- 3 weeks ago
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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, not getting rid of me.
01:02I just broke down what is going on.
01:05I'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.
01:18And that's really it.
01:19That's a very good piece.
01:21Yeah.
01:22Ah, Garda please.
01:23Garda in Cork.
01:24Yes, please.
01:25Thanks, Emilean.
01:26Hi, my name is Kate, I'm one of the CNM's here in the emergency room, and I'm
01:47from the emergency department and CUH.
01:48Can I let you know about a patient that's after leaving the emergency department that
01:52is confused and we're concerned about?
01:55He's under the influence of alcohol at the moment, but he also has an alcohol induced,
02:02say, encephalopathy.
02:03So he is confused, he does not have capacity, and we are concerned about him, and he is also
02:09left with an IV line in his arm.
02:16A five-year-old child is being rushed to CUH.
02:19She is barely conscious and her vitals are poor.
02:23There was a real panic there to get her in and get her seen, because the man in the back
02:27of the ambulance was, like, basically trying to call her, he was, he was really roaring
02:31to call her.
02:32She was barely responding to that, and he started on the head then.
02:38We received a call from the ambulance crew, a five-year-old little girl, Fia, is coming
02:44with a complaint of vomiting, and her heart rate is low and her blood sugar is low.
02:51She's still vomiting, so we need to treat all this very fast.
02:58There is a bit of a bumping bug in the house.
03:03Her older brother had the same kind of situation yesterday, but nothing at all to this extent.
03:10A heart rate of achy, irregular though, but pacemaker.
03:15Oh, pacemaker.
03:16Yeah.
03:17Okay, let's quickly get a line, yeah, and then...
03:22Fia is practically unconscious.
03:26She just looks barely breathing, and there's just nurses and doctors just swarming around.
03:33I feel like I'm half in the way, but don't want to be stepping back, but also don't want
03:41to be in the way, so like, it's just a head full of emotions there of like, what, where
03:47do I go, but I don't want to go anywhere.
03:50Okay, sweetie.
03:51Shh, shh, shh, shh, shh, shh.
03:54So only 21 pacemaker or any other history?
03:58Just the down syndrome, and after five months I think there was two holes in a hat repaired
04:03as well.
04:04Okay.
04:05I was with Fia all day long, and then she vomited, but like the fact that she was just
04:17so, so good all day long, happy out, playing, and just click of the fingers, and she was
04:24wiped out.
04:26She goes downhill really, really fast.
04:30It's scary just how quick.
04:33It is 1.36, pH is 7.315, bicarb is 22, sodium is 140.
04:41Oh, good girl, she's the best girl, yeah.
04:48She was becoming unresponsive.
04:51It was getting harder and harder to actually keep count.
04:56You're okay, sweetheart, you're all right, you're okay.
05:09You're okay, you're okay, you're okay, you're okay.
05:16Surgical oncologist Mark Corrigan has just started his shift.
05:21He specializes in preventative surgery.
05:25We know much more about cancer than we did 10 years ago, 20 years ago.
05:29And the different treatments that we have are really, really effective.
05:32They don't work for everybody.
05:34But for a lot of people they do.
05:36You know, there's nothing nicer than, you know, when you give good news to somebody,
05:39you say, look, okay, you've taken them through that horrible moment of, okay, we've got a
05:43problem, and we ought to do something with the problem, to that moment, maybe a couple
05:47of years later, when you finish the follow-up and the surveillance and everything else,
05:51and you say, we've done what we had to do, and we'll see you again.
05:55Maybe in Dunes or somewhere else, but not hopefully here.
05:58Today, Mark will operate on Antoinette O'Keefe.
06:02Hi, Jan.
06:04Six years ago, Antoinette received a diagnosis of aggressive breast cancer.
06:08I'm not a big drinker.
06:09I don't smoke.
06:10So I was thinking, like, I'm doing all the right things to prevent cancer coming to my
06:18door.
06:19And yet it still came.
06:21You end up into bed, and literally, I turned and said, good night, John.
06:25I gave him a kiss.
06:26And we turned, and he called over and he was like, put his hand on my chest and he was
06:29like, what's that in it?
06:30I was like, well, I don't know.
06:32I was like, nothing.
06:33I said, hang on.
06:34I better check now again.
06:35So I sat up in the bed and I was like, no, that's something.
06:38I said, that's definitely, definitely something.
06:40I don't know where I'll be afterwards.
06:43Here.
06:44Are you wearing it?
06:45I'm ready for everything.
06:46That's fine.
06:49I remember being told on the Friday, the toy show was on.
06:54I had toy show bags made up, and I remember sitting there and I kept crying.
06:58I hadn't told the girls.
06:59I kept crying, thinking, oh my God, is this going to be my last one?
07:02Like, afraid it was going to happen.
07:05Something bad was going to happen.
07:06And I kept saying, like, is this going to be my last one?
07:09Oh my God, please, can it be my last one?
07:10I haven't had enough time.
07:12Sorry, I get emotional.
07:13But yeah, that was the really hard part.
07:20You never think it's going to happen to you.
07:22And then when it turned out, it was something, obviously.
07:26The whole world changes immediately.
07:29You know, it's like somebody just turns on a switch and everything changes.
07:35You have no heart surgery?
07:36No.
07:37No, not like that.
07:39Yep.
07:40I had to have a full mastectomy.
07:42That was totally different.
07:44Looking down that day, you know, it's like, holy shit, like it's gone.
07:48Excuse my language.
07:49I was like, holy shit, it's gone.
07:50Like, and it's just, yeah, it was weird.
07:55To be honest, having had your surgery done recently, I expect they're fine.
08:00While the mastectomy on Antoinette's right breast cleared her cancer,
08:04tests revealed that she has a variant to the BRCA gene,
08:07which means that the chance of developing cancer in her left breast is very high.
08:12She has made the hard decision to remove that breast and is in CUH today for a mastectomy and reconstruction.
08:20Well, Antoinette.
08:21How are you?
08:22Good.
08:23All set?
08:24Yep.
08:25Yeah?
08:26All set as well.
08:27Okay.
08:28Antoinette, quite a long time now.
08:29And, I mean, she was very clear the minute that this was identified as a potential cause,
08:35it was no.
08:36It was, I want to take control.
08:38I want to manage my own risk.
08:39I want the information.
08:40And what are we going to do about it?
08:42Plan is today, mastectomy on the left hand side to reduce the risk.
08:45We're going to be taking the nipple and the areola.
08:47Yes.
08:48And then, Mr. Charles will be doing the reconstruction with the implant.
08:52No surgery underneath the arm today, so different to the last time.
08:55Any questions you want to ask us?
08:56No, just get on with it, Mark.
08:59Yeah.
09:00No.
09:01All right.
09:02All right.
09:03We'll see you inside in a little bit.
09:04All right.
09:05See you guys.
09:06This is something I get to do.
09:07I know I have this gene, so I had my tubes and ovaries removed in March.
09:12I'm taking something that I know right now is healthy.
09:15I'm taking this breast away, I'm like, and I'm going to put myself to the surgery again.
09:19I'm thinking of my kids like I'm here for a long haul, they're not getting rid of me.
09:31Oh, my God.
09:32How did the wedding go?
09:33Oh, it was great.
09:34Yeah.
09:35It was fabulous.
09:36Have you any photos?
09:37It was so long ago now.
09:38And did you go on any honeymoon or anything?
09:40I went to Italy for a week.
09:41Oh, lovely.
09:42Lovely.
09:43Let's see how ugly you are, go on.
09:44Oh, wow.
09:45Oh, jeez.
09:46You actually look like you go along in a movie.
10:05The paediatric allergy clinic in CUH is busy.
10:10Patients here are treated for a range of challenges, including food allergies.
10:16I was trained in Peru, then I went to Spain, and then I finished with my fellowship doing
10:22pediatric allergy.
10:23Cork has one of the biggest pediatric allergy service in the country, so I said this is a
10:27good opportunity, so I wanted to come here, and it changed my life.
10:32In 90% good things, 10% more stress.
10:36We need to sit down and tell them about the awareness of this, you know, that we are allergic
10:41and we need to carry the EpiPen all the time, okay?
10:43Yeah.
10:44Perfect.
10:47Eleven-year-old Ciarán O'Connell was diagnosed with a severe peanut allergy at an early age.
10:54I can't eat peanut or else I'll start getting sick and my throat will, like, start closing in.
10:59And I'll have to get, like, a needle in my thigh there.
11:02And, oh, I kind of have to carry around the medicine bag all the time with me, like, whenever I go places.
11:09It kind of annoys me sometimes.
11:11And I won't have to check the ingredients on anything, like, because every time I have
11:16something I just have to, like, check it, so.
11:19Ciarán's guess, peanut, that is life and death.
11:23At 11, he's very clued in.
11:25He's very aware of it himself.
11:27He checks packaging more than us.
11:30Still, for a living, it's hard to put that into your head to say that you could potentially die from this.
11:37If ever the worst-case scenario ever came and he went into an epileptic shock, his system starts shutting down.
11:42Rash forms, cough, the usual gasping for brace.
11:46So, obviously, that's when you need your auto-injecture and the shot adrenaline.
11:51He needs to be brought to a hospital straight away.
11:54EpiPens are the things that you bought in your leg if you eat a peanut or whatever you're in.
11:59Sometimes they look like this. They can be other types as well.
12:04And I have two for, like, just everywhere and then two for school.
12:09Ciarán is in CUH today for an oral food challenge.
12:13He is hoping the test will show he is no longer allergic to peanuts,
12:16which would mean no longer having to carry his life-saving EpiPen.
12:20The oral food challenge, they come to Dayward and we will introduce them.
12:26Low doses of, for example, peanut until we get to an amount that is approximately between 6 to 12 peanuts.
12:35And they don't have any reactions after 2 or 3 hours.
12:39We can safely say that they have an oral food challenge negative.
12:44Are you praying?
12:45No.
12:46Okay.
12:47How are you?
12:48Good.
12:49Good.
12:50So what are you trying today?
12:52Uh, peanut.
12:53Personally, I think today is Ciarán's last chance of maybe passing the test.
12:57For Ciarán it would be life-changing because it means he'll never have to inject himself,
13:02never have to worry about an epileptic shock anymore.
13:05And he can just go on with his life, eat what he wants and just be happy.
13:11And do you eat other nuts?
13:13Uh, yes.
13:14And this is an important question.
13:16If by any chance we're lucky and you eat peanuts and you don't have a reaction today,
13:21will you start eating peanuts at home?
13:23Yes.
13:24Okay.
13:25Crossing our fingers.
13:26Don't pray.
13:28It is going to be weird.
13:35Ciarán is physically going to take a peanut, an actual physical peanut.
13:40It's stage by stage by stage, you know, an eight of a nut, a half a nut.
13:44And they're just going to try to test, push Ciarán's tolerance as much as they can.
13:49This is Morphy's law, no?
13:52It only takes one person to introduce it at home that has an anaphylaxis that maybe they
13:57don't know how to use adrenaline and has a really bad output or outcome.
14:02And then everything is a mess.
14:04So that is why it's so necessary that every challenge has to be in a hospital-based.
14:10So internet, I'm going to swipe down, so it's okay.
14:13All right, that's it.
14:14Good, ma'am.
14:15Good, ma'am.
14:16Good, ma'am.
14:17Good, ma'am.
14:18Every time that we're doing that, we're also observing them, looking if they have the minor
14:23reaction whatsoever, because we need to look if they're going to start having an anaphylaxis,
14:29because we need to up quickly.
14:36Five-year-old Fia was rushed to CUH earlier today.
14:40Staff have worked to stabilise her, but she is still very ill.
14:44Shortly, she will be scanned so the team can investigate further.
14:48If he was born, it was just like any other birth.
15:00If he was born, and then there was a bit of silence in the room.
15:05The nurses were checking her over, and we just thought it as that.
15:10It went really quiet.
15:13And I was thinking, what's wrong?
15:15What's wrong?
15:16What's wrong?
15:17What's wrong?
15:18And then one of the nurses said, I think that she has Down syndrome.
15:22So I didn't know what to say.
15:25We didn't know that in any of the checks prior to that.
15:29There was nothing they saw that indicated anyway.
15:34Very short time when Fia was born, her oxygen levels kept dropping.
15:46She had to be brought down to neonatal.
15:48And so we had maybe 15, 20 minutes or so of John holding her between us.
15:57I wasn't allowed my phone in the NICU, you know, so I just spent hours staring at her.
16:06And I'd be just drawing out little hearts with my fingers on her.
16:12That was like me just being able to touch her.
16:15I wasn't allowed, like I wasn't able to hold her or anything, you know,
16:18because she wasn't strong enough for her.
16:22Lay down Fia, I'm here.
16:24Daddy's there.
16:25I'm here.
16:26I'm here.
16:34During Fia's time in neonatal, to see her fight through that,
16:38and like, from day one, just come out fighting.
16:44Good girl.
16:46Seeing what she's been through, none of us should be complaining about anything.
16:55We really shouldn't.
16:57Listen, stay still now.
17:01If she keeps moving, is it okay if you stay with her for the x-ray?
17:06Yeah, that's fine.
17:07I might get you to stay with her, please, because that's a good position here.
17:15Yeah.
17:17VH is like a beehive.
17:19Like, it's just, everybody's so busy, they know what they're doing.
17:22And if you don't talk bee language, it doesn't look like you know what's going on
17:28or it doesn't make sense, but everyone's working, getting it all done.
17:34And I'll ring you when she goes out to recovery.
17:38Antoinette has made a choice to have her breasts removed.
17:41Although it is currently healthy, she has a harmful variant of her BRCA gene,
17:46making her more vulnerable to the risk of developing cancer.
17:51Once I have an idea of what time she'll be out, I'll be back.
17:55And again, I actually can't tell you nothing.
17:57Oh, I know.
17:58As I say, you can take as long as it takes.
18:00John's my rock.
18:01We weren't together six months and he proposed.
18:04I think everyone thought we were insane getting engaged.
18:07Are you sure you don't even know someone after six months?
18:09John was 21, I was 24.
18:11Here we are, 17 years later.
18:14We've grown up together really in that and, you know, we've built a life and, you know,
18:19we've been best friends in that all down to years.
18:23So, you know, it's been incredible.
18:26The first part of the operation will be to remove Antoinette's breast.
18:31The second part will be a reconstruction, which will be carried out by consultant plastic surgeon Justin Chatterjee.
18:38What we're going to do, I'm going to just do some marking.
18:41Is that all right?
18:42Yeah.
18:43OK.
18:44All right.
18:45Before you do that, yeah?
18:46I'm going to get out and let you do this.
18:48Are you sure?
18:49Yeah.
18:50Do you have any?
18:51We'll give you a frame.
18:52I'll touch you before you leave there, OK?
18:55Oh, yeah, yeah, absolutely.
18:57I found it hard to be inside her.
18:59One second.
19:00They were drawing the lines on her body and it was upsetting her.
19:05I didn't want it to be seen that it was affecting me as much either.
19:09I'm not there for a second.
19:11He held my hand through the whole out of it.
19:13Every appointment, everything.
19:16Every moment of weakness that I had, the negative thought,
19:21he'd leave me around with it and say, OK, that's it now.
19:28He told me he's fierce too.
19:30And his fear was like losing me.
19:32He's just, he's my soulmate.
19:35I went, had coffee, just took a moment and came back then.
19:40I was, you know, you need to be strong.
19:44It's OK, dude.
19:49Very good, that's right.
19:50It's fine.
19:51It's fine.
19:52Great.
19:53It's fine, sir.
19:54It's very good.
19:58Kiran is being tested to see if he is still allergic to peanuts.
20:01A negative test will mean he is no longer at risk of a fatal anaphylactic attack.
20:07He has had two small portions of a peanut, so far.
20:10They came over then to do the third part of this, which was a half peanut, I think the
20:19nurse made a joke, she goes, do you like it, he goes, they're very salty.
20:23I told him sit back, relax, he was on his tablet, and he did give kind of one or two
20:28little small coughs, like I was just staring at him, you know, thinking, go on, keep going,
20:33I hope you get to stage five, I really do, I really hope you do.
20:36And they were looking, and I just went like that, I just tapped my ear like that, and
20:47they looked and you could see all these bubbles forming along Ciarán's ears, and the nurse
20:51called Dr. Trulio, and just pure professional came over, he goes, okay, that's the end of
20:56the testing.
20:57This is a positive reaction, and that's when Ciarán obviously got very upset, I think he
21:02was gutted actually.
21:03A little bit white dots here, that you're having, that makes a reaction, okay?
21:08Okay, sir, I will tell you something important, okay?
21:12So, sometimes, ah, don't worry, don't worry, this is not going to be a problem, we need to
21:18make sure that you're okay, I'm giving you that.
21:21Do you want it to eat peanuts, no?
21:24Yes, do you want it, do you want it to get a Snickers on the home?
21:29I know, it's disappointing.
21:30Yeah.
21:31I know it is.
21:32You did a really good job, are you so proud of yourself?
21:34Yeah, I know.
21:35Give Ciarán his adrenaline then, and literally within, I'd say, 30 seconds, that's a, joy,
21:42the tingling was gone, joy, he just felt way better on himself.
21:44So, I really hope that's stuck in his head, what adrenaline does to his system basically
21:47just gets him back to normal.
21:49Hit his home then, how his whole face changed, rash started forming his body, his ears became
21:56red and blistered in the space of minutes.
21:59He's back and he's been with him the whole time.
22:01All his injectors need to be with him, literally, the whole time.
22:04Okay, last, last couple of things.
22:07How do you feel?
22:08Bump it.
22:09Okay.
22:10Now we know that he's allergic, and now we also know that he needs to be careful,
22:16and don't, and take things seriously.
22:19Have you tried pecans?
22:20Um...
22:21Pecans?
22:22No.
22:23Okay.
22:24How about Kinder Bueno?
22:25Do you like Kinder Bueno?
22:26Yeah.
22:27Okay.
22:28I'm happy with that.
22:29Kinder Bueno is okay.
22:30Nutella is okay.
22:31Just please, no sneakers.
22:33Yeah, no.
22:34No this kind of things, okay?
22:35Yeah, no.
22:36We've never used the EpiPen.
22:38We have a training pen that he has practiced on himself.
22:41The only thing that you're never going to eat so far is?
22:45Peanuts.
22:46Perfect.
22:47So.
22:48If it does come to us, will he actually inject himself?
22:51That's, and that's a massive fear.
22:53So you don't have the fear of sticking a needle into your own body.
22:56Oh, like, I know they would save my life, but, like, I think they would hurt.
23:02Take off the topless, then you push it in around there until you hear a click,
23:07and then you just hold it for 10 seconds.
23:10The medicine stops, like, my throat closing in, and it, like, stop me, like, help me to breathe
23:19again and stuff.
23:20It is life and death.
23:21That's the bottom line.
23:22It comes down to that.
23:23It literally comes down to that.
23:24It's getting power at this school.
23:26When I hand over the back from now on, it should be aggressive.
23:29This is Ciaran's metal kit that needs to be used that will save his life.
23:33And that is the fact of it.
23:37After a diagnosis of cancer in her right breast, Antoinette had a mastectomy.
23:50Tests showed she has a mutation of the BRCA gene, increasing her chance of breast cancer
23:55into the future.
23:57She has decided to remove her healthy left breast, followed by reconstruction.
24:01We tend to focus on surgery as if there's a surgeon.
24:05And in this case, there's another surgeon.
24:07But actually, you know, you're looking at about 10 people.
24:10Two arm boards, please.
24:14The role of the surgical oncologist is to perform the wrist reduction mastectomy.
24:21What we want to achieve is that we've removed as much of the breast tissue as possible.
24:25And the role of the plastic surgeon is to perform the reconstruction.
24:30And then we'll do it.
24:32There's that.
24:33OK.
24:34And then we may have to take some of it.
24:36Just to keep it from yours.
24:37Yes.
24:38Bring the scar right now.
24:39Yes.
24:44The people that we meet who come into a hospital, it's a really unique situation
24:50because you're parachuted into the middle of their lives and to the middle of their confidence,
24:54which is a huge privilege.
24:56Here, I might swap.
24:57Can I swap you?
24:58Yeah.
25:01It was never going to be an option that was going to keep my breasts and risk it.
25:04I know I have this gene.
25:05Let's get ahead of it.
25:06I don't want to be in my 50s or my 60s or my 70s or even my 80s fighting breast cancer.
25:13And can I get two Alices off you, please?
25:19Yeah.
25:20You are meeting people when, you know, yesterday they were on their way to work and today they've
25:26just got news that's completely changed that.
25:28And so the things you were worried about yesterday just are not what you're worrying about today.
25:32And on a human level, I suppose you're frequently reminded, I suppose that, you know, for any of us we don't know what's around the corner.
25:45It's just...
25:46It's just...
25:47Yeah.
25:48But when they go home and they're trying to process all this and they're having a cup of tea or they're just having a cry.
25:54And, you know, that's where you see the incredible importance of the people around them.
26:01No.
26:02No.
26:03Okay.
26:04I'll come back to it.
26:05There.
26:06Okay.
26:07Hi, John.
26:08Mark here.
26:09Good.
26:10Everything went very well.
26:11Yeah.
26:12No.
26:13Please.
26:14Yeah.
26:15We're pleased with that.
26:16So I suppose Antonette will be waking up in the theatre now in the next five minutes or so because I promised her we'd bring in the minute we were done.
26:19So she's only going to be coming around.
26:21Once she wakes up, she'll be out to recovery.
26:24Perfect.
26:25Perfect.
26:26That's plenty of time.
26:28Not at all, John.
26:29All right.
26:30Take care.
26:31See you.
26:32Bye-bye.
26:33Are you not going home?
26:35Oh, I'll be going at six.
26:37Oh, six.
26:38Oh, there's...
26:39Have you eaten it?
26:40I have, yeah.
26:41Good girl.
26:42Turn around.
26:43Oh, I'm just here.
26:44Sweeties.
26:45Oh, that's very nice.
26:46I know.
26:47I'll have the crackers.
26:51Just 50 minutes ago, Fia was rushed to CUH by ambulance.
27:01She is now being moved to the paediatric emergency department and will continue to be monitored closely.
27:07She is stable but remains unwell.
27:10She has any siblings at home?
27:15Yeah, she is.
27:16She's by her home.
27:17How old is he?
27:18He's six.
27:19Six years.
27:20I was at home with Finn.
27:21I do go into a panic, like, when I see her.
27:24When I see her like that, you know, it's scary.
27:28Darren can keep calm, you know.
27:30As much as you can't do anything to help it as a sense other than be there and support Bev, Bev support me, be there for Fia.
27:48To myself and Bev, family is everything.
27:53Now, her numbers are all good now.
27:56I will just send her blood samples now there and we'll come back to you, okay?
28:00Okay.
28:01And we'll keep an eye on her numbers there, okay?
28:06Okay.
28:07Thank you so much.
28:08Perfect, thank you.
28:09Down syndrome, it's not all that she is, but to me it's the best part of her because, you know, I wouldn't change a thing about her.
28:22Like, she's, she's amazing.
28:26It is challenging, but it's not the end of the world.
28:31If I could say anything about it now, it's, it's not to be scared of it.
28:36Yeah, because, she's a great girl.
28:41We're at the front line.
29:01When you walk into the emergency department, you really can't expect what's going to be thrown at you, what you're going to face.
29:08And you don't know whose life you'll impact that day.
29:12I got a call, and it was Christy.
29:15He said, I'm in an ambulance, and he's having a heart attack.
29:19All of a sudden, like, you're sort of, what did he tell me, what did he tell me?
29:23It's a frightening thing, you know?
29:25He's my only brother.
29:29I have nine sisters now, but he's my only brother.
29:32Christy Jacob has been rushed to CUH from University Hospital Waterford.
29:37He's had medication for pain reduction, but is having a heart attack, and needs urgent treatment not available in Waterford at this time of night.
29:45Hi there.
29:46Hello.
29:47My name is Syma.
29:48I'm one of the doctors here.
29:49What time did the chest pain start?
29:50It started about eight o'clock.
29:51Eight o'clock.
29:52It's a good thing you came straight to hospital.
29:54Can we get a repeat ECG on him while he's here?
29:56Yeah.
29:57You know that you've had a heart attack?
29:58I heard that.
29:59They've told you that?
30:00Yeah.
30:01What has his blood pressure been en route?
30:03Hey, Dylan.
30:04How are you?
30:05This is Dylan.
30:06Listen for a second there.
30:07One second.
30:08Because the transfer time from Waterford to Cork University Hospital, because on blue lights, is around an hour.
30:13Sorry again?
30:14They do have to treat it before they transfer the patient over to CUH.
30:18And the treatment which then is given is to try and attempt to dissolve the blood clot, to limit the damage done to the heart muscle.
30:26Increase these case, unfortunately, the thrombolysis had not worked.
30:30Yes.
30:31So time is key.
30:32Okay.
30:33You've almost certainly got a blocked artery in your heart, okay?
30:36Yeah.
30:37We gave you some medication, then the water to try and unblock it.
30:39Yes.
30:40And it hasn't really worked as well as we thought it would.
30:42Yes.
30:43Okay.
30:44So we're going to need to proceed ahead and you may need a stent.
30:46Registrar Dylan Finnerty has been in constant contact with consultant cardiologist Richard Tanner.
30:53Richard is at home, but is on call for emergencies and has made a decision to activate the CAT lab.
30:59He has 30 minutes to get to CUH along with two specialist nurses and a radiographer.
31:09Where's the...
31:10Where's the...
31:11Where's the...
31:12Where's the...
31:13Where's the...
31:14Where's the...
31:15Where's the...
31:16Healthy...
31:17Healthy...
31:18Healthy...
31:19Do you smoke?
31:20How many...
31:21Are they...
31:22Roughly?
31:23A few...
31:24It seems to be different.
31:25I'd say five, ten, whatever.
31:26Asthma?
31:27No.
31:28And...
31:29No.
31:30No.
31:31Thanks, Luke.
31:32You see so much in the emergency department.
31:39You see so many illnesses.
31:41You see patients at their sickest.
31:43What cause?
31:44No.
31:45No.
31:46No.
31:47No.
31:48No.
31:49No.
31:50No.
31:51No.
31:52No.
31:53No.
31:54No.
31:55No.
31:56No.
31:57No.
31:58No.
31:59No.
32:00No.
32:01You don't really know what's going to happen.
32:03Even though they're treating you.
32:05You can still die.
32:06Things can change in an...
32:20An instant.
32:21I only want to know that and go there, which?
32:23Yeah, absolutely.
32:24I guess what we can say at the moment is you're...
32:26having a heart attack.
32:27Yes, I was told after...
32:28So we will just wait to go there and go there.
32:29Yeah.
32:30Yeah.
32:31Yeah.
32:32Yeah.
32:33Yeah.
32:34Yeah.
32:35Yeah.
32:36Yeah.
32:37Yeah.
32:38Yeah.
32:39Yeah.
32:40Yeah.
32:41Yeah.
32:42There you go.
32:44Not allergic to anything?
32:45No.
32:46No.
32:47So what we'll do is we'll lie you flat on the table.
32:49Yeah.
32:50And we'll go through a little artery of the wrist.
32:51Yeah.
32:52Okay.
32:53So preferably we go at the wrist.
32:54Sometimes we have to go at the top of the leg instead.
32:55All right.
32:56We've got a very fine wire up the arm down into the chest.
32:59We inject some contrast.
33:00I'll take some x-rays of the saxophone.
33:02And we're looking for a blockage.
33:03Okay.
33:04So if we see a blockage, we're trying to relieve it.
33:06Okay.
33:07All right.
33:08We'll get down.
33:09Thank you, Eddie.
33:10Thank you, Eddie.
33:11Thank you, Eddie.
33:13Thank you, Eddie.
33:21There was one person that came down and we were all tipped off
33:24before he came down that he needed to be called JC
33:27and not by his real name.
33:29The patient himself thought he was Jesus Christ.
33:33So we had to call him JC.
33:35Because if he was called by his real name, he would have gone ballistic.
33:38But unfortunately, one of the surgeons came out to meet him
33:42and he looked down at him and he says,
33:44Good morning, JC.
33:45How are you?
33:46My name is Mohammed.
33:47And the patient looked up at him and held his hand and he said,
33:50I waited all my life to see you.
33:56How's the pain in your chest like this?
33:58Oh, come on, boy.
33:59Still there.
34:00Christy Jacob is having a heart attack.
34:02He was treated in University Hospital, Wardford
34:05before being rushed by ambulance to CUH.
34:07First floor will probably be quicker.
34:10Just go up one and then go down one.
34:15Stabilized in the emergency department,
34:17he's on his way to the cath lab.
34:22On-call consultant cardiologist Richard Tanner
34:24has made it to the hospital within 30 minutes.
34:27When an artery is completely blocked,
34:30we know that the extent of damage is dependent on
34:33the time that artery remains closed.
34:36When it remains blocked and blood supply is cut off,
34:39it can lead to extensive damage to your heart.
34:42Even if we open up the artery at that time,
34:44there's a certain amount of muscle in his heart
34:46that'll be dead and it'll be irreversible.
34:49And the consequence of that is heart failure.
34:53So time is critical in the treatment of heart attacks.
35:00You think you're invincible, but you're not.
35:03And this kind of highlights the fact that you're mortal.
35:10There's a master butcher and he loves your meat.
35:15Fish is for cats.
35:18That's what he said.
35:20We're all guilty of overindulging and all that,
35:22but if it affects you that badly,
35:25you have to kind of stop it.
35:27Sing at the drop of a hat and he likes women.
35:31He's never married around, so he's a single man.
35:34He's a man about town.
35:36He can do what he wants.
35:37Kind of a party animal in a way,
35:39but he's an older party animal.
35:41You kind of can't blame him until something happens to you.
35:47Can I take stent, please?
35:50To keep the artery open, we place the stent,
35:53which is like the scaffold that keeps that artery open.
35:56So that stays in your body
35:58and it'll be there for the rest of your life.
36:01No, no, no.
36:02Almost done, almost done.
36:03Ready?
36:04Almost done.
36:05So Christopher, you stent in and the artery opens up, OK?
36:11He's a kind man.
36:13We want him around as long as we can have him.
36:16Five-year-old Fia continues to be monitored
36:28in the paediatric emergency department.
36:30She will be admitted when a bed becomes available.
36:36Oh, thanks a lot.
36:38Thanks and bye.
36:43Maybe because of the vomiting,
36:45the white cells in the blood is a little bit high,
36:47but her CRP kind of infection is normal.
36:51Nothing to worry,
36:52like because of the vomiting,
36:54the white cells are high.
36:55Okay.
36:56So anyway,
36:57they will follow up here in the ward.
36:59They're like, you know,
37:00they take more blood there and so on.
37:02Yeah.
37:03Yeah.
37:04So her primary concern to the hospital for Fia is now dehydration,
37:15vomiting and sugar, hypoglycemia,
37:17not because of any cardiac issue or trisomy 21 or Down syndrome.
37:21She is in the hospital.
37:23Only thing, the dehydration.
37:24So we are treating dehydration now.
37:39Today, Brian Murphy is scheduled for complex surgery to try and ensure he can continue to walk into the future.
37:46For the last couple of years, he had an awful lot of problem walking because he had so much trouble with his knees.
37:55Couldn't really walk very far.
37:56And if he was walking then, she was at a snail's pace.
38:00And I'm like,
38:01will we ever get home?
38:03I've played a lot of football with the bath club now.
38:08This might have nothing to do with it,
38:10but I terrible trouble with my knees.
38:17Eventually, I had to get him done.
38:19The pain was chronic.
38:21It still is.
38:22This is a bigger operation.
38:24Brian would be in pain every time he tries to walk.
38:28He's quite a stoic character.
38:29He's a man who doesn't complain,
38:31and I know that if he's complaining of something, he's genuine.
38:34The older you are and the frailer you are having a surgery,
38:37then the less likely you have of a better outcome.
38:39Morning, Brian.
38:40How are you?
38:41How are you?
38:42Good.
38:43Good.
38:44So, we're going to do your surgery this morning?
38:47All right.
38:48It's now causing him significant pain,
38:50and the only solution that I have to be able to reconstruct this for him
38:53is to give him a total femur replacement.
38:55I've no hearing aid.
38:56You thought I had to replace just the knee,
38:58but I have to replace the whole femur.
39:00Yeah, yeah.
39:01So, once you have to replace the entire femur,
39:03you're essentially replacing the entire knee and the entire hip in one go,
39:06and then replacing the entire femur at the same time.
39:09But I don't think you have a choice because I think that this thing is completely loose,
39:12and you've got so much pain, you can't walk on it.
39:15So, we just have to go ahead and do this.
39:17Right?
39:18You can say, look, I don't want to do it,
39:20but I don't think you're going to be able to walk and your pain won't go away.
39:23The challenge of trying to look after somebody with a problem that's more complex
39:26is challenging you to try and improve as a surgeon.
39:30If you do only simple things all the time, you never get better.
39:34So, you have to try and step up and do more complex things.
39:37This is a big surgery.
39:38There'll be a reasonable amount of blood loss in this.
39:41Just worry how long it'll take you to know.
39:44You shouldn't be worried about that.
39:46Oh, I know that.
39:47I don't know how long it's going to take.
39:49It'll just take as long as I need to get it done safely for you.
39:53You put your trust in them, then for those five, six, seven year olds,
39:59whatever you do, you'll have to.
40:02It is a substantial surgery.
40:03It's going to take a bit out of you.
40:06You may need a bit of blood or something like that afterwards.
40:08People like Brian, they can lose a lot of blood.
40:10The other worries you have with people like Brian are the risk of clots.
40:15And there is the very rare patient who gets a severe clot in the lung,
40:18and that can kill them.
40:23Here.
40:26How are you?
40:31Have you eaten?
40:32Did I catch you something?
40:36Antoinette is recovering from her mastectomy and breast reconstruction surgery,
40:40an elective procedure prompted by discovering she has a variation of the BRCA gene.
40:45I am lucky.
40:49Yes, I have the gene, but I'm ahead of that now.
40:52So I feel I'm incredibly lucky to get this far.
40:56I get to see my kids grow up.
41:00I get to see them graduate from national school to in secondary school,
41:04getting on with life.
41:06The gene obviously could go into the future.
41:14The girls will be checked as soon as they are 18,
41:17and they'll have consistent ISO testing and that going forward.
41:21so that at least they'll always be monitored.
41:24Into the corners like you like it.
41:29I won the lotto of life.
41:30I win because I beat it.
41:34So that's really important.
41:37Yeah.
41:38I kept my word to myself that I was never going to lose to this.
41:42Surgeon James Harty is preparing for major surgery.
41:52Patient Brian Murphy requires a knee, hip and femur replacement
41:56to try and keep him walking into the future.
42:00It's a substantial surgery.
42:02You have to prepare to have a patient who's on the table for quite some time.
42:06Can the lights be put up, please?
42:08Can you put some power on those lights because they're too weak?
42:12In Brian's case, I will start at the top, remove the femoral component,
42:17put the hip cup in and then go back down and put the knee bit in
42:20and then join the two from top to bottom by putting the femur in.
42:24The question then is, can I get the hip out first?
42:26Just before I do that, actually, let's just see, can I get the hip?
42:28Brian, I suppose, is the love of my life because, well,
42:31he's the only boyfriend of such, really, I'd say, that I ever had.
42:34He's kind of been the one and only.
42:36If I can dislocate the hip first, it might be easier.
42:39We met through his sister, Kay.
42:42Kind of got a bit friendly with him, but, like, Brian was always very,
42:45very shy back in those days.
42:47And, like, if I'd come in the door, he was gone.
42:49Try and dislocate that hip. Try and dislocate the hip.
42:51I don't know, it was like kind of a game of chasing.
42:53I just decided, I'm going to get you.
42:56Eventually, I managed to break him down and I did.
42:59I don't know, it was a kind of a mutual decision, just that we'd get married.
43:03I, like, I certainly don't ever remember him going down on one knee, that's for sure.
43:07I consider that this is a salvage type of surgery and I don't expect him to have the same function and outcome as somebody who might have a hip replacement or somebody who might have a knee replacement.
43:20OK, there's his proximal femur coming out. OK.
43:24It is a totally different procedure.
43:26The muscles don't attach to the bone and you need your muscles to be attached to your bone to be able to walk and move normally.
43:33And this implant will not allow the muscle to attach to the bone.
43:38Hit it again.
43:39Hit it again.
43:43Here she comes.
43:44OK, lift back now.
43:47Now, that's it. In she goes up.
43:48My expectation for Brian would be that he would walk.
43:51He'd walk pain free.
43:52I think he'll always use sticks or crutches.
43:55He wouldn't be able to go a long distance, but he would be able to go around and do his daily activities.
44:02In she goes. Now, give me the screwdriver, please, for that.
44:04So I can turn to the right direction.
44:05Yeah, it's got a spin.
44:06It's got a spin 180 degrees for me there.
44:08That's it.
44:12OK, there it is.
44:13Hold it there, Sarah.
44:15She's locked.
44:16Yeah, locked in.
44:18Let's get this closed up.
44:20And we start closing the skin first.
44:33OK, you happy, lads?
44:35OK, thanks a million.
44:37Lads, let's just close the rest of her.
44:40Oh.
44:42Right.
44:44You can't be dispassionate about the patients.
44:46You have to feel that you're giving each patient 100% when you're operating on them.
44:51And so when you've finished operating on them, you have the next patient and you have to be just as passionate about the second one as you were for the first one.
45:01OK.
45:02Oh, when did you come?
45:03Oh, I was on holidays last week.
45:04I started.
45:05Yeah.
45:06No better girl.
45:09You liking Cork so far again?
45:10Are you OK?
45:11You weren't going?
45:12Yeah, I was here before and I left for 10 years and now I'm back.
45:13Oh, good woman.
45:14You brought the weather with you.
45:15Yeah.
45:16I'm going to get a few of that rhesus cleared out.
45:17It's a bit messy.
45:18I need a thick back now.
45:19It's a thick.
45:20Margaret.
45:21Full rhesus gives me a bit of nerves in the morning like.
45:22Cardiologist Richard Tanner performed an emergency procedure on Christy Jacob during the night.
45:36Now he's back to check on his patient.
45:37Hi Christopher.
45:38Hi George.
45:39How are you doing?
45:40I'm doing great.
45:41All on account of you.
45:42Do you have any chest pain this morning?
45:44No.
45:45Any shortness or break?
45:46None.
45:47OK.
45:48And I didn't even have shortness or break before I went to hospital.
45:50It's just a pain in my arm and my chest.
45:52Yeah.
45:53Can I have a quick listen to your heart there?
45:54Yeah, of course.
45:55There was damage done to my heart.
45:58And the aorta, like they call it the widow maker.
46:01That's the one that was blocked, but they reckon it was 100% blocked.
46:05Which is scary.
46:07Like I said, what would have happened had I went to bed?
46:11They said you would never have woke up.
46:13So, smoking?
46:15I smoked my last cigarette before I came in.
46:18That will never ever happen again.
46:20Never happen again.
46:21This is really important because you could be back here again.
46:23Yeah.
46:24That I don't need.
46:25OK.
46:26I mightn't get back there next time.
46:27That's the problem.
46:28Hindsight is a great thing.
46:29If I knew then what I know now, I would have changed it all those years ago.
46:35But just having a good time all the time, I kept doing this until I had heart failure.
46:43You're doing very well overall, OK?
46:45Yeah, I'm happy and I'm grateful for you and the water staff as well for acting fast and getting me down.
46:53They did a good job looking after you.
46:54Yeah, yeah.
46:55Typically after, you know, what you've had, you're kind of three to four days in hospital.
46:59Yeah, OK.
47:00OK?
47:01Yeah.
47:02All going well, OK?
47:03That's brilliant.
47:04It's no problem.
47:05OK.
47:06Family calling?
47:07Hello.
47:08OK.
47:09Appreciate everything you've done for me.
47:10You're very welcome, OK?
47:11One of the things we do cardiology is that, you know, we had a man came in with a heart attack, which could potentially be fatal or have severe consequences for the rest of his life.
47:21And now he's, you know, sitting out of bed, had his breakfast pain-free, ready to continue his life again.
47:30All right.
47:33I'm not worried.
47:34I'm not worried about good things.
47:35I know I just do buy the book.
47:37You know, you'd have your arguments and small disagreements and nothing major, but a thing like this kind of brings things into perspective.
47:46Thanks, Danny.
47:47Talk to you then.
47:48I know.
47:53Christy is lucky.
47:54He got caught in time.
47:57I hope he makes his own look in future.
48:00The relief when she comes home is, it's brilliant, like, you know.
48:12Coming home from work and just, you know, run out, it just really warms my heart, like, just want to see more of that.
48:19I think, like, there is life before cancer and there's life after cancer.
48:31Like, there definitely is.
48:32There is definitely the whole things, like, I live my life carefree.
48:35I love Mark.
48:36He's lovely and he's an amazing doctor.
48:38I, no, I don't want to see Mark anymore.
48:40Just for him to tell me everything's going tickety-boo instead of a grand.
48:44.
48:51.
49:02.
49:06.
49:10Transcription by CastingWords
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