Isolated Incident Casualty


Isolated Incident

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I went for a drink with Linda, that's all.

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It wasn't a date, it wasn't even a dinner, it was just a drink.

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Just the two of you. On your own.

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You can cut out the raised eyebrows.

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Nothing happened! We had a nice time, it was all very pleasant,

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she had two drinks to my one. I paid.

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Which makes it a date.

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-I pay for yours!

-Steady.

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You don't think that she might think that we are...

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Listen, I would love to stop and chat but, you know?

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(WOMAN) That's it, no more.

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DOOR SLAMS

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Why do you think she says those things about you?

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Nothing to do with you.

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You shouldn't be drinking that. Granddad, please!

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You're a child, a stupid child!

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Every day in my house after school, which I never asked for.

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Granddad, stop!

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I've brought up my kids, I'm done with being that man,

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she looks after you, it's not my problem.

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You're not my problem!

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What?!

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DOOR SLAMS

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(DIXIE) We should go, it's Linda's leaving do.

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I don't think I can handle the hangover.

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Jeff. It's a few pints in the pub!

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You are joking, it's Linda! She's demob happy and it's Linda!!

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-Go on, it'll be a laugh.

-'Emergency call to 14 Charman Drive...'

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-I'll buy the bacon butties in the morning!

-'..female patient, collapsed,

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-'possible alcohol overdose.'

-Yeah, 3006 to Control. Received that and on our way over.

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Come on, 15 minutes is up.

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I could do with the rest of the afternoon,

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I've got to write the statement about the baby who nearly died.

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Has someone made a complaint? Surely it's just a formality?

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-You want to do it for me?

-I could but it'll cost you.

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And I'm guessing that won't come cheap!

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You know me so well!

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Um, Linda, the patient in cubicle three, what was his last BP reading?

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150 over 90.

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Well, recommend...

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Yes, a labetalol infusion. I know, you told me.

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You're one of those women, aren't you?

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Ordering your boyfriend's food while he's gone to the toilet!

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Aren't you my boyfriend?

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I know I'm leaving,

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but a long-distance relationship can work for the right person.

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Linda, we had a really nice time, but...

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Relax! I'm joking, it wasn't exactly the night of our lives

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and you talk a lot about work.

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Well, I'm sorry I don't read Heat Magazine.

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Maybe you should. Maybe it might teach you something!

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-Have you booked tomorrow off?

-Is it going to be that big a night?

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Girl's got to go out in style! It's going to be huge.

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-PHONE RINGS

-I'll see what I can do.

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The board are getting jumpy about a complaint we've had.

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They're chasing me for statements so I might be a little late.

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All right, no excuses!

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Quickly, please. She is down the end of the garden.

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OK, do you know what happened?

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My parents were supposed to be looking after her,

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I came to pick her up and found her slumped in here.

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-OK, is there any medical issue we should know about?

-No.

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-What's her name, love?

-Ria.

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Ria. Can you hear me? I'm Jeff, I'm a paramedic.

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Ria.

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Booze, mate.

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Oh, no! Dad's cider.

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Yeah, that's what I can smell, cider. Ria, come on, darling.

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Have you been drinking the cider?

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Good girl, we'll get this over your arm.

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We'll take her in and get her looked at, all right.

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I don't know if you remember but it's Mike's play later on,

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I was hoping to get away.

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OK, well help me with this one and then get off.

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What's the play?

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-I don't know but he's being a grumpy camel.

-Shakespeare, then?

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You'd think so, the amount of rehearsing.

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I wouldn't mind, but he's only got one line.

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-Which is?

-"Hello. I'm a grumpy camel."

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-Hiya, Tess.

-OK, through to HTC, please.

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This is Ria Jones, she is 12 years old.

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Found collapsed, intoxicated.

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She's been drinking her grandfather's home brew.

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GCS 13, no other symptoms or injuries. A few achy muscles though.

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Can you come with me to reception while they assess her?

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-Sick, feel sick.

-OK. It's all right.

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Give your details to Claire then you can see her very soon.

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Cheers, mate, see you later.

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Right, I'm just going to sit you up now, lovely, all right?

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Try and relax. Here you go.

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So what do you reckon?

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Strong reaction to alcohol!

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You the expert on that, are you?

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I've had my moments!

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SHE VOMITS

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All right.

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What's that?

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Are you all right?

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Can you smell that? That's chemical.

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Avoid contact with your skin as a precaution,

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and double bag your scrubs.

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You what?

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Zoe, I think we need to isolate a patient,

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possible toxic chemical ingestion.

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Hang on a second.

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Charlie, we've got a 12-year-old girl who's ingested

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an unknown noxious substance, she'd also drunk some alcohol

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which has masked the smell of the chemical.

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Her mum is over there.

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Can you have a word and see if she knows what it could be?

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-Sure. Mrs...?

-Jones.

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Tess, yes. There should be some glasses and face masks in there,

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put them on in case she vomits again.

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I'll send someone in to assess her as soon as I can.

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Continue with the fluids - high-concentration O2

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and we'll need bloods and a full tox screen.

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Mrs Jones, hiya, I'm Charge Nurse Fairhead.

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I don't understand what's happening. Why can't I see her?

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Well, hopefully you'll be able to soon. From her symptoms,

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it seems your daughter has ingested something toxic.

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I wondered whether you might be able to help us

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find out what that is.

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Toxic, what are you talking about?

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Nicola, how is she?

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Why weren't you there? How could this have happened?

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I'm so sorry, I only left her for a moment!

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You shouldn't have left her at all, not with him!

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He's given her something, I know he has.

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Sorry, could we carry on this conversation in the office?

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And I will give you an update on Ria's situation.

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And her breathing is becoming more laboured. Thanks.

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Did she say how long the fresh scrubs were going to be?

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Ria, are you OK?

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What?

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Kisses?

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They were a present, all right!

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I don't want to know.

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SHE COUGHS, VOMITS

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Here you go, sweetheart.

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I want a blood gas ASAP.

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How long ago did she ingest the substance?

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One hour, two at the most.

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And can you give these to Fletch, he got caught in the splash zone.

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He brews his own cider.

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And that's the only thing you could see she'd drunk?

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It makes David sick all the time.

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As in violently ill?

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Hangover stuff.

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You knew things were that bad and you left her in the house!

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I couldn't stay, I'm sorry. I couldn't stay.

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Kisses?

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Let's just save the jokes until later, eh! Thank you.

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She's maintaining a decent airway but she's tachycardic

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and has just had a small hematemesis.

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I'm concerned about her airway.

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There's widespread creps in both lungs.

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And she is steadily dropping her SATS.

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-Any muscle fasciculation?

-Yes.

-Dyspnoea?

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Her wheezing is getting worse.

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Constricted pupils, extreme salivation and lacrimation.

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Organophosphorus poisoning?

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Let's transfer her to Resus. There is a free bed now.

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She might vomit en-route. We're in a dependency room, we should do it here.

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Why take the risk?

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We don't know what she's taken, we'd have to decontaminate.

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-Fletch, you decent?

-Yes, as I'll ever be.

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0.02 milligram per kg body weight of atropine given as an IV bolus.

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You OK?

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Yeah.

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TEENAGERS LAUGH

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Whoa, check her out. Look at the body on that.

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So you'll give me your number, yeah? Hey, I'm talking to you.

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Don't try and walk away when I'm talking to you.

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Where you going? You going to the bus stop?

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We was going to go to the bus stop. You may as well wait with us.

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Don't you want to wait with us? With me?

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Lads, lads, come on. I think she'd prefer it if you left her alone!

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-Was I asking you?

-I'm just saying, she only wants to get home.

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-With me, if she's lucky!

-Are you all right, love?

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Just go.

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What is that? Are you blocking me?

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You want her for yourself, is that it?

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What is it? You her dad or something?

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Did I say we were done here?

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What's her BP?

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70 over 50, rapidly dropping.

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Respiratory rate?

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Also dropping.

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Why's the air-con off?

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The spread of fumes.

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Did Zoe order that?

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No, I did. A precaution, I suppose!

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It's too hot in here.

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MACHINE BEEPS

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What have we got? Tom?

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She's more tachycardic and throwing off the odd VE.

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You hiding in there? Come on.

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Get away, get away or I'll call the police!

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ENGINE STARTS

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THEY LAUGH

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Oi, no. Leave it alone.

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Get away.

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TYRES SCREECH

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CRASHING

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Stop the van! Let me out.

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Stop the van. I'm warning you!

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This ain't safe.

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Let me out, please.

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Please stop the van!

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She's fitting. She's in respiratory arrest.

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-We should have gone to Resus.

-Let's start bagging ventilation.

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Let's secure her airway and set up for a RSI.

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-I need ketamine and SUX please, Fletch.

-Yep.

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-You OK to run this?

-Yeah, I'm good.

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Zoe. She has gone into respiratory arrest.

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Put Tom on.

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-Tom. I got Zoe for you.

-Yeah.

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-Got it?

-Yeah.

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Tom. This is sounding like organophosphorus poisoning,

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Has she been given the atropine?

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Yeah. Intravenously at ten-minute intervals.

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Was there any improvement in her symptoms

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before the respiratory arrest?

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Tom, speak to me.

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-Not that I could see.

-Right, I'm coming through.

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-OK, you ready, Tom?

-Yep.

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Cricoid on. Ketamine going in.

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SUX going in.

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In.

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OK, we are ready.

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BP's 60 over 40.

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Tom. Tom, are you OK?

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Yes.

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The cyanosis is worsening.

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Tom, we've got to get on with it.

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OK, pause procedure, I'll take over bagging ventilation.

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Excuse me. Thank you.

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Let's start again. Suction please, Fletch, and a seven-tube.

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Tom.

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HE PANTS

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HE GROANS

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SIREN WAILS

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-Hello, mate.

-SCREAMING FROM TRUCK

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I'm Dixie, I'm a paramedic. Can you tell me your name?

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-There is another one in there.

-Do you want to deal with it?

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That's a pretty nasty cut you have got.

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You are going to be all right.

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Let's do something about that bleeding, eh!

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HE SCREAMS

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Help me, please. Help me!

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OK. Where does it hurt, mate?

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I can't feel my arm, I can't move it.

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I need to move some of this stuff. Bear with me.

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I need some help here.

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3006 to Holby Control, request fire service

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and second ambulance at Westbroke Avenue. Over.

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'This is Holby Control, request acknowledged.'

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Keep her oxygen levels up and maintain the atropine.

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I will get her attached to the ventilator.

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Good, the priority is to get her moved up to ITU.

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I'll chase for a bed ASAP.

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But if there is any delay, I'll try and arrange an anaesthetic

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and paeds review down here. Can we get a chest X-ray?

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OK, can the family see her?

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We still don't know what she ingested,

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so it's best to get this place decontaminated first.

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Oh right, that'd be my job, would it?

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You've been in close contact, why put the cleaners at risk?

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We're being abandoned in the danger zone?! Typical management.

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Nursing's a vocation, you do it for the love of helping, remember!

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I got covered in chemical vomit, I'm sure she's trying to figure out

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a way to invalidate my insurance claim!

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Nah, she's looking for ways to hold you responsible!

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Charming! Blame the contaminated ones!

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Sam. What happened to Tom?

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His glasses misted up. It was hot in there.

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That shouldn't happen.

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Standard issue equipment, no air-con, go figure.

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You got an explanation?

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The room was too small. We should have moved through to Resus.

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So claustrophobia now, is that it?

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Course not. I was hot, I got dizzy.

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Tom. You froze. It looked like you had a panic attack.

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Tess and Fletch might keep this to themselves.

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But I've had to just lie to Zoe.

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Some crap about your glasses misting up.

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Tom, what is it? You can tell me.

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I haven't been sleeping, that's all.

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It's just...that baby I'm writing the statement about.

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That's just a formality, you did nothing wrong.

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I came close. Normally I'm fine. I don't know why.

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I lie awake thinking about what could have happened.

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Well, if you need to speak to someone, talk it out.

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No, it's just stress. It came at the worst possible moment.

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I've got to write a statement in response to the complaint,

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I've got a meeting with the Trust, however informal they say it is...

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Tom. Just come here.

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It's OK.

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Is this the first panic attack you've had?

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Yeah. And the last.

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I've got to go.

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Won't be long now, mate.

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We have to make sure that this stuff is stable.

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So it doesn't come down on you when we get you out.

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I want my mum. I'm cold.

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It's all right. Someone will call her for you, OK?

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I never asked you your name, son.

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Scott.

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Scott. Wrap this round you. How old are you, mate?

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14.

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14. Blimey, I bet you'll have no problem

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when you want to start getting in pubs and all that.

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I was always proper young looking

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when I was a kid, you know, bit of a short arse.

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I used to get asked for my ID all the time.

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Bit embarrassing, really, especially when you were with a young lady.

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Then I went bald, get into a pub no problem.

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I just can't pull a bird for love nor money.

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Am I going to die?

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No, son, not today. Not if I can help it.

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Charlie, any word on the grandfather yet?

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No, nothing, he's not answering his phone.

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Neighbour says he hasn't been near the place.

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The police found this bottle at the scene.

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They think it most likely contained the chemical

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-she swallowed in addition to the cider.

-I see, right.

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They want to send it to the labs for analysis,

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but we know that is going to take ages.

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Can you talk to the family, see if it jogs their memory.

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OK. Yes, I will.

0:18:230:18:24

I heard the crash, But I didn't know he was in there.

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Don't worry about that now, we need to look at your head.

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Is he going to be OK? No-one's telling me anything.

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We don't know any more than you right now.

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If I'd known he was in there, I would have...

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What if he doesn't make it through? I need to know what's going on.

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Please, just try and relax.

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Right, they are going to jack up the load.

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The problem is the source of the bleed is where his arm's trapped.

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So it could be stemming a major bleed.

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Exactly. I can move his head and I've checked his neck,

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-so I don't think it's his C-spine.

-How's his BP?

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Stable but he's tachy.

0:18:540:18:55

I don't know what's going on internally, obviously.

0:18:550:18:58

OK, shall we get on with this?

0:18:580:19:00

OK, Scott. We are going to move you in a minute.

0:19:020:19:04

When we do, there will be a rush of blood to your nerve endings,

0:19:040:19:07

which means you could have a bit of pain. You understand?

0:19:070:19:10

The important thing is to stay as calm as you possibly can.

0:19:100:19:14

OK, then let's do this, yeah?

0:19:140:19:16

OK - inflate.

0:19:160:19:18

Inflate.

0:19:180:19:19

HE SCREAMS

0:19:200:19:22

Whoa, whoa, whoa. I got a bleep!

0:19:220:19:23

OK, mate, don't worry.

0:19:260:19:29

I will get you out.

0:19:290:19:31

OK, let's get this collar off.

0:19:310:19:34

OK, can you look to the left for me and to the right?

0:19:380:19:41

That's all good. OK, I am going to sit you up,

0:19:410:19:45

take a look at your wound.

0:19:450:19:47

Yep, that's still bleeding slightly.

0:19:500:19:52

We'll get you a fresh dressing, get the wound cleaned up

0:19:520:19:55

and then it needs suturing.

0:19:550:19:57

All right. Let's get this cleaned up.

0:19:570:19:59

Are you OK?

0:20:110:20:13

It was outside my father's house.

0:20:130:20:15

Those kids...they made his life hell.

0:20:170:20:21

They can't hurt you now.

0:20:210:20:23

They were just kids! Kids!

0:20:230:20:26

Doesn't matter how old they were.

0:20:270:20:30

I tried. They were hassling this young girl, I tried.

0:20:300:20:36

I could see him looking down on me.

0:20:390:20:41

Disappointed.

0:20:410:20:43

I let him down.

0:20:450:20:46

-Would you like some water?

-Yes, please.

0:20:490:20:52

Here you go.

0:20:570:20:58

Thank you.

0:20:580:21:00

You stood up to them. Not many people would have done that.

0:21:030:21:07

Thanks.

0:21:090:21:10

-Charlie.

-Yeah.

0:21:130:21:14

The paramedics have picked up a man close to where they found Ria.

0:21:140:21:17

He's also presenting with similar symptoms.

0:21:170:21:19

He's dizzy, drunk, vomiting.

0:21:190:21:21

Plus he has a persistent nose bleed. It could be our missing grandfather.

0:21:210:21:24

You are thinking chemical poisoning?

0:21:240:21:26

We'll it's hard to tell. I'm sending Tom in to assess.

0:21:260:21:29

Did the family know what was inside that bottle?

0:21:290:21:32

No, no idea.

0:21:320:21:33

-Well, maybe we should ask this guy. Maybe he knows.

-Sure.

0:21:330:21:37

The driver of the van is all patched up and ready for you to assess.

0:21:370:21:40

Is he being quite lucid? Any signs of concussion?

0:21:400:21:42

Emotionally, he's all over the place.

0:21:420:21:45

He was cleaning out his dad's house before the kids attacked him.

0:21:450:21:48

Just the facts, Linda, not his life story!

0:21:480:21:50

Heartless as well as boring. No wonder you're divorced.

0:21:500:21:54

Nice. Nice!

0:21:540:21:57

Medically, his GCS is still 14.

0:21:570:21:59

Thank you. I'll see him as soon as I can.

0:21:590:22:03

The other lad from the van accident is on his way in.

0:22:030:22:05

He's crushed his arm but we don't know the full extent of the damage.

0:22:050:22:08

But what sort of childhood did he have?

0:22:080:22:11

You know, in case it's relevant!

0:22:110:22:12

I'm clearly missing an in-joke.

0:22:140:22:15

And by the sounds of it, not a very good one!

0:22:150:22:17

He's due any minute now.

0:22:170:22:19

Do you think you're funny?

0:22:190:22:20

A little.

0:22:200:22:22

You better watch it, I might un-invite you to my leaving drinks!

0:22:220:22:26

Professional focus now, Linda! We've got a serious injury coming in.

0:22:260:22:29

You go robbing from the back of a van, you deserve all you get.

0:22:290:22:33

Straight to cubicles.

0:22:360:22:38

David, I'm sorry. I'm so sorry. I did this to you.

0:22:390:22:42

What has Ria taken, Dad? She drank something in your shed.

0:22:420:22:44

Excuse me. Give us a moment with David.

0:22:440:22:47

Ria? What's happened to Ria?

0:22:470:22:48

Nice and easy. Thank you very much.

0:22:500:22:52

We are just going to raise the bed up. Thanks, Charlie.

0:22:520:22:55

OK, lay back down gently.

0:22:550:22:57

What's happened to Ria? What's happened to her?

0:22:570:23:01

Right, David, it's really important that you listen to me.

0:23:010:23:05

We need to know what you've been drinking and what made you vomit.

0:23:050:23:09

You're granddaughter has been admitted with chemical poisoning.

0:23:110:23:14

We suspect she has been drinking what's in this bottle.

0:23:140:23:17

Do you remember what was in it?

0:23:170:23:18

BP's 120 over 80.

0:23:180:23:20

-My head's pounding.

-The ECG is normal.

0:23:200:23:22

Did you get hit in the face? Is that why your nose is bleeding?

0:23:250:23:29

And I see Elaine said sorry. Did she do this to you?

0:23:300:23:34

Did you have an argument, is that it?

0:23:360:23:38

And did little Ria see the argument?

0:23:400:23:42

Elaine left, I took it out on little Ri...Ria.

0:23:420:23:48

And she drank some cider.

0:23:480:23:50

And then she drank whatever was in this bottle.

0:23:500:23:53

Do you remember what you kept in here?

0:23:540:23:57

A spray, for the trees, pesticide.

0:23:570:24:02

I got it from a bloke down the pub, he's got his own farm.

0:24:020:24:05

Can you remember what the pesticide was called?

0:24:050:24:09

I don't know. Ma...mathoxo...

0:24:090:24:13

Malathion?

0:24:130:24:14

Yeah, I think so. Is little Ri...Ri...?

0:24:140:24:18

She's in a critical condition, I'm afraid, but she is stable.

0:24:180:24:22

David, this is really important,

0:24:220:24:24

can you tell me, did you drink any of this?

0:24:240:24:28

No. No.

0:24:280:24:31

Hi, Ash. This is Scott Lambert, 14 years old. Involved in an RTC.

0:24:340:24:37

He was caught under some heavy cabinets in the back of a van

0:24:370:24:40

for about 20 minutes.

0:24:400:24:41

Badly displaced compound fracture of the right radius and ulna

0:24:410:24:44

and exposed bone.

0:24:440:24:46

GCS 15 throughout. BP 96/60, pulse 100, SATS of 98%.

0:24:460:24:50

He's had 2.5 of morphine and 100mls of saline.

0:24:500:24:53

Thanks, Jeff.

0:24:530:24:54

I'm Linda and this is Dr Ashford,

0:24:540:24:56

we're going to get you through to Resus, OK?

0:24:560:24:59

Steady and lift. Thanks, Jeff.

0:24:590:25:02

He did this to me! He knew I was in there.

0:25:040:25:07

All right, calm down. Airway's obviously clear.

0:25:070:25:09

I want him done, I want him done for what he did.

0:25:090:25:12

Just try and keep calm.

0:25:120:25:14

Can we clear C-spine, please?

0:25:140:25:15

Get X-rays done so we can remove the collar.

0:25:150:25:18

IV lines, oxygen and IV analgesia - 2.5mg of morphine, antibiotics.

0:25:180:25:24

-And can someone do bloods, please.

-Yep.

0:25:240:25:27

I can't feel my hand, why can't I feel my hand?

0:25:270:25:30

-Is it your whole hand?

-Fingers, I can't feel my fingers at all.

0:25:300:25:33

OK, let me see.

0:25:330:25:34

The right radius has definitely gone, ulna exposed.

0:25:390:25:42

Let's get some views on that as soon as possible.

0:25:420:25:45

He's killed my arm, hasn't he? That bloke's killed my arm.

0:25:450:25:48

They rang me and told me he was here. So I want to see him.

0:25:490:25:52

You can see him.

0:25:520:25:53

I just need to speak to a nurse and find out where he is.

0:25:530:25:56

Oi, be careful.

0:25:560:25:57

Do you want to wait outside in the cold?

0:25:570:25:59

Then pack that in, you little munchkin.

0:25:590:26:01

Linda, you're dealing with Scott Lambert, right?

0:26:010:26:03

This is his mother, she wants to see him.

0:26:030:26:05

You can't stop me seeing my son!

0:26:050:26:06

No, no one's going to do that. If you'd like to take a seat,

0:26:060:26:09

I can talk you through what's happening.

0:26:090:26:11

We've identified the chemical and we know there's no further

0:26:140:26:17

risk of contamination, so you can see her in a minute.

0:26:170:26:20

She ingested Malathion pesticide, so you can take the masks off.

0:26:200:26:23

Let's start on IV Pralidoxime at 30mg per kg body weight

0:26:230:26:27

given slowly to back up the atropine.

0:26:270:26:29

The chest film shows some consolidation.

0:26:290:26:31

So we're looking at an early inhalation pneumonia.

0:26:310:26:33

She also has raised CK levels on the blood.

0:26:330:26:35

ETA on the transfer?

0:26:350:26:37

Not quick enough. I'm going to chase it up now.

0:26:370:26:39

Is she going to be all right?

0:26:410:26:42

What's happened to Ria is very serious.

0:26:420:26:45

And she is not out of the woods yet.

0:26:450:26:47

She had a respiratory arrest and she may also have damaged

0:26:470:26:49

her airway oesophagus and maybe her stomach.

0:26:490:26:52

I won't forgive him for this, he should never have left her.

0:26:520:26:54

Well, to have caused this much damage,

0:26:540:26:56

Ria will have swallowed quite a large quantity.

0:26:560:26:59

So it wasn't an accident? Did she do this on purpose?

0:26:590:27:02

I wouldn't like to speculate but in my opinion

0:27:020:27:05

she may well need psychological AND physical rehabilitation.

0:27:050:27:07

Just lots of support

0:27:070:27:09

David. Is he OK?

0:27:100:27:11

He's being treated for his minor injures now.

0:27:110:27:13

-Can I see him?

-Mum! I need you, Ria needs you.

0:27:130:27:18

You can see him. Excuse me.

0:27:190:27:22

Charlie. Have you seen Zoe?

0:27:310:27:33

You sure you don't mean Linda?

0:27:330:27:35

I want a second opinion on this X-ray.

0:27:350:27:37

It's the young lad who got trapped in the van.

0:27:370:27:39

Scott Lambert.

0:27:390:27:41

He's got compound fractures to his right radius and ulna,

0:27:410:27:44

with serious neurovascular compromise.

0:27:440:27:46

If we don't reduce the fracture here he could lose his arm.

0:27:460:27:49

I was hoping Zoe was around to help me pull it.

0:27:490:27:52

Right, well, if I see her, I'll tell her to come and find you.

0:27:520:27:55

We are talking about Zoe?

0:27:550:27:56

Unless you want us to be talking about someone else.

0:27:560:27:59

Zoe will do just fine, thank you very much.

0:27:590:28:01

Whoa! Calm down, boys! It's not a playground.

0:28:030:28:06

I'd take all the sweets out of the vending machines, if I were you.

0:28:060:28:10

Right, you lot! I have asked you enough times. Up against that wall.

0:28:100:28:14

Oldest there! Youngest one there!

0:28:140:28:15

I am not going to ask you again, come on.

0:28:150:28:18

Oi! What's happening to the other bloke, the driver?

0:28:180:28:22

-He's recovering from a nasty cut.

-Is he being arrested?

0:28:220:28:25

What for?

0:28:250:28:26

Scott's mates have been texting me, said it was dangerous driving.

0:28:260:28:30

Look! Have a look at this!

0:28:300:28:31

Did they tell you what they did to him? How scared he was?

0:28:350:28:39

I don't business, love the guys a nutter,

0:28:390:28:41

he knew my Scotty was in the back, did it on purpose.

0:28:410:28:44

Right, well, I just need to worry about getting him better.

0:28:440:28:47

We're good to go. Is that his mum?

0:28:470:28:49

Yep. She's just got three lively kids with her.

0:28:490:28:52

Right, pack it in! I am not going to ask you again!

0:28:520:28:56

This is silly, I'm all right. She whacked me and I deserved it.

0:28:580:29:02

From your loss of blood, it looks like more than a whack.

0:29:020:29:06

Well, I more than deserved it.

0:29:060:29:07

Just look this way for me, please.

0:29:070:29:09

And the other way.

0:29:120:29:13

Have you had any other symptoms recently?

0:29:170:29:19

A cold that she calls man-flu, aching muscles she calls laziness.

0:29:190:29:26

OK, I'm going to send you off for a CT to rule out any haemorrhaging

0:29:260:29:30

and take some bloods to rule out any clotting.

0:29:300:29:32

It's stopped now. I'll be all right.

0:29:320:29:35

Whoa.

0:29:350:29:37

OK, how much have you drunk today, mate?

0:29:390:29:42

Four, five pints.

0:29:420:29:44

I'm a little concerned about your alcohol intake.

0:29:440:29:47

And would you mind having a chat to Charlie, he's our senior nurse.

0:29:470:29:50

No, no, I'm fine.

0:29:500:29:52

It's just that you are obviously not happy with the way things are right now.

0:29:520:29:56

And your family are very concerned.

0:29:560:29:58

I think it would be a good idea.

0:30:000:30:02

He's your patient, but a scan just feels unnecessary.

0:30:070:30:10

-He's got a reduced GCS.

-Or he is just drunk?

0:30:100:30:12

He's had headaches recently, blurred vision.

0:30:120:30:15

It just feels over-cautious.

0:30:150:30:16

-Like I'm panicking?

-I didn't say that.

0:30:160:30:18

If you want to send him for a scan just to be on the safe side.

0:30:180:30:21

It's not a precaution.

0:30:210:30:22

It's a hunch that something else is causing the bleeding.

0:30:220:30:25

I want to rule out a haemorrhage and do further tests.

0:30:250:30:27

-I can't back you on a hunch.

-On the facts I've given you?

0:30:270:30:30

I'd release him. Tell him to be nice to his wife.

0:30:300:30:32

How's that statement? I want to read it before the meeting.

0:30:320:30:35

-I'm on it.

-Today, please. What's the latest on the grandfather?

0:30:350:30:38

I'm a little worried about his GCS,

0:30:380:30:40

so I'm sending him for a CT and doing bloods.

0:30:400:30:42

OK, keep me posted.

0:30:420:30:43

You know what you're doing, I'm sure you're right.

0:30:430:30:46

Oh wow, that sounds great.

0:30:470:30:49

(MOUTHS) Sorry.

0:30:490:30:50

(MOUTHS) It's OK.

0:30:500:30:52

I know, mate! I'm really sorry.

0:30:520:30:55

I did try to come but there was a really sick girl at work,

0:30:550:30:58

and she needed Daddy's help.

0:30:580:31:00

How did it go, mate? Did you remember your line?

0:31:000:31:04

Yep.

0:31:040:31:06

"Hello, I'm a very grumpy camel."

0:31:060:31:08

HE LAUGHS

0:31:080:31:10

Sounds great, mate.

0:31:100:31:12

Listen, is Mummy there? She's what? Too busy, is she!

0:31:120:31:17

Yeah. OK. Love you, bye! They get bored, they hang up!

0:31:170:31:23

The world might be a better place if grown ups did the same!

0:31:230:31:26

Sorry you had to miss it.

0:31:260:31:28

It's OK. I mean, he was all right about it.

0:31:280:31:31

But you never really know what's they're bottling up, do you?

0:31:310:31:35

Finally, transfer to ITU.

0:31:370:31:40

OK, Scott. We've given you some Midazolam, which is a sedative,

0:31:420:31:45

and morphine to block the pain,

0:31:450:31:47

so as we manipulate the arm, you shouldn't feel a thing.

0:31:470:31:49

It's OK, honey.

0:31:490:31:51

I'm going to pull on his arm, gentle traction to ease it round.

0:31:510:31:55

OK.

0:31:550:31:56

OK, I've got it.

0:31:560:31:58

Have you got any sensation in your fingers, Scott?

0:31:580:32:00

No.

0:32:000:32:01

Pulse?

0:32:010:32:03

No radial pulse.

0:32:030:32:04

No pulse! So what does that mean?

0:32:040:32:06

He's lost the blood supply to his wrist.

0:32:060:32:09

-You ready?

-Yeah.

0:32:090:32:11

HE MOANS LOUDLY

0:32:110:32:12

What are you doing? You're hurting him!

0:32:120:32:14

It's OK.

0:32:140:32:15

I'm lengthening out the bone in order to manipulate it round.

0:32:150:32:18

So we can slot it back.

0:32:180:32:19

BONES CRACK

0:32:190:32:21

What was that? Is that his bones?

0:32:210:32:23

Maintain traction.

0:32:230:32:24

OK, that's done it. Pulse?

0:32:260:32:29

There we go, a healthy pulse

0:32:290:32:31

Great. Let's get a saline pack and vac splint on that and then we will

0:32:310:32:35

do another X-ray to recheck, if we're happy we'll put a backslab on.

0:32:350:32:39

He will still need surgery to repair the internal breaks.

0:32:390:32:42

Good job.

0:32:420:32:44

(MOUTHS) What?

0:32:460:32:47

-Saline pack.

-Yep.

0:32:470:32:49

You silly boy. How could that man do this to you?

0:32:490:32:53

Because he was terrified.

0:32:530:32:55

And you think he wasn't?!

0:32:560:32:58

Linda!

0:32:580:32:59

Don't worry, honey, we're going to get him. We're going to get him.

0:32:590:33:04

I know it's her last day,

0:33:080:33:09

but do you think Linda is getting too involved in this one?

0:33:090:33:12

-I think she's got it under control.

-Yeah?

0:33:120:33:14

-PHONE RINGS

-Tess, I'm coming through.

0:33:140:33:16

What did the scans show?

0:33:160:33:17

Wow.

0:33:210:33:22

The radiologist is concerned that it might be a malignant growth

0:33:220:33:25

in the paranasal sinuses.

0:33:250:33:27

Causing the headaches, cold-like symptoms, the nose bleeds.

0:33:270:33:30

I'll tell him we're concerned, refer him to ENT,

0:33:300:33:32

but it's most likely the early stages of sinus cancer.

0:33:320:33:35

What do I know? Good spot.

0:33:350:33:37

Yeah, well, I could do without the next bit.

0:33:370:33:39

Delivering the bad news?

0:33:390:33:40

If I didn't have this statement to write,

0:33:400:33:43

-and the meeting to prep for...

-I'll do it, Just give me the notes.

0:33:430:33:47

Tea and sympathy. I could do with the practice!

0:33:470:33:49

Now she has been transferred, I should find David,

0:33:530:33:56

tell him where we'll be.

0:33:560:33:58

He's still your father.

0:33:580:33:59

Darling, we love Ria so much, but looking after her everyday,

0:33:590:34:03

with your dad like he is, it's too much.

0:34:030:34:05

So what am I supposed to do?

0:34:050:34:07

I don't know.

0:34:070:34:09

I don't know how you can show your face.

0:34:090:34:11

I-I wanted to see Ria.

0:34:110:34:13

She doesn't need you. We don't need you.

0:34:130:34:16

I don't want you anywhere near my daughter.

0:34:160:34:19

And if you're going to defend him, the same goes for you as well.

0:34:190:34:22

Dr Nicholls, Sam. I've been talking to my colleague, Dr Kent.

0:34:260:34:31

And we have the results of your CT scan.

0:34:310:34:33

I'd like to go through them with you.

0:34:330:34:36

If that's OK. Now a good time?

0:34:360:34:38

Follow me.

0:34:380:34:39

Are the police here for the driver of the van?

0:34:420:34:44

RTC, they're waiting for a police surgeon to do bloods.

0:34:440:34:47

Has Scott's mum made an allegation against him?

0:34:470:34:50

I didn't ask them, and they wouldn't tell me if I did.

0:34:500:34:52

Playing the victim like that.

0:34:520:34:53

It's in the hands of the police now, Linda.

0:34:530:34:55

First they hassle him on the street

0:34:550:34:57

and now they're throwing accusations at him.

0:34:570:34:59

If he's in the clear, there's nothing to worry about.

0:34:590:35:02

What is this? Team reasonable? You two a double act?

0:35:020:35:04

-Is that a problem?

-No, but it's a little dull.

0:35:040:35:06

ZOE LAUGHS

0:35:060:35:08

-Do you find that funny?

-Yeah.

0:35:080:35:11

You knew he was in the van, he was shouting and you did nothing.

0:35:110:35:14

-They were stealing stuff.

-You shouldn't be in here.

0:35:140:35:16

-Did you see him take anything?

-I need you to leave.

0:35:160:35:19

I'm not going anywhere until he admits it.

0:35:190:35:21

I need you to leave, now!

0:35:210:35:22

-He said he looked you in the eye, begged you to stop.

-Come on.

0:35:220:35:25

You're going to pay.

0:35:250:35:26

You know your son harassed a young woman on the street and

0:35:300:35:32

-that man stepped in to help her.

-He's 14.

0:35:320:35:35

Old enough to scare the hell out of someone!

0:35:350:35:37

They're all like that at his age.

0:35:370:35:38

So you've never been called to the school because of a fight?

0:35:380:35:41

Has he been driven home in a police car yet?

0:35:410:35:43

Don't act like you know the first thing about my family.

0:35:430:35:46

No, but I know about teenage boys, I see them in here all the time.

0:35:460:35:50

And if you don't get a grip of your son, he's going to get worse.

0:35:500:35:54

Nice one.

0:35:560:35:57

I don't know why I let myself get so involved.

0:35:570:36:00

That's what good nurses do.

0:36:000:36:01

You can add patronising to your list as well.

0:36:010:36:04

I would like to know what they've said to the police.

0:36:060:36:09

Well, she's not going to tell you.

0:36:090:36:11

No, but they might.

0:36:110:36:13

Can tell it's your last day.

0:36:130:36:15

And if we drive past a field of sheep,

0:36:150:36:17

I tell him they're woolly pigs!

0:36:170:36:18

That's cruel! What if he repeats it at school?!

0:36:180:36:21

Sausages are pink bananas, broccoli are shrunken trees.

0:36:210:36:25

And where does wind comes from?

0:36:250:36:26

Wind farms?

0:36:260:36:28

See, now you're getting it!

0:36:280:36:29

SHE LAUGHS

0:36:290:36:31

It means a lot to you, being a dad, doesn't it?

0:36:310:36:34

Of course it does.

0:36:340:36:35

But that is kind of all I am at home.

0:36:370:36:39

-Parenting's a full time job.

-Absolutely.

0:36:410:36:45

But when your wife has stopped using your first name

0:36:450:36:48

and only refers to you as Dad,

0:36:480:36:50

you know you've got the balance wrong.

0:36:500:36:53

It can't be that bad.

0:36:530:36:54

You want to go there?

0:36:540:36:56

Sorry to interrupt.

0:36:570:36:59

Fletch, do you put a hashtag at the start of a tweet, or the end?

0:36:590:37:02

Like I would know!

0:37:020:37:03

Please, I need some advice.

0:37:030:37:04

Go on.

0:37:060:37:07

Thank you.

0:37:080:37:10

-Go on then.

-I need advice on how to stop three little brats

0:37:140:37:17

from ripping up my reception.

0:37:170:37:18

-And you need a hashtag for that?

-I'm reaching out to my followers.

0:37:180:37:21

I didn't know you did all that!

0:37:210:37:23

How about, hashtag - someone needs to stop me whacking a kid!

0:37:230:37:27

Have you tried just being nice to them?

0:37:270:37:30

CHILDREN SHOUT, CHATTER

0:37:300:37:32

It's OK. We'll fight this.

0:37:360:37:38

It's quite often the case with men of your generation,

0:37:380:37:41

the nagging pain or persistent symptom goes on unaddressed

0:37:410:37:44

and is only discovered during an emergency admission,

0:37:440:37:47

often when it's too late, but we've caught this early.

0:37:470:37:50

I've been telling him to see a doctor.

0:37:500:37:52

I never would have gone.

0:37:520:37:54

With these early scans, and the description of your symptoms.

0:37:540:37:58

I think we've been very lucky.

0:37:580:37:59

So you can treat it?

0:37:590:38:01

I'll refer you to ENT.

0:38:010:38:03

But we've got a very good chance of beating this.

0:38:030:38:06

Thank you, Doctor.

0:38:060:38:08

I'll give you some time.

0:38:080:38:09

What is it?

0:38:170:38:18

The boys are saying he was aggressive towards them,

0:38:180:38:20

driving like a nutter and he stank of booze.

0:38:200:38:22

-A blood test will prove that.

-Did he seem drunk to you?

0:38:220:38:26

You said he was emotional, he was cleaning his dad's house.

0:38:260:38:29

Maybe he had a drink to say goodbye.

0:38:290:38:31

He's the victim in this, not that kid.

0:38:310:38:33

-So what do you want to do?

-Talk to him.

0:38:330:38:36

Is there any medical reason the driver's still taking up a bed?

0:38:360:38:39

His GCS is still 14,

0:38:390:38:40

so I thought I would keep him in for obs for a bit longer.

0:38:400:38:43

OK.

0:38:430:38:45

You've got five minutes. OK.

0:38:450:38:47

How's she doing?

0:38:520:38:54

If she was so unhappy,

0:38:590:39:01

if she knew how bad things were between my mum and dad,

0:39:010:39:07

why didn't she talk to me?

0:39:070:39:09

She's a kid. It's hard.

0:39:110:39:14

Am I that bad a mother that she can't turn to me?

0:39:160:39:20

I don't think you can't blame yourself for what happened.

0:39:220:39:26

I blame him.

0:39:260:39:28

I don't think you should do that either.

0:39:300:39:32

Was he always a drinker?

0:39:360:39:38

So when you were growing up, was he there for you?

0:39:420:39:47

His drinking has become a problem, but the way I see it,

0:39:530:39:57

he's doing exactly the same thing as Ria.

0:39:570:40:00

He's so frustrated with where he is in life at the moment that

0:40:020:40:07

rather than talking about it, or ask for help,

0:40:070:40:11

he just reaches for a bottle of cider.

0:40:110:40:13

I saw you sitting there, looking at your little girl,

0:40:170:40:21

with your heart breaking because you wanted to help her so much.

0:40:210:40:25

Do you think he feels any differently when he looks at you?

0:40:270:40:30

Sam, the grandfather, Tom's hunch, that was good.

0:40:440:40:47

-Something else was behind the nose bleed.

-Good call.

0:40:470:40:50

Any reason why you delivered the news?

0:40:500:40:52

It's just he's busy writing out the report,

0:40:520:40:54

the one you're so desperate for.

0:40:540:40:56

Ah, right. Diazepam?

0:40:560:40:58

For David. Tom's patient. He's struggling a bit.

0:40:580:41:01

I'm referring him to a GP for depression as well as ENT

0:41:010:41:04

to establish the nature of the lesion.

0:41:040:41:06

-Tough day for that family.

-Yeah.

0:41:060:41:08

I'm sorry...for letting you down.

0:41:220:41:26

I think you should be aware they've had the chance to

0:41:410:41:44

get their story straight.

0:41:440:41:46

Which is?

0:41:460:41:48

You were drunk, driving recklessly

0:41:480:41:50

and you turned the van deliberately to injure him.

0:41:500:41:54

Had you been drinking?

0:41:540:41:56

No.

0:41:560:41:57

If you'd seen the look in his eyes, the threats he was making.

0:41:590:42:04

In the van? You said you couldn't see him.

0:42:040:42:07

I was so angry with him, with myself.

0:42:070:42:11

I could see how young he was and yet I was still scared.

0:42:130:42:16

I wanted to see him suffer.

0:42:160:42:19

Do to him what he does to other people, make the little...

0:42:210:42:24

Do you know when you tell the police that,

0:42:240:42:26

they could do you for attempted murder.

0:42:260:42:28

If that's what they want to call it.

0:42:280:42:30

I can't focus.

0:42:560:42:58

I know that it's stupid, I know I did nothing wrong.

0:42:580:43:00

I know this meeting is lip service to the process.

0:43:000:43:03

It's OK, Tom.

0:43:030:43:04

If I'm not thinking about the baby,

0:43:040:43:06

I'm thinking about the poor girl in there with chemical poisoning

0:43:060:43:09

or the grandfather in there with a tumour the size of a golf ball.

0:43:090:43:12

Look, why don't you ask for some time off?

0:43:120:43:14

I don't want to do that.

0:43:140:43:15

No-one would say anything, you're a good doctor, you proved that today.

0:43:150:43:19

I just need to sleep. To unwind.

0:43:190:43:22

I think you should take these.

0:43:230:43:25

Diazepam?

0:43:260:43:27

I'm concerned about you, I think you should take one.

0:43:270:43:30

If it gets you though the meeting,

0:43:300:43:31

if it helps you write the statement,

0:43:310:43:33

if it gets you through the day - it's a short term solution.

0:43:330:43:36

What about the long term?

0:43:360:43:38

You have me.

0:43:380:43:39

OK.

0:43:410:43:43

I'm sorry if my attitude wasn't very professional.

0:43:510:43:53

I can see how scared you must have been in the back of the van.

0:43:530:43:56

Thanks for what you did, you know, my arm and that.

0:43:560:43:58

What you thanking her for? She only did her job.

0:43:580:44:01

Mum!

0:44:010:44:02

She would have blamed you for this if she could.

0:44:020:44:04

Look, I've said I'm sorry. And your son did terrify Mr Kebble.

0:44:040:44:08

What Scott did was kids' stuff, what he did was criminal.

0:44:080:44:12

I hope they lock him up.

0:44:120:44:14

All right. Take care.

0:44:140:44:16

That was brave, apologising like that.

0:44:170:44:19

I just hope it makes him think twice in the future.

0:44:190:44:22

It's nice that you care. I'm going to miss you, Linda.

0:44:220:44:24

Britney and Joe are lucky to have you.

0:44:240:44:26

At the end of the day, they're my family.

0:44:260:44:28

Linda. I'm not sure if I am going to be able to make tonight.

0:44:280:44:31

-I am a bit tired, mate.

-Fletch, don't you dare.

0:44:310:44:33

HE LAUGHS

0:44:330:44:35

-I'm not buying my own drinks though!

-All right.

0:44:350:44:37

Her passion for the job is incredible.

0:44:370:44:40

Honestly, she really took my breath away today.

0:44:400:44:43

She's quite a woman.

0:44:430:44:44

Well you need to tell her how you feel, before she leaves.

0:44:440:44:47

You're right, I will.

0:44:470:44:48

So it's 8.00 tonight, yeah?

0:44:480:44:50

Yeah. 8.00 it is.

0:44:500:44:51

Linda, you are going to have to give me a minute.

0:44:510:44:54

I've just got stuff I have to do first. OK.

0:44:540:44:58

No problem.

0:44:580:44:59

-You think she heard?

-Absolutely.

-You think she bought it?

0:45:020:45:05

Without a doubt.

0:45:050:45:06

That one's a rabbit, that's a lion.

0:45:070:45:11

And this one is a lion eating the rabbit with blood and gore

0:45:110:45:16

and everything. And they're all for me?

0:45:160:45:18

Yes!

0:45:180:45:20

-There you are, a natural mum!

-Not a chance.

0:45:200:45:22

-Drinks?

-Yes, please!

0:45:220:45:25

You stuck in here for the night?

0:45:280:45:30

This pile of paperwork has no respect for the fact that

0:45:300:45:32

we've been saving lives all afternoon.

0:45:320:45:34

So I can't tempt you to come out for a drink to

0:45:340:45:36

celebrate our decontamination and sending Linda off then?

0:45:360:45:39

I'll give her my goodbyes in a minute.

0:45:390:45:41

She's not going to let you get away with that!

0:45:410:45:43

I really need to get this done.

0:45:430:45:46

All right. Another night.

0:45:460:45:48

Is that a good idea?

0:45:490:45:51

Because of...?

0:45:540:45:56

What happened.

0:45:570:45:58

And what could happen?

0:46:010:46:02

Would that be such a bad thing?

0:46:090:46:11

No. We can't do this here.

0:46:230:46:26

We can't do it at all.

0:46:270:46:29

-Here you go.

-Cheers, Charlie.

-So is Tess not coming?

0:46:340:46:37

No, she said she had a lot on!

0:46:370:46:38

How did you let her get away with that?

0:46:380:46:40

I didn't! Can you give her a call and tell her to get here now.

0:46:400:46:43

I've just seen her, she was pretty manic.

0:46:430:46:46

All right, but I'll be having a word.

0:46:460:46:48

The statement was a fair and honest account of what happened,

0:46:480:46:51

can we discuss this tomorrow please?

0:46:510:46:53

Thank you. I promise you, that's the last work phone call tonight.

0:46:530:46:56

I heard you and Ash talking.

0:46:560:46:58

"Tell her how you feel before it's too late."

0:46:580:47:00

-What sort of advice is that?

-That was a private conversation.

0:47:000:47:03

Zoe, I can't handle it if he gets all serious of me.

0:47:030:47:06

It'll ruin my night.

0:47:060:47:07

Can't me and you just go somewhere have a girlie night.

0:47:070:47:10

Just me and you.

0:47:100:47:11

Linda!

0:47:110:47:13

Right, I am just going to be straight with him

0:47:130:47:15

and tell him that it's not going to happen.

0:47:150:47:17

I'm glad I caught you on your own. Have you got a minute?

0:47:170:47:20

Yeah, look, Ash...I think you're great and that,

0:47:200:47:23

and we have a laugh at work but I just...

0:47:230:47:25

What?

0:47:260:47:27

THEY LAUGH

0:47:270:47:28

-What?!

-I can't do this.

-Do what?

-You're useless.

0:47:280:47:31

Oh, you cow.

0:47:310:47:33

SHE LAUGHS What goes around...

0:47:330:47:34

That's it, you are totally uninvited tonight.

0:47:340:47:36

Come on! Let me buy you one drink!

0:47:360:47:38

Yeah, all right. I want a bottle of champagne!

0:47:380:47:40

-A bottle of champagne.

-Yes, go on. A bottle.

0:47:400:47:42

You heard the lady, a bottle of champagne.

0:47:420:47:44

-Sorry, couldn't resist.

-Look at you two! Quite the pair!

0:47:440:47:48

What's that supposed to mean?

0:47:490:47:50

I can see some chemistry bubbling away there!

0:47:500:47:53

As if!

0:47:530:47:55

Patronising, boring, talks about work all the time,

0:47:550:47:59

he could be your perfect bloke!

0:47:590:48:01

Right, enough of this. Cut the chat and drink your drink!

0:48:010:48:04

I'm going to miss this!

0:48:040:48:06

My little girl's not well.

0:48:120:48:15

-You can't just stand here.

-Wait!

0:48:150:48:17

Let's do a runner!

0:48:170:48:19

Oi you, wait there!

0:48:190:48:21

Can't you just pull it out? I'll do it if you like!

0:48:210:48:25

I want to see you, Tess.

0:48:250:48:26

I know you got this RCM thing tonight.

0:48:260:48:29

We would have the whole night together.

0:48:290:48:31

We have run every test and I think we need to consider

0:48:310:48:33

non-medical reasons for what is happening.

0:48:330:48:35

-What is your evidence?

-Something doesn't feel right.

0:48:350:48:38

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