- 5 weeks ago
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00:01On any given day, some 800 inpatients, 800 outpatients, and over 240 emergencies are
00:08cared for in one of Ireland's busiest hospitals, Cork University Hospital.
00:12It will take just one patient to come in, that just completely stops you and reminds
00:18you that, whoa, this is somebody's worst day of their lives.
00:21On any given day, some 4,000 staff come to work here, a place where life-changing decisions
00:27are made every minute, and every decision counts.
00:32Because I see a lot of sadness, I get great pleasure giving people the good news when
00:37I can.
00:38Here I am, hold my hand.
00:41You're having a heart attack.
00:44Filmed using 27 cameras following patient journeys across the hospital, each story in this series
00:49was captured in just one single day.
00:53Together they tell a bigger story of any given day.
00:57I'm here for a long haul, not getting rid of me.
01:00I'm frightened.
01:02I just broke down what is going on.
01:05I get the chance she didn't get, so I have to grasp it.
01:10A good shift is where you come out the door happy, thinking I made a positive difference
01:17today, and that's really it.
01:29Any issues overnight?
01:31No.
01:32Everybody behaving themselves?
01:33Yeah.
01:34Including the computers and the equipment?
01:36Yeah.
01:37CDU is full, AMAU is open and functioning, SAU is open and functioning, they've taken two
01:43from us this morning.
01:50A cyclist has been hit by a car.
01:53The air ambulance has been scrambled and is now arriving at CUH.
01:56So my gentleman is 46-year-old, Mr Barry Power.
02:02Mr Power was in Castleton Bear today, he was cycling out of the drive on the main road in
02:07Castleton Bear, so he literally cycled straight down the drive, never stopped.
02:10Car hit him.
02:11Hello.
02:12How are you?
02:13Hi.
02:14I know.
02:15I'm so sorry.
02:16Aww.
02:17I know.
02:18Barry came straight down my driveway and straight out onto, across onto the main road in front
02:25of an oncoming car.
02:26So head to toe, he's got quite a lot of lacerations over, he's got some over his frontal, over his
02:31occipital lacerations to his face.
02:33Barry came off his bike, onto the bonnet of this man's car, broke the window.
02:38In tone, about 30 metres, where the impact was to where he landed you.
02:42No helmet worn either.
02:43OK.
02:44And were we able to see the cars and there was any bullseye or anything?
02:47There was, to the front of the car there wasn't a bullseye, but there was damage to
02:51the front of the car, yes.
02:52OK.
02:54No problem.
02:56My role is the team leader.
02:57So I stand at the end of the bed and I have a clear overview of everything that's going
03:02on with Barry.
03:04Yeah.
03:05What's your role?
03:06Barry, you're doing great.
03:07Right now.
03:08Given the mechanism of injury, bike versus car, no helmet, it's important that we keep
03:14Barry staying still and get a scan of his brain and of his neck because we had concern
03:21for a head injury.
03:23Yeah.
03:24In the setting of his condition with Down syndrome, it was important for us to stay calm, to communicate
03:33calmly to him and to his family.
03:36And is that your sister that's here with you, Barry?
03:38Yeah.
03:39Your mum and dad are here as well?
03:41Right.
03:42We'll get everybody in just a moment, all right?
03:44They did ask me would it be OK if I came with them in the helicopter.
03:48And I could see that Barry was frightened and worried.
03:50He was asking for his mum.
03:52I want my mum.
03:53He was unaware of the extent of his injuries.
03:56The van stood outside there.
03:57Beautiful.
03:58Gorgeous.
03:59That's for Barry and just a little one for the front of your neck.
04:01It's like a big necklace.
04:02All right.
04:03I'm going to feel a little bit tight.
04:05Bit of a squeeze.
04:06Hold my hand here.
04:07Barry.
04:08Barry.
04:09Hold my hand here.
04:10Here I am.
04:11Hold my hand.
04:12That's it.
04:13Barry perceives pain much different to how you and I would and he can't express exactly
04:17where the pain is or what kind of a pain that is.
04:20Tell me, Barry, where in your tummy is it the most sore?
04:23Or is it just sore all over?
04:25Mm-mm.
04:26OK.
04:27OK.
04:28I think that's what we're going to get.
04:30Yeah.
04:31Yeah.
04:32So just given mechanism of injury, I think we're going to pan-scan him.
04:36So we'll book the scan.
04:38The team is now concerned about further serious injury.
04:42And a fuller scan is ordered to assess trauma to Barry's head, spine, chest, abdomen and pelvis.
04:49That's OK.
04:50You're all right.
04:51Look at you doing so well.
04:52You're the best patient.
04:53Yeah.
04:54Yeah.
04:55Well, then, but is it a patient?
04:57Your mom?
04:58Yeah.
04:59Yeah.
05:00Would you like, what we're going to do is we let her come in and see you in a few minutes,
05:03OK?
05:04What's your mom's name?
05:05I don't know.
05:06She's a nurse.
05:07Yeah, she is.
05:08Go away.
05:09Yeah.
05:10She's like Gusto.
05:11Yeah.
05:12Barry's parents are in the family room, waiting to hear news of their son's injuries.
05:26Yeah.
05:27She says Barry, you know, where they breathe strength, you know, it's hard to assess him
05:32because he's not in the series.
05:33No, I know she said he's in another area.
05:35He's peeing and, you know, it's hard to know where he's peeing is, you know.
05:39That's why they have to check through his whole body.
05:43What are your mom and dad's names, Barry?
05:48His mom is a nurse, Val.
05:49Oh, wow.
05:50I bet you she's the nicest nurse ever.
05:53Much nicer than us, Barry, is she?
05:55Yeah.
05:56Yeah.
05:57We'll have her waiting for you when you're back.
06:03He's moving a bit.
06:07So you can see the nice view of this baby's spine there.
06:10So with the little baby's head is up here by your belly button.
06:13The back is coming down here, down onto your right side.
06:16A little heartbeat there, a little tummy.
06:18Mm-hmm.
06:20Parents of two, Caroline and Rory Conboy,
06:22are having a 30-week scan of their new baby.
06:25Mm-hmm.
06:26So the baby's in that V position.
06:28Yes.
06:29So you see two little feet up here, just up by the head.
06:32Very happy with a little six-year-old boy and a three-year-old girl,
06:36and we will have another little boy soon.
06:39So we're just going to check the size, and then we'll have a little listen to the heartbeat,
06:43and I'll look at the flow through the cord.
06:46We really love the idea of family, and having somebody else was going to be great fun.
06:51As I said, we kind of just laughed at each other because it wasn't in the plan.
06:54I think day one where the biggest relief is that we can fit three kids in the back of the car.
06:59That wasn't an easy thing to work out.
07:03The head is up here by your belly button, so...
07:05Yeah, it's still there.
07:06We'll give another couple of weeks to figure out its head from its bottom.
07:09I can't wait for him to move down.
07:13You do have to kind of change your world for your kids,
07:17but it is definitely worthwhile for us.
07:22He's so cute.
07:24Once you hear the heartbeat of a child, once you see them on the scans, they're a real person.
07:28Yeah.
07:30Which one do you think he's like?
07:32I know, yeah. Familiar.
07:34Yeah.
07:36Caroline's dedicating an awful lot of herself to growing this person,
07:40and at the same time, your life partner is there,
07:43and they might have something very serious wrong with them,
07:46and you just can't separate the two necessarily.
07:53It's all those little hands.
07:56Eighteen weeks ago, Caroline received devastating news.
08:00Her 12-week scan revealed a large tumour.
08:03She has an aggressive cancer that is placing her and her baby's life in jeopardy.
08:09Baby's a very nice distraction.
08:11It's a very positive, very happy thing that's happening.
08:14Yeah.
08:15Very good. Well done.
08:16Thanks.
08:17If you let your kind of mind wander a bit too far, it can get a bit devastating.
08:22We would never have discovered my cancer, you know, without this pregnancy.
08:29So it was, like, definitely silver linings.
08:32Looking good.
08:33Yeah.
08:34He's doing very well.
08:35Yes.
08:36My little...
08:38Once he stops confusing...
08:39Sign him up for the rugby team now.
08:40Yeah, exactly.
08:41Once he stops confusing his head with his arse.
08:44So we'll go ahead then with chemotherapy and we'll touch base maybe next Friday and just do a check-in with baby.
08:51Is that okay?
08:52Perfect.
08:54What are you building?
08:56We're buying out of phones, mum and dad.
08:58Oh, yes.
08:59Yeah, yeah.
09:00Yeah.
09:01And how many rooms is it, you say?
09:03Seven.
09:06Will you fill them all with baby?
09:07Oh, yeah.
09:08Top one out there now.
09:09Seven.
09:10Do you see, actually, Gordon Ramsay's wife is looking to have her eighth child.
09:14Oh, my God.
09:15It's eighth.
09:16It's the seventh child, so...
09:19She's definitely 50-something.
09:25It's handover time in the emergency department.
09:2722-year-old, yeah, she was playing, I want to say Gaelic football yesterday, collision with another player.
09:34Advanced nurse practitioner Elaine Houlihan has just checked in.
09:38She's worked in CUH for almost 20 years.
09:41Gone home.
09:43Some of my best friends are in the emergency department.
09:46Nobody else kind of gets it.
09:47You're hardly going to go home.
09:48How was your day?
09:49You don't tell, you say.
09:50It sure was grand.
09:52And it can be terrible.
09:53And there are genuine terrible things happening there.
09:56You just have to go for a cup of tea.
09:58Do you want to chat?
09:59And usually you don't.
10:00You don't want someone.
10:01You just want to go away for five minutes.
10:02There you are.
10:03Thank you so much.
10:04You're welcome.
10:05Your life's over.
10:06Today's shift, like all ED shifts, will be busy.
10:0920 patients are on trolleys waiting to be admitted.
10:12Many of the less serious cases have been here for 12 hours or more.
10:16It's really tough because you don't want someone waiting there 12 hours.
10:21Our population has increased and our catchment is getting wider and wider and wider.
10:27And it is, you know, the busiest emergency department in the country.
10:31Now have a seat back where you guys were.
10:33Someone's going to come and collect you for x-rays then, okay?
10:35Like I won't be waiting 13 hours, am I?
10:37Oh, no.
10:38No, no, no.
10:39Not everyone's always happy all the time.
10:41But it can, you know, if you just kind of acknowledge, yeah, that's desperate.
10:46Because it is desperate.
10:47It's like sitting in an airport and your flight's delayed five times.
10:50Do you know what I mean?
10:52Oh, my boyfriend came up to see me.
10:54Oh, true love.
10:55I know.
10:56Leave this stuff there unless you don't know, honey.
10:58Leave it all there, okay?
10:59Yeah, yeah.
11:00Okay, so.
11:01Yesterday evening, 22-year-old Caitlin Denehan Barry was playing her first match after a long spell away from sport,
11:08when her time on the pitch was brought to an abrupt end.
11:11I don't know why you brought this with me.
11:13I don't know why you brought this with me.
11:14Come here.
11:15What happened?
11:16What were you playing?
11:17Harding a football?
11:18Football.
11:19Okay.
11:20Ball was in the middle.
11:21There was space.
11:22Myself and the other girl were running straight to it.
11:23And who was going to get to first?
11:24Clash.
11:25Clash.
11:26That was it.
11:27When I was playing before lockdown, I was four stone heavier.
11:29I was a good bit overweight.
11:31So going back, being four stone lighter, I underestimated my power, I think,
11:38because I would have had more power with more weight on me.
11:40Nothing.
11:41No, I'm sorry.
11:42I'm sorry.
11:43I'm sorry.
11:44I'm sorry.
11:45They're fancy paper stitches you have in code.
11:47I know.
11:48I was thinking the same.
11:49They're very posh, aren't they?
11:50I think we have a good first aid.
11:53You stay put there.
11:54I want to get Dan to do the extra there and there, and then we'll come back and we'll stitch you.
11:58All right, babe?
11:59Yeah.
12:00Cool.
12:01Caitlin plays both camogie and football.
12:04It's a big thing in her life.
12:06Two, three evenings, she comes in from work, into the gear, and off she goes.
12:09So she's a lot of commitment.
12:10Did she go past it?
12:11Oh, did you?
12:12How are you?
12:13Is that painful?
12:14No, no, I'm fine.
12:15Really?
12:16Yeah.
12:17Did she stitch it?
12:18No, she's not yet.
12:19She's going to put a real one stitch in it, in the middle.
12:22I was 21 when I had Caitlin.
12:24Turned 22 a couple of days later.
12:26Yeah, so we've done it all together.
12:28She said that the scar is going to be permanent.
12:30It might be a bit too...
12:32No, but now is the time, not later.
12:33I was wondering if we should go down the plastic surgery route, and it wouldn't bother Caitlin,
12:42and especially the fact that she got the scar playing sports, she thinks is amazing.
12:47I think it's kind of cool.
12:49Grinch you go with that, though.
12:51Maybe I will regret it, I don't know.
12:53I started playing camogie and football when I was early in primary school, so I grew a big connection with the gear.
13:00They always give you that sense of safety, that sense of home.
13:03You know, they'll back you on things that have nothing to do with the sport.
13:06It's still okay, take it easy on the field, will you?
13:09I know it.
13:10My God, like, I can see you full of adrenaline.
13:13When Covid came in, it kind of took ga away from me.
13:17I think at the age that I was, being 18, you know, you lose school, you lose some friends.
13:22It kind of took that time away to grow up and to really mature.
13:26You know, all of a sudden, you're 22, but you have the brain of a 17-year-old, it seemed,
13:31because you didn't have those social skills building up over those four years.
13:37When it all ended, and we just went back to normal life,
13:40I just felt really lost and really down, and I thought the only thing that might get me back up and going
13:47would be to get a foot back in the gap.
13:50And, um...
13:52Yeah, I just wanted to push myself with that, even though it took a...
13:58It did take a few months for me to feel familiar in it again,
14:02and feel comfortable in it again after being out of it for so long.
14:05But I was really happy. I pushed myself to get it back.
14:08Actually, get up your snappy chat with you, or whatever the thing is.
14:11Your face tube.
14:13So, look, let's explain things properly here.
14:16Oh, Jesus.
14:17I know, because we're looking at a white open there, and you're freaking out, right?
14:20Fuck!
14:21Let's look at it correctly.
14:22That's not bad, okay?
14:23Okay.
14:24Let's talk about reality here from what we need.
14:26That's actually...
14:27That is a cool scare.
14:28I don't want to...
14:29No, look it up here now.
14:30Look up.
14:31I'm going to show you what it's going to look like afterwards.
14:32So, you're not looking at the swirling around.
14:34Look at the little line.
14:35All right.
14:36Because I know she's not bothered right now, today.
14:38You won't be bothered now.
14:39You'll be bothered in a few weeks, so we're going to do the best job, right?
14:42Yeah.
14:43All right.
14:44Let's give that five Newton.
14:46All right.
14:47I'm back.
14:48If I just want that anesthetic to work with, so I'm going to leave that to work, but it's
14:53a melt in here.
14:54Your honour.
14:56That cut is so deep.
14:59That's...
15:00It's not even that.
15:01Like, you see that picture, it's deep.
15:03She kept going like that.
15:04I know.
15:05And I was like, I don't want to see her skull.
15:07I know.
15:08I know.
15:09I know.
15:10I know.
15:11I know.
15:12I know.
15:13I know.
15:14I know.
15:1540 minutes ago, Barry arrived to the emergency department at CUH by air ambulance, after he
15:20cycled into the path of an oncoming car.
15:23Barry?
15:24Yeah?
15:25You're in the CT scanner now, and we're going to get you over onto this table so we can get
15:30some scans, okay?
15:31Good.
15:32One, three, two, three, and roll.
15:35Three, two, three, and roll.
15:37He is being pan scanned to check for life-threatening injury to his head, neck, spine, chest, abdomen,
15:44and pelvis.
15:45Manage that.
15:46Okay.
15:47Alright.
15:48Otherwise we're going to start doing scans.
15:50Fine.
15:51Alright.
15:52He was at home and was going down his driveway, and got it on the mark.
16:03Breathe in.
16:04Hold your breath.
16:06So please bring.
16:07Yeah.
16:08Shall I?
16:09Amazing.
16:10Thank you so much.
16:11Very well done.
16:12Thanks a million, guys.
16:15You're doing so well.
16:29You're fantastic.
16:30I'm taking it.
16:31Come on again.
16:32Hello.
16:33It's your prayer.
16:34Yeah.
16:35You're Barry's mom?
16:36Yes.
16:37Do you want to come in to race us to see him?
16:38Yes.
16:39Have you been in already, guys?
16:40No.
16:41No.
16:42You haven't been in yet?
16:43No.
16:44No.
16:45No.
16:46No.
16:47You haven't been in yet?
16:48No.
16:49No.
16:50No.
16:52Yeah.
16:53I'm here.
16:54Are you there?
16:55Are you there, Barry?
16:56No, there.
16:57Oh, yeah.
16:58You've got a big fright.
16:59I remember.
17:00Why are these snakes?
17:01Yeah.
17:02You've got a big fright.
17:03Yeah.
17:04Can you remember it?
17:05Okay.
17:06I don't think it's all right.
17:07It's fine if you don't remember it, okay?
17:08But you had an accident, as you know.
17:09I was going to fix.
17:10And you were in the helicopter.
17:11You don't even remember that, because I'd say you were asleep.
17:13And Susan came with you all the way up here to the hospital.
17:15Okay?
17:16You had a busy day, yeah?
17:17Barry is 46 and my parents have cared for him all his life, in particular my mother.
17:35And I suppose he has formed the biggest bond with my mother.
17:38And when things go wrong, especially, you know, Barry would always look for his mother
17:44or his mam.
17:45Hi.
17:46Good evening.
17:47My name is Ogie.
17:48I'm the doctor looking after Barry.
17:49Yes, thank you.
17:50But you wouldn't like.
17:51How are you feeling?
17:52Don't worry, we're going to try and clean up your face, okay?
17:54That's fine.
17:55We just went on the official report from the radiologist and then we make a plan on what
18:07we're going to do.
18:08Hopefully it won't be too long.
18:09But for the meantime, we have to keep in mind and keep in with the colour.
18:12Like that you're not the only one either.
18:13We're going to need to have a look at the wounds and clean them up and tidy them up a bit.
18:18Yeah.
18:19There's five children in the family.
18:21Barry is the middle child of the family.
18:27Barry learned to cycle from a very young age.
18:29He just got on a bike and took off.
18:32Look over there, Barry.
18:33Look at the other side.
18:34Hey, Barry.
18:35Brian and Jill here.
18:36This side.
18:37It's very important for him, you know, that he's able to do the things he enjoys doing
18:41and have, you know, a good quality of life.
18:43You know, maintaining his independence and his enjoyment and keeping him safe has become
18:48more challenging.
18:50Don't sit up.
18:52Don't sit up now, Barry.
18:53No, lie down, Barry.
18:54Lie down.
18:55Fuck off.
18:56I know.
18:57I know.
18:58Don't sit up.
18:59Barry is very much his own person and has his own mind.
19:02And when he decides something, he means it.
19:04He was able to stay, you know, immobile for a while.
19:07But, and then he decided, you know, it was time for him to get up.
19:11Don't get up.
19:13Two minutes.
19:14Barry, relax.
19:15Barry, relax.
19:16Barry, just two minutes.
19:17Barry, don't get up.
19:18Just two minutes.
19:19Barry, Barry.
19:20Lie down.
19:21He was agitated after a while, not willing to listen, not willing to stay still.
19:27We haven't gotten the results from his CT scan yet.
19:31And so that was very crucial for us to keep him still.
19:35Push down the bed.
19:36Push down the bed.
19:37Push down the bed.
19:38Push down the bed.
19:39You're okay?
19:40Push down the bed.
19:41We're going to pull you down.
19:42Move you down.
19:43You lie back.
19:44Relax.
19:45Listen to mum now.
19:46Take your breath.
19:47So, don't take a good weight, you know, exercises very.
19:49And I know they're hard to do now, but just the breathing exercise through less.
19:54Printed something nice through less.
19:55The music.
19:56The music.
19:57I was inside the theatre one time and there was a patient lying down.
20:03She felt very nervous, you know, and she hadn't gone a bit white, you know.
20:07And Esther, one of the nurses, came in the door.
20:10Send for the priest, she shows.
20:12The patient looked up.
20:15And I looked at the pain.
20:18I said, what?
20:19I said, no, she called me.
20:22The patient.
20:23The priest is the next patient.
20:25Now, let's see.
20:27Are we rocking?
20:28Do you want to stunk her?
20:29No, you're fine.
20:30Nurse Elaine Houlihan is treating 22-year-old co-footballer Caitlin.
20:35Yesterday evening, an overexuberant tackle left her with a nasty gash.
20:40You could 50-50, you could glue it as well, but the reason why you're quite expressive, so you don't want to split.
20:47You know what I mean?
20:48That's why.
20:49I am, yeah.
20:50Yeah, you're all eyebrows.
20:51I wouldn't see you wrong at all, okay?
20:53Genuinely.
20:57You feel here?
20:58No?
20:59No.
21:00Lash.
21:01Let's get the ball rolling.
21:03Your face is your fortune.
21:05You're going to go to interviews and stuff, and people do make judgements about a scar on your face.
21:10They will automatically think the worst thing.
21:14It's about having the most cosmetically pleasing result is what you want.
21:21I'm growing up and I'm trying to start making my own decisions.
21:24My mum is trying to let me make my own decisions.
21:27My mum definitely wanted me to get that plastic surgeon because she was thinking ahead.
21:33That's all right, now you are a bit bumpy there because that's where you're bumpy.
21:37Yeah.
21:38I'm just going to cross my fingers and hope that it doesn't stay as prominent or as red, that it goes down and it fades away.
21:44I could have as easily fell off a bar counter than, you know, like, get hurt in a GA match,
21:49so I'm just trying to appreciate that it happened on the pitch and not at a bar.
21:54I'll get you a work cert and I want to get you a head injury vice and I'll get you a minister.
21:59How long am I getting off for?
22:01Wait.
22:03Three days.
22:05Why did I bring this?
22:08I know.
22:09Do you know what I was thinking though?
22:10Next time, if anybody's to go to ask an emergency, bring a pillow.
22:14Bring a pillow.
22:15If you're passing up pyjamas, phone charger and a pillow.
22:17Pillow.
22:18Just fingers crossed that this scar goes down and that maybe my wedding photos you won't be able to see them as much.
22:24That's fine.
22:25Oh, it's done.
22:26Yeah.
22:27It's done.
22:28Okay.
22:29Expectant parents Caroline and Rory are awaiting chemotherapy for Caroline's stage 4 cancer.
22:36It's my week 12 scan and my obstetrician found the cyst in my ovary.
22:41Within the four week period it, like, doubled in size.
22:45Do you know what?
22:46I did ask.
22:47Ciara told me to ask him about the whooping cough vaccine and whether I can have it or not.
22:51Oh, yes.
22:52I realised then that surgery was probably going to be required.
22:56I found quite a large tumour on my appendix.
23:00Obviously it had spread to the ovary.
23:02It also spread to some parts of my bowels.
23:06That's kind of why I had then the diagnosis of a stage 4 because it had spread beyond the appendix.
23:13It's rare.
23:14It's like a one in a million cancer.
23:16Caroline can't have the operation to remove the cancer until after her baby.
23:20is born.
23:21By which time the cancer may have spread further.
23:25That might have been the original cancer, right?
23:30Yeah.
23:31And it spread to that big thing then beside the baby.
23:33That's the baby, obviously, and that's the tumour.
23:36That's the cancer there.
23:37Caroline's oncologist is Dr. Richard Banbury.
23:42Cancer is still somewhat of a frontier.
23:46Science still hasn't caught up with it and still doesn't have all the evidence.
23:49So while cure rates are increasing all the time, the fact that you don't cure a significant proportion of patients
23:56and a significant proportion of patients die from their cancer is definitely the hardest thing.
24:02Richard has to decide the safest and best treatment for Caroline and her baby.
24:07He has little precedent to rely on.
24:10The two chemotherapy medicines that are best for her cancer, there is some limited evidence of their use in pregnancy in a safe way.
24:19So we've moved ahead and used those with careful monitoring of the baby.
24:24I think, you know, there's so much, so many moving parts.
24:29So that was the only thing that's kind of, we just don't know.
24:34We were afraid of being asked the question, whether it would be better to terminate the child for the health of Caroline.
24:42And we discussed the fact that this question might be asked, but I think we were very grateful that we never had to make a decision one way or the other.
24:51Did you get stickers outside?
24:53I do. I'll give them all to you. Actually, Rory has it.
24:55Yes, Rory has it.
24:56My lovely assistant has everything.
24:57Great to have an assistant.
24:58I know.
24:59Thanks a million, Rory.
25:01What gives me sleep this night about this case is the lack of prior experience internationally in this type of situation.
25:07The lack of clear consensus and guidelines about what the best thing to do is.
25:11So we have to make the best judgment we can with the limited information we have.
25:27It's not taking care of just one patient, there's two patients.
25:30So I'm hoping that she's getting the best treatment and I'm hoping that I'm not harming the baby with the chemotherapy.
25:36Done.
25:37All right.
25:38Wonderful.
25:39And if there's any issues, I'll stay with you.
25:41We'll knock on the door.
25:4760-year-old Joe Welch has an aneurysm in his brain.
25:51He requires an urgent procedure before it reaches rupture point and will be operated on today.
25:58What's your deal for?
25:5945-65.
26:00He was really sick with severe headaches.
26:06His eye was all puffed and hanging down.
26:10So we went down to Waterford and they'd done tests and scans.
26:16It was an aneurysm, but it was a big one.
26:20Nearly double the one that they'd normally do.
26:23One of them told him he was like a walking time bomb.
26:29Good morning, sir.
26:30Good morning.
26:31My name is Nick.
26:32I'm one of the nurses here.
26:33Now, show me your arm then, please.
26:36When a rupture happens, it's a devastating event.
26:41A third of patients will drop dead on the spot.
26:44A third of patients will be incredibly disabled, like a very bad stroke.
26:48The other third, although they get away with it, they don't really get away with it, in that they will have memory issues.
26:54When you look at them a year on, they're often working in a lesser role or part-time.
26:58So it has that devastating effect.
27:01Morning.
27:02Morning.
27:03How are we doing?
27:04Not too bad.
27:05You got here anyway.
27:06You'll manage off the cigarettes for the weekend.
27:07I'm gone often.
27:09Gone.
27:10Out the gate.
27:11How'd you?
27:13We'd often talk about smokers' aneurysms.
27:15And if you have one and you smoke and you continue to smoke, you have a much more increased risk of rupture
27:21and you have an increased risk of getting other aneurysms.
27:24It's very, very simple once we meet a patient who's a smoker with an aneurysm.
27:29They have to stop.
27:31His aneurysm is dangerous.
27:32It's large and irregular and has to be treated.
27:34His risk of rupture is very high.
27:39OK.
27:41So, as we know, we've got those blood vessels.
27:48OK.
27:51So what we're going to do, you'll have little incisions.
27:53Yeah.
27:54Both legs.
27:55We're going to travel all the way up here.
27:57And on one side, we're going to put those little platinum coils into the aneurysm and then we're going to rebuild the wall on the other side to stop it coming back.
28:07We're essentially going to fix the bank of the river.
28:10Yeah.
28:11So that'll divert the flow.
28:14Yeah.
28:15And that'll hopefully be the end of it.
28:18The girls were after being in and they came out upset so I kind of knew then that Joe would be.
28:25He was after saying goodbye to the girls, not knowing was it the last time.
28:30I told him everything was going to be OK, but no, we didn't think so.
28:38Because he could have been left like a vegetable.
28:42He'd come out a bit good or he wouldn't.
28:45So they were the three choices we had when Joe went down.
28:50It's two hours since 46-year-old Barry arrived to CUH by helicopter after a collision between a car and his bike.
29:08Listen to her because she's trying to help you.
29:10I love to see.
29:11I know you are because you're good enough to listen when you have to be.
29:15Very luckily for Barry, the CT scan is showing no injury to his spine.
29:32I am a nurse and my mother is also a nurse.
29:34It's a different situation when it's a member of your own family and you're entrusting them into strangers as such
29:41and being the health professionals on the day.
29:48While Barry's neck, chest, spine and pelvis seem undamaged,
29:52the team is still awaiting results of his brain scan to check if there is injury or internal bleeding.
29:59Barry, we always saw as special because he is special to us.
30:03You know, he does have a learning disability but that didn't prevent him from being a brother to us in any way.
30:12So, Barry?
30:14You're getting the best way into it, I think.
30:16Living in a small community, you know, has many benefits and we're very lucky here in that people know Barry
30:22and Barry knows people and he feels very comfortable with all these people.
30:25I remember at one point somebody picked Barry up on the road and they were going back to work in the hospital
30:31and they told Barry, well, you know, I'm stopping at the hospital.
30:34And Barry said, oh, well, I'm going to Super Value.
30:37So, they had to continue on and bring Barry to Super Value.
30:41The community is brilliant.
30:42We know you're sore. It's probably an understatement not to say sore, but we have to clean just so the doctor can see where to dress the wound.
31:00Your eyebrows are beautiful. Did you get them done?
31:02Thank you. I actually just plucked them yesterday myself.
31:05No, but they're really nice. They're lovely.
31:07Thanks.
31:09Oh, they're my clothes.
31:13Joe is waiting to go to surgery to have his brain aneurysm treated.
31:17So, when you go out...
31:19I'll come back in.
31:22Can you just say what time you're going down now?
31:24Shortly.
31:26The procedure will be performed by neuro-interventional radiologist Gerry Wise.
31:32However, Gerry has been urgently called to a more immediate emergency.
31:35Excuse us, we're going to have some more like this.
31:37Dermot Moynihan was recovering in CUH from cardiac surgery when the alarm was raised.
31:43Patients like this who've had cardiac intervention, they've been on various drugs, they've been on bypass.
31:49All of these things give us that thrombotic risk, where you've that risk of forming clot.
31:54Can you wiggle your fingers on your right hand?
31:58Dermot is having a stroke.
32:00Gerry and his team have to act fast to remove the clot.
32:04Okay, just relax there now.
32:07Most strokes are due to lack of blood flow to the brain.
32:10As time goes on, obviously there's more and more damage to the brain.
32:15Every 30 minutes we lose a 10% chance of being independent.
32:20So we have to get it out.
32:21And it's getting a tube up there that can actually just suck out the clot.
32:25That's essentially just to suck the clot out.
32:44We can open the blocked pipe, blood is re-established, those parts of the brain are re-perfused and we give our patients a chance at recovery.
32:57So this is what we've essentially sucked out of that bar trim.
33:03In less than 15 minutes Gerry has successfully removed Dermot's clot.
33:07Most families, you know, would have had that experience of stroke.
33:13My own grandfather would have stroked his dominant hemisphere and unfortunately lay in a bed for several years unable to speak,
33:20paralysed down one side of the body.
33:22So it's certainly something I had witnessed.
33:25And that level of disability that we were all far too familiar with.
33:29And back then, you know, we had to accept and thankfully today we don't have to accept.
33:34So this is the clot and that's what's gone from the heart up and blocked the artery.
33:47Caroline is 90 minutes into a chemotherapy session.
33:51Dr. Richard Banbury is hoping the specially designed treatment will contain her tumour,
33:57giving her the best chance to survive while also protecting her baby.
34:00Less obvious today with pins and needles that I had with the neuropathy, but...
34:06Using chemotherapy in a lady who's pregnant is fraught with risk because, you know, the baby is still developing.
34:15You good? Yeah, it's flowing away happily there.
34:18Can't know what's going on.
34:20Chemotherapy normally is aimed at killing off those types of cells, but when you get to the third trimester,
34:25the baby's organs are formed and using chemotherapy is more feasible at that stage.
34:31You're doing okay, Rory?
34:33I'm doing fine.
34:34You're working away all the time?
34:36Yeah, I've been lucky to be able to get the classes moved around from Friday.
34:39Okay. Fair play.
34:41Good.
34:42I don't really have nausea.
34:43I'm at Caroline in my final year of undergraduate at University College Cork.
34:58I definitely remember her being just a ray of sunshine when you walk into the room.
35:04I think within a month or two we kind of expected that we'd be spending the rest of our lives together.
35:09We're going to lower the dose of the oxalioplatin a little bit because it can cause the pins and needles,
35:16and that can get worse over time.
35:18We can't be sure that the chemotherapy is working at the moment.
35:23We have to take a leap of faith, do three months of treatment, aim to deliver the baby safely.
35:29And once the baby is delivered, do an up-to-date CAT scan, and that will look at her lungs, her liver, her bones,
35:34and everywhere else, and fingers crossed, it won't show the cancer having spread to any other parts of her body.
35:41To give some margin for error, maybe give a three-week break, and then assume everything is okay and to go ahead with delivery at that stage.
35:49There are days when it's just a bad day, and you feel like, oh, what will happen if I'm not here?
35:57You know, people have said, oh, will you write letters for your children?
36:01And I thought, no, I'm not going to write them letters that, like, might be irrelevant in 20 years' time.
36:06There's things, I suppose, what we've decided to do is just to have fun now, make sure that we're continuing to, like, do fun things,
36:15like go to Florida Wildlife Parking and having fun with them, you know, going down to the beach and digging holes everywhere.
36:21Trying to not have them just remember me as someone who was sick, you know, so to have their active happy mommy,
36:28being active happy mommy, so...
36:31No. Maybe bring me home.
36:36You've got to appreciate what you do have rather than worrying about what you might lose or what you might not have.
36:44We're hopeful for the best possible outcome, and we certainly want to get rid of this and grow old together.
36:51Oh, yeah. We're trying to kind of...
36:53Do you want me to get another extract or anything?
36:55No, it's perfect. This is great. It's nice.
36:57You have to seriously consider how you're going to bring up two kids, maybe three kids on your own,
37:03without the person that you've been relying on and shared your life with for so long.
37:10You're free to go and have a lovely weekend.
37:14Stay tuned. Enjoy it. No worries.
37:15You keep kind of joking, remission by Christmas, but, you know, but it's still, we want it to happen in that way.
37:24So there's a lot to be said for having that kind of positive outlook. I do want to be here for my kids.
37:29I think all of the time I've had nearly 20 years now with Caroline has been very precious to me.
37:38Of course, I want as much as I can, but it's been everything to have Caroline in my life.
37:46And as long as she's still with us, we're going to make the most of it, myself and the kids.
37:53A gentleman came in one day and he said, where do I get an echo?
38:09Oh, being from Cork, everybody in the country knows that the echo is his favourite in Cork.
38:14We said, oh, in the shop.
38:16It was up to the cardiac unit he was going, not to buy a paper where we sent him.
38:21It was up to Cork.
38:24After a delay to allow Gerry Wise to urgently treat a stroke patient,
38:28Joe has been taken to theatre for his critical aneurysm procedure.
38:33Joe, I'm going to walk you on the trolley.
38:35Hey, good enough.
38:37Just take the back of that out.
38:40Okay.
38:42It's quite a complicated aneurysm, isn't it?
38:46Yeah.
38:48There's two ways into the aneurysm, one from each side.
38:51So...
38:53And it's partially thrombosed.
38:55So there's a clot in it.
38:56There's a clot in the base.
38:57For all of our procedures, we'll have two people with experience scrubbed in.
39:02It puts two heads in the room for complex cases.
39:05And, you know, when choices need to be made during a case, it's that kind of combined work that, you know, keeps people safe and ultimately keeps the patients safe.
39:17Two heads are better than one.
39:18We're together nearly 40 years now.
39:19We have three children.
39:20Denise has her own salon and Caroline works in the hospital in Kilkenny.
39:36We lost our son, Niall, ten years ago due to a motorbike accident.
39:45Like, he left here half seven on that evening and by half eight, the guards were here telling us it was fatal.
39:57I had Niall's memory card asking him to save Joe, that his time hadn't come.
40:09But I never prayed as much to Niall as I did that morning.
40:13The procedure starts with getting access into the vascular system and you can do that from the top of the leg.
40:27We then basically put a long tube all the way from the leg up to the artery in the neck.
40:33Then another tube, which is smaller, which is the micro catheter, goes all the way up and we navigate that under x-ray guidance to the actual aneurysm itself.
40:43So we'll then gently enter the aneurysm, as it were, with that small tube.
40:53And sometimes as you're placing a coil, I've learned to just stop and breathe.
40:59Because there's an increased tension on you as you're actually placing the coil.
41:04And you realize we all need to relax, let the coil relax and let yourself relax as you go on placing them within the aneurysm.
41:13They're platinum, and we essentially go into the aneurysm and push that little piece of metal.
41:25And it's going to form a ball.
41:27That ball will then occupy the space in the aneurysm.
41:31And as a result of that, we get clot formation around it.
41:35So in other words, the aneurysm closes off.
41:37After two and a half hours, we started to panic because we were saying it must be over, it should be over.
41:53Did something go wrong?
41:55Did something go wrong?
41:56Just waiting, looking at the phones for that phone call.
42:00The hardest thing in these procedures is learning when to stop.
42:08You need to put enough coils in it to make sure that the aneurysm is occluded and going to stay occluded.
42:15But you can't be too aggressive that you do something too much at the end and you end up rupturing the aneurysm.
42:34It is now just over three hours since 46-year-old Barry arrived to the hospital by air ambulance after cycling out in front of a car in West Cork.
42:44He's been closely observed in the critical dependence unit while awaiting brain scan results.
42:50Barry, how are you?
42:53Barry, how are you?
42:55Hello, sir.
42:56Maybe I'll let you around this side so you can see you better.
42:58Oh, OK.
42:59Hello.
43:01Hello.
43:02He has something called like a contusion where it's kind of like the brain is just kind of bruises around it, OK?
43:10And so what we plan to do is we keep him for 48 hours.
43:16Those little...
43:17Barry, stop, stop.
43:18Stop, stop.
43:19Take a big break now.
43:20I know you're very upset.
43:22I know you're very, very upset.
43:25And this would be the last place you want to be in today.
43:29But you will get better.
43:31We want to see how we can help you get better so we can get you home.
43:37OK?
43:38Is that OK?
43:39Lift your finger if it's OK, Barry.
43:45You could tell he was visibly upset.
43:47Because he had that frown on his face.
43:49He wasn't responding to me at all.
43:54I'm like, I need a miracle right now.
43:56Good.
43:59To be honest with you, sir, he is after taking ecstasy.
44:03So he's high on ecstasy at the moment.
44:04He's intoxicated and he's openly admitted to smoking cannabis as well.
44:10Oh, of course, sure.
44:11He's gone wild after working so hard.
44:12Sure, we've all, we've all, we've all done it.
44:17Yeah.
44:18Yeah.
44:19Yeah.
44:20Yeah.
44:21Until he's seen and assessed by the doctor, yeah.
44:24Joe's surgery is over.
44:25For his wife, Mary and daughters Caroline and Denise, it's their first chance to find a
44:29hospital.
44:30having working so hard sure we've we've all we've all we've all done it
44:38yeah yeah yeah until he's seen and assessed by the doctor yeah
44:48Joe's surgery is over for his wife Mary and daughters Caroline and Denise it's
44:54their first chance to find out for themselves if the procedure has been
44:57successful the nurse just asked him who we were just to make sure he was you know
45:20his mind was back to normal take your time take your time
45:27how are we doing how are we awake yes yeah just about yeah you get a word in edgeways no
45:44that went very well and now it's a great chance to give up the cigarettes
45:51yes that's the important thing if you have a successful procedure it's very very gratifying
46:00and it makes all those late nights all the times you got out of bed at three o'clock in
46:05the morning worthwhile it's 15 hours since Barry arrived to CUH he has spent the night in the critical
46:28dependency unit
46:29oh three weeks observing Barry and his family you see the bond and I thought of my own parents
46:46um wishing maybe they were here with me at that at that time it makes me grateful to be part of a
46:55family who would be there for you no matter what thank you very much do you want to do it yourself
46:59cheers cheers
47:01my mother and father are caring for Barry all their lives Barry's part of six now what's going to happen
47:12to Barry when maybe they're not able to care for him anymore or maybe they have passed on
47:17it's a major worry for my parents especially with my mother who has this very special bond with Barry
47:23oh sorry sorry sorry Barry sorry Barry that's one to you all
47:33here all this bone yourself right yeah have the Weetabix because it'll help your sore mouth
47:41it'll help it get better okay yeah that's it I'll take away we'll have a takeaway later
47:49yeah it turned out he did have a bit of swelling on his brain but thankfully it was nothing life
48:04threatening and resolved after a few days the bike is still at the guard station we haven't collected it
48:10I think it's the safest option at the moment I was in pain for so long I didn't know what it was like
48:18not to have pain when I woke up after that operation like the the the pain that was lifted off my head
48:24was unreal it's the best outcome I could have had
48:48thanks for listening and we'll see you in the next one
48:59yeah
49:02yeah
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