Common Vector Casualty

Morning, Red.

Scarlett. Do anything good last night?

I went to a public debate about the proposals

to run a new by-pass through the green belt west of town.

Lovely(!)

I cooked a Jamie recipe, re-read the guidelines on Good Clinical Ward Practice

and watched When Harry Met Sally. Again. Alone.

And yet your life sounds sadder than mine.

You are about to debut on my blog.

Miss Scarlett out of scrubs.

No! I hate that picture. Take another one.

Er, no. The peoples needs to see the NHS like it is.

Bad hair day and all, Red.

Scarlett!

KNOCKING ON DOOR

-Mary, you seen Annie this morning?

-No.

Annie?

Annie!

Annie!

Oh, my God.

Annie?

Annie...

Annie!

-Morning, Obi-Wan. We are ready to be mentored.

-Yeah?

I've been looking at your charts to see what you haven't been assessed on.

And, er, oh, look!

It's says here Staff Nurse Asike

hasn't tried inserting a catheter.

Cubicle six. Elderly gent in retention.

Staff Nurse Conway, if you could make sure all commodes and bed pans are clean, that'd be great.

Lloyd, with me.

Oi, what you doing?

-Agh!

-Argh!

Argh...

Thanks. Yeah, she's erm... she's in 'ere,

she's just beside the door.

Is she going to be all right?

We'll find out in a minute. What's her name?

-Annie.

-Annie, can you hear me? Annie?

-Do you live here?

-No, I'm a friend. She lives alone with her baby.

-I'm taking your blood pressure, OK?

-Know what happened?

-No. We spoke last night, she were fine. We were going out with Evie.

-Is this Evie? Annie's baby?

Yeah, yeah, she usually has a sleep about now.

-She taken anything?

-No, not that I know of.

Come on, Annie. You going to wake up for me?

OK, we've got a BP 120 over 90, pulse 110, GCS 12.

Let's take her in.

Fiona?

Fi?

Fiona!

Are you awake?

Happy Birthday.

Come on. Breakfast's ready.

Come on, you.

Time to get up.

-Anything like this ever happened to her before?

-Er, not that I know of.

No obvious head injury, some facial weakness.

-Has she complained of a blow to the head recently? Or any headaches?

-No, not to me.

-Anything that you know of that could explain this?

-No.

-Does she often drink heavily?

-No, she's clean-living.

OK, I'll need routine bloods, FBC, U and E, LFT, CRG and cultures.

Er, Linda, an ECG, please,

and can you find out the waiting time on a CT scan?

Is it serious? It sounds serious.

-Could you wait outside? I'll speak to you shortly.

-Come with me.

Can we hang up a litre of saline?

Aw! Happy birthday, darling!

Here you go. Open your present.

Thanks, Mum.

Oh, it's lovely.

I kept the receipt in case it didn't fit.

-I'm sure it'll be fine.

-You lost a bit of weight recently,

so I had to get you a smaller size.

Ta-da!

There you go. Eat up.

So, here's the plan - we're going to start off by getting a proper breakfast

at that nice place on Brockwell Street.

And then, we're going to have our hair done and then hit the shops,

and I've got us booked into a spa.

And tonight, I've got us a table booked at that nice Italian restaurant that you like.

Are you OK?

-It's Chloe, isn't it?

-Yeah.

OK, we're waiting for Annie's test results.

I'm afraid she might be here for some time.

-Do you know what childcare provision she has?

-Yeah, you're looking at it.

I'm Evie's godmum. She's with Mary, the next door neighbour, at the moment.

She baby-sits regular so she's tops.

-Erm, Dr Winters? There's a slot available for that CT scan.

-OK.

Er, Mac, could you take Ms McLean in Resus through to X-ray?

Right you are.

This is Richie. Fell over at the skatepark.

He's got a fractured right wrist. BP's 120 over 80, pulse 90.

He's had five of morphine and Entonox.

He's got good feeling and circulation in his fingers, as well.

Let's get him in that cubicle there, please, Dixie.

You're looking pretty hench, mate. Is that what you'd say? Huh?

Scarlett, with me on this, please.

Oh, aye. Mentoring the pretty ones, are we?

I thought she could help translate when you try your teen speak thing.

Slide over for me, mate. Nice and easy.

-There you go, lad.

-OK, well done.

-Cheers, guys, thank you.

Right, Richie. I'm Lenny, I'll be one of the doctors.

-This is Jay, Scarlett.

-What happened to you, then?

I fell from the top of the pole.

-Oh, aye, what were you trying? 360?

-All right, check you out, Tony Hawk.

-How's your pain? Anything hurting other than your wrist?

-No.

-No?

OK.

Still feeling that OK?

Yeah.

Yeah? OK, let's take a look.

Ah, yeah, you got some clear deformity there, mate.

I think we should get that wrist X-rayed.

Let's get it wrapped up again.

Now, you boys get street names, don't you?

-What's yours?

-Hamer.

Hamer.

It's actually supposed to be Hammer,

but I'm, like, dyslexic so I spelled my tag wrong.

HE LAUGHS

-Has someone called your parents?

-Yeah.

Do you know what? I'd be Lionheart.

Len of the lions.

That's good.

Tell you something. I've not had a shot on one of them for ages!

There we go.

-Now turn round, come back quicker!

-Doing it!

Oh, smooth! Smooth!

Oi!

THEY LAUGH

Serve you right!

Don't worry, Staff Nurse Conway is well impressed!

-Jim Levy. I'm looking for my son, Richie. He's had an accident.

-Oh.

Hi there, Mr Levy.

I'm, er, Richie's doctor, Lenny.

We suspect he's broken his wrist but we're taking him up for an X-ray.

So, erm, I'll show you to his cubicle.

He's had some pain medication, so he might be a bit woozy,

but otherwise he's doing great.

Here's your dad.

-Sorry, Dad.

-Hey, it's all right, Son.

-I'll get a porter along in a second.

Ah, hello, Annie.

Right, let's see if we can find you a nice quiet corner, shall we?

Annie! Oh, love, how are you feeling?

-Where's Evie?

-Evie is with Mary, taking her next door.

The paramedics saw her when they came for you. She's fine.

What happened?

Annie McLean's records - she's been on methadone for 12 months.

-She's on a drug treatment programme?

-Cleared all tests so far.

-The last one was shortly after her baby was born.

-Did her bloods come back yet?

High white cell count and raised CRP.

Which would suggest inflammation or infection of some kind.

Dilated pupils are the exact opposite of what we'd expect

if she was using again or if she'd taken methadone.

We'll need to wait for the scan results to know more.

She's going to be all right, isn't she?

Oh, yes, course she will. You'll be out and about with your boyfriends in no time.

-Boyfriends!

-Will you call Mary and make sure Evie's OK?

Oh. So, you're not spoken for, then?

Matter of fact, we're not, mate.

So, maybe you could find us a nice couple of doctors while we're here?

I'll do my best.

Annie, hi. I'm Dr Winters - I treated you earlier.

-Can you tell me what happened?

-I don't remember.

I'd just got Evie to sleep.

OK. Annie, can you raise your arms for me?

Babe, just lift your arms up.

Oh, I feel sick.

She's dropped her pulse and pressure.

We need to get her through to Resus.

Can we get some help here, please?

17 - I feel so old.

You've got your whole life ahead of you, Fi, you know that.

-You've just got to get better first.

-I know. I will.

Have you thought any more about it?

Yeah. I just need to be a bit happier first.

So, what about a boyfriend? Are you seeing anyone?

-Mum.

-What?! You know you can talk to me about that stuff.

Can I go to the bathroom, now?

Not yet. You've got to get something to eat first.

It's a fast-progressing muscle weakness.

Cranial and peripheral nerves to limbs were fine earlier.

I need to find out more about her history of drug abuse.

You didn't tell us that Annie was in a drug treatment programme.

I didn't think it mattered. We've been clean a year.

-You're on the programme together?

-Yeah. Yeah, at the clinic here.

Annie, well, she went on methadone cos she was pregnant.

I tried it, lapsed, so they stuck me on the diamorphine.

-They went ahead with their drugs clinic?

-Charlie runs it.

-Actually, I'm due a dosage. Do you mind if I...?

-That's fine.

I need a doctor.

You've come to the right place! Uh, OK, erm...

Can I get some help here, please?

-OK, er, this way, Mr...?

-Gillings.

-Chris Gillings. I think I have food poisoning.

-Oi!

Oh, thank you. Here, cheers. Keep the change, thanks.

-Feel better now?

-Yeah.

Thanks, Mum. It was a lovely breakfast.

Right, well, we'll go and have our hair done.

Then we'll go shop!

Let's get you on the bed.

Mr Gillings, this is Dylan, one of the doctors.

HE WRETCHES

I ate some dodgy prawns last night.

That new seafood restaurant in Edwalton - J. Shaw's.

Oh, right. Any reaction to shellfish before?

-No.

-He's hypercardic.

Burning up a bit. Erm, how was Shaw's?

Apart from the whole "they might have poisoned you" thing?

All right, keep still. You have much to drink?

Just wine.

-A bottle.

-I'm not much of a playboy,

but if Sister Bateman were to take pity on me for example,

I wouldn't want to poison her on the first date.

38.1.

-That's warm-ish. Any diarrhoea, Chris?

-That, too.

OK, erm, let's get a drip up, routine bloods

and a, er, stool sample.

I'm going to keep you in for observation.

Just try to relax. Let it come out by whatever means.

I'll leave Mr Gillings with you, Sister.

Hey.

No, I can't. I'm shopping with my mum.

No, I can't tonight, I'm busy.

Yeah.

Erm, you know what, I'll give you a call later, OK?

They can't fit us in for another hour.

-So, do you fancy grabbing a coffee?

-Yeah, I could do with sitting down.

-You OK?

-Yeah.

Let's find a cafe, then.

So, er, who was that on the phone?

Just a friend. Just wishing me happy birthday.

Oh, that's nice. Which one?

Phil.

-He says he's got a birthday present for me, as well.

-Phil?

How can he afford that?

He can bring it round the house when I'm there, OK?

Yeah, I know, Mum.

Good.

That top will look gorgeous.

Then, we've just got to get you a coat and we'll be finished.

Fiona!

Oh, Fiona!

Oh, oh!

Fiona! Fiona!

Oh, my God.

Help! Somebody help me!

OK, got your X-rays back, mate.

You got a badly displaced fracture of the distal radius

and ulna with a significant dorsal angulation.

OK, in short, erm, you've buggered your wrist right up.

-We can, however, fix it...

-Mum.

I came as soon as I got Dad's message.

Sorry, Doctor. Go on.

No, it's fine. I was saying we can, however, fix it, but you'll need an operation.

-Will I have scars?

-I'm afraid so.

-Cool.

-Let's have a look.

-I've referred you to the orthopaedic surgeons.

They'll take a look at you and the anaesthetist will talk you through what he'll do.

Looks a bit sore. We'll clean it up for you.

All right.

This is Fiona Reardon, 17, took a tumble in town.

KO'd briefly for about 30 seconds, GCS was 14 when we got there,

BP's 110 over 90, pulse 80 and SATS at 97 per cent.

-She's got a nasty deep cut on the back of her head.

-OK, let's get her across.

Right, when you're ready, please.

Everybody got some? On three - one, two, three.

-This is Fiona's mum, Jane.

-Is she going to be OK?

-Can you tell me what happened?

-She just fell down the stairs.

-Fiona, can you hear me?

-It's her birthday, as well.

-She's only 17.

-Pupils are reactive - that's good.

-Mum!

-Fiona, can you hear me?

-I'm here. Let the doctors look at you.

-Heart rate 82.

-OK, let's get some fluids up and I want bloods,

FBC, U&E, glucose, group and save.

-I fell.

-I know, you gave me a right fright.

-Nice deep breaths for me, Fiona.

-You must have slipped.

Good. Can you keep an eye on oxygen SATS?

-Let's log-roll her.

-You're doing brilliantly.

Call X-ray. I want portable films of chest and pelvis, then we'll go for a CT.

Let's just get this on.

HE GASPS

Er, sudden onset respiratory problems, staccato speech.

-He's dropped his BP.

-You've never had a reaction like this?

-No!

What about family members?

Oxygen saturation 90 per cent and falling.

No freckling, no heart murmurs. This is odd.

His chest sounds clear, his lungs are normal, but his breathing's off.

Let's get him to Resus.

-So, this operation - it'll be a general anaesthetic, right?

-Yeah.

Do you do tests first to make sure there's no allergies to anaesthetic?

Well, no, no. Reactions are extremely rare,

so even if anything happened, the anaesthetist would change up the cocktail of drugs,

and perform a thing called a modified rapid-sequence induction.

No, of course. You know what you're doing.

Sorry. Thank you, Doctor.

All right.

Right, then. Scarlett will clean this up

and I get to mark her for her expertise in wound care.

-I'm just going to go for a...

-I'll join you.

-When you're ready, Staff Nurse Conway.

-Thank you.

Can you do me a favour? Can you take a pic on my mobile? I want to show my mates.

Yeah, sure.

We'll take a pic of you with the pretty nurse. They'll be well impressed.

Scarlett, if you could take it, that'd be great!

-Brilliant. My mates will love that.

-Did you do this when you fell?

I don't remember. I suppose so.

There's no dirt in it. What did you land on?

It all happened fast.

But the bloke... He kind of pushed me down the pole.

I thought you just took a spill.

-Someone pushed you?

-Junkie on the rob. We've seen him around.

It's just a scratch, isn't it?

Yeah. I need to talk to Dr Lyons, OK?

Didn't you make him take his helmet with him this morning?

Oh, God. If he'd landed on his head...

Do you have to do that?

Can we not do this today, please? We're here for Richie.

Were you thinking of Richie when you fell into bed with her?

SIREN WAILS

OK. Unknown male found collapsed in the street

displaying clear signs of habitual IV drug use.

His GCS was eight, his resps are six.

OK, let's get him over. On three - one, two, three. OK.

Pupils...

..are dilated.

Erm, OK, can we get his clothes off, please?

Let's get the monitoring on as soon as.

Mrs Reardon, we need to clear the room for X-ray.

Let me take you to the Relatives' Room.

Is she going to be OK?

Dr Winters is still assessing, but Fiona took a nasty tumble.

There's the possibility of concussion. She'll have a nasty headache.

So, it's definitely a head injury? There's nothing else wrong with her?

The X-ray and CT scan will tell us for sure, OK?

Thank you.

Could I have a quick word, please?

Right, erm, we think Richie might have got himself a needlestick injury at the skatepark.

-Oh, my God.

-It was a junkie trying to steal from the kids' bags -

that's what caused him to fall in the first place.

So, it could have given him an infection?

Well, it doesn't normally develop this fast.

Erm, we've cleaned out the wound and...

All right, look, the greatest risks from a needlestick injury

are HIV, Hepatitis B and Hepatitis C.

But the odds are well in Richie's favour. We've taken baseline bloods,

we'll make sure that Richie's GP follows up in three months' time.

-We have to wait for three months?

-I'm sorry.

If it's any consolation, the junkie would have to be in a right state

for Richie to actually catch anything.

All right, mate. There you go.

OK, he's gone into cardiac arrest. PEA. Can we start CPR?

One milligram of adrenalin, IV and another litre of saline, please.

You all right?

I see you got your fix, then.

I'm sensing your disapproval of my best efforts to turn my life around.

Just because it's free, doesn't make you not a junkie.

We do all the counselling, but we had it bad.

Working on the streets, you know what I'm saying?

Working girls.

I'll just erm, put, er...

You're still a little feverish. As you're still nil by mouth,

I need you to roll over onto your side, please.

-Bad luck, mate.

-I'm fine.

I advise you to take your medicine

until we find out what's wrong with you.

Just relax.

It's only uncomfortable for a little while.

-What have you done here?

-Nothing. It's just a scratch.

Given the amount of drugs Richie's on,

isn't it dangerous to operate?

It's still critical that we reduce the fracture at the earliest opportunity.

If you have specific concerns, I can have the anaesthetist talk you through it.

Yeah, maybe I should. I just, erm...

He's my only child, you know?

And with this scratch, it all seems to be...

..complicated.

If you have information that's germane to Richie's treatment,

you need to tell me.

Richie's father suffers from malignant hyperpyrexia.

I understand it's hereditary.

Yeah, 50 per cent of the time, yeah.

But that's not a problem. If he does have it, theatre can cope.

Why didn't you tell me about this before?

-Because Jim's not Richie's father.

-OK.

And he doesn't know.

Ah.

OK. Thank you.

He's got an output - that's as healthy as this gentleman's ever likely to be.

-Well done, everyone. Did we get an ID or next of kin?

-They just said no.

-Right, unknown male it is.

-So, Ambulance Control have called.

We've got three similar collapses en route. People seem to be dropping in the streets.

-This is Larry Foster, 62, works in the bookies, became disorientated.

-I've got this.

-Slurred speech and breathing difficulties.

-Did he go out for dinner?

-He lives alone, apparently.

-We might be looking at an outbreak.

Dr Winters, I need to show you something.

-It's about Annie McLean.

-In a moment.

-Check him for muscle weakness.

Yes, thank you, Dr Keogh.

Hello, it's Dr Keogh here,

from the Emergency Department at Holby City Hospital.

Hello. Erm, I want an honest answer to this question -

have you had any complaints of food poisoning

since last night's service?

No, I'm not accusing, I'm asking.

No, you sure? No-one? No?

OK, thank you. Oh, erm, yes, in that case,

can I make a reservation, please, for this evening?

Eight o'clock.

Yeah, Keogh.

No, Key-oh.

No, just for one. Unless you accept dogs? No?

No, no. OK. All right. Thank you.

Erm, the patient that you wanted to talk to Ruth about -

is she one of them?

One of who?

One of our peculiar neurological cases?

Yeah. I found a wound that we didn't know about.

Hello. I'm Dr Keogh. I'm very good at fixing people. Roll over, love.

The other doctor was a lot nicer.

Come on, Annie. We're not going to hurt you.

Right.

Nurse Thingy, with me, please.

He's not big on bedside manner, is he?

We're missing something.

A lot of today's intake share a common vector.

We are dealing with different symptoms across a range of patients

and no-one has any idea what's wrong.

We need to figure out what we're dealing with.

Spread the word.

The chances of you having anything more than just a bit of a bug

are so slim they're practically anorexic.

So, I can go home tonight?

-What?

-Erm, you'll have to stay in tonight, darling.

Don't worry, you'll hardly notice. You'll be asleep.

But it's only lunchtime.

Mightn't he recover by this evening? Don't want to clog your beds up.

That's very kind of you. No, er, different people react in different ways to anaesthetic.

-Sometimes it takes longer to recover.

-There's not something in his test results

-that makes you think the operation's going to be complicated, is there?

-No.

-It's all perfectly standard.

-What is?

-Uh, erm...

Right, OK, erm...

I have reason to believe that you may have a condition

called hyperpyrexia.

It's nothing to worry about, it's nothing dangerous,

but you might take a bit longer to recover after an operation,

and it means that we need to keep an eye on you in case of any potential fevers.

"Reason to believe"?

It... It came up in an observation.

There is one thing you guys need to know.

In 50 per cent of cases,

this can be handed on to the offspring.

Which means when little Richie-boy here

hands you two a pair of grandchildren,

it's going to be your job to let the paediatricians know

-about this condition.

-It's hereditary?

Yeah, I mean, like I say, half the time.

I mean, it only takes one parent to... For it to pass on.

But Carol and I don't... Are you sure?

Excuse me, Dr Lyons. Emergency staff meeting.

Right.

I'm really sorry, erm...

I'm going to have to speak to my colleagues. I'll be right back.

Right.

We're in trouble, here.

OK, erm, we have a problem.

This department sees what, erm, 200 patients a day?

Broken limbs, heart attacks, things stuck up strange orifices.

And yet, today, we have four patients admitted

and three more on the way, displaying hugely different yet entirely similar symptoms.

My food poisoning comes in with the, erm, usual problems

and within an hour,

he's experiencing respiratory difficulties and limb weakness.

-Your Miss Maclane...?

-McLean.

..comes in, looks like a stroke, rallies under treatment,

and then she develops another case of muscle weakness.

Your run-of-the-mill boy comes off his skateboard,

breaks his wrist - he's developed an infection.

-I know why.

-What about your elderly patient, the one you just admitted?

Neurological irregularities - he's gone for a CT.

See, we're burning through the scans today.

What do they all have in common?

We're looking at a range of ages, socioeconomic groups.

Hold on, you say you know why?

Well, yeah.

My patient got a needlestick injury.

I mean, we've done all the baseline bloods

but, you know, the wound itself got inflamed pretty fast.

Take a look at that wound.

It's badly infected. It'll need incision and drainage.

-How did you get the wound, Annie?

-I don't remember.

-How's the methadone working out for you?

-Yeah, great.

-I'm proud of her.

-Can't be easy being a single mother.

I think I'm just run down, you know?

Look at me, Annie.

Annie? Look at me.

At me!

Now, I've only got a dog. I know how hard that can be.

You have to feed them, wash them, make sure that they're looked after

if you're going away for too long. Sometimes, they won't sleep,

they think they've heard a mouse scratching around.

I can only imagine, it must be twice as hard.

-Dr Keogh.

-You know what I'm getting at.

Have you told us everything we need to know

to diagnose your condition?

It doesn't mean you're a junkie again.

Just means you've had a relapse and we can help you with that.

-It's just been really difficult.

-Annie!

It's easier for you - you're on diamorphine.

I kept clean for Evie but...

..it's so hard.

-You've been injecting here, right?

-Just a couple of times. But it got sore.

I don't know, the needle, maybe.

It's hard to keep the house clean these days.

-What are you doing?

-Having an internal monologue about little pricks.

-I think I've got to the bottom of your condition.

-You have?

Ah!

Why do you inject yourself in the foot?

It's normally only long-term junkies that do that.

I lost my business...

..and then my house and wife.

I wasn't in a good place.

It became, erm, a means of survival.

Look, I've cut right down. It's only an occasional thing.

It's never only an occasional thing.

My latest intake, elderly man, needle marks all over his arms.

My man's been injecting, as well.

Oh, that's it.

The dilated pupils, that's what threw us off.

Clostridium botulinum.

-Botulism?

-All our patients, some are hiding it better than others,

but they're intravenous drug users.

Their heroin has been infected at source, probably by bacteria in the soil.

If you do not know the appropriate treatment, look it up.

Tess, organize blood and stool samples for all suspected cases,

and put in a call for emergency supplies of botulinum toxin.

We're heading towards a public health emergency

so I'll warn management and check capacity in Intensive Care.

You'll be fine, darling.

OK, Mum.

See you in a bit, Son.

If it is botulism that Richie's picked up from the needlestick,

the anti-toxin will take care of it in no time.

Erm, he's going to be out for some hours, now,

so, why don't you two go and get a cup of tea or something?

-No, you're all right.

-We want to be here when he wakes.

-However long it takes.

-OK.

He's still my son.

It changes nothing.

All this time you knew...

..and you were so...

..unforgiving when I made the same mistake.

I can't help how I felt.

Nor could I.

So, what are we going to do?

For now, Richie needs us.

And as for the future...

I don't know, Carol. I don't know.

Whatever the living arrangements, I'll always be his dad.

Hey, we're going to be here a while.

Want to play charades?

SHE LAUGHS

He's going to be OK, isn't he?

Come here.

In every way. Yes.

Can you let the mother know?

-Linda, we need to give Annie McLean her penicillin and metronidazole.

-OK.

Mrs Reardon, Fiona's CT scans show no problems in the skull

-and there are no fractures.

-Oh, thank God.

She's taking it easy now. Rest is best.

OK. Thanks for letting me know.

Erm, is there a chapel in the hospital?

-I just, you know...

-I'll show you how to get there.

Just stop it now, come on, just stop worrying about it.

Now you've had Evie, maybe they'll put you on diamorphine.

-That stuff isn't just handed out like sweets, you know.

-Thank you.

OK, we think we've discovered what the problem is. You may be infected with botulism.

Botulism?

You're lucky you only started injecting a few days ago.

We'll need specific tests to confirm the diagnosis,

but in the meantime,

I'll put you on antibiotics to treat the infection.

You've no allergy to penicillin, right?

What's the matter, babe? What is it?

Evie. I've been breastfeeding Evie.

You breastfed your baby whilst injecting?

Well, the bacteria can't be passed on through breast milk.

But heroin can.

I don't... Yeah, just once.

Erm, last night...

This morning before... Before this happened to me.

-Can you let Dr Keogh know?

-Yeah.

Check the neighbour's.

-Control, this is 3004.

-Control receiving.

The neighbour's not in.

Annie needs to tell us where she might have taken Evie.

Local parks, playgroups, shops, cafes?

And alert the local plod. We need to find her.

-Understood. Control out.

-Let's go.

FRANTIC BEEPING

She's fitting.

Oxygen on, get her on her side.

-OK, come on, Fiona. Can you draw up four milligrams of Lorazepam?

-Lorazepam, right.

And let X-ray know that she'll need an urgent CT

as soon as we stabilise her. Tess.

Four milligrams, done.

This cannula's very positional.

OK, good.

Right, let's get some suction!

Pulse has dropped to 40, oxygen saturations 80 per cent and falling.

BP unrecordable.

Pulse now only 30.

She's very cyanosed, can you see that? And bradycardic.

I can't get an output, anything there?

She's arrested, let's start CPR.

Tess, can you put a bigger line in?

BEEPING

Ruth? She's another one.

She's got to be somewhere.

Sorry, I thought you were someone else.

Omar!

-Mary? Mary, hiya. Do you remember us from this morning?

-Yeah.

OK, Annie's fine.

-It's Evie we need to check over, OK?

-Why?

Don't worry, it's nothing you've done at all. Is she all right?

Signs of opioid intoxication.

She's got pin-prick pupils. We need to take her.

-Alert ED.

-OK, do you want to come with us?

Hold.

No, no pulse, still PEA.

Carry on. Can you get some adrenaline standing by?

Scarlett, you can take over after me.

-Where's the mother?

-She's not back from the chapel.

She's had 60 micrograms of Naloxone,

made good response, some spontaneous crying,

-maintaining respiratory rate and saturations.

-OK, on the bed there, please.

Come on, Fiona.

No, I've got nothing. Recommence.

-Evie!

-Annie!

-Let the doctors do their job.

-Do me a blood sugar, please.

Is she OK?

Is she OK?!

I should have seen this morning.

Just, she was sleeping peacefully.

-She was drugged up. There's no way you could have known.

-We'll check the pulse.

OK, erm... This child,

appears to be functioning in a normal baby way.

Thank you.

Oh, God, thank God.

Oh, hello.

Thank God.

BEEPING

Two minutes.

She's still asystolic. Ruth, I think we should stop.

OK, you're right.

Time of death, er...

14:17.

I'll go through all this with both of you. You did really well.

Lloyd, can you get some wipes and a clean gown?

Let's clean her up before Mum sees her.

Scarlett, let's clear away all the equipment.

Nurse, did you get the X-ray?

-Can I see Fiona now?

-Er, no.

I mean, erm, to both.

Well, has she woken up yet?

Mrs Reardon, I, er... I don't know how to...

Sorry.

-Fiona's no longer with us.

-What do you mean?

-Has she been transferred somewhere?

-No.

I mean, there was a problem.

What sort of problem?

-With the X-ray?

-Fiona's...

-We lost her.

-What? Has she walked out?

You have no idea. If she's on the streets on her own...

-I've been protecting her from that.

-No, I don't mean...

Fiona died.

I'm sorry.

No.

What do you mean?

What happened?

Fiona started fitting.

We tried stabilising her,

but she kept vomiting in her oxygen mask.

We ventilated her, performed CPR,

did everything we could, but she didn't make it.

It looks she may have been using heroin. I'm sorry.

OK, Staff Nurse Asike, thank you. I'll take over here.

Mrs... I'm sorry, I don't know your name.

Jane Reardon.

My daughter's just died.

OK.

I'm so sorry, Mrs Reardon.

Let me take you to see her, OK?

I'm sorry, Mrs Reardon. Is there someone we can call for you?

I never thought it would end like this.

A fall down the stairs.

I am sorry.

Did you know that Fiona was using heroin?

It's why her father left.

He couldn't cope.

I was looking after her, helping her.

It's been two years, now.

She couldn't have overdosed.

-Addicts can be very resourceful about finding the means and opportunity to inject.

-No.

She's been with me all day. I know she didn't overdose.

You've made a mistake.

You didn't diagnose her condition properly.

-I'm going to get a solicitor.

-I understand you're upset.

We believe there's a batch of heroin infected with botulism.

No. The heroin did not kill her!

She only had one small fix this morning.

Wait, you knew she injected?

And I know she didn't have any overnight

because I make sure her bedroom's secure.

-You knew and you didn't tell us?!

-Can you leave us, please?

I've been reducing her fixes.

She was getting better!

You supplied her with drugs.

Do you have children?

No. Well, my love for my daughter was unconditional.

That's how it works.

Soon after she started using, she disappeared for a month.

If I hadn't brought her back, helped her,

she'd have been on the streets and I was protecting her from all that.

That's not wrong, is it?

She fell, the heroin didn't kill her. It couldn't have.

I was so careful.

The post-mortem will tell us that for sure.

-What were you thinking, man?

-She took me by surprise.

-You don't give a relative those details.

-I didn't think.

You don't have the experience or the seniority

to be breaking news to relatives yet.

When in doubt, keep your mouth shut

and always wait for a senior nurse or a doctor.

When she's calmed down, I want you to apologise to Mrs Reardon

and hope that she doesn't sue us for emotional distress.

I'm not apologising. She killed her daughter.

We don't know that. She wasn't trying to kill her,

-she was trying to cure her.

-You can't agree with what she did.

-You're getting too emotionally involved.

-You're damn right I am!

When I told her it was a head injury, she was relieved.

She was protecting herself by not telling us about the junk.

That was manslaughter.

If you learn one thing today, learn this.

God, the universe, is determined to kill humans

by any and all means necessary.

You're going to see that every day for the rest of your career.

If you get angry about it, it'll eat you alive.

Shift's not over. Get back to work.

I, erm, I brought you some of these.

Oh, thank you.

Oh, and erm, and this.

HE LAUGHS IN A GOOFY MANNER

They've given you plenty of formula, so you won't need to, erm...

Well, you know.

So, what's your name, anyway?

Er, round here they call me Big Mac.

Big Mac, eh?

Well, Big Mac, you've been so lovely to us.

Not like that Nurse Andrews. She's been a right mardy with me.

She's not a bad girl. Maybe, you know,

she's having a bit of a bad day.

Anyway, you'll be all right. Get plenty of rest.

Oh, I'm resting.

This is the most restful few hours I've had in months.

You know, when I get out, promise me a girls' night in.

DVD and takeaway. I can't remember the last time I saw a movie.

-I've never been present at a death before.

-Me neither.

If nothing else, I'm glad we crossed that bridge together.

I don't want these. You're about Fiona's size.

Oh, no. I can't.

-I know nurses don't get paid very much.

-I just don't think it's...

Thank you. We'll donate them to the hospital charity shop.

So, this drug clinic of yours...

After today, do you still think it's a good idea

to hand out free drugs to junkies?

Yes. More than ever. And it's not drugs, it's medication.

But look what happened.

Annie McLean used us to provide her with enough methadone to see her through her pregnancy,

and then she's straight back on the hard stuff.

Look, Annie had a relapse.

It's probably due to the pressure of bringing up her baby on her own.

It happens.

Don't bother with the lecture.

It's self-inflicted sickness.

Annie's learnt her lesson. She doesn't need criticism.

She needs support, from us.

Which, by the way, is our job.

Thanks.

-Evening, ladies.

-More meds?

The best medicine of all.

Laughter! Pick one.

I couldn't get you a takeaway - that's against hospital regulations, however...

..our vending machine has an excellent choice.

Is this where the cool kids are hanging out tonight?

-Oh, yeah, definitely that one.

-No, no, no.

-Oh, come on.

No, no, no, no. What are you talking about? Have you seen that?

I just wanted to check that you and Evie were comfortable.

I can see that you are.

Would you like to hold Evie?

Yeah.

Come on.

Look, let's do it by show of hands. Who wants this one?

Budge over, budge over!

Crisps, anyone?

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