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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
00:49this series was 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.
01:22Yeah, good peace.
01:24It'll be about a half hour before he's here, darling, all right?
01:33Is that your dad?
01:34Yeah.
01:35What's his name?
01:36Finny.
01:37Finny?
01:38Finny, yeah.
01:39Finny, yeah.
01:40She's a steady girl.
01:41She has a right throat or finger anyway.
01:44That's the way to be, eh?
01:46Orthopaedic surgeon Declan Reedy is on his way to meet patient Patrick O'Sullivan, who
01:58has fallen from a roof.
01:59And bend the knee for me, and don't let me straighten it.
02:02You try and straighten it, and I'll try and bend it.
02:04Keep pushing.
02:05That's good.
02:06He needs urgent spinal surgery.
02:08It could be.
02:09It could be from your...
02:10It could be another direct injury from the fall.
02:12You've no idea of what way you fell, or how you hit the ground, or anything.
02:16You know, I landed and we used to walk.
02:18Going back years ago, like, if you saw scaffolding and timbers that they actually stood on, you'd
02:27say, I don't know how they weren't killed.
02:30And it was just really just a fluke accident.
02:34He said, just like a leaf, you were blown off the roof.
02:38There's five bones in your back, and it's the L3 that's broken.
02:42The bone crushed, and then the fragments went in all directions.
02:45And there's one little fragment went towards the back, which is where your spinal cord and
02:49spinal nerves are.
02:50And that's the one we'd be a little worried about.
02:52We were supposed to go to Waterford that evening.
02:55We were going to a wedding.
02:57He said, you know, we'll get ready.
02:59We'll go to Waterford.
03:01And I said, are you sure you're able to go?
03:04He said, oh, he said, this one wedding, he said, I ain't missing.
03:07And we headed off then to the wedding.
03:11His brother-in-law walked with him to the toilet.
03:14And when he came back, he said, no, he said, I have to go.
03:18He said, he just couldn't believe what the distance of the walk to the toilet was doing to his back.
03:26Look, I said, we're going home.
03:28I said, he walked in, texted in this emergency.
03:31They nearly had a freak attack.
03:33The nurse said, you fell off, and you're actually after walking in here.
03:37Straight away, they got the stretcher, like, and the padding, and put him into it straight away,
03:42like, and wheeled him straight down.
03:48Excellent.
03:49You can just see it here on the axial.
03:51So you can see it's gone back and narrowed his spine.
03:53You can see the burst elements of the fracture around the front.
03:55Patrick has a very unstable pattern of fracture,
03:58with a significant amount of the bone pushing towards the canal
04:03through which all our nerves and spinal cord go.
04:05But if he were to get up and walk around on it, it would get worse.
04:08That's in L2.
04:12And the fragments could move towards his nerves
04:14and cause partial or complete paralysis.
04:16Can I tell you before we leave here again?
04:18Oh, they will, yeah?
04:20Yeah.
04:21I'll find out how long it's going to be in the pipe.
04:23You'd nearly want to tie Patrick to a chair to get him to sit.
04:26He loves his running, loves his cycling.
04:29He often came home from work there at half, five, six o'clock in the evening,
04:32and he said, I'll go for a cycle now.
04:34He said, perform it for the dinner.
04:36So he began off for a cycle, or he could be going off for a run.
04:39I didn't want it.
04:40I was tired.
04:42When Dr. Reedy told him, like, the damage that was done,
04:46and try and not move, that he wouldn't do more damage.
04:54And he could be paralysed.
04:56I was going through my head was, I'm going to have to get the house revamped.
05:02Do you know, if he does come in a wheelchair,
05:05you know, if he's going to be paralysed,
05:07that would destroy him.
05:09And I know that.
05:13In the Cystic Fibrosis Unit,
05:27a multidisciplinary team led by Professor Barry Plant
05:30are discussing a new drug that might save a patient's life.
05:34Back in 2019, before she would...
05:36The new drug will drop people whose sweats are 40,
05:40potentially down to even 20.
05:43So, I mean, we don't know until we try it for her,
05:46but she seems amenable, doesn't she, James?
05:48She does, yeah.
05:49Whether it's lung transplantations, these new superdrugs,
05:52with a chronic genetic condition like Cystic Fibrosis,
05:55you're buying time all the time.
05:59Kim Dohani is in the clinic today to be assessed and briefed
06:02on the new drug which has just finished the clinical trial stage
06:05but is not yet approved.
06:08You never think about having to breathe
06:11until you're not able to breathe,
06:12and then it's all you think about.
06:17It's progressive disease, so as the years go on,
06:20you do have more problems with it.
06:22My lung function was dropping.
06:24I couldn't keep up with people anymore
06:26and struggling to breathe.
06:28Even just things like having a shower,
06:30like climbing a mountain when you're really short of breath.
06:32You made a trip up okay?
06:34All the way from Watford.
06:36Yeah.
06:37I was always told,
06:38oh, you're not going to live to this age or that age,
06:40so I never really planned for a future
06:42because I always thought,
06:43well, I'm just going to die young anyway,
06:45so that was always what was in my mind.
06:48Yeah.
06:49So how were you over the last two weeks?
06:51Um, very tight-chested.
06:53Um, short of breath.
06:55And I started getting achy,
06:56so I had to go to bed,
06:57and I knew, I was like,
06:58something's not right here.
06:59You okay?
07:00Did your lung function get up, please?
07:01Yeah.
07:02Six years ago,
07:03a revolutionary new CF drug called Caf Trio became available.
07:09Well done.
07:10Good effort.
07:11Good effort.
07:12And saved Kim's life.
07:13Relax.
07:14I was practically living in hospital.
07:16I was on oxygen 24-7.
07:18I needed a wheelchair.
07:20She had very severe lung disease.
07:22Her lung function was about 20% of normal.
07:25She was on continuous antibiotics.
07:27She would be coughing up mucus all day.
07:29Keep going now.
07:30Keep going.
07:31Finish it out.
07:32Well done.
07:33Well done.
07:34She was at the end stage of her cystic fibrosis.
07:36Keep going now.
07:37Keep going.
07:38Well done.
07:39I really felt hopeless at the time.
07:41And relax.
07:43My consultant told me,
07:44you know,
07:45you're on the edge of a cliff here.
07:46So I was really hanging on.
07:49Literally,
07:50hours after starting the drug,
07:52I just felt so light and free.
07:55Yeah,
07:56like,
07:57it's like I was awake.
07:58I was coming back to life is all I can say.
08:00It felt like it was just,
08:01it was unbelievable.
08:03You know,
08:04things have been shocking long before.
08:05Yeah.
08:06Been pretty stable for the last couple of years.
08:08Yeah.
08:09But just not as well as everyone would like, I think.
08:12Over the last year,
08:13the drug that once saved Kim's life has become less effective for her.
08:17Her condition has worsened significantly.
08:20She needs a new drug to keep her alive.
08:23I could be coming to the end of my life.
08:25Yeah.
08:26And in my thirties.
08:28Yeah.
08:29No worries.
08:30Oh.
08:31Those are all of you.
08:32Unless they don't know where her husband is,
08:33he forget her family.
08:34Or his circulate's来.
08:36Then I'm trying to find him are Эфy and Change.
08:37Tell her what you want.
08:38About one more sit while he doesn't know.
08:39That there's a life to go.
08:40It may bepat cent.
08:41Here comes when I knew you say modern times.
08:43Anytime you hear that
09:13patients inbound, you're in resus, you're always filled with a sense of anxiety.
09:18The patient's even the highest level of care available in the emergency department.
09:22Being able to take a step back and avoid panicking is the most important thing.
09:2869-year-old Mary Cotter has been transferred to the emergency department from St Finbar's hospital.
09:34She has suspected sepsis, a potentially fatal infection.
09:38That's your finest day, Mary, you poor thing.
09:40You didn't expect to end up inside here today?
09:42Okay.
09:44We're just going to get you over onto the trolley, okay?
09:46Then we'll get a quick handover.
09:49Mary had sepsis syndrome.
09:50She felt miserable.
09:52She felt sick, fast heart rate, as well as things like fever.
09:57Can you get her sick bowl?
09:58She's going to get sick.
09:59Can you get her sick bowl?
10:00Can you get her sick bowl?
10:00Can you get her sick bowl?
10:00Can you get her sick bowl?
10:04MS, pneumonia and type 1 respiratory failure as well.
10:07That's great.
10:08I'm going to check there for you guys.
10:11We'll get you something for the sickness.
10:13Are you allergic to anything, Mary?
10:14No.
10:14No.
10:15Okay.
10:16Sepsis is an infection, essentially, takes over your body's whole immune system.
10:21The severe end of that is septic shock.
10:22And do you live at home, usually?
10:25Yeah.
10:25Yeah, super.
10:26And is there somebody with you at home with you?
10:27Yeah, I've got a phone call saying that mum was being transferred over to passenger emergency
10:35in the COH.
10:36That was her second or third time in resourcing the space of maybe three or four months.
10:41Will, is it?
10:42Yeah.
10:43Did you want to come in?
10:44Yeah.
10:44I mean, in February, she had urinary sepsis.
10:51She had a cardiac event, then contracted double pneumonia.
10:56Just giving antibiotics there and some fluids.
10:59We were all brought in to say our goodbyes.
11:02So she went through a lot.
11:05But it was just kind of upsetting to see her like that again.
11:09Just try to keep your arm as straight and as still as possible.
11:12Okay.
11:14We are treating her for sepsis because she's scoring all the markers for sepsis.
11:26Her heart rate's up, her breathing is up, her blood pressure's a small bit down, and she's
11:31on the oxygen.
11:32So she's being covered essentially with IV tazicin.
11:37The immediate priority is to find the source of the infection.
11:40The faster that can be done, the greater the chance of survival.
11:47Now, sorry, Mary, I'm very rude.
11:48I'm here on the medical register on call.
11:50So I know one of our ED doctor colleagues was around earlier.
11:52The first thing I always want to get is I want to get some sort of story before I make
11:55any other action.
11:57I want two-minute story before I make any quick decision.
12:00What's her son's name?
12:01Oh, Will, sorry.
12:02Will, no, no, no, I was speaking to the junior doctors over in Finbar's.
12:06You live with your mother, is that right?
12:07Yeah, yeah.
12:08Those other things you look up, how her hands are like warm, cold, what's her perfusion like?
12:11That was one of those things I was quizzing Mary with questions.
12:14There's a cough.
12:15Do you have any sort of cough at all?
12:16I'm coughing.
12:17Yeah, there is a cough.
12:18And is that last day, two days, week, month?
12:20Last week or two.
12:21Okay, bring up any phlegm with that, so it's a dry cough.
12:23She can't.
12:24She can't.
12:25She can't.
12:26She can't.
12:27She can't.
12:28She can't.
12:29She can't.
12:30She can't.
12:31She can't.
12:32She can't.
12:33She can't.
12:34She can't.
12:35She can't.
12:36She can't.
12:37Okay.
12:38Yeah, so that right lung certainly still sounds quite crackly.
12:41So for Mary, her heart rate was high, and when your heart rate's 130, 140, my heart rate
12:47sitting here, I would hope, is maybe about 60 or 70, so her heart rate is already double in
12:51a much older heart.
12:52So to maintain her blood pressure, which is already low, her heart is working extraordinarily
12:56hard.
12:57That can only continue for so long.
12:58So go here over your kidney.
12:59Yeah, just don't help me.
13:00Mm-hmm.
13:01If someone's in research, really what you're looking for is what is going to kill them in
13:04the UK.
13:14I had finished med school, and I wanted to be in an English-speaking country in Europe.
13:21And I remember walking down on one of the streets in Dublin.
13:26And I stood there for God knows how long.
13:30And then a woman walks up to me and says, are you okay?
13:34In all my years of me being in Europe, that never happened to me.
13:40And so I'm still here.
13:41And I'm still getting that same Irish love from everyone in Ireland.
13:47Now, sir.
13:48We'll give you a ring once more.
13:49I see you don't hear so.
13:50Patrick is about to have spinal surgery.
13:51He has avoided paralysis after a fall, but is still at risk of a poor outcome.
14:04He was up cleaning a roof, the equivalent of a two-storey fall, about 19 feet.
14:11I think he's one of these guys who did it for a living.
14:14He's very comfortable and calm and doesn't see the danger.
14:18Okay, snug him over towards me.
14:21We might just bring him to the edge of the bed before we do the flip, okay?
14:24Patrick, I suppose.
14:27Hardworking.
14:29Loves the son.
14:31Loves his GA.
14:33Likes to be kept busy all the time.
14:37God, he scratched himself a bit coming off the roof, didn't he?
14:40Dr. Reedy told him, like, we will operate.
14:43We will be putting in rods and bolts or whatever, like, but not all operations go the way they should go.
14:55Cool.
14:58Take a shot there, see where we are.
15:00We wouldn't really know more until they actually opened him up to see the damage, really.
15:05Okay, so we're just below fracture there.
15:08Just between spinous processes, so if I go into the lower one.
15:12A knife now would be good, Francis, when you're ready.
15:15I know you're trying to keep these sharp things away from me.
15:35Okay, try that.
15:36We are trying to avoid doing any further damage to the spinal cord.
15:43There is a lot of interesting blood vessels just in front of the spine that we don't want to damage.
15:48So in that sense, it has to be extremely precise.
15:50You have the broken bone in the middle, and you want to put some screws in above it, and you want to put some screws in below it, and join those together with rods.
16:02We're just making the rods the right size, so we have pre-made rods of certain sizes, but he's just fell between two of the pre-made, so we're making a 100 rod into a 90.
16:16And the idea is that when he then stands up, probably 80% of his weight will go through the screws and rod construct, and only 20% through the fracture.
16:30And then tap the other one down, and then tap that one again.
16:33And then when we distract, we'll open up the back of it.
16:37It's like breaking a crunchy bar and leaving the wrapper on, and taking the two ends of the crunchy bar and pulling it up.
16:45Down with pressure.
16:46Good lad.
16:47As tight as it can go now.
16:48So we see where we're at now, up up there.
17:03Kim is in the CF clinic today to be assessed and briefed on a new drug that is not yet approved.
17:08Without a new treatment, Kim will need a transplant to keep her alive.
17:12Kim takes 25 different medications a day.
17:18At this point in her life, you know, really her full-time job is to work as hard as she can, to stay as healthy as she can every day.
17:26That is a real challenge.
17:28If she didn't have these drugs, she'd be in trouble in the morning, and we're still looking at a transplant, which is still a massive thing to do, you know.
17:36Approximately 60 to 70% of patients who get a lung transplant will be alive five years after the transplant, which means that approximately 30 to 40% won't be.
17:50Kim, how are you?
17:52I'm okay.
17:53Good to see you.
17:54You too.
17:55Barry hopes to get the new drug that might help Kim on compassionate grounds.
17:59...with everything that's been going on.
18:01The drug has now, in Europe, this new drug.
18:03It's at the point where they're sort of ready to put it forward for approval.
18:07Yeah.
18:08But we've reached out to the company, and they remember you from the last time.
18:13Yeah.
18:14But they don't know your name, but they remember your story because they're not allowed to know your name.
18:18Yeah.
18:19And we've sent them all your details.
18:20Yeah.
18:21And we're discussing with them now as to whether or not there's an opportunity.
18:25And if there is, I mean, in the same way, I'd give it a go.
18:29Yeah, definitely.
18:30Yeah.
18:31Definitely.
18:32So then at the same time, obviously, we work with the transplant people so that we'll cover both options.
18:38Do you know what I mean?
18:39When we hear a drug trials, everybody with CF wants to be part of it.
18:42Whether they get a placebo or they get a drug, like, people just want to be part of it.
18:47We have a chance to live a normal life.
18:52Every day I wake up and I'm feeling okay, it's a great day for me.
18:56Next week could be different, next week I could be in hospital, I could be on antibiotics.
19:01At times I feel worthless.
19:03Like, I can't work, so I don't have an identity as such.
19:07I'm just a person with cystic fibrosis.
19:09It's tough when people say, oh, what do you do?
19:12Like, well, I don't do anything.
19:13I just try to stay alive.
19:22It's not, because it was 80.
19:2480?
19:25It was 80 and then it went to 90.
19:27An hour ago, 69-year-old Mary was admitted to the emergency department with a serious infection.
19:35She has a high heart rate and low blood pressure and is at risk of developing septic shock.
19:40So there's the pressure ulcer.
19:41This is the pressure ulcer.
19:42And is this, at the base of the, is that the heel or is it up like a...
19:46No, it's the heel.
19:47It's the heel.
19:48Would you feel pain down there?
19:49Sometimes.
19:50Sometimes.
19:51Has that pain changed long the last few weeks?
19:52No, since then.
19:53Alright.
19:54Because they had to give you a painkiller for Friday, I think.
19:57Sometimes there is pain.
19:58No.
19:59The more tension there isn't there.
20:00No.
20:01Something I've learned over the years is that the patient with the worst blood results,
20:04the sickest patients, they often have very little pain.
20:07I'd never let an absence of pain guide away from some things.
20:10And it's one of those things that people react very differently to the same insult.
20:13Who's the last person who would have looked at the ulcer here, at the pressure sore?
20:17When was this last looked at?
20:18Not sure.
20:19The nurse over in...
20:20Will obviously had been through the rollercoaster of Mary's health.
20:24Not just over the last four months.
20:25You know, Mary's had multiple sclerosis for many, many years previously.
20:29And I could see that Will was an advocate for his mother.
20:32Is that sore when I look at this?
20:35Is that sore?
20:36Well, not so far anyway.
20:38There's certainly gum coming out of it.
20:39I think that's all what we call physiological, i.e. your body's immune system.
20:42If your mum's ill, you should be there.
20:46If you can.
20:47I think most people would do that for their parent, I'd imagine.
20:51I'd hope.
20:56It's handy to have somebody in the house.
20:59Like, I know of other elderly people and they have nobody
21:02and they're very alone and afraid kind of things most times.
21:05So, it could be a very different story.
21:08Yeah, they sit over and remember.
21:10Because it was healing my sleep.
21:11Will and his siblings have grown up caring for their mother, who's been battling MS symptoms since 1999.
21:29Mum, like, she's been ill since I was about 11, I think.
21:33So, it's all we've kind of known, really, as a grown-up.
21:37Can I take a deep breath?
21:38Yeah.
21:39That's not a deep breath.
21:40Huh?
21:41That's not a deep breath.
21:42It's a deep breath.
21:43Will has significant health issues of his own.
21:52His mother Mary's illness is a distraction from the pain he suffers with severe thoracic scoliosis.
21:59Sitting for a long time would affect my back and things and the pain and things like that.
22:04I've been advised not to be lifting, kind of helping mum to and from things, but I still do.
22:11I mean, the OT and the physio have said not to, but needs must, so we just carry on.
22:16You're probably going to kill me, but I need more blood from you again.
22:20I know.
22:21One lung is almost completely obstructed now, so the consultant asked me, or like, how's the pain every day?
22:28And I said, like, it's okay, it's normal pain.
22:30And he was saying, well, there should be no pain every day.
22:33But I'm used to pain now this day, because you have to be, otherwise you wouldn't get out of bed, kind of thing.
22:39Where do I notice then?
22:41We'll try maybe that hand again, will we?
22:43My condition doesn't bother me, it's more the visual aspect of it.
22:48You see people sometimes looking.
22:50The kind of severe hunch kind of thing that's coming out.
22:53The uneven shoulders kind of thing.
22:55That to me is more painful than the actual pain.
22:58The disfigurement of it.
23:04Are you trying to relax your hand on my hand?
23:06Is that a flop?
23:07Will I leave?
23:08Oh, yeah.
23:09You're very tense.
23:10There is no cure, it's a progressive thing.
23:12Oh.
23:13I know it's an awful thing to say, but I mean, would it not be better to get cancer, and get that treated, and cut out, and hopefully be rid of it.
23:21Whereas, like, with my condition, you can't cut out your spine and get rid of it.
23:25Or with mum's MS, you can't cut it out, get chemotherapy for it, and hopefully go into remission.
23:31Watching the monitor again.
23:32Like, that's all we were doing at the start of February.
23:33Watching that.
23:34Watching that.
23:35To check the breathing, to check the oxygen levels.
23:36It should be below 20.
23:37Yeah.
23:38What is it not?
23:39The team are running a series of tests to try and determine the cause of Mary's severe infection.
23:51She remains at risk of septic shock.
24:05When I wake up in the morning, I wake up with disbelief that it's half five.
24:12Anyone who works in an emergency department is a problem solver.
24:16And I would say also an optimist, because we're always working to try and get the best outcome for everybody.
24:25Four-year-old Zach O'Leary is struggling to breathe.
24:28His mum Catherine called an ambulance early this morning.
24:31I found him slumped at the bottom of his bed, purple.
24:36That's not normal.
24:38Spasmodic croup episodes.
24:42There is no pre-warning with them, so they just come out of nowhere.
24:46And he can't breathe.
24:47It's fight or flight mode, really.
24:48Like, I just have to get on.
24:50Get it done.
24:51Get him in.
24:52I mean, I've just watched him suffer for so long.
24:56It actually makes me sad.
24:58Like, it just takes a lot for me, like, to see him like that.
25:02Like, he's only four.
25:03Tell me, is this the finger you used to pick your nose?
25:06No.
25:07Yeah.
25:08It is!
25:09Ew.
25:13OK, I'm going to go get you some medicine.
25:15Is that alright?
25:17The treatment with croup is usually steroids.
25:20You can hear from his cough, it's very clearly croup.
25:23So, first line, always try and get the steroids into him.
25:26Alrighty, I'm just going to wait for this medicine to dissolve a small bit.
25:29During my pregnancy, I wasn't well.
25:32They did tell me I was going to be expecting a very small, small baby.
25:36And I suppose when he was born then, it was apparent he was very sick.
25:41It was all the lungs.
25:43We left there thinking, you know, that this was just a scare.
25:47And then it just turned into be something that we live with every day.
25:50With no answers.
25:52Were you here recently?
25:53I think I met you.
25:54Yeah, we were here.
25:55We were here in February.
25:56We were here in February.
25:57Yeah, he was admitted that time when he was quite sick.
25:58Yes, I remember.
25:59Yeah.
26:00Zach, do you want to take it in one go or two?
26:01Your purple medicine.
26:02Ready, steady.
26:03Swallow that.
26:04Good job Zach.
26:05Ready, one more go.
26:07Can I please?
26:08Can I please?
26:09Can I please go rocking?
26:10Oh, you can go rocking but can we take this?
26:12Zach's case is quite complex.
26:13The broad spectrum I suppose, they don't use levels anymore as far as I know.
26:14It's just, if you're on, if you're on, you're on, you're on, you're on, you're on, you're on, you're on, you're on.
26:15Zach's self-soothing is rocking.
26:16He loves to rock, it's the deep pressure and, you know, he's hitting his back off of a hard surface and, you know, he's hitting his back off of a hard surface and, you know, it's just, you're on, if you're on the spectrum, you're on the spectrum.
26:39The soothing is rocking. He loves to rock. It's the deep pressure and, you know, he's hitting his back off of a hard surface and it just calms him down and I'll just leave him have at it. It works.
26:52Let me see if I've got something else up my sleeve.
26:56The life I have with him is normal. It doesn't look normal to other people because they don't have to go through the things that I have to go through and all the loopholes that I have to and the obstacles, you know, to just get small things done or small achievements for Zach.
27:09Come on, quick, because your cough is going to get worse again.
27:17I'm OK, thanks.
27:19I'm OK. You're OK. But you're going to be even more OK if we finish off the rest of this.
27:24I had Zach early and then I had Lillia in my early 20s, so there's just three of us.
27:32Please take that. Do you want to pop him on your lap?
27:34Yeah.
27:36I'm sorry.
27:37I'll give you a hug.
27:39He deserves the normal life, too. I mean, I would love to have the problems that some people have.
27:44The child won't go to bed or this or that, whereas that's not what I'm dealing with.
27:48I'm literally standing over him, making sure he's still breathing and, you know, that he's going to be OK.
27:54And even on nights when he's not unwell because they're the nights when it strikes.
27:59If you can talk one arm behind you.
28:01Oh, yeah, there we go.
28:03Okey-doke.
28:04Well done.
28:05That's right.
28:06That's it, sweetheart.
28:07You're doing really, really well.
28:08That's it, sweetheart.
28:09OK.
28:10Good job.
28:11Can I get you more tissue?
28:13I'm sorry.
28:14I know that's not nice.
28:15But it's the only medicine that's going to make you better.
28:21Yeah.
28:22You consider all the things that parents have to go through when they're at home, especially if you're in often.
28:28It's a huge mental load that a lot of parents around Ireland carry.
28:34Everyone wants their kid to be well and you're going to do everything in your power to make sure that they stay well.
28:55I live in fear, basically, I suppose you could say.
29:02I try not to, but it's very hard not to when it's so frequent because we're just waiting for the next one to happen.
29:18Patrick O'Sullivan has just undergone spinal surgery to try and prevent future paralysis.
29:24Sergeant Declan Reedy hopes his repair has worked.
29:27Patrick, you did very well.
29:29Mr. Reedy here again, Declan Reedy.
29:31Remember, I met you before your operation.
29:33I know you.
29:34You're very sore, I think, in the back, are you?
29:36No.
29:37I'm not fully happy that I've done everything right until I physically see the patient awake after surgery.
29:43I will always go out as soon as the patient wakes up and check that they're wiggling all their toes and moving their legs.
29:48Do you mind if I have a quick look at the legs?
29:50How do they feel?
29:52Can you move them up and down for me?
29:55Can you lift them straight up off the bed?
29:58Not only was he wiggling his toes, but he was doing straight leg raises.
30:01He was lifting his legs off the bed and I think he wants to get back to running and cycling.
30:05I think he wanted to do it that day.
30:07Well, we won't let you home until maybe Tuesday or Wednesday.
30:10Oh.
30:11We want to be sure you're over the worst of it, okay?
30:14I got the phone call to say that he was out of surgery and I said, oh, thank God.
30:21I said, that's all I could say, thank God.
30:24And I'd say, about three minutes, I was back off at CUH.
30:29And then everything's coming off the bed.
30:32Are you happy on the scene, Kathleen?
30:33Are you happy on the scene, Kathleen?
30:34Yeah.
30:35All right, now relax, relax now.
30:44You'll be okay now, relax.
30:51You'll be able to get up and walk again in about three or four days' time.
30:59Just take every day as it comes now.
31:01You're after it now, and that's the main thing.
31:05How did I get to Limerick?
31:06What Limerick? No, you're not in Limerick, you're in Cork.
31:13That's all I know from the anesthetic.
31:16You were probably dreaming about this.
31:22So I went to HSC antenatal class the other day.
31:25Oh, yeah.
31:26Ten till four.
31:28It's two days of it.
31:29Go away.
31:30With me, it was relaxing my jaw, and I found a few things that I saw really helpful.
31:39Whereas I remember Michelle Howard, your jaw is connected to down there.
31:43So if you have a loose jaw, or if you hold your jaw, you then will be holding it.
31:51So it's like, ah, ah.
31:53To drink, literally, like, ah.
31:56To drink, go into labour.
31:57No, no, no, no, to, while you're in labour, to get the baby out.
32:01Like, you know, so if you keep a loose jaw, then loose bits, like, yeah.
32:06Good work, yeah.
32:07I have been a consultant for six years now.
32:18I got more questions when I was younger.
32:21How many operations have you done?
32:23Have you been doing this long?
32:25But I worked for a consultant in the States years ago, and he told me, like, the optimal
32:30years really are your 50s, like mid-40s to mid-50s, because before that, you're kind of
32:35asking, are you too young, and then after that, they're wondering, are you too old?
32:39I suppose before, the older-fashioned stereotype of a consultant would have been more austere.
32:45But, like, I can understand taking the attitude of kind of completely detaching yourself from
32:50the patient, because at the end of the day, you have a job to do.
32:53And, like, most patients, if they're going for heart surgery, and you ask them, do you
32:56want someone with a lovely bedside manner, or do you want somebody who can work through
33:03an extremely stressful environment if the operation isn't going according to plan?
33:07They'll ask for the latter.
33:11I wouldn't see why we would need to see him again.
33:15Eleven days ago, Tara's patient, Jimmy Skelton, collapsed and nearly died.
33:20Today, he will be having open-heart surgery.
33:23Ready to go home?
33:24I'm ready to go.
33:25I'm going to the chapel.
33:29I think it's going to be me and Jesus all day long.
33:31As long as your chest is open, that's what I'm going to be doing.
33:35We're with a tour group, and we had just gotten to Killarney.
33:39He took the luggage upstairs to the hotel room, and he sits down, and he says, this chair sure
33:45is low to the ground.
33:46And I turn around and look, and his eyes are fluttering.
33:49I thought he's having a stroke, and I'm getting no response, nothing.
33:54He's dying in front of me.
33:57And I thought to myself, God, are you really going to do this?
34:00Are you going to do this here and now again to me?
34:04And then I immediately went into nurse mode, started CPR.
34:09By the time the ambulance got there, he was back to baseline.
34:12He was trying to get up.
34:15We get to the emergency room at Cary.
34:17The doctor said, are they treating your heart murmur?
34:21And I said, what heart murmur?
34:23I didn't know he had a heart murmur.
34:25So that led to the echo, which led to the 85% blockage of his aortic artery.
34:35It's pretty scary for them.
34:38Jimmy requires a full valve replacement, a complex operation that requires his heart to be stopped
34:43for a period of time.
34:44There's no, like, herd option where there's no risk.
34:49That doesn't exist.
34:51His risk of death at two years is about 50% without having it done.
34:59Lots of people praying for you.
35:01I'm not ready for him to leave me.
35:03And this happens to so many older people.
35:06You work and work and work and you save.
35:08And then when you get ready to go and enjoy life, something terrible, terrible happens.
35:15And it's just not fair.
35:17It's still early back there.
35:18Oh, 1 o'clock, 1 a.m. our time.
35:211 a.m.
35:22I met him at the Dairy Queen in our little hometown.
35:26He was my brother's best friend.
35:28And my brother said, you better not hurt his feelings.
35:32Yes, sir, I won't.
35:33We both went to school after we were married.
35:37Jim graduated high school and went to work.
35:40I graduated high school and went to college and had a great time.
35:45I was 20 when we married, so I was 30 when our first child was born, 32 when the second
35:50one was born.
35:52Our world revolved around our family and our church and our little league baseball and Jim
35:59coached the boys in baseball.
36:03We brought so many children into our home because our kids were going to be fine.
36:08And we had to save everybody else's children.
36:12All right, let's pray.
36:15Lord, watch over Jim and be with the OR team.
36:24Everybody that's in the room, God, just lay your hand on them.
36:29In Jesus' name I pray.
36:31Amen.
36:38He's a good man.
36:40He's a loyal man.
36:41If he tells you he's going to do something, he's going to do it.
36:45He's just a good man.
36:47Always has been.
36:49I love you.
36:51Where are you from?
36:53Alabama.
36:53Oh, I'm always with my mom.
36:55We had had the conversation moments before he left.
37:04I want you back, but if God wants you more, then that's the way it's going to be.
37:11I really don't have any control over it.
37:13God is the one that has control over those situations.
37:17If I'm going to say I have faith, I've got to live it.
37:21I was skeptical about the robot, I'll be honest, because I was so good with the laparoscopic
37:31and keyhole stuff, I didn't think anything could be better.
37:34But in actual fact, it is massive.
37:36The robot is entirely controlled by the surgeon.
37:40It just helps to improve what we do on the patient.
37:44So it helps refine our movements.
37:46We're seeing patients with a lot less pain afterwards, so they recover much quicker.
37:50They have less complications.
37:52If I was needing an operation to remove my bowel, I'd want somebody who could use the
37:57robot on me.
38:02Ready to rock and roll.
38:03Ready to rock and roll.
38:04Okay, so we're going now.
38:07I'll leave this.
38:11Jimmy is being readied for major open-heart surgery after collapsing while on holidays in
38:17Kerry.
38:20I want to be focused on Jim and channeling myself to him.
38:38I want to be close to him.
38:42Then I don't have a lot of hope.
38:44That goes back to my trust in my two children didn't live, so why would God let my husband
38:50live?
38:51My oldest, his name's Adam, he had just turned 26, and he passed away in December of 12.
39:02He overdosed in our home.
39:05We did CPR on him.
39:07We found him in the bathroom, and he had been down quite some times.
39:10I knew when I saw him that we were not going to bring him back to where he was, but because
39:17Jim was there, I had to try.
39:18It was two weeks, almost, to the second anniversary, when our youngest son, Andrew, overdosed.
39:29He just could not deal with the death of his brother.
39:35That grief was very different.
39:36That was when we got angry.
39:38That was when we really got angry, and we left the church.
39:41I don't like seeing the patient in the morning of surgery.
39:55I remember before I did a patient, and he had two young children, and they wanted to
39:59see me the morning of the operation, and I was in the first year of my consultancy, and
40:02I went and I spoke to them, and I thought, I'm not doing that again, because it didn't
40:07facilitate that level of detachment I wanted going into the operation.
40:11Okay, I might come back on the line a bit.
40:14Okay, clamping here.
40:15It's not that, you know, you don't care about the patient.
40:19You're hyper-invested in the patient.
40:21That's why you developed this strategy.
40:30Once you have stopped the heart, then the timer is on.
40:33The longer it goes on and on and on, the patients are more likely to have complications.
40:41Okay, let's open a size 23 valve, please.
40:51Marriages do not survive the death of one child.
40:54It certainly was not going to survive the death of two children.
40:58So we made conscious decisions.
41:04We did some very, very hard counseling because our marriage had to survive.
41:10He retired early, and we sold our home.
41:15We bought the motor home, and we left town, and that's what we did.
41:20We just, we were gone, and we were just together.
41:22And we didn't have to tell people our story if we didn't want to.
41:26We could be around people if we wanted to.
41:28We could be with each other, you know, just whatever we needed.
41:31But we needed to be together.
41:32We both missed the boys, and we're both ready to go at any moment.
41:43You can turn off your green and your blue again.
41:46Once you open the heart, as in Jimmy's case, you let air into the heart, and that will cause an arrhythmia.
41:53The heart kind of has a funny rhythm.
41:54Get ready to shock, please.
41:58Okay.
41:59Charge to 20, please.
42:0120, 30.
42:03Okay.
42:03We put the defibrillaries directly on the heart, and we shock the heart.
42:08Shock.
42:09And what you want to see is the patient go back into a normal rhythm again.
42:19Two hours ago, four-year-old Zach arrived to CUH after a spasmodic croup attack.
42:24You've still got a cough, but I think you're much better.
42:32Staff have administered steroids to help ease his breathing.
42:35Rory's my name.
42:36Can I sit down here in the bed?
42:38Is that okay?
42:39At the end of the bed?
42:40Hi, nice to meet you.
42:41Rory's my name.
42:42Hi, Catherine.
42:43Hi, Catherine.
42:44How are you?
42:44Look right up there.
42:45It is amazing.
42:47That is so good.
42:48And is this yours as well?
42:50Put that there.
42:51That goes there.
42:51Okay.
42:52Fair enough.
42:52It's mine.
42:53Very good.
42:54He's so, so bright.
42:56Like, there is a good future there for Zach, definitely.
42:59And with the right supports, I can make sure that happens for him, you know?
43:03You can guess what I made.
43:04You made a tower.
43:07He loves washing machines.
43:09He loves household appliances.
43:10All different kinds of things.
43:11He does, yeah.
43:12Not your typical stuff.
43:15And by God, he can take them apart too.
43:20He just doesn't, he hasn't quite figured how to put them back together, but I'm sure he will.
43:25Yeah, certainly breathing nice and easy right now.
43:27Yeah.
43:27Yeah.
43:35Zach, just breathe in and out.
43:38And again.
43:38Never in my life would I've ever thought I'd be where I am now, sitting in front of doctors
43:45and being told, we've done X, Y and Z and this is clear and that's clear, but it's evident
43:50that something is wrong somewhere.
43:53We'll need to observe him for another few hours just to make sure, given the extent
43:58of what happened, that he's an episode of cyanosis or purple discolouration.
44:03We don't have a choice.
44:05I hope that in time that there will be something better for him.
44:08Do you know where treatments are concerned?
44:11Because at the moment, there is none.
44:12I might see if I can touch base with one of the respiratory team just while you're here.
44:17I think he probably is okay to go home at some point after a period of observation.
44:21Yeah, it's like clockwork, like, you know, when you go in, this is what's going to happen,
44:26I know what the steps are, I know what needs to be done, I know what gets done when he's
44:29in there and then home and just wait for the next time.
44:34It's going to be hard to predict 100% if that's going to happen again tonight.
44:43Yeah, in the ED, she's still in the resource department, so they're waiting until she's
44:46stable and then they might try moving her then.
44:50Yeah, yeah, yeah.
44:51And she's just getting a chest x-ray now as well, so.
44:56In Rhesus, there is still concern about Mary's low blood pressure and the source of her problems
45:01are still a puzzle.
45:05Infectious disease consultant Sarah O'Connell is reviewing her case.
45:09But if the blood pressure doesn't pick up, despite the fluid, sometimes who we do need
45:13to ask are the intensive care doctors.
45:15Sometimes people might need a chemical to help keep the blood pressure open.
45:19Because of the blood pressure open.
45:20Yeah, yeah.
45:21How are you doing?
45:22I'm married.
45:23Loads of friends.
45:24A lot of neighbours call and things like that.
45:25She's one friend. She comes on a Friday night and they have their Captain Morgan and their wine
45:30and they'll be watching the Lil H or during the summer it's some either Joe Dolan or something
45:35on YouTube to watch and so they have fun with that. That involves getting a larger nine put in.
45:41Is that blood again? No. Oh no blood. It's a chemical. It's a blood, it's a blood I drink.
45:47She loves her garden. She's kind of upset this year that she wasn't able to plant the flowers
45:50herself but she was very good at giving orders to everybody else on how to plant them.
45:54So I'm reluctant because I don't think that this XX good pressure is 90 hours.
46:03With mom's MS she could have just ended up in a bed and not deciding to do anything with the
46:08last 30 years but she gets up every day. It's just up and down. Yeah exactly.
46:14I could just stay in bed with the pain and not do anything but I get up, I work.
46:20It's good to do stuff, just strive on kind of thing.
46:24I think this is pneumonia, looking at the chest x-ray, the pneumonia that was there and was improving
46:29has gotten worse. Okay. Yeah.
46:31Yeah. Mom never moans. She's very slow to give out about the condition or anything like that.
46:36We'll have to see what happens if we've changed the antibiotics.
46:38We are having a little bit to go back after giving a lot of fluids.
46:42Joe, when she's not mobile, she needs somebody to do stuff for her.
46:45I'm there to do that kind of thing. Most of the time. Well, all of the time really.
46:53The team has confirmed that Mary has pneumonia which is the likely cause of her sepsis.
46:58A decision has been made to admit her.
47:11I think this is here. Hello.
47:16Hi Sherry. Everything went fine.
47:21Jimmy's been in the ICU now and he's stable. If that was bad enough, you know,
47:26we definitely need to have done sooner rather than later I would say.
47:29Hopefully, if everything goes okay, we'll start waking him up later this evening.
47:33Perfect. Perfect.
47:36Is that okay? Thank you.
47:37Any questions for me? No. Music to my ears.
47:42Good woman. Okay. I'm sure I'll see you later.
47:45Okay. Thank you so much.
47:47Okay. No problem. Bye Sherry. Bye. Bye-bye.
47:50It was very fortunate that even though it was obviously very traumatic for his poor wife to have been there,
47:55you know, that's pretty shocking. I think it was fortunate that he got this what you would call as a warning sign.
48:03You know, he's lucky that this is how he presented. It's not always like that.
48:07Yeah. Come on up here.
48:09He's still asleep on the ventilator.
48:11Okay.
48:16He's good. He's very good.
48:17Hey, that's great. His color looks good.
48:19Good. Yeah.
48:20Good. Yeah.
48:20Good.
48:21Good.
48:22Good.
48:24He's warming up.
48:26All right.
48:27That was such a good feeling. He was warm. He had blood blowing through his body,
48:31and he was warm. And then I was like, yeah, we're gonna be okay.
48:44I wish I was a bit better, I wish I could go out to matches and go outside, you know,
48:59or something like that, but I'm most grateful to be where I am, and if to take another two
49:05months or whatever, so be it.
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