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00:00On any given day, some 800 inpatients, 800 outpatients, and over 240 emergencies are
00:08cared for 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
00:37I can.
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, we're in a long haul, you're not getting rid of me.
01:02I just broke down what is going on.
01:05I get 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.
01:21Yeah, good piece.
01:28Any issues overnight?
01:30No.
01:32Everybody behaving themselves?
01:33Yeah.
01:34Including the computers and the equipment?
01:36Yeah.
01:37CDU is full, AMAU is open and functioning, SAU is open and functioning.
01:42They've taken two from us this morning.
01:50A cyclist has been hit by a car.
01:52The air ambulance has been scrambled and is now arriving at CUH.
01:56Ladies and gentlemen, he's 46-year-old, Mr Barry Power.
02:02Mr Power was in Castleton Bear today, he was cycling out of the drive on the main road
02:07in Castleton Bear, so he literally cycled straight down the drive, never stopped, car hit
02:11him.
02:11Hello, how are you?
02:13Hi.
02:14I know, I'm so sorry.
02:16Aww.
02:16I know.
02:18Barry came straight down my driveway and straight out onto, across onto the main road in front
02:25of an oncoming car.
02:26So head to toe, he's got quite a lot of lacerations over, he's got some over his frontal, over his
02:30occipital lacerations to his face.
02:33Barry came off his bike, onto the bonnet of this man's car, broke the window.
02:38He came thrown about 30 metres from where the impact was to where he landed you.
02:43No helmet worn either.
02:44OK.
02:45And were we able to see the cars and there was any bullseye or anything?
02:48There was, to the front of the car there was, there wasn't a bullseye but there was damage
02:51to the front of the car, yes.
02:52OK.
02:52Yeah.
02:54No problem.
02:55My role is the team leader.
02:57So I stand at the end of the bed and I have a clear overview of everything that's going
03:02on with Barry.
03:04OK.
03:05What's your role?
03:05Barry your team great.
03:07Given the mechanism of injury, bike versus car, no helmet, it's important that we keep
03:14Barry staying still and get a scan of his brain and of his neck because we had concern for
03:22a head injury.
03:24Yeah.
03:26In the setting of his condition with Down syndrome, it was important for us to stay calm, to communicate
03:33calmly to him and to his family.
03:36And is that your sister that's here with you Barry?
03:39Yeah.
03:39Your mum and dad are here as well?
03:41Right.
03:41We'll get everybody in just a moment, alright?
03:44They did ask me would it be okay if I came with them in the helicopter and I could see
03:49that Barry was frightened and worried.
03:51He was asking for his mum.
03:52I want my mum.
03:53He was unaware of the extent of his injuries.
03:56Avanced out just right there.
03:57Beautiful.
03:58Gorgeous.
03:59That's for Barry and just a little one for the front of your neck, it's like a big
04:02necklace.
04:03Alright.
04:04I'm going to feel a little bit tight, bit of a squeeze.
04:06Hold my hand here.
04:07Barry.
04:08Barry.
04:08Hold my hand here.
04:09Here I am.
04:10Hold my hand.
04:10Hold my hand here.
04:12That's it.
04:12Barry perceives pain much different to how you and I would and he can't express exactly
04:17where the pain is or what kind of a pain that is.
04:20Tell me Barry, where in your tummy is it the most sore?
04:23Or is it just sore all over?
04:25Mm-mm-mm.
04:26Okay.
04:27Okay.
04:27I think this is what we're going to get.
04:30Yeah.
04:30Yeah.
04:31So just given mechanism of injury, I think we're going to pan-scan him.
04:36So we'll book the scan.
04:38The team is now concerned about further serious injury and a fuller scan is ordered to assess
04:44trauma to Barry's head, spine, chest, abdomen and pelvis.
04:50That's okay.
04:51You're all right.
04:51Look at you doing so well.
04:52You're the best patient.
04:54Yeah.
04:55Yeah.
04:56Is it a patient?
04:57Your mom?
04:59Yeah.
04:59Yeah.
05:00Would you like...
05:01What we're going to do is we let her come in and see you in a few minutes, okay?
05:04What's your mom's name?
05:05I don't know.
05:09I don't know.
05:11I don't know.
05:12I don't know.
05:12I don't know.
05:13Hmm?
05:13Is she a nurse?
05:14Yeah, she is.
05:14Go away.
05:16Yeah.
05:16She's like Gusto.
05:18Yeah.
05:19Barry's parents are in the family room, waiting to hear news of their son's injuries.
05:47What are your mom and dad's names, Barry?
05:49His mom is a nurse, Val.
05:50Oh, wow. I bet you she's the nicest nurse ever. Much nicer than us, Barry, is she?
05:55Yeah.
05:57We'll have her waiting for you when you're back.
06:04He's moving a bit.
06:07So you can see the nice view of this baby's spine there.
06:11So with the little baby's head is up here by your belly button.
06:14The back is coming down here, down onto your right side.
06:17A little heartbeat there, a little tummy.
06:20Parents of two, Caroline and Rory Conboy, are having a 30-week scan of their new baby.
06:27So the baby's in that V position, so you see two little feet up here, just up by the head.
06:33Very happy with a little six-year-old boy and a three-year-old girl, and we will have another
06:38little boy soon.
06:40So we're just going to check the size, and then we'll have a little listen to the heartbeat, and I'll
06:44look at the flow through the cord.
06:46We really love the idea of family, and having somebody else was going to be great fun.
06:50And as I said, we kind of just laughed at each other because it wasn't in the plan.
06:55I think day one where the biggest relief is that we can fit three kids in the back of the
06:59car.
07:00That wasn't an easy thing to work out.
07:03The head is up here by your belly button.
07:05Yeah, it's still there.
07:06We'll give another couple of weeks to figure out its head from its bottom.
07:09I can't wait for him to move down.
07:13You do have to kind of change your world for your kids, but it is definitely worthwhile for us.
07:22He's so cute.
07:24Once you hear the heartbeat of a child, once you see them on the scans, they're a real person.
07:28Yeah.
07:30Which one do you think he's like?
07:32I know, yeah.
07:33Familiar.
07:34Yeah.
07:36Caroline's dedicating an awful lot of herself to growing this person.
07:41And at the same time, your life partner is there, and they might have something very serious wrong with them.
07:46And you just can't separate the two, necessarily.
07:53It's all his little hands.
07:5618 weeks ago, Caroline received devastating news.
08:00Her 12-week scan revealed a large tumour.
08:03She has an aggressive cancer that is placing her and her baby's life in jeopardy.
08:10Baby's a very nice distraction.
08:12It's a very positive, very happy thing that's happening.
08:15Very good.
08:15Well done.
08:16Thanks, Grace.
08:17And if you let your kind of mind wander a bit too far, it can get a bit devastating.
08:22We would never have discovered my cancer, you know, without this pregnancy.
08:29So it was, like, definitely silver linings.
08:32Looking good.
08:33Yeah.
08:33He's doing very well.
08:35Yes.
08:35He's doing.
08:36My little.
08:38Once he stops confusing.
08:39Sign him up for the rugby team now.
08:41Yeah, exactly.
08:41Once he stops confusing his head with his arse.
08:45So we'll go ahead then with chemotherapy.
08:47And we'll touch base maybe next Friday.
08:50Yeah.
08:50And just do a check-in with baby.
08:51Is that okay?
08:52Perfect.
08:55What are you building?
08:57We're buying out of phones, Mom and Dad.
08:59Oh, yes.
09:00Yeah, yeah.
09:00Yeah.
09:02And how many rooms is it, you say?
09:03Seven.
09:06Will you fill them all with baby?
09:08Oh, yeah.
09:08Top one out there now.
09:10Seven.
09:10Do you see, actually, Gordon Ramsay's wife is looking to have her eighth child.
09:15Oh, my God.
09:16It's the eighth.
09:16It's just the seventh child.
09:18So, she's definitely 50-something.
09:24It's handover time in the emergency department.
09:2722-year-old, yeah, she was playing, I want to say Gaelic football yesterday, collision with another player.
09:34Advanced nurse practitioner Elaine Houlihan has just checked in.
09:38She's worked in CUH for almost 20 years.
09:41Gone home.
09:43Some of my best friends are in the emergency department.
09:46Nobody else kind of gets it.
09:47You're hardly going to go home.
09:48How was your day?
09:49You don't tell.
09:50You say, sure, it was great.
09:52And it can be terrible.
09:53And there are genuine terrible things happening there.
09:56You just have to go for a cup of tea.
09:58Do you want to chat?
09:59And usually you don't.
10:00You don't want someone.
10:00You just want to go away for five minutes.
10:02There you are.
10:03Thank you so much.
10:04You're welcome.
10:05Your life's over.
10:06Today's shift, like all ED shifts, will be busy.
10:1020 patients are on trolleys waiting to be admitted.
10:13Many of the less serious cases have been here for 12 hours or more.
10:17It's really tough because you don't want someone waiting there 12 hours.
10:21Our population has increased and our catchment is getting wider and wider and wider.
10:27And it is, you know, the busiest emergency department in the country.
10:32Have a seat back where you guys were.
10:34Someone's going to come and collect you for x-rays then, okay?
10:36Like, I won't be waiting 13 hours, will I?
10:38Oh, no.
10:38Oh, no.
10:39Not everyone's always happy all the time.
10:42But it can, you know, if you just kind of acknowledge, yeah, that's desperate.
10:46Because it is desperate.
10:47It's like sitting in an airport and your flight's delayed five times.
10:51Do you know what I mean?
10:56I don't know what I mean.
10:58I don't know what I mean.
10:58I don't know what I mean.
10:59I don't know what I mean.
10:59I don't know what I mean.
11:00I don't know what I mean.
11:00Okay, so.
11:01Yesterday evening, 22-year-old Caitlin Denehan Barry was playing her first match after a long spell away from sport,
11:08when her time at the pitch was brought to an abrupt end.
11:12I don't know why you brought this with me.
11:14Come here.
11:15What happened?
11:16What were you playing?
11:16Harding a football?
11:17Football.
11:18Okay.
11:18Ball was in the middle.
11:19There was space.
11:20Myself and the other girl were running straight to it.
11:22Who was going to get to first?
11:24Clash.
11:24Clash.
11:24That was it.
11:26When I was playing before lockdown, I was four stone heavier.
11:29I was a good bit overweight.
11:31So going back, being four stone lighter, I underestimated my power, I think,
11:38because I would have had more power with more weight on me.
11:40Nothing.
11:41Oh, I'm sorry.
11:41I'm sorry.
11:42I'm sorry.
11:42I'm sorry.
11:45They're fancy paper stitches you have in code.
11:48I know.
11:48I was thinking the same.
11:49They're very posh, aren't they?
11:51I think we have a good first aid.
11:54You stay put there.
11:55I'm going to get Dan to do the extra there and there, and then we'll come back and we'll stitch
11:58you.
11:58All right, babe?
11:59Yeah.
11:59Cool.
12:00Caitlin plays both camogie and football.
12:04It's a big thing in her life.
12:06Two, three evenings, she comes in from work, into the gear, and off she goes.
12:10So she's a lot of commitment.
12:12Did you go past it?
12:14Oh, did you?
12:15How are you?
12:15Is that painful?
12:16No, no, I'm fine.
12:17Really?
12:17Yeah.
12:17Did she stitch it?
12:19No, she's not yet.
12:20She's going to put a real one stitch in it, in the middle.
12:22I was 21 when I had Caitlin.
12:24I turned 22 a couple of days later.
12:26Yeah, so we've done it all together.
12:28She said that scars wouldn't be permanent.
12:31It might be a bit...
12:32Do you need to ask her to talk to a plastic surgeon?
12:35No, but now is the time, not later.
12:37I was wondering if we should go down the plastic surgery route.
12:41And it wouldn't bother Caitlin, and especially the fact that she got the scar playing sports,
12:45she thinks is amazing.
12:48I think it's kind of cool.
12:49Grant you go with that song.
12:51Maybe I will regret it, I don't know.
12:54I started playing camogie and football when I was early in primary school,
12:57so I grew a big connection with the ga.
13:00They always give you that sense of safety, that sense of home.
13:03You know, they'll back you on things that have nothing to do with the sport.
13:07Still, though, kid, take it easy on the field, will ya?
13:09I know it.
13:10My God, like, I can see you full of adrenaline, just...
13:14When Covid came in, it kind of took ga away from me.
13:17I think at the age that I was, being 18, you know, you lose school,
13:21you lose some friends.
13:23It kind of took that time away to grow up and to really mature.
13:26You know, all of a sudden, you're 22, but you have the brain of a 17-year-old,
13:30it seems, because you didn't have those social skills building up over those four years.
13:38When it all ended and we just went back to normal life,
13:40I just felt really lost and really down,
13:43and I thought the only thing that might get me back up and going
13:47would be to get a foot back in the ga.
13:51And...
13:54Yeah, I just wanted to push myself with that, even though it took a...
13:58It did take a few months for me to feel familiar in it again
14:03and feel comfortable in it again after being out of it for so long.
14:06But I was really happy. I pushed myself to get it back.
14:10Actually, get up your snappy chat with you or whatever the thing is.
14:12Your face tube.
14:14So, look, let's explain things properly here, Chips.
14:16Oh, Jesus.
14:17I know, because we're looking at a white open there and you're freaking out.
14:20Fuck.
14:20Let's look at it correctly.
14:22That's not bad.
14:23Okay.
14:24Let's talk about reality here and what we need.
14:27Stop.
14:27That's actually...
14:28That is a cool scare.
14:29I don't want to...
14:29No, look it up here now.
14:31Look up. I'm going to show you what it's going to look like afterwards.
14:33So, you're not looking at the swirling around. Look at the little lime.
14:35All right.
14:36Because I know she's not bothered right now today.
14:38You won't be bothered now. You'll be bothered in a few weeks.
14:41So, we're going to do the best job, right?
14:42Yeah.
14:43Right.
14:44Let's give that five-minute.
14:47All right.
14:50I'm back if I just want that anesthetic to work with.
14:52So, I'll leave that to work, but it's a melt in here.
14:54Your honour, thank you.
14:57That cut is so deep.
15:00That's...
15:00It's not even that.
15:01You see that picture, Steve?
15:03And she kept going like that.
15:05I know.
15:05And I was like, I don't want to see her skull.
15:11So, I'm just going to the white machine and I'm just going to move out.
15:15Forty minutes ago, Barry arrived to the emergency department at CUH by air ambulance,
15:20after he cycled into the path of an oncoming car.
15:26Barry?
15:27Yeah?
15:28You're in the CT scanner now.
15:30And we're going to get you over onto this table so we can get some scans, okay?
15:34Good.
15:34One, two, three, and roll.
15:37He is being pan-scanned to check for life-threatening injury to his head, neck, spine, chest, abdomen,
15:44and pelvis.
15:45Absolutely going to stay like that.
15:46You can manage that.
15:47Okay.
15:48All right.
15:49Otherwise, we're going to start doing scans.
15:51All right.
15:51It's fine.
15:52All right.
15:56He was at home and was going down his driveway.
15:59And, um, got it on the mark.
16:02Yeah, sure.
16:03Breathe in.
16:04Hold your breath.
16:05Breathe in.
16:06So please bring it.
16:08Yeah.
16:08Shall I?
16:09Amazing.
16:10Thank you so much.
16:11Very well done.
16:14Thanks a lot, guys.
16:17Thanks a lot, guys.
16:22Come on, let's sit outside there, right?
16:25No.
16:28You're doing so well.
16:30Oh.
16:30You're fantastic.
16:31Oh.
16:36I'm taking it.
16:37Come on again.
16:39Hello.
16:40It's your bar.
16:41Yeah.
16:41You're Barry's mom?
16:42Yes.
16:43Do you want to come in to race us to see him?
16:45Thanks.
16:45Have you been in already, guys?
16:47No.
16:48You haven't been in yet?
16:54Are you there?
16:56Are you there?
16:57Oh, yeah.
16:57You're here.
16:58Yeah.
16:59That's pretty good.
17:00That's pretty good.
17:01You've got a big fright.
17:02I remember.
17:02Why are you snakes?
17:04Yeah.
17:04You've got a big fright.
17:06Yeah.
17:07Can you remember it?
17:08Okay.
17:08I don't know.
17:09It's all right.
17:10It's fine if you don't remember it, okay?
17:12But you had an accident.
17:13Yeah.
17:14I didn't know.
17:14And you were in the helicopter.
17:18You don't even remember that, because I'd say you were asleep.
17:22And Susan came with you all the way up here to the hospital.
17:26You had a busy day.
17:29Barry is 46, and my parents have cared for him all his life.
17:34In particular, my mother.
17:35And I suppose he has formed the biggest bond with my mother.
17:39And when things go wrong, especially, you know, Barry would always look for his mother,
17:44or his mam.
17:47Hi.
17:48Good evening.
17:49My name is Ogie.
17:50I'm the doctor looking after Barry.
17:52Yes.
17:53But you wouldn't like.
17:54How are you feeling?
17:57Don't worry.
17:57We're going to try and clean up your face, okay?
18:00That's fine.
18:01We just went on the official report from the radiologist, and then we make a plan on what
18:08we're going to do.
18:08Hopefully it won't be too long.
18:10But for the meantime, we have to keep in mind and keep in with the colour.
18:13That's crazy.
18:13Like that you're not the only one either.
18:14We're going to need to have a look at the wounds and clean them up and tidy them up a
18:18bit.
18:20There's five children in the family.
18:21Barry is the middle child of the family.
18:25Oh my God.
18:27Barry learned to cycle from a very young age.
18:30He just got on a bike and took off.
18:33Look over there, Barry.
18:34Look at the other side.
18:35Hey, Barry.
18:36Brian and Jill here.
18:36This side.
18:37It's very important for him, you know, that he's able to do the things he enjoys doing and
18:41have, you know, a good quality of life.
18:43You know, maintaining his independence and his enjoyment and keeping him safe has become more challenging.
18:52Don't sit up. Don't sit up, no, Barry.
18:54No, lie down, Barry.
18:55No, lie down.
18:56Fuck off!
18:56I know, I know.
18:57Don't eat language.
18:59Barry is very much his own person and has his own mind.
19:02And when he decides something, he means it.
19:04He was able to stay, you know, immobile for a while.
19:08But then he decided, you know, it was time for him to get up.
19:13Don't get up.
19:14Barry, relax.
19:15Barry, relax.
19:16Barry, just two minutes.
19:17Barry, don't get up.
19:18Just two minutes.
19:20He got agitated after a while, not willing to listen, not willing to stay still.
19:27We haven't gotten the results from his CT scan yet.
19:31And so that was very crucial for us to keep him still.
19:35Push down the bed.
19:36Push down the bed.
19:37Push down the bed.
19:37Push down the bed.
19:38You're OK?
19:39Push down the bed.
19:39We're going to pull you down to move you down.
19:41You lie back.
19:42Relax.
19:43Listen to me now.
19:4450 breaths.
19:44So don't think of the breathing exercises that Lindsay gave you.
19:50And I know they're hard to do now.
19:52But just the breathing exercises through less.
19:54Think of something nice through less.
19:56The music.
19:57Your music.
20:00I was inside a theatre one time and there was a patient lying down.
20:04She felt very nervous, you know, and she hadn't gone a bit white, you know.
20:08And Esther, one of the nurses, came in the door.
20:10Send for the priest.
20:12She shows.
20:13The patient looked up.
20:15What?
20:15What?
20:17And I looked at the patient.
20:19I said, what?
20:20I said, no, she called me.
20:23The patient.
20:23The priest is the next patient.
20:27Now, let's see.
20:28Are we rocking?
20:29Do you want to stung her?
20:30No, you're fine.
20:31Nurse Elaine Houlihan is treating 22-year-old co-footballer Caitlin.
20:37Yesterday evening, an overexuberant tackle left her with a nasty gash.
20:41You could 50-50, you could glue it as well, but the reason why you're quite expressive,
20:46so you don't want to split, you know what I mean?
20:48That's why.
20:49I am, yeah.
20:50Yeah, you're all eyebrows.
20:51I wouldn't see you wrong at all, okay?
20:54Genuinely.
20:58You feel here?
21:00No?
21:00No.
21:01Lash.
21:02Let's get the ball rolling.
21:04Your face is your fortune.
21:06You're going to go to interviews and stuff, and people do make judgments about a scar on your face.
21:10They will automatically think the worst thing.
21:14It's about having the most cosmetically pleasing result is what you want.
21:21I'm growing up, and I'm trying to start making my own decisions.
21:24My mum is trying to let me make my own decisions.
21:27My mum definitely wanted me to get that plastic surgeon because she was thinking ahead.
21:33That's all right.
21:34Now, you are a bit bumpy there because that's where you're bumpy.
21:36Yeah.
21:37I'm just going to cross my fingers and hope that it doesn't stay as prominent or as red,
21:42that it goes down and it fades away.
21:44I could have as easily fell off a bar counter than, you know, like, get hurt in a GA match,
21:49so I'm just trying to appreciate that it happened on the pitch and not at a bar.
21:54I'll get you a work cert, and I want to get you a head injury vice and a two-minute
21:59skirt.
22:00Thank you. How long am I getting off for?
22:01A week.
22:03Three days.
22:07Why did I bring this?
22:08I know.
22:09Do you know what I was thinking, though?
22:10Next time, if anybody's to go to ask for an emergency, bring a pillow.
22:14Bring a pillow.
22:14If you're passing up pyjamas, phone charger, and a pillow.
22:17I know.
22:18Just fingers crossed that this scar goes down, and that may be my wedding photos,
22:22you won't be able to see them as much.
22:25Oh, it's done.
22:28Okay.
22:30Expectant parents Caroline and Rory are awaiting chemotherapy for Caroline's stage 4 cancer.
22:37It's my week 12 scan, and my obstetrician found the cyst in my ovary.
22:42Within the four-week period, it, like, doubled in size.
22:45Do you know what, I did ask, Kira told me to ask him about the whooping cough vaccine,
22:51and whether I can have it or not.
22:52Oh, yes, yes.
22:52I've realised, then, that surgery was probably going to be required.
22:57I found quite a large tumour on my appendix.
23:00Obviously, it had spread to the ovary.
23:02It also spread to some parts of my bowels.
23:07That's kind of why I had, then, the diagnosis of a stage 4,
23:11because it had spread beyond the appendix.
23:14It's rare, it's like a one-in-a-million cancer.
23:17Caroline can't have the operation to remove the cancer until after her baby is born,
23:23by which time the cancer may have spread further.
23:28That might have been the original cancer, right?
23:30Yeah.
23:31And it spread to that big thing, then, beside the baby.
23:34That's the baby, obviously, and that's the tumour, that's the cancer there.
23:40Caroline's oncologist is Dr Richard Banbury.
23:45Cancer is still somewhat of a frontier.
23:47Science still hasn't caught up with it and still doesn't have all the answers.
23:50So, while cure rates are increasing all the time,
23:53the fact that you don't cure a significant proportion of patients
23:56and a significant proportion of patients die from their cancer
24:00is definitely the hardest thing.
24:02Richard has to decide the safest and best treatment for Caroline and her baby.
24:07He has little precedent to rely on.
24:10The two chemotherapy medicines that are best for her cancer,
24:14there is some limited evidence of their use in pregnancy in a safe way.
24:19So, we've moved ahead and used those with careful monitoring of the baby.
24:25I think, you know, there's so much, so many moving parts.
24:29So, that was the only thing that's kind of, we just don't know.
24:34We were afraid of being asked the question,
24:37whether it would be better to terminate the child for the health of Caroline.
24:43And we discussed the fact that this question might be asked,
24:46but I think we were very grateful that we never had to make a decision one way or the other.
24:51Did you get stickers outside?
24:53I do, I'll give them all to you. Actually, Rory has it.
24:55Rory has it. My lovely assistant has everything.
24:58It's great to have an assistant.
24:58I know.
24:59Thanks a million, Rory.
25:00What gives me sleep this night about this case is the lack of prior experience internationally
25:06in this type of situation.
25:08The lack of clear consensus and guidelines about what the best thing to do is.
25:12So, we have to make the best judgement we can with the limited information we have.
25:27It's not taking care of just one patient, there's two patients.
25:30So, I'm hoping that she's getting the best treatment and I'm hoping that I'm not harming the baby with the
25:35chemotherapy.
25:36Done.
25:37All right.
25:38It's wonderful.
25:39Yeah.
25:39And if there's any issues, I'll stay here.
25:42We'll knock on the door.
25:4860-year-old Joe Welch has an aneurysm in his brain.
25:51He requires an urgent procedure before it reaches rupture point and will be operated on today.
25:58Mm-hmm.
25:58Mm-hmm.
25:59Mm-hmm.
26:24Mm-hmm.
26:26Mm-hmm.
26:31Mm-hmm.
26:35Yeah.
26:36Yeah.
26:37Yeah.
26:37Yeah.
26:37When rupture happens, it's a devastating event.
26:41A third of patients will drop dead on the spot.
26:45A third of patients will be incredibly disabled, like a very bad stroke.
26:49The other third, although they get away with it, they don't really get away with it in that they will
26:54have memory issues.
26:55When you look at them a year on, they're often working in a lesser role or part-time.
26:59So it has that devastating effect.
27:02Morning.
27:02Morning.
27:03How are we doing?
27:03Not too bad.
27:04You got here anyway.
27:05You'll manage off the cigarettes for the weekend.
27:07I'm gone often.
27:09Gone.
27:10Out the gate.
27:11Told ya.
27:13We'd often talk about smokers' aneurysms.
27:16And if you have one and you smoke and you continue to smoke, you've a much more increased risk of
27:21rupture
27:21and you have an increased risk of getting other aneurysms.
27:24It's very, very simple.
27:26Once we meet a patient who's a smoker with an aneurysm, they have to stop.
27:31His aneurysm is dangerous.
27:32It's large and irregular and has to be treated.
27:35His risk of rupture is very high.
27:39OK.
27:42So, as we know, we've got those blood vessels.
27:49OK.
27:51So what we're going to do, you'll have little incisions.
27:54Yeah.
27:54Both legs.
27:55We're going to travel all the way up here.
27:57On one side, we're going to put those little platinum coils into the aneurysm and then we're
28:02going to rebuild the wall on the other side to stop it coming back.
28:07We're essentially going to fix the bank of the river.
28:10Yeah.
28:12So, that'll divert the flow.
28:14Yeah.
28:14And that'll hopefully be the end of it.
28:18The girls were after being in and they came out upset.
28:23So, I kind of knew then that Joe would be.
28:25He was after saying goodbye to the girls.
28:28Not knowing was it the last time.
28:30I told him everything was going to be OK, but no, we didn't think so.
28:38Because he could have been left like a vegetable.
28:42He'd come out of it good or he wouldn't.
28:45So, they were the three choices we had.
28:48And Joe went down.
29:00It's two hours since 46-year-old Barry arrived to CUH by helicopter after a collision between a car and
29:07his bike.
29:09Listen to her because she's trying to help you.
29:11I'd love to see.
29:12I know you are because you're good enough to listen.
29:14And you have to be.
29:15Very luckily for Barry, the CT scan is showing no injury to his spine.
29:32I am a nurse and my mother is also a nurse.
29:34It's a different situation when it's a member of your own family.
29:38And you are entrusting them into strangers as such and being the health professionals on the day.
29:45It will give you a good deal there.
29:48While Barry's neck, chest, spine and pelvis seem undamaged, the team is still awaiting results of his brain scan to
29:55check if there is injury or internal bleeding.
29:59Barry, we always saw as special because he is special to us.
30:03You know, he does have a learning disability, but that didn't prevent him from being a brother to us in
30:09any way.
30:16Living in a small community, you know, has many benefits and we're very lucky here in that people know Barry
30:22and Barry knows people and he feels very comfortable with all these people.
30:26I remember at one point somebody picked Barry up on the road and they were going back to work in
30:31the hospital and they told Barry,
30:33well, you know, I'm stopping at the hospital and Barry said, oh, well, I'm going to Super Value.
30:38So they had to continue on and bring Barry to Super Value.
30:42The community is brilliant.
30:47We know you're sore.
30:49It's probably an understatement not to say sore, but we have to clean just so the doctor can see where
30:55to dress the wound.
31:00You're eyebrows are beautiful. Did you get them done?
31:02Thank you. I actually just plucked them yesterday myself.
31:04No, but they're really nice. They're lovely.
31:06It's like...
31:07I'm excited. Thank you.
31:09It's all the fun ones.
31:10Yeah.
31:13Joe is waiting to go to surgery to have his brain aneurysm treated.
31:17So when you go in...
31:18I come back in.
31:22Can you just say what time you're going down now?
31:24Certainly.
31:26The procedure will be performed by neuro-interventional radiologist Gerry Wise.
31:32However, Gerry has been urgently called to a more immediate emergency.
31:38Dermot Moynihan was recovering in CUH from cardiac surgery when the alarm was raised.
31:44Patients like this who've had cardiac intervention, they've been on various drugs, they've been on bypass.
31:49All of these things give us that thrombotic risk where you have that risk of forming clot.
31:58Dermot is having a stroke. Gerry and his team have to act fast to remove the clot.
32:04It's okay. Just too relaxed there now.
32:07Most strokes are due to lack of blood flow to the brain.
32:11As time goes on, obviously there's more and more damage to the brain.
32:16Every 30 minutes we lose a 10% chance of being independent.
32:20So we have to get it out.
32:21And it's getting a tube up there that can actually just suck out the clot.
32:35And it's getting a tube up there that can actually just suck out the clot.
32:41That's essentially just to suck the clot out.
32:46If we can open the blocked pipe, blood is re-established, those parts of the brain are re-perfused and
32:53we give our patients a chance at recovery.
32:57So this is what we've essentially sucked out of that bar trim.
33:02In less than 15 minutes Gerry has successfully removed Dermot's clot.
33:09Most families, you know, would have had that experience of stroke.
33:13My own grandfather would have stroked his dominant hemisphere and unfortunately lay in a bed for several years unable to
33:19speak,
33:20paralysed down one side of the body.
33:21So it's certainly something I had witnessed.
33:25And that level of disability that we were all far too familiar with.
33:29And back then, you know, we had to accept and thankfully today we don't have to accept.
33:35So this is the clot and that's what's gone from the heart up and blocked the artery.
33:48Caroline is 90 minutes into a chemotherapy session.
33:52Dr. Richard Banbury is hoping the specially designed treatment will contain her tumour,
33:57giving her the best chance to survive while also protecting her baby.
34:08Using chemotherapy in a lady who's pregnant is fraught with risk because, you know, the baby is still developing.
34:15You good?
34:16Yeah, it's flowing away happily there.
34:18Got loads going on.
34:20Chemotherapy normally is aimed at killing off those types of cells.
34:23But when you get to the third trimester, the baby's organs are formed.
34:28And using chemotherapy is more feasible at that stage.
34:31You're doing okay, Rory?
34:33I'm doing fine.
34:34You're working away all the time?
34:35Yeah, I've been lucky to be able to get the classes moved around from Friday.
34:39Okay.
34:40Oh, fair play.
34:41Good day.
34:42They're very supportive of your work.
34:43Yes.
34:44Okay.
34:51I don't really have nausea.
34:53I'm at Caroline in my final year of undergraduate at University College Cork.
34:59I definitely remember her being just a ray of sunshine when you walk into the room.
35:05I think within a month or two, we kind of expected that we'd be spending the rest of our lives
35:09together.
35:11We're going to lower the dose of the oxaliplatin a little bit because it can cause the pins and needles.
35:16And that can get worse over time.
35:18So we can't be sure that the chemotherapy is working at the moment.
35:23We have to take a leap of faith to do three months of treatment, aim to deliver the baby safely.
35:29And once the baby is delivered, do an up-to-date CAT scan.
35:32And that will look at her lungs, her liver, her bones and everywhere else.
35:37And fingers crossed, it won't show the cancer having spread to any other parts of her body.
35:41To give some margin for error, maybe give a three-week break.
35:45And then assume everything is okay and to go ahead with delivery at that stage.
35:52There are days when it's just a bad day.
35:54And you feel like, oh, what will happen if I'm not here?
35:58You know, people had said, oh, will you write letters for your children?
36:01And I thought, no, I'm not going to write them letters that, like, might be irrelevant in 20 years' time.
36:07There's things, I suppose, what we've decided to do is just to have fun now.
36:11Make sure that we're continuing to, like, do fun things like go to Photo Wildlife Parking and having fun with
36:18them.
36:18You know, going down to the beach and digging holes everywhere.
36:21Trying to not have them just remember me as someone who was sick.
36:24You know, so to have their active happy mommy, being active happy mommy.
36:30So, you know, maybe bring me home.
36:38You've got to appreciate what you do have rather than worrying about what you might lose or what you might
36:43not have.
36:44We're hopeful for the best possible outcome and we certainly want to get rid of this and grow old together.
36:51Oh, yeah. We're trying to kind of...
36:53Do you want me to get some extra energy for you?
36:55No, it's perfect. This is great. Yeah.
36:58You have to seriously consider how you're going to bring up two kids, maybe three kids on your own,
37:04without the person that you've been relying on and shared your life with for so long.
37:11You're free to go and have a lovely weekend.
37:14Stay tuned. Enjoy it. No worries.
37:17You keep joking, remission by Christmas, but, you know, but it's still, we want it to happen in that way.
37:24So there's a lot to be said for having that kind of positive outlook.
37:27I do want to be here for my kids.
37:32I think all of the time I've had nearly 20 years now with Caroline has been very precious to me.
37:39Of course, I want as much as I can, but it's been everything to have Caroline in my life.
37:48And as long as she's still with us, we're going to make the most of it, myself and the kids.
38:03A gentleman came in one day and he said, where do I get an echo?
38:09Oh, being from Cork, everybody in the country knows that the echo is his favourite in Cork.
38:14We said, oh, in the shop.
38:17He's just up to the cardiac unit he was coming, not to buy a paper where we sent him.
38:23After a delay to allow Gerry Wise to urgently treat a stroke patient,
38:28Joe has been taken to theatre for his critical aneurysm procedure.
38:33Joe, I'm going to walk you on the trolley.
38:34Is there?
38:35Hey, looking up.
38:36Yeah.
38:36Okay.
38:37Just take the back of that out.
38:40Okay.
38:43So if I really, it's quite a complicated aneurysm, isn't it?
38:46Yeah.
38:48There's two ways into the aneurysm.
38:49One from each side.
38:52So what we...
38:53And it's partially thrombosed.
38:54So there's clot in it.
38:56There's clot in the base.
38:57For all of our procedures, we'll have two people with experience scrubbed in.
39:02It puts two heads in the room for complex cases.
39:06And, you know, when choices need to be made during a case,
39:10it's that kind of combined work that, you know, keeps people safe
39:14and ultimately keeps the patients safe.
39:17Two heads are better than one.
39:23We're together nearly 40 years now.
39:27We have three children.
39:30Denise has her own salon.
39:33And Caroline works in the hospital in Kilkenny.
39:39We lost our son, Niall, ten years ago due to a motorbike accident.
39:47Like, he left here half seven on that evening.
39:53And by half eight, the guards were here telling us it was fatal.
40:00I had Niall's memory card.
40:04Asking him to save Joe.
40:07That his time hadn't come.
40:09But I never prayed as much to Niall as I did that morning.
40:20The procedure starts with getting access into the vascular system.
40:24And you can do that from the top of the leg.
40:27We then basically put a long tube all the way from the leg up to the artery in the neck.
40:33Then another tube, which is smaller, which is the micro catheter, goes all the way up.
40:38And we navigate that under x-ray guidance to the actual aneurysm itself.
40:43So we'll then gently enter the aneurysm, as it were, with that small tube.
40:53And sometimes as you're placing a coil, I've learned to just stop and breathe.
40:59Because there's an increased tension on you as you're actually placing the coil.
41:04And you realize we all need to relax.
41:06Let the coil relax and let yourself relax as you go on placing them within the aneurysm.
41:20They're platinum.
41:21And we essentially go into the aneurysm and push that little piece of metal.
41:25And it's going to form a ball.
41:28That ball will then occupy the space in the aneurysm.
41:32And as a result of that, we get clot formation around it.
41:35So in other words, the aneurysm closes off.
41:44After two and a half hours, we started to panic.
41:49Because we were saying it must be over, it should be over.
41:54Did something go wrong?
41:56Just waiting, looking at the phones for that phone call.
42:04The hardest thing in these procedures is learning when to stop.
42:09You need to put enough coils in it to make sure that the aneurysm is occluded and going to stay
42:15occluded.
42:16But you can't be too aggressive that you do something too much at the end and you end up rupturing
42:22the aneurysm.
42:34It is now just over three hours since 46-year-old Barry arrived to the hospital by air ambulance.
42:41After cycling out in front of a car in West Cork.
42:44He's being closely observed in the critical dependence unit while awaiting brain scan results.
42:52Barry, how are you?
42:56Hello, sir.
42:57Maybe I'll let you around this side so you can see you better.
42:59OK.
43:02Hello.
43:03Hello.
43:03He has something called like a contusion.
43:06Where it's kind of like the brain is just kind of bruises around it.
43:10OK.
43:11So what we plan to do is we keep him for 48 hours.
43:16Those little...
43:19I know you're very upset.
43:23I know you're very, very upset.
43:26And this would be the last place you want to be in today.
43:30But you will get better.
43:32But we want to see how we can help you get better so we can get you home.
43:37OK.
43:38Is that OK?
43:40Lift your finger if it's OK, Barry.
43:45You could tell he was basically upset.
43:47He had that frown on his face.
43:49He wasn't responding to me at all.
43:54And, like, I need a miracle right now.
43:57Please.
44:14To be honest with you, sir, he is after taking ecstasy.
44:18So he's high on ecstasy at the moment.
44:21He's intoxicated and he's openly admitted to smoking cannabis as well.
44:26Oh, of course, sure.
44:28He's gone wild after working so hard.
44:31Sure, we've all, we've all, we've all done it.
44:39Yeah.
44:39Yeah, until he's seen and assessed by the doctor, yeah.
44:49Joe's surgery is over.
44:51For his wife, Mary, and daughters, Caroline and Denise,
44:54it's their first chance to find out for themselves if the procedure has been successful.
44:58How are you feeling?
45:00He's now fixed his face.
45:03Are you all right?
45:03Ask me, do you want brown bread?
45:05Because you're awake, it's all over.
45:08Done.
45:09No, he doesn't.
45:10No.
45:13The nurse just asked him who we were, just to make sure he was, you know, his mind was back
45:22to normal.
45:25I don't know.
45:26Take your time, take your time.
45:27Is it going through time?
45:28The bad boy?
45:29Oh, I see it.
45:30Yeah?
45:31No.
45:32Oh, my.
45:33Big trouble.
45:35Oh, yes, ma.
45:38How are we doing?
45:39How are you?
45:40Are we awake?
45:40Yes.
45:41Just about.
45:42Yeah.
45:43You get a word in edgeways, no?
45:45Not much even, I just like them.
45:48So it went very well.
45:49And now it's a great chance to give off the cigarettes.
45:51Yeah.
45:52He saved up already.
45:54Yes.
45:55So that's the important thing.
45:57If you have a successful procedure, it's very, very gratifying.
46:00And it makes all those late nights, all the times you got out of bed at three o'clock in
46:05the morning, worthwhile.
46:06All right, we'll leave you to it.
46:07I'll talk to you all.
46:17Please, it's for Barry.
46:18Yeah, we'll give you a hand to sit for with Barry so you can look into the bath for late.
46:22It's 15 hours since Barry arrived to CUH.
46:26He has spent the night in the Critical Dependency Unit.
46:29Oh, no, no, no, no, no, no, no.
46:30It's a big six.
46:30Oh, that's better.
46:31Exactly.
46:32You know, you think you're coming to hospital for this.
46:35Okay.
46:36Did we get one weighted-bix for you, Barry?
46:38You got three.
46:38Oh, three weighted-bix.
46:40Observing Barry and his family, you see the bond,
46:45and I thought of my own parents,
46:48wishing maybe they were here with me at that time.
46:52It makes me grateful to be part of a family
46:55who would be there for you no matter what.
46:58Thank you very much. Do you want to do it yourself?
47:00Cheers. Cheers.
47:02It's a different Barry now that was over for a while ago.
47:06My mother and father are caring for Barry all their lives.
47:09Barry is four to six now.
47:11What's going to happen to Barry when
47:13maybe they're not able to care for him anymore
47:15or maybe they have passed on?
47:17It's a major worry for my parents,
47:19especially with my mother who has this very special bond with Barry.
47:25Oh, sorry.
47:26Oh, cute.
47:28Sorry, I'm sorry. Sorry, Barry.
47:30Sorry, Barry.
47:32That's 20-year-old.
47:3420-year-old.
47:35Here, hold the spoon yourself.
47:37Right.
47:38Yeah.
47:39Have the Weetabix because it'll help your sore mouth.
47:42It'll help it get better.
47:45Okay?
47:46Yeah.
47:47I'll take away.
47:48We'll have a takeaway later with the Weetabix first.
47:51Yeah, I'll take a takeaway later, Barry.
47:53Yeah, I love the Weetabix.
47:55Yeah.
47:59It turned out he did have a bit of swelling on his brain,
48:02but thankfully it was nothing life-threatening
48:04and resolved after a few days.
48:07The bike is still at the guard station.
48:09We haven't collected it.
48:11I think it's the safest option at the moment.
48:14I was in pain for so long.
48:17I didn't know what it was like not to have pain.
48:19When I woke up after that operation,
48:21like, the pain that was lifted off my head was unreal.
48:26It's the best outcome I could have had.
48:58It's the worst outcome which I was in pain but can't get low.