
00:19:59It's going to be very weird having all this happen.
00:20:02I used to be a chef in the Navy.
00:20:04Food's always been such an important part of my life.
00:20:07I love food, I love anything to do with it.
00:20:08And so, you know, to lose, you know, what your tongue does,
00:20:13which, you know, we all take for granted every day.
00:20:16So I'm going to have to relearn how to eat again.
00:20:21And there'll be problems with my speech.
00:20:23Yeah, so it's going to be a bit of a journey.
00:20:26And whatever happens afterwards, when I come to,
00:20:30you know, I'll just deal with it.
00:20:35Right, chairs and contractors.
00:20:36It's all about getting back to my daughter.
00:20:58I love her very much.
00:21:00And this has been tough for everyone.
00:21:02You know, this isn't just about me.
00:21:03The wider family and the impact it has on them, which is dramatic.
00:21:10So this is Asana.
00:21:12Oh, yeah.
00:21:16Even though I'm the one with the cancer,
00:21:18it doesn't matter, everyone else is going through it.
00:21:19That's lovely. Will his head go into there?
00:21:22I'll get my clothes on while you put the arm out, sir.
00:21:26That's all right.
00:21:27The main risks is bleeding.
00:21:29We're operating in the neck,
00:21:30next to the carotid artery and jugular vein.
00:21:31And, you know, you can make holes in these vessels,
00:21:32and the bleeding can be significant.
00:21:35So this is a complex operation,
00:21:36and you can make holes in the vessels.
00:21:38his head go into there. I'll get my gloves on while you put the arm out, sir, if that's
00:21:44all right. The main risks is bleeding. We're operating in the neck, next to the carotid
00:21:53artery and jugular vein. And you can make holes in these vessels and the bleeding can
00:21:59be significant. So this is a complex operation. I'm going to be working on removing the cancer
00:22:07from Julian's tongue, while my colleague Sat will be raising the flat from Julian's arm
00:22:11that will be used for reconstructing the tongue. We're going to take the skin from the arm with
00:22:17the blood supply, and with it will be two tiny veins. So basically we're taking that skin
00:22:23and the nice thing is you've got a tattoo there, it'd be nice not to disturb it, so we'll just
00:22:28make a straight line incision so we can get it back together fairly accurately. Duration?
00:22:34It's a massive operation for Julian and you always get a little bit nervous because you're
00:22:52putting the patient through something massive. You always have that slight degree of anxiety,
00:22:59which I like to think helps you perform better. All right, ready to start. I'll have the lower
00:23:07premolar forceps. To access Julian's cancer, I need to get right to the back of his throat.
00:23:13We don't want to take out any more teeth than we have to. I'm going to give it a wobble.
00:23:21We're just going to give it a little dab. Thank you.
00:23:28So at the moment we're just cutting through fat in the neck. What we find is that in this bit here
00:23:36between the underneath the chin and the neck, if you do a straight line, as it heals, you end up with
00:23:42a tight scar band. And so by throwing this little zed in, it tends to be a bit less obvious.
00:23:51I'm going to be really careful about the nerve which moves his lower lip.
00:23:56It's only a little nerve. So if we separate those like that, that's lovely.
00:24:02So the nerve which moves his lip is going to be down here somewhere.
00:24:05And the facial nerve is a nerve which supplies movement to the face.
00:24:11If I cut this nerve, Julian could have permanent damage to his speech and swallowing.
00:24:16So I'm coming onto the gland and then forward. And this way I'll be protecting the nerve.
00:24:26He's got a right plethora of veins here, which makes life a pain.
00:24:35There's a 25% chance that Julian has cancer in his lymph nodes, so we're going to remove them.
00:24:42Unfortunately, I'm working down a big hole where at the base of that hole is the jugular vein.
00:24:50It's a big vein. It's usually about the diameter of your thumb.
00:24:53It's a big blood vessel that drains blood from the head and neck.
00:25:02So I'm just being a bit careful at the moment because he's got loads of little veins.
00:25:06But clearly, the last thing you want to do is to make a hole in the jugular vein.
00:25:13If I damage that, it could lead to a serious bleed,
00:25:16which could be a risk to Julian's life.
00:25:30I need to go and speak to the patient.
00:25:31Hopefully, those are the haemophilters wrong.
00:25:36If you'd like to go down there, Matt, if you'd like to go down there, Matt, if you'd like to go down there.
00:25:43There's something going on to see us, John.
00:25:45It should be.
00:25:46No, it was.
00:25:48It was, it's been a long time.
00:25:51We need to make a decision, but we need to make a decision quickly.
00:25:54Yeah, yeah.
00:25:57Okay.
00:25:58So timelines, do you think, um, 11 at the moment, so I'll just have to, sure, okay.
00:26:04If we don't try now, I don't think he'll do very well afterwards because, um,
00:26:10he can't carry on with the pain, uh, like he is.
00:26:14And he's been so close to suicidal a few times that he would want us to carry the risk with him.
00:26:20Luke is now at significant risk of fatal cardiac arrest.
00:26:26We need to have a chat with the medical director to see if, um, we should proceed.
00:26:31Hi, Peter. Sorry.
00:26:32I just wanted to sort of let you know that this was going on.
00:26:35He's been anathetised, but, um, we've now, um, he just wasn't responding very well.
00:26:40There's a risk of death that there wasn't before.
00:26:43And, you know, I know Luke really well.
00:26:45You see, he's been, he's been with me for 10 years, more than 10 years now.
00:26:50So we've kind of gone through in our minds, really, that, you know,
00:26:54Luke would want us to carry on.
00:26:56I just wanted to make sure that you were aware rather than anything else,
00:26:59rather than, you know, um, you know, so that you know what it's like with these decisions.
00:27:04It's always a bit tough.
00:27:07You know what I mean?
00:27:08It's one of these things that, um, you know.
00:27:14No.
00:27:14Yeah, great.
00:27:18No, no, okay.
00:27:19Yeah, sure.
00:27:21Okay, thanks, thanks, Pete.
00:27:22Okay, cheers.
00:27:22Yeah, okay, bye, bye.
00:27:23Thanks, let me know.
00:27:24Okay, cheers, bye.
00:27:32Okay, all right, let me phone her then, and let's just, I'll put one speaker.
00:27:36Yeah, yeah.
00:27:37I need to have a call with Luke's wife, Abby.
00:27:39I need to make her aware that the risk of Luke dying on the table is much more significant.
00:27:43Hi.
00:27:44Hi, Abby.
00:27:45Hi, yeah.
00:27:45Yeah, um, so you've got myself and Damien in the room.
00:27:49We're just going to sort of talk to you.
00:27:52Effectively, we've not started his operation yet, but we've,
00:27:55we've come on to a few hurdles, mainly around his cardiac functions.
00:27:59His ejection fraction is probably, you know, if I'm being very optimistic, 20%,
00:28:03but we're running between 10 and 20%, and we've got a lot of monitoring down to work that out.
00:28:10So, in an, in a ideal situation, we'd cancel him now, and we'd sent him to the cardiologists,
00:28:20um, you know, to work out what to do, um, and how we could optimize him.
00:28:25But I think we all feel that the chances of us getting him back here at this state right now,
00:28:31of, um, next to nil, um, so this is, this is where we are.
00:28:35He, he, he's, I suppose the way to say it, I mean, he's at risk of dying from this procedure,
00:28:43more than we thought.
00:28:46Okay.
00:28:48Yeah, so what, what's the chance of Luke's survival now?
00:28:52I don't know.
00:28:55We've never seen this, you know, this kind of case before.
00:28:57I can't actually give you a number.
00:28:59What I can tell you is it's not as good as it was before, yeah.
00:29:04It's impossible for us to put your figures on things.
00:29:06That's not what we're after now.
00:29:07We just, you know, what, what we need to impart to is that, you know, if this is what, what?
00:29:14Yeah, I, yeah, I think Luke wants surgery.
00:29:18He wants to try and get a normal arm back.
00:29:20We don't have, like, Luke doesn't have any form of life, um, at the moment anyway.
00:29:25And I think that's important for us to understand so that we can share this with the team so that
00:29:29the team will feel, um, is the right thing to do.
00:29:32Yeah.
00:29:33Okay.
00:29:33So Luke's new one is if surgery doesn't kill you, the pain and the medication and will kill
00:29:41yourself if he carries on on this.
00:29:44Go ahead.
00:29:45I think that's the understanding.
00:29:46It was kind of our decision to make and I think me and Mark have decided I think that's the way to go.
00:29:52Uh, given all the things we've said to you.
00:29:56Yeah.
00:29:56All right.
00:29:58Yeah.
00:29:59I'll, um, you could drop me to give Gary a call.
00:30:02I'll give his dad a call now.
00:30:03Yeah.
00:30:04Okay.
00:30:04And, and just try to keep yourself busy.
00:30:06I'll give you a call afterwards.
00:30:07Yeah.
00:30:08All right.
00:30:09Okay.
00:30:09Okay.
00:30:10Okay.
00:30:10See you next.
00:30:10Yeah.
00:30:11Okay.
00:30:11Bye.
00:30:11Bye.
00:30:12Bye.
00:30:12See you next time.
00:30:13See you next time.
00:30:15Bye.
00:30:16Bye.
00:30:21Are you going somewhere else?
00:30:22No, I'm just hanging around for a couple of minutes.
00:30:31We have made a decision that, um, with knowing him and having a conversation with his wife,
00:30:38that, uh, although he's under significant risk now, I'm sure he would be telling us to carry
00:30:45on and to, you know, I certainly don't want to put him through any thing that is unnecessary.
00:30:52But of course, now we feel that this is life sailing.
00:31:02I need him right down this way as well.
00:31:05Okay.
00:31:10And just someone grab the consent form for me.
00:31:14And so plan procedure is that we're going to do this bilateral sciatic nerve explorations,
00:31:20just to bring the team into the discussion.
00:31:22I think beforehand, I think we didn't think there was a significant risk of death as part
00:31:32of the procedure.
00:31:32I think we now think there is a significant risk.
00:31:35Uh, I've discussed this with his wife.
00:31:37I've also spoken to the medical director as well, who is supporting our, um, proceeding based on the
00:31:44fact that this is probably the only time we're going to get Luke here in this position.
00:31:48And he's already at significant risk, but we feel that is worth it.
00:31:52It's what he would want.
00:31:53And that's what we've gone down.
00:31:54Um, is there anybody that really feels strongly about proceeding?
00:31:58Great.
00:32:03I think it's important that we all feel together on this.
00:32:06There's definitely a pressure that, you know, I do feel that making decisions, um,
00:32:14for him have to be very circumspect, uh, which is completely why I've involved many other members
00:32:19of the team, try not to allow any relationship that might have developed between us, uh, as friends
00:32:24to, to cloud what we are, um, what we're trying to do to help him.
00:32:29Well, I think he's, he's placing all of the success on this.
00:32:33He's at the point where he's willing to try anything.
00:32:35Yeah.
00:32:36Let's hope we can find the bloody nerves quickly.
00:32:39As in, when we make the first incision.
00:32:43Okay, how are we doing then?
00:32:45Are we ready to?
00:32:46The bomb blast damage to Luke's thigh makes locating the nerves particularly challenging
00:32:50and we only have a limited amount of time under anaesthetic.
00:32:53The neuroma's somewhere there.
00:32:54Yeah, okay.
00:32:55We go a bit like that.
00:32:57Yeah, that's good.
00:32:57We are going in at the top of Luke's thigh on the right side of his remaining pelvis.
00:33:02Great, a knife please.
00:33:06I'm going to make it this big, I think.
00:33:08We don't want him under anaesthesia for too long.
00:33:10Time pressure acutely to the surgery now is more because of the anaesthetic risk
00:33:15and the longer he's under surgery, the longer his body is experiencing trauma.
00:33:23Well, the right leg is going to be, is easier.
00:33:26This is the right that we're doing now.
00:33:28This is slightly easier as opposed to his virgin territory.
00:33:33The bigger the better.
00:33:34Yeah.
00:33:35Prior to this, the risks were from the operation itself,
00:33:38risks to his bowel, risk of bleeding and things like that.
00:33:41Now it's risked his actual whole body because of his heart.
00:33:54I made the incision.
00:33:55We've just gone through the skin and we're just into the secretaneous fat now.
00:33:59So we're now going to raise tissue to allow us to, to see the nerve.
00:34:02I think we've got, we might be close to the nerve.
00:34:06We're just trying to orientate ourselves a little bit.
00:34:08So we can feel, we can feel the bone there.
00:34:12Is that nerve or the scar?
00:34:16We need to find the nerve that has the neuroma on the end of it,
00:34:19which is causing Luke's pain.
00:34:20It's all right.
00:34:21Oh, is it there?
00:34:22Yeah.
00:34:24Yeah.
00:34:25So, so we're just, I'm just exposing the nerve now.
00:34:27I think you can see it.
00:34:30That's the neuroma.
00:34:30Yeah, you can feel it.
00:34:32Yeah.
00:34:32The body of the nerve is in the spinal cord or in your brain, you know, the cell body.
00:34:37So the nerve doesn't die when the nerve gets cut.
00:34:41It's like a starfish trying to regrow its, its, its legs.
00:34:45So the, when you cut the nerve, the ends,
00:34:47the nerve cells are still alive at the end of the nerve and they try to regrow.
00:34:52But there's nothing to regrow to.
00:34:54So they, they grow in a chaotic fashion and they, and that causes a lot of pain.
00:34:59Sam is going to give the nerve that is causing the pain something to do
00:35:03by stitching the freshly cut end into some muscle.
00:35:06The hope is that we'll grow into the muscle and stop giving him pain.
00:35:11And particularly these muscles that we're choosing aren't really doing very much now.
00:35:15And so if we can give them something to do, it will really help.
00:35:21Yeah.
00:35:21We'll remove the neuroma.
00:35:22We'll cut it back to where the nerve's healthy.
00:35:25Take a nice good chunk there.
00:35:27Make sure we're a couple of centimeters from the neuroma.
00:35:29And then just make a nice clean sawing cut there.
00:35:33And you can see how healthy the nerve fascicles are there.
00:35:37Yeah, you can see this, this lump that's formed where, where these fascicles at this
00:35:46end have tried to form new connections and not been able to.
00:35:53And then that is very exquisitely sensitive.
00:35:56So as soon as you bash on that a tiny little bit,
00:35:58it will send a big electrical signals down the nerve and cause him intense, excruciating pain.
00:36:03I mean, this is quite big, so I'm going to just wrap it with muscle.
00:36:08So this is kind of a belt and braces type thing.
00:36:10So microscope, is it ready?
00:36:11I should get this out.
00:36:12Do you want to turn this to 62?
00:36:17The anaesthetist is especially important in this operation.
00:36:20They're keeping a close eye on how Luke's heart is coping at every stage.
00:36:23Yeah.
00:36:25So we're just doing microsurgery just to join up that branch we found to the main sciatic nerve.
00:36:40We really want to make sure that the cut nerve iron securely with the muscle to form a healthy
00:36:44connection that will grow. Otherwise, there is a risk that Luke's pain comes back.
00:36:48So it's tiny stitches. That's why we need the microscope.
00:36:53And we orientate it to the correct sort of fascicles as well.
00:37:00Oh, we're going for a third one here.
00:37:02Yeah, actually, I like that idea, yeah.
00:37:06Just to orientate it a little bit more.
00:37:09Looks great, Sam.
00:37:12Oh yeah, brilliant, mate. Brilliant. Really good.
00:37:14Okay. Yeah, we're done. We're just going to close up.
00:37:21Back out, back out, please.
00:37:23Great.
00:37:26So part one done. We've done the right side.
00:37:29Yes, we managed to excise the neuroma.
00:37:32Then now on to the left side, the bigger challenge, yeah.
00:37:37We've successfully completed half the operation,
00:37:40but now we're moving on to the more difficult left side, where there are more risks.
00:37:44It's very close to the peritoneum, very close to the bowel, so it would mean us
00:37:50inadvertently tearing a bit of scar tissue that's attached to the bowel that would then
00:37:55open up the bowel, which obviously is full of bugs.
00:38:00This could cause a life-threatening infection like sepsis.
00:38:04So we've been, what have we been, two in a...
00:38:07We've been two hours, haven't we, really?
00:38:08The longer he's under surgery, it's a load on his heart, which is already compromised.
00:38:16I'm worried that Luke's heart could stop at any moment,
00:38:20just as we're about to go into the most risky part of the operation.
00:38:22Is he okay?
00:38:29If he did end up going into cardiac arrest, we'd have to obviously stop what we're doing,
00:38:34get the drapes off, turn him onto his back as quickly as possible, and start cardiac compressions.
00:38:38We've got two, all right, thanks, H.
00:39:01Medium swap, please.
00:39:06We're trying to get low in the neck, and access is always tight and difficult.
00:39:21Julian has a survival advantage by us removing the lymph nodes in his neck that may have cancer in them.
00:39:27So I'm just going to come onto the jug from above.
00:39:30We're avoiding all the named blood vessels,
00:39:35but there are plenty of little blood vessels that don't have a name,
00:39:39which are big enough to spoil your day in a way.
00:39:43The langlenbeck, please.
00:39:44So now I can finally get access to his lymph nodes and remove them as a whole.
00:39:52In the neck is all the fat and the glands that have got cancerous cells in there.
00:40:04We've removed all the lymph nodes in the neck,
00:40:06and in doing so we've come down to the jugular vein.
00:40:13So we've separated the jugular vein, we've taken all the tissue out from around it.
00:40:16The first stage of the operation is over, so now I need to split Julian's jaw to get to the cancer in his tongue.
00:40:2515 plates, and we're going to split the lip and do a mandibulotomy.
00:40:30I'm just going to stab through the lip all the way, and then carve through the lip.
00:40:41Lovely.
00:40:42So squeezing the lip and pulling it up and out.
00:40:47And so I'm going to cut through that muscle in a minute,
00:40:51and then come above it.
00:40:53Just going to go straight through the blade, back to you.
00:40:55So we're going to go straight down.
00:41:01Straight down the middle.
00:41:09And when we do our bone cuts, we need to do our bone cuts such that we don't
00:41:13injure the teeth, and we don't injure the nerve.
00:41:16Soar into me please.
00:41:31So we're just completing the bone cuts now.
00:41:36So that in a second the jaw will hopefully break.
00:41:38And a mallet please.
00:41:48So we're just doing some little tap taps.
00:41:51And you can just see the beginning, it's beginning to open up.
00:41:54Now you've got good movement.
00:41:57So you've got to be careful that we don't tear this too much.
00:42:01Because obviously here, it's all about preserving function.
00:42:06There will be a muscle on the inside called mylohyoid,
00:42:09which we're going to need to cut as well.
00:42:11So you can see us opening the jaw.
00:42:24So I can cut through this now.
00:42:26And then we'll be able to swing the jaw out.
00:42:38Now I can get to the back of Julian's tongue where the cancerous tumour is.
00:42:43We want to make sure that as much of Julian's tongue as possible functions normally.
00:42:48Two forceps to me please.
00:42:50Could 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.
00:43:02So now we're going into the tongue.
00:43:12So unfortunately the nerve which gives sensation to the tongue on that side is going to go.
00:43:18It just means that the tip of his tongue is going to be numb.
00:43:23He's still going to have taste.
00:43:27Suction please.
00:43:30So I'm just going a little bit deeper here.
00:43:33I'm going to come across the base now.
00:43:34Just coming right to the back.
00:43:49And it's right at the base of the tongue.
00:43:54So this is the base of the tongue.
00:43:57And that's where the positive margin was.
00:43:58And we need to get a centimetre on that.
00:44:00That's why we've had to go back as far.
00:44:02And so we've removed here almost half of Julian's tongue.
00:44:07And if we don't reconstruct this he's going to find it very difficult to
00:44:10eat and speak again properly and his quality of life will be intolerable.
00:44:17So basically I'm done. Sat's going to have a quick look at the blood vessels.
00:44:24So we're going to use a flap of skin from Julian's arm with its blood supply
00:44:29to reconstruct his tongue.
00:44:30So I've divided the two veins that travel with the artery.
00:44:38And then we'll divide the other major vein.
00:44:44When you're using muscle flaps, the amount of time you can survive without blood supply
00:44:50is markedly decreased.
00:44:51I'll just release this one vein.
00:45:01So here you can just see everything detached.
00:45:04We must connect with the flap as quickly as possible as the longer it is without a blood supply,
00:45:11the more likely the flap will die.
00:45:13And then we may have to abort the reconstruction.
00:45:15Where is the patient going back to abscess?
00:45:23Obviously I mean his health concerns are there.
00:45:36Yeah, they're more of them now, aren't they?
00:45:41And so now we're going to do the more challenging side.
00:45:46Getting the nerve out is going to be a little bit more difficult.
00:45:50It's going to be close to big vessels within the pelvis and close to bowel, which is obviously one of our concerns.
00:45:57Luke's pain is unbearable and it's brought his life to a standstill.
00:46:02We need to locate the nerve at the top of the left thigh to give him the best chance of a life worth living.
00:46:07You okay?
00:46:08Yeah.
00:46:08Happy? Everyone all right?
00:46:09Yeah.
00:46:10We're doing the left side now.
00:46:12This side is slightly more complicated because we don't have the normal landmarks anymore
00:46:17in this side that we would normally follow to get to the nerve.
00:46:21So it's much more difficult to make things even more complicated.
00:46:25This is the area where the nerve is right in front of the bowel and all the big vessels as well.
00:46:34What's that rim?
00:46:35Is that... I'm not sure.
00:46:37So there's something sharp here.
00:46:39Can you feel that?
00:46:40Where are my fingers exactly?
00:46:43So you see that thing there?
00:46:44Can you see this?
00:46:44This is muscle.
00:46:45You see this here?
00:46:46Scarred.
00:46:47Yeah.
00:46:48I don't know what that is at the moment.
00:46:51The challenge is first finding the nerve.
00:46:56It just can't...
00:46:57It all gets a bit red, doesn't it?
00:46:59You can't...
00:47:02Can't quite work out what's going on.
00:47:05Probably like all these things is that everything looks the same.
00:47:11I'm finding it's quite hard now because I can't work out where it goes.
00:47:22Every time I do anything, it's just bleeding.
00:47:24That's probably...
00:47:24Mm.
00:47:25It's everything's the same.
00:47:26Yeah.
00:47:28Oh, it's just all red and horrible.
00:47:30There's some... there's a sort of something there.
00:47:33There's...
00:47:38And I think we've got to find some anatomy that we're familiar with at the moment,
00:47:41because we're making very slow progress at the moment.
00:47:47I don't feel we're getting anywhere.
00:47:51Luke's anatomy is almost unrecognizable as a result of the bomb blast.
00:47:55We're struggling to identify the correct nerve to operate on.
00:47:58Oh, my God.
00:48:01I might have to stop and look at the anatomy in a second, you know, on the scan again.
00:48:06I'm worried if we can't find the nerve on this left side,
00:48:09Luke's entire operation may have been wasted.
00:48:12I just can't get myself orientated at the moment.
00:48:14Do you want to have a little go, and I'm going to just de-scrub a second,
00:48:16because I want to have a look at the scan and get the scan out.
00:48:18All right.
00:48:20Um...
00:48:20I can't find the nerve.
00:48:24So I want to look at the scan again, just get myself orientated.
00:48:28I'm not sure I've got many more of these cases in me to the nasty.
00:48:32Luke's been under anaesthetic for three and a half hours.
00:48:35Every minute puts more stress on his heart.
00:48:40Time pressure acutely to the surgery now is more because of the anaesthetic risk.
00:48:44It's a load on his heart, which is already compromised.
00:48:47So the longer we take, the higher the risk is.
00:48:50The higher the risk is.
00:49:01Which theater was it?
00:49:02Um...
00:49:0223.
00:49:0323.
00:49:13Do you need another way?
00:49:17Come on, I'm sweating here.
00:49:20The problem is it's just really difficult to identify the anatomy because he's only got half a pelvis.
00:49:33It all looks like scar tissue.
00:49:43I still think it's that.
00:49:45Do you think you've got it?
00:49:46I found something I thought might be it.
00:49:50I don't know if that's the stump there.
00:49:52I've tried cutting it, but...
00:49:56The one scanner I wanted to look at, I can't...
00:49:59It doesn't say.
00:50:00Well, you just can't see it properly.
00:50:02Yeah, I want to see the other graph.
00:50:04Let me re-scrub.
00:50:06The problem is the scar looks very much like nerve.
00:50:10It was there before, so it's quite hard at the moment.
00:50:13I'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.
00:50:22I was just wondering if this is the stump of the nerve here, and this is the notch.
00:50:34I want to see what you mean, yeah, right there, yeah.
00:50:37Yeah.
00:50:38Yeah, you're right, aren't you?
00:50:40Can you see there?
00:50:41Yeah, yeah.
00:50:42There, that's it.
00:50:43The nerve is here.
00:50:45So, you could go around it a bit more.
00:50:48And then we could cut it then and put some, and just put some muscle around it.
00:50:53Yeah.
00:50:56I think we've got to go on this bit of bone as far as we dare.
00:51:00We can either put some muscle or something in there.
00:51:02We'll cut support these.
00:51:06And then I think, I think we've got right where it's all scarred up onto the bone.
00:51:10God, yeah.
00:51:11Yeah.
00:51:12And the problem is now, is what I'm a bit nervous about, is that as we, as I pull this, I'm feeling that there's stuck.
00:51:19You're pulling abnormal contents.
00:51:20I'm pulling abnormal contents this way, or certainly peritoneum, so.
00:51:23Yeah, yeah.
00:51:24Because we can't really free it up anymore here without damaging the peritoneum.
00:51:28No.
00:51:29And there's bowel there that is causing us, and lots of big veins.
00:51:33We are now operating deep inside Luke's pelvis, very close to his bowel.
00:51:37There's a risk that we can inadvertently put a hole in it, which could cause Luke lots of problems after surgery.
00:51:44There, look, there's some decent muscle there, look.
00:51:48Oh, yeah, yeah.
00:51:49Yeah.
00:51:50So I think, take a bit of that muscle there.
00:51:53So we're taking some, a small amount of piriformis to wrap around the end of the nerve that's quite scarred.
00:52:00We've freed it up as much as we can from the bone, but we can't really get any deeper without risking damage to bowel now.
00:52:08We, we, we want to try and minimize his time under anesthesia if we can.
00:52:12It's not too bad.
00:52:13What time are we on now?
00:52:14Half five.
00:52:15So we're, we've, we've done five hours so far.
00:52:18What we're going to do next is we're just going to cut the, 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.
00:52:29I think what, what we're trying to do is, is hopefully allow the nerve to have some muscle around it that is protecting it from scarring up to the bone again.
00:52:44And that will be really important.
00:52:47That looks great.
00:52:49There's a, there's a few little bits to do, but we're very close to starting to close.
00:52:56And that's it done.
00:52:59We're really hoping that we'll 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.
00:53:14We've got through it. It's really challenging surgery.
00:53:20I'm pleased that Luke's heart has managed to get him through this lengthy operation.
00:53:24This really is the last chance of improving Luke's pain.
00:53:28.
00:53:31Hi.
00:53:36Happy. It's Mark Foster.
00:53:38Are you okay?
00:53:40Yeah?
00:53:41Yeah, yeah. Very good.
00:53:42yeah um so we just finished everything's gone really well he's fine um hopefully you can rest
00:53:52um a bit easier he's not completely out of the woods as you can imagine it will now be an eye
00:53:57to you and they'll be able to keep everything uh and very tight from my perspective i just think
00:54:01you know you know we've done exactly what we can um but yeah it's taking it's taking its toll today
00:54:07i have to say the left side has caused us some um not problems so much but we i couldn't get as
00:54:17much around the nerve as i wanted to it's just far too deep so we've got on to the end we think
00:54:23i don't know how successful this will be i have to say i think we've not been able to see the nerve
00:54:30as clearly as we wanted to we're really hoping that we'll get some relief from this
00:54:37okay thank you yeah go keep going okay stop it
00:54:54what we'll do now we're just going to move that uh loop if we make that's all right
00:55:08so this is going to be the front and the back and these two blood vessels we're just going to lay
00:55:12into the neck like there the skin that we've used to reconstruct the tongue is quite thick the problem
00:55:21is it's so thick that it needs a blood supply without this blood supply basically the flat would die
00:55:28within a number of hours and it's got to have an inflow and an outflow
00:55:33and we're just going to start insetting the skin here three ovicral please if we don't get this
00:55:39plumbed in in a timely manner the skin will start to die off if the skin flap dies then the reconstruction
00:55:45wouldn't work well that would mean that julian would be left without a functional tongue and this
00:55:49would affect his ability to speak and eat and an eye no stitch so the stitch we use as you'll see is
00:55:55quite small they're about one and a half two mil this is where you see how badly we all shake
00:56:05you try and get a nice little stitch in gotta be a bit careful i'm just lost where i am there's one
00:56:12more i think just at the top just gotta kind of pull that that's it it's all right this is the last
00:56:23stitch so that's just tying this off and then i think fingers crossed will be done
00:56:29it looks quite nice here doesn't it the important thing is the artery in the neck you can see
00:56:38pulsating really well so you've got a lovely pulse you've got a good pulse going into the flap
00:56:45i think fingers crossed so hopefully it'll be watertight
00:56:51and you're able to just lift it up all we've got to do then is just close it
00:56:56with the flap now in place we can start putting julian's jaw back together again
00:57:01so we're going to be using metal plates and screws to hold the jaw in place
00:57:08so we're not doing this rigid yet we're just going to get these screws on one more thing
00:57:13we're going to plate it together and then i'll just try and get the stitching at the back so
00:57:18needle to you thanks screw please manipulate it into a good position and tighten up
00:57:29so his teeth are in a good a bite that's it and you'll feel it lock but the jaw is all together in
00:57:36one piece and we've got that skin on the side of the tongue going right into the back
00:57:44so what we need to do now is just a little bit more closing here the skin stitches should really just
00:57:51be gently holding together what your deep stitches have done
00:57:57the patients have no idea what you've done on the inside they don't know if you've done a good job or a
00:58:01bad job so all they see is the stitching that you've done and if your stitching looks poor then
00:58:09quite rightly they've probably got to think to themselves well hold on if they're not that
00:58:14bothered about what it looks like on the outside what have they done on the inside
00:58:18you just relax julian just let everyone do the work for you you just lie there and relax it's all
00:58:41gone well okay you just relax and let yasmin do all the work for you
00:58:51you walk away thinking there shouldn't be any problems however you never know
00:58:56really until the patient goes home which will be about 10 days time you never truly relax
00:59:02you
00:59:19good morning
00:59:22great so we're going to see luke today he's um two weeks following his surgery now it's been a bit
00:59:37of a bumpy road actually following his um his surgery certainly with lots of conditions uh that have kind
00:59:44of revealed themselves as we've gone on uh but yeah we'll see how he is today
00:59:49how are we doing hello hi wow got everybody here today including the frog excellent great to see
00:59:59you good to see you guys nice to see you again hello you all right hi dad all right yeah very good
01:00:06bro um so we're i think we're two weeks down the line now um it's been a rocky road um with pancreatitis
01:00:14pees uh that we've had and you've had you had some problems on one of the days of um uh developing
01:00:20a chest infection as well uh and that um i really put you back a little bit um and your pain's been
01:00:25intermittent over that time yeah um but last day or two i hear that things are getting a lot better
01:00:32how are you feeling i'm good at this the pain i'm getting is more from the from the scar i think
01:00:38um i am i am getting a bit of nerve pain on the right but nothing drastic no so i think it's more
01:00:46just from the wounds yeah it's touchwood sure and then the left side that's fine yeah and that's quite
01:00:53surprising for me actually that the left side has been done so well and because we pulled quite a lot
01:00:59of the nerve away from the bone and and the scar and that would probably explain why um actually that's
01:01:05done okay yeah whereas the right side was very much a fresh cut through the nerve that's why it really
01:01:09does cause a bit of pain to start with uh but then that's that's eased now great we won't really know
01:01:14whether it's absolutely worked for a number of weeks um yet uh and maybe for months it's just to
01:01:20see how it goes and i think you know as every week goes on every month goes by um that's a good sign
01:01:26that um we'll get things and what happens is the nerves got to grow down it's got to re-innovate right
01:01:31and that does take weeks to happen it's early days i don't want to give you any false hopes
01:01:36i don't think you know we're going to go the right way um and then you know i think the hard work for
01:01:42you is now on as well we want you to you know really get yourself as healthy as you can you know
01:01:46because that will help everything settle down help um the the pain that was um happening not re-establish
01:01:53itself yeah on behalf of my family and abby and everybody else i'd like to thank you and the
01:01:58team for the great job you've done with me it's a team effort um absolutely i have to say i felt
01:02:04i've earned my money with you it's truly amazing we probably wouldn't have luke if it weren't for you
01:02:10guys all right well um thank you it won't be goodbye i know what this is like luke so we'll see you in a
01:02:15few weeks in the clinic um i think probably about the six week point okay great shall we later yeah
01:02:21thanks sir cheers thank you i'm excited i'm uh hopefully i can get back home today
01:02:31there's good news about my uh my surgery i think um this this one might be the one that works
01:02:39i've been i've had about four or five days now where i've not really had any pain it's like it's
01:02:44completely flipped it on it so it's quite mad to see he's definitely um turned the corner now as
01:02:54we hoped and predicted uh yeah so he's doing much better uh his pain's now really settling and i think
01:03:01we i would expect him now to have a good period of relief you can see from him that he's dramatically
01:03:08different uh this has made a massive difference in just in the short term now
01:03:15i think we're all very cautious um i've been through this with luke a few times now um i'm
01:03:21i'm yeah i'm really pleased with how he is i'm really pleased for him um we're always humbled at
01:03:26being in this these scenarios we don't really do it for um for the reward we do it because it's the right
01:03:32thing hi julian if you come into my clinic over here um i'll have a good look in your mouth and just
01:03:49touch base with you about where we stand you did remarkably well obviously the starline doesn't look
01:04:00particularly good at the moment because you've got hair growth around it um so um you've got a little
01:04:05bit of um you've probably seen yourself that um the skin is just overlying and overlapping a little bit
01:04:11underneath and all this neck is going to settle down the bit that we really want to get right when
01:04:17we stitch it together is that little junction between your lip and the skin and that's spot on
01:04:23but should i have a look inside your mouth so if you can make yourself comfy i'll put some gloves on
01:04:30so i'll have a quick peek inside if i may just open a little bit for me
01:04:36so we did go a long way back actually you can let your tongue relax let it all go soft and floppy
01:04:41so i can see the flap at the back you've got some purple stitches in there we've got the skin there
01:04:47always swells up a bit i'm just going to pull it right back it's looking really nice everything's
01:04:53going the way it should be statistically the most likely outcome is going to be you know all been
01:05:01well no residual cancer there are things you probably weren't expecting um but this will go the right
01:05:07way lovely lovely i'll let you go and you have done remarkably well as i say it is going to be peaks and
01:05:12troughs it's all about regaining as much form and function of my tongue as i can and yeah you've done an
01:05:18amazing job on that you know it's a team yeah thank you so much thank you all right i'll let
01:05:22you go cheers julian thank you very much um i'll let you go thank you all the best cheers then see
01:05:29yeah thank you the main thing for me was quite simply was how this graft took on my tongue tastes
01:05:41all right actually amazingly so it hasn't really impacted my taste which is great
01:05:47towel down for you okay oh it's so good to get that off i bet it's all stepping stones for me this now
01:05:54sets off on my journey to getting back to health get through this major major surgery and come out
01:06:01the other end okay is it's huge yeah so i'm really happy with that thank you okay
01:06:14not everyone will survive a heart operation but this operation is really the only chance that matt has
01:06:20and the heart is out all the breast has been replaced by the tumor itself we are a racing against time
01:06:32it's possibly one of the most significant moments of their life we are in the tumor now this is inside
01:06:38the belly of the beast
01:06:50the heart is
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