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00:01On any given day, some 800 inpatients, 800 outpatients and over 240 emergencies are cared
00:08for 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, you're not getting rid of me.
01:02I just broke down what is going on.
01:04I'm getting 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.
01:19And that's really it.
01:21What's the job?
01:25Message received, thanks.
01:34Look, I am getting absolutely hammered.
01:37Hi, it's Lane over in Aeney.
01:39I'm just wondering, is that bed ready yet?
01:41You don't have no beds, but like 4C are taking patients off of you.
01:44They not gone yet?
01:45Yeah, does that mean you have one space?
01:50Yeah, so does that mean we give it 40 minutes, 20 minutes, 30 minutes?
01:59Okay, look, it's half as one now, will we be over by half as two?
02:02Will the handover and the patient be up at the ward and everything like that?
02:07Fabulous.
02:10Nine.
02:13Okay, speaker on speakerphone.
02:15A four-year-old girl, Madison, is being rushed to hospital by ambulance.
02:23She is suffering prolonged seizures.
02:24I'm a question of your airway.
02:26Robin, are you okay on drugs?
02:28Yeah, I think that would be, and antibiotics and fluids, and you might need a second person.
02:34Emergency consultant, Rory O'Brien, is leading the team in Resos.
02:37Rachel, I think access is going to be the thing.
02:40With a sick child, you need a lot of people, but you want things to be calm, you want things
02:44to be measured.
02:45I mean, do you mind doing assessment?
02:46You want to be making the best decisions.
02:49Prolonged seizures, we know, aren't good for you.
02:52Fifteen-minute seizure, had a further one-minute seizure.
02:55The oxygen going to your brain, which is what you're trying to protect, may be reduced,
02:59which can affect brain metabolism, so we need to stop the seizure.
03:04Medicine's mother, Shannon, called the ambulance.
03:07I know what seizures are like.
03:08I just felt there was something just different about this one.
03:11We gave the rescue medication after five minutes, which I administered myself, and the jerking
03:15of the body stopped.
03:17But then the lips started twitching, and the eyes were starting to roll into the back of
03:21her head, and her breathing is starting to be affected, which had never happened with
03:25Madison before.
03:34Madison's condition has continued to deteriorate en route to hospital.
03:38Her breathing is compromised.
03:42She looked lifeless, like, as if she was gone.
03:46Just see that, like, when they're pushing the bag down, and your child is, like, unresponsive.
03:51It's horrible.
03:53That's clearly a major concern, because I'm wondering, is this a problem with her airways?
03:58Is that why she's not breathing appropriately?
04:00Is it a problem with her lungs?
04:01Is it a problem with her circulation system?
04:03Or is it a problem with her neurological system, with her brain?
04:06I thought we were never going to get there.
04:34She's had one more seizure en route, with a great focus there, also tonic.
04:39Her limbs stiffened, also.
04:41Just connect back with yourself.
04:42Yep.
04:43Yep.
04:44Hey, Madison.
04:45Hello.
04:46Hello.
04:47Hello.
04:58We're just looking for an NPA.
04:59You know, they need to bring you away for a child.
05:01She's still seizing, to be honest.
05:02Yeah.
05:03She's quite, she's a lot stiffer on this side there.
05:05I mean, I'm giving her jaw for her, so she's not doing much.
05:08She's too well.
05:09I'd say we give another lorals there.
05:10I think she's still seizing.
05:11To a child who's having a prolonged seizure, you're fundamentally worried about any primary
05:16or secondary injuries that would be happening to their brain.
05:18Do you think she's seizing?
05:19There is a very high chance that this child will need to be placed in a ventilator, while
05:24we give her very potent medications to help stop the seizures.
05:30As the resource team work to stabilize Madison, her parents and grandparents are waiting in
05:34the relative's room.
05:36I don't know.
05:37I don't know.
05:38A nurse came out to us and said, look, we're going to have to prepare you for the worst.
05:41She probably has been seizing then.
05:43To hear that then, it just broke my heart.
05:45What are her eyes like?
05:48Is she...?
05:49And they're not fixed.
05:50They're not...
05:51Yeah.
05:52Yeah.
05:53I think they're too cool.
05:55And she was stiff on the right side, so...
05:58And eyes were slightly deviated to the right, so probably seizing.
06:02There was uncertainty as to whether Madison would need to be placed on a ventilator,
06:07so you do need to introduce that idea early on, because you have to prepare Madison's parents
06:12for that very possible outcome.
06:15I just said to my mum, I can't lose her.
06:26I can't lose my child.
06:40Howard Grice has motor neuron disease.
06:43He is in CUH today with his wife, Yvonne, to check the progression of the condition.
06:55Hmm.
06:56My name is Howard Rice.
06:58I was born in Sheffield, Yorkshire, in 1966.
07:02I moved to Towering County Cork in 1994 with my partner, Yvonne.
07:07Hmm.
07:08I have motor neuron disease.
07:10It has affected my speech and swallow, amongst other things as well.
07:15Hmm.
07:16Perfect.
07:17Howard is treated by a multidisciplinary team, including respiratory physiotherapist Kevin O'Sullivan.
07:26I've really been without speech since about a year and a half ago.
07:30So I use this app to communicate now.
07:34From your point of view, how is the breathlessness?
07:41A recording of my speech was made when it was deteriorating.
07:44What you hear now is a repaired version of my speech.
07:48It can be frustrating, but you get used to it.
07:51Hmm.
07:52Hmm.
07:53You've done this before.
07:55Yeah?
07:56Big deep breath in.
07:58Hmm.
07:59Coffee into the mask.
08:00And we're going to just see how it's showing out.
08:02We'll be doing three or four.
08:03Go on.
08:06I'll turn away from you, otherwise I'll be laughing and not about to do it.
08:12When Howard laughs, his whole body would shake.
08:15His face would just erupt and he'd just, you'd laugh with him.
08:18You don't know what he was laughing at, but you'd laugh with him, you know?
08:21It's difficult watching him and knowing what he was like before.
08:27He was very talkative.
08:29He was the life and soul of the party.
08:31He'd be the first in and the last to leave.
08:35Just a top guy, you know?
08:39Recover.
08:40Big breath.
08:41Cough.
08:44Hmm.
08:45Motor neurone disease, it's a severe degenerative disorder of the nervous system.
08:49And we don't, unfortunately, have a cure for it.
08:53We do have limited medical therapy, which is shown to slow things down,
08:58but unfortunately it doesn't stop the disease from progressing.
09:01My cervical spine identified a disc at C5-6, but his symptoms were...
09:05Consultant neurologist Aisling Rhine has been treating Howard since his diagnosis.
09:09It's always difficult to communicate the diagnosis of motor neurone disease to a patient.
09:16You never get used to it.
09:18You try to be there for that person and be the go-to link or be the coordinator for their care for as long as you can.
09:27So, a small dip today compared to the last time you were in clinic, okay?
09:32The most common cause that people die of, finally, in motor neurone disease is respiratory failure.
09:37Even if your lungs are okay and you've never smoked a day and you've perfectly healthy lungs,
09:43we still need innervation of our chest muscles to actually move our rib cage up and down
09:48and that slowly over time fades for patients with motor neurone disease.
09:56And relax, okay?
09:58I know.
09:59Take a breather.
10:00Give him a minute.
10:01You're going to have to be doing this another two or three times as well, okay?
10:04He likened it to a thief taking from you the whole time.
10:09The thief has got his hand in your back pocket and he's taking everything.
10:12He's taking your speech, your mobility.
10:16Better.
10:17It's like a gradual chipping away of the person that you are.
10:22I had always been a very active person and felt the threat of losing my ability to continue living
10:27as I had been accustomed to would be a very difficult challenge.
10:35A lot of negative emotions, anger, fear, sadness, worry.
10:40It's a headwrecker.
10:43Super.
10:44Well done.
10:46And there's your other soft collar.
10:48And that's our number on that one, isn't it?
10:49Yeah.
10:50Yeah, that's fine.
10:51Just so you have it, okay?
10:52How are you?
10:53We'll see you again, okay?
10:54We'll be in touch.
10:55Bye-bye.
10:57Are you from Limerick?
10:59No.
11:00I'm from Cork.
11:01I don't know what you think.
11:02Why would you think I'm from Limerick?
11:04You have the features of a Limerick girl.
11:08Do I?
11:09Yeah.
11:10Thanks.
11:11I don't know, is that a compliment or not?
11:12Limerick girls are the best lucky girls in the country.
11:14Who?
11:15Limerick ladies are the best lucky girls in the country.
11:16Who?
11:17Limerick ladies are the best lucky girls in the country.
11:18Oh, so it's a compliment.
11:19Yeah.
11:20Thank you very much.
11:21Yeah.
11:22Yeah.
11:25Dr. Jason Vandervelde is on duty in the emergency department and also on call for emergencies outside of the hospital.
11:32The golf car.
11:33Seven minutes out of.
11:34Yeah, I mentioned it's cold and stiff, but I'm sure it's beyond any help.
11:40Roger, the golf car is on its way.
11:42That's perfect.
11:43Thank you very much.
11:45Good.
11:47Very good.
11:48I can't.
11:49Good.
11:50Good.
11:51Good.
11:52Really good.
11:54Cyclist George Fuller has dislocated his kneecap.
11:58Jason will seek to realign it.
12:04I stumbled into pre-hospital care.
12:09I don't know if I'll do it again.
12:11Again, I'll probably be a vet in another life.
12:17I was a lifeguard, beach bum, didn't do great at school.
12:23Joined the ambulance service, really enjoyed it.
12:26Absolutely loved being a paramedic.
12:28I just won't go for it.
12:31I'll be so hard.
12:33Use the top finger on the top to actually strengthen it.
12:37And I'm going to not do anything to you for two minutes.
12:39I actually want you intoxicated.
12:40And then I'm going to straighten it.
12:43Got injured.
12:44But I still wanted to carry on.
12:46And so I suppose that injury in myself enabled me to go to college, study further.
12:52And so we're in medical school.
12:54I'm going to do bigger breaths than that.
12:55I think it's that community of pre-hospital care that's so special.
12:58Your head will swim. That's fine.
13:00I just want you completely intoxicated.
13:03Deep breaths.
13:06Deep breaths.
13:08You're doing perfect.
13:08Well done.
13:11You're doing perfect.
13:13Deep breaths.
13:14And relax yourself down.
13:17There we go.
13:17Well done.
13:19Deep breaths.
13:20You've done magically.
13:22Keep going.
13:24Just turning the kneecap the right way around.
13:28Well done.
13:28You've done brilliantly.
13:31Okay.
13:34All straight.
13:35Just like an in.
13:36Well, no.
13:38Yeah.
13:41I'm out of here, dads.
13:42Jason is dispatched to a serious incident near Firmoy.
13:48A man has been kicked directly in the chest by a racehorse.
13:51A patient is coughing and spluttering.
13:56Making loud blocking noises there.
13:58Or ear clutches.
13:59Screw heavy.
14:00It frees human surgery.
14:05Bottom line is people do not get injured at the front door.
14:09Of the hospital, you get ill or injured at home, on the farm, in the workplace, on the road.
14:16And our role is to bring the expertise of the hospital to where you've become ill or injured,
14:22to slow down, hopefully halt the dying process.
14:25I see a man in a farmyard.
14:34He's also being kicked by a horse.
14:37The big worry.
14:39You've taken a full force of a massive animal kicking you into the chest.
14:44That energy has to go somewhere.
14:47It hits your chest wall.
14:48Bruises in the lung.
14:50Bruises to the heart.
14:51I have to assume the worst at this stage.
14:57Yeah.
14:58So it was just a straightforward kick into the chest.
15:01And you didn't get thrown backwards?
15:03You did?
15:03He did.
15:04Up against this one.
15:04Here he's at.
15:05Okay.
15:06And did you hurt your back at all?
15:09You did.
15:09Okay.
15:10So you're in charge of your own pain.
15:14You've got to be very, very vigilant that they haven't damaged the spinal cord.
15:18Bones can break.
15:19They can break all the way through to your back.
15:21Any pain to the chest?
15:23Yep.
15:24That's the one.
15:25He was in a lot of pain.
15:28The ground here is not going to make it stable.
15:30Hang on.
15:32Hang on.
15:33Right.
15:34I'm going to keep on stopping.
15:35And the horse was still standing between me and James, so I couldn't get to him.
15:40All I could think about was what damage is after being done.
15:44And when I heard it was in the chest, all I could think about was what's going on inside
15:48in him right now.
15:49I'm going to get you in the ambulance with a much, much better look at you.
15:54I'll knock me out.
15:55I'll get up to you.
15:57It won't be far off.
15:58Far off it.
15:59Just go with it.
16:00Okay.
16:00I'm just going to get some scared.
16:05James?
16:05When you see someone you love lying on a stretcher and they're pinned down to it and their eyes
16:21start to roll and the colour drains from their face.
16:24Is he bleeding internally?
16:27I didn't know what was happening.
16:29That's when we all got really frightened.
16:32Four-year-old Madison was rushed to CUH earlier today.
16:46The team have successfully stopped her seizures, but she is yet to regain consciousness.
16:50We just wanted her to come around, like, to far to open her eyes, so she knew that we were there.
16:59I'll come over this.
17:00I don't want to hold that one.
17:01Can I hold her hand?
17:12Yeah, sure, sure.
17:13I'm holding because it was a bit cold, so I'm a rough year.
17:17She is cold.
17:19There's one thing seeing her have a seizure, but to see her the way she was, like, literally
17:24out cold from being given medication to keep her comfortable.
17:31And we were just talking to her and, like, saying, come on, baby, like, you're okay, like,
17:41we're here.
17:43And you just want to be with your child and make, like, take her place so she isn't going
17:48through what she's going through.
17:49It's very hard.
17:50It's very, very hard.
17:55She's been fighting since the day she came into this world.
17:58We never thought she would do anything that she's doing, like, now.
18:04But Madison, like, she just surprises us every day with how, like, strong she is.
18:09And we're just so proud of how far she's come.
18:12I was only 19 when I found out I was pregnant with Madison.
18:19I was happy, sad, scared.
18:22My partner, James, found out I was pregnant three weeks after meeting him.
18:27I was like, oh, my God, like, does he want this?
18:30Like, is he going to walk and leave me on my own?
18:32But he didn't.
18:32He said, we did this together and there's no one going back, like, we'll do it together.
18:38The birth was, it was, like, it was hard, but it was beautiful.
18:42And I was just in awe.
18:43I was so happy that, like, my body was able to bring Madison into the world and that I
18:49had James' support as well.
18:50And then everything changed, everything changed.
18:58We went in with the consultant and they said Madison has been diagnosed with DYRK1A syndrome.
19:05We were, like, so worried.
19:07I was like, what is wrong with her, like?
19:11She's the only child in the Republic of Ireland that's been diagnosed with it.
19:15Like, I think there's, like, 30-something kids in the whole world with it.
19:19Like, it's very rare.
19:20Madison, like, can't talk.
19:25She's autistic.
19:26She's epilepsy.
19:27Feeding problems, walking problems.
19:29There's so many to do with her disability.
19:32Like, she suffers from constipation, reflux.
19:35Like, there's so much.
19:38I weigh very heavily on how the parent is viewing their child.
19:42They'll know the condition better than I will.
19:44They'll know the nuances.
19:46Madison is extremely ill and will need to be closely monitored
19:50in the coming hours.
19:51Then you can go suspecting.
19:53She's now getting oxygen to her brain,
19:56but things can change at the drop of a hat.
20:00Madison can start seizing again,
20:02and her oxygen levels can start going down again,
20:04and her breathing can become depressed again,
20:07and so you maintain a holding pattern.
20:15James is very, he's a very caring person, very kind.
20:19He said, and no matter what, we'll be the best parents,
20:22and show our kids, like, what love is like as well.
20:25Like, show them that, like, no matter what,
20:26we're always going to be by their sides.
20:28It is hard, like, it's very challenging,
20:33and it's, like, it's around-the-clock care,
20:34like, it's constant, constant medications,
20:38dosage, dosage change, hospital admissions.
20:41They're entrusting you with their child,
20:46so at this moment, they are saying,
20:48you need to come in, you need to help us.
20:51I couldn't imagine what it's like.
20:53It's that lack of control,
20:55having to give control over to the team.
20:59It must be a very uncomfortable kind of feeling
21:02for the family to do that.
21:06We're living it every day.
21:08This is what our life is with Madison every day.
21:15CUH, it's like a big city with little villages, you know?
21:21Each of our own little set group that we work with,
21:24but then we kind of call to the neighbours every now and then
21:26for the bottle of milk, you know?
21:32You okay, James?
21:33What's the most beautiful?
21:35Yeah.
21:35The bags are, I would say, it's lumbar.
21:37Where's my Niamh?
21:38Where's Niamh?
21:39Niamh's outside there.
21:4149-year-old James Fenton was kicked in the chest by a racehorse.
21:46Emergency doctor Jason is concerned he may have life-threatening chest
21:49and back injuries.
21:52Paramedics are preparing to move James to CUH.
21:55There's two specific points, thoracic spine,
21:58upper thoracic spine and lower thoracic spine,
22:02and he's also tender into the lumbar spine.
22:04If you have a chest wall injury,
22:06excruciatingly painful because every time you breathe,
22:10it's pain.
22:11I have not got a CT scanner that's going to tell me definitively
22:14that those lungs are not contused
22:16or that heart is not bruised.
22:19So my first priority is just getting as much analgesia
22:22as he needs to enable him to breathe effectively.
22:26I don't know if I have to give him a name.
22:37I'm on fucking cloud.
22:40Oh, that's good.
22:41There's no pain, though.
22:42No, I'm good.
22:43He was on cloud nine.
22:45I think it was the results of the ketamine in his system.
22:49He didn't feel like he was here with us.
22:53He proposed again.
22:55I love you.
22:57I'm going to get married next week.
23:00Really?
23:00Yeah.
23:01Yeah.
23:02I was eight months pregnant,
23:05trying to keep calm.
23:08Hi, where are you?
23:09I'm going to follow you into the hospital.
23:11What hospital?
23:12See you here.
23:13Good enough.
23:14I was just trying to think,
23:15how am I going to juggle all of this?
23:17And I'm going to be on my own doing all of it.
23:19What if this is more serious
23:23and that the ketamine and all the other drugs he's on
23:27are masking what he's actually going through?
23:29Howard has motor neuron disease.
23:43Following his respiratory assessment earlier,
23:46he and his wife, Yvonne,
23:47are waiting to see consultant neurologist Aisling Ryan.
23:50Hi.
23:55How are you?
23:56Come on in.
23:59Take a seat there, Howard.
24:01Can I just get a sense of what you can do there?
24:03So just arms up if you can.
24:05Good.
24:05And keep that up against me.
24:07Good.
24:07Keep that up.
24:09Good.
24:09Maybe a little weak there.
24:10Push down for me nice and strong
24:11and push down nice and strong.
24:13Okay, good.
24:13He still has quite good strength in his arms and legs.
24:16So he's walking.
24:17He's able to be independent in many aspects.
24:20But unfortunately, that will change over time.
24:23And then it's dealing with the challenges that that brings up.
24:26And how is he going to manage?
24:28How is he going to...
24:30Is he going to be able to walk around his house?
24:32Is he going to be able to dress himself?
24:33Et cetera, et cetera.
24:34And this time, pull towards you.
24:36Pull in towards you.
24:36I've got fantastic support from Yvonne.
24:39There are things I can no longer do for myself
24:42that she now helps me with.
24:43And she's had to handle my frustrations.
24:47I'm fairly good at releasing emotion.
24:50I don't like bottling it up.
24:52Better that it comes out.
24:55And just the grip strength.
24:56Just squeeze me tight there.
24:58Okay.
24:58And squeeze tight here.
24:59So, yeah, that's a little weaker in that left hand, isn't it?
25:02How's the strength in the leg?
25:03I just like to look after him.
25:05You know, it's not a big deal.
25:08It's just that's what you do for somebody that you love, I think.
25:10We have an issue with the wedding ring.
25:13The fingers have swollen.
25:14Oh, okay.
25:14And we can't get it off.
25:16It looks to me like it probably needs cutting off.
25:18They will have a ring cutter.
25:19They always have one down in the emergency room
25:21because sometimes this happens.
25:23I mean, it's sort of a difficult thing to, you know,
25:25cut the wedding ring.
25:27Do you want that done today if we could organize it?
25:30Not really.
25:31Do you want to think about that a little bit?
25:33It's nice to just sit and be together and hold hands.
25:37It's just a bit of closeness amongst all the hustle and bustle.
25:42That's a precious moment.
25:45Maybe the next time you're coming, or if that's too far away,
25:47we can get it done in between.
25:49We all know how it ends,
25:54but the challenge is to make the most of the remaining time I have.
26:00Despite my deteriorating health,
26:03I still feel very fortunate.
26:05I have a loving family.
26:07I have a lot to be thankful for.
26:09I don't think about what I may miss,
26:14but concentrate on what I have enjoyed
26:16over the last 20-odd years with them.
26:22Life's too short for all those to be worrying about how it all ends.
26:26The trick is to enjoy each day.
26:28Is he playing G.I.O.S. sports?
26:38It was sports day.
26:40It was everything, yeah.
26:42Tag, rugby, I think.
26:44First and last time, I think.
26:47We're giving you more medication there now, Jude, okay?
26:52Very good.
26:55It's almost done now.
26:57It's almost done, it's almost done.
26:59Well done.
27:0464-year-old Tim Murphy has advanced lung cancer.
27:08Today, doctors will attempt to surgically remove the cancer
27:11in a bid to save his life.
27:15That'll be 40.
27:19The consultant came in and told me
27:21that Tim had a tumour on his lung
27:25and it was cancer.
27:27I've had two uncles that actually died of lung cancer,
27:35so I just thought,
27:39oh, God, here we go.
27:41He's gone.
27:42Number 14.
27:44Well...
27:45I just remember Dr. Collins' initial words were,
27:53oh, it's a big boy,
27:55was what she called the tumour.
27:56I first met Tim in the autumn of last year.
28:03He would have discussed his case in our multidisciplinary team meeting
28:06and we would have looked at all his images
28:08and made a decision that actually pre-surgery,
28:11chemotherapy with immunotherapy,
28:14I suppose a regimen that we call neoadjuvant,
28:16was the right way forward for Tim.
28:18And the whole purpose of that would be to shrink down the cancer
28:20because as he currently was with his diagnosis,
28:24he probably would have lost his entire lung
28:26if he had gone straight for surgery.
28:28Great.
28:28We might have a quick look at the board then.
28:30When I walk through the hospital,
28:33there is a professional persona that kicks in.
28:36But one of the hardest things that I do
28:38is when I, you know, have patients and have to tell them
28:42that this cancer is going to shorten their lives significantly,
28:46that they are, you know,
28:49going to not be around for their children or their grandchildren.
28:55Thanks, Robert.
28:56You know, we give people hope, we buy people time,
28:59but it is emotionally very draining.
29:03It can be really hard to shake it off at the end of the day
29:07and to, you know, head home and pretend that I just,
29:10you know, put in a nine-to-five.
29:13Following a regime of chemo and immunotherapy
29:15to reduce Tim's tumour,
29:18surgeon Kishore Dodakula will attempt to remove his cancer completely,
29:22also hoping to save his lung.
29:25So if we look at the differences, I suppose,
29:28where we were after 12 weeks of treatment,
29:32there's obviously been significant change.
29:34You can see a disease, a big cancer here
29:36and then, you know, obviously much smaller now.
29:38You never know till you really go in,
29:40but I'll try and save,
29:42but you know, you'll help, you know,
29:43unless we go in, we won't know.
29:45Do you smoke?
29:48So he's off them now two years since the 14th of April.
29:54There was a point,
29:57and now Tim doesn't know this,
29:58but I felt very angry at him.
30:02Like, initially, it took everything in my power not to say,
30:10you were warned.
30:14He had this god-awful cough.
30:16Sometimes he'd nearly choke with it,
30:18and I just couldn't understand how he carried on smoking.
30:24But you just have to try and think of where do we go from here.
30:27So we'll start the pre-op.
30:32They'll check your operation site later on.
30:35My operation what?
30:36Operation site.
30:37Just so we always mark where we're going to operate.
30:39I'll send it.
30:40Make sure it's the right site.
30:41Exactly, yeah, it's just a check.
30:43Do you know the reason for your admission?
30:46Yeah, lung cancer.
30:47Lung cancer, and you're going to,
30:49this is a surgical ward,
30:50so you're going to have surgery on your left lung.
30:53Yeah.
30:54Is that okay?
30:54And hopefully they'll be removing the tumour.
30:58To be told that the tumour had shrunk by half was huge.
31:05We knew then that he could go for surgery.
31:08We just had to see what they could do.
31:10Who's next of kin?
31:11Kit.
31:12Is it partner, wife?
31:15Partner.
31:15I asked the same question myself.
31:17Not yet.
31:20Later this year.
31:21Yeah, okay, brilliant.
31:23Congratulations.
31:24What?
31:26The goal is to get him to surgery,
31:28so being able to, I suppose,
31:30shrink down his cancer
31:31and have it then removed by a surgeon
31:34is the best outcome
31:35and what we could hope for for Tim.
31:37What are you doing?
31:38Let's sit down here.
31:39Good.
31:39Oh, no, no, no, please sit down.
31:41Sure.
31:41It's all right, yeah, yeah.
31:42How are you feeling?
31:43Great, brilliant.
31:44Good?
31:45The day has come.
31:46Yeah, I heard so.
31:47Yeah?
31:48So heading into surgery fairly soon?
31:50Yeah.
31:50The chemotherapy and the treatment,
31:52are you feeling together?
31:53I didn't feel good.
31:53I didn't suffer badly with it at all.
31:55Yeah, yeah.
31:56Just pins and needles,
31:57just tiredness.
31:58Yeah, beat you up a bit,
31:59and in addition to beating the cancer up a bit.
32:01Yeah.
32:02That's the plan.
32:02You did that, though, didn't it?
32:03Good job.
32:04Yeah.
32:04Did a big job in that.
32:05Yeah, yeah, yeah.
32:05Thanks for the call.
32:06Good.
32:07The big fear for us is that, you know,
32:10when the surgeon goes in to operate,
32:12that he doesn't get it all.
32:14And Tim might end up losing the whole lung
32:16in order to try and get clearance.
32:18And, of course, there's risks to surgery.
32:20I mean, having a portion of your lung removed
32:22is not without, you know, potential for potentially devastating impact.
32:27So, yeah, it is what it is.
32:32I know.
32:33We're getting done what we're getting done, you know?
32:35I know.
32:36So we can't do much more about it, I think.
32:47She's cold.
32:48The team has stabilised Madison
32:51following a series of prolonged seizures earlier today.
32:54Just ring me.
33:00Madison suffers from a rare genetic condition
33:02called DYRK1A syndrome.
33:07We always said from the start
33:09when we found out Madison was sick,
33:10like, no matter what, we'll deal with it together.
33:13But as a family, I do get lonely at times.
33:17But then I have the, like, support of my mother,
33:21my father, my partner, James,
33:23my siblings, his parents and his siblings.
33:26So, like, we can just ring them,
33:27but it's very hard to, like,
33:30you know, kind of explain how you're feeling.
33:32This is her dad.
33:33This is her dad, James.
33:34I'm constantly blown away.
33:36Just the level of care and dedication that parents have.
33:41You know, their whole lives have gone down a path
33:43they didn't think they would go down.
33:46But you never see regret.
33:49You only see love.
33:52And it's just, it's mind-blowing.
33:57Madison will be admitted to the paediatric ward
33:59so she can continue to be closely monitored.
34:02She's just a lot more stable now,
34:06so we're happy that we're going to bring her back
34:08and then just kind of wait for her to come around.
34:10We'll keep an eye on her.
34:12Madison does have need,
34:13and that's just the way it is,
34:15but she brings so much happiness to all our lives,
34:18and everyone is, like, so happy.
34:20Like, she puts a smile on everyone's face that she meets.
34:24Just looking forward to the future as our family.
34:27James was kicked in the chest by a racehorse earlier today.
34:45Pre-hospital physician Jason Vanderville is concerned
34:48he may have significant injuries to his chest and spine.
34:54I've been there with horrific trauma
34:56when it's your own family member.
34:58You know, my son fell off the banisters,
35:01you know, from the top story down to the bottom story
35:04and literally went splat on the tile floor below.
35:09Having to manage that will always stick with me.
35:12I live rural.
35:13I live 50 minutes from the hospital,
35:15so I had to switch into clinician mode.
35:19Did not have any other option.
35:23And the one thing that I've appreciated
35:26is my colleagues, the CUH family,
35:28because I was able to hand over care
35:30with my severely traumatically injured five-year-old.
35:35I knew he was in completely safe hands.
35:38And he's multiple creptice
35:40down the left-hand side of the chest.
35:42He's had one pentrox.
35:44Before James can be sent for a vital CT scan,
35:47his pain needs to be controlled.
35:51All right, we're just going to get some local anaesthetic
35:54and we're going to get, uh...
35:55We're going to get some local anaesthetic
35:57and try to take the pain down here.
35:59Yeah.
35:59Yeah.
35:59Yeah.
36:03It's the left side that we're blocking.
36:05Yeah.
36:08It's all right.
36:13I seem to be very calm on scene,
36:15or my parents on scene is very calm,
36:17almost non-empathetic,
36:19but actually I've been there.
36:21And I know that the most effective way
36:23of managing somebody who's traumatically injured
36:26is to push emotion to one side.
36:28and focus on the clinical,
36:32on what really matters.
36:35A lot of this is just the ketamine
36:36because you don't feel in control.
36:39And yourself...
36:39yourself being the boss, normally at work,
36:43you're always in control, aren't you?
36:44Is that all right?
36:45The day before James's mum had passed away,
36:49to see a completely opposite side of James
36:54being so vulnerable, so upset
36:56that his mother had passed away,
36:58then in so much pain
36:59from getting a kick from a horse,
37:01all in the space of 24 hours,
37:03it was very, very hard to know what to do
37:07or how to make things better
37:08and how to be there for him.
37:10Okay, I'm checking there for you.
37:12Ooh!
37:14Okay, I know you're hurting a lot,
37:16so what I'm going to be doing
37:16is getting a bit of local anaesthetic
37:19just into the world where it hurts the most.
37:26You can see the bruise coming up now, eh?
37:28I'm going to die just now.
37:29I know, I know.
37:30I know, I want you to get up with your phone, okay?
37:33I think just one thing at a time, all right?
37:37Because in fairness,
37:38you took quite a belt off that horse, all right?
37:40No, you're definitely not hot enough to be in hell.
37:53Sometimes you call this place hell,
37:54but it's not.
37:55It's C-U-H.
38:01I'm a paediatric nurse by background.
38:03I started off actually as an actor
38:05over in the UK.
38:06I'm from Wales originally.
38:08And I went into the hospital
38:09as a play specialist
38:10working with puppets and children.
38:12Funny, really,
38:13that a lot of the TV stuff
38:14which I did as an actor
38:16was hospital-based,
38:17like I was extras in Casualty
38:18and a few other hospital-based programmes.
38:21So when I first came to work
38:22in hospitals over in the UK,
38:24I didn't actually like things
38:25like injections and blood,
38:27so I just used to pretend
38:28I was back on set of Casualty.
38:34Eugene O'Leary
38:35has been brought to the emergency department
38:37following a chainsaw accident.
38:39You were cutting the hedge,
38:42were you?
38:43Yeah.
38:45It needs a few stitches,
38:46doesn't it?
38:47I would think so, yeah.
38:48Yeah.
38:49How many cuts are there?
38:50So the thumb index...
38:51You wouldn't do it
38:53with a knife next time,
38:54would you?
38:55Eugene's hand was quite simply a mess.
38:57If you have a wound there,
38:59bacteria in that dirt
39:00love blood
39:01and they just grow
39:02and grow and grow and grow.
39:03Ah, it's a whole mess, isn't it?
39:05But there's still leaf
39:07on that.
39:09Leaf.
39:09There's still leafs on you.
39:10There'll be heads growing here.
39:13I'll jump my flip in there.
39:14One of the most mangled hands
39:27that I've had to try
39:28and put it back together
39:29in a long time.
39:29Good night.
39:34Do you have any kids?
39:38I'm not married.
39:39Right.
39:40Doesn't mean you can't have any kids.
39:41No one would have me.
39:45No one would have you.
39:46You escaped.
39:48You want to be confident
39:50with the patient
39:50and I think that by having
39:52the chat with the patient
39:53at the same time
39:54as you're doing something
39:56very important to his hand,
39:58I think it feeds back,
39:59it reduces his level of stress.
40:01What are you doing?
40:02Come on.
40:03What are you doing?
40:05My father is eight months
40:07and my eldest is eight years.
40:09And then three and five.
40:13So a nice spread of them.
40:15Yeah.
40:15All very good.
40:16All girls.
40:17All girls, yeah.
40:19Blessed among women, all that.
40:21You know?
40:22So I'll be in big trouble
40:23later on in life.
40:26That hand was properly mangled
40:30with a chainsaw.
40:31There were so many little bits
40:32of skin poking out.
40:35Ultimately,
40:36we wouldn't have gotten
40:37a very good closure
40:38on the wounds.
40:40So he'll need more
40:41long-term definitive care
40:42under the hand surgeons,
40:43which is the plastic surgeons
40:44in our hospital.
40:46All right, Lily.
40:46See you later.
40:47All right.
40:48Good afternoon,
40:52CUHFM Hospital Radio.
40:54All day, every day
40:55with your classics
40:56from the 60s and 70s
40:58and the 80s.
41:00Do you remember this guy,
41:01Harry Belafonte?
41:02Hey, that's me.
41:05I'm good.
41:06I'm Dave.
41:06I'll be taking upstairs there now.
41:08That's fine, Dave.
41:09Tim has advanced lung cancer.
41:13Surgeon Kishore Dodakula
41:15is preparing for high-risk surgery
41:17to try and remove his tumour
41:18while also saving his lung.
41:22He won't know
41:23until after he has begun
41:24the procedure
41:25if that will be possible.
41:28The most important thing
41:30is their life.
41:32And the second most important thing
41:33is get all the cancer out.
41:37Any operation, I suppose,
41:38done by a cardiothoracic surgeon
41:40is life-saving
41:41because the stakes are very high.
41:44If you take out the whole lung,
41:46the risk is as high
41:47as one in ten won't make it.
41:49So the priorities are three.
41:50One, safety,
41:53so that his life
41:54is not in danger.
41:55Number two,
41:56I want to get all the tumour out.
41:58And number three,
41:58I want to leave behind
41:59as much of lung as possible
42:01so that he can have
42:02a good quality of life
42:04after this surgery.
42:07Terrifying.
42:08One of the loneliest times of my life.
42:12I think I didn't want to be
42:14thinking about the reality
42:16of what could happen.
42:18And I didn't want to think
42:20of my life without Tim.
42:21I was terrified of the surgery.
42:32It was just all of the risks
42:33associated with
42:34just the surgery itself
42:36outside of
42:37what they were trying
42:38to actually remove.
42:41Okay, spread us, please.
42:42I don't remember my life
42:50before Tim.
42:52I was separated.
42:54I didn't ever think
42:55I would meet somebody
42:57again,
42:58but Tim is the one.
43:01It's the only way I'll put it.
43:02To see how we can
43:06negotiate
43:08this lobe and this lobe.
43:14Quarterly, please.
43:16Two hours into Tim's operation,
43:18Kishore has made his decision
43:20on what to remove.
43:23Say this, please.
43:25There is a tumour there.
43:36Sometimes
43:37the lymph nodes are involved.
43:51While James' pain
43:53has been brought under control,
43:54there is concern
43:55he could have severe damage
43:57to his chest and spine.
43:59A CT scan
44:00has been ordered
44:00to assess the damage.
44:02They gave you the ketamine.
44:05It wasn't pleasant
44:07to see the reaction.
44:10Ketamine.
44:11Why?
44:11It was just the way
44:14you reacted to it,
44:15which we were told
44:15is normal anyway.
44:17What's the idea?
44:19Your breathing,
44:20it was like you couldn't breathe,
44:21like you were starting
44:22to suffocate
44:23and your eyes
44:24just went completely
44:25wide and still.
44:28James is turning 50 this year
44:30and I'm 37.
44:33But once we got
44:34to know each other,
44:35it was never,
44:37never a question
44:38brought up
44:38between the two of us.
44:40It was evident
44:42very early on
44:43that things were
44:45going in one direction.
44:46We were coming up
44:50to Valentine's
44:51and he just said,
44:52I hope himself
44:53is taking you out
44:53and I said,
44:54no, no,
44:55there's no himself.
44:56So he asked me
44:57if I'd go out
44:58for a dinner
44:59with him on Valentine's
45:00and of course
45:02I said yes.
45:03And we went
45:05to Bella Cafe
45:06in Fermoy
45:07but we had
45:09to go
45:09to the folding unit
45:10before we went
45:11for dinner.
45:12So I was introduced
45:13to horses
45:14straight away.
45:21He's very sore,
45:22very specific,
45:23one side of his chest.
45:25We're going to get
45:25the scans done.
45:26Okay.
45:27So I'm going to go down.
45:31As you've been kicked
45:31and you see visible bruises
45:33on the chest wall,
45:34you don't see visible bruises
45:36in the lung.
45:37The consequences
45:38of that don't happen
45:39immediately.
45:40Okay.
45:40See you then.
45:41Yeah.
45:41So I'm just going to try
45:42and line you a tiny bit
45:43flatter.
45:44Oh, yeah.
45:46Yeah, yeah.
45:48So this is going to go
45:49tight again.
45:49Okay.
45:50Thanks, nurse.
45:53Oh, yeah.
45:54Okay.
45:57When James was wheeled away
45:59for the scan,
46:01it was then
46:01that I just broke down
46:03and I said,
46:04what is going on?
46:05What's going to happen?
46:07Is he going to be okay or not?
46:09No.
46:09And you can take care of yourself
46:10as well.
46:11All right.
46:12Okay.
46:12Off the scan.
46:14Take the ball to the
46:15off.
46:15Here we got your spine.
46:17Just rest.
46:21You're safe.
46:22It's all over, Tim.
46:24All right.
46:25All right.
46:25It's all over.
46:27No.
46:28We set you up, Tim.
46:29Would that help?
46:30Yeah.
46:30Yeah.
46:31Tim is in recovery
46:32following major lung surgery.
46:35Consultant Dervila Collins
46:36is on her way
46:36to brief Tim's partner, Kay.
46:38The best outcome is
46:40that the cancer was removed
46:41and that Tim's lung was saved.
46:43He was able to take out
46:48just the lobe.
46:49So do you remember?
46:50Fantastic.
46:50Yeah.
46:51He didn't have to take
46:51the whole lung?
46:52No, he didn't.
46:53Brilliant.
46:53So he's left about
46:54two-thirds of the lung in,
46:55all right?
46:56Fantastic.
46:56And has taken, you know,
46:58I suppose one of the lobes
46:59and just a little bit
47:01at the top.
47:01But he's happy
47:02that he's got everything.
47:04Took out all the lymph nodes.
47:05Thank you so much.
47:07I'll be just kidding.
47:08I'll be off with my tears again.
47:11That's my job.
47:12Yeah.
47:13So they send that off
47:14now to the lab.
47:15Sometimes we see
47:16a little bit of cancer.
47:17I mean, we know the stuff worked.
47:19Yes.
47:19Because we know from the scans,
47:20we know that things
47:21looked much better.
47:22Okay.
47:22And so we're really happy
47:23with, I suppose,
47:24the kind of the result
47:25that we went to theatre with.
47:27And I think it's just
47:28take another two weeks
47:28before we get the full
47:30information about...
47:32Oh, I'm so relieved.
47:34I hope at least
47:35you're a little bit more...
47:37Relieved.
47:38Yeah.
47:38Relieved.
47:39Yeah, after, I'm sure,
47:40it was a very stressful day.
47:42Stressful months.
47:44While it's good news
47:45that most of Tim's lung
47:47was left in place,
47:48there still remains a risk
47:50that not all the cancer
47:51was removed.
47:52What we want
47:54is for when the pathologists
47:56look at that cancer
47:57that's being removed
47:58under the microscope,
47:59we want to see no cancer.
48:01We want to see that cancer
48:03having melted away
48:04with the chemotherapy
48:05and the immunotherapy,
48:07and that's the win.
48:13When we were in the hospital
48:15and that we knew
48:16that it was a fracture to a rib
48:18and that his spine was okay,
48:19you have to look at the positives
48:21as well and see that
48:22he was okay at the end of it,
48:25but he was also extremely lucky
48:26to be okay at the end of it.
48:28You get a second chance.
48:30The family's always
48:31going to be number one.
48:32The horses will be all right.
48:34But really,
48:35they're the hobby.
48:37Do you like the horses
48:38all the noises?
48:39Yes, yes, yes, yes, yes.
48:41I'm cancer-free.
48:52Live healthy and happy.
48:54A lot to be said
48:55to be living healthy and happy.
48:57What more would you want?
48:58What more would you like?
49:28To be continued...
49:40Alright, let's get started.
49:42Bye.
49:42Bye.
49:43Bye.
49:43Bye.
49:43Bye.
49:44Bye.
49:44Bye.
49:45Bye.
49:46Bye.
49:46Bye.
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