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00:00On 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.
00:31Because I see a lot of sadness, I get great pleasure giving people the good news when I
00:37can.
00:39Here I am, hold my hand.
00:41You're having a heart attack.
00:43Filmed using 27 cameras, following patient journeys across the hospital, each story in
00:49this series was captured in just one single day.
00:52Together, they tell a bigger story of any given day.
00:57I'm here for a long haul, you're not getting rid of me.
01:02I just broke down what is going on.
01:05I'm getting the chance she didn't get, so I have to grasp it.
01:09A good shift is where you come out the door happy, thinking, I made a positive difference
01:17today.
01:18And that's really it.
01:21What's the difference?
01:29Message received, thanks.
01:34Look, I am getting absolutely hammered.
01:37Hi, it's Lane over in Aeney.
01:39I'm just wondering, is that bed ready yet?
01:41You don't have no beds, but like, 4C are taking patients off of you.
01:44They're not gone yet?
01:47Yeah, does that mean you have one space?
01:52Yeah, so does that mean we give it 40 minutes, 20 minutes, 30 minutes?
01:59Okay, look, it's half as one now.
02:01Will we be over by half as two?
02:02Will the handover and the patient be up in the ward and everything like that?
02:06Fabulous.
02:17A four-year-old girl, Madison, is being rushed to hospital by ambulance.
02:22She is suffering prolonged seizures.
02:25It's a question of your airway.
02:27Robin, are you okay on drugs?
02:28Yeah, I think that would be on antibiotics and fluids.
02:31You might need a second person.
02:34Emergency consultant Rory O'Brien is leading the team in Resos.
02:38Rachel, I think access is going to be the thing.
02:40With a sick child, you need a lot of people, but you want things to be calm.
02:44You want things to be measured.
02:45Do you mind doing assessment?
02:47You want to be making the best decisions.
02:49Prolonged seizures, we know, aren't good for you.
02:5350-minute seizure, had a further one-minute seizure.
02:55The oxygen going to your brain, which is what you're trying to protect,
02:58may be reduced, which can affect brain metabolism.
03:02So, we need to stop the seizure.
03:04Madison's mother, Shannon, called the ambulance.
03:07I know what seizures are like.
03:09I just felt there was something just different about this one.
03:12We gave the rescue medication after five minutes, which I administered myself,
03:15and the jerking of the body stopped.
03:18But then the lips started twitching, and the eyes were starting to roll into the back of her head.
03:22And her breathing is starting to be affected, which had never happened with Madison before.
03:27She had a seizure this morning at approximately 29, lasting 16 minutes.
03:33When we got to her...
03:34Madison's condition has continued to deteriorate en route to hospital.
03:38Her breathing is compromised.
03:42She looked lifeless, like, as if she was gone.
03:46Just see that, like, when they're pushing the bag down and your child is, like, unresponsive.
03:51It's, it's, it's horrible.
03:54That's clearly a major concern because I'm wondering, is this a problem with her airways?
03:58Is that why she's not breathing appropriately?
04:00Is it a problem with her lungs?
04:01Is it a problem with her circulation system?
04:03Or is it a problem with her neurological system, with her brain?
04:10I thought we were never going to get there.
04:14I saw it.
04:33En route here.
04:34She's had one more seizure en route with a great focus there.
04:38Also tonic, her legs stiffened also.
04:44Hey Madison, hello. Hello.
04:58We're just looking for an NPA, you know they need to wear a dual airway for a child.
05:01I think she's still seizing to be honest. She's a lot stiffer on this side there.
05:05I mean I'm giving her daughter so she's not doing much.
05:09I'd say we give another Loralse there, I think she's still seizing.
05:12To a child who's having a prolonged seizure, you're fundamentally worried about any primary or secondary injuries that would be
05:18happening to their brain.
05:19Do you think she's seizing?
05:20There is a very high chance that this child will need to be placed in a ventilator while we give
05:25her very potent medications to help stop the seizures.
05:30As the RESUS team work to stabilize Madison, her parents and grandparents are waiting in the relative's room.
05:36I don't know.
05:36I don't know.
05:37The nurse came out to us and said, look we're going to have to prepare you for the worst.
05:42She probably has been seizing then.
05:43To hear that then, it just broke my heart.
05:48What are her eyes like? Is she...
05:50And they're not fixed, they're not...
05:52Yeah, yeah.
05:54We're doing good for her today.
05:55Don't feel too cool.
05:56And she was stiff on the right side, so...
05:59And eyes were slightly deviated to the right, so probably seizing.
06:02There was uncertainty as to whether Madison would need to be placed in a ventilator, so you do need to
06:09introduce that idea early on,
06:11because you have to prepare Madison's parents for that very possible outcome.
06:24I just said to my mum, I can't lose her.
06:26I can't lose my child.
06:41Howard Grice has motor neuron disease.
06:43He is in CUH today with his wife, Yvonne, to check the progression of the condition.
06:56My name is Howard Grice. I was born in Sheffield, Yorkshire in 1966.
07:02I moved to Towering County Cork in 1994 with my partner, Yvonne.
07:09I have motor neuron disease. It has affected my speech and swallow, amongst other things as well.
07:15Mmm.
07:20Howard is treated by a multidisciplinary team, including respiratory physiotherapist Kevin O'Sullivan.
07:27I've really been without speech since about a year and a half ago, so I use this app to communicate
07:33now.
07:34From your point of view, how is the breathlessness?
07:41A recording of my speech was made when it was deteriorating. What you hear now is a repaired version of
07:48my speech.
07:49It can be frustrating, but you get used to it.
07:52Hmm. Hmm.
07:54You've done this before, yeah?
07:57Big deep breath in, coffee into the mask, and we're going to just see how it's showing out.
08:02We'll be doing three or four. Go on.
08:06I'll turn away from you, otherwise I'll be laughing and not about to do it.
08:12Ah.
08:12Yeah.
08:12When Howard laughed, his whole body would shake, his face would just erupt, and he'd just...
08:18You'd laugh with him because... You don't know what he was laughing at, but you'd laugh with him, you know?
08:23It's difficult watching him and knowing what he was like before.
08:27He was very talkative. He was the life and soul of the party. He'd be the first in and the
08:33last to leave.
08:35Just a top guy, you know?
08:40Recover, big breath, cough.
08:45The motor neurone disease, it's a severe degenerative disorder of the nervous system, and we don't unfortunately have a cure
08:52for it.
08:53We do have limited medical therapy, which is shown to slow things down, but unfortunately it doesn't stop the disease
09:00from progressing.
09:01My cervical spine identified a disc at C5-6, but his symptoms were...
09:06Consultant neurologist Aisling Rhine has been treating Howard since his diagnosis.
09:11It's always difficult to communicate the diagnosis of motor neurone disease to a patient.
09:16You never get used to it.
09:18You try to be there for that person and be the go-to link or be the coordinator for their
09:25care for as long as you can.
09:28A small dip today compared to the last time you were in clinic, okay?
09:33The most common cause that people die of, finally, in motor neurone disease is respiratory failure.
09:38Even if your lungs are okay and you've never smoked a day and you've perfectly healthy lungs, we still need
09:45innervation of our chest muscles to actually move our rib cage up and down, and that slowly over time fades
09:52for patients with motor neurone disease.
09:56And relax, okay? I know. Take a breather. Give him a minute. You're going to have to be doing this
10:02another two or three times as well, okay?
10:04Better.
10:05He likened it to a thief taking from you the whole time. The thief has got his hand in your
10:11back pocket and he's taking everything. He's taking your speech, your mobility.
10:16Better.
10:17It's like a gradual chipping away of the person that you are.
10:21I had always been a very active person and felt the threat of losing my ability to continue living as
10:27I had been accustomed to would be a very difficult challenge.
10:35A lot of negative emotions, anger, fear, sadness, worry. It's a head wrecker.
10:44Super.
10:44Super.
10:44Well done.
10:45Just a lot.
10:45Oh.
10:46Okay.
10:46And there's your other soft collar.
10:47And that's our number on that one, isn't it?
10:50Yeah.
10:50Yeah.
10:50That's fine. Just so you have it, okay?
10:52All right.
10:52We'll see you again, okay?
10:53I will be in touch.
10:54Bye-bye.
10:55Good thought.
10:59Are you from Limerick?
11:00No.
11:01I'm from Cork.
11:02I don't know what you're saying.
11:03Why would you think I'm from Limerick?
11:04You have a seat.
11:06Who do...
11:08Do I?
11:09Yeah.
11:10Thanks.
11:10I don't know, is that a compliment or not?
11:13The girls are the best-looking girls in the country.
11:15Who?
11:16Limerick ladies are the best-looking girls in the country.
11:17Oh, so it's a compliment.
11:19Yeah.
11:19Thank you very much.
11:21Yeah, yeah.
11:25Dr. Jason Vanderveld is on duty in the emergency department and also on call for emergencies outside of the hospital.
11:32I do have the golf car, seven minutes out though.
11:36Yeah, I mentioned it's cold and stiff, but I'm sure it's beyond any help.
11:40Oh, Roger, no, the golf car's on its way.
11:42That's perfect.
11:43Thank you very much.
11:49Dead.
11:54Cyclist George Fuller has dislocated his kneecap.
11:58Jason will seek to realign it.
12:08I stumbled into pre-hospital care.
12:10Don't know if I'll do it again.
12:11I'll probably be a vet in the life.
12:17I was a lifeguard, beach bum, didn't do great at school.
12:23Joined the ambulance service, really enjoyed it.
12:26Absolutely loved being a paramedic.
12:28I'll just...
12:29I won't move it.
12:30Oh, no.
12:31That'll be so long.
12:32Mm-hm.
12:33Use the top finger on the top to actually strengthen it, and I'm going to not do anything to you
12:38for two minutes.
12:39I actually want you intoxicated, and then I'm going to straighten it.
12:43I got injured, but I still wanted to carry on.
12:46And so I suppose that injury in myself enabled me to go to college, study further.
12:52And so we're in medical school.
12:53You're going to do bigger breaths than that.
12:55I think it's that community of pre-hospital care that's so special.
12:58Your head will swell, that's fine.
13:00Right?
13:00I just want you completely intoxicated.
13:02Deep breaths.
13:06Deep breaths.
13:08You're doing perfect.
13:09Well done.
13:11You're doing perfect.
13:13Deep breaths.
13:14And relax yourself down.
13:17There we go.
13:17Well done.
13:19Deep breaths.
13:20You've done magically.
13:22Keep going.
13:24Just turning the kneecap the right way around.
13:27Well done.
13:29You've done brilliantly.
13:31Okay.
13:33Nice one straight.
13:35Just like an in.
13:36Well, no.
13:38Yeah.
13:41I'm out of here, dads.
13:44Jason is dispatched to a serious incident near Formoy.
13:48A man has been kicked directly in the chest by a racehorse.
13:52A patient is coughing and spluttering.
13:55Making loud-blocking noises there.
13:58For any of the car, she's screw-headed.
14:00It's freezing.
14:01It's just...
14:05Bottom line is people do not get injured at the front door of the hospital.
14:10You get ill or injured at home, on the farm, in the workplace, on the road.
14:16And our role is to bring the expertise of the hospital to where you become ill or injured,
14:22to slow down, hopefully halt, the dying process.
14:32I see a man in a farm yard.
14:34He's also being kicked by a horse.
14:37The big worry.
14:39You've taken a full force of a massive animal kicking you into the chest.
14:44That energy has to go somewhere.
14:47It hits your chest wall.
14:48Bruises in the lung.
14:50Bruises to the heart.
14:52I have to assume the worst at this stage.
14:57Yeah.
14:58So it was just a straight-forward kick into the chest.
15:01And you didn't get thrown backwards?
15:03You did?
15:03He did.
15:04Up against this one.
15:04Here he is.
15:05OK.
15:06And did you hurt your back at all?
15:09You did.
15:09OK.
15:10So you're in charge of your own pain.
15:14You've got to be very, very vigilant that they haven't damaged the spinal cord.
15:18Bones can break.
15:19They can break all the way through to your back.
15:21Any pain to the chest?
15:22Ah!
15:23Yep.
15:24That's the one.
15:24He was in a lot of pain.
15:27No.
15:28The ground here is not going to make it stable.
15:30Hang on.
15:32Hang on.
15:33Right.
15:34I'm going to keep up.
15:35And the horse was still standing between me and James, so I couldn't get to him.
15:40All I could think about was what damage is after being done.
15:43And when I heard it was in the chest, all I could think about was what's going on inside
15:48in him right now.
15:51I'll get you in the ambulance with a much, much better look at you.
15:54I'll knock me out.
15:55I'll get up to you.
15:56Yeah.
15:57It won't be far off.
15:58It's all right.
15:58Far off it.
15:59All right.
15:59Just go with it.
16:00OK.
16:00I'm just going to get some, some scared.
16:04James?
16:06Let's have a quick look at your lungs, all right?
16:07Just while you're here.
16:09Mmm.
16:10There we go.
16:15When you see someone you love lying on a stretcher and they're
16:19pinned down to it and their eyes start to roll and the colour drains from their face.
16:25Is he bleeding internally?
16:27No.
16:27I didn't know what was happening.
16:29That's when we all got really frightened.
16:34Ah.
16:37Ah.
16:38Ah.
16:38Ah.
16:41Four-year-old Madison was rushed to CUH earlier today.
16:46The team have successfully stopped her seizures, but she is yet to regain consciousness.
16:54We just wanted her to come around, like, to fire to open her eyes so she knew that we
16:58were there.
17:19There's one thing seeing her have a seizure, but to see her the way she was, like, literally
17:24out cold from being given medication to keep her comfortable.
17:36And we were just talking to her and, like, saying, come on, baby, like, you're okay, like,
17:41we're here.
17:43And you just want to be with your child and make, like, take her place so she isn't going
17:48through what she's going through.
17:49It's very hard.
17:49It's very, very hard.
17:55She's been fighting since the day she came into this world.
18:00We never thought she would do anything that she's doing, like, now.
18:04But Madison, like, she just surprises us every day with how, like, strong she is.
18:09And we're just so proud of how far she's come.
18:14I was only 19 when I found out I was pregnant with Madison.
18:18I was happy, sad, scared.
18:22My partner James found out I was pregnant three weeks after meeting him.
18:27I was like, oh, my God, like, does he want this?
18:30Like, is he going to walk and leave me on my own?
18:32But he didn't.
18:33He said, we did this together, and there's no one going back.
18:36Like, we'll do it together.
18:38The birth was, it was, like, it was hard, but it was beautiful, and I was just in awe.
18:43I was so happy that, like, my body was able to bring Madison into the world, and that I
18:49had James' support as well.
18:51And then everything changed.
18:53Everything changed.
18:58We went in with the consultant, and they said Madison has been diagnosed with DYRK1A syndrome.
19:05We were, like, so worried.
19:07I was like, what is wrong with her, like?
19:11She's the only child in the Republic of Ireland that's been diagnosed with it.
19:15Like, I think there's, like, 30-something kids in the whole world with it.
19:19Like, it's very rare.
19:22Madison, like, can't talk.
19:25She's autistic.
19:25She's epilepsy, feeding problems, walking problems.
19:29There's so many to do with her disability.
19:32Like, she suffers from constipation, reflux.
19:35Like, there's so much.
19:38I weigh very heavily on how the parent is viewing their child.
19:42They'll know the condition better than I will.
19:44They'll know the nuances.
19:46Madison is extremely ill and will need to be closely monitored in the coming hours.
19:53She's now getting oxygen to her brain, but things can change at the drop of a hat.
20:00Madison can start seizing again, and her oxygen levels can start going down again,
20:05and her breathing can become depressed again, so you maintain a holding pattern.
20:15Madison is a very caring person, very kind.
20:18He said, and no matter what, we'll be the best parents.
20:22And show our kids, like, what love is like as well.
20:25Like, show them that, like, no matter what, we're always going to be by their sides.
20:30It is hard, like, it's very challenging.
20:32And it's like, it's around the clock here, like, it's constant.
20:36Constant medications, dosage, dosage change, hospital admissions.
20:42They're entrusting you with their child.
20:46So at this moment, they are saying, you need to come in, you need to help us.
20:51I couldn't imagine what it's like.
20:53It's that lack of control, having to give control over to the team.
20:59It must be a very uncomfortable kind of feeling for the family to do that.
21:06We're living it every day.
21:08This is what our life is with Madison every day.
21:16CUH, it's like a big city with little villages, you know?
21:21Each of our own little set group that we work with.
21:24But then we kind of call to the neighbours every now and then for a bottle of milk, you know?
21:32You OK, James?
21:33Where's Niamh, too, sir?
21:35Yeah.
21:37Where's my Niamh?
21:38Where's Niamh?
21:39Niamh's outside there.
21:4049-year-old James Fenton was kicked in the chest by a racehorse.
21:46Emergency doctor Jason is concerned he may have life-threatening chest and back injuries.
21:52Paramedics are preparing to move James to CUH.
21:54There's two specific points thoracic spine.
21:58Upper thoracic spine and lower thoracic spine.
22:02And he's also tender into the lumbar spine.
22:04If you have a chest wall injury, excruciatingly painful because every time you breathe, it's pain.
22:11I have not got a CT scanner that's going to tell me definitively that those lungs are not contused or
22:17that heart is not bruised.
22:19And so my first priority is just getting as much analgesia as he needs to enable him to breathe effectively.
22:26I want Niamh.
22:28I want Niamh.
22:28Niamh.
22:29I want Niamh.
22:30Yeah, I want Niamh.
22:32I want Niamh.
22:33Everyone's there looking after everyone.
22:35I don't know what else.
22:35I'll give them Niamh.
22:37Ketamine.
22:38I'm on fucking cloud.
22:40Oh, that's good.
22:41There's no pain so.
22:42No, I'm good.
22:43He was on cloud nine.
22:45I think it was the results of the Ketamine in his system.
22:48He didn't feel like he was here with us.
22:53He proposed again.
22:56I love you and we'll get married next week.
23:00Really?
23:00Yeah.
23:01Yeah.
23:02I was eight months pregnant, trying to keep calm.
23:08How are you?
23:09I'm going to follow you into the hospital.
23:11What hospital?
23:12See you here.
23:13Good enough.
23:14I was just trying to think, how am I going to juggle all of this?
23:17And I'm going to be on my own doing all of it.
23:21What if this is more serious and that the Ketamine and all the other drugs he's on
23:27are masking what he's actually going through?
23:40Howard has motor neuron disease.
23:43Following his respiratory assessment earlier, he and his wife Yvonne are waiting to see consultant
23:48neurologist Aisling Ryan.
23:53Hi.
23:55How are you?
23:56Come on in.
23:59Take a seat there, Howard.
24:01Can I just get a sense of what you can do there?
24:03So just arms up if you can.
24:05Good.
24:05And keep that up against me.
24:07Good.
24:07Keep that up.
24:09Good.
24:09Maybe a little weak there.
24:10Push down for me nice and strong and push down nice and strong.
24:12Okay, good.
24:13He still has quite good strength in his arms and legs.
24:16So he's walking.
24:17He's able to be independent in many aspects.
24:19But unfortunately, that will change over time.
24:23And then it's dealing with the challenges that that brings up.
24:26And how is he going to manage?
24:28How is he going to?
24:29Is he going to be able to walk around his house?
24:32Is he going to be able to dress himself?
24:33Et cetera, et cetera.
24:34And this time, pull towards you.
24:36Pull in towards you.
24:36I get fantastic support from Yvonne.
24:39There are things I can no longer do for myself that she now helps me with.
24:43And she's had to handle my frustrations.
24:47I'm fairly good at releasing emotion.
24:50I don't like bottling it up.
24:52Better that it comes out.
24:55And just the grip strength.
24:57Just squeeze me tight there.
24:58Okay.
24:58And squeeze tight here.
24:59So, yeah, that's a little weaker in that left hand, isn't it?
25:02How's the strength in the leg?
25:03I just like to look after him.
25:05You know, it's not a big deal.
25:08It's just that's what you do for somebody that you love, I think.
25:11We have an issue with the wedding ring.
25:13The fingers have swollen.
25:14Oh, okay.
25:14And we can't get it off.
25:16It looks to me like it probably needs cutting off.
25:18They will have a ring cutter.
25:19They always have one down in the emergency room,
25:21because sometimes this happens.
25:23I mean, it's sort of a difficult thing to, you know, cut the wedding ring.
25:27Do you want that done today, if we could organize it?
25:30Not really. Do you want to think about that a little bit?
25:33It's nice to just sit and be together and hold hands.
25:37It's just a bit of closeness amongst all the hustle and bustle.
25:42That's a precious moment.
25:45Maybe the next time you're coming, or if that's too far away,
25:47we can get it done in between.
25:52We all know how it ends, but the challenge is to make the most of the remaining time I have.
26:00Despite my deteriorating health, I still feel very fortunate.
26:04I have a loving family.
26:07I have a lot to be thankful for.
26:12I don't think about what I may miss, but concentrate on what I have enjoyed over the last 20 of
26:18years with them.
26:22Life's too short for all those to be worrying about how it all ends.
26:26The trick is to enjoy each day.
26:36What are you playing?
26:37Yeah, it was sports.
26:38It was sports day.
26:41Everything, yeah.
26:42Tag, rugby, I think.
26:44First and last time, I think.
26:47We're giving you more medication there now, Jude, okay?
26:55It's almost done now.
26:57It's almost done.
26:58It's almost done.
26:59Well done.
27:0464-year-old Tim Murphy has advanced lung cancer.
27:08Today, doctors will attempt to surgically remove the cancer in a bid to save his life.
27:14That'll be 40.
27:19The consultant came in and told me that Tim had a tumour on his lung and it was cancer.
27:30I've had two uncles that actually died of lung cancer, so I just thought, oh God, here we go.
27:40He's gone.
27:43Oh, I see.
27:43Number 40.
27:47I just remember Dr. Collins' initial words were, oh, it's a big boy, was what she called the tumour.
27:56What's the date of birth?
27:5719th of July, 62.
27:59I first met Tim in the autumn of last year.
28:03He would have discussed his case in our multidisciplinary team meeting and we would have looked at all his images
28:08and made a decision that actually, pre-surgery, chemotherapy with immunotherapy, I suppose a regimen that we call neoadjuvant, was
28:17the right way forward for Tim.
28:18And the whole purpose of that would be to shrink down the cancer because as he currently was with his
28:23diagnosis, he probably would have lost his entire lung if he had gone straight for surgery.
28:28Great.
28:28We might have a quick look at the board then.
28:40Great.
28:56You know, we give people hope, we buy people time, but it is emotionally very draining.
29:03It can be really hard to shake it off at the end of the day and to, you know, head
29:09home and pretend that I just, you know, put in a nine to five.
29:11Okay.
29:12So I, it's carrying another thing.
29:13Following a regime of chemo and immunotherapy to reduce Tim's tumour, surgeon Kishore Dadakula will attempt to remove his cancer
29:21completely, also hoping to save his lung.
29:25Okay.
29:26So if we look at the differences, I suppose, in where we were after 12 weeks of treatment, there's obviously
29:33been significant change.
29:34You can see a big cancer here and then, you know, obviously much smaller now.
29:38You never know till you really go in, but I'll try and save, but you know yourself, you know, unless
29:43we go in, we won't know.
29:47Do you smoke?
29:48No.
29:50So he's off them now two years since the 14th of April.
29:54There was a point, and now Tim doesn't know this, but I felt very angry at him.
30:02Like initially it took everything in my power not to say, you were warned.
30:13He had this God awful cough.
30:16Sometimes he'd nearly choke with it.
30:18And I just couldn't understand how he carried on smoking.
30:24But you just have to try and think of where do we go from here.
30:29So we'll start the pre-op.
30:32They'll check your operation site later on.
30:35My operation what?
30:36Operation site.
30:37Just so we always mark where we're going to operate.
30:39I'll send it.
30:40Make sure it's the right side.
30:41Exactly.
30:42Yeah, it's just a check.
30:43Do you know the reason for your admission?
30:46Yeah.
30:46Lung cancer.
30:47Lung cancer.
30:48And you're going to, this is a surgical ward, so you're going to have surgery on your left lung.
30:53Yeah.
30:54Is that okay?
30:54And hopefully they'll be removing?
30:56Hopefully.
30:57The tumour.
30:58Yeah.
30:59To be told that the tumour had shrunk by half was huge.
31:05We knew then that he could go for surgery.
31:08We just had to see what they could do.
31:10Who's next of kin?
31:11Kit.
31:12Okay.
31:12Is it partner, wife or?
31:15Partner.
31:15I asked the same question myself.
31:17Not yet.
31:20Later this year.
31:22Okay, brilliant.
31:23Congratulations.
31:24What?
31:26The goal is to get him to surgery.
31:28So being able to, I suppose, shrink down his cancer and have it then removed by a surgeon
31:34is the best outcome and what we could hope for for Tim.
31:38Let's sit down here.
31:39Good.
31:39Ah, no, no, no.
31:40Please sit down.
31:41Yeah, sure.
31:41It's all right.
31:41Yeah, yeah.
31:42How are you feeling?
31:43Great.
31:44Brilliant.
31:44Good.
31:45The day has come.
31:46Yeah, I heard so.
31:47Yeah.
31:48So heading into surgery fairly soon?
31:50Yeah.
31:50The chemotherapy and the treatment, are you feeling together?
31:52Yeah, I feel good.
31:54I didn't suffer badly with it at all.
31:55Yeah, yeah.
31:56Just pins and needles.
31:58Tiredness.
31:58Yeah.
31:58Beat you up a bit.
31:59In addition to beating the cancer up a bit.
32:01Yeah.
32:01Yeah.
32:02That's the plan.
32:02You did that though, didn't it?
32:03Did you?
32:04Yeah.
32:04Did a big job in that.
32:05Yeah, yeah, yeah.
32:06Thanks be to God.
32:06Good.
32:07The big fear for us is that, you know, when the surgeon goes in to operate, that he doesn't
32:13get it all.
32:14And, Tim, I end up losing the whole lung in order to try and get clearance.
32:18And, of course, there's risks to surgery.
32:20I mean, having a portion of your lung removed is not without, you know, potential for potentially
32:25devastating impact.
32:28It's just that.
32:30So, yeah, it is what it is.
32:32I know.
32:33We're getting done what we're getting done, you know?
32:35I know.
32:36Can't do much more about it, eh?
32:47She's cold.
32:48She's cold.
32:49She's cold.
32:49She's cold.
32:50The team has stabilized Madison following a series of prolonged seizures earlier today.
32:55Just ring me.
32:57She's cold.
32:58I know.
32:59She's cold.
33:00Madison suffers from a rare genetic condition called DYRK1A syndrome.
33:07We always said from the start when we found out Madison was sick, like, no matter what,
33:11we'll deal with it together as a family.
33:15I do get lonely at times, but then I have the, like, support of my mother, my father,
33:22my partner James, my siblings, his parents and his siblings.
33:26So, like, we can just ring them, but it's very hard to, like, you know, kind of explain
33:30how you're feeling.
33:31This is her dad.
33:33This is her dad James.
33:34I'm constantly blown away.
33:36Just the, the level of care and dedication that parents have.
33:41You know, their whole lives have gone down a path they, they didn't think they would
33:45go down.
33:46But you never see, eh, regret.
33:49You only see love.
33:52And it's, it's just, it's, it's mind blowing.
33:57Madison will be admitted to the paediatric ward so she can continue to be closely monitored.
34:04She's just a lot more stable now.
34:06So we're happy that we're going to bring her back and then just kind of wait for her
34:09to come around.
34:10We keep an eye on her.
34:12Madison does have needs and that's just the way it is.
34:15But she brings so much happiness to all our lives.
34:18And everyone is, like, so happy.
34:20Like, she puts a smile on everyone's face that she meets.
34:24Just looking forward to the future as our family.
34:41James was kicked in the chest by a race horse earlier today.
34:45Pre-hospital physician Jason van der Velde is concerned he may have significant injuries
34:50to his chest and spine.
34:54I've been there with horrific trauma when it's your own family member.
34:57You know, my son fell off the banisters, you know, from the top story down to the bottom
35:04story and literally went splat on the tile floor below.
35:09Having to manage that will always stick with me.
35:12I live rural.
35:13I live 50 minutes from the hospital.
35:15So I had to switch into clinician mode.
35:19I did not have any other option.
35:23And the one thing that I've appreciated is my colleagues, the CUH family.
35:28Because I was able to hand over care with my severely traumatically injured five-year-old.
35:35I knew he was in completely safe hands.
35:38He had multiple creptice down the left-hand side of the chest.
35:42He's had one pentrox.
35:44Before James can be sent for a vital CT scan, his pain needs to be controlled.
35:51All right.
35:52We're just going to get some local anaesthetic and we're going to get...
35:56We're going to get some local anaesthetic and try to take the pain down here.
35:58Yeah.
35:59Yeah.
36:00Yeah.
36:03It's the left side that we're blocking.
36:05Yeah.
36:07It's all right.
36:13I seem to be very calm on scene, or my parents on scene is very calm.
36:17Almost non-empathetic, but actually I've been there.
36:21And I know that the most effective way of managing somebody who's traumatically injured
36:26is to push emotion to one side and focus on the clinical, on what really matters.
36:35A lot of this is just the ketamine because you don't feel in control.
36:39And yourself being the boss, normally at work, you're always in control, aren't you?
36:45Is that right?
36:46The day before James's mum had passed away, to see a completely opposite side of James
36:54being so vulnerable, so upset, that his mother had passed away, then in so much pain
36:59from getting a kick from a horse, all in the space of 24 hours.
37:03It was very, very hard to know what to do or how to make things better and how to be
37:09there for him.
37:14I know you're hurting a lot, so what I'm going to be doing is getting a bit of local anaesthetic,
37:20just into the ground where it hurts the most.
37:26You can see the bruise coming up now, eh?
37:28I'm auto-digested.
37:29I know, I know.
37:30I know, I want to be there for the funeral.
37:35I think just one thing at a time, alright?
37:37Because in fairness, you took quite a belt of that boss, alright?
37:50No, you're definitely not hot enough to be in hell.
37:53Sometimes you call this place hell, but it's not.
37:55It's C-U-H.
38:01I'm a paediatric nurse by background.
38:03I started off actually as an actor over in the UK.
38:06I'm from Wales originally.
38:08And I went into the hospital as a play specialist working with puppets and children.
38:12Funny really is that a lot of the TV stuff which I did as an actor was hospital-based,
38:17like I was extras and casualty and a few other hospital-based programmes.
38:21So when I first came to work in hospitals over in the UK,
38:24I didn't actually like things like injections and blood.
38:27So I just used to pretend I was back on set of casualty.
38:34Eugene O'Leary has been brought to the emergency department following a chainsaw accident.
38:41You were cut in the hedge, were you?
38:43Yeah.
38:45It needs a few stitches, doesn't it?
38:47I would think so, yeah.
38:48Yeah.
38:48Yeah.
38:49How many cuts are there?
38:50So the thumb index...
38:52You wouldn't do it with a knife next time, would you?
38:55Eugene's hand was quite simply a mess.
38:57If you have a wound there, bacteria in that dirt love blood,
39:01and they just grow and grow and grow.
39:03Ah, it's a whole mess, isn't it?
39:05But there's still leaf on that.
39:09Leaf.
39:09There's still leafs on there.
39:11There'll be hedge growing here or something.
39:13I'll dump that in there.
39:22I think, um...
39:26One of the most mangled hands now that I've had to try and put back together in a long time.
39:29Good night.
39:36Do you have any kids?
39:38I'm not married.
39:39Right.
39:40Doesn't mean you can't have any kids.
39:44No one would have me.
39:45No one would have you.
39:46You escaped.
39:48You want to be confident with the patient.
39:51And I think that by having to chat with the patient at the same time as you're
39:55doing something very important to his hand,
39:57I think it feeds back...
39:59It reduces his level of stress.
40:01What are the edges of you?
40:03What are the edges of you?
40:05What are the edges of you?
40:05My...
40:05My father is eight months.
40:07Oh.
40:08And my eldest is eight years.
40:09Oh.
40:10And then three and five.
40:13So a nice spread of them.
40:14Yeah.
40:15All very good.
40:16All girls.
40:17Oh.
40:18All girls, yeah.
40:19Blessed among women all that.
40:21You know?
40:22So I'll be in big trouble later on in life.
40:26What?
40:28That hand was properly mangled with a chainsaw.
40:31There was so many little bits of skin poking out.
40:36Ultimately, we wouldn't have gotten a very good closure on the wounds.
40:39So he'll need more long-term definitive care under the hand surgeons,
40:43which is the plastic surgeons in our hospital.
40:46All right, Lily.
40:46I'll see you later.
40:47All right.
40:47All right.
40:51Good afternoon, CUHFM Hospital Radio.
40:54All day, every day with your classics from the 60s and 70s and the 80s.
40:59Do you remember this guy, Harry Belafonte?
41:04Hey, that's me.
41:06How are you?
41:06I'm Dave.
41:06I'll be taking upstairs there now.
41:08That's fine, Dave.
41:09Tim has advanced lung cancer.
41:13Surgeon Kishore Dodakula is preparing for high-risk surgery to try and remove his tumour
41:18while also saving his lung.
41:22He won't know until after he has begun the procedure if that will be possible.
41:28The most important thing is their life.
41:31And the second most important thing is get all the cancer out.
41:37Any operation, I suppose, done by a cardiothoracic surgeon is life-saving
41:41because the stakes are very high.
41:44If you take out the whole lung, the risk is as high as one in ten won't make it.
41:49So the priorities are three.
41:50One, safety so that his life is not in danger.
41:55Number two, I want to get all the tumour out.
41:58And number three, I want to leave behind as much of lung as possible
42:01so that he can have a good quality of life after this surgery.
42:07It's terrifying.
42:08One of the loneliest times of my life.
42:12I think I didn't want to be thinking about the reality of what could happen.
42:18And I didn't want to think of my life without Tim.
42:29I was terrified of the surgery.
42:31It was just all of the risks associated with just the surgery itself
42:36outside of what they were trying to actually remove.
42:41Okay, spread us, please.
42:48I don't remember my life before Tim.
42:52I was separated.
42:54I didn't ever think I would meet somebody again.
42:58But Tim is the one.
43:00It's the only way I'll push it.
43:03To see how we can negotiate this loop and this loop.
43:14Quarterly, please.
43:16Two hours into Tim's operation, Kishore has made his decision on what to remove.
43:23Say this, please.
43:31There is a tumour there.
43:36Sometimes lymph nodes are involved.
43:39There is a tumour there.
43:44There is a tumour there.
43:51While James' pain has been brought under control, there is concern he could have severe damage
43:57to his chest and spine.
43:58A CT scan has been ordered to assess the damage.
44:01And they gave you the ketamine.
44:05It wasn't pleasant to see the reaction.
44:09Ketamine.
44:12It was just the way you reacted to it, which we were told is normal anyway.
44:18Your breathing, it was like you couldn't breathe.
44:21Like you were starting to suffocate and your eyes just went completely wide and still.
44:28James is turning 50 this year and I'm 37.
44:32But once we got to know each other, it was never, never a question brought up between the two of
44:39us.
44:40It was evident very early on that things were going in one direction.
44:48We've was coming up to Valentines.
44:51And he just said, I hope himself is taking you out.
44:53And I said , no, no, there's no himself.
44:56So he asked me if I'd go out for dinner with him on Valentines.
45:01And of course I said yes.
45:03and we went to Bella Cafe in Fermoy
45:07but we had to go to the folding unit
45:10before we went for dinner.
45:12So I was introduced to horses straight away.
45:20He's very sore, very specific, one side of his chest.
45:25We're going to get the scans done, okay?
45:27So Andrea's a porter, we're going to go down.
45:30As you've been kicked and you see visible bruises
45:33on the chest wall, you don't see visible bruises
45:36in the lung.
45:37The consequences of that don't happen immediately.
45:40Okay.
45:40See you then.
45:41Yeah.
45:41So I'm just going to try and line you a tiny bit flatter.
45:44Ooh.
45:45Yeah.
45:46Yeah, yeah.
45:48So this is going to go tight again.
45:49Okay.
45:50Thanks, nurse.
45:52Oh, yeah.
45:54That'd be easy.
45:55Okay.
45:56Yeah.
45:57When James was wheeled away for the scan,
46:01it was then that I just broke down
46:03and I said, what is going on?
46:05What's going to happen?
46:07Is he going to be okay or not?
46:09Take your ball, so it's the ball already.
46:12Okay.
46:12Off the scan.
46:14Take the ball.
46:15Here we go.
46:16Just stand there.
46:17It's just.
46:21You're safe.
46:22It's on over, Tim.
46:23All right, all right.
46:26It's all right.
46:27We set you up, Tim.
46:29Would that help?
46:30Yeah.
46:31Tim is in recovery following major lung surgery.
46:35Consultant Dervila Collins is on her way
46:36to brief Tim's partner, Kay.
46:38The best outcome is that the cancer was removed
46:41and that Tim's lung was saved.
46:46He was able to take out just the lobe.
46:49So do you remember?
46:50Yeah.
46:51He didn't take the whole lobe.
46:52No, he didn't.
46:53Brilliant.
46:53So he's left about two-thirds of the lung in, all right.
46:56Fantastic.
46:57And has taken, you know, I suppose one of the lobes
46:59and just a little bit of the top.
47:01But he's happy that he's got everything.
47:04Took out all the lymph nodes.
47:05Thank you so much.
47:07Oh, no.
47:07I'd be just going to get, I'd be off with my tears again.
47:11That's my job.
47:12Yeah.
47:13So they send that off now to the lab.
47:15Okay.
47:15Sometimes we see a little bit of cancer.
47:17I mean, we know the stuff worked.
47:19Yes.
47:19Because we know from the scans,
47:20we know that things looked much better.
47:22Okay.
47:22And so we're really happy with, I suppose,
47:24the kind of the result that we went to theatre with.
47:27And I think it'll just take another two weeks
47:28before we get the full information about it.
47:32Oh, it's all relieved.
47:34I hope at least you're a little bit more...
47:37Relieved.
47:38Yeah.
47:38Relieved.
47:39Yeah, after, I'm sure, it was a very stressful day.
47:42Stressful months.
47:44While it's good news that most of Tim's lung was left in place,
47:48there still remains a risk that not all the cancer was removed.
47:52What we want is for when the pathologists look at that cancer
47:57that's being removed under the microscope,
47:59we want to see no cancer.
48:01We want to see that cancer having melted away
48:04with the chemotherapy and the immunotherapy,
48:06and that's the win.
48:13When we were in the hospital and that we knew
48:16that it was a fracture to a rib and that his spine was okay,
48:19you have to look at the positives as well
48:21and see that he was okay at the end of it,
48:24but he was also extremely lucky to be okay at the end of it.
48:28You get a second chance.
48:30The family's always going to be number one.
48:32The horses will be all right.
48:34But really, they're the hobby.
48:37Do you like to have any noises?
48:49I'm cancer-free.
48:51I live healthy and happy.
48:54A lot to be said to be living healthy and happy.
48:57What more would you want?
49:00The horses will be all right.
49:45Transcription by CastingWords
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