Lest Ye Be Judged Casualty

MUSIC PLAYS

Lucy?

Lucy, sweetheart, can you hear me?

Come on, sweetheart, you need to wake up now.

-Robert...

-Morning.

I've just been in to Lucy and I can't wake her.

-She's really hot.

-You mean she's got a fever?

Yes! She's burning up.

MUTED SPEECH

HE GASPS

RAZOR RASPS

HE GASPS

Bobby?

Bobby.

She needs intravenous antibiotics and steroids.

Without them she could get very ill. We should get her to hospital.

I'll call an ambulance.

-No, it'll be quicker if we take her. Car keys?

-Kitchen.

-OK, get the car started. I'll bring her down.

-Right.

MOBILE PHONE RINGS

OK, come on then.

-Oh, Lenny, can you make sure Mr Chapman gets his referral?

-OK.

Mr Hammond, dislocated elbow, it's now reduced

but he's going to need a fracture clinic appointment, OK.

See the guy with Nick? He's from the GMC.

-Morton.

-Yeah.

You OK about that?

Sure. I always knew it was going to happen, so...

What've we got?

Lucy Wheldon. Age 8, taken ill overnight.

This is Dr Carson, her GP and her mother Debbie.

Her temperature was 39 at home. Pulse of 140 regular.

She complained of a sore throat last night.

OK, any medication?

Yes, she's on 5mg of prednisolone each morning for nephrotic syndrome.

She was fine till this morning, and then I couldn't wake her.

When was she diagnosed with nephrotic syndrome?

Six weeks ago.

Six weeks ago, OK, well let's get her stabilised

and we'll see what we can find.

I feel like a new man already. No kidding.

OK, Patrick - I just need to give you

some leaflets on wound care and lifestyle.

Not exactly wounds though, are they?

Don't think the girls'll even notice them

when I'm stretched out on the beach next summer.

Probably not.

Is there anything else you want to ask before you leave?

Nah, I'm fine - except I haven't had the full English yet,

that was included in the fee, right?

A gastric by-pass isn't a get out of jail free card, you know.

What, I can't just stuff myself as much as I like? I thought that was what I'd paid for.

Patrick, you need to read...

Very funny. No-one likes a smartarse - even when they're slim.

You finished your shift? Off home to bed?

Something like that. Well, good luck with everything.

Maybe I'll see you on the beach next year.

If you do, you won't recognise me.

Of course I will.

You'll be the twelve stone smartarse surrounded by girls, right?

OK, let's get a canula in and blood for FBC, U&E,

and CRP and a venous gas.

10ml per kilo bolus of saline fluid and 50 milligrams of hydrocortisone.

OK.

-Tonsillitis?

-That's my guess.

Good thing you brought her in before she got more septic.

I was just concerned it was going to become Addison's.

Let's hope not.

-Did you spot the kidney disorder, the nephrotic syndrome?

-Yes.

Good catch.

Just lucky.

-It's more than that. And you brought her in.

-Yeah, well, it was quicker.

They just live down the road from me.

The perils of being a country GP?

You do tend to get roped in a bit.

Sam, have you got a sec to look at Mr Jevons in cubicle three?

Yeah, sure. ..Do you want to bring the mother up to speed or have you got to shoot off?

-No, no, that's fine. I'll tell her.

-OK, cool.

Do let me know if there's anything else you need.

Thank you.

I'll keep people away from their duties for as short a time as possible.

So you're viewing it as pretty straightforward then, are you?

-Which, of course, it is.

-I couldn't say. The case examiners will make that decision.

Perhaps I could start with Staff Nurse Conway?

It was my understanding that she actually wasn't present when the incident took place.

No, but she did treat Mr Parr subsequently

and I need to get an insight into him as a patient.

Righto. I'll see if she's available.

CLASSICAL MUSIC PLAYS ON CAR RADIO, CAR REVS

Thank you for coming, Staff Nurse Conway.

I'm Jacob Morton, a lawyer from the GMC.

This is Miss Kilby. She'll be keeping a record.

If you'd like to sit there.

Her temperature and pulse have settled

and her lactate's only slightly raised now.

-Does that mean she's going to be all right?

-She's going to be fine.

It's a good job Dr Carson brought her in right away.

I knew!

I knew I should have asked you to look at her last night.

I just... I just thought she was tired.

It wasn't your fault.

The main thing is she's going to be all right, OK?

Yeah. Thank you!

It's what we're here for.

I'll try to get her admitted as soon as there's a bed.

CLASSICAL MUSIC CONTINUES

ENGINE REVS

HORN BLARES

HISSING

Hey, fella, you all right?

Hey! You stay there, don't move, OK?

So when you treated Mr Parr... what was his attitude?

I don't know, um, normal.

Just like any other patient?

Yes.

He wasn't troublesome or abusive?

No, not at all. Not with me, anyway.

OK.

So let me ask you about Dr Nicholls.

How would you characterise her as a doctor?

Um, well I'm not really sure that's up to me to say, is it?

You must have some opinion about, about her as a person.

Well, I guess I'd say she's strong.

Physically strong? Because of her army training?

No, no, I didn't mean that. I mean strong personality.

Well, she knows what she wants.

Ah. So would you say she was headstrong -

unwilling to take no for an answer?

No, no - I just meant she's confident, that's all.

I see.

The car... It belongs to my son.

Don't worry about the car, mate. You got any pain anywhere?

In my arm.

Rheumatism.

Need some painkillers.

OK, right, he's got good breath sounds.

Still seems a bit disorientated to me.

OK, sweetheart, we're going to get you into the ambulance,

-then we'll get you sorted, all right?

-Yeah.

-Won't be a tick.

Yeah, OK, great. Thank you.

Morning.

Oh...

Just so you know - Jacob Morton from the GMC is here today.

And I had such high hopes for today.

He'll need a statement from you about the Keith Parr incident.

Well, let's see how busy we are.

We do need to cooperate with the enquiry -

whatever our personal feelings.

I'll certainly bear that in mind.

I know, I know.

I thought your mid-week partying days were over, Linda.

It's a one-off.

On three, please - one, two, three. No loss of consciousness.

No obvious injury. Down on three - one, two, three.

But he did seem a bit vague at the scene and he asked for painkillers.

-We gave him five of morphine.

-Great lovely. Thanks, Dixie.

Hello, George, my name is Doctor Sam Nicholls.

Do you have pain anywhere? Your neck, chest, head?

My neck's a bit stiff.

The paramedics said you seemed a bit dazed.

-What do you remember from the accident?

-I don't know. Just a bloody great bang.

OK, I'm just going to give you the once-over, all right?

It's just as well I've got clean grollies on, then.

-Grollies?

-Undies.

-Pants.

-Does that hurt?

-No, it's nothing. It's just rheumatism.

Can you tell me what it feels like?

Yes, tingly, like...

Lloyd, he's suffering from anterograde amnesia and paraesthesia in his arm.

I think we should just skip the X-ray and jump straight to a CT scan of his brain and C-spine.

-Right.

-Listen, Doctor...

-Try and keep still now.

I told you, I'm OK.

Old soldiers never die, eh, they just get stroppier?

How did you know?

We still call them "grollies".

They won't let me wear my uniform round here -

they say it intimidates the other scab lifters.

"Scab lifters?" We used to call them "Medicos".

Well, see, there's just no respect any more, George.

All right.

If you could lie nice and still for me try to relax, and I'll be back in a sec.

-Everything OK?

-Not really.

I just spoke to the guy from the GMC about Sam. Pretty certain I messed up!

In the end it's just going to be about what happened between Sam

and that bloke and that's it.

You think?

Absolutely.

Listen, the other day.

I'm sorry.

-I shouldn't have...

-Kissed me?

I mean, I just want to be sure we're OK.

Yeah, yeah, course we are. It's fine.

You sure?

Mmm.

Mr Statham, head-on collision with a car, was it, yeah?

Yeah, an old boy. He was over my side of the road.

Nothing I could do about it.

-You feel that?

-Yeah.

Right, the other films came back fine.

-Let's get an X-ray of that thumb.

-OK.

MOBILE PHONE RINGS

Dr Carson.

Yes.

What - my car? Where?

Who was driving?

Is he hurt?

No, no, I'm there now. Yeah.

Right, are you fit and well otherwise?

-Apart from the asthma. Never used to have that.

-Seen your GP?

Yeah. He says it's just one of those things.

Sometimes it can be, um...

Right, well as far as the thumb's concerned you have an ulnar collateral injury.

You mean it's broken?

No, you've torn the ulnar collateral ligament.

Basically what's happened is this went that way and this didn't,

so this ligament here has been torn.

No bony involvement but you will need to get it immobilised.

For how long? I've got work. Emergency plumber.

-I can't afford to be off.

-It's going to be five or six weeks, I'm afraid.

-Are you OK to get that in a cast?

-Yeah.

Right, well, I shall leave you in Linda's capable hands. If she can stay awake...

PHONE BEEPS

Can I?

Good job you've still got one working thumb.

Everything OK?

-I need to get home. How long will it be?

-Not too long.

Once we get your thumb immobilised you should be able to go.

Doctor Nicholls.

-You still here? I thought you'd be gone by now.

-I just wanted to make sure Lucy was settled.

Has a George Carson been brought in?

Yes, he's... Wait - Carson? Is he a relative of yours?

My father. How is he?

OK. Bit shaken up. He's just through here.

Dad? What the hell happened?

Someone drove into the car.

Yeah, I know. The police called me.

Where were you going?

I was going to the shops. Now listen, about the car...

I don't care about that.

I just don't understand what you were doing.

Well, you weren't at home were you, eh?

All right, Dad, just give me one minute. ..Sam.

The paramedics said he was unfocused at the scene

and he has paraesthesia in his left arm.

-Any loss of consciousness?

-He says not.

Mind you he wouldn't tell you if there was.

If he'd broken his leg he'd try not to limp.

I'm sorry about this. He's not the easiest man in the world to deal with.

He lives with you?

The last six weeks. His place has got subsidence.

It should've been sorted years ago

but he wouldn't ask anyone to look at it.

Then the end wall started to fall down...

-He's keen to hang on to his independence?

-Putting it mildly.

Dr Keogh?

-Yes?

-Mr Morton would like to see you.

-I'm sorry. You'll have to tell him I'm busy.

-Now Mr Jordan said if you said that...

No. Not possible. I'm fully engaged.

Let's not wear out the other thumb, too, shall we, Mr Statham?

Will you sit forward for me, please.

-Oi, listen...

-That's exactly what I'm going to do.

You told Dr Lyons you had asthma.

Correct? Recent or since childhood?

Just this last year.

-OK. Good.

-Good?

-Linda, can we get a full blood count on Mr Statham, please.

-But Dr Lyons didn't want that.

I'm sure Doctor Lyons would want us to avail Mr Statham

-of our full range of services. U&Es, too, please.

-Right.

-How long will this take?

-As Einstein said,

it's all relative. Now look up for me, please.

-Hello.

-Jacob Morton.

Sam?

I told you I was fine.

You want me to pull rank on you?

-I'd like to see you try. I go... Ah!

-George? Talk to me.

-Where's the pain?

-Here.

Move your fingers.

I can't.

-OK.

-Ah!

Is that better or worse?

Oh, that's better.

-It's going away now.

-Have you had this pain before?

Yeah. A few months.

It comes and goes.

What about earlier today? At the time of the accident?

Yeah, I had it earlier today. I was going to get some painkillers, from the chemists.

-Have you seen your doctor about this?

-I wouldn't take up her time. Anyway, Robert gave me some pills.

Tramadol, I think. It worked - least it used to.

What do you mean "used to"?

-When was the last time you took them?

-The day before yesterday, it was the last one.

Robert said he didn't have any more. I thought I could manage, but I needed something.

-Have you been feeling rough, too - had the sweats?

-How'd you know?

Just a guess.

OK, well I'm going to try and bump you up the list for that scan.

-In the meantime, at ease, OK?

-Yeah.

So you'd tried to stop Mr Parr from entering the staff room

but you couldn't, is that correct?

Yes. He wouldn't calm down.

When he saw Dr Keogh he went straight for him.

He was physically threatening?

Absolutely. He had him up against the wall.

And because of that Dr Nicholls put him in a headlock.

Yes, but only after Mr Parr pushed Dr Keogh against the lockers

and went to punch him.

I see.

So in your opinion, Dr Hanna,

was Dr Nicholls' action in restraining Mr Parr reasonable?

Well it stopped him from further assaulting Dr Keogh, so yes.

And if you were in her place would you have done the same thing?

Personally?

No, I don't think I would have tried to physically restrain him.

But under the circumstances I don't think that what Dr Nicholls did was wrong.

Even to the extent of breaking his neck?

I'm sure that wasn't the intention.

But it was the outcome.

How's he doing?

OK. Can I have a word with you?

Yeah, sure. What about?

George is complaining of pain in his left arm.

He says he's had it before.

His rheumatism. I think it bothers him more than he'll admit.

This is acute.

He said you gave him Tramadol?

-Yes.

-What was his dosage?

-100mg when needed. Look...

-Was he sticking to that?

As far as I know.

-So why wouldn't you give him any more?

-I...

You do realise he's in withdrawal. At least, that's what it seems like to me.

I don't know, I haven't seen him today.

But you did think he was developing a dependency?

I thought he might have been upping the dosage, yeah.

A couple of weeks ago he came to me

and said he'd lost some tablets, then he said he needed some more

-because they hadn't been working as well as they had been before.

-Did you examine him?

-He wouldn't let me. You've seen what he's like.

-Yet you still gave him Tramadol.

Up until a couple of days ago, yes.

I thought if I told him I'd run out it'd force him

-to go to his own GP to be properly examined.

-Instead he got in a car and went looking for a chemist.

You must've have been aware of the dangers... KNOCK ON DOOR

Dr Nicholls? Sorry. CT can take Mr Carson now.

OK, thanks.

Are you hiding?

I don't hide. I may have been concealed.

Looks like hiding to me. Anyway, it's your turn to give a statement.

-Have you been in?

-Mm-hm.

-And?

-We're not supposed to discuss it. Anyway, you'll find out when you get in there, go on.

No, I'm busy.

Dylan, you can run but you can't hide.

Mr Statham's results.

Excellent.

Elevated eosinophil level and a slightly low HB. That's interesting.

It could just be the asthma...

Doc, can I go now?

Patience, Mr Statham.

I'd like a full rheumatoid screen, including ANCA and a urine sample.

For a thumb injury?

No, of course not. Well?

OK.

Janey!

-Oh, God, are you OK?

-Yeah, yeah, I told you, I'm fine.

OK, so come on then, let's get home.

No, I can't. There's this doctor running tests. Something to do with me asthma.

Asthma? You've seen your own doctor about that.

Anyway there are other things we should be doing right now.

So come on, there's still time.

Um, can he go? We need to get home.

No, sorry, Dr Keogh needs to run a few more tests.

-Can I have a urine sample please?

-Is that really necessary?

That's him.

Sorry, is there a problem, Mr Statham?

-Why can't he come home?

-He can - once I have established there's nothing wrong with him.

-But if his thumb's all right...

-Sorry, why is it everyone keeps talking about his thumb?

Nurse, could you show Mr Statham to the toilets, please?

-Perhaps you'd like to wait over there?

-This way.

-OK, George, well the scan shouldn't take too long.

-I'll go with you, Dad, OK?

-You don't have to.

-Dad. For God's sake...

Can we get on with it?

Right, the Med Reg has just phoned.

He's reviewed her scans and it definitely a PE.

He wants us to start treatment down here.

OK, Linda, Will you set her up with a bolus of 5,000 units

of unfractionated heparin. I'll repeat the FBCs and clotting.

I'm just going to take some blood off you again, OK?

Actually, I'm going to get another drugs chart.

Can you give us a hand?

What?

5,000 units, yeah?

That's 50,000.

-Oh, my God.

-Yeah, right. Do you want to do it again?

I'm so sorry.

Listen, about what you were saying earlier. You were right.

I should've made him have an exam before prescribing -

or at least insisted he visit his own GP.

If it had been anybody else I would have done.

So why didn't you with him?

Because I knew he wouldn't go.

I knew he'd just suffer in silence.

-Excuse me, they are ready for you now.

-Great thanks.

He's going to need help getting off that level of pain relief.

I know.

-Has he always been as stubborn?

-Pretty much.

He was always stiff and bull-headed - at least with me.

The irony is, of course, he spent 40 years

working at the probation service with young offenders.

Got them to trust him, got a lot of them out of trouble.

-Well, why don't you take a leaf out of his book.

-How d'you mean?

Well get him to trust you, at least talk to him.

It'd be a start.

I know. Rule one, day one - check the dosage and if in doubt, ask.

I'm really sorry.

A first-year trainee wouldn't have been that stupid.

-Or that tired?

-No.

-Look, it happens, but...

-Not with me, it doesn't. It hasn't before.

-So, what was it, then?

Is it just the partying, or is there something else keeping you up?

I'm getting too old to be burning the candle at both ends.

It won't happen again, I promise.

Work comes first.

Enough said, then.

MOBILE PHONE VIBRATES

BP's 120/60, he's tachycardic.

His breathing's shallow and fast. He looks like he's vomited.

He's got a high temperature, laceration to his head.

-Could have been from the tumble.

-Yeah, well, you know what they say - the bigger they are ...

Right, let's get him in.

You volunteering to get the spinal board?

Thank you, Jeffrey!

As it's you.

Excuse me, love.

BEEPING

Mickey...?

If we go in the disabled...

What?! No!

Look, we haven't got much time left.

Come on...!

Please?

No. No way, I'm doing it in a hospital toilet.

Zoe'll hit the roof if she finds out!

Partying's one thing, but pulling another night shift before you come in.

The Pennicott have just asked me to go full-time.

Mmm, and?

Oh, go on, you're not seriously considering it?

Well, yeah, I am.

You'll be a thermometer waitress?

It's better pay, and regular hours.

Right, but what about your principles?

And you'll be prostituting all your experience and training for, what, the private sector?

What, like the doctors, you mean?

Not all of them, thanks.

No, but then again, some aren't very bright.

It's ridiculous.

What sort of tests can he need for a sprained thumb?

As I have previously indicated to you, Mrs Statham,

this is not about his thumb.

So what is it about?

That's what I'm trying to find out.

Be a lot easier if we just didn't let the relatives in, right?

Yes, yes, it would.

Sorry, Dylan, um, Mr Jordan wants you to...

Mr Jordan wants you to go now. Um, you're the last one.

Right, well at the moment I'm more interested in getting answers than giving them.

Right, Mrs Jarvis...?

Sorry.

Pupils equal and reactive to light.

Could be concussion compounded with alcohol but...

He's got a severe metabolic acidosis - pH 7.15, lactate 6.4.

Hmm, the high temperature and tachycardia - that would fit with sepsis, but where's the source?

He had bariatric surgery a couple of days ago.

A laparoscopic Roux-en-Y.

What, here?!

At the Pennicott Clinic. He was discharged this morning.

Right.

Yeah, there's the generalised guarding.

We should have another chat later on. OK, I think this is a perforation.

Let's get an erect chest, plenty of fluids, some Cef and Met ASAP.

Lenny, will you get an art line in and you tell ITU? I'll speak to CT about an abdo scan.

SHE SIGHS HEAVILY

This is just stupid. There's nothing wrong with you.

Come on, let's go.

-What about the tests?

-We can come back later - afterwards.

-But...

-Look! An hour. We can still get home.

-Maybe we should wait.

-I mean, we can still do it later.

-If it's later, it's no good.

But it's not as if we haven't tried, is it?

-Are you saying you don't want us to have a baby?

-No, no, of course not, but...

I thought you wanted to try as much as me, but if you don't...

Janey, don't. Jane...

-You...?

-Yeah, I get about a bit, me.

Do you remember what happened?

I was sick and then there was a terrible pain.

I think I passed out.

Yeah, you fell and gashed your head. You've got peritonitis

because there's been a leak from one of the joins in your intestine.

Is that bad?

You're going to need surgery again.

They won't undo it, will they - I'll still have the by-pass?

I can't afford to pay for it again.

No, you'll still have it.

I'm just useless!

I don't want to be like this, but I was going past this cafe and...

The full English? Well, that didn't cause it.

Look, weight loss isn't just about eating or surgery.

It's about lifestyle and changing the habits you've had for years.

-Hiya, they are ready for Mr Leyland upstairs now.

-OK, there you go.

Don't worry, you'll still get into your new clothes.

Although the cords... they might be a mistake.

Doesn't matter, they're a 36-inch waist.

Ahh, good old private medicine.

Great for elective surgery, bit crap if it all goes wrong

and you need an ED.

Still, don't suppose you'll be worrying about that for much longer.

You've got some old scarring there, George. What's that from?

An accident. The army.

What kind of accident?

What's that got to do with anything? It was 50 years ago. More.

Dad, Dr Nicholls can't do her job if you don't tell her everything she needs to know.

I did tell her - I told her it was an accident.

George, your CT scan is showing a foreign body in your neck

very close to your jugular vein

and it's pressing on the brachial plexus, which is a large

bundle of nerves - hence why you're getting the pain in your arm.

I want you to see an ENT surgeon,

OK, but first I really need to know what we're looking at.

If you must know - it was a grenade.

Malaya, 1955.

What?! What happened?

What do you think?

-Were you treated at the time?

-Some bandages. I didn't need anything else.

You did, you just didn't think you did.

OK, so more recently.

When did you first start to get the pain in your arm?

-It's been getting worse these last few months.

-Why didn't you tell me?

-Why did you pretend it was rheumatics?

-You don't need to know everything about me.

Even something would be nice.

You know you could get him into a lot of trouble, don't you?

Me? How?

Lying about the pain in your arm, pressing him to give you

painkillers, which family member GPs are not supposed to do.

-He didn't tell me that.

-Of course he didn't.

You wouldn't go see your own GP, so what's he supposed to do -

let you suffer? You're his dad, aren't you?

BEEPING

Janey? Come on, babe, don't be upset.

Look, four weeks isn't that long.

It doesn't matter, not if you've changed your mind.

-No, it's not that.

-It sounded like it.

BEEPING

We could still go into the disabled.

What? No! Just - just stop. I'm sick of that bloody app.

It's like Big Brother. We only ever do it when it says so.

-No, we don't, it's...

-Yes! Yes, we do!

Its like - like it's taken over.

It's just there to help.

It doesn't though, does it! I hate it.

-It's not fun anymore.

-I don't want to have fun, I want to have a baby.

-It's not... I can't...

-Mick! Mick!

Help! Someone help, please!

-Hi, I'm Dr Hanna. What's happened?

-I don't know! I think it's his asthma.

OK, Scarlett, can we have a trolley and oxygen stat.

It's OK.

Blood results on a Mr Statham?

Yes, mine. Thank you.

Dr Keogh?

Um, not a great time, actually.

Now.

Fine. Patient care versus pointless bureaucracy. No contest.

Dr Keogh, thank you for coming.

As I said, I hope this won't take very long.

I know you're busy.

So, perhaps I could start by asking you about your relationship

with Dr Nicholls.

You're married, I believe?

No.

Sorry? I thought...

Separated.

Ah. I see.

I doubt that.

In the interests of clarity and efficiency I have prepared a written statement.

Which I'll think you'll find contains all the relevant information.

-I am sure, but I'd prefer...

-I have nothing to add to that, but I do have patients to treat,

so if you'll excuse me...

So why didn't you ever tell me you'd been in Malaya?

It was before you were born.

You didn't think I might be interested?

It's in the past - it's gone.

Not all of it.

Listen, Dad, I know the past few weeks haven't been easy for you,

I know you'd rather be in your own place.

At least I'd be out of your way.

You're not in my way, Dad. I wish you were.

-What are you talking about?

-You're in the house, but I hardly see you.

We talk, but not about anything that matters.

-And you tell me everything, do you?

-What do you mean?

Like how you could've got into trouble for giving me those pills.

Yeah, well, if you hadn't have said that it's just rheumatism,

or taken more tablets then I said you should...

So we're both in the wrong, are we?

And when I get out of here, I'll go back home.

You can't. Your place isn't fixed yet.

I can manage.

At least we won't have to tell each other any more lies.

Elevated eosinophil, rheumatoid screen, ANCA...

Is your husband's asthma recent?

Yes, just the last year or so.

Oh, God, it's not connected with trying for a baby, is it?

No, I don't think so. Is that how long you've been trying to conceive?

It feels like forever.

I just wanted to do it before I was 30

but we can't seem to.

Well research does show that the more pressure you put yourself under the harder it is to get pregnant.

-Feeling better?

-Yeah. Thanks. I've never had it like that before. Do you know what caused it?

Well, I've just been looking at the tests Dr Keogh ordered.

And the asthma and the ANCA and eosinophilia results all indicate

-that you probably got something called Churg-Strauss Syndrome.

-What?

-What does that mean?

-It's a form of vasculitis - inflammation of blood vessels.

It's very rare but it can cause problems if it's not treated.

-So, is it serious?

-In extreme forms, yes, it can affect the heart,

-the lungs, kidneys and yes, it can be fatal.

-Oh God, Mick!

But I don't think you got anything to worry about here because Dr Keogh

spotted it early on enough so we can put you on a course of treatment.

-In fact, if you've got time I could make an appointment with a clinic now.

-Yes, please.

You still feeling OK?

Is Robert here?

Try and keep still. I think he's getting a coffee.

I can fetch him for you, if you like.

No. No, it's OK.

You won't get him into trouble over those tablets, will you?

-It wasn't his fault.

-No. From what I've seen Robert is a good doctor.

You should have let him look after you properly.

Listen, this operation. Could I die?

With every operation there is always a risk,

but I think it's a small one in this case.

-Is that's what's bothering you?

-Not that, no.

What, then?

You can tell me.

I've been having nightmares. Ever since it started hurting.

I was leading a platoon.

17-year-olds. National Service lads.

It was their first mission.

We were clearing villages.

When we cleared the last one, Burkit Chandu...

..it was stinging hot.

And all I wanted was a cold beer. I let the lads go ahead.

And then this there's shout and I see it as soon as they do.

A gold watch.

But before I could stop them, there's a blinding flash and I'm on the ground.

It was a booby-trap.

Ten...

Ten of our lads killed outright.

And I walk away with only this.

The painkillers helped.

Stopped the pain...

and the memories.

-It was a war.

-It was my fault.

I should have gone in first.

They were someone's sons.

Have you ever told anyone?

No.

Not even Robert?

How can I tell my own son...

when I robbed so many families of theirs?

I'll, um,

check on ENT.

If I see Robert I'll ask him to come in.

You should tell him.

Dr Nicholls?

How's Lucy doing?

She's going to be fine.

They want to keep her in so I'm just going to nip home

and get her some things.

But I just wanted to say thanks again, for everything you did.

Oh, no. You're welcome - it's really Robert you should be thanking.

I know. He's just been great.

Did he see Lucy at home or at the surgery?

The surgery. I brought her in.

-Why?

-Oh, he just mentioned you lived close to him, so I just wondered.

Is Robert your GP, too - I mean as well as Lucy's?

-I never have time to be ill.

-Lucky for you.

-Debbie, I'm just...

-Sam?

ENT say they'll be ready for Mr Carson in a few minutes.

OK, cool. Thanks, Lloyd.

I'd better go. I don't want to leave Lucy too long.

-But thanks again.

-Fine.

OK, George, five minutes and you're up.

-Have you seen Robert?

-Er, no.

Don't worry, I don't think he's far away. I'll get one of the nurses to look, OK?

Oh, no, don't bother.

Just, eh...

HE STRUGGLES FOR BREATH

-George, George? Can I get some help here, please?

-What's happened?

His airway's occluded.

He's had a piece of shrapnel imbedded in his neck for years and I think it's nicked his jugular.

The bleeding's obstructing his airway.

-I'm sorry I've been such a cow.

-You haven't, not really.

I know how bad you want it and I do too, but...

No, you were right. It was like being taken over by it.

ALARM SOUNDS

No more timers.

I want to go back to it being fun, too.

I still want a baby, you know that, don't you?

It might be ages before it happens, though.

So what? When it happens, it happens.

I don't care when.

Just as long as you're there to be its dad.

Linda - difficult airway trolley.

Sam? What happened?

His airway's occluded. OK, we need to get ready for a Cricoid.

Let's get him a tube in now.

Sats at 90%. Oxygen not improving.

You may struggle to get the tube down if he's that swollen

-so be prepared to do a tracheostomy.

-I'm going to try, OK. Lloyd 120mg of ketamine and 100 of sux.

OK, Cricoid on.

-The anatomy's so distorted, I can't...

-Just take your time, Sam.

-Sats at 65.

-OK, I can see the cords.

Got it, I'm in. OK, Bougie.

OK.

10ml.

OK, bag on.

Yeah, good breath sounds.

Great, OK. Cricoid off.

-Sats improving.

-Let's get his tube secured, transfer him upstairs. ENT's expecting him.

-Got it?

-Yes.

You should go with him.

-No, he...

-He'll want you to.

-Let's go.

-Thanks.

-Good save.

That's what we do, right?

Mr Statham.

Raised eosinophils, mild anaemia, elevated creatinine,

proteinuria and microscopic haematuria - a raised ANCA.

-Yes, I know.

-Put it all together and you've got Churg-Strauss syndrome.

-Yes, yes, I know that.

-Ha! Easy to say when I've just told you.

Er, no. Look.

"Change socks"? In fact, it could say anything.

Your handwriting's appalling.

It clearly says Churg-Strauss.

It's OK, can tell him all about the course of treatment. I've set it all up.

Right, Mr Statham -

-And Mrs Statham, um... Right. Er...

-CREAKING, WOMAN LAUGHS

If you'd like to pick up your appointment details from the desk.

When you're ready.

I said no.

Why? The Pennicott's bound to have better pay and better hours,

-and if it helps you get the kids, Linda...

-You know me.

What d'you think I'm going to say

-when someone complains their pillow's too hard?

-True.

To be honest I was bored there. I prefer it here.

-So you going to carry on moonlighting?

-No, I've told them that's it, so you're stuck with me.

Dammit(!)

Tell you what, how about we go to the pub after shift for one drink?

Yeah, sounds good.

You finishing, then?

Yeah.

About today - the GMC thing.

I'd rather not go into it.

I know you held off from talking to them for as long as you could and...

I just wanted to say thank you.

It helped me feel - supported.

You think I did that because...?

You have no idea, do you?

-I don't understand.

-Don't.

-Dylan?

-Just don't!

-After you.

-Thank you.

-Bye-bye again.

-So the interrogations are over, then?

-Until the final hearing.

Oh, listen, you'll get a notification in writing,

but he said that you'll be called as a witness.

Well, I'm happy to do that for Dr Nicholls,

-but I can only tell them what I told him.

-No, you'll be a witness for the GMC.

Oh. Right.

-They said he's going to be all right.

-Yeah.

The brachial plexus was OK

and they managed to repair the vascular damage.

Doesn't look like much, does it,

but I thought he might want it as a souvenir.

It's been with him long enough.

-He won't.

-What did he tell you?

Speak to him. He might be a different person now it's gone.

I, um, managed to speak to Debbie a bit earlier.

-She said you'd talked.

-Yeah.

We met in a pub - on a blind date, would you believe?

I've never actually treated her for anything. She told you that, didn't she?

Whether you have or you haven't it doesn't matter, you're having

a relationship with a patient. If someone reports that to the GMC...

Look, I wasn't trying to hide anything.

I just didn't want to make a big deal of it - to Debbie -

until I knew if it was serious or not.

And is it serious?

Yeah, I think so, yes.

Look, I'll take her off my list, tomorrow.

I should've done it before. But there is no... What I mean is...

You know what? I'm not passing judgement on anyone today.

Just sort your dad out, and sort your life out.

And tell George he's entitled to some counselling,

old soldier or not.

It's a lot better than it used to be.

And tell him that...

no-one passes judgement there either.

Is that personal experience?

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