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00:00:00the clock is ticking this is a serious life
00:00:05saving operation he's at risk of dying from this
00:00:09procedure
00:00:10we can go from under
00:00:15control to emergency in a flat-off an eyelash
00:00:20beef means don't do that again
00:00:25it is very personal for me
00:00:30if you put a hole in here he'd be at risk of dying on table
00:00:35this is either life or death
00:00:40you
00:00:45it's a scary prospect it's your independence
00:00:50this is inside the belly of the beast
00:00:54we are in
00:00:55the tumour now
00:00:56it's bleeding
00:00:57and that can cause massive stroke
00:01:00and i gotta hate steve and not like
00:01:05if you pick up
00:01:06your life is literally in someone else's hand
00:01:10the longer the heart
00:01:15it is out of the body the worse the outcome
00:01:18and the risk of the patient dying
00:01:20you
00:01:25Oh, God, it's scary, isn't it?
00:01:30This team is like a parasite feeding on animals.
00:01:35This body which can be deadly.
00:01:37We are racing against time.
00:01:40Oh, God, it's scary.
00:01:45Oh, God, it's scary.
00:01:50So today we're going to be...
00:01:55Operating on Liz, she's got quite a sizable plums...
00:02:00...tumor on the left-hand side of the back of her brain, quite deep, deep inside.
00:02:05The tumour is underlying a piece of brain that...
00:02:10...tumor controls vision, which is obviously a really important thing for anybody, but in particular...
00:02:15...it's at risk.
00:02:16We need to be extremely careful about the way we handle that brain.
00:02:19There's other things at risk as well, such as stroke, major stroke, bleeding...
00:02:24...insection, seizures and epilepsy.
00:02:27We do not really have any other...
00:02:29...option other than to operate.
00:02:30If we do not operate, it will continue to grow and may...
00:02:34...pose a real threat to her life.
00:02:37She's clearly good.
00:02:39She's going to be nervous.
00:02:40She's clearly going to be frightened.
00:02:41There's a lot of strength for Liz.
00:02:43She'll be surprised by some people's death.
00:02:45That's herך, she's really funny.
00:02:46She'll get into the weather.
00:02:47Look at her.
00:02:48Her head is racist.
00:02:50She'll be at her throat.
00:02:51And I should see her...
00:02:52...but she's got it.
00:02:53She's got it.
00:02:54She's got it.
00:02:55She's got it.
00:02:56She's got it.
00:02:57She can see her.
00:02:58It's a nice day.
00:02:59She's got it.
00:03:00She's got it.
00:03:02And it's a nice thing to talk to her.
00:03:03She's got it.
00:03:04She's got it.
00:03:05She's got it.
00:03:07She's got it.
00:03:09She's got it.
00:03:11She's got it.
00:03:12You got it.
00:02:48Hello!
00:02:50Thank you, thank you.
00:02:52Oh, hi, ladies.
00:02:53Ladies first, ladies first.
00:02:55How do you do? How do you do? It's so good to meet you.
00:02:57Yeah.
00:02:58Yeah, I'm fine.
00:03:00Thank you, sir.
00:03:02So, we're hoping to nip this...
00:03:03Yeah.
00:03:04...to get it all out and to essentially get you on with the rest of your life.
00:03:07Yeah.
00:03:08I really don't want to frighten you because you're frightened enough as it is.
00:03:12I can, you know...
00:03:13But the tumour is in a position, you know, next to the visual...
00:03:18...areas of the brain.
00:03:19It's also next to areas of planning your movement and...
00:03:23...so should anything be injured, you wouldn't expect just...
00:03:26...a right eye.
00:03:28It doesn't work like that.
00:03:29That would be an optic nerve injury.
00:03:30That's a relief.
00:03:31It would be the right side.
00:03:33...of both your eyes.
00:03:35Oh, both eyes?
00:03:36Yes, like that, you see, so...
00:03:38It's a little bit more complicated than one whole eye.
00:03:40And we will also be monitoring the activity...
00:03:43...of the cortex, that brain, while we're operating.
00:03:46Okay.
00:03:47To try...
00:03:48...and minimise it, but still a risk.
00:03:50Still a risk.
00:03:51But I will still have vision.
00:03:52Yes.
00:03:53Yes.
00:03:54Yes.
00:03:55It is...
00:03:56There isn't a clear operative...
00:03:58...factor that would lead you to be completely blind...
00:04:00Yes.
00:04:01...unless there was a very large...
00:04:03...stroke concerning the large blood vessel in the middle.
00:04:07So I'm not...
00:04:08...I'm not going to say it's impossible.
00:04:09You're a really sensible lady.
00:04:13And...
00:04:14...you know...
00:04:15...what we're doing.
00:04:16And there is a small risk to life.
00:04:18Yeah.
00:04:21So how...
00:04:22...how do you feel about all this?
00:04:23It's scary.
00:04:24Of course it is.
00:04:25Of course it is.
00:04:26It's very scary, but...
00:04:27...we...
00:04:28...you know...
00:04:29...we've talked about it.
00:04:30I've made...
00:04:31...the decision.
00:04:32And I take your advice.
00:04:33I've never been in your seat.
00:04:34So I can't imagine how difficult it is.
00:04:37But...
00:04:38...just assure that we will be...
00:04:39...being as careful as we possibly can be.
00:04:41At no moment we'll be taking it for granted.
00:04:43We'll really be trying to...
00:04:44...do the very best that we can.
00:04:46Yeah.
00:04:47Thank you David.
00:04:49Thank you very much.
00:04:50And I'll see you again very soon.
00:04:51Okay.
00:04:53Let me out.
00:04:55Thank you David.
00:04:56Not at all.
00:04:57Not at all.
00:04:58Not at all.
00:04:58I started to get migraine headaches...
00:05:00...which were unusual for me.
00:05:02Um...
00:05:03I'd had them years ago.
00:05:04But...
00:05:05...but nothing like this.
00:05:06And it was sort of...
00:05:07...every few weeks.
00:05:08...and...
00:05:09...um...
00:05:10...they felt a bit different really.
00:05:11So I thought I'd better go to the GP.
00:05:13He assured me he thought they were migraines...
00:05:15...and...
00:05:16...um...
00:05:17...but he said...
00:05:18...if you're worried I will send you for a CT scan.
00:05:21They looked it up.
00:05:23...and gave me the...
00:05:25...the shocker.
00:05:26Um...
00:05:27...and said that you've got to leave.
00:05:28...and I said...
00:05:29...you mean a tumour?
00:05:30And he said yes.
00:05:31Um...
00:05:33...so...
00:05:35...to lose my sight would be my biggest fear.
00:05:38I think.
00:05:39Um...
00:05:40...it's a scary prospect.
00:05:41It's your independence.
00:05:43Um...
00:05:45You can...
00:05:46...you can...
00:05:49...to establish.
00:05:50Right.
00:05:51...it's...
00:05:52...i know...
00:05:53...is...
00:05:54...merely.
00:05:55You can...
00:05:56...do lose your reach.
00:05:57I'm...
00:05:58...like...
00:05:59...ah...
00:06:00...as...
00:06:01...and...
00:06:02...is...
00:06:03...not...
00:06:04...the...
00:06:05...the...
00:06:06...the...
00:06:07...the...
00:06:08...the...
00:06:14Okay.
00:06:19So here we've got Liz's MRI scan.
00:06:23These are her eyes.
00:06:24This is Liz's nose.
00:06:26At the back part of her brain on the left hand.
00:06:29There it is.
00:06:30This is the meningioma.
00:06:33It's about...
00:06:34Four centimetres.
00:06:35It's a plum size.
00:06:38A lot of...
00:06:39A good sized plum.
00:06:40Or the size of perhaps a small, easy peel orange.
00:06:44The tumour is actually very deep.
00:06:45It's close to being in the middle of her head.
00:06:48So...
00:06:49Our approach.
00:06:51We will need to move the brain out of...
00:06:54The way.
00:06:55And then progress.
00:06:56To reach the tumour underneath it.
00:06:59The brain does not like to be moved.
00:07:00It really does not like to be moved.
00:07:02And this is something that we'll...
00:07:04We need to be very, very careful about.
00:07:09There are a great deal of risks.
00:07:12Critically, vision.
00:07:13This is...
00:07:14The vision.
00:07:15Cortex.
00:07:16So we need to be very careful working around here.
00:07:19The other problem is...
00:07:21There's large blood vessels around the area in which...
00:07:24We wish to enter.
00:07:25These are referred to as the sagittal sinus.
00:07:28It is not...
00:07:29A blood vessel which is like a hose.
00:07:31It is more like a...
00:07:33Carrier...
00:07:34A bag.
00:07:35Full of blood.
00:07:36And therefore is very difficult to repair.
00:07:38Should actually...
00:07:39We injure it.
00:07:40Any injury to this...
00:07:41Greatly increases the risk of stroke fillers.
00:07:44Any injury to the...
00:07:45I'm going to...
00:07:46Take off.
00:07:47Take off.
00:07:48We get under the trolley.
00:07:49Sorry about the...
00:07:49We're in a window at the moment.
00:07:50We have an opportunity to remove this.
00:07:54And hopefully, strong word, we don't often use it in neurosurgery, but we...
00:07:59We will hope to cure her.
00:08:15Hi.
00:08:16Oh, I don't...
00:08:20See you later.
00:08:21Yeah, I'll see you the other side.
00:08:23Okay.
00:08:24Be okay.
00:08:25Yep.
00:08:26Only a few hours.
00:08:27We'll be back.
00:08:28Yep.
00:08:29See you later.
00:08:30See you later.
00:08:31Okay.
00:08:32Thank you very much.
00:08:33Bye then.
00:08:34Bye.
00:08:35Bye.
00:08:36Bye.
00:08:37Bye.
00:08:38Bye.
00:08:39Bye.
00:08:40Bye.
00:08:41Bye.
00:08:42Bye.
00:08:43Bye.
00:08:44Bye.
00:08:45Bye.
00:08:46Bye.
00:08:48Bye.
00:08:49Bye.
00:08:54Bye.
00:08:55Bye.
00:08:56Bye.
00:08:57Bye.
00:08:58Bye.
00:08:59Bye.
00:09:00Bye.
00:09:01Bye.
00:09:02Bye.
00:09:03Bye.
00:09:04Bye.
00:09:04Bye.
00:09:05Bye.
00:09:06Bye.
00:09:07Bye.
00:09:08Bye.
00:09:09Bye.
00:09:10Bye.
00:09:11Bye.
00:09:12Bye.
00:09:13Bye.
00:09:14Bye.
00:09:15Bye.
00:09:16Bye.
00:09:17Bye.
00:09:18Bye.
00:09:19Bye.
00:09:20Bye.
00:09:21Bye.
00:09:22Bye.
00:09:23Bye.
00:09:24Bye.
00:09:25Bye.
00:09:26Bye.
00:09:27Bye.
00:09:28Bye.
00:09:29Bye.
00:09:30Bye.
00:09:31Bye.
00:09:32Bye.
00:09:33Bye.
00:09:09And once I've seen the tumour, I'll be happier because I know I'm in the right place.
00:09:14There's a lot at stake for Liz, a successful outcome.
00:09:19We'll allow her to live the rest of her life as she's living it now, an independent lady.
00:09:24If we either do nothing or the surgery is dogged.
00:09:29By complication, she has the capacity to lose all of that.
00:09:33It's...
00:09:34Possibly one of the most significant moments of her life.
00:09:44Hello, my investors!
00:09:51Hello.
00:09:53Hello.
00:09:55Hello.
00:09:59Hello.
00:10:01Hello.
00:10:03What's the plan to see the side of the side?
00:10:06So it is a left side...
00:10:08...craniotomy or occipital meningioma.
00:10:11Principal steps.
00:10:13Drilling over the sinus.
00:10:18Let's just get it in a position that we can work with it.
00:10:22We will set up...
00:10:23...our image guidance...
00:10:25...which is essentially our sat nav.
00:10:27So that where we know...
00:10:28...in space where any part of her head and brain are...
00:10:32...in order to plan...
00:10:33...the position of our craniotomy.
00:10:37I do like to see...
00:10:38...what we're doing.
00:10:39So that's our tumour dead centre.
00:10:42I'm just marking the midline.
00:10:43There's a very large vein there...
00:10:45...but we want to make sure we know where it is.
00:10:48And the tumour we know...
00:10:49...just lies next to that vein.
00:10:52Mid...
00:10:53Mid tumour...
00:10:54...lateral border, yeah.
00:10:55Yeah.
00:10:56Right, so tumour dead centre is...
00:10:58...there.
00:10:59That might be here.
00:11:00Okay.
00:11:01Let's get rid of some of this lovely...
00:11:03...her hair, unfortunately.
00:11:04Bless you.
00:11:08That...
00:11:11...is our incision.
00:11:14And...
00:11:15...our craniotomy will be...
00:11:17...summing around.
00:11:18...like...
00:11:19...like that, as you say.
00:11:22Okey doke, let's start.
00:11:23Swab and knife.
00:11:25Swab and knife.
00:11:27Swab and knife.
00:11:28Swab and knife.
00:11:29Saw the clock.
00:11:30Yeah...
00:11:31We will do a...
00:11:32...a sort of...
00:11:33of two-piece opening.
00:11:36Nice bath, thank you.
00:11:38We use this monopolar to stop the bleeding as we go through.
00:11:43When you use a knife it can just cut through all the blood vessels and you get a lot of
00:11:46bleeding.
00:11:47The one thing we don't like...
00:11:48neurosurgery is blood. We're now just stripping.
00:11:53The muscles off the surface.
00:11:58The skull, lovely.
00:12:00Should we do midline and sinus?
00:12:02So we just mark...
00:12:03Marking out these big blood vessels that we want to know where they are.
00:12:06Yeah, we'll go...
00:12:07Oh!
00:12:08Like that.
00:12:09Just round the outside of it.
00:12:10And then we'll have one, two...
00:12:13Three barrels, just the other side.
00:12:16This essentially...
00:12:18Is our craniotomy.
00:12:20Yeah, do the distal one.
00:12:21Lovely.
00:12:22And suction to myself.
00:12:23Thanks.
00:12:24Nice and perpendicular.
00:12:25Good one, Nick.
00:12:28Good one, Nick.
00:12:29Good one.
00:12:30Good one.
00:12:31Good one.
00:12:32Good one.
00:12:33So this is a bit that we're a bit careful about because we're going right over the sinus.
00:12:38And that's a big, big blood vessel.
00:12:40We need to be careful.
00:12:43Multiple things that we need to worry about.
00:12:45If it actually gets damaged...
00:12:48Clots off.
00:12:49That can cause massive stroke.
00:12:51If it bleeds and gets injured...
00:12:53For example, if the drill catches it and tears it...
00:12:56You can bleed out.
00:12:58People have died within minutes.
00:13:03But it's childcare...
00:13:04No
00:13:08What's up?
00:13:09What's up?
00:13:10I'm not gonna hear you.
00:13:11But I'm not gonna hear you.
00:13:12How are you?
00:13:13Matthew's 37 and he has the condition...
00:13:18...of his heart where the chains of the heart are swollen and that means the heart...
00:13:23...doesn't pump as efficiently as it should do.
00:13:28He's been in the hospital with us now for about three weeks and his heart is...
00:13:33...pulling so poorly that we need to put him on a special machine, a bivad, which sits outside...
00:13:38...of his body and takes over the function of his heart.
00:13:41It's a temporary device.
00:13:43And it can only stain for so long.
00:13:45So he needs a heart transplant.
00:13:48Matt has a chance of dying if he doesn't get the operation but equally there's a chance...
00:13:53...not dying if he does get an operation.
00:13:56Are you okay?
00:13:57Yeah, I'm okay.
00:13:59I'm okay.
00:14:01You want me to go down.
00:14:02I'm sorry.
00:14:03You're not you.
00:14:04I'm sorry.
00:14:05You're not here for us.
00:14:06You're just the best as I can like this.
00:14:08You're not coming.
00:14:09I'm not happy with this.
00:14:10I don't like this...
00:14:11...you're not here.
00:14:12You're not here.
00:14:14So he needs to be rebuttal to me.
00:14:16You're not here for me, but...
00:14:20You're not here for me to come to the hospital.
00:14:22That's right.
00:14:24I need to get to the hospital.
00:14:25efficiently and so matt's in real trouble when that happens being on the
00:14:30bivads means that this is a time pressured situation for matt he's been placed on the highest category
00:14:35of heart transplant wages in the country the super urgent list
00:14:40without a transplant he would die
00:14:45before this happened i was a very keen cyclist and i used to
00:14:50uh he's sort of like a good amateur road cyclist so lots of
00:14:55lots of races up and down the country very fit very
00:15:00one knows fitness fanatics and i've been staying with my dad and
00:15:05they had a noise one thursday night
00:15:10he was lifeless on the bed um so
00:15:28you
00:15:15so i pulled him onto the floor and we started cpr
00:15:20and that did come round which was amazing i did feel his his ribs cracked
00:15:25which you hear you know when you do cpr properly you do break
00:15:37you
00:15:30ribs so so i heard that
00:15:35so we put him into recovery position
00:15:36so we put him into recovery position not long later the first of the
00:15:39um uh first responder turn up
00:15:53you
00:15:44so my dad called me got myself to the hospital and they took us into like the little family room
00:15:58you
00:15:50and said like we're in a quite a precarious situation now
00:16:05you
00:15:54Um, we need to do something quite fast, basically.
00:15:59It's hard to suddenly find themselves in here, strapped to a machine, knowing that was cute.
00:16:04I mean, I'm currently just playing the waiting game until they...
00:16:09...come and tell me they might have a heart for me.
00:16:13Love you.
00:16:14Every day without a new...
00:16:19...the new heart is critical for MAP.
00:16:21We're now waiting for a phone call to say that a suitable heart is available.
00:16:24Hello?
00:16:27Hey, hey, hey, hey, Simon.
00:16:29You all right?
00:16:34Thanks very much, Simon.
00:16:35Appreciate that.
00:16:36I think that sounds reasonable.
00:16:37I think it's a reasonable thing to...
00:16:39...to proceed.
00:16:41We've had phone calls saying there's a donor heart...
00:16:44...and we're in the process of assessing that heart.
00:16:48This heart will...
00:16:49...will mean a new life for MAP.
00:16:51We know that with a transplant, MAP has the best chance of...
00:16:54...long-term survival and a good outlook.
00:16:57I'm assuming that you know his heart...
00:16:59...fighting waste.
00:17:00Yes, I've got it all.
00:17:01Yeah, yeah.
00:17:02Fine.
00:17:05This means everything to Matthew.
00:17:06It will mean a huge amount to him and his family.
00:17:09Hello.
00:17:10Hello.
00:17:11Hello.
00:17:12Are you okay?
00:17:13Yeah.
00:17:14How are you feeling?
00:17:14Nervous.
00:17:15Yeah?
00:17:16So, as soon as everything is together, we are going.
00:17:18Yeah.
00:17:19The heart looks good.
00:17:19Brilliant.
00:17:20Yeah.
00:17:21The team are happy with the function.
00:17:22Brilliant.
00:17:23So, no sign of any disease.
00:17:24It's overcome every hurdle, so...
00:17:25Yeah.
00:17:26Yeah, brilliant.
00:17:27This is the good part.
00:17:28Yeah, yeah, yeah.
00:17:29It's an honour.
00:17:29I'm a bit dazed.
00:17:30No, of course you are.
00:17:31That's absolutely fine.
00:17:32Are you okay?
00:17:33Yeah, yeah.
00:17:35Have you got any tissues?
00:17:36Are there any tissues?
00:17:37No, that's me!
00:17:38Oh, my God!
00:17:39So, what happens from here is...
00:17:44The perfusionists will get...
00:17:45They look after the machine, so we're kind of...
00:17:47Yeah.
00:17:48Dictated by them and get...
00:17:49Getting everything together.
00:17:50Yeah.
00:17:51We'll go round to theatre, we'll skip the anaesthetic room...
00:17:54Because of the size of the machine, stay with you until you're fast asleep.
00:17:57Yeah.
00:17:58And then throughout, we'll be there.
00:17:59Yeah.
00:17:59Okay.
00:18:01Yeah, yeah, thank you very much.
00:18:02Okay.
00:18:03Thank you so much.
00:18:04Okay.
00:18:04It's definitely fast.
00:18:05I know, yeah.
00:18:06It's faster than we thought, isn't it?
00:18:07Yeah.
00:18:08I'm excited.
00:18:09I'm super nervous.
00:18:10I...
00:18:11I don't really know.
00:18:12I just...
00:18:13It's a whole new experience, obviously.
00:18:14I just don't like what it does to other people.
00:18:16Sorry.
00:18:17I'm just emotional.
00:18:18And what it puts them through.
00:18:19She's been...
00:18:20Been my rock.
00:18:21We've been dating, what, five months before this happened?
00:18:24But we've been talking about all sorts of things.
00:18:26Marriage, kids, moving in together.
00:18:29It is.
00:18:30No.
00:18:31So...
00:18:32Yeah.
00:18:33It just...
00:18:34I don't know.
00:18:35I think we just opened...
00:18:34Up to each other, perhaps in a way that...
00:18:36You wouldn't necessarily, if you weren't...
00:18:37Yeah.
00:18:38In a situation...
00:18:39Like this.
00:18:40Um...
00:18:41But...
00:18:42That...
00:18:43You know...
00:18:44That's, I think, sometimes...
00:18:44Some of the benefits of these situations.
00:18:45You know?
00:18:46You...
00:18:47You realise how much you love someone.
00:18:48And...
00:18:49Uh...
00:18:50Yeah.
00:18:51It's a nice thing to realise.
00:18:53So...
00:18:54Yeah.
00:18:54Yeah.
00:18:56So...
00:18:57He's got so many things...
00:18:58He's got so many things to 있.
00:18:59he wants to do, wants to get out and see the world and do things.
00:19:04And I think this hopefully will let him.
00:19:09New beginning.
00:19:10I'm trying.
00:19:11I want my eyes.
00:19:12I get it all the time.
00:19:13Come on.
00:19:14Come on.
00:19:15Come on.
00:19:16Come on.
00:19:17Come on.
00:19:18Come on.
00:19:19Come on.
00:19:20Bye.
00:19:21Bye.
00:19:22Bye.
00:19:23Yeah.
00:19:24Bye.
00:19:25Bye.
00:19:26Bye.
00:19:29Bye.
00:19:30Bye.
00:19:31Bye.
00:19:32Bye.
00:19:33Bye.
00:19:34Bye.
00:19:35Bye.
00:19:37Bye.
00:19:38Bye.
00:19:39Bye.
00:19:40Bye.
00:19:41Bye.
00:19:42Bye.
00:19:43Bye.
00:19:44Bye.
00:19:46Bye.
00:19:47Bye.
00:19:48Bye.
00:19:49Bye.
00:19:50Bye.
00:19:51Bye.
00:19:52Bye.
00:19:53Bye.
00:19:54Bye.
00:19:55Bye.
00:19:56Bye.
00:19:57Bye.
00:19:58Bye.
00:19:59Bye.
00:20:04Bye.
00:20:09Bye.
00:20:11Bye.
00:20:12Bye.
00:20:13Bye.
00:20:14Bye.
00:20:15Bye.
00:20:16Bye.
00:20:17Bye.
00:20:18Bye.
00:20:19Bye.
00:20:20Bye.
00:20:21Bye.
00:20:22Bye.
00:20:24Bye.
00:20:25Bye.
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00:20:27Bye.
00:20:29Bye.
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00:20:32Bye.
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00:21:00Bye.
00:21:05Bye.
00:21:10Bye.
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00:22:00Bye.
00:22:01Bye.
00:22:02Bye.
00:22:03Bye.
00:22:04Bye.
00:22:05Bye.
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00:22:07Bye.
00:22:08Bye.
00:22:09Bye.
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00:22:47Bye.
00:22:48Bye.
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00:22:50Bye.
00:22:51Bye.
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00:22:54Bye.
00:22:55Bye.
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00:22:58Bye.
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00:23:01Bye.
00:23:02Bye.
00:23:05Bye.
00:23:07Bye.
00:23:08Bye.
00:23:10Bye.
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00:23:12Bye.
00:23:13Bye.
00:23:14Bye.
00:23:15Bye.
00:23:17Bye.
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00:23:45Bye.
00:23:46Bye.
00:23:47Bye.
00:23:48Bye.
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00:24:00Bye.
00:24:02Bye.
00:24:03Bye.
00:24:04Bye.
00:24:05Bye.
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00:24:11Bye.
00:24:12Bye.
00:24:13Bye.
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00:24:15Bye.
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00:25:00Bye.
00:25:01Bye.
00:25:02Bye.
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00:26:00Bye.
00:26:03Bye.
00:26:04Bye.
00:26:05Bye.
00:26:10Bye.
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00:26:12Bye.
00:26:13Bye.
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00:26:15Bye.
00:26:16Bye.
00:26:17Bye.
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00:26:19Bye.
00:26:20Bye.
00:26:21Bye.
00:26:22Bye.
00:26:23Bye.
00:26:24Bye.
00:26:25Bye.
00:26:26Bye.
00:26:27Bye.
00:26:28Bye.
00:26:29Bye.
00:26:30Bye.
00:26:31Bye.
00:26:32Bye.
00:26:33Bye.
00:26:34Bye.
00:26:35Bye.
00:26:36Bye.
00:26:37Bye.
00:26:38Bye.
00:26:39Bye.
00:26:15Now we're just trying to identify the structure of the heart so we can take this heart out safely.
00:26:20It's one of the crucial steps in this operation.
00:26:25Yeah.
00:26:30yes please
00:26:33bye
00:26:35half eight
00:26:38arrival
00:26:40Chris at the wear room
00:26:41now at half eight
00:26:45arrival
00:26:45the transport company
00:26:49have just found
00:26:49to say that they
00:26:50made a bit of
00:26:51headway with their
00:26:52travel time
00:26:53ETA 20 minutes
00:26:55right
00:26:56thanks in progress
00:26:56biggest worry now
00:27:00is that we
00:27:00need to be ready
00:27:01to take Matt's
00:27:01heart out
00:27:02as soon as the
00:27:03donor heart arrives
00:27:05these are the pipes
00:27:06which will connect
00:27:07Matthew to the
00:27:09heart and lung
00:27:09machine
00:27:10so the heart-lung
00:27:11machine takes over
00:27:12the function of the
00:27:14patient's heart and
00:27:15lungs
00:27:16and that
00:27:16makes sure the
00:27:18patient stays alive
00:27:19while the heart's not
00:27:19beating
00:27:20because it's then
00:27:20sending oxygenated
00:27:22blood around
00:27:24to the
00:27:25brain
00:27:25and the rest of the
00:27:26body
00:27:26and then we'll
00:27:28remove Matthew's
00:27:29heart
00:27:30and implant the
00:27:31new heart
00:27:35okay
00:27:37okay
00:27:40okay
00:27:40just give me one
00:27:41second
00:27:42we're gonna go down
00:27:44to meet the team
00:27:44okay
00:27:45this is a time-critical
00:27:49part of the operation
00:27:50this is a time-critical part of the operation
00:27:50the donor heart's arrived
00:27:52and the longer it stays out of the body
00:27:53the greater the chance of it failing
00:27:55if that happens
00:27:57Matt could die
00:27:58if that happens Matt could die
00:27:58if that happens Matt could die
00:28:00so we're just going outside to meet the retrieval surgical team
00:28:05to get the heart
00:28:07and escort them up to theatre
00:28:10okay
00:28:15after you guys
00:28:16we have to
00:28:20move quite quickly
00:28:21just in order to optimise the outcome of the heart
00:28:24then
00:28:25we can work to implant it straight away
00:28:27okay
00:28:29so it's theatre
00:28:30which is just this one
00:28:32the heart is in a perfusion
00:28:35device
00:28:36it reanimates the heart
00:28:40perfuses it with blood supply
00:28:42and pastes it
00:28:42so it's a beating heart
00:28:43outside the body
00:28:44hi
00:28:45the heart has arrived
00:28:46thank you
00:28:46successful
00:28:50yep
00:28:51on you go
00:28:54okay
00:28:55going on
00:28:55bypass
00:28:56okay
00:28:58so we're only on bypass now
00:29:00so we're on the heart lung machine now
00:29:05the next stop
00:29:07the next stop will be to stop Matt's heart
00:29:09and then take it
00:29:10open out
00:29:10so the heart of
00:29:15so the heart of
00:29:15so the heart of
00:29:15so the heart of
00:29:15It's stock completely now.
00:29:20It's stock completely now.
00:29:25So now we're going to stop.
00:29:30It's removing Matt's heart.
00:29:33Seven inches.
00:29:34It gave us the auto.
00:29:35The heart is about to come out.
00:29:40And the heart is out.
00:29:45Significant member for Maske.
00:29:50This is the point of no return from that.
00:29:52We've taken his old heart out and we can't put it back in.
00:29:55If the new heart doesn't work, then Matt may not make it through.
00:30:00So now we're going to stop.
00:30:01We're going to stop.
00:30:02We're going to stop.
00:30:03We're going to stop.
00:30:04Let's go.
00:30:05Let's go.
00:30:06Let's go.
00:30:07Let's go.
00:30:09Let's go.
00:30:10Let's go.
00:30:11Let's go.
00:30:15Let's go.
00:30:16Let's go.
00:30:17Let's go.
00:30:19Let's go.
00:30:20Let's go.
00:30:21Let's go.
00:30:22Let's go.
00:30:24Let's go.
00:30:26This is essentially inside the belly of the beast.
00:30:29We are literally inside.
00:30:30in the tumour now.
00:30:31And it seems to be, it's bleeding quite a lot.
00:30:36It's just bleeding a lot.
00:30:37I'm trying to get behind it.
00:30:38And every time I move it.
00:30:39It's more or less that.
00:30:40Lovely.
00:30:41Every time I move it.
00:30:42It bleeds.
00:30:45This in many ways is one of the most worrying bits of the surgery.
00:30:50We need to cut it down very well.
00:30:51I'm trying to get behind this.
00:30:52We need to cut it off.
00:30:53We need to cut it off.
00:30:54We need to cut it off.
00:30:55Let's go.
00:30:56Let's go.
00:30:57Let's go.
00:30:58Let's go.
00:30:59Let's go.
00:30:55oh no it's bleeding to be honest it's just
00:31:00in a way quite badly now
00:31:05get on top of it
00:31:09oh dear me
00:31:10oh
00:31:15I like that
00:31:17I like that
00:31:20no this is not great
00:31:25no
00:31:26no
00:31:27no
00:31:28no
00:31:29yeah
00:31:30if you clad it there
00:31:32buzz the outside of the tumour
00:31:33yep
00:31:35we're doing some cauterization to try and stop the bleeding
00:31:39we're doing some cauterization to try and stop the bleeding
00:31:40we're doing some cauterization to try and stop it
00:31:44yeah
00:31:45There we are, so the bleeding now is actually under a bit more control.
00:31:50We can make headway for...
00:31:55Although the bleeding has stopped, the vessel is still attached to the tube.
00:32:00Before I can take the tumour out, I really need to get underneath it and separate...
00:32:05...it from the vessel.
00:32:06So what we've been doing so far is essentially trying...
00:32:10...to get round it very gently.
00:32:13But it's...
00:32:15...it's getting to the point now where we want to really just try and get it out more quickly.
00:32:21She doesn't have time...
00:32:24...to stay under...
00:32:25...under anesthetic all day and...
00:32:28...put up with the stress of this...
00:32:30...that's happening all day.
00:32:32Let's start making some bloody progress.
00:32:35Let's go.
00:32:36Let's go.
00:32:37Let's go.
00:32:38Let's go.
00:32:39Let's go.
00:32:40Let's go.
00:32:41Let's go.
00:32:42Let's go.
00:32:43Let's go.
00:32:44Let's go.
00:32:45Let's go.
00:32:46Let's go.
00:32:47Let's go.
00:32:48Let's go.
00:32:49Let's go.
00:32:50Let's go.
00:32:51Let's go.
00:32:52Let's go.
00:32:53Let's go.
00:32:54Let's go.
00:32:55Let's go.
00:32:56Let's go.
00:32:57Let's go.
00:32:58Let's go.
00:32:59Let's go.
00:33:00Let's go.
00:33:01Let's go.
00:33:02Let's go.
00:33:03Let's go.
00:33:04Let's go.
00:33:05Let's go.
00:33:06Let's go.
00:33:07Let's go.
00:33:08Let's go.
00:33:09Let's go.
00:33:10Let's go.
00:33:11Let's go.
00:33:12Let's go.
00:33:13and um that's unfortunate we are going in between
00:33:18rather um to the side of the part of the brain that controls vision
00:33:23and uh we're having to move it out the way and keep it out the way while we work on
00:33:28the tumor it's actually quite challenging because we have to keep giving it rest and now
00:33:33it seems that we may have irritated it a little bit it's still working but there is a reduction in
00:33:38the actual signal that we're getting so um it means probably just have to proceed
00:33:43and get it out as quick as possible
00:33:48attraction in general it's squirming
00:33:53come on come on you bastard let me get the
00:33:58idea oh my god that is oh yes
00:34:03oh bloody right yeah we're on the right side of it now i'll hold it there yeah good lad
00:34:08lad oh that's that's better that's better we're on the other
00:34:13side of it this is the underside of the tumor this is the back of it
00:34:28you
00:34:18there it is
00:34:34so this is where the two
00:34:23comes from and gets his blood supply from this fit now
00:34:28so this is where the two of them
00:34:46you
00:34:33You
00:34:38I think we're nearly there now. Here it is. Here's the tumour.
00:34:43Just got around it all the way.
00:34:48And...
00:34:53And last, big wash, thanks.
00:34:58We've got it out now.
00:35:01So it's now just a matter of...
00:35:03Sorting out all the leftover bleeding and hopefully finishing.
00:35:08Give her a nice photo.
00:35:13Just removing all of her monitoring.
00:35:18Cleaning her up.
00:35:19Making sure that essentially she's able to wake up comfortably.
00:35:23And safely.
00:35:28So.
00:35:29So.
00:35:30So.
00:35:32So.
00:35:33So.
00:35:36By now I feel I've done my job.
00:35:38To the best of my ability.
00:35:39But.
00:35:40What's going through our mind now is whether or not we've done any serious damage.
00:35:43It was a vision.
00:35:44But you never know.
00:35:45You just simply.
00:35:48Do not know until they wake up.
00:35:53Plan theiox what.
00:35:54I'm done.
00:35:55그리 sú.
00:35:56Too many.
00:35:57There's nothing next time.
00:35:58Like walking.
00:35:59And now I got hit.
00:36:00You can change around calling calling calling calling calling calling calling calling calling calling calling calling calling嫌 calling name calling calling calling calling calling calling calling calling..
00:36:02How?
00:36:03Welcome.
00:36:04T Clyde officer.
00:36:05This video show you can change it.
00:36:06Needed it.
00:36:07Let me know.
00:36:09But it's only apload instead of leaving.
00:36:10Whatos all your availability games.
00:36:12Just make sure we've noticed.
00:36:13I can agree with that.
00:36:14This recording will soon.
00:36:15I'm trying to but not really not for 저는.
00:36:17It's really very important.
00:36:18I'll go ahead and why we wanted to put in the car.
00:36:20All of these kinds of things.
00:36:21Why are nothing going through this part way.
00:36:22The tissues are necrotic and rotten and actually smelling.
00:36:27That's why it's having a great impact on our life.
00:36:31We're going to be planning.
00:36:32We're planning to remove this tumour quickly.
00:36:37We can also reconstruct the chest wall because if we leave it, it will be...
00:36:42in an opera with an act you can kill it.
00:36:47Hey!
00:36:48How are you feeling?
00:36:49Scared.
00:36:50Nervous.
00:36:51I am.
00:36:52Hmm.
00:36:54My breast was getting larger and I was just high.
00:36:57You shut down, didn't you?
00:36:58I shut down, yeah.
00:36:59I shut down, yeah.
00:37:00I shut everyone out.
00:37:02And I've been, yeah, I've kept pushing people away.
00:37:06So...
00:37:07I didn't have to spend time with people.
00:37:09So I'm in Harley's and she's come home.
00:37:12from work and she's asked me several times what the smell was.
00:37:17She...
00:37:17She thought I had an infection so she was going to phone the doctors to get this one.
00:37:22antibiotics.
00:37:23In the end, I said it's not an infection.
00:37:26Well, it is an infection.
00:37:27It's a big infection.
00:37:28It's a big infection.
00:37:29But I showed her...
00:37:30I didn't show her...
00:37:32the tumour.
00:37:33I showed her my breast and...
00:37:37it was just so upsetting.
00:37:39And we went to the hospital.
00:37:41I think she's...
00:37:42she said, I'm dying.
00:37:43And this big lump appeared.
00:37:45When I took her to A&E...
00:37:47I said to the receptionist, I said,
00:37:49my mum has got a lump.
00:37:51I said, and it's...
00:37:52the size of my head.
00:37:54Like, we need to be seeing...
00:37:55That's what she said.
00:37:56...right now.
00:37:58It's just knocked you for six, hasn't it?
00:38:00Yeah.
00:38:01It has.
00:38:02It's took over my whole life.
00:38:05Because everything is...
00:38:07to think...
00:38:08from when you wake up...
00:38:09till you go to sleep at night...
00:38:11I have a...
00:38:12I have a potato.
00:38:13And this...
00:38:14Okay?
00:38:15Now...
00:38:17You are not real.
00:38:18I still have...
00:38:19your choice already.
00:38:20And today...
00:38:21something...
00:38:22the way to hang...
00:38:23your wife is true.
00:38:24Your wife...
00:38:25because the penalty...
00:38:26you're not really...
00:38:27it's hard to reach out of water.
00:38:28You'll give your bills....
00:38:31your clothes.
00:38:32...until to...
00:38:32how to hang...
00:38:33...your clothes.
00:38:33Your clothes is!
00:38:34You are usually too...
00:38:35and this is something...
00:38:36What's very...
00:38:37is...
00:38:39for my子 follower.
00:38:40I will give you...
00:38:41the tumour is starting to appear there, big lump there as we're going, this is...
00:38:46growing up, this is over 20 centimeters plus, you can see it is...
00:38:51protruding through the skin here, and it's forming like a mushroom.
00:38:56Some type of, you know, growth there.
00:38:59Ghana has had this tumour for four months.
00:39:01This area is now infected because it is...
00:39:06not covered by skin.
00:39:08And it's invading the ribs there, this is the...
00:39:11rib there, this is another rib there, and then the muscles in between the ribs.
00:39:15All this is in...
00:39:16the tumour is invading that.
00:39:18And...
00:39:19so the...
00:39:20the plan for...
00:39:21the surgery, it's...
00:39:22to try to get this big tumour out.
00:39:26in a safe way, and also at the same time, including a negative marginal...
00:39:31as much as possible surgical margin around the tumour.
00:39:36A surgical margin means that there is no cancer left behind.
00:39:40This very...
00:39:41very rare tumour has a very high instance of recurrence coming back...
00:39:46if we do not get a surgical margin.
00:39:49The risks involves...
00:39:51bleeding...
00:39:52surgical site infection...
00:39:53problems with infection in the chest.
00:39:56we call it pneumonia...
00:39:57that could end up by respiratory failure, which means...
00:40:00she...
00:40:01she cannot breathe...
00:40:02she has a big battle ahead of her.
00:40:04We are racing...
00:40:06again it's time.
00:40:08Good luck.
00:40:09Don't.
00:40:10Don't do that.
00:40:12Good luck.
00:40:13Love you.
00:40:14Love you.
00:40:15Love you.
00:40:16Love you, Anne.
00:40:20I think she was really...
00:40:21scared.
00:40:22She was really scared.
00:40:23And that's why she's hid it.
00:40:25I've got...
00:40:26been thinking...
00:40:27well...
00:40:28what did I miss?
00:40:29Where...
00:40:30where was the point that I should have picked up on this?
00:40:31that Anna wasn't?
00:40:32Hello.
00:40:33Hello.
00:40:34Anna.
00:40:35Nice to meet you.
00:40:36Nice to meet you.
00:40:36My name is Hannah.
00:40:37I'm your theatre sport worker.
00:40:38I'll be taking you down to surgery.
00:40:39Hi.
00:40:40I'll be...
00:40:41with you throughout the whole surgery.
00:40:42So if you feel nervous or anything...
00:40:44you've got my hand to squeeze.
00:40:47Mum's very, very strong.
00:40:50Mum's trying to...
00:40:51stay in the most positive...
00:40:52frame of mind for her.
00:40:54Because I just think she needs...
00:40:56people around her...
00:40:57that are saying...
00:40:58it's going to be fine...
00:40:59and we are going to get through there.
00:41:01We will get rid of there.
00:41:02We will get rid of there.
00:41:06it's not too late.
00:41:09No words?
00:41:10No word?
00:41:11I hear no numbers.
00:41:15Why can't I explain how her never will be left here?
00:41:31Why can't I just go to give birth?
00:41:34Yeah.
00:41:39Good morning, come on, I'm Sam, good guy.
00:41:44I've come to hold your hand.
00:41:49Relax your hand though.
00:41:51Now let us do our magic.
00:41:54You've been happy for what type of guy?
00:41:56It's going to fall into the night.
00:41:59That was good.
00:42:04The challenge is to make sure that we...
00:42:09...remove this tumour with a good safety margin.
00:42:13And also...
00:42:14Try to avoid contamination of the surgical fields.
00:42:19It's a very complex operation.
00:42:21She has a very high risk of bleeding, infection...
00:42:24...a clot in her leg...
00:42:26...which can travel to her lungs.
00:42:28But if she...
00:42:29...doesn't have the surgery...
00:42:30...we know there's only one outcome...
00:42:32...which is basically the tumour...
00:42:34...of going...
00:42:35...and invading all her body...
00:42:37...and eventually losing her life.
00:42:39We have to do the best...
00:42:41...as a multidisciplinary team for us.
00:42:44So, blood pressure...
00:42:49...yeah.
00:42:50I'm happy.
00:42:53This surgery is gone.
00:42:54It's very complex...
00:42:55...and high risk.
00:42:56So, we need two surgeons.
00:42:58My throat...
00:42:59...the colleague Mr. Calcutt...
00:43:00...will be removing the tumour...
00:43:02...and Anna's affected ribs.
00:43:04And then we'll reconstruct Anna's chest wall...
00:43:07...after the infected...
00:43:09...and Anna's has been taken away.
00:43:11We'll take the dressing off...
00:43:13...and...
00:43:14...then we will clean the area around it...
00:43:16...and then we'll isolate that mask...
00:43:18...because...
00:43:19...it has opened up...
00:43:20...and it is smelling...
00:43:22...and it is going to be infected.
00:43:25The things which concern us is...
00:43:27...this is infected mask...
00:43:28...so we...
00:43:29...we have to make sure...
00:43:30...the surgical field remains sterile...
00:43:33...if not...
00:43:34...or the infection can spread...
00:43:35...to the surrounding tissues.
00:43:38Can I hear?
00:43:39Remove the dressing now, guys.
00:43:44Come in, this is myissa Выplac's première.
00:43:50...Ivoặc get on.
00:43:51It's making sure this...
00:43:52... parameters...
00:43:55...gotten close by...
00:43:57...but...
00:43:59...you can dont do good mix...
00:44:00...and...
00:44:03...evalid panties...
00:44:05When we open a star baby...
00:44:08...to...
00:44:10Step, step, step, step, step, step.
00:44:15Oh
00:44:20It has grown to that size so rapidly that it has just...
00:44:25...opened up. It is all that dead tissue which is...
00:44:30...infracted.
00:44:32There's no breast tissue. All the breast has been replaced.
00:44:35That's why the tumour itself.
00:44:37Now the tumour is exposed, we really have to work carefully...
00:44:40...so the infected mass doesn't contaminate any other parts of Anna's body.
00:44:45I'm sorry.
00:44:50Hello, please send me a reception.
00:44:56How can I help?
00:45:25to take the heart off the perfusion machine, the OCS machine.
00:45:30Go for it, take it off the rig.
00:45:35The heart is out.
00:45:40All right, thank you very much.
00:45:45It's important to implant the heart as quickly as possible.
00:45:50Because at the moment the heart is not getting a blood supply to it.
00:45:55We know that the longer the heart is out of the body, the...
00:46:00the worse the outcome and the risk of the patient dying.
00:46:06We want the heart to get the oxygen and the blood
00:46:08and its normal nutrients back to it.
00:46:10As quickly as possible.
00:46:12So we just need now to trim things to the right.
00:46:15Thanks.
00:46:16We can serve it in.
00:46:17Hold on.
00:46:18Very careful there.
00:46:21Okay, fine.
00:46:22There's things at the back.
00:46:23Let's take that.
00:46:24So on.
00:46:25One.
00:46:26Two.
00:46:27This is...
00:46:29Three and four.
00:46:30That's all right.
00:46:31Can I have a swab, please?
00:46:32Water on the blues, please?
00:46:33Okay.
00:46:35Two.
00:46:36Two.
00:46:37Two.
00:46:38Two.
00:46:39Two.
00:46:40Two.
00:46:41Two.
00:46:42Three.
00:46:43Two.
00:46:44Three.
00:46:45Two.
00:46:46Two.
00:46:47Six.
00:46:48Ten.
00:46:49Two.
00:46:50Two.
00:46:51Three.
00:46:52.
00:46:54Three.
00:46:55Eight.
00:46:56One.
00:46:58Three.
00:46:58Three.
00:46:59Ten.
00:47:00Three.
00:47:01Eight.
00:47:02二.
00:47:03Six.
00:47:04One.
00:47:07Three.
00:47:08Two.
00:47:09So please pull me out.
00:47:14So now we've joined all the bits of the heart up and in a moment, we're going to.
00:47:19Let the blood flow back into the heart.
00:47:22So we gradually...
00:47:24Reduce the flow of blood from the heart-lung machine and start...
00:47:29...to return the blood back to the body.
00:47:32So that's the point at which we...
00:47:34...to see whether the heart starts to beat or not.
00:47:39I gently run some warm blood into the roof.
00:47:42Gently running some warm blood.
00:47:44Blood only.
00:47:49Blood only.
00:47:50Blood only.
00:47:51Blood only.
00:47:52Blood only.
00:47:53Blood only.
00:47:54Blood only.
00:47:55Blood only.
00:47:56Blood only.
00:47:57Blood only.
00:47:58Blood only.
00:47:59Blood only.
00:48:00Blood only.
00:48:01Blood only.
00:48:02Blood only.
00:48:03Blood only.
00:48:04Blood only.
00:48:05Blood only.
00:48:06Blood only.
00:48:07Blood only.
00:48:08Blood only.
00:48:09Blood only.
00:48:10Blood only.
00:48:11Blood only.
00:48:12Blood only.
00:48:13Blood only.
00:48:14Blood only.
00:48:15Blood only.
00:48:16Blood only.
00:48:17Blood only.
00:48:18PVI at 60, please. Feel free to pull it out at any point.
00:48:23PVI at 60, please.
00:48:28PVI at 60, please.
00:48:33PVI at 60, please.
00:48:38I can see it moving.
00:48:40Slowly starting to contract.
00:48:43And the heart is just gradually starting to beat a little bit stronger.
00:48:48Which is a good stop.
00:48:53PVI at 60, please.
00:48:59We're completely off the heart-lung machine.
00:49:01And...
00:49:03Matt's new heart is doing all the work.
00:49:05So at the moment we're just taking out the...
00:49:08Pipes which are in the heart for the bypass and then...
00:49:13Close the chest.
00:49:14PVI at 60, please.
00:49:15PVI at 60, please.
00:49:16PVI at 60, please.
00:49:17PVI at 60, please.
00:49:18PVI at 60, please.
00:49:19PVI at 60, please.
00:49:20PVI at 60, please.
00:49:21The heart function is...
00:49:23Reasonable.
00:49:24Uh...
00:49:25But he's needing quite a lot of...
00:49:27Drugs.
00:49:28Just keep your blood pressure open.
00:49:33Matt can go back to the intensive care.
00:49:38We're not quite out of the woods yet.
00:49:43So we'll continue observing very closely.
00:49:46But now Matt's got a chance of...
00:49:48A new life.
00:50:08I need a bowl with a bit of...
00:50:13The design and the huck towels and the stapler.
00:50:16We are basically trying to...
00:50:18To isolate the tumour which is infected...
00:50:23And opened up to air.
00:50:25So that we can work around it.
00:50:29And keeping our field...
00:50:32Of searching.
00:50:33As clean as possible.
00:50:37We need to ensure...
00:50:38The infection doesn't spread to...
00:50:40Other part of Anna's body.
00:50:43Where's the virus?
00:50:44The sinus?
00:50:44The ḵᴛᴄᴈᴛᴘᴛ naj riesაᴛᴛ ※ᴪăsa�етᴕᴜᴛ
00:50:48okay good well done
00:50:53so the next test will be we will try it
00:50:58to remove the whole mass along with the rib cage to which it
00:51:03is attached it is crucial that we
00:51:08do not leave any tumor cells behind it is an aggressive tumor
00:51:13grow back and Anna's life will be in danger
00:51:18we are trying to just go around the tumor
00:51:23try to separate it from the normal area
00:51:26we will just try to
00:51:28keep it at least about a couple of centimeters all around
00:51:32so we will
00:51:33like to have as clear margins as possible
00:51:38you can see the blood vessels which is supplying the tumor there
00:51:43there is another big blood vessel there
00:51:45there is lots of lots of big blood vessels
00:51:48applying the tumor
00:51:49because this this tumor needs blood to survive
00:51:53this tumor is like a parasite feeding
00:51:58on Anna's body and to remove it we have to cut through these vessels
00:52:02but we must be careful
00:52:03so that we don't cause a major bleed which can actually be deadly
00:52:08can we have the legature for Mr. Calcutt
00:52:13so we are just going to secure this blood vessel
00:52:16so we are just going to secure this blood vessel
00:52:18at the moment I think we are just trying to control the bleeding
00:52:23give me Liger
00:52:24Liger
00:52:25Liger
00:52:26Liger
00:52:27Liger
00:52:28yeah that's perfect
00:52:29yeah that's perfect
00:52:33you can see now it's starting to peel off a little bit from the
00:52:38maybe chest full
00:52:39maybe chest full
00:52:43yeah but you can see the ribs are there so we were down to the ribs
00:52:48and the chest full muscle
00:52:51we are just about
00:52:53about to take the whole tumor out along with the two ribs
00:52:57so
00:52:59this is all coming out as one big mass
00:53:01this is all coming out as one big mass
00:53:03let it taste
00:53:04let it taste
00:53:05let it taste
00:53:06let it taste
00:53:07let it taste
00:53:08let it taste
00:53:09let it taste
00:53:10let it taste
00:53:11let it taste
00:53:12let it taste
00:53:13let it taste
00:53:14let it taste
00:53:15let it taste
00:53:16let it taste
00:53:17let it taste
00:53:18let it taste
00:53:19let it taste
00:53:20let it taste
00:53:21let it taste
00:53:22let it taste
00:53:23let it taste
00:53:24let it taste
00:53:25let it taste
00:53:26let it taste
00:53:27let it taste
00:53:28let it taste
00:53:29let it taste
00:53:30let it taste
00:53:31let it taste
00:53:32let it taste
00:53:18That also goes away.
00:53:23Yeah, so...
00:53:28We have just taken two ribs, so we have taken them out along with...
00:53:33The tumour.
00:53:35This is the tumour there.
00:53:36This is the breast area.
00:53:38And this is the muscles of the chest.
00:53:40And these are the ribs.
00:53:42I'm confident that we have removed the whole tumour, but our worry is that...
00:53:47On a CT scan, they looked that there was a shadow on her lung.
00:53:52And we need to make sure and to check if the tumour has spread deeper.
00:53:57Into her chest or not.
00:54:02So that's your heart.
00:54:04At the moment, we have collapsed...
00:54:09We have lost her right lung.
00:54:10So she is, at the moment, being ventilated.
00:54:14Only on one lung, which is the left one.
00:54:19And this is the right lung.
00:54:20So it is the right lung.
00:54:21So, I think...
00:54:22Go ahead.
00:54:24is collapsed as you see you can basically feel the lungs.
00:54:29If there is any shadow or any nodding.
00:54:34You will feel it against your fingers.
00:54:36We are just going to feel it.
00:54:39We are just going to feel it.
00:54:44Is it there?
00:54:49Is it there?
00:54:51Is it there?
00:54:53Is it there?
00:54:55Is it there?
00:54:57Is it there?
00:54:59Is it there?
00:55:01Is it there?
00:55:03Do you know what I'm saying?
00:55:10You might have got me now.
00:55:13I don't know, my lovely operation's all over you.
00:55:15I'm just waking up, take some nice big breaths for me.
00:55:19Oh, there we are.
00:55:20Nice big breaths, nice big breaths in and out.
00:55:25Of course, men, it's all over you.
00:55:30I think you have to get nice and wide.
00:55:36Still worried.
00:55:38Obviously, we haven't formally tested any.
00:55:40Only a fool would be complacent now.
00:55:45We would have to talk to you both
00:55:46out.
00:55:48.
00:55:55Well, well, Liz.
00:56:00It's so good to see you awake, honestly.
00:56:04It wasn't an easy operation.
00:56:05There was quite a lot of bleeding, but we got it all out.
00:56:10Not at all.
00:56:11Not at all.
00:56:11Hey, it's absolutely great.
00:56:13Now, what I want to do quickly is just look at you.
00:56:15Can you cover one of your eyes?
00:56:17It doesn't matter which.
00:56:19Okay.
00:56:20Okay, cover it properly.
00:56:22So, if you keep looking at my nose here, keep looking at my...
00:56:25Can you see my finger there?
00:56:28Yeah.
00:56:28Lovely.
00:56:29You stay still.
00:56:30Can you see...
00:56:30Can you see my finger there?
00:56:31Look at my nose.
00:56:32Look at my nose.
00:56:33Can you see my finger there?
00:56:35Just, yeah.
00:56:36There?
00:56:37Yeah.
00:56:37Brilliant.
00:56:37Now, put that hand down.
00:56:38Lovely.
00:56:40Can you see my finger there?
00:56:42Keep looking at my nose.
00:56:43Can you see my finger there?
00:56:45Just...
00:56:45Yeah.
00:56:46That's really good.
00:56:47It seems you've got a full field of vision.
00:56:50Yes.
00:56:50Your job is just to rest over the weekend now.
00:56:53I'm very glad how things turned out.
00:56:55Thank you, David.
00:56:57It's a great relief.
00:56:59Yeah.
00:57:00That's all.
00:57:01You take care of yourself now.
00:57:36We are just going to feel it.
00:57:40I have completely looked at...
00:57:45...and I can't feel any more doom.
00:57:48So, thankfully, the tumour hasn't...
00:57:50...filtrated into her lungs.
00:57:54And what we have...
00:57:55...left is a gaping hole in Anna's chest.
00:57:59This hole...
00:58:00...the organs are exposed.
00:58:03The heart, the lungs.
00:58:05All these are vital structures that no human being can live without them.
00:58:09So, we need to...
00:58:10...protect them.
00:58:11If we don't reconstruct this properly, then Anna wouldn't be able to...
00:58:15...breathe and she would be at risk of a life-threatening infection like sepsis.
00:58:20Okay, let's have the mesh.
00:58:21Mesh, please.
00:58:22Mesh.
00:58:23This is basically a biological mesh.
00:58:25Which with various materials they have used to process it.
00:58:30Because otherwise, your body will react to it.
00:58:35So, that's the mesh which we are going to use to fill the defect.
00:58:40Those are the absolute creator for a漂亮 and później sw dedicate to it.
00:58:44So, that's the other side.
00:58:47In-person robot.
00:58:49One parts.
00:58:50One.
00:58:51Here is service.
00:58:52Here is service.
00:58:55She's red.
00:58:56There is serviceizard werden by N Trumpucha.
00:58:58Here is service 찾아 bride.
00:58:59There is service over there.
00:59:01There is service card gonna happen.
00:59:04Now good place.
00:59:06Then save well school.
00:59:07And take welfare place.
00:59:08In-person media is not neces mesela.
00:58:45These are the
00:58:50I'm going to use to secure that mesh.
00:58:55So it's all completed. So the defect is gone.
00:59:00So
00:59:05Now we're going to start thinking about closure.
00:59:10Before the tumor was removed, I detached the skin and the muscle.
00:59:15I have a flap from Anna's back, which I stored in her body.
00:59:19It's still connected.
00:59:20To its original blood supply and I will now use it to complete the chest wall reconstruction.
00:59:25Okay, now
00:59:30Can we have the Alice, two Alice's?
00:59:35And this is the, the flap is being fished there.
00:59:40Okay.
00:59:42So we're just checking if we can close this.
00:59:45This is the maximum amount of skin that we could have taken from the back.
00:59:49But if it's not big enough,
00:59:50we may need to do an entirely new skin graft.
00:59:55Give me the stapler.
00:59:57I like, look.
00:59:59See?
01:00:00See?
01:00:01See?
01:00:02See?
01:00:03See?
01:00:04See?
01:00:05See?
01:00:06Let's measure the flow.
01:00:09Okay.
01:00:10I don't think we do in here.
01:00:10Do you require a skin graft?
01:00:13This is a flap which is sitting nicely.
01:00:15Hopefully, in this position, we need to test the...
01:00:20the original blood supply to the flap
01:00:22to check if it's still flowing or not
01:00:24because if it's not...
01:00:25the tissue could die.
01:00:30According to the canal part,
01:00:32there are many different возможность
01:00:35type of raw materials.
01:00:37The dock with the
01:00:50premium, and the
01:00:55very important
01:00:58Can we have a Doppler?
01:01:01Basically, it's like an instrument that...
01:01:03...that we use to measure the flow of the blood.
01:01:08I need to hear the steady pulse, which means the blood is flowing.
01:01:13...into the blood vessel.
01:01:18...the blood vessel.
01:01:23...the blood vessel.
01:01:23...the blood vessel.
01:01:25...the blood vessel.
01:01:27...the blood vessel.
01:01:28...the blood vessel.
01:01:30Yeah, it's good news.
01:01:33The flow in the blood vessel is good.
01:01:37We are looking...
01:01:38...we're looking good.
01:01:39We're now closing the skin.
01:01:41It seems that someone up there is taking...
01:01:43...care of us.
01:01:47Fantastic.
01:01:48...quite as planned today.
01:01:53I'm pleased with Anna.
01:01:54She behaved herself as she promised before the surgery.
01:01:58I think she's going to be quite very emotional...
01:02:00...when she wakes up and sees that this has...
01:02:03...is gone.
01:02:04Anna.
01:02:05It's all done.
01:02:06I'm just breaking up, okay?
01:02:07...
01:02:08I'm just relaxed.
01:02:09It's gone.
01:02:10It's all gone.
01:02:11It's gone.
01:02:12It's all gone.
01:02:13You did.
01:02:14You did.
01:02:15You did.
01:02:16You did.
01:02:17You did.
01:02:19I bet you feel lighter.
01:02:20You are.
01:02:21Yeah.
01:02:22We've got an 80.
01:02:23Chinese.
01:02:24I'm not sure you'll get your Chinese tonight...
01:02:26...but hopefully you'll get it tomorrow.
01:02:28...but hopefully you'll get it tomorrow.
01:02:29It's all right.
01:02:33...and I'm hoping...
01:02:37...and I hope you'll get it tomorrow.
01:02:38that the flap continues to work and...
01:02:43Hannah recovers with her chest wall functions.
01:02:46We will be monitoring the...
01:02:48We will be monitoring her vital signs.
01:02:50Anything can happen at any point.
01:02:53Amen.
01:03:03Hello.
01:03:04Hi, Matt.
01:03:05Hi.
01:03:06How are you?
01:03:07Very well, thank you.
01:03:08Good.
01:03:08Good to see you.
01:03:09Good to see you.
01:03:10And you.
01:03:11Good to see you.
01:03:12So, just over two weeks now.
01:03:13Yep.
01:03:14How are you feeling?
01:03:15I'm feeling pretty good, all things considered.
01:03:17Good?
01:03:18Yeah.
01:03:18Having my strength back up.
01:03:19When you're back on the bike?
01:03:21Well...
01:03:22I have...
01:03:23How long is a piece of string?
01:03:24Let's see.
01:03:25Not just yet, but...
01:03:26Yeah, I'd like to.
01:03:27You were fit.
01:03:28Beforehand.
01:03:29Yeah, that's it.
01:03:30All good things for you.
01:03:31Yeah.
01:03:32It's getting you back to that.
01:03:33Yeah, that's it.
01:03:34That's it.
01:03:35And we'll hold you to getting you back on the bike.
01:03:38It's amazing.
01:03:39Thank you's not enough, really.
01:03:40It's incredible.
01:03:41No problem.
01:03:42So, yeah.
01:03:43I feel very blessed.
01:03:44So, thank you.
01:03:45Good.
01:03:46Cheers, Matt.
01:03:47Thanks very much.
01:03:56I think life...
01:03:58After this, Matt will be different.
01:03:59I think he'll have a different outlook on life.
01:04:01And he'll want to grasp life with it.
01:04:03With both hands.
01:04:04It's given me an appreciation as well for what Matt...
01:04:08...physical science can do as well.
01:04:09Because here I am, you know, with a new chance ahead.
01:04:13My second chance.
01:04:14And, you know, I've already got some big plans and...
01:04:18Yeah.
01:04:19Just looking forward to it.
01:04:24My second chance.
01:04:25How was it?
01:04:26I enjoyed the next day.
01:04:27Let's go.
01:04:28Come on.
01:04:29I am right back.
01:04:30I am right back.
01:04:31I can't.
01:04:32I guess?
01:04:33Yeah.
01:04:34I'm right back.
01:04:35I am too handsome.
01:04:36I don't know what it is about it.
01:04:38I'm not sure.
01:04:39I am too handsome.
01:04:40I don't know what it is.
01:04:41I can't.
01:04:42I can see my face.
01:04:44How was it?
01:04:46I am so handsome.
01:04:47I am too handsome.
01:04:48I am so handsome.
01:04:49I'm so handsome.
01:04:50I am so handsome.
01:04:51fine the sim
01:04:56you're gonna be free like an eagle now all right once i've had my chinese
01:05:13you
01:05:01yeah so all this is out of the way now
01:05:06thank you so much god bless take care of yourself take care of yourself
01:05:11keep on bathing keep on bathing thank you young man
01:05:16because i'm young i'm getting older now
01:05:21and it's doing really great i'm really pleased we've removed the dressings today
01:05:38you
01:05:26and the winds looks perfectly fine there's no signs of any infection
01:05:31so she's going to be able to go back to uh her um
01:05:36normal daily activities normal social life um and uh
01:05:41i believe that this has dramatically improved her quality of life
01:05:45and she can
01:05:46gain back the control on her life again
01:05:51i'll probably think it for the rest of my life now how did
01:06:06you
01:05:56get rid of that it was like a miracle
01:06:01and it was a miracle lived and on me
01:06:27you
01:06:16I got a significant bleed.
01:06:21A child of death, stroke and blindness.
01:06:26He's a big monster.
01:06:30I didn't think he was going to be.
01:06:31He's going to be this bad.
01:06:32It's a nightmare.
01:06:36Not only can the patient bleed to death, if it's injured...
01:06:41It can cause stroke.
01:06:46New Surgeons, A Matter of Life or Death is back next Wednesday at 9.
01:06:51If you are someone you know has been affected by any of the issues raised in this program,
01:06:55please go to channel5.com.
01:06:56slash helplines for information and support.
01:07:00New tomorrow at 9.
01:07:01Ben Fogel is headed to a remote spot in Uganda where Alison's lived off-grid for 30 years.
01:07:06New lives in the wild.
01:07:08Next, new Ambulance Code Red.
01:07:11New tomorrow at 9.
01:07:12New tomorrow at 9.
01:07:13New tomorrow at 9.
01:07:14New tomorrow at 9.
01:07:15New tomorrow at 9.
01:07:16New tomorrow at 9.
01:07:17New tomorrow at 9.
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01:07:20New tomorrow at 9.
01:07:21New tomorrow at 9.
01:07:22New tomorrow at 9.
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01:07:24New tomorrow at 9.
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