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Any Given Day: Cork University Hospital - Season 1 - Episode 04
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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, not getting rid of me.
01:02I just broke down what is going on.
01:05I'm getting a 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.
01:29It'll be about a half hour before he's here, darling, all right?
01:33Is that your dad?
01:35Yeah.
01:35What's his name?
01:36Vinnie.
01:36Vinnie?
01:37Vinnie, yeah.
01:38Okay, now you've got her.
01:40She's a deadiest girl.
01:42Well, she has him wrapped around her finger anyway.
01:45That's the way to be, you know?
01:53Orthopaedic surgeon Declan Reedy is on his way to meet patient Patrick O'Sullivan, who
01:58has fallen from a roof.
02:00And 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.
02:05I have a pain now, my tie.
02:06He needs urgent spinal surgery.
02:09It could be.
02:09It could be from you, or it 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.
02:16No, I landed.
02:17We used to walk.
02:18Hmm.
02:19Going 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.
02:34Like, he said, just like a leaf, you were blown off the roof.
02:39There'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.
02:46And there's one little fragment went towards the back, which is where your spinal cord and
02:50spinal nerves are.
02:51And that's the one we'd be a little worried about.
02:53We were supposed to go to Waterford that evening.
02:56We were going to a wedding.
02:58He said, you know, we'll get ready.
03:00We'll go to Waterford.
03:02And I said, are you sure you're able to go?
03:05He said, oh, he said, this one wedding, he said, I ain't missing.
03:08And we headed off then to the wedding.
03:11His brother-in-law walked with him to the toilet.
03:16And when he came back, he said, no, he said, I have to go.
03:19He said, he just couldn't believe what the distance of the walk to the toilet was doing
03:26to his back.
03:27Look, I said, we're going home.
03:29I said, he walked in, texted in an emergency.
03:32They nearly had a freak attack.
03:34The nurse said, you fell off my roof, and you're actually after walking in here.
03:39Straight away, they got the stretcher, like, and the padding, and put him into it straight away,
03:43like, and wheeled him straight down.
03:48Excellent.
03:50You can just see it here on the axiom.
03:52So you can see it's gone back and narrowed his spine.
03:53You can see the burst elements of the fracture around the front.
03:57Patrick has a very unstable pattern of fracture,
03:59with a significant amount of the bone pushing towards the canal
04:04through which all our nerves and spinal cord go.
04:06If he were to get up and walk around on it, it would get worse.
04:09That's in L2.
04:13And the fragments could move towards his nerves and cause partial or complete paralysis.
04:17I tell you before we leave the oven, yeah?
04:20Oh, they will, yeah?
04:21I'll find out how long it's going to be in the pipe.
04:24You'd nearly want to tie Patrick to a chair to get him to sit.
04:27He loves his running, loves his cycling.
04:29He often came home from work there at half, five, six o'clock in the evening,
04:33and he said, I'll go for a cycle now, he said, for the dinner.
04:36So he began off for a cycle, or he could be gone off for a run.
04:40I didn't want it.
04:42I was tired.
04:43When Dr. Reedy told him, like, the damage that was done, and try and not move,
04:51that he wouldn't do more damage, and he could be paralysed.
04:59I was going through my head was, I'm going to have to get the house revamped.
05:03You know, if he does come in a wheelchair, you know, if he's going to be paralysed,
05:09that would destroy him.
05:13And I know that.
05:25In the Cystic Fibrosis Unit, a multidisciplinary team led by Professor Barry Plant are discussing
05:31a new drug that might save a patient's life.
05:37The new drug will drop people whose sweats are 40, potentially, down to even 20.
05:44So, I mean, we don't know until we try it for her, but she seems immune.
05:48Doesn't she, James?
05:48She does, yeah.
05:49Whether it's lung transplantations, these new superdrugs,
05:53with a chronic genetic condition like Cystic Fibrosis, you're buying time all the time.
06:00Kim Gohani is in the clinic today to be assessed and briefed on the new drug,
06:04which has just finished the clinical trial stage, but is not yet approved.
06:09You never think about having to breathe until you're not able to breathe,
06:13and then it's all you think about.
06:17It's progressive disease, so as the years go on, you do have more problems with it.
06:23My lung function was dropping.
06:24I couldn't keep up with people anymore, and struggling to breathe.
06:28Even just things like having a shower, it's like climbing a mountain when you're really short of breath.
06:32You made a trip up okay? All the way from Watford.
06:36Yeah.
06:37I was always told, oh, you're not going to live to this age or that age,
06:41so I never really planned for a future, because I always thought,
06:44well, I'm just going to die young anyway, so that was always what was in my mind.
06:49Yeah.
06:49So how were you over the last two weeks?
06:52Very tight-chested, short of breath, and I started getting achy,
06:56so I had to go to bed, and I knew, I was like, something's not right here.
06:59You okay to lung function, please?
07:02Yeah.
07:02Six years ago, a revolutionary new CF drug called Caf Trio became available.
07:09Well done. Good effort, good effort.
07:12And saved Kim's life.
07:14Relax.
07:14I was practically living in hospital. I was on oxygen 24-7. I needed a wheelchair.
07:20She had very severe lung disease. Her lung function was about 20% of normal.
07:26She was on continuous antibiotics. She would be coughing up mucus all day.
07:30Keep going. Keep going. Finish it out. Well done. Well done.
07:33She was at the end stage of her cystic fibrosis.
07:37Keep going now. Keep going. Well done.
07:39I really felt hopeless at the time. And relax.
07:43My consultant told me, you know, you're on the edge of a cliff here.
07:47So I was really hanging on.
07:50Literally, hours after starting the drug, I just felt so light and free.
07:57Yeah, like, it's like I was awake. I was coming back to life is all I can say.
08:00It felt like it was just, it was unbelievable.
08:04You know, things have been shocking.
08:06Yeah.
08:06And pretty stable for the last couple of years.
08:09Yeah.
08:10But just not as well as everyone had like, I think.
08:13Over the last year, the drug that once saved Kim's life has become less effective for her.
08:18Her condition has worsened significantly.
08:21She needs a new drug to keep her alive.
08:24I could be coming to the end of my life. Yeah. And in my thirties.
09:12Any time you hear that patient's inbound to a resource, you're always filled with a sense of anxiety.
09:18The patient's even the highest level of care available in the emergency department.
09:21Being able to take a step back and avoid panicking is the most important thing.
09:28Sixty-nine-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?
09:43I didn't.
09:44We're just going to get you over onto the trolley, okay?
09:46Then we'll get a quick handover.
09:48Mary.
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 bones?
09:58She's going to get sick.
09:59Can you get her sick bones?
10:00Can you get her sick bones?
10:00Can you get her sick bones?
10:00Can you get her sick bones?
10:03MS, pneumonia and type 1 respiratory failure as well.
10:07That's great.
10:08I'll get a chart there for you guys.
10:11We'll get you something for the sickness.
10:13Are you allergic to anything, Mary?
10:14No.
10:15Okay.
10:16Sepsis is an infection that essentially takes over your body's whole immune system.
10:20The severe ended out is septic shock.
10:22Yeah.
10:23And do you live at home usually?
10:25Yeah.
10:25Super.
10:26And is there somebody with you at home?
10:28Super, super, yeah.
10:30I got a phone call saying that mum was being transferred over to accident emergency in the
10:35COH.
10:35That was her second or third time in the space of maybe three or four months.
10:41Will, is it?
10:42Yeah.
10:43Did you want to come in?
10:44Yeah.
10:47I 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.
11:04But it was just kind of upsetting to see her like that again.
11:08Just try to keep your arm as straight and as still as possible.
11:21We are treating her for sepsis because she's scoring all the markers for sepsis.
11:26Her heart rate's up.
11:27Her breathing is up.
11:28Her blood pressure's a small bit down.
11:30And she's on the oxygen.
11:32So she's being covered essentially with IV tazacin.
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.
11:46Now, sorry Mary, I'm very rude.
11:48You're 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 your son's in there?
12:01Oh, Will.
12:02Sorry.
12:02Will, no, no.
12:03I was speaking to the junior doctors over in Finn Bars.
12:06You live with your mother itself, right?
12:07Yeah, yeah.
12:07So the other things you look at, how her hands are like warm, cold, what's her perfusion like?
12:12That was one of those things I was quizzing Mary with questions.
12:14Cough?
12:15Do you have any sort of cough?
12:17Yeah, there is a cough.
12:18And it's at last day, two days, week, month.
12:21Last week or two.
12:22Okay.
12:22Bring up any phlegm with that?
12:24So it's a dry cough.
12:24She can't.
12:25When she was here, they were doing suction.
12:28Oh, yeah.
12:29Oh, bless.
12:30All right.
12:32Yeah, good.
12:35Good, good, good.
12:38Okay.
12:38Yeah, so that right lung certainly still sounds quite crackly.
12:42So for Mary, her heart rate is high and, you know, when your heart rate is 130, 140,
12:47my heart rate sitting here, I would hope, is maybe about 60 or 70.
12:50So her heart rate is already double in a much older heart.
12:53So to maintain her blood pressure, which is already low, her heart is working extraordinarily hard.
12:57And that can only continue for so long.
12:59So I'd go here over your kidney.
13:00Yeah, just don't.
13:01Okay.
13:01Someone's in recess, really, what you're looking for is what is going to kill them in them.
13:14I had finished med school and I wanted to be in an English speaking country in Europe.
13:23And I remember walking down on one of the streets in Dublin.
13:27And I stood there for God knows how long.
13:31And then a woman walks up to me and says, are you okay?
13:36In all my years of me being in Europe, that never happened to me.
13:42And so I'm still here.
13:44And I'm still getting that same Irish love from everyone in Ireland.
13:52Now, sir, we'll give you a ring once further.
13:56I see you don't hear so.
13:58Patrick is about to have spinal surgery.
14:00He has avoided paralysis after a fall, but is still at risk of a poor outcome.
14:07He was up cleaning a roof, the equivalent of a two-story fall, about 19 feet.
14:12I think he's one of these guys who did it for a living.
14:15He's very comfortable and calm and doesn't see the danger.
14:20Okay, snug him over towards me.
14:22We might just bring him to the edge of the bed before we do the flip, okay?
14:26Patrick, I suppose, hardworking.
14:30Loves the son, loves his GA.
14:34Likes to be kept busy all the time.
14:38God, he scratched himself a bit coming off the roof, didn't he?
14:41Dr. Reedy told him, like, we will operate.
14:44We will be putting in rods and bolts or whatever, like.
14:49But not all operations go the way they should go.
14:56Cool.
14:59Take 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.
15:07Okay, so we're just below fracture there, just between spinous processes.
15:11So if I go into the lower one.
15:13Now, a knife now would be good, Francis, when you're ready.
15:16I know you're trying to keep these sharp things away from me.
15:36Okay, try that.
15:40We are trying to avoid doing any further damage to the spinal cord.
15:44There is a lot of interesting blood vessels just in front of the spine that we don't want to damage.
15:49So in that sense, it has to be extremely precise.
15:55You have the broken bone in the middle.
15:57And you want to put some screws in above it.
15:59And you want to put some screws in below it and join those together with rods.
16:07We're just making the rods the right size.
16:10We have pre-made rods to certain sizes, but he's just fell between two of the pre-made.
16:14So we're making a 100 rod into a 90.
16:18Well done.
16:20And the idea is that when he then stands up, probably 80% of his weight will go through the
16:24screws and rod construct,
16:25and only 20% through the fracture.
16:33Tap the other one down, then tap that one again.
16:38And then when we distract, we'll open up the back of it.
16:40It's like breaking a crunchy bar and leaving the wrapper on and taking the two end of the crunchy bar
16:46and pulling it.
16:47Downward pressure.
16:49Good lad.
16:52As tight as it can go now.
16:59So we see where we're at now.
17:01Hop up there.
17:03Kim is in the CF clinic today to be assessed and briefed on a new drug that is not yet
17:08approved.
17:08Without a new treatment, Kim will need a transplant to keep her alive.
17:15Kim takes 25 different medications a day.
17:19At this point in her life, you know, really her full-time job is to work as hard as she
17:24can,
17:24to stay as healthy as she can every day.
17:27That is a real challenge.
17:29If she didn't have these drugs, she'd be in trouble in the morning,
17:32and we're still looking at a transplant, which is still a massive thing to do, you know.
17:38Approximately 60 to 70% of patients who get a lung transplant will be alive five years after the transplant,
17:47which means that approximately 30 to 40% won't be.
17:51Kim, how are you?
17:53I'm okay.
17:54How are you?
17:54Good to see you.
17:55You too.
17:55Barry hopes to get the new drug that might help Kim on compassionate grounds.
18:01The drug has now, in Europe, this new drug.
18:04It's at the point where they're sort of ready to put it forward for approval.
18:08But we've reached out to the company, and they remember you from the last time.
18:14Yeah.
18:15But they don't know your name, but they remember your story because they're not allowed to know your name.
18:19And we've sent them all your details, and we're discussing with them now as to whether or not there's an
18:25opportunity.
18:26And if there is, I mean in the same way, I'd give it a go again.
18:30Yeah, definitely.
18:30Yeah.
18:31Definitely.
18:32Yeah.
18:32So then at the same time, obviously, we work with the transplant people so that we'll cover both options.
18:39Do you know what I mean?
18:39When we hear of drug trials, everybody with CF wants to be part of it.
18:43Whether 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.
18:53Every day I wake up and I'm feeling okay, it's a great day for me.
18:57Next week could be different, next week I could be in hospital, I could be on antibiotics.
19:02But at times I feel worthless.
19:04Like, I can't work, so I don't have an identity as such.
19:07I'm just a person with cystic fibrosis.
19:10It's tough when people say, oh, what do you do?
19:13Like, well, I don't do anything, I just try to stay alive.
19:23It's not, because it was AD.
19:24It was AD.
19:25It was AD and then it went to 90.
19:29An 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.
19:41So there's the pressure ulcer.
19:42This is the pressure ulcer.
19:43And is this at the base of the, is that the heel or is it up like a...
19:47It's the heel.
19:47Would you feel pain down there?
19:49Sometimes.
19:50Sometimes.
19:50Has that pain changed on the last few weeks?
19:52No, since then.
19:53All right.
19:54But it was stronger because they had to give you a painkiller first Friday.
19:57Sometimes there is pain.
19:59The more tension there isn't.
20:00Yeah.
20:01Something I've learned over years is that the patient with the worst blood results, the sickest
20:05patients, 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.
20:14Who's the last person who would have looked at the ulcer here at the pressure sore?
20:18When was this last looked at?
20:19Not sure.
20:20The nurse over in Femme.
20:21Will obviously had been through the rollercoaster of Mary's health.
20:25Not just over the last four months.
20:26You know, Mary's had multiple sclerosis for many, many years previously.
20:30And I could see that Will was an advocate for his mother.
20:33Is that sore when I look at this?
20:35Is that sore?
20:37Well, not so far anyway.
20:39There's certainly gum coming out of it.
20:40I think that's all what we call physiological, i.e. your body's immune system.
20:44If your mum's ill, you should be there.
20:47If you can.
20:48I think most people would do that for their parent, I'd imagine.
20:52I'd hope.
20:57It's handy to have somebody in the house.
21:00Like, I know of other elderly people and they have nobody.
21:03And they're very alone and afraid, kind of things, most times.
21:06So, it could be a very different story.
21:09Yeah, they said over in Rimmer, they were feeling nicely.
21:23Will and his siblings have grown up caring for their mother, who's been battling MS symptoms since 1999.
21:30Mum, like, she's been ill since I was about 11, I think.
21:34So, it's all we've kind of known, really, as a growing up.
21:38Can you take a deep breath?
21:41Yeah.
21:42That's not a deep breath.
21:44Huh?
21:44That's not a deep breath.
21:47It's a deep breath.
21:49Will 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.
22:00So, sitting for a long time would affect my back and things and the pain and things like that.
22:05I'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.
22:17You're probably going to kill me, but I need more blood from you again.
22:21Oh!
22:21Oh, something juicy.
22:22One lung is almost completely obstructed now, so.
22:26The consultant asked me, or, like, how's the pain every day?
22:29And I said, like, it's okay, it's normal pain.
22:31And he was saying, well, there should be no pain every day.
22:35But I'm used to pain now this day, because you have to be, otherwise you wouldn't get out of bed,
22:40kind of thing.
22:40Where do I notice then?
22:42We'll try maybe that hand again, will we?
22:45My condition doesn't bother me, it's more the visual aspect of it.
22:49You'd see people sometimes looking.
22:51The kind of severe hunch, kind of thing that's coming out.
22:54The uneven shoulders, kind of thing.
22:56That, to me, is more painful than the actual pain.
23:00The disfigurement of it.
23:03It's a touch.
23:05Will you try and relax your hand on my hand?
23:07A little flop.
23:08Will I leave? Oh, yeah.
23:09You're very tense.
23:10Oh, yeah.
23:10There is no cure, it's a progressive thing.
23:13Oh.
23:14I know it's an awful thing to say, but I mean, would it not be better to get cancer and
23:17get that treated?
23:18And cut out and hopefully be rid of it.
23:22Whereas, like, with my condition, you can't cut out your spine and get rid of it.
23:26Or with mom's MS, you can't cut it out.
23:29Get chemotherapy for it and hopefully go into remission.
23:33Watching the monitor again.
23:35Like, that's all we were doing the start of February.
23:39Watching that.
23:40Watching that.
23:41To check the breathing, to check the oxygen levels.
23:44It should be below 20.
23:45Yeah.
23:47The team are running a series of tests to try and determine the cause of Mary's severe infection.
23:52She remains at risk of septic shock.
24:05When I wake up in the morning, I wake up with disbelief that it's half five.
24:13Anyone who works in an emergency department is a problem solver.
24:17And I would say also an optimist.
24:19Because we're always working to try and get the best outcome for everybody.
24:264-year-old Zach O'Leary is struggling to breathe.
24:29His mom Catherine called an ambulance early this morning.
24:34I found him slumped at the bottom of his bed.
24:37Purple.
24:37That's not normal.
24:41Spasmodic croup episodes.
24:43There is no pre-warning with them.
24:45So they just come out of nowhere.
24:47And he can't breathe.
24:48It's fight or flight mode really.
24:49Like, I just have to get on.
24:51Get it done.
24:52Get him in.
24:54I mean, I've just watched him suffer for so long.
24:57It's...
24:57It actually makes me sad.
24:59Like, it just takes a lot for me, like, to see him like that.
25:03Like, he's only four.
25:04Tell me, is this the finger you used to pick your nose?
25:07No.
25:08Yeah, it is!
25:10Ew.
25:12OK, I'm going to go get you some medicine.
25:16Is that all right?
25:17The treatment with croup is usually steroids.
25:21You can hear from his cough.
25:22It's very clearly croup.
25:24So, first line, always try and get the steroids into him.
25:27All righty.
25:27I'm just going to wait for this medicine to dissolve a small bit.
25:30During my pregnancy, I wasn't well.
25:33They did tell me I was going to be expecting a very small, small baby.
25:37And I suppose when he was born then, it was apparent he was very sick.
25:42It was all the lungs.
25:44We left there thinking, you know, that this was just a scare.
25:48And then it just turned into be something that we live with every day.
25:52With no answers.
25:54Were you here recently?
25:55I think I met you.
25:56Yeah, we were here.
25:57We were here in February.
25:59We were here in February.
26:00Yeah, he was admitted that to him when he was quite sick.
26:02Yes, I remember.
26:03Yeah.
26:05Zach, do you want to take it in one go or two?
26:07Your purple medicine.
26:11Ready.
26:12Ready.
26:12Steady.
26:14Swallow that.
26:16Good job, Zach.
26:17Ready?
26:18One more go.
26:22Can I please?
26:25Can I please go rocking?
26:27Oh, you can go rocking, but can we take this?
26:30Zach's case is quite complex.
26:32The broad spectrum, I suppose, they don't use levels anymore as far as I know.
26:36It's just, if you're on the spectrum, you're on the spectrum.
26:39Zach's self-soothing is rocking.
26:41He loves to rock.
26:41It's the deep pressure and, you know, he's hitting his back off of a hard surface.
26:45And it just calms him down.
26:47And I'll just leave him have at it.
26:50It works.
26:52Let me see if I've got something else up my sleeve.
26:56The life I have with him is normal.
26:58It doesn't look normal to other people because they don't have to go through the things that
27:01I have to go through and all the loopholes that I have to, and the obstacles, you know,
27:06to just get small things done or small achievements for Zach.
27:11Come on, quick, because your coffee's gonna get worse again.
27:17I'm okay, thanks.
27:19I'm okay.
27:20You're okay.
27:21But you're gonna be even more okay if we finish off the rest of this.
27:24I had Zach early and then I had Lilia in my early twenties.
27:28So, there's just three of us.
27:32Will you please take that?
27:33Do you want to pop him on your lap?
27:35Yeah.
27:36I'm sorry.
27:37I'll give you no more.
27:39He deserves the normal life too.
27:41I mean, I would love to have the problems that some people have.
27:43The 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,
27:52that he's going to be okay.
27:54And even on nights when he's not unwell, because they're the nights when it strikes.
27:58If you can talk one arm behind you.
28:01Oh, yeah.
28:02There we go.
28:03Opie doke.
28:07And blow.
28:12Well done.
28:13And blow.
28:14That's it, sweetheart.
28:16You're doing really, really well.
28:18That's it.
28:18Okay.
28:20Good job.
28:20Oh.
28:22Can I get you more tissue?
28:25I'm sorry.
28:26I know that's not nice.
28:28But it's the only medicine that's going to make you better.
28:33Yeah.
28:34You consider all the things that parents have to go through when they're at home, especially
28:38if you're in often.
28:43It's a huge mental load that a lot of parents around Ireland carry.
28:50Everyone wants their kid to be well.
28:52And you're going to do everything in your power to make sure that they stay well.
28:59I 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.
29:07Because 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.
29:24Surgeon Declan Reedy hopes his repair has worked.
29:26Patrick.
29:27You 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
29:41after surgery.
29:43I will always go out as soon as the patient wakes up and check that they're wiggling all
29:46their toes and moving their legs.
29:47Do you mind if I have a quick look at the legs?
29:50How do they feel?
29:51Can 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, he was doing straight leg raises, he was lifting his legs
30:02off the bed.
30:02And 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 till maybe Tuesday or Wednesday.
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.
30:22I said, that's all I could say, thank God.
30:24And I'd say, about three minutes, I was back off for CUH.
30:32Are you happy?
30:33I'm just seeing Kathleen.
30:35Yeah.
30:35Can I talk to you?
30:36I don't want to say that.
30:42Alright, now relax, relax now.
30:44My feet are falling.
30:46You'll be okay now, relax.
30:51What are you doing?
30:52As long as I get up.
30:54You'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.
31:02And that's the main thing.
31:05How did I get to Limerick?
31:06What Limerick?
31:07No, that's...
31:09That's...
31:10No, you're not in Limerick, you're in the car.
31:13That's all I know from the anesthetic.
31:15You are probably dreaming about these.
31:22So, I went to HSE Enternatal class the other day.
31:25Oh, yeah.
31:26Yeah.
31:2610 till 4.
31:28That's two days of it.
31:29Go away.
31:32With me, it was relaxing my jaw and...
31:34You know, just I found...
31:36A few things that I saw really helpful.
31:39Whereas I remember Michelle Howard.
31:41Yeah, yeah, your jaw is like connected to down there.
31:43Is it?
31:44Yeah.
31:45So, if you have a loose jaw...
31:48Uh-huh.
31:48Or if you hold your jaw, you then will be holding.
31:51So, it's like...
31:54To drink.
31:55Literally like...
31:56To drink going to labour?
31:57Yeah, no, no, no, no.
31:58To get it out.
31:58While you're in labour, to get the baby out.
32:00Like, do you know?
32:01So, if you keep a loose...
32:02That's the weirdest effort.
32:02Loose jaw, then...
32:04Take some jasper.
32:05Loose bits, like...
32:06Good work, yeah.
32:16I 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?
32:25Um...
32:26But I worked for a consultant in the States years ago.
32:28And he told me, like, the optimal years really are your 50s.
32:32Like, mid 40s to mid 50s.
32:34Because before that, you're kind of asked, are you too young?
32:35And 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,
32:56do you want someone with a lovely bedside manner?
32:59Or do you want somebody who can work through an extremely stressful environment
33:05if the operation isn't going according to plan?
33:07They'll ask for the latter.
33:11I wouldn't... I 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 home.
33:26I'm going to the chapel.
33:29I think this is 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,
33:44this chair sure is low to the ground.
33:46And I turn around and look, and his eyes are fluttering.
33:49I thought he was 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.
34:07Started CPR.
34:08By 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.
34:18The 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.
34:37Jimmy requires a full valve replacement,
34:40a complex operation that requires his heart to be stopped for a period of time.
34:46There's no, like, third 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.
34:58Lots 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.
35:07And then when you get ready to go and enjoy life,
35:12something terrible, terrible happens.
35:15And it's just not fair.
35:17It's still early back there.
35:191 o'clock, 1 a.m. our time.
35:21I 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.
35:31Yes, 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.
35:52And our world revolved around our family and our church and our little league baseball.
35:58And Jim coached the boys in baseball.
36:03We brought so many children into our home because our kids were going to be fine.
36:08We had to save everybody else's children.
36:12All right, let's pray.
36:17Lord, just 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. Amen.
36:38He's a good man. He'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. Always has been.
36:49I love you.
36:51Where are you from?
36:53Alabama.
36:53Oh? How was the way from home?
36:55Uh, we, uh, we don't clear down the bus door.
36:59We 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.
37:26I was skeptical about the robot, I'll be honest,
37:29because I was so good with the laparoscopic and keyhole stuff,
37:32I didn't think anything could be better.
37:33But in actual fact, it is massive.
37:36The robot is entirely controlled by the, by the surgeon.
37:39It just helps to improve what we do, uh, on the patient.
37:44So it helps refine our movements.
37:46We're seeing patients with a lot less pain afterwards,
37:49so they recover much quicker.
37:51They have less complications.
37:52If I was needing an operation to remove my bowel,
37:55I'd want somebody who could use the robot on me.
38:02I'm ready.
38:02Ready to rock and roll.
38:03Ready to rock and roll.
38:05Okay, so we're going now.
38:11Jimmy is being readied for major open heart surgery
38:15after collapsing while on holidays in Kerry.
38:31I want to be focused on Jim and channeling myself to him.
38:38I want to be close to him.
38:42And I don't have a lot of hope.
38:44That goes back to my trust in my two children didn't live,
38:49so why would God let my husband live?
38:52My oldest, his name's Adam, he had just turned 26,
38:58and he passed away in December of 12.
39:02He overdosed in our home.
39:04We did CPR on him.
39:06We 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.
39:16But because Jim was there, I had to try.
39:19It was two weeks almost to the second anniversary
39:24when 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.
39:43Okay, thank you.
39:45Right up on yellow, please.
39:46And right up on yellow.
39:47And right up on green as well, please.
39:48Okay, let's give this back, guys.
39:52I don't like seeing the patient in the morning surgery.
39:55I remember before I did a patient, and he had two young children,
39:58and they wanted to see me the morning of the operation.
40:00And I was in the first year of my consultancy,
40:02and I went and I spoke to them.
40:04And I thought, I'm not doing that again.
40:06Because it didn't facilitate 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.
40:29Once 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.
40:46Let's open a size 23,000, please.
40:51Marriages do not survive the death of one child.
40:53It certainly was not going to survive the death of two children.
41:00So 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.
41:34We 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,
41:50and that will cause an arrhythmia.
41:53The heart kind of has a funny rhythm.
41:55Get 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 see UH after a spasmodic croup attack.
42:28You've still got a cough, but I think you're much better.
42:32Staff have administered steroids to help ease his breathing.
42:36Rory's my name. Can I sit down here in the bed?
42:38Is that okay? At the end of the bed?
42:40Yeah.
42:40Hi, nice to meet you. Rory's my name.
42:42Hi, Catherine.
42:42How are you?
42:44Look what I made up there.
42:45It is amazing.
42:46That is so good.
42:48And is this yours as well?
42:50I'll put that there.
42:51That goes there.
42:51Okay, fair enough.
42:52It's mine.
42:53Very good.
42:54He's so, so bright. Like, 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. He loves household appliances.
43:10All different kinds of things. He does, yeah. Not your typical stuff.
43:17And 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.
43:24Yeah, certainly breathing nice and easy right now.
43:27Yeah.
43:35Zach, just breathe in and out.
43:38And again.
43:40Never in my life would I have ever thought I'd be where I am now.
43:44Sitting in front of doctors and being told, we've done X, Y and Z and this is clear and that's
43:49clear.
43:49But it's evident that something is wrong somewhere.
43:54We'll need to observe him for another few hours just to make sure, given the extent of what happened.
43:59Yeah.
43:59That he's an episode of cyanosis or carpal discoloration.
44:03We don't have a choice.
44:04I hope that in time that there will be something better.
44:07For him, do 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.
44:15Okay.
44:16Just while, while you're here.
44:17I think he's probably is okay to go home at some point after a period of observation.
44:22Yeah.
44:22It's like clockwork.
44:24Like, you know, when you go in, this is what's going to happen.
44:26I know what the steps are.
44:27I know what needs to be done.
44:28I know what gets done when he's in there.
44:30And 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.
44:45So they're waiting until she's stable.
44:47And then they might, 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 resource, there is still concern about Mary's low blood pressure.
45:00And the source of her problems are still a puzzle.
45:03You're all good.
45:05Infectious disease consultant Sarah O'Connell is reviewing her case.
45:09But if the blood pressure doesn't pick up, despite the fluid,
45:12sometimes who we do need to ask are the intensive care doctors.
45:15Sometimes people might need a chemical to help keep the blood pressure up.
45:19Oh, yeah.
45:20Mary, loads of friends, a 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
45:29and their wine and they'll be watching the Lil H.
45:31Or during the summer it's some either Joe Dolan or something on YouTube to watch.
45:36And so they have fun with that.
45:38That involves, I suppose, getting a larger line put in.
45:41Is that blood again?
45:42No.
45:43No.
45:43No.
45:44No.
45:44No.
45:44No.
45:44No.
45:45No.
45:46No.
45:49No.
45:57No.
45:58No.
46:01No.
46:09No.
46:09No.
46:09It's just up and down.
46:13No.
46:13No.
46:13Yeah, exactly.
46:15I could just stay in bed with the pain and...
46:18not do anything.
46:19But I get up, I work.
46:20It's good to do stuff...
46:21just strive on Kind of thing.
46:23I think this is pneumonia, looking at the chest x-ray, the pneumonia that was there and was improving has
46:29gotten worse.
46:30OK, yeah. Mum never moans. She's very slow to give out about the condition or anything like that.
46:36We'll have to see if we've changed the antibiotics.
46:39We are having to go back to giving a lot of fluids.
46:42Joe, when she's not mobile, she needs somebody to do stuff for her. I'm there to do that kind of
46:46thing.
46:47Most of the time. Well, all of the time, really.
46:52The team has confirmed that Mary has pneumonia, which is the likely cause of her sepsis.
46:57A decision has been made to admit her.
47:15Hello?
47:17Hello?
47:17Hi, Sherry. Everything went fine.
47:21Jimmy's back in the ICU now, and he's stable.
47:25If I was bad enough, you know, we definitely need to have done sooner rather than later, I would say.
47:29Hopefully, if everything goes OK, we'll start waking him up later this evening.
47:33Perfect. Perfect.
47:36Is that OK?
47:37Any questions for me?
47:38No.
47:39Music to my ears.
47:42Good, woman.
47:43OK, I'm sure I'll see you later.
47:45OK, thank you so much.
47:50It was very fortunate that, even though it was obviously very traumatic for his poor wife
47:54to have been there, you know, that's pretty shocking, I think it was fortunate that he
47:59got this, what you would call as a warning sign.
48:03You know, he's lucky that this is how he presented.
48:06It's not always like that.
48:07Yeah, come on up here.
48:09It seems to have a seat on the bench right here.
48:11Oh, OK.
48:13He looks great. His color looks good.
48:19Yeah, yeah.
48:24He's warming up.
48:26All right.
48:27That was such a good feeling.
48:29He was warm.
48:30He had blood flowing through his body, and he was warm.
48:33And then I was like, yeah, we're going to be OK.
48:54I wish I was a bit better.
48:55I wish I could go out to matches and go outside, you know, or something like that.
49:00And I was most grateful for to be where I am.
49:04And if to take another two months or whatever, so be it.
49:09See you.
49:21See you later.
49:21Bye-bye.
49:21Bye-bye.
49:30Bye-bye.
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