Slipping Under Casualty

Is that Steph, Carmel's mum?

THEY SCREAM

Our daughter is not communicating. I have every right to be concerned.

Why don't you move in with me?

Well, I could stay a couple of nights.

I'd like to request a visiting order, please.

What do you want, Connie?

I want you to plead guilty. Spare Grace from the trial.

DOOR CLICKS

Gemma?

Gemma.

Gemma?

Gemma! Whoa, hang on! Gemma!

Whoa, whoa, whoa, whoa. Hang on a minute.

I don't get this. Where are you going?

Anywhere else.

What? And you took my stuff! Why?

What choice did I have? I can't do this.

I can't go back with Mum. I don't have any money.

I can't get a job. I've got NOTHING, Iain.

You're not even listening to me!

All right, lads? Yeah, leave it. It's mine.

It's for my Bat Bin.

See you later.

I can't believe you've still got that!

What do you look like?

I look like a bloke that's just been robbed by his own sister.

So what happens now?

Right.

We go home and try and work out what's going on with you.

Home? That isn't my home.

Yes, it is. Walk!

It was an accident.

No, it wasn't.

You might only get three years.

Oh, right.

And miss Carmel growing up.

You almost killed my daughter. Do you ever think about that?

Because you wouldn't stop.

You wouldn't be reasonable.

I will do everything I can to keep you from your daughter.

No! No!

No!

SHE SOBS

It's OK. I'm here. Thank you.

Grace, stop this! Please, Grace.

Please. Enough.

-A.

-A?

First thing on the list.

You steal from me again and I'm phoning the police.

-Tough love, is it?

-B.

We need to make you a plan for the future.

Why would I stay here?

You're not exactly overburdened with choices, are you?

So you're only doing all this because you feel sorry for me?

C?

Let's "C" if we can get you a job.

Last week it was your grandmother's funeral, again!

That's the third time the poor old dear's died.

And don't ask for a reference unless you think

"slow, late and largely useless" will look good on your CV.

She got told, mate!

-You good to take this through?

-Yeah, yeah, yeah.

-Patsy, isn't it?

-Yes.

I couldn't help overhearing...

Yes, you could, but I'll let that slip.

Right. Are you OK?

Perfectly fine, thanks.

Right. Am I right in thinking there's a vacancy?

You thinking of moonlighting?

No, actually, it's for a bright, keen, young woman.

My sister.

Central office are doing the interviews.

Central office? Come on, Patsy, we couldn't just...?

No.

OK.

As soon as you can. Great! Sorted.

Thanks! That's a real help.

Pleasure.

Sam? What are you doing down here?

We needed a couple of geriatric beds.

I know you tried yesterday, and they said...

They said yes to Sam.

Well, yes to the Medical Director.

The new Medical Director. I take it you knew?

Yes.

Connie, could I have a word?

A little incident with Grace this morning.

A protest.

-She's not hurt, is she?

-She's fine.

I got to her in time. But she's miserable here.

She needs to go home.

But we still don't know what's happened to her speech.

I know, and I'm on it. I'm making the calls.

But she needs you, her mum, to take her home today.

OK?

-Thank you.

-Yes, thank you very much.

Did you know he did a trauma fellowship in New York?

I think we may have got lucky there. Connie.

Iain! We've got to go. Got a call to the women's prison.

Finally!

Oh, don't start.

Why so late?

Had to fire her.

That's a shame.

Not really. She's a liability.

There you go, boy.

There you go.

I didn't ask you to make lunch, Nick.

But thank you.

Fair play. You're getting better.

Oh...

You OK?

Slept funny. Hardly got a wink.

Let's see what I can do, eh?

I should be getting back to work.

Aye, of course. Whatever.

Come on, Bruce! Come on.

Let's go for a walk. Some fresh air, yeah? Come on!

I'll come.

Are you sure?

Nothing more pressing?

I said I'd come. Don't start an argument.

Just let me get changed.

OK, this is Stephanie Sims, 37 years old.

She's just another patient, guys, all right?

She was found unconscious in her cell, suspected overdose.

GCS 3 on arrival.

She's had 800mg of naloxone,

GCS is now 12,

BP 90/60, pulse 70, sats 96%.

OK, opiate OD. Anything else?

Could have been anything.

It was Steph.

GCS 3 on scene. Overdose.

Looks like the real deal.

Finally she feels some remorse.

Watch your step on this sand, love, it's tricky.

You all right?

Yeah?

It's probably just the fresh air - you're not used to it.

There we go. Go on! That's it.

Look at him, eh?

You know, he's so much better on the new medication.

It's changed.

Did all this used to be here?

It's quite nice now.

You see? You should come with us more often.

I just don't want you pawing at me, OK?

I thought we agreed not to argue.

A kiss is not an argument!

Look... Patsy!

Patsy!

Patsy!

Patsy?

Patsy, hold on, love.

Just hold on.

Give me your hand.

Give me your hand!

I've got you. It's OK. I've got you. SHE SCREAMS

Just hold still, love. Just hold still, Patsy.

-Get me out! Get me out!

-I've got you, love. I've got you.

-I'm going to pull you out.

-No! No! No! My leg's stuck!

All right. Just keep calm.

SHE WHIMPERS Just stay calm, right?

Just stay calm, I'm here.

SHE SOBS

It's all right. It's all right, sweetheart.

Come on, come on, come on.

I've got you. You're safe, all right?

You're safe.

All right. Let's see what we're dealing with here.

Jacob, can I get another 400 of naloxone IV, please?

Jacob?

I'm not doing this.

Wouldn't be appropriate.

Thank you.

Need an extra pair of hands?

Oh, yes, I do now.

OK, Louise, can I get bloods, LFTs, U&Es and clotting?

Paracetamol and salicylate levels?

Yeah, that would be just dandy, thank you.

Oh, and a venous blood gas as soon as.

-Did she vomit?

-A little.

-Chest X-ray?

-Yes.

Those big, brown eyes staring up at you, Charlie? Careful.

-Pupils size three, equal and reactive now, thankfully.

-OK.

She's playing us.

Do you know what I think?

I think grief and anger have affected her judgement.

Mrs Beauchamp, I could do with your advice.

I'm concerned this is more than an opiate overdose.

Excuse me, I don't think it would be appropriate for

Mrs Beauchamp to deal with this patient. Connie?

Great. So who can work on her, then?

We need some help here! DOG BARKS

Hello!

Anybody hear me?

PATSY SOBS

Listen, I'm going to try to release your leg, all right? OK?

SHE SCREAMS

OK, OK! It's all right. Sorry.

It's all right, sweetheart.

Hello? Ambulance.

SHE WHIMPERS

It's OK, sweetheart. Come on, come on. That's it.

Hello, yes? We need some help.

It's my wife. We're on Holden Forest Walk.

Yeah, yeah, we're about... Yeah, ten... Oh.

Don't let me go.

Never.

How are you? Are you all right?

Yeah. I'm absolutely fine, Charlie.

Good man.

Bloods, clotting and LFTs normal.

Negative paracetamol and salicylate.

Hmm. Small mercies, but OK.

Is that absolutely necessary?

After last time, yes.

SHE VOMITS

Steph, do you know what you took?

If you could just describe them.

It's the only way we can help with the pain.

So it's not just an opiate overdose, then.

Yeah, OK...

No idea.

Steph, just tell us.

I'm cold.

Hello?

We're here!

Hello, mate!

My wife's trapped!

-Is she breathing?

-Yeah, but she's freezing.

Fancy a swim, Jez?

Go on, then - ladies first.

-How did you find us?

-Mobile phone masts.

My name's Jez. I'm going to drag her out now, OK?

No, no, no! No, you'll hurt her.

Her leg's trapped under there somewhere.

I don't know what it is. I couldn't reach it.

DOG BARKS

I'm going to have to go in.

Stay nice and calm.

We're going to get you out of there, OK?

OK.

Patsy?

Patsy, it's Iain. OK, love.

We're going to get you out of here.

-Stay calm, Patsy, OK?

-OK?

I'm just trying to untangle it.

I'm going to have to go under.

Don't worry, sweetheart.

We're going to get you out of here, all right?

It's OK, we'll get you out. Just relax. Stay calm.

-Nice deep breaths, darling.

-Deep breaths now.

SHE CRIES OUT

It's all right, I've got you.

Pull her out! Get her out!

I've got her. Come here.

Well done.

Her leg - she's bleeding.

Yeah, we're going to get that sorted. Saline, Jez.

There we go!

Let's get this irrigated and see what's what.

-Can I have some?

-Yeah.

Anything I can get for you?

Nothing?

My daughter.

You might ask Connie.

She's no fan of protocol.

I understand you want to see Carmel, but this could be

very upsetting for her.

You haven't asked me why I did it.

Because you wanted to die.

Charlie, Cal - I hear you need some help.

Yes.

What did she take?

OK, well, we don't know, she won't tell us,

but there is some tablet debris. Certainly an opiate.

Several other unknowns.

She's drowsy and has severe abdo pain.

Her resp rate is 23.

Oh, and some red dye staining in her vomit.

MUDPILES -

Methanol, Uraemia, Diabetic Ketoacidosis, Paraldehyde, Iron...

-Ferrous Sulphate!

-Correct!

-Wow, that is a painful death.

-Yeah.

We need to confirm with a serum iron.

OK, Charlie? Thank you, bringer of light!

Sam...

Are you aware of who she is?

Her resp rate is falling - she's getting drowsy.

OK.

Pupils are pin-point.

-Another 400 of naloxone?

-Yep.

Yeah, great. And let's prep for an infusion.

Come on. I thought you wanted to see Carmel.

OK. I'm going to make a call.

This is the ECG printout I did because of her fainting.

You see - atrial fibrillation.

Thank you.

Hi, Patsy. How are you?

This is going to need stitches, but it's nothing too serious.

Will it scar? My leg?

Probably, a little. We'll do our best.

Now, we'll get you a shower and we'll find you some clean clothes.

Oh, thank you.

Right, I'll get myself cleaned up.

Patsy, if you need anything, you're in very good hands, OK?

And can you make sure she gets the best NHS experience?

-Of course.

-I'm talking like...

-Of course.

Right, I'll be off.

(It's for Gemma, not me.)

Patsy, have you felt faint before?

Any chest pains, palpitations, breathlessness?

I had a well woman thing recently. No problems.

And you're not currently taking any medication?

No. Nothing.

OK. Duffy, can we get a 12 lead ECG,

please, when you're back from the shower?

And let's give her flucloxacillin,

metronidazole and a tetanus immunoglobulin, please.

OK.

I'll be back in a minute.

How are you doing?

It's going to scar.

I really liked my legs.

Oh, you've got great legs.

I'm so sorry, love.

Why?

You were brilliant, sweetheart.

OK, Charlie! RTC!

All right.

Hurting, hmm?

Like my daughter.

I can't work out if it's an act, or the guilt has finally kicked in.

Hey! I don't think much of your bedside manner.

I'm here as a mother, not a doctor.

Then you shouldn't be in here.

So, you take a handful of vitamins, a bit of morphine,

-and come demanding to see your daughter.

-Connie.

-Can you call her off?

-I think you should leave.

Enough, Connie.

What is it? Do you not remember what she did?

That six months ago, here, my daughter!

No-one remembers what that woman did!

-Come on.

-Do I have to make this official?

Connie, wait!

I don't care what your position is - don't talk to me like that.

And while you are employed in this department, you are a doctor,

first and foremost, Connie.

She could put in a complaint. She has a witness.

She's playing the system, Charlie. There nothing wrong with her.

She's not suicidal!

What makes you so sure about that?

-Because she was fine this morning.

-This...

This morning? How?

I saw her in prison. OK?

You did what?! That could jeopardise everything.

That's what she meant about protocol.

It went well, I see.

This is Connie, as usual, trying to control every aspect of everyone.

Yeah! For my daughter? Absolutely.

What, and even risk the trial? Steph could get off.

Do you not see that?

So she was fine.

You visited and she attempted suicide.

What did you say to her, Connie?

Well, I just...

No.

No, this has nothing to do with me.

Back off, both of you.

Mr Sims.

I am so sorry that we meet again under these circumstances.

I mean, it's an awful, awful stunt.

Stunt? I was told...

Well, we know what she's like, and I would really hate for...

I just don't want to see her manipulate you and Carmel again.

You wouldn't let her do that, would you?

I've spoken to your GP, who confirms that you're not on any medication.

-Here. You can use mine.

-Thank you.

Your heart has an arrhythmia - a slight irregular pattern.

Given your general good health,

could this be related to your menopause?

Nick. Can you give us a minute?

I want to hear this.

Please. It's a bit...

A bit what?

Private?

Right, OK.

I didn't want to discuss it in front of anyone.

Patsy, he's your husband.

Yeah, and it's become a problem with him.

Between us, I'm just not...

..keen any more.

Keen?

Yeah. You know.

You mean sex?

Excuse me.

I found, when I went through it...

For example, at work, I didn't like to talk about it.

But then when I spoke to my colleagues,

they were really supportive, including the men.

Most of them have no idea what we go through.

That's because no-one talks about it.

Oh, yeah, and with good reason.

You're a nurse.

Your colleagues are meant to be nurturing.

I'm a retail manager at the end of her career.

It's hard enough as it is without telling anyone I sweat like

I'm running uphill, my hair's falling out and,

oh, sometimes I wet myself.

Who wants that on their CV?

And why would I tell my husband?

It's hardly...feminine.

It's certainly not sexy.

Where is she? You promised!

Why would I allow you to see her?

I want to see my daughter!

It's been months.

This morning you didn't care if you ever saw her again.

Did you think about the effect on Carmel for one moment?

What happens when you go back to prison?

Are you going to pull a stunt like this again?

Why would I expose my daughter to that?

Our daughter.

I'm taking out an injunction against you.

However the trial turns out, I'm going to fight all contact.

No.

No! No!

-No, no, no! Don't do that.

-No, no!

-Stop resisting. You'll hurt yourself.

-No!

No!

Maybe the best thing would be if I tell her you got your wish -

you died in here.

No!

No, no, no!

All right, all right.

Please?

All right.

He's lashing out. He's hurt.

You're still her mum.

Phil! Stop!

What?

You OK?

She was my wife, mother of my child,

so, no, I'm not OK.

Can I ask you just to think before you make any decisions?

And telling Carmel that her mother is dead could be

enormously damaging for everyone.

Every child needs one parent they can trust.

It's confirmed. She's taken ferrous sulphate.

-Can I have a look at that chest X-ray?

-Yeah.

I mean, I didn't see anything.

What do you think? Give her charcoal?

No effect.

I had a very similar patient a few years ago.

Died of a massive gastric bleed. Really suffered.

Took a couple of hours. Nothing we could do.

Cal, sorry about earlier.

It's fine.

There. You can just see the shadow.

Ferrous sulphate shows up on an X-ray.

I missed it. I was only looking at the chest.

Anyone would. You have to know what you're looking for.

You had no idea what she swallowed.

Steph's in more pain. She's deteriorating.

So, what are we thinking? Bowel irrigation?

Too risky. It means waiting for the tablets to break down.

Can we get her up to gastroenterology?

They could do an emergency OGD.

So reach in and physically take out the pills before they dissolve?

I've never seen that done. Have you?

Once, in the States.

Keep it! I don't want your stupid job anyway!

Gemma! What's up?

If I'm honest about my past, they say no.

If I'm not, I'll get sacked anyway as soon as they find out.

All right, calm down.

That's the second time today. I told you, it's pointless.

Come here. Come on.

Let's not lose hope just yet, OK?

I'm working on something.

Come on.

Change of plan. Gastro can't take her.

We'll do it right here.

Now? Here?

-She can't wait any longer.

-And you've seen this, what, once?

Yes.

Anyone with a better idea?

I'm not doing this.

Um, we have consent, right, Charlie?

I'm never going to see Carmel again.

You don't know that.

Think, Steph.

Give yourself a chance.

I know right now carrying on seems the hardest thing in the world,

but that feeling will pass.

Steph...

Your daughter needs you.

So, is that a yes?

OK. Let's bring the scope over...

..here. Sorry, I didn't catch your name.

This isn't going to work.

We have very strict instructions.

Coffee break? OK.

I have a very sick patient, five members of staff

and a four-foot length of fibre optic probe

I'm about to push down her throat.

I don't think she's going anywhere, do you?

Thank you.

OK. Left lateral position. She needs some sedation.

Let's start with 5mg of midazolam. I'll change.

Yup. OK. Sorry.

Patsy's BP is 160/80 and she's still in atrial fibrillation.

-She's 62, yeah?

-Mm-hmm.

-So the AF could be menopausal.

Start her on bisoprolol and refer her to the medics

if the heart rate doesn't slow.

Her liver function's also off.

Given that she's not on any medication and she's had

a clean bill of health from her doctor recently, it just seems...

A bit odd, yeah.

What would cause sudden heart and liver problems? A virus?

Maybe. Do an abdominal ultrasound and a hepatitis screen.

Oh, and, Lily, ask again about the meds.

Sometimes people need a second go at remembering.

Thank you.

Patsy, these are for you.

Oh! That's really kind of you.

So, Iain, how's your sister? Currently available?

Very capable. Lovely girl.

Ah. This again!

Really? That's your subtle? I just said just mention her.

I did.

Look, you obviously care about your sister,

but I've been through an awful lot today.

Yeah. Yeah, you're right. I'm sorry.

Maybe I misjudged this.

Oh, wait.

I really do like the flowers and I'm very grateful to you.

And, as I don't seem to be going home, tell your sister...

Gemma.

Tell Gemma she can prove her commitment by coming in now.

Patsy, you are a legend.

Robyn, I need the ultrasound, please.

See? direct, honest and to the point.

-Always works in business.

-Yeah, thanks for that. You're fired.

You like these, don't you?

Why an ultrasound? I'm not pregnant.

Your blood tests indicate some issues with your liver.

First my heart, now my liver.

What's going on?

In a little bit more. Bit more.

That's that out the way.

Where are you?

Where are you...?

There's one!

Right.

OK. I'm just getting into position. You can retract it.

Extending.

I'm going to go for it.

Got it!

OK. There's no sign of any bleeding or ulcerations.

I tell you what, this needs to be the future for A&E.

You should come and talk to me, I'll introduce you to some people.

Looking good, Steph.

All right. We'll take this out and we'll go in for the others.

Well done.

Coffee?

Ah! My one-a-day. You are a life saver.

I'm not a charity, though. £2.50.

Hang on, it's £2 in the shop.

Yeah, do you normally get tray service?

I'm hoping this is my interviewee.

(Good luck.)

Takings for the day.

I knew they'd be gagging for a brew when the shop shut.

Good thinking. Shows initiative.

Gem.

Patsy.

Don't get too excited - you've not heard the bad news yet.

Good. Don't let me forget.

I won't.

I'll put you in front of the right people.

That's great, thank you, Sam.

Medical Director in scrubs. That'll impress the troops.

So, the thinking behind Grace's lack of speech is a psych issue.

You mean neuro. We know she has epilepsy.

I mean psych.

I've spoken to Jones, top people here,

colleagues in the States, top of their field.

I sent them Grace's medical notes and MRI scans.

She had a serious head injury...

There is no neurological reason why she's not talking.

I wondered if perhaps it was voluntary.

Why would she do that?

Many reasons.

Maybe PTSD, maybe she just doesn't want to talk.

Subconsciously, of course.

Well, I'm glad you told me about your past.

It's best to be open and honest about these things from the start.

That's a straight no, then.

I think everyone deserves a second chance,

especially someone as young as you.

And I was very impressed with your display of initiative earlier.

-So...

-There you go, love.

-Thanks, love.

Just a couple of forms to fill in before we go any further.

I'll take these home and I'll send them to you.

Oh, it'll only take a couple of minutes.

And it's good to see someone's handwriting, too.

Let's just call it a verbal agreement.

Don't be daft. However entrepreneurial you might be,

it's important you listen to your boss.

What do you need forms for anyway? I've told you everything.

I don't understand. What's the issue?

This is standard procedure.

The issue? You're the issue.

Hey. Watch your manners, young lady.

Don't "young lady" me just because she's an old witch.

Hey...!

What's that about?

Your second test confirms you've got some problems with your liver.

Are you taking HRT, or self-medicating HRT?

I'm not on any medication. Is that clear?

Look, she got a clean bill of health not three months ago.

Perhaps it's you that's got it wrong.

-I've repeated the test...

-Maybe you're not competent, then!

Nick! Be quiet.

Sir, you'll be respectful to our staff or you will be asked to leave.

Fine. I could do with a breather.

I'm so sorry.

He's never like this normally.

Hey, sweetheart.

SHE SIGHS

GRACE MOANS

Gracie?

Gracie, did you say something?

Gracie, talk to me.

Grace, talk to me!

Now listen, this might not be any of my business, but I couldn't

help but notice your reaction in there.

Is there something you're not telling us?

There's, um...

There's no confidentiality thing between us, is there?

Paramedic and husband of patient? No.

So...

So if I tell you something, you'll have to tell her.

I have a duty of care, yeah. What is it, Nick?

Have you done something?

She'd given up on us. On me.

And she won't talk about it. I didn't know what to do.

Since she hit the menopause, it's...

She seems to think I didn't notice.

And after the dog was sick, the vet gave him some medicine,

said it would boost his energy and that.

I took some myself to see if it would work

and see if it caused any...

..any harm.

You've given her dog pills?!

Powder. Not that that matters.

What have I done?

HE WHISTLES

They need to know, don't they?

Er, yes. They absolutely do.

Louise, go and get cleaned up.

You can't treat the patient like that.

You sure?

Yeah, it's fine. I'll watch her.

OK. I'll be two minutes.

You have no idea how much my daughter is suffering.

SHE SPLUTTERS

SHE CHOKES

CHOKING STOPS

What are you doing?

My job.

-Get out.

-Charlie.

-Charlie...

-Get out!

I thought if it was safe for dogs, then...

Veterinary medicines aren't safe for humans.

It could have been very dangerous.

And why do it in secret?

-Because...

-If this is about me, Doctor...

..shouldn't I be informed?

What is it?

Your husband's been feeding you this.

For about three months.

I, um...

..mixed it into your food.

Why?

Is this what damaged my liver?

Possibly. We'll have to check with the National Poisons Centre.

-Are you trying to get rid of me?

-Of course not, love.

Nick...

I thought you...

I'm sorry, love, I...

Keep him away from me.

I, um...

I forgot to turn the suction on, that's all.

Is that your best shot?

It's your word against mine.

No, no, no, no. Let's not pretend.

We both know what happened in there -

what would have happened, if I hadn't walked in.

You have got to get a grip, Connie.

Your emotions are all over the place.

First it was Elle and now it's Steph.

And what do you propose to do about it?

I know what I should do.

The Poisons Centre said that the powder could have caused

your arrhythmia and liver problems.

But nothing long-lasting.

I'm not convinced he was trying to harm you.

But he did.

It wasn't malicious. I've done this job a long time,

you get an instinct.

It wasn't malicious.

I don't even like these.

He's a man trying to find a fix, something practical.

Anything, but talking it through.

I haven't been in a talking mood, to be honest.

And even if I had been, would he have wanted to hear it?

He could have said nothing, you know. Just taken you home.

He chose to come clean.

How are you feeling?

I've hurt too many people.

I want to make it right, Charlie.

We need to secure the prisoner again.

How is she?

Better.

Physically, at least.

She's out of danger, we think.

I've just been driving round and round, thinking about what you said.

I'm holding off any decisions. Would you tell her, please?

It may be better if you do it.

Better not.

You sure?

Yeah.

OK.

I'll be right back.

I don't know who I am any more, Charlie.

And it terrifies me.

I came so close.

So close.

Yes, you did.

Idiot.

But I know you weren't trying to hurt me.

Never.

Sometimes, it's just easier not to have those conversations.

Not really. Not in the long run.

And I'm here for the long run.

I just need to know if you think there's an us worth the struggle.

I need to hear you say it, sweetheart.

Do you still love me?

Of course I do.

Do you still love me, though?

You don't have to ask.

Iain, you did good today.

Thanks. You didn't do too bad yourself, Dr Chao.

Hello? We know you're out there.

Couldn't help overhearing.

Listen, I really wanted to apologise for my sister's behaviour earlier.

Sister?

Yeah. The interview.

-That was your sister?

-Yup.

She's quite a character.

But I'm sure we can...

I'll see her at eight o'clock on Monday morning. Prompt.

And thanks.

Yeah.

OK, let's have a look.

Oh! Here she is.

I'm so sorry, sweetheart. All right, I'm here now.

Right, from today, things are going to change.

All right? And I'm here for you.

OK? Now, all we need to do is get you home.

Right, well, everything's sorted, everything's packed.

Where have you been?

We, um...

We had some difficulty downstairs.

-We've been waiting half an hour.

-Can we not do this now?

-No, darling. Stop doing that.

-Whoa, whoa, whoa, whoa, whoa.

Stop doing that, darling, you're going to hurt yourself.