but see, the chordomas destroy bone. this cannot be a chordoma, if you mean chordoma. dobre vecher. >> igor: the people, they stay outside...

cell phone ringing ] in the queue, in the... [ laughter ] [ baby cries ] >> igor: that's a child in their family. she's a grandma. >> henry: i would judge that tumor to be inoperable, basically. 's in the brainstem, it's all in the pons. and, uh... i'm afraid the child has less than a year to liv [ igor interpreting ] >> henry: but obously, as we find it very, very difficult to do nothing. it's very hard. igor interpreting ]

[ woman speaking ukrainian language ] >> igor: so, what to do? somethinto do? >> my opinion is, there is nothing to do but wait for the child to die. [ igor interpreting ] life can be very cruel.@@ >> i'm sorry.

[ baby cries ] >> [ speaking ukrainian language ] [ cell phone ringing ] >> without surgery, she probably will... she probablyill die within the next five years or so. the surgery is safer than no surgery. d she'll continue to get worse as time goes by.

all these cases i'm seeing, i would operate on them all in london without any hesitation. sure, they're risks, but i would be reasonably confident -- i'd be quite certain that the risks of treatment, or the risks o f surgery, were less than the risks of no surgery. so, when you translate that into the circumstances here, it's different and it's much more difficult to know. so in that sense, it's very... it's very frustratg, you know. they're all salvageable people. >> a so, you're looking for, in english it's called a "jubilee clip."

>> igor: yes. many things i bought in this place. >> henry: yes. >> igor: for our clinic. for the hospital. >> henry: there we are. that one's slightly better quality than the other one. it's better made. it's got better... >> igor: it's very nice. >> henry: better metal on the worm drive. wish i knew the size. did you buy your bosch drill in a place like this? >> igor: uh, yes. with a 24-volt? we do >> igor: um, no, no. >> henry: pity. it's not really strong enough,@@ that cordless drill, is it?

>> now, the problem with tryg to remove all of the tumor is there is some risk, there is some danger, that the operation could leave you paralyzed down the right -- the tumor's on the left. the left side of the bra is responsible for the right side of the body. and there is a risk, if we try to remove all of the tumor, of arm and the right leg. the right >> henry: usually, we have the patient under a general anesthetic to begin with when we make the opening, the cision in the head and the bone. and then we wake the patient u and remove the tumor.

so i think it would be simpler and you have a better chancef success if you are awake throughout the whole time of the operation. it makes the operation safer because it makes the surgeon braver, because i know, i can see what i'm doing, because i can see you, i can talk to you, and leg, a that gives us a much, much better chance of removing all of the tumor.

>> henry: there will then be about 10 minutes, which is not painful but is unpleasant. that is when dr. kurilets is sawing, cutting through the bone of your skull. it's a very noisy -- and you'll feel the pressure of the drill pushing on your head. um, and that is unpleasant, but it's okay. the only part of the head which feels pain is the skin. that is all. thbrain itself does not feel pain. so, in a strange, in a strange way, to remove a brain tor under local anesthetic is not, is no different from going to the dentist. and i really, really think we can do this, and i mean that, from my heart.

okay? >> o >> henry: harasho. >> harasho. >> henry: right, we have a plan. >> igor: but, the most... the most important to put the plan into action. >> henry: yes. >> making plans, it's a soviet... [ chuckling ] >> well, soviet national health service. >> but making -- >> national health service is not in the plans. >> so maki plans, it's nothing.

>> i've yet to have a catastrophic result here in the ukraine, but... you know... soer or later, things are going to go bad. but nothing ventured, nothing gained, i suppose. and however much you tell patien ts there is risk, they never really take it in. if you're very nice and charming with them, they're always going to trust you and they think, "i'll be all right." well, that's human nature. we all think, "it's never going to happen to me."

>> igor: doing risky surgery means losing job and disqualification. four years ago i was unemployed for two years. >> yes. >> so it was, uh, cry. but i had no job in this country. >> but it seems to me, you're in a particularly difficult position, trying, because you're not supported, and so many people are trying to stop you. if you have any bad results, you're a lot more likely to have serious problems because you're outside the system. >> igor: if ukraine will export... they're the st capable and most clever people, as we now exported seven million people. so it will be a disaster for this country.

>> are you ready to eat? >> uh, let us play for 10 minutes first, if that's all right. let's have a look at this perforator. i'm sure we could use it dozens of times. maybe you can just somehow make a metal sleeve to go over it. you said your toolmaker has died, alas. >> yes, from brain tumor. >> did a lot of good wor for you, and he made you the operating table, this thing as well. >> and the bar for sitting position. >> he made that? that's very nice. that'sery sad because he made it very nicely. need a pair of sort of circlip pliers. my department, i calculated, it is unbelievable. it spend£40,000 a year, just on those. >> a year? >> yeah, we use 10 a week. they cost £80 each. we must use at least 10 a week. ich is, um... 800 quid a week, times 50. i mean, it's... extraordinary. >> i use one

for 10 years. >> yeah, i know. >> henry: have you got the compressed air he for the ventilator? >> igor: yes, sir. >> henry: and it fits? >> i've... made fix in here. so we'll try... >> woman: bye-bye. >> henry: see you tonight. >> woman: good luck. >> henry: thank you. >> igor: you like my idea? >> henry: yeah, fine. in eland, i don't have to plumb in the ventilators myself. we've got somebody else to do that. you're just a one-man hospital. my job is to do the operating.

>> igor: you're privileged. privileged. [ elevator door opens ] >> igor: we must be responsible for everything.

>> can she see any light? is the light in her eye now? i think that's the end. >> igor: how much time we have? >> henry: none. it's too late. she's totally blind. it's too late. you have to operate for raised intracranial pressure before they completely lose their eyesight. typical problem here because diagnosis is so often delayed. and by the time a brain scan

is done,he damage is done. even with benign tumors, people have gone blind or suffered irreversible damage. you get an earlier diagnosis if you have more scanners, but even though a brain scan in ukraine costs $50 to $100, even $50 to $100 for many people here is a huge sum of money, and they can't afford it. and so things get left too late. >> we cann run good treatment of the patients in our hospitals. >> how far away do you think you

are from aually starting building your own hospital? >> it depends on finance. >> yeah. and you had to borrow the money, presumably, from... >> we can, butt is very difficult to run clinic if you have a... >> henry: a large mortgage, large debt. >> yes, from bank. so, here we are. that's place. >> what a dream, eh? is it yourream? >> yeah. >> it must be. your own hospital, igor. >> no, no, it'-- that's a field. >> hen: yeah, i know, but it's a field of dreams. >> yes. >> this is where it will be. isn't it fantastic? it's so exciting. igor, this can be the ornamental lake. >> igor: yeah. >> henry: for your hospital. [ chuckling ] >> igor: i like it. [ igor speaking ukrainian

language ] >> henry: so... so the front of the building will be where? >> will be here. >> henry: will be here. it's a water pipe -- it's a deep water pipe here. >> henry: and the patients' rooms will look onto the courtyard? >> igor: yes. >> henry: and there will be a garden in the middle of the courtyard. that's wonderful. igor, it's so important to have good design in hospitals, because hospitals are like prisons -- they're places where a sll number of people are doing nasty things to a large number of people. >> igor: nice weather.

[ speaking ukrainian language ]

>> you do realize this is a very big, serious case, don't you, the one we're going to do now? >> igor: yes, henry. the risk of surgery. >> henry: and the patient realizes, i hope. >> the problem is that if you're unsuccessful, clinic... so nobody realize how risky surgery can be. >> henry: i know, but you've got to tell them. >> igor: yes, i told them, i told them, but they reply that, uh, you had... you d good results. we asked many patients, so we suggest that... >> henry: yeah, but they were simpler, smaller tumors. this is a terrible, big tumor. >> igor: you became less enthusiastic with years. >> henry: no, crap! it's not that!

it's just you're giving me more and more difficult -- you're difficult operations,ore that's the problem. at's what it's about. every time i come, you show me a bloody more dangerous operation. >> igor: but you told that we should, step by step, make progress. >> henry: yeah, but one day we're going to make a step too far. bloody cossacks. >> igor: ukrainian cossack. >> and now that the die is cast, we're actually going to start the operation, i cheer up a bit. a certain amount of... whether it's blood lust or training, i'm not quite sure. surgery isn't just about rational altruism. i mean, it's a blood sport, in a way. i mean, surgeons become surgeons for the excitement of it and the sort of fierce joy of operating. so in that sense i supse it is a slightly cossack activity. you know, a sort of brave

ukrainian heroism, things like that. right, well, off to battle. >> henry: could you tell him that it will hurt a little bit, a little bit like being stung by a bee, when he puts the local anesthetic in there? [ igor interpreting ] >> woman: bomkee, the word for "bigger...

mosquitoes." >> henry: a bigger bomkee is a big mosquito. >> igor: yes. 's a western ukrainian word. >> that's fine from this side, igor. is that all right for you? >> igor: yeah. >> henry: because his head is rigidly fixed, he can move, he can do anything he likes. [ marian and woman speaking ukrainian ] >> henry: no, no, not at all. dr. kurilets is quite happy up there. [ marian speaking ukrainian language ] >> woman: he can hear something scratching. >> henry: it will get very noisy when dr. kurilets starts drilling. because the whole skull will act like the soundboard of a piano. so it will be very, very loud.

[ drilling begins ] a colleague of mine, a neurosurgeon, once did an experiment where he had a coeague of his drill a hole in his head. it was somscientific experiment with putting an electric wire into the inside of his head to measure the pressure. i mean, crazy. but he said it was very noisy, having the hole drilled in his head. [ marian speaking ukrainian language ] >> woman: he can't hear anything. >> henry: he can't? that's interesting. [ marian speaking ukrainian language ] >> henry: , he can't hear our voice because of the noise. yes, yes, yeah. i think the 24-volt version might be better, igor.

battery is a bit flat. >> igor: all the hole's done. >> henry: good, all right. yeah yeah, okay. [ igor speaking ukrainian language ] henry: what's he saying now? >> woman: he's already used to these sensations. >> henry: he's getting used to them, all right. he's bed, yes. he'll probably fall asleep soon. we'll have to abandon the operation because he's fallen asleep. [ woman interpreting ] [ laughter ] >> wom: he won't fall asleep, don't worry. >> henry: he'll fall asleep? >> woman: no. >> henry: he won't fall asleep. >> woman: no. >> henry: we're now, igor is now cutting through the skull.

[ drill whirring ] >> [ marian speaking ukrainian language ] >> henry: to have a pulse rate of 70 while yore lying there having your he sawn off is quite something. well, we will start removing the tumor in 5, 10 minutes. >> [ marian speaking ukrainian language ] >> woman: it's the mt important thing. >> henry: igor, i'll go and get scrubbed up. i'm feeling extremely tense at the moment. and admittedly i always do before serious operations. i suppose it's rather like stage fright with experienced actors -- the worst of all surgical sins is complacency, so a certain amount of anxiety, i suspect, is necessary.

and there is always a critical moment is, will we be able to see the tumor clearly? you know, is it going to be straightforward or not? right. igor, hang on a minute. let's have a look. where is the tumor? >> igor: maybe here. henry: what do you mean, "maybe here"? thank you, all right. now, um, yes. igor, come and have a look. i think we can -- i think we can tell the difference. that's a little bit discolored, we know from the scan, there's a big vein. we're trying to preserve that vein, but i thk that will be very difficult. of a tumor like that --edges what we need to do now is open it, which, we know he's safe here because the motor mapping, which was very easy, is showing us where the motor is, but that's tumor.

normal brain has the consistency of very smth cream cheese. very thick cream cheese. and tumors makes it rubbery. it's slightly more rubbery and stickier and thicker. this is all tumor, igor. >> igor: it's a big tumor. >> henry: elena? >> woman: yes? >> henry: you can tell marian that the beastly tumor, which has been ruining his life for so many years, i am now starting to remove it. you can feel with the sucker. but that's too firm. that's possibly the edge. this is very nice, this is very clear. [ suctioning in progress ]

>> henry: see what his movements are like. marian is the reassuring check. by seeing that he can move his right side as we contie, i know that i'm not producg any serious weakne in his arm as i take the tumor out. which makes me braver. is he all right? >> woman: yeah. >> hen: okay. [ woman whispering ] >> woman: he's having a fit. >> henry: he's having a fit? a big fit? [ igor speaking ukrainian language ] >> henry: is he having a fit?