At the Edge of Life
Cambridge is home to two of the country’s most groundbreaking hospitals – Addenbrooke’s and Royal Papworth, where surgeons take on some of the most challenging medical cases in the UK.
In this second episode, Addenbrooke’s neurosurgeon Rod Laing performs what is probably the most difficult spinal operation there is; removing a slipped disc deep in the spine that is pressing on the spinal cord and threatening the patient with paralysis.
His patient, 65-year-old psychologist Colin, started having problems walking and was eventually diagnosed with a slipped disc in the thoracic or middle part of the spine. Colin discovered that if nothing was done, he could eventually become paralysed from the waist down and lose control over his bladder and bowel function. He also found that most surgeons refused to do the operation to remove the disc because of the high risk of paralysis during the procedure. His salvation came in the form of Rod Laing, who was prepared to take on the case.
The operation is so challenging because to reach the slipped thoracic disc, Rod must enter through the side of the chest and work his way deep into the body, avoiding important nerves and blood vessels as he makes his way to the spine. The hole that Rod must operate down is probably one of the deepest there are in surgery, with the instruments just long enough to reach the site of the disc. And when Rod reaches the disc, the risks are at their highest, as it is pressing against the spinal cord. He must remove it millimetre by millimetre without disturbing the cord, or else he risks paralysing Colin.
At Royal Papworth, consultant cardiothoracic surgeon Narain Moorjani is also operating at the edge of what is possible. His patient Gertrude is an active and vibrant 80-year-old who needs surgery on three of the four valves in her heart. An irregular heartbeat has caused two of these valves to become defective, so her heart does not pump enough blood around her body. Without the operation, her heart will fail, and Gertrude, who says she still feels 30 years old, does not want to sit around waiting for her life to end.
To operate on the valves, Narain needs to put Gertrude on heart bypass and stop her heart. The bypass machine will take over the job of circulating and oxygenating Gertrude’s blood. But with a patient as old as Gertrude, being on bypass is a great strain on the body, so Narain needs to work swiftly and with precision.
Two of Gertrude’s valves need to be repaired, so Narain needs to call on all his technical skills to carefully stitch flexible rings into the tissue around the valves to strengthen them. But the aortic valve, which controls how blood is pumped around the body, is so damaged it needs to be completely replaced with an artificial valve that must sit tightly against the heart. Even if Narain can safely do the repairs, the biggest challenge for Gertrude will be coming off bypass, when her heart must take back the demanding job of pumping blood around her entire body.