All language subtitles for super surgeons a chance at life S01 E02_track3_[eng]

This program me contains discussion
of life and death stories

and scenes of surgery that some
viewers may find distressing

The human body is an extraordinary
machine. Every day, billions of

our cells are being
replaced with new ones.

But sometimes things go wrong,

and when they are deemed
untreatable,

people turn to us.

Because we take on some
of the world's most difficult cases.

Patients come from far away
with the most complex medical

problems in the world.

And we understand
that this is their only hope.

The patients we see will die
without our help.

And to save their lives,

we have to push the limits
of what is surgically possible.

If we get only one chance
to get these cuts right.

If it goes wrong, it can do
patients terrible harm.

Ooh, oh!
We've got a hole in the vein.

OK, hold it, hold it. Clip, please.

In the worst circumstances,

it could even mean not making
it off the operating table.

You have to make sure that the risk
is justified

by the opportunity to cure them.

Oh, wow!

It's a lot of pressure on you
as a doctor.

I sometimes have sleepless nights.

The stakes are tremendous.

So you try your utmost to save every
life coming your way

because you realise
how fragile life is.

I've done a lot of things
in my life.

I've been in the Army.
I've done a lot of other things.

I've done a lot of good things,
and I've done a lot of bad things.

But looking back on all of it,
I have produced a good family.

I've got three daughters.

I've got 11 grandchildren

and one great—grandchild.

I'm good for breeding.

No, I'm not any more, I'm not,
but I was.

I was bleeding in my mouth
and my girls kept telling me,

"Go to the doctor's, Dad."

I said, "That's all right. It's only
an abscess,"

because that's me, that is.

He's always wanted to protect us.

I understand that's the way you are,
but it didn't benefit —

keeping it to yourself... No.
..that something wasn't right. Yeah.

I eventually went and saw a doctor.

There were large tumours. Hmm.

And I mean, they still are.

The radiation and the chemo
hasn't worked on me.

When I go to a party and people
ask me what I do, I say,

"I'm a cancer surgeon."

I do all cancers above
the collarbone,

except the brain and the eye.

And the next question is,

"Tell me about the last complex
operation you did."

And then I'm scratching my head
thinking,

almost every operation we do is
complex.

I can do something that is unique,

that changes a patient's life,

and, of course, that cures something

that was previously thought
to be incurable.

Morning, young man.

I've known Peter for a year.

He's a lovely gent
with a great sense of humour.

Let me get a word in, OK?
I'm being quiet as a mouse.

No, no, you're not being quiet
as a mouse.

He came to us with quite
an aggressive cancer of the back

of his throat and his tongue.

That cancer hasn't responded
to radiotherapy and chemotherapy.

So this needs urgent treatment.

And if we don't do something
about it, we lose a window of cure.

So we are going to look inside
Peter's throat

under anaesthesia and try and
define how extensive the cancer is

and whether we can take
this cancer out surgically.

It's definitely diseased, isn't it?

I didn't expect to see that.

Is that a radiation ulcer?

We need a biopsy that.

Yeah, this is a tumour.

A recurrent cancer for me
is a puzzle

and the whole cancer puzzle keeps me
going.

How can I take out the cancer,

do less damage,

and offer the patient
a good quality of life?

That's a Holy Grail.

But how do we do that?
How do we solve that puzzle?

Is his daughter here? I don't think
she's here, but I'll give her a call.

PETER: All right, mate?
I'm all right. How are you?

How are you feeling? Eh?
How are you feeling?

All right.
PETER SPEAKS INDISTINCTLY

Good news or bad news?

The cancer we can see on the scan...

Yeah. ..it looks
like it'll come out. Right.

But I saw one more ulcer
the back of your throat,

which wasn't there before,

which I think is caused
by the radiation side effects.

Right.

Which we see from time to time.
Yeah.

So I've taken some biopsies.

If that comes back as positive
for cancer... Yeah.

...then it'll be difficult
for us to do much.

HE MOANS DISAPPOINTEDLY

But if that's negative,
then I'm still optimistic. Right.

Well, let's hope it's that, then.

But if it's not,
there's nothing you can do?

I can't operate on you surgically,
if that's positive.

Because it becomes too big then.
Right. Yeah.

So the tissue has been sent
away for testing. Right.

We'll see what comes back. OK.
Thank you. OK? Yeah.

See you, doc.

Thank you very much.
Thanks a lot, Professor.

Not quite the news we wanted to
hear. No.

Still...

...it is what it is. So.

SHE SOBS
Sh, sh, sh.

Come on. All right.

I've learned a lot from my patients
with recurrent head and neck cancer.

They're the bravest patients.

The stakes are high
across the board.

Families suffers.

I don't want to give up.

I want to try and cure them.

Frankie!

Come here.

Sweet.
DOG BARKS

Good boy. Good boy.

It is finding one to make it work.

I used to drive a fairly big lorry.

There's not many women actually in
cargo that do drive the lorries and tugs.

But I love the job.

That's Daniel and Abby walking
Frankie.

Hasn't always been easy
because I split from their dad,

and even though he's always
been in their lives and still is,

I've more or less brought
them up on my own.

I've just managed to work

and be around for them
the whole time.

Just over a year ago, I started
to get some pains

outside of my left ribs,

and I know now that it was
a lymph node that was swollen.

And every time you pressed it,
it's just like,

"Mm, that's uncomfortable."

So I went to hospital for a scan.

The ultrasound picked up a sort
of a shadow,

and they said to me,

"It's cancer and it's in
the pancreas.

"And we are referring you
to the Royal Marden."

The first thing you think is,
"Oh, my God, I'm going to die."

And then it's like,
"How long have I got?"

And then you think of your family
and friends and pets as well.

I don't like worrying people.

I don't really want
the attention on me.

I'm just not that sort of person.

I can't imagine there's any part of a patient's
life that remains untouched by pancreatic cancer.

I can only imagine how they must
feel.

Here, everybody's striving to
improve life for our patients.

The operations we do now, maybe
ten, 15 years ago would not

have been possible.

The level of risk that we're willing
to take on

on behalf of the patients
has definitely increased.

So pancreatic cancer is known
as the silent killer.

It often doesn't give
any symptoms to the patient

until it's relatively advanced.

Thus far, Janet has had eight months
of very strong chemotherapy

and radiotherapy in an attempt
to shrink the tumour to the extent

that we can contemplate
an operation.

I need to make sure that Janet
understands the risks of surgery.

This is a big decision
for her to take.

I was initially told that this may
not be operable, which meant

I would have to live with a dormant
tumour

that could start growing again
at any time.

HE KNOCKS

When you initially had your scans
early last year, you could see

that there was a fairly big tumour
within this part of your pancreas.

Right. The good news is that
has responded very well

to the treatment.

It has gone down from 45cm
down to a centimetre.

It does give us the opportunity
to think about an operation. OK.

We're going to remove probably
around about 50% of your pancreas.

The difficulty for us
is going to be the vein.

There's a blood vessel that comes
from the bottom part of your tummy

and runs up to your liver.

This is called the portal vein.

So this supplies around about 80%
of the blood to your liver.

And we could see on the original
scan the tumour had actually wrapped

itself around this particular
blood vessel.

That's part of the thing that adds
the risk to this particular

operation, because there's a risk
of bleeding

as we're manoeuvring
the vein away from the tumour.

OK. Does that makes sense? It does.

Done the chemo, and the radio.

I would rather have the risk
of the operation to take

the tumour away.

Every faith in you, Dr Bhogal. OK.

Thank you. OK, I'll see you
soon. Thank you. OK.

Just relief, really,
that it's going ahead.

And we've had
that conversation today.

It's a fork in the road.

Janet, she hasn't got
any other treatment option.

Which is, I think why you probably
have a lot more angst

before the operation because
you want to make sure you do

the right thing, because that's
probably going to be your biggest

influence on patient survival.

WOMAN: Did you get much sleep last
night? Not much, to be honest.

A bit nerve-racking.

We just have to wait for the biopsy
results and see.

We wait until they tell us here
now the bottom line...

...the best, the best that can happen
and the worst that can happen.

And then I'll make the decision
with you.

KNOCKING

Hello. Hello. Good morning.

How are you? OK. You OK? Yeah. OK.

I want to have one more look
before we get chatting. OK? Right.

So the last time you were here,
we had a look inside

and found a new ulcer.
Here, let me show you.

This tumour is in the tongue
and tonsil and soft palate.

You see this ulcer here?
That's the one we biopsied.

So that is negative.

I'm convinced
there's no tumour here.

It wasn't too bad, was it?

What you were saying was making me feel
a little bloody better, I tell you that.

Yeah, it was making me feel I came
here for doomsday.

So game plan? Based on all
the assessments we have so far,

it looks like this is an operation
that can be done.

It'll be a long operation.
We're talking about 12 hours.

We'll split your lip and chin,
take part of your tongue away.

The same time, we'll take tissue
from your leg.

We'll bring it up, put it all back
together

wire the jaws back together.

I must be up front — even if we
do the operation,

the chance of being disease-free
is around 15% or so

at five years.

Is it worth going for it?

That's a decision that... I can't
make that decision for you.

What's the other alternative? ls

support you with your symptoms,
with pain control,

and then manage them as we go along.

How long's the piece of string?

So it ranges from one month
all the way to 12 to 14 months.

Right. But the mid line, the middle
is about six to nine months.

Well, six to nine months.

I'm going... I'm going for the
surgery.

I mean, what have we got to lose?

Let's go for it. Let's go for it.

I'll tell you now, because I saw
it in her eyes.

I saw it in her eyes straight away.

These are difficult decisions
to be made for Peter and his family.

The chance of curing this cancer
with surgery is between 15% and 20%.

But Peter is very clear in his mind.

He wants the operation, he wants
to grasp at that chance of cure.

PHONE RINGS OPERATOR: Good
afternoon, Macmillan. How can I help?

PHONE RINGS

OPERATOR: It's difficult, isn't it?
Trying to balance everything, I guess.

The word cancer elicits fear,
elicits worries about survival,

but with appropriate treatment,
especially if the cancer is early,

the chances of defeating
the disease are very high, indeed.

PHONE RINGS

If possible, every patient coming
under my care must get a shot

at curative treatment.

I will push the boundaries
as much as I can.

Mum, can you see me? OVER
MOBILE: Yeah. OK. Venga.

Because he's going in at 8.30.
I'm going in at 8.30, babe.

Yeah, OK.

Peter's cancer's centred around the
side of his throat

at the back on the tonsil.

It goes up to his palate and goes
down into his tongue base.

And there is some tumour
in his lymph nodes as well.

It's about 45cm in size.

Love you, babes. Good luck.

This operation is as complex
as it gets.

We're going to work around fairly
large arteries and veins

that take blood to the brain.

And we have to create tissue
from the thigh to reconstruct

a soft palate on the side
of his throat.

We're ready. We're ready? Right.

I feel like Rocky.

I'm not exaggerating when I say that Peter can
say set the limits of surgical resectability.

If it is any bigger,
if it's gone any lower,

we'd be not offering
Peter the treatment.

I love you.

You get one shot at these things.
DOORBELL RINGS

Oops, excuse me.

There's no chance of going back and
rectifying your mistakes.

Bye, Dad. We'll look after him.

Yeah. OK. Quickly. Sorry, he's one
of those.

All right. I need my huggies.
He needs his hugs.

I hope we get this right for
him, poor guy.

Hello, sir! Welcome.
Hi-de-hi-de-hi.

Let's keep you covered behind.

And get up on the bed and
make yourself comfortable.

And then we'll restore some dignity
to this entire situation.

No peeking.
I've absolutely no way.

It's a long operation.
So let's see how it goes.

The idea of not having him around
is something I'm finding hard.

I want him to have a shoulder.
That's what family is for.

All done. Sweet dreams.
You've done it.

We're going to look after you now, OK,
Peter? We are going to look after you.

PETER: I just want to have a
good quality of life, what's left.

And I will take it day by day.

I'll be at home with my family.

And I'll carry on lying to them
when they ask me how I feel.

If I feel rotten,
I'll tell him I feel great.

I don't want to pass any suffering
or pain on to them.

Because I know they're going through
it anyway, just looking at me,

to see me like this.

I've been a fighter all my life, so
I'm not going to change now I'm old.

The first step in the operation
is to open up Peter's neck

so that we can remove
his lymph nodes.

We need to be careful here

because we're going to be working
around the jugular vein.

So that's the tumour here.

You're doing really well.

While we're working on the cancer,

we're also simultaneously preparing
the tissue in Peter's leg,

and that'll be transplanted later
on into his mouth and throat.

So I'm going to now cut his lip.

Seems brutal, but you have to split
the jaw to get to Peter's tumour.

So that's it. We split the jaw now.

I'm fighting a battle
for the patient.

I need to get this right.

And I'm invested quite heavily
in getting this right.

That's interesting.

Hang on a minute. Well, there's one
more tumour there.

We've just found another tumour.

It wasn't seen on the scan.

This seems to be confined
to the lining of the throat.

So that wasn't expected.

We just have to take a bit
more tissue.

Peter so needed this done.

We've taken away the cancer.

Now we can use the tissue
from Peter's leg to reconstruct

the soft palate and throat.

We're transplanting living tissue
here, so we need to establish

a blood supply and connect it,
otherwise this tissue will die.

We have one artery and
one vein, and both of them

have to work at 100%.

The human body is an amazing thing.

We can transfer a piece of leg
tissue covered with hair

into the mouth and neck,
and over time the skin will adapt

to its new environment.

My colleagues now need to reconnect
the artery and the vein

from the leg tissue
to the new blood vessels.

And this is tricky
because they're only a couple

of millimetres in diameter.

This is a stitch in going in.

It's quite a nice match
in terms of size of vessels.

Clamping the flap side off first.

Just here, there's a leak.

We'll need a stitch back again,
please.

Stop. Let's get the bleeding sorted.

Loads of blood
coming out of that vein.

The vein's now isolated,
which stopped the blood coming out.

These are the crucial blood vessels.

If those blood vessels don't work,
then the whole flap will fall apart.

But Peter's blood vessels are good,
so we are optimistic.

As we had to split Peter's jawbone

and I had to put it back together,
using metal plates and screws.

Now we're going to close the lip off
and put it all back together.

I'm going to ring his daughter now.

PHONE RINGS
Hello.

Hi, Luann, it's Vin.

I'm just calling to say Peter's
operation has gone really well.

Oh, brilliant. So we've got all
the cancer out.

Nothing to worry. We're really
happy. Thank you, Professor.

Morning, Peter. Good to see you.
How are you feeling?

It's gone really well.
Gone very well.

You have every reason to be positive
about this.

I was very comfortable
with the margins.

It looks like you're not in
pain and difficulty.

So we'll just wait this out,
I think.

He's saying thank you. My pleasure.

Oh! You've got good strength now.

That's good going.
Oh, God, no, that hurts!

We'll get you sat up and get you
walking around. I'm really pleased.

Yeah. Great. Take care, Peter.

He looks amazing today.

He's got his naughty smile
back on his face.

You can see that.

Things can go wrong and that's
always a worry for us,

especially with Peter.

So we will assess that.

But I'm cautiously optimistic.

PHONE RINGS

OPERATOR: Good afternoon.
Macmillan Support, how can I help?

PHONE RINGS

OPERATOR: So you are really
concerned about it returning?

That fear is very common.

You're not alone.

PROFESSOR VIN: We don't have a good
grasp on why some cancers progress

despite treatment
while others don't.

It is completely unpredictable.

PHONE RINGS

MN". I'm nervous.

It's almost like you've been
preparing to go away on holiday.

Make sure this is done.
And then it's about what you pack.

What do you pack?

I've popped over to see my friend,
Dani.

SHE SNIFFLES

Cos I had to speak to her about
looking after the kids...

...In case I didn't pull through.

Try not to think about things
like that, but, you know,

it is a reality.

DR BHOGAL: Before the operation,
I think for me,

it's a psychological weight, really.

Particularly the morning before,
your mind will keep going back to,

"How am I going to do it
if this happens?

"What will I do if I encounter this?
Will I stop? Will I go ahead?

"How about something
really terrible happens?

"How am I going to get myself
out of this problem?"

It's having plan A, B, C, D
in your mind before you go in.

Morning, Janet. Hello.

Everything been OK since I saw
you in clinic? Yeah, yeah, fine.

No changes? No. OK.

What we end up doing exactly
in the operation will depend

on exactly what we find. Yeah.

It's now very difficult to even see
the tumour on the scans,

it's responded so well to the
chemotherapy and radiotherapy.

If, when we remove this,
there isn't much pancreas left,

we may just have to remove
all the pancreas,

which is a bigger operation.

If I have to remove all of it,

then you're going to become a
diabetic straight after the operation.

OK. I'm in your hands.
We'll do our best, Janet.

OK. Thank you. All right.

That shook me.

I don't think I've ever appreciated
having a pancreas so much.

I just hope that I can keep
as much of it as possible.

It's quite scary.

So I'm feeling a little bit nervous.

I think you always do before
an operation like this.

Once we divide Janet's pancreas,
we're going to send a sample

of it to our pathology colleagues

to make sure that area is clear
of any tumour.

So this is an operation
that does make you sweat.

There's going to be three
or four important steps

that we're going to have to make.

Once we've made those,
there's no way back we go.

In you go. OK.

How are you? Nervous.
My name is Adam. Nervous, yeah?

Nice to meet you. That's normal.
OK.

If they don't operate and take out
the tumour,

I will basically be lucky to have
two years to live.

The thought of death scares me.

I want to do whatever I can to make
sure that I survive.

All I want is more time

with friends and family.

We're starting.

I'm going to begin by just starting
to lift the duodenum away

from the back of the abdomen,
so we can get close to the pancreas.

This is the pancreas.

I mean, it's really,
really shrunken.

There's quite a lot of reaction
here to the radiotherapy,

quite a lot of inflammation.

So we just have to go a bit
carefully, a bit slowly here.

Bloody hell.

Oh, my God. Like rock.

It's really stuck here.

The stomach is getting in
the way.

There is vein involvement here.
Hmm?

Feels pretty stuck.

HE EXHALES FORCEFULLY
OK.

That's where we're going to do
divide it

if we want to get a clear margin.
Yeah.

Tie it up.

My hands please.

It needs another stitch. Yep. To
remount the needle for me.

Let me put it in now.

Suction, please.

Stay in, stay a bit longer.

When we're trying to get
the pancreas off the vein,

we've had a bleed into the main
vein,

so we've just controlled that with
sutures.

It's a bit risky here.

I think we should divide
everything now.

It's getting unsafe.

We're getting into bleeding
we can't get control.

Hopefully...start to try and take
the tumour out.

OK. We're going to divide the
pancreas now.

Yeah. Beautiful.

Very nice.

We're almost there now. We're almost at the
point we're going to take the cancer out.

Go into the vein.

The back of the portal vein.

You sure? Yeah. Yeah. There it is.

Got it? Yeah, yeah.
So now it's real clear, that.

Scissors.

The cancer now is hanging
on the last thread.

That is the specimen.

That area there is the pancreas.

It's completely rock solid
from the radiotherapy.

Normally the pancreas is about
that size, but it's tiny.

And the tumour is here.

So what we're going to do now is we're going
to go upstairs to the pathology department.

What we want to make sure
is that there's no cancer there.

If he said it's all OK,
we'll come back and we'll do

we'll do three joints.

If he says no, we'll come back
and remove the rest of the pancreas

and then we'll have to do
two joints.

Andy, hi. The tumour,
it's all been pulled in here.

We've divided it in the body
and taken everything this way.

There's about that much
pancreas left.

She's 55, and we're keen to try and
maintain some pancreas if we can.

OK. Thank you very much, Andy.

JAN: Just can't wait to start
putting my life back together.

There's some things I'd like to do.

I want to get back on the horse
as soon as possible.

There's places that I want to go,
round the Devon coast.

Clovelly, I want to go back there
one day.

I'd love to be able to take my mum.
That'd be nice.

There's just dozens and dozens
of things.

It's just I want to do this and I want
to do that. I want to do everything.

He's had a look at it under
the microscope

and there's no evidence of cancer.

It means that we don't have
to remove the remaining part

of the pancreas,
that can stay in place.

So that's a good news.

So the pancreas is now joined
back to the valve.

It's looking good. Should be OK.

Put the first one around and then
put the drains in...

Yeah, yeah. Thanks.

It was a good effort, guys.

That's a team effort.
It's not a one-man job, that.

It's very, very tough to do.
That was a difficult one.

Thankfully it's all gone very well.

We get this moment of elation,
where we think,

"Yeah, we've done it, we've got it."

But there's always a wait until we
get the full histological results back.

These are the operations that give
us grey hair.

Morning, Janet.

How are you? A bit better?

Janet, the operation went
pretty much as planned.

So we've taken the tumour away and taken a bit
more of the pancreas than we would normally do.

So you've still got a part
of your pancreas gland in place.

It all looks very, very good.

It's equivalent to winning
a lottery.

So I couldn't ask for better news.

Um, I know it all hurts,
but that will recover in time.

I think celebrations are in order.

JAN: I have a new name
for the chicken house.

It's the first job I've done.

That's it, I'm done for the day.

Look at this space.

It's peaceful. It helps me relax
and to recover quicker.

Today is a follow—up call
from Mr Bhogal, the surgeon.

Part of the pancreas was sent
off for analysis,

so there might be
some information on that.

I hope I'm cancer-free.

PHONE RINGS
OPERATOR: Are you there?

Hello. DR BHOGAL: Hey. Hello there.

You're looking very well, Janet.

Yeah, I feel much, much better.

I feel less pain each day.

Janet, I've got some good news for
you. OK.

When we've had a look at what we
sent at the time of the operation,

it's all clear.

Fantastic. Brilliant. OK. That's the
best news I could wish for.

Thank you so much.

OK. Right. Take care. All the best.
Bye-bye. Bye.

MOBILE TRILLS

Hello? You all right?

Yeah, right now I've got
some news for you.

Yeah? I've spoken with Mr Bhogal,

and he's now said
that I'm cancer-free.

Mum! Good.

No, it's good news.

So a roller-coaster ride over.

Yeah. Why is the dog
in the washing basket?

Send me a picture of him, right?
Love you, bye. Bye.

Probably have a good cry now.

There's Frankie on top
of the washing basket.

Just elated. Just...

Just a year's horror story out
the way, just gone.

Just put it behind me.

Well, I just want to go and shout
and tell everybody I'm free.

I'm free.

Yes. That's fantastic news. Yes.

Over the moon.

PROFESSOR VIN: The human body is in
a constant state of change.

There are billions of cells
that make our body,

and these cells are dividing every
single second.

When this happens at such a
frenetic pace, things can go wrong.

Peter's so gung ho.

And he told me each time, "Go ahead,
do it." And he wanted that chance.

We gave him the chance.

So that swelling is new, on the tip
of the epiglottis.

We are seeing a new growth
on this voice box

and I need to figure out
what it is.

I need to get some new scans done.

I didn't expect to see that.
It worries me. Yeah.

PETER: Yeah.

I'm sorry to keep you waiting.
That's all right.

How are you, Mrs White? Fine,
thanks.

Yeah, I do.

Uh-oh. I'm sorry. It's not good news
on the MRI scan, Peter. Uh-oh.

So the cancer's come back.

Yeah.

I know we went through a long
journey with this. I'm so sorry.

I won't say a couple of years.

If you look at the scan
from a couple of months ago,

there was no tumour,

because if he had seen this on
the scan from two months ago,

we wouldn't have done
the operation in the first place.

Right. So this is new tumour and I
think it's growing fairly rapidly.

PETER CHUCKLES

You're amazing with your resilience
and your sense of humour and...

Yeah. Absolutely.

I feel...| feel gutted.

Yeah, yeah.

I feel awful that we just didn't
control it for a good enough time.

We have tried.

PETER COUGHS

Thank you.

You think that you would get
better with that.

You'd learn to do it better
as time goes on.

But the older I get, it becomes even
more difficult to break bad news.

It's really horrendous.

You do it because you think
it's going to benefit him,

but it hasn't.

It's come back so rapidly.

It's the worst part of this job.

He's lovely as well,
he and his wife. That's hard.

Hmm. Let's go see the next one.

HE GROANS

Right.

I know in my heart of hearts
that we've given them the best

possible care we can, but I get
frustrated that we can't do better

for the patient.

I get frustrated that we don't
have any other medicines available

to make the patient better,
to cure the cancer.

And you carry the sadness.

You're never free of it.

These patients, they become friends.

It's VERY hard to lose a friend.

The tumour is enormous.

We've got a table, guys?

It weighs 7.5kg. Oh, wow!

We're going to reconstruct
the throat.

And I'm invested heavily
in getting this right.

I'm going to fracture the voice box.
BONES CRACK

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