01x05 - Episode 5

[bunniefuu]

Hiya. You all right?
Morning, everybody.

KNOCKS ON DOOR

This programme contains
scenes of surgery.

Newcastle. Home to one of the
biggest and best hospital trusts

in the UK.

The staff here are unique
because of this Geordie blood

that they have. They always meet you
here with a smile.

Do you want to questions or do
you want to do muscles?

Definitely muscles. Muscles. Ooh!
They are big ones.

Across a shift... I'll have a
satsuma. Go for it. Wahey!

..we meet the dedicated staff.

I love your dancing. They're kind
and they're caring.

They have a sense of humour
that is second to none.

I went to see the new dog.
What have you named her?

She's called Lady. So, when you
getting the tr*mp?

Exactly, Lady and the tr*mp.
That you? Yeah.

From world-class medics saving
lives... It's a young lady's kidney.

We'll call it Cassandra.
GROANING

You can do the lift from
Dirty Dancing.

There's just bits of artery dangling
off everywhere.

..to the support teams

who make it possible.

There you go, sir.
Here we go. Well done.

We're a bunch of odd bods. We
laugh from morning, noon and night.

Committed to caring
for people like you and me...

That's the actual tumour
that we're dealing with.

..and transforming lives forever.

You just walked!
That was amazing, Jase!

Thank you very, very, very much.

When you sell them, Kieran,
you've got a sound French.

Bonjour, bonjour! Come and get
le onion.

We catch up with some of the 17,000
hospital and community staff working

out of the Royal Victoria Infirmary
and Freeman,

including surgical clinical director
Jeremy French.

Once people come here, I think they
get the Newcastle bug as it were,

and that they really feel part of a
family and a team that's

striving for the same thing.

It's about putting the
patients first.

You haven't got a headache
or anything, have you? No?

Are we ready, sir? I'm ready.
Off we go, sir.

I was born ready.
Oh, you're born ready!

It's almost like the organization's
a living beast.

Come on in. This is Tom. So he'll be
seeing you this morning,

if you just want to have a seat
in the chair.

And there's so many different parts
to it, and each person has got

a role and a job to do
within that organisation.

Hiya, how you going?

We come to work to actually
do a good job and feel

like you've made a difference.

Before he begins in theatre, keen
sportsman Jeremy often works out

in the hospital gym.

I grew up in Sheffield,
but I've been in Newcastle

for 30 years.

It's in my blood.

I love the northeast people
and I love living here.

Just three months ago, Jeremy
was a patient

at the Freeman Hospital himself.

I had a major hip operation.

I had arthritis in my right hip.

So one of my orthopaedic colleagues,
who actually has the next locker

to me in the surgical changing room,
did the operation.

A few weeks after the operation,

I could hardly lift that up like
that. I could hardly lift it.

Having ill health does
teach you some things.

So, from a position of perhaps
feeling as though

you're indestructible, it's a case
of, well, actually, you're not

and you do need other people's help.

The goal is to be back fit.

So to do that,

you need to put some effort in.

# Boy, oh, Danny, boy. #

I think, Kieran, that could be all
for bananas.

We'll just stick all bananas.

Hi, Maddie, it's Sean.
I've got a chap

who came to see me in clinic
and we'd thought

the stone had gone.

Specialist nurse Sean Marshall Kelly
has a full list of 15 patients

to see today.

PHONE CHIMES
Hi, it's Sean. Can I help?

I'm the nurse lead for patients
that are admitted

with known kidney stones.

I would like to get him
scanned kind of urgently.

I co-ordinate their care,
I deliver treatment

and I review them post-treatment.

I'm Sean, I'm the specialist
nurse. Have a seat for us.

Sometimes it's a really
stressful job.

Picked up the wrong consent form.

PHONE RINGS
Is that my phone?

I'll ring you back.

But I do love my job and I'm very
fortunate to have the job I have.

So, these little blighters
are the bane of my life.

So these are fragmented
kidney stones.

You wouldn't think something as
small as these - some of the pieces

are just like a grain of sand -
would cause so much horrendous pain

that women describe worse
than childbirth.

Sean's next patient is 50-year-old
musician Gary, who has come

in for an ongoing course of
lithotripsy that's using magnetic

pulses to break-up his
kidney stone.

Come on, let's crack on.

Let's get you in.

OK, I'm coming.

Come and have a seat.

So, we need to check your
blood pressure.

Let's get this up.

Gary, I'm just going to not
talk to you for a minute

just because it's struggling to
read your blood pressure, right?

It's not that I don't want
to hear your voice.

You won't be the first.
SEAN LAUGHS

I was brought up in Newcastle,
in a place called Byker,

which is probably
one of the roughest parts.

Hopefully, this will get rid of it.
Fingers crossed. Has it got smaller?

It's got smaller, almost
halved in size.

But, you know, it was great because
it was very community-based

and the area that I lived in,
there was kind of a row of houses

in a square.

And everybody looked out for each
other and everybody used

to kind of look after
each other's kids.

So I want you to lie down
into this, OK?

To work where I grew up is kind

of a bit of a privilege, really,
because I find that I'm able to give

a lot back to the people that
helped me, kind of shape,

kind of shape who I am.

So I think we've clocked it.
Well, I've clocked it.

Let's see if Graham moves in the
same direction as me.

An X-ray camera is used to locate
the stone before magnetic pulses

are triggered that will
reduce its size.

So, he's good, he's a good 'un. Has
he located it? He's done it before.

So Graham's nickname is
The Sledgehammer.

Some of them just give it
a little tap.

Graham goes all in, bang! Bang!

Look at a lot of people that are in
jobs where they don't get

any kind of satisfaction or thanks

and, you know, I'm very lucky.

So we're just increasing the energy,
Gary, OK?

OK. Remember, the higher the energy,
the better chance we've got

of the stone breaking up. Right,
Gary, I'm going to leave you.

I'll leave you in Graham's
capable hands.

He's better company
than I am anyway.

Hiya, Sharon. You all right?

How's Tom this morning?

Not bad. I was in the sun trying to
tan, but it's a bit red.

It was like Costa del England,
wasn't it?

It's the closest I'll get to be
on a holiday this year.

Also starting his shift
is spinal surgeon Andy Bowey.

I think my colleagues would describe
me as fastidious, neat.

People often comment that I'm quite
smart at work.

Hi, you OK?

All I do is I wear a suit and
a shirt and a tie to come to work,

which to my mind is,
isn't that unusual.

It does seem to stand out
these days.

My parents are very proud
of me being a surgeon,

but they don't throw it
around in every conversation.

My gran did when she was with us.
I think the entirety of Newcastle

that knew her knew I was a surgeon.

You do realise you're staying for
a month? A month?

You've packed for a month,
so you're staying for a month.

I wouldn't mind that.

Andy's first patient in theatre

today is 13-year-old Amelia,
who needs a complex operation

to straighten her spine.

Today's surgery is surgery for
adolescent idiopathic scoliosis,

so that's curvature of a spine,
in a young lady called Amelia,

and she's got a double curve I need
to straighten, to stop

this curve from getting
worse as she ages.

Hi. Morning. Thank you so much.

Thank you. Come in, come in.

It was about 16 months ago when
my mum first noticed it,

and it's, it's definitely got worse.

I've noticed that it's progressed
because my shoulders are starting

to drop a bit more

and my bottom curve is now like
sticking out my back.

When I do go out,

I do try to cover up a bit more.
Like, I'll just put a light

little jacket over the top.

Morning. Hi.

Hi, how are you doing?
I'm good.

Good, good. How are you?
Feeling all right?

Yeah. A bit nervous. A bit nervous.
That's to be expected.

Scoliosis and the type that Amelia
has tends to affect teenagers.

So we've got your waist asymmetry
there, haven't we?

Just bend forward and touch your
toes? Good.

And we've got that rib there.

And, unfortunately, children
can be unkind to each other

and certainly if they notice
any abnormalities in their shape,

you know, children tease each other
and it has a huge effect on

children's mental wellbeing
and anxiety and things.

Thank you. See you in a bit. Thank
you. You're welcome. Bye for now.

I don't want to show people
that I'm worrying about it

because then, like, people
like my mum, they'll worry more.

Pop that on there.

Might be a bit cold cos it's first
thing in the morning.

Amelia and I are really close.

She's a real, independent
little girl,

but, yeah, she still loves her
mummy.

You know, it's going to squeeze your
arm really, really tight. Yeah.

But just try and relax.

AMELIA'S MUM: Never once cried
or said, "Why me?"

Or, "Why have I got this wrong
with my back?"

She's so accepting of it.

DR ANDY BOWEY: Unfortunately for
Amelia, there's no real alternative

to surgery. So, if we left Amelia's
curve alone, we know

that because of the magnitude
of her curve, it would get worse

every year for the rest of her life.

Mum, I think you've signed
a consent form. Yeah.

So, when she hits, you know, late
adulthood, she'd have a really big

curve, which would definitely cause
problems with pain and potential

restriction in her
lung function as well.

OK, lovely. That's great. Thank you,
Sharon. Thank you. Thank you.

I think it was just about a few
months ago

the pain started to kick in
and it mainly affects us

when I'm dancing.

I love to dance, and it just makes
us feel so good about myself.

If I had to stop, it would
just be heartbreaking.

I'm coming, darling.
The surgery itself potentially

can have very high risks...

..which, unfortunately, certainly
for paediatric surgery,

can be paralysing a child.

Shall I pin them back a bit?

We have to be able to cope
with that risk and understand

that and be able to still do our
job, knowing that that potentially

could happen.

So, how long have you lived in
Byker? All me life. Me too.

Well... I moved from the old
Byker to the new Byker.

Oh, so did my parents. They used to
live in the old Byker

before it was pulled down.

Eh, God, those are the days.

Oh, yes. We're old and haggard now,
aren't we, pet?

SHE LAUGHS

I always have a cup of tea
before I start.

Just a spot of milk, builder's tea,
and that'll set me up for the day.

Morning.

Surgeon Jeremy has recently
returned to work,

ten weeks after having
a hip operation.

You do have in the back of your
mind, you think,

"Is it going to go well?

"Am I going to be able to get back
to this, that and the other?"

So, actually, that gives me
first-hand experience

about when I treat patients

and they may have those things going
through their mind.

I think it, well, it empathises with
them and probably, hopefully, makes

it a better experience
for the patients.

Today is a hernia day.

Good day to start the week. Monday
operating, so we're doing

three hernias today.

Hello there. Lovely. Have you been
well in yourself?

Jeremy's first patient is
76-year-old Ray, who's been driven

in by his wife, June.

That's our direct line there, so you
can give us a little ring early

this afternoon, we'll let you know
what's happened.

Oh, that's great.
Thanks a lot.

See you later. Take care.
You take care.

Right, Ray, we're just in this one.

That's lovely.
Thank you. OK?

Very supportive wife, June.

We've been married for
a million years or 46.

And then we got married in 1975

and not a wrong word between us.
SHE LAUGHS

Right. If I could just check your
blood pressure then, Ray.

Oh, dear.

And I was beginning to like you.

She's a worrier.

She'll go home now and, she's
a worker, she can't sit still,

but if she gets in the garden and
things, that'll be fine.

Not if she sits around,
because that's just not her.

Pop that one on your wrist there.
Thank you.

Ray and June have been waiting
for this hernia repair surgery

for 18 months.

I think he's full of bravado
sometimes,

and I think he'd be quite
nervous and, erm,

he'll just want to get it over with.

Hello, sir. Hello.

Hello, Raymond, Jeremy French.
Jeremy, it's good to meet you.

How are you?
I'm very well indeed. Yourself?

I'm pretty good, thank you.
Fantastic.

You might be feeling a little bit
nervous.

I'm reasonably relaxed.

You know, I'm feeling relaxed.
This is what I do.

This is my day job.
That's what's important.

OK, what I was going to do now
was just ask you to stand up

and then I'm going to just
have a little look at this hernia.

A hernia occurs when internal
organs push through a breach

in the abdominal wall.

OK, that's fine.

So what we can see here, this is the
defect in this area, just here,

you can see that this is
pushing out just there. Yeah.

This is... Ray recently had a liver
transplant

and now his bowel is forcing
its way through the thin layer
of scar tissue.

So, Raymond has a large abdominal
incision,

and what he's got is multiple areas
of herniation through the incision.

We'll have to open up
the entire wound.

We'll have to identify
the hernial areas

and then repair the hernia itself.

Now, any final questions for me?

Just do a good job.

No, I'm ready to go.

OK. OK.

Doing an operation such as this,

on someone who's had a liver
transplant, the stakes are higher.

Great. Fantastic.

I'll see you later, then.

Good to meet you. See you in a bit.
Cheers.

He is on immunosuppressive drugs.

These drugs reduce the immune system
to stop rejection of the liver.

However, what they do is they reduce
your immune system, which therefore

means that he is more
susceptible to operation.

If a mistake is made,

then, actually, the consequence can
be more dire for the patients.

SINGS: # Why can't you see

# Boo-doo, boo-doo, boo

# What you're doing to me? #

HE CHUCKLES

Hey. Are you all right?

Yeah, I'm all right. How are you?
I'm all right.

Lucy Clarke has been an eye
plastic surgeon for 11 years.

I genuinely have always
had a joy in fixing things.

The time that I decided I wanted
to be a surgeon,

I was five years old and we were
on holiday in France.

And my dad got a splinter
in his hand,

and my sister is not very
good with blood

and decided she definitely
couldn't deal with it,

and my mum's got shaky hands
and she couldn't deal with it.

And my dad took me and we sat
on a picnic table and he gave me

his Swiss Army knife and asked me
if I wanted to remove the splinter.

And I just thought,

"I think that this is probably
what I want to do."

I was five years old and it
was a complete success.

I think the thing that most
attracted me was the idea

that I could fix something
that no-one else could.

Are you feeling OK? No.

Are you very nervous?
Yeah, absolutely.

Well, I'm sure they know what
they're doing with you, baby.

Take care, baby. Love you.

Love you.

Lucy's patient today
is 44-year-old Lisa,

who is having eye surgery
to remove a benign tumour.

Heya, are you OK?
What's your name?

Lisa. Oh, lovely, Lisa,
my name's Emma.

I'll be looking after you today,
so I'll show you where we're going,
all right?

So Lisa has a tumour behind her eye.

So a tumour is just a swelling,

and in her case, it's an abnormal
knot of blood vessels.

Do you just want to have a seat
in here, Lisa?

I'll be in in a few minutes, all
right, I'll get you on our system.

Imagine, like, some varicose veins
that have all got tied into a knot.

So like the size of a big
blackberry.

Hey, Lisa. Hello. Got you some of
our lovely gowns to wear.

Oh, marvellous, thanks very much.

So I'll pop them there.

Lisa and her partner, Jason,
have been together for seven years.

Jason's life in the next few weeks,
he's going to be trained to clean,

I've trained him to mop the floors.

As long as the floors get mopped,

and as long as Honey gets looked
after and there's food

in the cupboards, anything
else is an absolute bonus.

Come on, Honey.

Walkies. I feel a bit scared.

I'm just going to try and keep
myself busy and work as normal

during the day and then obviously
come and see her later,

cos obviously I love her to bits
and everything,

and we're like best
buddies and soulmates. So...

NURSE: Right, so what are your
blood pressure first?

Despite ten years of significant
facial pain,

only recently has Lisa felt ready
to commit to an operation.

Take your temperature.

I'm fearful of surgery.

I didn't know what it would entail,
but I just knew it needed to be out.

So I thought, I've got to go for it.

You don't take any blood
thinners at all?

No, nothing. Lovely.

My main worry is the
actual sleep and not waking up.

It's absolutely terrifying.

Hey. Hello. All right to come in?

Yes, fine, yeah.
How are you doing, Lisa?

I'm all right.
Yeah? Getting ready for today?

Yeah, I'm just feeling a bit
anxious, yeah. OK.

Do you want to tell me
what you're most anxious about?

Yeah, erm, the going to sleep
and not waking up.

In Lisa's case, fear is
incredibly common,

and I think it's a natural response.

I think most people would be
terrified of having surgery

because you're handing over
control to somebody else.

Just bear in mind that whatever I do
in there, you're my top priority.

At the end of the day, 100%,
I've got my eye on you.

I promise I'll look after you.

And that's what I said to him.
Yeah. I trust you, I trust you.

Because you're removing a tumour
from behind the eye,

it's directly in contact with
the eyeball and the muscles

and the nerves that help keep
the eye straight and allow

the patient to see.

So if you were to cause
damage to those structures,

you could give her double vision,

you could risk blinding
her with the surgery.

A frightened, frightened girl.

This is run-of-the-mill normal stuff
for us. It's a normal day.

Average day on Ward 20.

See you later.
Thank you very much, Sister.

Thank you. Bye-bye.
All right, I'll leave you...

Right, down we go.

Right.

We're cooking on gas.

How was that?

It wasn't as bad as I thought
it would be. Good, good.

Kidney stones nurse Sean is partway
through administering lithotripsy

to his sixth patient of the day,

78-year-old retired
science lecturer John.

I had a lovely weekend.

Thanks for asking.
So what did you do?

I had a very quiet one, actually.

Do you have any children yourself?

Do I have any children?
No, I don't.

But I would love to have children,
and I do plan on having children.

Erm..

No.

Looking to settle down again

is a bit of a funny one for me
because I think I'm very lucky

in the sense of I have been
in love, been loved and...

...lots of people don't get
that within their life.

So I've kind of got it in my head
now that if it happens again,

great,

but if it doesn't happen again,
I've had it before.

Someone said to us if I could
keep fish alive, right,

for a year, then I should
move on to a dog.

If I can keep the dog alive,
then I should go

on to children, right?

So that's the plan
to have had me fish for 13 months.

I want to have kids.

I always thought it would be
difficult to do that on your own.

But once again, I'm getting
to a point in my life where I am

getting a bit older and I want
to be able to crawl under coffee

tables and do that sort
of stuff and have fun.

I'm going to adopt some
children, actually, hopefully.

So I've kind of resigned to the
fact that I'm potentially,

will have to do that on my own.

Drink plenty. Right.

You need to be drinking at least
two to three litres per day.

No, no G&T?

Oh, you can have a G&T.

Wait a day or so until you've got
no blood in your water, right?

Right, OK.

Right. You get yourself
dried and dressed, OK?

See you in a moment, John.

OK, an open, nice and wide.

OK, it's just this one, here,
isn't it?

Aha.

With all the biscuits and chocolates
around in the hospital,

you've got to keep taking the
stairs, otherwise...

Midlife is hard enough as it is.

Right, so we've got Amelia,
a 13-year-old girl with AIS.

She's for a selected posterior
correction of scoliosis.

Surgeon Andy is briefing the theatre
team before starting an operation

to remove the curve from
teenager Amelia's spine.

All right. Let's go.

Thank you.

It's really hard as a mum
to sort of just walk away from her

knowing she's got all these tubes
attached and she's going

in for major surgery.

It's just awful. You just want to be
there holding their hand.

We've got Solera Medtronic screws.

I always wanted to be a doctor
from sort of late teens, really.

And then my gran had a hip
replacement,

which made her from pretty much a
lady who couldn't move

to a lady that was,
you know, walking miles every day.

I think that's it.
Everyone, happy? Brilliant.

Thanks, everyone.

That's, I suppose, what made me
initially interested in orthopaedics

cos it was the specialty where you
gave people their, you know,

life back, really.

So at the moment, we've got our
anaesthetic colleagues

are making sure all of their
monitoring's on correctly.

We use spinal monitoring
for all scoliosis procedures,

so we have a great team of spinal
physicists who put electrodes

on our patients and
they're constantly monitoring

how happy the spine is throughout
the whole operation.

And they work as an early
warning system to us

so that when we straighten
the spine, that we don't

cause any harm.

So now we're draped, we can start
exposing the spine.

Starting.

The operation has two stages.

The first, inserting screws into the
spine,

followed by attaching
metal rods to pull it straight.

So this is placing a pedicle screw.

We use what we call pedicle screws.

They work as our anchor point
so we can then put rods in

to hold the spine into the position
we want it to be in.

An X-ray camera carefully monitors
the placing of the screws

into the spine with
pinpoint accuracy.

We should be able to see on
the X-ray, here,

where, where things are.

So that helps me navigate.

Essentially, it gives a sort
of X-ray vision, if you like.

I suppose my meticulous personality
fits this quite well,

because it is, it's complex surgery.

You know, the screw has to be in
exactly the right place.

So I know, there, that's
where the screw should go.

We've got the spinal cord,
which we can't touch.

If we do, we'll unfortunately,
potentially, paralyse the child.

65x40 screw this time.

We can also hit major blood vessels,

so we can cause catastrophic
bleeding, or we can hit the lungs

or abdominal contents as well.

This is the last screw going in now.

There's not much room for error,
so you have to get it right.

Good, right.

So that's all the screws in.

So now we can put the rod in.

So this is really the critical
part of the operation.

Retractor, please.

It definitely takes a certain person
to choose to do a spinal surgery.

Everyone will have a
complication eventually,

and it's how you deal with that and
move forward and keep your head.

Right, OK, love you. Love you
anyway. Give you a kiss.

Love you, bye. Bye.

Nice pair of baggy greens.

Not an Australian cricket
cap, unfortunately.

Right, we've got another drape.
We've got two big 'uns.

Sister, you're spoiling us.

Clinical director Jeremy
is preparing for his third operation

of the day.

I only use the middle tap.

Yeah, I don't know why.

It's just nice to do.
It just feels comfortable.

Feels at home, feels relaxed.

His next patient, Ray, needs
a large hernia repairing -

a hole where his bowel has pushed
through thin scar tissue

on his stomach caused by a
previous liver operation.

So, Richard, are we OK to start?
We are. Fantastic.

Excellent. OK. Thanks, guys.

So let's just take that scar out.

The bigger the hernia, then the more
a challenge it is for the surgeon.

It has to be a bigger incision.

There may be some organs
attached to the underside

of the defect.

Scissors, please.

The challenge is to identify
the defect...

..to repair the abdominal wall and
then ensure a secure closure.

Feel, feel there. That's solid,
that's solid, absolutely solid.

It's about that thick, whereas
here, it's just paper thin.

I mean, that's into the abdomen.

There should be a muscular layer
over there, but there isn't,

because that's, that's the defect.

One of the key moments is, when
we've identified the hernial sack,

is to make sure that there aren't
any abdominal organs adhered

to the underside of the hernia.

So you can see there's some bowel on
the other side, actually,

that we should have stuck
to the inside.

So just take care to peel it off.

Normally it shouldn't be
stuck like that.

That's as a consequence
of having a previous operation,

which in this case, of course,
was a liver transplant.

What we don't want to do is cause
inadvertent damage, for example,

to some small bowel, cos that
will release infection,

which then would compromise
recovery.

It doesn't look too bad
at the moment, which is good.

Right, OK, so I think we've defined
those edges quite nicely now,

which is super duper.

With the hernia isolated,
Jeremy moves on

to the most crucial part of the
operation -

repairing the hole itself.

Typically, hernias over a few
centimetres would normally

be reinforced with a mesh.

Right, let's have a little
look at the mesh.

Where is the mesh?

So a mesh provides mechanical
support, but it also provides

biological in-growth potential.

So that means that the body's
tissues can grow onto the mesh

and then provide some structural
support.

Ray's hernia repair requires
the largest mesh available

just over the size of an A4 pad.

The crucial part of the hernia
operation, such as Raymond's

is to make sure that we get the mesh
at the right tension,

in the right position to provide
support for repair of the hernia.

If you have too much tension in the
wounds,

then it just doesn't, doesn't heal.

It takes an hour for Jeremy
to position the mesh

across the hernia.

Pretty happy with that, actually,
it's tense, but not too tense.

There are times when the blood's
pouring, but not today.

Fantastic, time to close up.

Being a patient myself
did evoke new feelings.

Now I do say to patients, look,
it's going to take quite

a while and a lot of hard work
to get over this operation.

So let's put it into perspective.

Good. Excellent. Well done.

Well done, Carol.

Excellent.

I've seen things from a patient's
perspective,

and I think it's actually made
me a better surgeon.

DIAL TONE

Hello. June, it's Jeremy French
from the Freeman.

Oh, hello there... Hello.
..thanks for calling me.

No, everything's gone
absolutely fine.

He's going to need
a lot of support, though, June,

you know, in the next few
weeks. He did say he'd got himself

a little bell to ring, but I didn't
know whether he was lying or not

or telling the truth.
JUNE LAUGHS

Fantastic. OK, well, I'll catch
you up soon, June.

Many thanks. Thank you for the call.
I appreciate it.

Cheers, then, bye-bye.

I mean, when you get to give phone
calls like that and the patients

are thankful, the relatives
are thankful,

it's a privilege to do that job,
actually.

You know, it is, honestly.

Oh, I need to eat.

Shall we go to the canteen?

I'm so hungry.

Right.

Can we have a rain fusion drain?

And a swab.

Where are you from, Manchester?

Leicester. The same place.

SHE LAUGHS
It's not.

In the emergency dental clinic,

nurse Abbey Johnson and dentist Tom
are halfway through today's shift.

If you could have a themed
wedding, what would it be?

I mean, the obvious one's a Disney
wedding, but everyone does that.

No, never a Disney wedding.

Mine would be something like a
prison break type wedding.

Every table is going to do
like a escape thing.

An escape room?
Yeah, that'd be awesome.

You've thought about this,
haven't you?

Even the bride, then I can run away.
Yeah, see you.

We get a lot of scared
patients in and I think

as soon as the nurse sets the tone,

then you can have a laugh and
a giggle with them.

It just calms them right down
in they know that, like,

you're here for them.

Luke, please?

Hello, are you all right?

The next patient is 32-year-old
builder Luke,

who is suffering with his
wisdom teeth.

OK, how are we doing now? Not bad.

So I've had a look at your X-ray,

the issue we had is that
this wisdom tooth

is quite close to the nerve.

It needs to come out cos it's
causing you pain

and there's an area
of infection there.

Obviously, you don't have to have
any treatment done today,

if you don't want, but I'm assuming
you do want to do that.

Don't worry, we'll hold
your hand the whole time.

It's quite a clinical environment,
and I think a lot of people

just kind of shrink in and be like,

"Oh, my goodness, I'm so scared,
what is going on?"

A lot of TLC at home after this,

or would you not get no sympathy?

Oh, I would...

Do you know the ones
that are the more scared?

And it's always the guys that say,
"I'm terrified of needles,

and they're covered head to toe in
tattoos, and you think, "what?".

Well, you're definitely not
needle phobic, are you?

All the tattoos,
how many have you got?

What happens in this room, stays in
this room, so feel free to cry.

Just trying to get it
loose, to start with.

The truth is nice and moving.

It's mobile. It's how we want it.

It's just getting hold of it to
get it out in one piece.

We'll get there eventually,
don't worry.

And we'll try the forceps
again, please. Mm-hm.

Lots more pressure here, OK.
Just nice deep breaths.

So you're probably going to feel
just a few little bits of tooth

starting to snap now.

The noise of dentistry is
something you have to get used to.

If you hear any weird noises,
please don't be alarmed.

We go into a
zone and you just think

"Oh, that's just the
normal noises of work."

CREAKING

There's nothing that freaks me out,
actually, weirdly enough.

Unless you put a spider
in the dental sink, I'm fine.

You looked after it that well,
it just doesn't want to come.

It's quite happy. What we explain
that the patient is we've got

a wiggle it about first before
we can then pull it out.

But it is quite a tough procedure,
but our dentist can do it no bother.

SHE CHUCKLES

Lots of pressure.

OK.

So that's the tooth
just snapped there.

We've just got to see
what we've got left now, OK?

Good job he goes to the gym, innit?
THEY LAUGH

Changing someone's opinion of the
dentist is an amazing thing.

You're doing great.
Well done.

I've seen so many people
come in just so worked up

and then, they'll come out and
they'll be like, "Well, actually,
it's not that bad."

And it just makes me feel great that
I've made someone happy.

Yeah? Fantastic. Job done. Yeah?

A lot of complicated extractions
are always wisdom teeth.

See you soon. See you soon.

It's just one of those things,
and it's a shame that they do cause

a lot of problems for a lot
of people, but, hey,
we'd be out of a job.

Are you happy?

I don't know. I'm sitting on
the fence.

You'll be fine, don't worry.
Ooh! OK.

So, one patient to do -

Lisa, a 44-year-old lady who has...

Eye plastic surgeon Lucy

is about to remove a tumour
from behind the right eye

of her patient, Lisa.

So I need to mark the incision and
then put some local anaesthetic in

once she's asleep.

I was always brought up to have
courage and trust myself

and believe in myself, and I think
that's probably one of the biggest

things that's allowed me
to do what I want to do.

Happy? Yeah. Fab.
Thank you very much.

The operating theatre is definitely
one of my happy places.

So I'm just going to extend the skin
crease through the layers

underneath. So we're just making our
way down through the subcutaneous

tissues to find the bone.

To access the tumour,

Lucy needs to temporarily remove
a piece of bone from the side

of Lisa's eye socket.

BUZZING

It's a small saw.

It's pressurized, air driven,
but it's still pretty powerful.

It's a small thing.

It's such an important thing
to be able to steel yourself

and be calm and take a deep breath
and gain control over your body.

So we're going to make a cut
in the bone.

Happy, yeah? Yeah.

SAW BUZZES

In such a tiny area, there's so many
different things that can go wrong.

It really is incredibly specialist
surgery to get it right

and the tiniest small thing
will make a massive difference.

Good. That's the bone out.
There we go.

If you can keep that to one side.
Can I have the headlight, please?

That's it, this is the tumour here,
that we're surrounded by.

So we've got to try and detach
it from its blood vessels,

which you can see running
in on the surface.

Lisa's tumour is dangerously
close to her optic nerve.

The optic nerve is the cabling
between your eyeball and your brain,

so it's responsible,

it's like the cable coming
out the back of your TV.

It sends and receives
all the information that your eye

is receiving back to your brain.

We're operating in depths
of millimetres

rather than centimetres

and you need to be very careful.

Find a bit of purchase on it.

It is slippery so and so.

This is a tumour that's rich in
blood vessels,

can bleed, and if you cause

any bleeding behind the eye, given
enough time, it would compress

the optic nerve, which would cause
her irreversible sight loss.

It could blind her.

Are you a fan of the dentist?

Erm, I was until the last time out.

Do you like nurses?

Yeah... She didn't touch me.
It's fine. She likes me.

Shorten it slightly.

Can I have the towers?

Spinal surgeon Andy has reached
the final stage of straightening

13-year-old Amelia's spine,
inserting two rods to correct

her double curve.

John bends the rod to the shape
that we want the spine to go to

and we put these reduction towers
onto the screw heads to help

aid pulling the...

..rod into the spine.

We put rods in to pull the spine
into a straight

position and de-rotate the spine
as well.

Not only is scoliosis a curve,
it's a curve with a twist

and we want to get rid of that
twist that sticks the ribs out.

With the first rod inserted,
Andy carefully pulls Amelia's

spine into place.

When we put the rods in to pull
the spine straight, that can cause

damage to the spinal cord
and that can take half an hour

to show itself.

It's always in the forefront
of your mind when you're doing

an operation on the spine.

But we just do it nice and
gradually.

Gives everything a chance

just to relax naturally,
puts less stress.

Doing anything suddenly
is rarely a good thing.

So that's the first rod in and now
we'll do the same on the other side.

Years ago, before we had the screws
and rods, the surgery

was a lot more brutal.

Basically, we had to essentially
break the spine, wrap the patient

up in plaster,
held in their new position,

and then they would have to stay
in hospital for six months plus.

Final tight now.

Now they're in hospital
three to four days,

so it's been a huge revolution
in how we treat scoliosis,

which makes it safe and why
we do it so frequently.

So now we're just de-rotating
the spine.

So we're just getting the alignment
of the rod right. The snap off

means that we've torqued
the screws sufficiently.

Good. So both the rods in,

the majority of the reduction's
done now, which is good.

And have a little calm and a swab.

We know that Amelia's got quite
a significant rib prominence.

What we'll have to do is what
we call a costoplasty.

So what we do is we cut out tiny
sections of the most prominent ribs

and then the ribs will flatten
themselves down.

SAW BUZZING

Good. So now we've taken out the
sections of ribs under here,

basically means that when she bends
forwards, the ribs won't stick

up as much.

Right, let's have...closure, please.

To recovery after this,
for her to wake up.

And gently bite together
for me. Does that feel OK?

Yeah? Fantastic! Job done.

Short and sweet.

Can I have another gauze?

Lucy is an hour into removing
a benign tumour lodged next

to her patient Lisa's optic nerve.

About to take the tumour out.

This is the moment of truth.

I'm just trying to gently separate
the tissues

that are holding the last bit of
this tumour in. Nearly there.

There we go. So that's it.

Wow.

I mean, it's a fair beast
of a thing.

That was good.

That went about as well as I would
ever hope that to go.

Now that the tumour has been
removed, Lucy can reinsert the bone

from Lisa's eye socket
and carefully close up.

The operating theatre

is the culmination of what
you've been trying to achieve

with a patient.

So we're just going to tidy up,
clean her up.

When you've gone through a journey
with somebody

trying to work out what they need,

the operation's the final
piece of the puzzle.

It's a really good feeling.

Hello, Raymond. Hello,
it's Jeremy French. Hello.

So what I normally say to patients
at this stage is that I did

the hard work today.

Who's going to start the hard
work tomorrow?

June. June.

Amelia has just woken up
in the recovery ward...

The best toast I've ever had.

..after a four-hour operation
to straighten her spine.

Hi. Hello. Hi. Hello.

So I thought we'd show
you your X-rays. Yeah.

Shall I give you a copy? Wow.

Oh, my gosh.

So that's obviously pre-op
with the curve.

That's amazing.

And now you've got the straight
spine, which is what we wanted.

This is so good.
So that's good.

That's amazing.
Thank you so much.

The surgery Amelia's had, it's great
because it's, it's one

operation that's fixed her
for the rest of the life.

It's transformative surgery.

You look pretty good.

Yeah, I feel good.

Yeah? Yeah. Excellent. That
medicine's working well.

That's always good. Yeah.
Oh, it's been fabulous.

Excellent. All right.

Good. See you later, guys.
Bye. Bye now.

It's incredible to see the change
in what her spine was

and her ribcage, and then to see it
now like that, it's, it's amazing.

Incredible. Absolutely amazing.

We can see that it positively
affects kids.

They feel their level of
self-esteem can improve

because they look
cosmetically better.

She'll be incredibly flexible,
so it's not going to have any

detrimental impact on her career
as a dancer.

So I think she's going to have
a really, a full, happy life.

Happy? Yeah, really happy.
Are we happy? Yay!

I'm excited for the jelly and
ice cream later.

LAUGHTER

You OK for me to come in?

The operation went really well.
So we've got all the tumour out,

came out really nicely. Yeah.

It's not damaged the nerve
or the muscle behind the eye.

Oh, brilliant. You're amazing.
Thank you so much.

No worries at all, OK?
You rest good

and I'll see you tomorrow.
Oh, thank you so much.

No trouble. I would kiss you
if you didn't have your mask on.

All righty. OK, we'll leave you
in peace now, all right, love?

Thank you.
Thanks.

Grand.

Oh, she's just amazing.

She's been round to speak
to us a couple of times

and she's just five-star, can't say
anything more about her.

Really good. Yeah, good day's work.

To be able to leave work knowing
that you've achieved something

and done something really well
is a really good feeling.

I love my job and that's
because I genuinely feel

that we're able to do so much
good on such a regular basis,

that it is a really good
and happy place to be at work.

Oh, my gosh, I've grown.
Look at the size of you.

I'd say you're about 5'9".

You're definitely taller than me.
And she hasn't even got shoes on.

She hasn't even got shoes on yet.
You're looking down at your mum now.

I heard you tried to battle
a car but lost.

They somehow rolled over my leg.

My God! You poor thing!

My first year in
emergency trauma surgery,

that's where my hair
started going grey.