No Other Medicine Casualty

(Nick.)

Nick? Nick?

Have you been here all night? You must be exhausted.

-I'm fine, Diane.

-How is she?

Nick, I've just been speaking to Dr Earle.

He says it's in her best interests to...

To what?

To stop the drugs today.

I don't know if she'd want to go on like this.

I just want to do what's right for her.

Nick? Are we doing the right thing?

Where is he?

-Dr Earl?

-Mr Jordan.

Yvonne's mean arterial pressure is dropping.

I think we need to increase the inotropes.

You know there's a limit to what we can achieve with them.

I think we've reached that limit.

Well, I'm sorry. I don't feel the same way.

With respect, you may not have the distance to judge.

I've already spoken to Mrs Hart.

Yes, I know you have.

And I do not appreciate you co-opting the opinions

of vulnerable relatives just to suit your own agenda.

I've been caring for Yvonne at home for six months.

You've had her in here for what, 24 hours?

So I think I'm better placed than you to judge what's best for her.

Continue with the activated protein C

and increase the inotropes to a MAP of at least 70.

I'm going to look into some additional options.

I will not give up on her, Diane. I promise you that.

I'm afraid it's not terribly good news, Lauren.

Your body's been put under a lot of stress by the illness.

We need to admit you today and look at some more treatment options.

I know it's hard going through it all over again.

I don't want you to give up hope.

We both know what my chances of recovery are.

I don't need the platitudes.

I'm going to speak to St Mary's Hospice.

When the time comes, I'll go there.

There's more we can do for you here.

No, there isn't.

Steady, steady. Let me do it, let me do it.

Take your time, take your time. That's it. You all right?

Have a sit down. I can take a look at you.

Is it coffee you're having?

Are you a doctor?

Yes, I am. Actually, today, I'm just a relative.

My...partner is...

-In ITU?

-Mmm.

-What's wrong with her?

-Quite a lot, actually.

-Is she going to make it?

-We're hopeful.

The miserable have no other medicine but only hope.

Well, it's better than nothing.

It's far worse. Thanks for the coffee.

Right, everyone, I'm afraid Tess isn't very well today.

Bunking off.

So Linda, you and Robyn in resus, and Lloyd, can I have you and Jamie on cubicles?

-Sam and Tom in cubicles as well.

-I've got a patient in resus I'd like to finish with.

The blonde? Funny that.

-Shh.

-Fine. More importantly,

the first person to find my mobile phone will get

a drink bought for them.

Sorry I'm late. I was sorting the drip for Mrs Clements.

We're going to practise suturing after this, if you want to come.

-I'm kind of busy.

-Right.

-Any word from Nick?

-No.

-Well, let me know if you hear anything.

Yeah, I will.

Right, I need a word with you folks.

Ally, I'm afraid, has decided that nursing,

and especially ED nursing, is just not for her.

So she's taking some time out to decide exactly what it is

she wants to do.

But she always wanted to be...

-Whatever that turns out to be, she won't be coming back here.

-Robyn?

Hi, I ordered a cab about 20 minutes ago.

-Get in.

-No.

-Get in.

-No.

Just do it! Get in now!

Dr Thorne called you, did she?

What did you expect?

I'm not going back into the hospital.

It's not up to you any more.

Hello? Hello? Hiya.

-We got a call to this address?

-Not me.

Right, well, is there no-one else it might have been?

Kids round here have been playing up a bit.

Sorry you've had a wasted journey.

Great, another bacon sarnie goes stone cold for nothing.

Oi! Oi, pack it in!

Hey, it's all right, stay where you are. Are you all right?

-Yeah, I'm fine.

-What was all that about?

-Nothing. They're idiots.

-Let's have a look at you - oooh.

You have had a bit of a bump there, mate.

Think we may have to take you in, get that seen to.

-You live around here?

-Yeah, but no-one's in.

Fancy a ride in that big yellow taxi, then? Yeah? Good lad.

Looks like I didn't waste my bacon sarnie after all.

Thought you were seeing that woman up there?

Nah. It was a hoax call.

Some people have got a really rubbish sense of humour.

What's your name, son?

-Wayne.

-Rooney?

Well, what are our options?

I don't care what it costs.

Yes, I have got the money.

So it's obvious he forced her out.

Does seem a bit harsh.

She just needed a bit of encouragement.

He's just a cynical old bully.

Robyn, I need you with me.

Just be a sec.

"Hashtag hope I never get old"?

I need to vent. Excuse me.

-We're here to learn, not slag our bosses off.

-Can I have that back?

You can have it back later.

I'm sure you've got work to be getting on with.

Ally's our friend and she's been the victim of bullying.

If she couldn't cut it, sorry, but it's better she realised sooner rather than later.

-Look, I know you're upset about the Craig stuff.

-I'm sorry?

It was harsh the way you had to find out.

This has got nothing to do with that.

Sorry, Fletch.

-That's all right.

-This is Wayne Gwyn, 11 years old.

We found him scrapping with other kids on our way back from a hoax call.

He's got a bit of a laceration and a bump to his forehead.

But apart from that, he is fine.

Wasn't KO'd, GCS has been 15. He put up a good fight.

Not the first time I've had to punch someone.

-Right, OK. No mum or dad with him?

-No, can't get hold of them.

All right, can you whack him in cubicles? I'll be there in a minute.

-Yeah. Come on, Wayne, this way, son.

-Cheers.

-Cheers, Fletch.

All right, Aoife, we're up.

Listen, if you need to go and have lunch early or something?

Why on earth would I want to do that?

I heard about...your fella.

We're nurses. We're here to help people with real problems.

And I intend to be one of the best.

That's really the only thing I am thinking about.

Now, maybe we could crack on.

Higher. Higher. That's it. Quickly...

back into bed before she sees you. Good lad.

OK, I've spoken to your mum. She says we can check you over here

but she wants you straight home afterwards.

-Here's the doctor now.

-OK, what have we got?

Took a bit of a smack to the head, but his obs are fine.

I'm thinking Steri-Strips.

-Any previous history, Fletch?

-No.

Look straight ahead for me.

I heard there was a paeds case.

I should probably take a look.

I thought you were busy in resus.

OK. Well, I'll leave you to it.

Is he your ex or something?

No.

OK, well, let's clean up his head, Steri-Strip the wound

-and keep an eye on him.

-Are you OK?

Now, please.

Sam. Just the person.

Listen, when you were in the military,

what was your experience of using low tidal volume ventilation?

-Um, not a lot, I'm afraid.

-No, OK.

How is she?

-She's fighting, Sam.

-We've missed you, you know.

This is Lauren Hargreaves. She's 29, collapsed in the street.

-A passer-by found her.

-Hi, Lauren, I'm Dr Hanna.

Has anything like this ever happened to you before?

No, I just missed breakfast. Stupid, really.

I feel fine now.

Hello again, young lady.

-Coffee man.

-I knew I should have checked you over.

Honestly. I'm all right.

Are you going to tell her or shall I?

What are you doing out of bed?

Just looking round.

Well, I need to check your obs.

Are you feeling sick or dizzy at all?

Any blurriness in your vision?

Why?

It might mean you'd injured yourself more seriously.

Actually, I do feel a bit sick.

I think you're fine. I think it's high time you went back to school.

It's an inset day.

Is it indeed?

It looks quite nice, really.

I mean, it's not Claridge's,

but it's on the less grim end of the hospice scale.

It's got a duck pond.

What's your consultant said?

We haven't exactly seen eye to eye.

-What treatment have you had?

-The lot.

Spent the last decade in places like this, with people like you.

No offence.

But I should have just spent it on a beach somewhere.

I know that chemo can be very gruelling, Lauren,

but even if there's a small chance, it is worth taking.

I'd like to speak to your consultant.

I know you're trying to help.

But I'm not going through it again.

I'm not going to be readmitted.

Zoe.

Your heart rate is very slow.

Are you on any other medication, beta blockers?

Right, let's get her bloods sent off straight away, please,

and pull up her records off Noel.

Linda, we need to get her into resus now.

What do you think you're doing?

-He's obviously a chancer.

-Who?

Wayne. I caught him by a dressing trolley, trying to see what he could loot.

-What does a kid want from a dressings trolley?

-I don't know,

-whatever he could get.

-He's an ill child, Aoife.

He's skiving off. There's nothing wrong with him.

He's just vomited and he's complaining of blurred vision.

We're sending him for a CT.

Look, I know you're trying to make your mark.

But as a student nurse, you should learn to watch

and listen before you try and diagnose.

Maybe Fletch could show you how to take bloods or something.

Louise. You used to work in Ambulance Control, didn't you?

-Yeah.

-Someone like you,

I expect you've still got a lot of clout there.

What are you after?

Lauren, this is the executive suite,

you'll find everything you need in here.

Could be a reaction to chemo.

We won't know until we've got her old notes.

Start her on a cardiac monitor for now.

-OK.

-Diana.

Dr Hanna.

How is she?

-Nick is looking into all sorts of new treatments.

-Is he?

He's found a drug that he thinks will help.

Something to do with kick-starting her nervous system.

And does her consultant agree with this?

He doesn't know the situation as well as Nick does.

Nick's a brilliant doctor.

But you need to listen to her consultant as well.

Make sure you have all the information you need.

It's very different for you.

You understand everything that's going on,

the drugs, the treatments and everything else.

I have to trust Nick.

I brought him a sandwich.

I don't want him to get low blood sugar.

I'll take it to him. Take a seat.

Thank you.

So what are these new treatments you're looking into?

Diana brought you this.

Nick, we all know how hard you've tried.

I know how tired you must be.

But I think you should just go and be with Yvonne now...

Don't patronise me, Zoe, please.

I appreciate your support and I appreciate the way

you've stepped in to look after the department in my absence.

But I'm still your senior clinician.

Please don't forget that.

How are we doing?

Blood results have just come through.

Right. Hi, Lauren. Potassium level's very low, it's 1.8.

Better get a blood gas.

Get back to the lab and check her calcium and magnesium.

-Can you do that?

-Yeah.

Lauren, is there a GP that we can contact for you?

I don't want my doctors involved.

OK, let's replace her potassium with a normal saline drip

of 40 millimoles of KCl over four to six hours.

-What's that for?

-Well, for some reason, your potassium level's low.

That's probably causing your symptoms, so we're going to put you on a drip.

What does that mean exactly?

When your potassium drops too low, you'll become weaker.

And?

You could end up with major breathing problems.

Your heart rhythm could be affected.

And if it's left untreated,

it becomes so erratic that you can have a cardiac arrest.

Then don't treat me.

-What?

-I've had enough of fighting. Look at me.

I'm done.

She's here. Lauren's mother has arrived.

-Hello.

-Is she all right?

-Yes.

She has low blood pressure, but we should be able to stabilise it.

Thank God. Her father's on his way in.

Well, I'm sorry, but Lauren has asked for some time on her own.

I'm sure she only needs a few minutes. Nick, would you mind?

Yes, let me take you through to the relatives' room.

I'll get someone to make you a cup of tea.

SHE MOUTHS

-Here you go.

-Thanks. That's very kind.

-Thanks.

They say hot sweet tea for shock, don't they?

Please try not to worry yourself, She's in very good hands.

I just wish she wouldn't shut me out like this.

Well, just give her a bit of time.

People with terminal diagnosis often deal with it in ways

that don't always make sense to us.

Lauren doesn't have a terminal illness.

How's she doing?

She's hypokalemic and refusing potassium.

OK, Lauren. Enough messing about.

The team need to restore your potassium levels to prevent

an abnormal cardiac rhythm.

No.

You do realise there isn't a hospice in the country

that would admit you as an in-patient, don't you?

Why not?

There are people who are really dying in this hospital.

It's an affront to them.

Not to mention the dozens of professionals who have

already had to save your life.

Nick, what's going on?

I'm giving Lauren a medical reality check.

I've fought this illness for the majority of my life.

My body's giving up. I can't fight it any more.

Well?

She doesn't have cancer, Zoe. She's anorexic.

She's only 29, and she's had 16 acute admissions,

four prolonged stays in eating disorder units, and stints on ITU.

She's spent longer in here than out.

Including one stint of six months under a section three.

And taking into account her anorexia, there is a risk

she'll develop ventricular tachyarrhythmia.

Plus the calcium and magnesium deficiency. We've got to be careful with the IV fluids.

Too much, and we'll put her at risk of heart failure.

OK. I'm going to contact psych for when she really digs her heels in.

-Sectioning?

-I hope it won't come to that.

Who's the best person to speak to up there?

Nick, she's an adult with capacity and you know it.

As long as we're satisfied that she understands and retains

the information that we are giving her, we can't force anything on her.

You could try putting it before a judge.

Charlie, we've got hours, not days.

What will happen if she keeps refusing the drugs?

There's a chance she will die.

How big a chance?

Sorry, can I just steal you for a moment?

It would be really helpful if I could complete her history.

Thanks. Yes, you don't need to worry.

We'll sort it all out this end. Yes. It's Nurse O'Reilly.

You're an angel.

Easy. They love me there. What do you want it for, anyway?

I'm about to find out.

CT's clean as a whistle.

That shouldn't be on. Whose is it?

It's me. I asked Louise to get the number

that made the hoax call this morning.

The one that Jeff and Dixie got called to.

-Is this true?

-No.

You know, the scan we did doesn't show anything wrong.

-You really got those symptoms?

-Yeah.

I think you made yourself sick so that we'd think you were really ill.

So we'd make you stay longer. Am I right?

I've also spoken to Wayne's head teacher.

He said Wayne's got a record of truancy and disruption. He's missed 15 school days this year.

You don't know nothing about me.

Wayne, I'm going to need to check your pockets.

-Get stuffed, you nosy cow.

-Wayne, why have you got these?

Mac! Grab him, will ya?

Hey, come here.

Are you all right?

It started when she was about 13.

Was there some sort of trigger which you can remember, something that...?

I almost wish there had been.

It would have made it easier to understand.

But she was such a happy little girl.

Least, I thought she was. Ah, it's my husband.

Where is she?

She's in the resus room.

Is she all right?

-She won't let me in.

-Haven't you spoken to her?

-What have you done to yourself?

-Cracked my head on the mantelpiece.

-It's still bleeding.

-For God's sake, woman.

-I should take a look at that.

Can you tell me who's in charge, please?

I want to discuss my daughter's treatment.

I'm sorry. He's upset.

What's going on with that kid?

He's been dealt with.

Really? I just saw him leaving.

-It's under control.

-What happened?

He lied about his symptoms, stole a lot of syringes

and, well, you know, I sorted it.

Sorry, Doc, he legged it before I could stop him.

But he dropped this, though.

Out of date prescription in the name of Karen Gwyn?

Thank you.

Well, what exactly is the treatment plan?

We have to respect her patient confidentiality.

Come on. I'm her father.

-I know, and I'm sorry.

-Look, you know what she's like.

She just needs a bit of time.

I do know what she's like.

She can't be trusted on her own.

Lauren has made it very clear that she doesn't want any visitors.

If you want to wait in the relatives' area...

Why don't I take this gentleman into a cubicle and sort that out?

Could I speak to Dr Singh, please?

Yeah I'm trying to track down a patient

under the name of Karen Gwyn.

Not easy, the first time you get a mouthful like that.

It's fine. Really. All in a day's work here.

It's all right to be upset, you know.

I'm not upset. I'm just glad we got it sorted.

Make sure that's folded over.

Do you have an address for Wayne?

-Why's that?

-Need to send someone round there.

-I think there might be a problem with the mother.

-What sort of problem?

She was on peritoneal dialysis.

But she hasn't seen her GP in six weeks.

Very good.

-Mum?

-You should be in school.

Just popped home for a minute.

What have you done to your face?

I fell over.

What's all this?

-Answer me, then!

-You need clean stuff.

I know it was you that called the ambulance this morning.

You're ill, Mum. You need to go to the doctor's.

I'm a bit better today.

Listen to me, Wayne.

I know we don't always have it easy.

I wish I could do the things that other mums do.

Take you to the park and stuff.

It's fine, I like going on my own.

They might not see it like that. They might think...

I can't be your mum any more.

We've got to learn to manage on our own. Leave it.

Mum.

Show me. Multiple ectopics. OK, Lauren, you've made your point.

We are going to treat you. Start the potassium, please, Linda.

-Just a slow infusion over eight to 12 hours.

-No.

Lauren, if we don't treat you soon, two things are going to happen -

respiratory failure or cardiac arrest, which could prove fatal.

Do you understand that?

Yes. I do. I want this all recorded in my notes.

Is there something I could sign?

Yes, if you really want to, but understand that if you arrest,

-we won't be able to resuscitate you.

-I know.

Lauren, listen to me.

I've seen a lot of people die in this room,

A lot of parents having to watch their children dying.

And it's always ugly. Very ugly.

If you choose to do that -

if you actually CHOOSE to put somebody through that -

that is an act of immense selfishness.

Do you think I chose to end up like this?

Well, let's ask somebody with inoperable cancer.

I think you know what the answer would be.

Lauren, why don't we stabilise you?

And then we can discuss other treatments.

Do you know what the "other treatments" are?

I was sectioned last year.

I was sedated and fed through a tube in my nose.

I spent three months barely conscious,

staring up at a hospital ceiling.

When I woke up, I was two stone heavier

and I thought I was going to go mad.

I lost all the weight within a few months.

I cannot go through that again.

I cannot live my life like this. THIS is not life.

Lauren. Lauren, please, look at me.

Listen, please.

You must understand that the way you see your body is irrational.

I-It's just wrong and we can help you see things differently.

We all have our private delusions. You should know that.

That's not the same thing.

It's exactly the same thing.

I do realise that other people don't see themselves in this way.

If there was a pill to make me normal, I'd take two.

But there isn't. So don't tell me I have a choice.

-MONITOR BEEPS

-BP's dropping.

I don't feel much pulse.

-OK, pulse back.

-Non-sustained VT. She's back in sinus now.

Lauren, please. This will only get worse.

This is pretty deep. Must have been a nasty whack.

Will it need stitches?

It's a bit...close to the eye for comfort.

I think I need to get plastics to have a look.

How long will that take?

Well, it could be a while. We'll need to refer you.

No, I need to stay with Lauren.

I can stay with her.

You're too soft with her. Always have been.

If you'd been stronger when she was a child,

none of this would have happened.

Anorexia doesn't always have a cause as such. It's a mental illness.

Everyone keeps saying. But all she needs to do is eat.

Right, I'll put in a call to plastics.

You do understand what's happening to you, don't you, Lauren?

You may lose consciousness soon, you can still change your mind.

I won't change my mind.

-OK, let's make her comfortable, please.

-Zoe, please, wait.

We have to respect her wishes. She's made it very clear.

-What's going on?

-I'm afraid Lauren has refused any further active intervention.

-What?!

-I'm sorry, Dad.

-Surely she can't be allowed to do this?

-I'm afraid she can.

Then she should be sectioned. Treated for her own good.

I told you this morning, Dad. I can't do this any more.

I want you to leave now.

Please...she's being ridiculous.

No, no, she's an adult and capable of making her own decisions.

She's decided she doesn't want to see you and that she wants you to leave.

Please, just treat her.

Sorry, you'll have to leave.

KNOCK ON DOOR

Wayne? HE KNOCKS AGAIN

It's Jeff from the ambulance. Can you open the door?

Keep quiet. They'll get bored and go away.

You're not in any trouble.

Come on, son, I know you're in there. We just want to help.

We need to have a word with your mum.

-Get rid of them.

-She's not in! Go away!

Right the thing is, mate,

we know she's missed some of her appointments at the clinic.

If you let us in, we can help you - we can help your mum, too.

I said get rid of them. Now!

You can't come in.

Look, I know your mum's on dialysis.

Well, someone must have been helping her with it every day.

Yeah, well, I like doing it.

That must be pretty tough.

I reckon if your mum's not had her dialysis checked for a bit,

she's going to be a bit poorly by now. Am I right?

You're ill, Mum. They want to help you.

No, Wayne. Don't you dare.

Don't you dare open that door!

Good lad.

JEFF: Well done, young man.

OK, Karen. My name's Dixie, I'm a paramedic.

I'm just going to take a little look at you, darling.

I'm not going to the hospital.

I think you've got an infection, you need to get it treated.

-You told them.

-They just want to help you.

You lied!

DOOR BUZZES

How's she doing?

Not very good, I'm afraid. BP's down to 70.

Have you increased the pressors?

She's been on double-strength for the last hour.

Right, and what about the activated protein C?

We did try it. We both know it's not helping.

There's been no improvement. She's simply too ill.

I don't know how it works up here, Dr Earl,

but in the ED, we don't deny patients treatment because they're too ill.

I gave it against my clinical judgement. On your insistence.

I've been treating Yvonne since she first became injured.

We almost lost her before we even got her here.

I had to open her up in the back of an ambulance

and do an emergency thoracotomy I massaged her heart,

I got it going again, when people like you would have...given up.

Mrs Hart?

Nick knows better than any of us what's best for her.

-Increase the adrenaline.

-OK, please calm down.

-Do it now.

-Mr Jordan?

-Yes?

Dr Hanna said I'd find you here.

I understand your wife is very sick.

I wonder if we might help each other.

I saw you in there with that doctor.

We're the same, you and I.

Men like us don't let things beat us. We fix them.

I'm a wealthy man, Mr Jordan.

The NHS is no good to you now. She needs the best.

We can get her transferred -

private hospitals, clinical trials, the US, whatever it takes.

Lauren needs help. She doesn't know what she's doing.

So...

you want me to sedate your daughter and treat her against her will?

No-one need know.

I'd take care of everything.

That was your tenth birthday party.

Do you remember?

Mum...

Look at you. Such a little tomboy.

Mum...

I'm sorry.

I just can't help remembering.

You deserved a better daughter.

I just want this one back.

This is Karen Gwyn, 42.

She's got a known history of diabetes, on CAPD.

Abdomen's tender. The kit she was using was in a bit of a state.

Pulse is 120, BP's 110 over 65. She's confused and combative.

Great, OK. Let's take her through to HDC, please.

I want to go home, Wayne, take me home...

Listen, Karen, just relax, you're here now, let us help you, all right?

We may need to look into some emergency foster care.

HEART MONITOR BEEPS

Is everything OK?

Nick?

What did that man want?

He wanted me to help his daughter.

Are you going to?

No, not in the way he wanted.

He's just desperate, you know?

The kind of desperation that makes you try anything,

if it could just buy you a bit more time.

-No, Nick.

-I'm sorry, Diana.

You don't get to make this decision. I am her mother.

You don't get to make this decision on your own.

Diana. The sepsis has spread through her body.

Her systemic reaction to the infection

means her organs are not getting enough oxygen. They're just...

shutting down.

Her lungs, her-her liver, her kidneys.

Her heart. They're...

They're all gone.

You let me believe you could save her!

You just couldn't let her go.

I had to try everything I could.

When everyone else was giving up,

I thought they were just being weak, but they were being realistic.

You...promised...me!

Diffuse abdominal tenderness.

Looks like a spontaneous bacterial peritonitis,

could be caused by the infected PD catheter.

OK, let's get her some fluid in,

and I want FBC, U&E, CRP, cultures and a venous blood gas.

No...I don't want to stay here. Get off me.

I know. Try and stay calm for us, Karen.

-I'm also going to need an abdo scan.

-I want to go home.

I know. Just breathe nice and deeply for me.

KAREN BREATHES DEEPLY

KAREN WHIMPERS

HEART MONITORS BEEP

HE SIGHS

HE WHISPERS

OK, let's go get you a drink.

No, I'm staying here.

You can't stay here, Wayne.

I said I'm staying here!

Please, I just want to go home.

Karen, just try and relax, right? We're going to make you feel better.

She's going to need a gram and half of Cefuroxime

and 500 of Metronidazole.

Can we set up for an ascitic tap as well, please?

I'm really sorry, Wayne. We're just trying to help.

We're on your side, you know.

Yeah, right(!) You just like telling people what to do!

Um...what's going on?

I want to stay with my mum.

OK, why don't you give me that?

No. I'm not going into care!

Look, I know that must be really scary

and it's got to be horrible seeing your mum like this. But...

When did she stop wanting to go out?

Ages ago.

Right, I think she's got something called agoraphobia

-and that's something that means she...

-I know what it means.

Of course you do. That's because you know a lot of things, don't you?

And, basically, you've been doing our job, but all on your own.

You must be knackered.

-Is she going to die?

-No.

And that's because you've been too good a nurse.

Why don't you let me take that?

Good lad.

Why don't you go and have a break?

Right, it'll just take a minute for that...

anaesthetic to work its way through.

And then I'll need you to be very, very still, all right?

OK.

I don't know why she doesn't let us help her.

Well...

just imagine you're on a ship and it gets wrecked,

and you end up in the water.

And it's cold and it's dark and it's stormy...

and you've got one lifebelt.

Then you hear someone shouting, "Just swim towards me...

"..but you got to let go of the lifebelt."

How easy would you find it to let go?

You see...

..the anorexia is her lifebelt.

She can't let go.

She can't trust anyone who tells her to.

It really isn't your fault.

-How's Lauren?

-She's the same.

Right, young lady. This is what's going to happen.

We're going to treat you and you're going to recover.

You're young, you've got your whole life ahead of you.

I understand that you need to believe that.

But the reality is not everyone gets better.

I know.

I've just had to stop the medication of my partner.

HE SNIFFS

She died...ten minutes ago.

Hardest thing I've ever done. But it was real. It had to be faced.

And the reality for you is that you're alive.

Your body WANTS to live.

You're going to let us treat you, and you are going to live.

I don't care how hard it is.

You will not delude yourself any more.

Can you get Zoe and Charlie, please?

Have we got consent?

Yes, Zoe.

We have consent.

Charlie, you're needed in resus.

-Right.

-What's going on?

She's back in VT, and this time it's sustained.

Still in VT. Linda, stand by with atropine, please

-150, Zoe.

-On it.

Everyone clear?

-Shocking.

-DEFIBRILLATOR DISCHARGES

Mm...she's out of VT but she's still bradycardic.

OK. Try 600 micrograms, Linda.

We'll need a mobile intensifier down from the cath lab, please,

and a radiographer. She'll need a temporary pacing wire.

Got an output but it's not good, still no ABP.

She's not responding to the atropine.

No, OK. Let's use an external pacer, please.

That should stabilise her until I can get the wire in.

Linda, temporary pacing pack, 6-French femoral lead.

-Charlie, will you take over here, please?

-Yeah.

Let's get her intubated.

Are you sure this is the right environment?

No, no. No time. We do it here and now. I'll get scrubbed up.

OK, let's get the RSI sorted. I'll intubate.

Something's going on in resus. Come and watch?

I have notes that need writing up.

Come on, we might learn something.

Thanks but I'm kind of busy.

OK. Screen, Zoe.

Follow the lead up, please. Slowly. Nice and slowly.

Slowly.

Nice and steady.

OK, stop. That's it.

Right, we're in the right atrium.

Move the intensifier to the left, please.

Multiple ectopics.

And that's OK.

We're in the RV.

OK. Switch off, please.

Let's connect up, Charlie.

Now we are going to pace at 60... at four volts.

-Pacing spikes.

-PACEMAKER BEEPS

-I've got a good pulse.

-Good.

Good. Let's check the threshold. Leave it at 60.

Bring the voltage down to three volts.

Three volts.

Pacing.

-Two volts.

-Pacing.

-One volt.

-Pacing.

PACEMAKER BEEPS

Good. OK, now bring it down 0.1 volts at a time until I tell you to stop.

Point nine.

Pacing.

-Point eight.

-Pacing.

Point seven.

Pacing.

-Point six.

-No, no, we've lost it.

OK, take it back up to four.

The threshold is 0.7, Charlie.

Good. PACEMAKER BEEPS

Good.

OK. Let's pace her at VVI 70 at four volts, please.

Thank you, everyone. Can someone get onto cardiology, please?

She'll need to go through to CCU.

Linda, she'll need potassium...

and probably some magnesium as well. Thanks, everyone.

HE SNIFFS

HE SOBS

Sorry. I'm just taking a minute.

It's a long minute.

I thought you'd be in there, watching all the action.

I just don't know if I'll ever be able to do it myself.

Of course you will. I mean, you told me yourself -

-you're going to be one of the best, ain't you?

-Yeah.

I always knew I would be.

Just like I knew I'd marry Craig

and have three kids by the time I'm 30,

and live in a big house in Wicklow.

Turns out I didn't know anything.

Listen...

I'd be more worried if you thought you did.

This job's hard.

There's why they pay us so much money!

HE CHUCKLES

You're a good girl.

I'm really pleased you're on my team.

Now...

..are you going to come and talk to Karen?

Hi.

Is Wayne OK?

The social worker's coming now.

Is he going to be taken into care?

He might be. Temporarily, at least. But nobody wants that.

They want to help keep him with you.

They say that but they don't, not really.

They do, Karen.

But you have to help yourself.

We'll sort out all the referrals for you -

for mental health and for the practical stuff, too.

This isn't going to go away by itself.

And it's certainly not going to go away if you close the curtains on us.

I wanted to be a good mum.

There's still time.

But you can't do it by yourself. And...

neither can Wayne.

You need to let him be a little boy again.

WAYNE LAUGHS

What was that thing they did with the wire today?

Transvenous pacing.

I don't know how you remember it all when the pressure's on like that.

Well, I have been doing it since before you were born.

Maybe it's something we can try tomorrow?

I think you've got a few more basics to cover first.

See ya.

You coming for a drink? I owe you one.

I can't. I've got to get back for the kids.

-Maybe another time, then?

-I'm going to hold you to that.

Be careful. He's your boss.

And he's married.

It's funny. She looks so young.

Like when she was a little girl.

What was she like when she was a child?

She never cried.

Not even when she was little.

She was never scared.

Tell me something else about her.

Subtitles by Red Bee Media Ltd