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"These are to be used as a self-assessment tool to indicate a level
"of perceived competence and also to record all of your training needs."
Whatever all that means. Bit of a mouthful, isn't it?
Er, Harry Timms. Er... the new teaching assistant. I was told to...
Now don't get me wrong. Of course, we want you to be proficient in high-level ED care.
But never forget what you're here to do. It's quite simple -
it's called nursing.
That means caring for people and using these.
Who's frightened? Who's uncomfortable? Who's alone?
-Sorry, excuse me.
-Miss said I could wait here.
-I'm not doing anything wrong!
-You don't understand, I'm not saying...
-Then leave me alone!
I catch you talking to a member of staff like that again and you're back to Mrs Khan's office!
-Now, get to class.
Sorry, it's Harry, isn't it? Come in.
Someone call an anaesthetist, please. I have no intention of trying to intubate this man.
You'll see many more of these in your time here. It's nothing to worry about.
No shouting. No panic.
It's an organised environment.
Quiet and controlled.
-Thank you, Jay.
Lloyd Asike and Scarlett Conway, I presume. Welcome.
-Which one of you's going to take over?
You mean now!
-I'll do it. I did an ED placement at St James'.
I've seen the drill in Resus hundreds of times.
-Tens of times.
-Another milligram of adrenaline, please, Tess.
OK, that's two minutes. Stop for a moment.
No. Still in VF. OK, charge to 150 joules, please, Dr Lyons.
Wait. No. OK, let's go.
A little bit further down.
He was in mainstream education till he broke his teacher's ankle.
Is there a best way of...dealing... you know, er, managing him?
Be firm. Be clear. Be direct.
You're a teaching assistant not his friend.
So no hesitations, no sign of weakness.
-And the others, are they...?
System was installed at vast expense last summer.
-Pity about the rest of the place.
-Are any of the others...
dangerous? I've only worked in mainstream before.
And you're terrified?
Look, I've been doing this a long time. Just follow my lead. If you do as I tell you, you should be fine.
Good. Effective compressions.
-Happy to carry on?
-You sure, or are you getting tired?
No, I'm good. I'm good.
OK, that's two minutes. Stop for a moment.
No, still in VF. Oxygen away.
OK, everyone clear. Shocking.
No, still in VF.
-Have we considered therapeutic hypothermia?
I was just wondering, have we considered therapeutic hypothermia?
-You're going to have your hands full, Charlie.
-I hope I'm not speaking out of turn.
We looked at the research and ALS guidelines at college.
I know some of you guys have a different take on things,
but I just wondered is it something you'd consider?
Good. Strong pulse, decent rhythm.
Well done, Mr Asike. You just managed to save your first life at Holby City. Your turn next.
-That's five more minutes everyone.
Was it that you didn't understand Miss Davies' explanation?
Was it that you're thick, lee?
-Are you filming me?
-Shut up, Ryan.
-You both need to be quiet now!
-Thank you, Ryan.
I said...thank you, Ryan.
-I will not have this behaviour.
-But it wasn't me.
-Am I clear?
-I wasn't doing anything.
-It was Ryan!
-I'm counting to three.
-It wasn't me.
Cardiac compressions. Tick, tick, boom!
-There he is!
-There he is!
-Ah, yes, the man of the hour. Nice one, mate.
-Oh, it was nothing.
Oh, modest, isn't he?
Hey, listen, don't worry,
I was terrified about getting my first cardiac arrest when I started.
I used to run and hide in the loos every time the red phone went off.
-Thanks, that's really sweet.
-It's true, though.
-You did well.
-How do you do it?
Come on, Lee.
You'll get used to it. Sometimes, we even get to do some teaching.
It was nothing to do with me...
Lee... I... I'm so sorry.
-Leave me alone!
It wasn't me!
I'm very sorry, Lee. I shouldn't have hit you.
If you let me or Harry come to the door, then we can let you out.
OK, Lee? You need to calm down.
-You know what I'm going to do.
-Lee, just put it down.
-Shut up! Shut up!
You should be more comfortable now, Mrs Harley.
Just let us know if you need anything. OK?
Just so you know, Scarlett, it's absolutely par for the course
to be a bit apprehensive about a cardiac arrest. OK?
Scarlett. I just wanted to make sure I didn't tread on your toes in there.
-I can get a bit carried away sometimes.
-We're in this together, yeah?
I wasn't trying to get one over on you. I've just wanted to be on a cardiac arrest
since the moment I started training and...I got excited.
-That's all it was, you know that, yeah?
-Lloyd, it's fine, really.
Ah, it was such a rush. The team, Mr Jordan...
He knew who we were. He was expecting us!
I think that's brilliant, don't you?
Sorry, I don't normally do this.
-Would you be interested in dinner tonight?
-You know where to find me.
-Was he from before? In Resus?
-You'd not met him before today?
-Don't you think that's a bit...?
You've got your strengths and I've got mine.
You're doing really well, son. All right, good boy.
I'm going to put this bandage on first, mate and then I'll take a look at the rest of you. OK?
There we go. Can you just stay with her for a minute. I just need to go to the ambulance and get a trolley.
You all right, Emma? OK, I'll be one minute.
-It's my fault.
-Try not to worry.
-To slap Lee, of all people!
-Please, you need this.
You've busted yourself up pretty good there, pal.
-Might want to try the door next time, eh?
He touched you first. You were provoked.
-I can say that when I make a statement.
-It's end of career.
-It was instinct. Self defence, almost.
He's a child. I'm his teacher.
Only...one way out...
Claim...it never happened.
-You demean yourself.
-Actually you demean us all. Nurses.
-Clearly I've been underestimating my impact on the world and on the nursing profession.
We're professionals. And you're telling me all you think you're good for is a bit of flirting?
Three years at university, training, studying, going on placements.
All that was in aid of you bagging yourself some rich doctor like it's still 1952? Sad.
I like to call it realistic.
Lloyd, you're in Resus with Charlie today, and Scarlett,
you'll be assisting Dr Winters in CDU.
You want to be a nurse, yeah? A good nurse?
Of course I do.
Try having some self respect. Try having a bit of faith in yourself.
OK, this is Emma Davies, she's 38. She's had a severe asthma attack.
We've nebulised her and her breathing's improved en route.
Sats are of 95. Tachy at 110.
All right, Emma. Let's put her in cubicle six. I'll send Dr Hanna in.
Lee Stark, 15, he's got lacerations to his head, face and arms.
-He's refused pain relief.
-Hello 'lacerations', I'm one of the ED doctors.
-Can we put him into Paeds?
-Assaulted a window at his pupil referral unit. Can't say I blame him.
Is that hurting, Lee? Give you something to take the pain away if you like. Do you understand me?
All right, Lee.
Just shufty over for me, mate, all right? That's it, good boy.
Lee. The doctors... they want to know if it's hurting.
She hit me! Miss hit me.
Miss hit you?
D'you know what he's talking about?
-Looks like your own work to me there, 'lacerations'.
Can I sit you forward, please? There we go.
Scissors, please, Charlie.
Arm up, please.
You've got an FB there, 'lacerations'.
It's Lee. My name's Lee.
Dr Keogh. Very nice to meet you.
All right, Lee. You've got some glass under your skin.
That's what the doctor's saying. FB, that means foreign body.
That's what the glass is. It's nothing to worry about. We'll soon have it sorted.
X-ray, whip out the FB and stitch him up, thank you.
-Are you going?
-It would appear so, yes.
-So drunk she bit into the wine glass.
-Sounds like a good night!
OK, I need you to put a cannula in.
Right, a cannula.
You are fit, you are.
-Has anyone ever told you that?
-Like I said...
We need to rehydrate her before we do anything else.
-We haven't got all day.
Oh, and you need to tie that hair back.
-D'you want me to call the police?
-Why? Has Mr Jordan been at the nurses' custard creams again?
Never, ever tell a doctor you've got biscuits.
Lunch break. Come on.
-So you've called them, then?
-The police! About the boy.
-But he said he'd been hit. It's a child protection issue.
The school have got their own procedures.
Caring for people who are frightened, alone, uncomfortable.
-I thought that's what being a nurse was all about.
I've seen kids like him before who've been hit so many times they don't feel anything any more!
With all due respect, we've seen a lot more kids like Lee than you have.
They're the one who always get brushed aside. It happened earlier. He's not 'lacerations', he's Lee.
-He's a person.
-Lloyd, lunch. Now.
-Wait, what's the first thing you need to do?
Sorry. Warn the patient.
-Sharp scratch coming up.
Sharp scratch then.
First time. Perfect.
Can you run a litre of saline over two hours? Thanks.
Beautiful or clever -
which would you rather be?
Both I suppose.
-I wish I was beautiful.
-You ARE beautiful.
No, I'm clever.
Just got into medical school. Hence last night's...celebrations.
-Your parents must be thrilled.
Bet being that beautiful means you get whatever you want in your life.
Sorry, just a minute.
I don't know what's wrong with it.
Is everything OK?
I-I don't understand. I've definitely attached it right.
It's not tissued, I've waved her arm around. The bag must be faulty.
-The saline's not going anywhere.
-It wouldn't - tourniquet's still on.
I'm fit, right?
Scarlett triumphs again!
What's the stupidest thing you could possibly do
-when you're trying to flush through a cannula?
-Leave the tourniquet on.
-Got it in one.
You seem pretty angry with that chicken.
Want to talk about it?
-Whatever it is that's making you look like you're about to explode.
First day of my first ED job.
Alcoholic, homeless guy come into cubicles, boss asks me to flush through the cannula.
-What d'you think I did?
-You left the tourniquet on.
Sure did. Saline ran into the soft tissue, before anyone realised,
-poor guy's arm had started to swell up.
Oh, and, um, very important game of Charlie Bingo in the pub tonight.
-And you two are playing.
Charlie Bingo, you know! "Quiet, controlled environment".
Ker-ching. "Don't overstep your experience". Ker-ching.
"Nursing is very simple. Who's frightened? Who's uncomfortable? Who's alone?"
It's a full house. Get in!
It's just a bit of a laugh. Charlie'll probably be there, too.
He might buy you a pint or something?
That kid you were with. What was he talking about, "Miss hit me"?
I'm sorry. I-I haven't worked with him before today.
-I don't know the boy.
-So why did he smash up the classroom?
He didn't like being told off.
And that was it?
What are you saying, he just...
made it up? Why would he do that?
-I don't know.
-Or could he have been talking about another time,
or could it have happened when you weren't in the room?
-So what happens now?
-What d'you mean?
-What do the school do?
-Investigation, call the police in?
-I'm sorry, I don't know!
-I'm new, it's my first day.
-What's that's got to do with it?
-Only that I don't know what'll happen next!
-It's about right and wrong.
It's got nothing to do with being new. Nothing to do with it.
Can you feel that? Is that numb?
Earlier on you said someone hit you.
You said, "Miss hit me".
This is normally the part where I ask people to stay
Did you mean your teacher?
There we are.
All done and dusted.
If she hit you, it does matter.
I don't want to get into trouble.
Well, if it's true,
you won't get into trouble.
Sorry about earlier.
-At least the saline didn't get trapped in your soft tissue and make your arm swell up!
-Er, Staff Nurse Conway will be assisting me.
-She'll just be cutting the stitches.
-I wouldn't want me anywhere near my face either.
-Aren't you going to refer me to plastics?
-Are you sure?
-If it was beyond my skills I would've referred you,
but the wound edges should come together very neatly
-if that's what you're worried about.
-I want to go to plastics!
I can call them, but when I explain the injury to them
they'll say that I'm wasting their time. They are very busy up there.
I want you to call them and ask for Professor Fitch.
-Just tell them his daughter's here.
If you're his daughter, why didn't you call him?
He's far too busy with his patients to answer the phone to me.
Coming here's the quickest way to get through to him.
Er, I was trying to find you. I've been discharged.
-How is he?
Emma, I want to help you, I do.
But.. he could be for excluded for this, couldn't he?
What'd happen then? Where would he go? He'll end up with no school to go to at all.
-It's not the first time this sort of thing's happened.
-But if nobody knows what provoked him,
that's not right, is it?
It's not right that you and I or the other kids have to live with
-the threat of that level of violence!
I've been doing this job for 15 years. I've been punched, kicked,
knives held to my throat, and not once have I retaliated!
Not once. Until today. And for that I'll be mincemeat.
Is his mum here yet?
-No, course they're not.
But the minute they hear I even touched their son,
their son who's had more time and more attention from me
than he's ever had from them,
the minute they find out, they'll be here.
The poor kid's already got a child protection plan in place
because of the threat of violence from his dad, real violence.
-But that's it.
He's a child, probably has some kind of learning disability.
He already thinks the world's against him.
I've gotta tell the truth.
You've been teaching for five minutes, Harry!
I'm trying to think about him, about how he feels, that's our job, isn't it?
Our job is to be firm, clear, direct. LABOURED BREATHING
No hesitation. No signs of weakness. That's all we...have time for.
-We have to stick together.
-Talk to me.
-She's acutely short of breath again.
Unable to speak in full sentences.
-I've started her on another five of salbutamol.
-Let's add 2.5 of Ipratropium to the nebuliser, please.
We'll look after her from here.
-Chest x-ray and blood gases.
-All right, Emma, here come on.
-Resps 34, sats 96%, pulse 120.
Slow your breathing down for us, please.
-Do you want him to stay?
Just take her hand. Quiet, positive reassurance. We need to keep her calm.
-You're doing well.
-Linda, can we add 200 of IV hydrocortisone, please?
Come on, Emma. Let's slow down your breathing for us, please.
Nice and calm.
Well done, Emma.
She's getting tired.
Can we check the state of the ITU bed, please?
Emma, I'm so sorry. You don't deserve this.
Please forgive me.
We stick together.
-You were right.
-Good. That's it.
Good, yeah, her breathing's improving.
Monitors show signs of good oxygen absorption.
-You'll be fine.
Professor Michael Fitch. World-leading plastic surgeon.
Also a tutor in the European Microsurgical Course in Milan.
Wife number five's an actress. Which figures.
He's operated on half of Hollywood!
Special interests include all aspects of aesthetic surgery, in particular
face, breast and body contour.
And he's coming our way.
Hi! I'm Dr Winters, this is Staff Nurse Conway.
Delighted to meet you, Dr Winters.
So, Professor, shall we...?
If the wound had crossed the vermillion border, or if there were some skin loss,
I would have thought about a plastics referral.
-But even then I was...
I have absolute faith in your abilities
and your decision-making skills.
Mr Jordan tells me it's your first day.
Sorry. I got a bit drunk. More than a bit, actually.
Never mind my face, you should see the wine glass!
Dr Winters, your judgement is impeccable.
Not an appropriate plastics referral.
It's been a pleasure to meet you both. Good luck with your first day.
-I look forward to checking your craftsmanship.
You're in the right place, and I have a clinic to get back to.
I hear you've been speaking to the nurse about this morning.
-About what Miss Davies did.
-She hit me.
So I won't get into trouble.
when I saw you this morning for the first time by the doors at school,
I think you were scared that I was going to tell you off
and that made you angry. Yes?
Well, I think it's the same for you and Miss Davies.
She got scared. When you grabbed her arm, she got angry and hit you.
When you get angry, you...
get into trouble.
Yeah, but the consequences for her could be very serious.
Because she got angry.
I didn't see Miss Davies hit you.
If anyone asks, that's what I'm going to have to say.
Then I'll get into trouble.
That's not fair!
Am I clear?
What happened last night?
I told him about medical school.
"Well done, Grace."
And that's it, he's gone.
Not even so much as a hug.
He can't even look me in the eyes.
I'm just a stupid little girl.
Grace, you're beautiful.
I'm clever, and he doesn't care about clever.
I'm sure he does.
I don't even know why I thought THIS would make
-a difference in the first place.
-It wasn't an accident, was it?
Oi! Matey? All right, that's enough.
-That's an expensive one...
-IT'S NOT FAIR!
-No! All right, hold your ground.
-Everybody stay back, I'm calling Security.
-..what's not fair?
-Situation in reception, one young male, you need at least two.
Well, find it!
I just wanted to let you know that I'm going to go ahead and suture Professor Fitch's daughter.
-Er, thank you, Ruth, yes.
-He's been to see her
and he agrees that it would be appropriate for us to...
-to treat her here.
-Then I'm sure that's the correct form of action.
Of course, um, I-I mean, I'd understand
if you wanted to do the sutures yourself.
He is a world-lead surgeon.
And I am a highly skilled, experienced
and confident ED doctor, more than capable of doing an excellent job.
-Dr Winters, do you have a moment?
Grace Fitch. It wasn't an accident½.
-I think she did it to get her dad's attention.
Erm, what should I do?
Nothing - patient confidentiality.
Cubicles one to six. Basic obs. OK?
I've put your lad Lee in cubicle three.
-Would you mind keeping an eye on him for me, please?
-I've called the police.
-About the teacher? The slap?
No, he's a minor and he needs to go home with his next of kin.
I've asked them to call in there. Mum's not home
-and she's not answering her phone.
I've also called the school just to report the accusation.
The TA said he'd log it, but, er, I wanted to make sure.
Not still fussing about 'lacerations', are we?
I think you'll find that most of the patients in here have given names.
Tends to help all round if we use them.
The patients being real people, human beings with feelings
and emotions, some of them maybe even pet owners,
not to be reduced coldly to mere diagnoses and so forth.
Yeah. Indulge me.
Why not? Why not?
Didn't think you cared.
I don't want to have to say this more than once. This is your first day.
For everyone's sake, please, try not to overstep your experience.
Your social worker's on the way.
Thought you might be hungry.
We're meant to encourage five a day, but...
Fruit and veg?
My gran calls it 'the reds'.
there's nothing you can do.
And it's not fair.
And it feels so hot...
..you're so angry,
and then bang!
And suddenly, you're the one who's in trouble.
How's that right?
You're the one...who's in trouble.
That's the one.
Some of us, we're always going to get them, yeah? Can't help it.
I don't know about you,
but me...I find it helps if I try and make a plan.
I sit down...
and I ask myself, "What can I do to fix this?"
-Yeah, a plan.
-Staff Nurse Conway, isn't it?
-I thought you had a clinic to get back to?
-It can wait.
How is she?
Gracie? Is she...
Actually, she's not fine.
I think what she really wanted was for you to do the stitches.
-when you looked at her, did you not wonder how she got it?
-What are you talking about?
Can't you see why she's here? It's because of you she did this!
Professor Fitch, the injury was deliberate.
-I barely took my eyes off him.
-Can you look in the toilets for me?
I checked them already. I was doing obs in the other cubicles.
I know. One last scout round and I'll put a rocket under Security.
I've spoken to him.
I don't think he'll say anything.
-Just try not to worry. Concentrate on getting better.
-Can I have some help here, please?!
-Where is she?
-Lee? What's happened?
She's the one who got angry. She should get into trouble!
-No, leave him! Leave him.
Where is she? WHERE IS SHE?!
-She's has to tell the truth.
All right, Lee.
She's the one who got angry and now I'm...
I'm the one who's going to get in trouble. I'm the one who's...
-I won't let you get into trouble.
-Let's get him into resus.
-All right, we've got you.
-She slapped you. Miss Davies slapped you.
-Mr Jordan! He took the glass out of his back pocket.
-I think it may have nicked an artery.
-No, lie back down! Please.
-Two litres of saline.
Bloods, glucose, FBC, Us&Es, clotting.
-Come in, come in.
-Cross match for six units, I think.
-I think it's the popliteal artery.
-OK. Let's roll him, please.
Quick as you can, everyone.
-Anyone got any scissors?
Yep, that looks nasty. Thank you. Right, let's have a little look.
There we go.
-Right on the money, Tess.
-He only needed to have slipped or crouched down for a moment.
Can we get a firm pressure dressing on this, please? OK, Lee?
-He's trying to say something.
-He's trying to say something and no-one's listening to him!
-We're trying to save his life.
Concentrate on what you're doing.
Hard as you can, please, I'll call Vascular.
I...had a plan, I had a plan.
-I can assure you your daughter is in very capable hands.
-I sincerely hope so.
You can't go around breaching patient confidentiality.
-He needed to know.
-He wants his daughter stitched up and discharged.
You'd better hope he doesn't take this further.
Do you know what, just keep quiet and do what I tell you.
These sutures have got to be perfect.
Finally! Quick as you can, please.
-Get off me!
It's all right, I've got it, I've got it!
-Stay still, please!
Come on, we need those bloods now!
-He's in class four shock here.
Get it through the infuser.
When I was a kid, my dad used to take me swimming every Saturday.
-I used to spend all week working out my moves for the diving board.
Bit longer next time, it's important to leave enough room to cut them out.
Saturday would come and... he'd watch and clap and laugh at me.
And then one week, I was doing my moves
and I looked down and he wasn't there.
He was in the cafe, having a bag of chips. And that was it.
It was the same every week from then on.
-He just wasn't interested any more.
-Try not to speak, please.
Took me years to realise. He was embarrassed.
Suddenly I wasn't his little girl any more. He didn't know where to look. Your dad...
he only knows how to relate to women in one way -
to charm them, flirt with them.
But you're his daughter, his beautiful, grown up daughter.
-He just doesn't know how to be with you.
-Staff Nurse Conway!
You need to remind him that you're still his little girl.
OK, I'll get the lift.
Is he going to be OK?
He's lost a lot of blood
and the surgeons will have to repair the artery, but yes...
should be OK.
Excuse me, I...
I don't blame you for not wanting to talk to me.
It was about right and wrong. I was wrong. I should've listened to you.
You don't want to listen to me.
Lee listened to me. Look what happened to him.
Beautiful work, Dr Winters.
I asked Nick Jordan to make sure the best person in the department did the job. And I can see she has.
-..you remember my old needle and thread?
Whenever I had a tiny graze on my arm or a scratch on my knee, I'd show you and you'd say...
"Looks like you need some stitches, Gracie."
And you'd get that rusty old needle and make me pretend to stitch you up!
Then when I was stitched up,
you'd give me a big hug and say...
"There you go, Gracie. All better now".
You've...grown up so fast.
And the blood gases and chest x-ray have come back fine. Now we normally recommend a quiet,
calm environment for a good few days after an attack like that.
How is he?
Out of surgery. They think he's going to be fine.
The Deputy Head's here.
We'll have to make statements about this morning.
About you slapping him.
..I-I wanted to say...
First of all I wanted to say sorry.
I think you probably feel the whole world's against you.
What we did was wrong.
We're the ones who should be in trouble.
Who made it worse.
I know this is difficult to believe, Lee...
..but I'd like to try to be your friend.
I have it on good authority we're playing a spot of Charlie Bingo in the pub.
-I told him to make a plan.
-You were trying to help him.
You care, and that's a fact. It isn't everything, but it's a hell of a good start.
-CDU turned out to be brilliant.
Stitched up the daughter of a world-class plastic surgeon!
-He's a leading tutor in European Microsurgery.
Well respected in Milan, Italy...
-How about you, Mr Cardiac Compressions?
Er, resus was cool. Saved a kid's life.
-Me and Charlie just got back from the surgical ward.
A great first day all round, then?
Yeah. Couldn't have gone any better.
Hello there. Right. Pub. Who's for a pint? Jay?
-Er, Ruth? Pint?
-Yeah, I'll come for one.
OK! Oh, here's the man. Lloyd. First day. Unfortunately that means your first round.
-Lloyd's done well.
-Well, you did pretty well, too.
-What with my cool, calm, collected response to the cardiac arrest(!)
-Or my stunning show of clinical expertise with the tourniquet.
-I meant your work with Grace Fitch.
Come on then. Both of you.
Which gems did you get? Eh?
Was it, um, "You may feel like fish out of water,
"but just remember you are key players in the department"?
Or was it, "Just remember one thing- patients are unknown quantities.
"Never try and second guess them" Come on! Spill!
-What's the ma...? Hey!
I'm glad to see you three are getting along so well.
-Cos as it turns out Jay here is going to be your official mentor. In fact, you're team leader!
-Tess and I think that it's appropriate to your professional development.
I wouldn't want to overstep the limits of my experience.
We think you're ready for it.
You are, after all, a key player in this department.
You all are!
No. No, no, no, no, guys! Seriously...
I may be a nursing disaster of spectacular proportions, but...
I've still got my self respect, right?
65-year-old male found collapsed in the street...
disorientated. Query left side skull fracture...
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