01x03 - Episode 3

[bunniefuu]

Morning. Morning. Hiya, you
all right? Morning, everybody.

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 wanna do questions
or do you wanna do muscles?

Definitely muscles.

Muscles? Oh, they are big ones!

Across a single shift...

I'll have a satsuma. Go for it.

Wey!

..we meet the dedicated staff.

I love your dancing.

They're kind and the 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 are you
getting the tr*mp?

Exactly. Lady and the tr*mp.

From world-class medics
saving lives...

It's the young lady's kidney.

We'll call it Cassandra.

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've just walked!

That was amazing, James!

Thank you very, very, very much.

It's the start of the day
for the staff at

the Royal Victoria Infirmary,

Great North Children's Hospital
and the Freeman.

MAN GRUNTS

Woo!

Right, we're going to go
with a nice lunge now.

Ohh. Watch you don't split
those pants, Louise!

LAUGHTER

A handful of medical staff
are taking welfare at work

to another level...

Deep breath and exhale.

..with a pilates class led by
clinical nurse specialist...

Well done. ..Sean Marshall-Kellie.

Try and touch your toes.

Ooh, you can touch your toes,
Louise!

I'm very passionate about wellbeing
at work because during the pandemic,

there was a period of time
where I really struggled

with mental health.

I've heard someone's elastic
go in their tights!

Coming to work was the only thing

that got rid of me anxiety,
weirdly enough...

Stretch those hamstrings.

..and wellbeing at work is something
that I try and lead on.

There we are. Harder than you think
it's going to be.

Shush! More breathing, less talking.

I'm not very good at the teaching
or the leading of the group...

Hold on to your ear.

Yeah. Arms up.

..but I'm an A-star
at providing the fun element.

And then exhale down.

HE EXHALES

And a little namaste.

Well done, group.
APPLAUSE

Same time next week.

At home on the outskirts
of Newcastle, orthopaedic surgeon

Milton Ghosh is making preparations
ahead of a big day in theatre.

HE KNOCKS DOOR

Dylan. Wakey-wakey.

Lucy. Yeah? You've got to get up.

Ben.

Come on, get ready for school.

What do you want for breakfast?

Anyone?

Here you go, little dudes.

Not lost one yet.

I want to keep it that way.

I have a weird job title,
which is orthopaedic oncology.

Ben! Yeah?

Are you done?

That essentially means someone
who deals with cancer affecting

the bones and muscles and
everything in between.

Alpha male surgeon.

That is your classic
personal profile, really.

I am not an alpha male
in any way, shape or form.

I'm bottom of the pile at home.

I'm telling you, these guinea pigs
have a five-star lifestyle.

Keeps you grounded.

Why is my phone not ringing?

On the morning of surgery,
I do get nervous.

I go over the operation in my head
over and over and again...

Right, I'm just going to get
the X-rays up.

..to try and get my mind prepared
for that day.

OK, kids, are we ready?

Yeah. Let's go, guys.

Just going to pop this on your arm,

so it'll just go tight for a
few seconds. Yeah, no problem.

Being prepped for Milton's arrival

is 63-year-old Donald, who's having
surgery to remove a sarcoma -

a type of cancer - from his thigh.

First noticed the problem on my leg.

One evening, I went outside and sat
on the garden bench.

I felt round the thigh

and there was a lump.

Was about the size of half
a golf ball.

Initially, I wasn't put out at all.

Once the word "cancer" was
mentioned, then I started to think,

er, this could go the wrong way.

The growth on the back of my leg's
now grown three, four times the size

as what it was.

That is the actual sarcoma in there.

On a night, trying to lay in bed,
it's different pains, but the main

one is like a stabbing and
it really, like, shakes you up.

Cos this thing eventually
will take over and k*ll us.

Knowing Milton is going to be doing
the surgery is absolutely brilliant.

He makes sure you understand
everything.

I wouldn't wish
anyone else to do it.

PHONE RINGS

Hi, can I help?

Well, we don't open till 7:45.

We're just having safety brief,

so we'll be there
as soon as possible, OK?

There's a queue forming
outside one of the busiest wards

in the hospital.

So, Rachel, would you be able
to help me with the SMA children

in bay one? Yeah. Yeah.

26-year-old staff nurse
Rachel Atkinson

is the youngest member of the team.

She's worked in the children's
day surgery unit

for the last two-and-a-half years.

Scales are like gold dust.

Trying to find them, you'll usually
see us kind of running around the

ward and just pulling scales around.

So we've got ours prepped
for our patients.

I decided I wanted to be
a children's nurse on a whim.

I was in hospital for, like,
one night as a child

cos I had my tonsils out
and that was it.

They came in, they did some meds,

I went to theatre and I thought,

"This is great. I'll do that."

Just checking everything
turns on and works.

Ward A is definitely
organised chaos.

In the morning, like, you have
about 15 minutes of bliss

where it's all quiet
and there's no-one there...

..and then the doors open.

CHILDREN CRY

And you get 30 kids
and it is just crazy.

Good morning. You all right?

Hi. Hi. Good morning. Morning.

Rachel's first patient is
eight-year-old Harrison,

who's come in with his mam, Nadia.

What do you like us to call you?
Do you just get Harrison

or do you get something else?

I actually like being called
Harrison. That's OK. Perfect.

He's come in to have an operation

on his vocal cords
to strengthen his voice.

Do you wanna do questions
or do you wanna do muscles?

Definitely muscles. Muscles?

Oh, they are big ones!

It's going to squeeze quite tight.

Oh, no.

And then this one, this one's
the girlfriend tester.

I definitely don't have
a girlfriend!

Well, we're going to find out!

OK, so this one just goes
on one of these fingers.

OK, so we need to have a look
at the little heart.

The heart is how many girlfriends
you've got. Are you ready?

Do I have 61 girlfriends?

61 girlfriends, that's what it says!

I don't! Are you sure? No!

Well... I'm sure I don't!

OK. That's just your heart rate.

The girlfriend counter is something
I've stolen from other nurses

because it just works like a charm

and it gets a great reaction
every time.

There might be potatoes
growing in there. Potato!

Potatoes in ears? I don't know.

I think that one might be my own.

Two potatoes. Not bad.

We find lots of things in
children's ears, not just potatoes.

Speaking of potatoes,
I'm quite hungry.

For Harrison, the problems
with his voice began

when he was born at 22 weeks.

Part of the prematurity is some
babies have this hole in the heart,

and he needed surgery for that,

and that seems to be the cause

of damage to the nerve that feeds
the vocal cord.

Children born term, you would expect
noise when they got to the babbling

stage and chatting, and he never
really did that.

# Spider-Man, Spider-Man

# Does whatever a spider can... #

But then when he did start to speak,
his voice was really different.

It was more of a whisper.
You couldn't really hear him.

By the time he was at school,

you could tell it was actually
making him quite tired to talk.

Have you got any hair clips,
any make-up?

No!
HE CHUCKLES

Any jewellery? No!

No? OK.

The hope is that Harrison will
leave the hospital today

finding it easier to be heard.

We've waited a long time
for this day to come around.

Right now, I'm just trying to keep
myself calm and not be overly

optimistic, but I'm hopeful.

I feel a bit scared and nervous.

It's because it might hurt.

Meanwhile, Milton is heading
to Ward 22 to talk Donald

through major surgery
to remove his tumour.

Hey, buddy. Did you sleep?

Yeah, on and off, mate,
to be honest, you know what I mean?

Just a bit. Yeah. It's nervous,
isn't it? You know how it is.

Yeah, yeah. Did YOU sleep well?

I slept well. That's good!
I slept like a rock.

Did you? Yeah, yeah.
Well, that's brilliant.

Donald's sarcoma is misbehaving.

It's growing quickly,

so we've got to get in there
and remove it fast.

Just to recap, I'm going to dissect
all the muscle compartments

in the back of the thigh and
remove the tumour completely

whilst preserving the main nerve
to the back of the thigh,

called the sciatic nerve.

You're going to time-travel
cos you're going to go to sleep

at about 8:30 and you're going
to wake up at 6pm.

All right. OK?

It's all right for me, innit?
Exactly!

The operation to remove Donald's
cancer could take up to nine hours

for Milton and his team.

This kind of surgery entails
a big risk for Donald, certainly.

The bigger the operation,

the more you're putting
a human being through,

I would say, a controlled car crash.

Get gowned up, cos I think

we're going to be sending for you
pretty soon.

Two...

Clinical nurse specialist Sean
is on shift

in the urology department.

Hiya, I've got an appointment.

Just a few weeks ago,

Sean's next patient, Kimberly,

received a live kidney transplant
from her big sister.

The transplant gives us more energy,

more freedom.

Kimberly Bell,
do you want to come in?

I just needed to get this procedure
done and then everything's perfect.

Good.

Today, Kimberly is returning
to have a stent or drain removed

from her replacement kidney.

This will be the final step
of her treatment.

So the procedure we're going to do
involves me passing

a small telescope
just into your water pipe.

We'll look for the stent and
remove it.

OK?

I will say it's a lot easier
on a woman than it is on a man.

With a woman,
the urethra is very short,

so you're just
straight in the bladder.

This is probably one of
the only examinations

where a woman comes off
better than a man.

So Kimberly, if you just come around
and I want your bottom

to just kind of be where that pad is
and get yourself comfortable.

It's a good job
I've got thighs of steel.

I have to swap, though, sometimes!

THEY LAUGH

I think I'm quite bubbly
and some people like that.

Some people find it very irritating.

We'll get you cleaned up
with some antiseptic.

It's the worst part.
It's freezing cold.

And men always make a funny joke
about it, but I'll not bore you

with that element of it, right?

The patient group that I see,
we do a lot of intimate procedures,

and I think I'm very good at
judging situations and seeing

who I can have a laugh with,
who I can't.

Sometimes the worst part on a woman
is finding the water pipe.

And it's not like the textbooks.

I've found it very easily there.

If you can make somebody feel
comfortable and just distract them

for 30 seconds, that just
makes them feel more at ease.

Well done. And a bit of water
going in there now.

For Kimberly, the drain removal

marks the beginning of
a new-found freedom.

My life's transformed.

The focus for me now is to do things
with my family.

Go to the beach, go out for a meal.

It's all the simple things in life.

There it is, and I'm just
going to pull it out, OK?

Little bit of discomfort.
Well done.

I'm going to do more for my kids
and I'll have the energy

to just be there when they need us.

Lovely to meet you, Kimberly.
You take care.

I'm really happy.

We'll have a cup of coffee now,
Louise.

I think we deserve it.

You probably deserve it
more than me. No!

Here we are. Hello, you OK?

On Ward Eight, staff nurse Rachel is
taking eight-year-old Harrison

down for his voice box operation.

This is the bit you were looking
forward to, going for the ride.

Okey doke. Let's fire away!

The day surgery unit can be
overwhelming for its young patients.

He probably won't remember much of
going off to sleep

because he's had this medicine.
Yes.

It's all about building up
a relationship with them

before they go so they've got a
little bit of trust in what you say.

My bedtime...

This feels like bedtime?
That's it, bedtime now, eh?

It's children who are on kind of
possibly the most terrifying day

that they've ever had
in their life so far.

If I die...

There'll be no dying.

It's not going to happen.

So if I...so if I...

so if I die...
GARBLED, SLURRED SPEECH

Oh, yeah, you'll be...not dead.

There's none of that happening,
my darling.

I wish that...

Harrison's a really special
little boy.

You know, he was born so, so early.

The fact that he's alive, there's
some elements of miracle to that,

he'd been through so much,
he had surgery even just ten weeks

after he was born,
just a tiny little baby.

And whole weeks where we didn't know
if he was going to make it or not.

Did I fix it?

Unfortunately, Harrison's twin
brother died at three weeks old.

But the journey continued
with Harrison.

Where's the party?

Where's the party? Don't know.

Arrrrgh!

Shhh, you're all right.

So, the nicest thing,
a few weeks ago,

I had to write Harrison's
perspective on being a twin.

And he said, "I have
a twin brother called Rafe.

"I love Rafe. Rafe died.

"I miss him,
but I'm glad I'm alive."

The surgery today is really just
about giving him that chance

to fit in a little bit more.

Be heard, be confident in himself
and helping him into adulthood,

giving him that quality of life.

Good morning, everyone.

Good morning, everyone.

The end result is going to look
like a shark has taken a chunk

out of his thigh, leaving nothing
but the sciatic nerve.

Surgeon Milton and his team are
preparing for a surgery to remove

a large cancerous sarcoma
from Donald's thigh.

In the morning,
when the anaesthetist

has anaesthetised the patient
and then it's my time to scrub,

those five minutes of scrubbing,
my heart races.

It's the same feeling you get,

whether you are about to
go onto a roller-coaster

or if you've ever been on a bungee
rope, when your heart just goes.

Weirdly, I wash my thumbs more
when I'm about to start

a complex case.

I don't know if it just buys me
a bit more time thinking.

And then when you actually start
the operation,

everything is calm and you begin.

Before making an incision,
they must decide how much tissue

around the sarcoma to remove.

The margin.

Margins are the key to
a successful operation.

All the way to about here, don't we?
Yeah.

You remove the tumour itself,
but you also have to remove a cuff

of normal tissue because within
that cuff of normal tissue

can sit tiny, microscopic
cancer cells.

And if you don't take
that margin of tissue out,

you can potentially leave
cancer cells behind

and all that will happen,
it will simply come back.

The thing is, as surgeons,
we can't see that invisible halo

around the sarcoma.

We can't see cells
with our naked eye.

Today, Milton is using a new
cutting-edge technique

to pinpoint the spread
of the cancer cells.

In simple terms, we're going to try
and make his sarcoma glow.

To do that, we're going to
inject Donald with a dye.

There we go.

So we can see it there.

The lump itself with the cancer
cells will retain the dye,

so we shine near-infrared light
and the dye molecules will glow.

So do you see the halo
and the aura around the tumour?

So this first line is where
we thought a decent margin would be.

And then we put the spy camera on,
and you can see that

there was this kind of white halo,

which is a good six or seven
centimetres more distal.

The tumour has got bigger.

When Donald was first scanned,
it was the size of a navel orange.

Three weeks after,
it's the size of a honeydew melon.

The sarcoma has enveloped major
blood vessels in Donald's leg.

Yeah, go nice and high.

That's lovely, yeah.

Milton will be working alongside
microvascular surgeon Mani Ragbir.

This is all about accessing
and dissecting the vessels.

We have to change our tactic.

We have to remove a portion
of the main blood vessels to his leg

and reconstruct them.

But this kind of surgery
entails a big risk.

Scissors, please.

When you're replumbing the main
blood supply to someone's leg,

if that goes wrong, he could
lose his leg completely.

Forceps, nurse.

Where are we going back to?
We are going back to cubicle two.

Consultant Kevin McEleney is one
of only 12 male fertility experts

or andrologists in the UK.

Male fertility is kind of complex.

As men, we're kind of all brought up
with the understanding that

if we kind of look at a girl
the wrong way, she'll get pregnant.

Morning!

Kevin is about to carry out
a surgery which he hopes

will give his patient
the chance to start a family.

If you look at what most doctors do,
it's trying to preserve life.

What we do is different.

What they want is a baby.

For many of them,
the stakes are pretty high.

It might be the last chance
they have of becoming

biological parents together.

So you feel quite a lot
of responsibility.

Kevin's male fertility specialism
is a role that some of his friends

don't fully appreciate.

They call me sperm boy.

They have various
kind of descriptive terms

for describing what I do.

Cubicle three, right.

My patients are important.

I think the work I do is important.
I know it's valued by them.

So, yeah, I don't take any notice!

On Kevin's list today
is 21-year-old Karl,

who is hoping to start a family with
childhood sweetheart Bethany.

Me and Beth has been together now
for nine years.

Got together when we were
about 12 or 13.

We met each other,

I think we were just outside,
just playing.

Definitely when we were
in secondary school and stuff.

I thought it was more like
a friendship, like, I never thought

I'd ever seen myself with him.

There was one day we were in maths,

he was like flirting and stuff,
and then I was walking home

with one of my friends
and I had a message off Karl.

And then on that night,
he asked us to be his girlfriend.

And here we are today.

So I'm just going through
the checklist now.

Karl was diagnosed with the life
limiting condition cystic fibrosis

at just nine months old.

He's been through the wars and back.

When I first got with him,
his health was quite poorly.

But since he started new drugs
and stuff over the years, obviously

he is a lot better.

They told us I was infertile
when I was 14.

Obviously, at the time,
never really affected me and Beth.

All right? Hi, Karl, how are you?

All right? Not too bad.

Nerves starting to kick in
a bit now. Yeah, that's normal.

That's normal.

In Karl's particular case,

we suspect sperm is being made,
but it can't get out

because the pipes aren't there
to carry it away

so it can accumulate
inside the cap at the top.

The thing about people like Karl
is that

because of the cystic fibrosis,

they're faced
with chronic health challenges

that can affect their ability
to make sperm also.

So today, you go down
to the operating theatre,

and we'll see if we can find sperm
from the cap at the top

with a fine needle.

We're looking for good swimmers.
Good numbers...

Michael Phelps.
Michael Phelps, yeah.

Now, if we can't find sperm there,
I'll take some biopsies.

So if we do do biopsies,
then what we'll do is,

we won't know the result today,

but we'll bring you back tomorrow
and check the wound.

I'll see you in a bit, OK?
Spot on. Thank you.

HE HUMS

Probably about 15% of men have
some kind of sperm quality issue.

Maybe one in 100 men
have no sperm at all.

Not all men would wish to
have children,

but for those that do and can't,

it's a shock and it's a stress,

and it's a heavy burden
for them to carry.

I really want to be a mum,
and Karl's definitely the one.

I have nieces and he's really good
with them.

I do really think he would be
a fab dad.

Karl and Bethany are hoping to find
out if their dream of having a baby

could become a reality.

We always do everything we can
to help them,

but sometimes it works
and sometimes it doesn't.

You've got to accept that
success is never guaranteed.

Sean?

ALL: # Happy half birthday
to you... #

Oh, did Melissa make that?

# Happy half birthday to you... #

I wish I had. It looks great!

THEY CONTINUE SINGING

LAUGHTER

CHEERING

You cook cake really well
compared to me.

But I feel like I should do it,

since it's my cake and I feel like
you're taking over.

If you cut it that way...

This year, we didn't have
a Sean birthday party

because of Covid and food sharing
and things like that.

It doesn't look dry, either.

You can tell you haven't
made this one. Charming!

One of the radiographers, Margaret,
that I work closely with

had mentioned that we would
have a half birthday.

I just want a little slither
cos I'm on a diet.

I like a good bit of cake.

It's delicious!

I mean, I'll definitely have
another slice.

I tell you what I really want.

I want a cheese.

You know, like the cakes
that look like cheese.

I want one of those.

This is gonna, like, play havoc
with my heartburn, you know.

Tuna, cheese savoury or ham?

So what are you going to eat
when you come back?

Watermelon.

I'm a chicken nuggets
kind of person. Yeah!

Watch your heid.

Donald's sarcoma
is bigger than expected.

For Milton and his team, the
priority is removing the tumour,

but it's surrounded by essential
nerves and vessels.

So what I'm trying to do now

is find out where
this guy's sciatic nerve is.

Is that it there, is it?
That's the sciatic nerve?

The sciatic nerve
is a very large nerve,

and it supplies the muscles
that move your foot.

Tumour is there. That's good.

All right.

If damaged, can lead to
significant disability.

So it's being displaced
by the tumour.

Cancer surgery isn't rehearsed.

You have to deal with
what you are faced with.

Sciatic, sciatic,
sciatic, sciatic...

Cancer doesn't respect
anatomy or borders.

Yes, that's good.

This is his sciatic nerve
and this is free of tumour.

Awesome. Okey dokey.

Cancer surgery keeps you
on your toes.

So the hamstring's attached to
a bone in the back of the pelvis.

We don't have to go that high,
but we're getting close.

Amazing dexterity, Mr Rankin.

You can do the lift from
Dirty Dancing.

My goodness.

He's a big boy, isn't he?

Phoof!

Removing the sarcoma will leave
a very large hole

in the back of his leg.

You can't simply stitch
the skin back together.

It is not feasible. It won't heal.

There you go. This is a tumour.

Now we try and endeavour for as much
limb preservation as possible.

Not as long as even 20 years ago,

a lot of these operations
were amputations.

Obviously, an enormous hole.

Donald has grandchildren.

He has family.

He wants to spend as much time
as he possibly can with them.

And my job is to make sure
that happens

through whatever means necessary.

I love the slippers.

You'll wake up
and they'll not be here any more.

Oh, no!

Meanwhile, staff nurse Rachel
has handed over Harrison

to surgeon Claire McLarnon
for his voice box surgery.

He was only three or four
when I first met Harrison.

He was born very, very prematurely,
and as a result, he ended up

with one side
of his voice box paralysed.

We've got Harrison.

He's an eight-year-old little boy

who's coming for
a micro-laryngoscopy

and left vocal cord injection.

Harrison's the first person
of his age that I'll have performed

this surgery on.

What we're planning to do today
is put a filler injection

to make the vocal cord
not quite that big,

but a sort of a fatter vocal cord.

Normally your vocal cords sit
in a V-shape and they're open

when you're breathing,
but when you're talking,

you need to close them,
and it's the air coming up

through the vocal cords
that make them vibrate.

But when you've got a side that
doesn't work or it's paralysed,

it tends to sit away so you never
get a proper closure.

I'm ready whenever you are, then.
Super.

We're going to be putting
what we call a laryngoscope,

which is a little instrument
that keeps the mouth open.

So by getting the end of it
in the right position, hopefully

we'll see the vocal cords.

This isn't going to be
the easiest of views, is it?

When our view is here,
the voice box is up here,

so we can't, we can't see it.

So just adjusting
the head position.

So that's the epiglottis,
which is the little flap

above your voice box, which ideally
you want out of the way.

Just some de-mister there, please.

If the injection does go
in the wrong place,

you can cause damage
to the vocal cords.

It's really important that
it's in the right place.

And there are the vocal cords,
those two white lines.

You can sort of see that
that left vocal cord looks

a little bit thinner.

So we use this long
injecting needle.

It's just a little prefilled syringe
of the actual filler that we use

to inject directly
into the vocal cord.

You can see it plumping up.

The big moment for me is actually
seeing it filling up.

And I know I've got it
in the right place.

I probably wouldn't do
much more than that.

That's us all done.

So, a little bit of a fiddle
trying to get the view,

but actually was really pleased
that injection went in really well.

We'll see how that all works out.

Nobody wants a positive result
more than his mam, Nadia.

Right now, I'm feeling hopeful,
but quite nervous.

We have waited four or five years
for this moment, and I don't know

if he's actually going to sound
any different or not.

All right, thank you, everybody.

Me dad text us. Oh, really?

He's been messaging me.
Has he? Seemed good.

Upstairs in the urology department,
Kevin is preparing to carry out

a sperm retrieval procedure.

Karl? It's all ready for you now,
we can go along.

This is fairly extreme stuff
for people.

People don't fall in love,
want to have a child and then think,

well, the next thing I'm going to do
is I'm going to have an operation

on my testicles to recover sperm,
because that's how it's done.

Have you got it tied at the back?
No.

Yeah. That's fine...

It's basically the end of
a lot of decisions

and processes and discussions.

What we're going to do today is
to see if we can find moving sperm

in the testicles of the patient.

We do find good quality
moving sperm,

we should be able to freeze
that sperm, store that sperm

so his partner can come back
and have IVF treatment with it.

All right, I'll see you in a bit.

Bye. Later.

We just need one moving sperm
to make a baby

if it works out well for us.

What's amazing about this, really,
is the patient, a few years ago,

you wouldn't live this long,
but it's modern medicine.

The light on, please.
Table up, please.

OK. Able to start.

Lovely.

Two clips.

An embryologist with a microscope
will be in theatre in the hope

that even a singular sperm
can immediately be identified.

The only slight fly in the ointment
is the issue of the cystic fibrosis.

I mean, Karl's got significant
health challenges.

He's got a tunnelled line in,

for example, to administer
medicines through.

There's a small amount of tissue
there which we'll have a look at.

It's just in there,
that's all we've got.

On this side, there might be
a little bit more, maybe.

If you've got chronic
health problems,

it can affect your body's
ability to make sperm, particularly

if you're likely or exposed to
getting chronic recurrent

infections, as Karl will be.

Are you ready? I'm ready.
Pull back now.

Kevin has taken some fluid samples
to test under the microscope.

Yeah, there's not a great deal
of fluid in this, I don't think.

You can send it across
and see what we've got.

The difference between success
and failure is very, very slim.

I know Karl will be, like,
a fab dad.

I think he would just do anything
to make it happen.

And I couldn't see myself wanting
to have a child with anyone else.

It would be sad to see him
go through what he's going through

if they don't get good results
from the sperm.

There's only one chance
we're going to get, so hopefully...

OK, so when you're ready?
Yep.

Different people have different
levels of understanding,

but they have one thing in common -

they're all anxious,
very, very anxious.

The uncertainty for them
is the k*ller.

It's the worst bit. They don't know
what the outcome is going to be.

There's no sperm, unfortunately.

While Karl is in theatre, Kevin
is going to try one last thing.

It's disappointing that we didn't
get sperm from the aspiration part

of the procedure, but we're still
in with a shout here.

If we don't find any sperm,
then we make just a few little nicks

in each testicle, squeeze out
a little bit of tissue.

This is the seminiferous tubules,
which are kind of like

the factory, with the hope
that we'll be able to recover sperm

from those biopsies.

Karl and Bethany's chance
of having a family rests

on the results in 24 hours' time.

You have to appreciate that despite
the fact that you do the best

that you can, it's not always
going to work.

Hello.

The time has finally come...
Oh, wow. ..to go home.

How's your day been?
Not bad. Not bad?

That's pretty good.
Different from the normal.

Yeah, I can imagine
a little bit different.

There we go.

You are free to go.

Thank you so much.
Thank you.

Bye. Bye-bye.
Thanks.

The tumour has been removed
from 63-year-old Donald's leg,

but now Milton and fellow surgeon
Mani must attempt to rebuild it.

So now we need to prepare
for a free tissue transfer.

Mani always has this phrase that,

"I don't care how big a hole
you make, I can fix it."

Nice one.

That's his mantra.

In order to fill the big defect
in the leg,

Mr Ragbir's team is taking muscle,
fat and skin from the opposite thigh

with its own blood supply.
Staples, please.

And they're going to plumb it
into the other side because as soon

as that flap is starved of blood,

they'll become malnourished,
essentially.

So a clock starts and we try
and make sure

it gets really plumbed in
as soon as possible.

The flap of tissue can only
survive for 90 minutes

without a blood supply.

I can see one really good one here.

The microvascular vessels
are so small that you need

a microscope to stitch them up,
so it's extremely intricate surgery.

Can I have another pair, please?

So two veins... Two veins.
One end with a coupler. Yeah.

You simply cross your fingers
that when the clamps come off,

that the connection isn't kinked,
there isn't a clot in there,

there's no leak.

Now just to make sure
that it's working.

45 minutes in and the team are ready
to put the flap to the test.

Whenever you're ready, Mani,
we'll get d*ck to inject the ICG.

Just say when.

Here we go.

Luminous dye will show
whether there is blood flow

in the newly transplanted flap.

If a corner here or a corner there
doesn't get perfused

and nourished with blood, it will
die, and be it now or in several

days' time, it will turn
black and nasty.

So it is, it's very,
very nerve-racking.

So what you're seeing on the camera
is this glow appearing as the blood

is carrying dye
into the transplanted flap.

That is beautiful,
that is beautiful.

So where there is blood,
there is that dye -

that equals success.

So that's great news.

Don't sound so shocked, Alex.

So what Mani gets now
is a fist pump.

Well done, Mani.
Well done, buddy.

Thank you.

At the end of a really difficult
operation, you're exhausted,

you're mentally exhausted, you go
through your head what went well,

what could have gone better,

but first and foremost is always,
is my patient going to be OK?

Because at the end of the day,
that's what we're here for.

We're here to make sure
not only that Donald's OK,

but that cancer is out.

The final task of the day for
staff nurse Rachel is to collect

eight-year-old Harrison
from theatre.

He's recovering from an operation
on his vocal cords, which he hopes

will strengthen his voice.

You feeling better?

We're staying quiet.

We can take that out
when we get back.

Yeah? First, it's time
for another ride.

So now all the hard bits are over.

You just get to chill.

Yeah?

Little smile there.

Mam Nadia is waiting to find out
if the surgery has improved

her son's voice.

Somewhere in the back of my mind,
and I'm trying to push it down

a little bit, is when he does speak,
what will he sound like?

Will there be any immediate glimmers

of the surgery having made a huge
difference for him?

Claire has arrived to put Harrison's
vocal cords to the test.

Hiya.

Oh, sorry, I've caught you eating!

Hiya, Harrison.

It's been a slightly long
road to get here.

Good.

Offering the injection
into the voice box is a fairly

new procedure here in Newcastle.

Can I give you a little drink?

If it works...

There you go.

..then he should see the impact
of it and the difference

of being able to be in the
schoolyard, his friends hear him.

So, Harrison. Can you count to five?

One, two, three, four and five.

I think that sounds a lot
better, actually.

I can hear a difference already,
so fingers crossed that continues

to develop and... Am I doing good?
You're doing really well.

You are. You're a superstar today.

It's always a relief because,
you know, particularly

when it's something that maybe
is a newer thing

for you or it's slightly
more challenging surgery...

We'll only count to three,
but we'll get louder each time.

One, two, three! Good!

You plan, you prepare for it,
but it's always good after.

It's when you know
that it's gone well.

Well, maybe not do
the high notes just yet.

We can practise them later.

After the injection,
we tell them not to talk

for a couple of days, so it's almost
a bit of a mean thing.

You've maybe given them
a better voice, but told them not

to use it for a couple of days.

See you later.
Bye, Harrison.

Bye. Bye.

I'm so proud of Harrison.

He has battled through so much,
and I don't think he'll ever

really understand
what his journey's been.

You sound good.

Yeah. Do I?

I think... Oh, remember... Do I?
Remember, Claire said

not to speak too loudly,
because you've had that fantastic

voice operation.

Are you glad we did this today?

Yes. You glad we came? Yes.

Hello.

How are you doing?

So, do you think you're ready
to go home?

Rachel four years ago questioned
everything that she does.

We are just going to check
those muscles one more time,

do you think they've shrank yet?

No, still looking pretty strong.

And now, I feel really confident
in the role that I work in.

My favourite moment in a shift
is probably when you're watching

a child go home and they're smiling
and they're like, "Yeah, it was OK."

That's probably the best bit.

Woohoo!

After a long day, it's time
for the team to head home.

Today, Karl and Bethany will find
out whether they can become parents.

It was a long day
for us both yesterday.

We're just both hoping
for the best results.

Karl's surgery to find sperm
was unsuccessful.

So the couple's chances
of having a baby rests

on whether a sample of tissue taken
yesterday contains sperm.

Everything about this morning,
it's critical for them.

They're going to be
really, really anxious.

Hi, how are you? All right?

Good, thanks. Everything OK?
Yeah, not too bad.

Any news yet?
Just processing the sample now,

we'll let you know
as soon as we know.

Fingers crossed. OK, I'll see you
in a bit, then. Thanks.

This is predicting how they're going
to be able to form families

in the future or not.

I mean, being the one
who gives information,

it's a double-edged sword, really.

A couple of patients described
the swing doors

through into the consulting rooms
in the fertility unit

as the doors of doom
or the doors of happiness.

Hi, Karl. How are you?
All right? Hi, Bethany.

Come on through.

How are you feeling, Karl?
All right?

A bit tender. A bit sore? Got the
John Wayne walk going this morning?

It is a couple either coming out
beaming massive smiles

on their faces, or they come out
in floods of tears.

We're a bit nervous this morning.
Of course you would be.

It's natural, as I say,
it's the uncertainty of it.

The operation went OK yesterday,

and we've got sperm from you
that's stored.

It's brilliant news.
There's plenty there.

There's a bucket-load, so hopefully
all you need for any amount

of treatments going forward into the
future, which is fantastic news.

Don't cry!

When you tell the couple good news,
it's fantastic, it's transformative

because they've built
all their hopes up to this.

Often they'll come in quite deadpan,

but you can see the anxiety
in their eyes.

Feeling quite shocked, to be honest,

because like I say, when Karl
was told at a young age

he would never be able to have
a child,

getting the results we need,

I am probably feeling
a bit more nervous.

It's wonderful to be able
to give good news.

It's really, really wonderful to see
that they've still got a chance.

We want them basically to just
be normal, to be normal families,

forget about it all and move on
and put it all behind them

and just be normal. This is what
we're looking for, completely.

I'll have to cancel me Strictly Come
Dancing contract, obviously.

So, nice and easy,
nice and relaxed.

I do extremely complex cases which
can have catastrophic outcomes.

Dear Diary, today I slammed
my finger in the car door.

We're going to need to do
just a little operation

for you to try and get everything
back to where it should be.

Nice deep breath.
Don't forget to breathe.

Angry people come in
and happy people go out.

There you go. Good girl!
Job done.