War of the Roses Casualty

Nietzsche - had something to say about most things.

From where I stand, the NHS, this hospital, my department,

it all runs not BECAUSE of people like you,

but DESPITE people liked you.

My job is to help patients, isn't it? To saves lives.

And if I wasn't able to do that with Cal...

..then what am I even doing here?

-HEART RATE MONITOR FLATLINES

-Do we all agree?

Time of death...16:25.

It is with regret that I resign from my post as Medical Director

with immediate effect.

SIREN WHOOPS

You've got some nerve, haven't you?

Cheers, boys.

-SAM:

-What have we got?

Stab wound, 19-year-old male. Right, let's get him in.

Morning!

This is Shane Johnston, 19 years old...

Penetrating stab wound to the torso received at 7:30am.

Extensive blood loss at the scene.

What you doing here?

Uh, Lily? With me, please. Straight through to resus.

Pulse 105, BP 100/50, sats 97, resps 30.

I've got a bag of saline going in and he's had five of morphine.

Great, bay three.

-OK. Morning, how are you?

-Fine.

Uh... We've got this, thanks.

Hi, can you take this through to Mr Dunham?

Morning!

Good morning.

You look like you've seen a ghost.

Give me one good reason why I don't call security

and have you escorted from my office.

Is this how you treat all your junior doctors?

-SHE SCOFFS

-You wouldn't dare.

Well, Clinical Fellow, technically, but still.

No... No, over my dead body.

Oh, I hope it doesn't come to that.

-Hanssen would never agree to it anyway, so...

-On the contrary,

when I approached him with the idea, he almost bit my arm off.

Call him.

He's waiting to hear from you.

You would seriously go from Medical Director to a trust grade doctor?

No, it's too humiliating. What are you playing at?

Well, it's really very simple.

The NHS are looking to save money and I'm looking for more...action.

I see.

It'd be foolish to turn away someone of my calibre

just because they happen to be your ex-boss.

Or is it because I'm your ex?

Oh, trust me, it's neither.

OK. Well, I suggest you reacquaint yourself with the rest of the team.

Show them the calibre they'll be working with.

Good idea. I'm sure I'll win them over.

-Eventually.

-Good luck. You are SO going to need it.

It's emergency medicine, Connie.

How hard can it be?

Mm!

TRAIN HORN BLASTS

TANNOY JINGLE PLAYS

TANNOY: The train now arriving at platform two

is the 0800 Central West service to...

Calling at Melwood Green...

PHONE RINGS

Hello, love.

Hi, where are you?

I'm at the station.

Don't get on the train!

I have to, sweetheart, I can't let them down.

Well, just wait for me, I'm nearly there!

-What's happened, is it the baby?

-PHONE BLEEPS

-Steve!

-Hello?

-Hello!

-Hello? Helen?

Uh!

SHE SIGHS

-They're coming.

-I thought I was imagining it.

Well, he's probably just here to see Connie, isn't he?

In scrubs?!

Tah-dah!

Maintenance took it down yesterday.

That goes there.

Actually, I'll have it.

Hm... Nice little memento.

Are you here to apologise?

As a matter of fact, I'm here to work, Dr Keogh.

We were told you'd stepped down.

That's right.

So, uh, what sort of work are you here to do, then?

I'm filling the registrar vacancy.

"The Vacancy"? Is that what we're calling it now?

-No, I didn't...

-A man died, you're calling it a vacancy.

That's a new low, even for you.

Welcome to the team.

-There you are!

-You forgot this.

Is that all? You had me worried!

Thanks. You look lovely.

Well, I'm the size of a car, but thanks for saying so.

-I wish you didn't have to go.

-Yeah, well, we need the money, love!

I know.

Well, what if I go into labour while you're away?

I-I was reading about this poor woman...

Babies are like trains - they never arrive on time.

-I'd better go.

-I could come with you.

I'll call you later.

-See ya.

-Bye.

Steve?

-YELLS:

-Steve!

SAM SIGHS

Infected leg ulcer, cubicle two.

Yeah... I could murder a coffee.

Hey, how about you? Get yourself one too...

Staffroom. Kettle. Use it.

Ah...

Leg ulcer... I've just drained an abscess.

Who do you bribe to get the most exciting cases around here?

JACOB CHUCKLES

So, would you like me to go and cause a pile-up

so you can have an interesting day at work?

I'm just saying that minor injuries probably isn't the best use

of my time or talents, that's all.

And as Clinical Nurse Manager,

they're probably not the best use of mine.

But then, I don't pick and choose.

We treat whatever comes our way.

Get used to it.

-Helen?

-SHE KNOCKS ON CARRIAGE

DOOR RATTLES

Oh!

Helen!

Are you all right?

Oh...

Oh!

Steve!

TRAIN POWERS UP, HE WINCES

HE PANTS

BREATHING EASES

Ah, good morning, Dr Keogh.

-Morning.

-Uh, Dr... Dr Keogh... Ah, if you recall...

You-You said...

Well, perhaps at a time more convenient to you, of course,

cos you're a busy man and I appreciate that, so...

David, can you cut to the chase? I'm losing the will to live here!

Well, you said...you'd help me... tick the box.

Oh, right, yeah. Yeah.

Well, we-we-we were going to move onto work next.

-Yes, yeah, we were, weren't we?

-Mm, yes.

Um, OK, right. Well, I'll... I'll have a word with Jacob

about having a word with you about promotion.

-Well, I'm not interested in promotion.

-No?

No, that's-that's not how I view work.

Well, how DO you view work?

Well, it's-it's all about the patients and their care.

Yeah, patient care.

OK, well, it's a bit difficult to quantify, isn't it?

But, you know, whatever peels your banana.

I'll, um... I'll see what I can think of.

-Ah, well, thank you. Thank you.

-Yeah, OK.

Yeah, yeah, yeah, yeah!

-STEVE YELLS:

-Helen!

-Stop! Stop the train, stop!

-WHISTLE BLASTS

-Stop!

STOP! Stop the train!

HE GROANS

-BRAKES SCREECH

-Aah!

-No!

HE SCREAMS OUT IN PAIN

TANNOY JINGLE PLAYS

Hello, mate. My name's Iain, I'm a paramedic. Can you hear me?

-What's his name?

-Steven. Steven Crompton.

All right. Steven?

I'm going to have a look at this leg for you

while the fire boys work on getting you out, OK?

Let's start him on ten of morphine.

-Helen. Helen.

-I'm right here. I'm right here, love.

-Aah!

-STEVE YELLS IN PAIN

All right, mate.

Right. This could take some time. Let's get a team out here pronto.

What, am I his PA?

I bet that's how he became Medical Director,

-by throwing his weight around...

-Lou.

-This is going well.

-What did you expect?

Well, is a little love too much to ask?

You're kidding, right?

Yeah, you know, until recently,

I was the most senior medic IN this organisation...

Who wanted to sack half of this department, including me!

Yeah, I was doing my job. I'm not a bad person.

You know what? I'm a real softie underneath once you get to know me.

Aw! You're not seriously trying to flirt with me, are you?

PHONE RINGS

Sam Strachan.

Yes, this is Holby City ED.

Uh, yep. Mm-hm. How many casualties?

-Well?

-WHISPERS: Wait.

Yeah. Great. Yeah, there'll be someone there shortly.

-What is it?

-Entrapment - Holby West.

-OK, Jacob, I am going to get my things...

-No, I'll do it.

Sam, it's your first day. If I were you...

Yeah, well, you're not me

and, I mean, no offensive, but I'm an experienced trauma surgeon,

so for THIS case, I AM the best doctor this department has.

-Wow!

-You know what? You're right. You should go.

Yes! Glad someone agrees.

You know what? Just nice to get a breath of fresh air. Thank you.

Pudding, what was that - "You should go"?

No, no, no, trust me, Connie will be all over this.

If he makes a single mistake, it'll be his last.

Except I don't think he makes mistakes.

Huh, want to bet?

JACOB CHUCKLES

-Excuse me, please!

-Madam!

-Priority coming through!

-You're not supp...

Nurse! Yes, you! I'm having a cardiac event.

Probably an acute myocardial infarction.

-Yes, please do have a seat!

-Oh, that's better.

David, David, David. I'll have a look.

Hello there. Hello.

If it is an MI, you did very well to get here unassisted, is that what happened?

Excuse me, my pulse is resting at 105,

I have retrosternal chest pains, constricted breath,

I'm 70 years old...

If it is not a heart attack, then what is it?

Well, no, I didn't say that, but I do need to have a look at you.

Well, then, get busy!

Right. If you get a "thank you" from this one,

you can tick the box, all right?

Come on! I'm having a heart attack, I haven't got all day!

-OK. Shall we go through here?

-Yeah.

Excuse me, excuse me. Coming through. Thank you.

Excuse me. Hiya, cheers, thanks.

-You again.

-Oh, well, it's your lucky day, eh?!

-What have we got?

-Steven Crompton, 34 years old.

He fell from a stationary train which then shuntered forward.

GCS 14, pulse 94, resps 18. His BP's 90 systolic.

-Analgesia?

-20mg of morphine, but the pain's nowhere near controlled.

No. Steven? It's all right. My name's Sam.

I'm going to make you more comfortable, OK?

Have they made any attempt to move the train yet?

Uh, they can't without further injury.

The step's the problem,

we don't know if it's embedded or just pinning him.

It's my fault!

Oh, this is Helen, Steven's wife. Her dress got caught in the door.

She took a tumble, Steven tried to help, and that's when he fell.

Well... He forgot his wallet, so I took it to him on the train.

I wish I didn't wear this stupid dress! I nearly didn't, but...

Is it your first baby?

-Yeah.

-Boy or girl?

Don't know.

Don't mind.

Steve's convinced it's a boy.

He plays Sunday League football...

Can't wait for a kickaround with his son.

There you go.

So, uh...

..how do the fire crew get him out?

The fire boys are saying they can use a hydraulic spreader

to push the train away from the platform,

but that could make the carriage unstable.

Or?

They cut the step away - if we've got time.

Oh, if they do that, they may as well just...

-Whoa, whoa, whoa...

-You mean amputate it, don't you?

Look, Helen, we need to get him out as quickly as possible.

-No, don't...

-The more we delay it, the worse the outcome.

No. No, you can't, please, I'm begging you.

He's going to be a dad! Don't, please!

All right. I'll talk to the fire crew.

Oh, by the way, we do have an audience.

Oi!

-All right, Steven... Nice and calm, mate, you're going to be fine.

-CHAINSAW BUZZES

-Are you on any medication, Mrs Patel?

-Furosemide, hypertension.

OK, is it well controlled?

Well, not today, obviously!

Right. Um...

OK, well, it doesn't look like an obvious cardiac event,

your heart rate's hovering about, uh, 103.

Blood pressure's very high,

you've got a slight arrhythmia I'd like to get to the bottom of, so...

-Um, full bloods and troponin, then, please, David.

-OK, sure.

HEART RATE MONITOR BLEEPS

All this bleep, bleep, bleeping...

When I first trained, we used our eyes and our ears.

-You were a doctor?

-Nurse.

I came here in 1964. Spent my whole career in the NHS.

Without these machines, you wouldn't know what to do, eh?

And all this modern holistic rubbish -

"treating the whole person"...

Hah! Whole load of hippy nonsense.

Nursing is about discipline, discipline,

discipline!

SHE TUTS

Sorry.

Is there, um, anyone I can call for you, Sanjeedah?

Only call my children when I'm dead already.

Busy people, important jobs.

Did any of them follow in your footsteps?

Why don't you mind your business, eh?

Oh, um, sorry, uh, to...

-HELEN:

-Thank you.

No pedal pulse. Foot's white, cold. Evidence of compartment syndrome.

What does that mean?

It means the circulation to the leg is severely compromised

and if it's left untreated for much longer,

then the lack of blood supply may mean loss of limb.

So, you're... You're saying that he's going to lose that anyway?

I'm saying the only thing we can do is operate to relieve

the pressure, but we are a long way from a theatre.

-We just won't make it.

-Well, then, just do it here, now.

-No, he'll lose way too much blood.

-Can you at least try?

SAM INHALES DEEPLY It's a risk...

What else do you need?

A sterile environment, a well-trained surgical team.

Oh, what the hell - you lot will do.

Thank you.

-Ever assisted a fasciotomy?

-Not on a train platform, no!

-Armed Forces, right?

-Yeah.

Yeah, well, this should be a walk in the park for you.

-The kids...

-That's the ketamine talking.

-The kids...

-The baby's fine, love. We're right here.

OK, scalpel.

-TV BLARES

-Toast is ready.

Come on, can you move your bowls, please?

Come on!

-TV:

-..Who is expected to be taken by ambulance to Holby City Hospital.

His condition is said to be stable.

The train station is closed on all platforms...

-Get your coats on. Come on, now, get your coats.

-Why?

We've... We've got to go. Just, come on.

Right, OK. Scissors.

Uh...

We don't have a retractor, you're going to have to hold it open.

Yeah.

Yeah, OK.

Perfect.

Avoid the peroneal nerve.

Got it.

Right. OK. This is where it gets messy.

-Ah, damn, it's bleeding.

-What happened?

Uh, I caught a vein. A pretty big one.

Heart rate's climbing - 110.

Ah, I can't see. Uh... Your phone, the torch on your phone...

Come on.

Right, there it is. Right, clip...

SNIPPING GROANS: Got it.

OK, right, we need to pack this

and get him to the ED as quickly as possible.

HE EXHALES DEEPLY

-So, are you in or are you out?

-Yeah, go on, put me down for a fiver.

-All right.

-Although, you know I don't approve of gambling.

-Well, I do.

-Then I have a solid gold opportunity. Odds are 2-1.

OK, I'm in. Oh, hold on, odds on what?

-Well, Sam loses his job by the end of the day.

-Why?

He went on a shout without Connie's permission.

-INHALES:

-OK, I'm in for...five? No, no, no, make it ten.

-Uh-huh.

-No, no, make it an even 15.

-Mm.

-No, I can't afford 15.

-You know what? Take this.

Got it! Right, Steven Crompton, 34 years old.

Ten past eight, his lower leg was crushed between a train

and a platform for approximately 45 minutes.

GCS 14 until ketamine sedation.

Pulse 94, BP 119/64, sats 98%.

He's had 20 of morphine, 80 of ketamine.

Fire Service extracted him before Mr Strachan performed

a fasciotomy at the scene.

Did he now?

-And since then perfusion to the left limb has significantly improved.

-D'you know what? No, not now.

-Blood loss?

-Less than a unit.

Lucky for you!

Right, Steven, nice and steady, mate,

can you transfer yourself across?

STEVEN GROANS

Mm...

Knee feels doughy.

Possible tibial plateau fracture

and we have extensive soft tissue damage.

Let's have full bloods, cross-match three units.

Duffy, we'll do chest and pelvic X-ray here and send him down for tib/fib views.

OK, let's call the anaesthetist

and confirm with on-call surgeons that they're ready for us.

I saved this man from a life-changing injury.

-And exactly how many lower-limb fasciotomies have you done?

-I've seen several.

So you improvised with little support

and barely the right equipment?

-Oh, but he was amazing, wasn't he?

-Yeah, it was pretty impressive.

-It was nothing.

-So I see.

Surgeons are aware, they'll be down as soon as they're free.

-How long?

-They can't say.

-It's OK. He's stable.

-Ooh...

-SHE WINCES

-You all right?

-Yeah... It's just a twinge.

I've had a few recently, they don't last long.

-I take it you checked her over?

-Iain did. She was fine.

-Do it again.

-No, I will stay with my patient.

He's MY patient now.

-Duffy, go with him, please.

-Fine. OK, Helen, this way.

SHE EXHALES DEEPLY

Right, well, we've had your bloods results back, um...

Your potassium's a little low, so... Nothing too drastic.

I'm wondering if you're not just a little dehydrated.

-Have you been fasting for Ramadan?

-Of course.

You know you don't have to at your age?

I've done it all my life, I'm not going to stop now.

-Uh... Litre of saline, please.

-Yes, I'm on it.

Saline. I'd rather have a cup of tea... Here. There.

-Bag?

-Mm.

There you are.

Ah, yes, I think we can stretch to a cuppa.

Is your... Is your breathing a little... A little laboured?

-Not sure if it's just me, huh!

-What are you going to do about it?

Uh... Bear with me. Bear with me.

Is, um...? Can I...?

-You're googling my symptoms, eh?

-Ha! Well, um, that's not...

Well, this is... It's a very highly respected online diagnostic tool.

-What you need is this.

-What's that?

Nursing manual published in 1966. I...

-DYLAN CHUCKLES

-I think I'll stick with Google

if it's all the same to you.

Um... Right, OK. Uh, let's have an eGFR.

Um, a urine dipstick and...

check her lipids.

And, David, this might take a little bit of time,

-so you should be looking to getting her a bed as well.

-Right.

In my day, a consultant was a walking encyclopaedia.

-They were revered!

-Right, well, I'm sorry I'm not a god.

BABY'S HEARTBEAT PULSES

Sounds healthy and strong.

It's wonderful, I could listen to it all day.

-Ha!

-Do you have kids?

A daughter who's 11 going on 17. Knows it all already.

-Ah, that never changes!

-Mm, yeah!

-Hm.

But in all honesty, she is the light of my life.

Hm. Well, she's lucky.

I can tell you're a good dad.

Not that I know what a good dad looks like.

One who's there for a start...

-I never knew mine.

-I'm sorry to hear that.

Hm. But everything's going to be different for this little one.

Steve's going to stop working away so much.

He's going to be right here with us.

That's good. Thank you, Duffy.

Well, I'm sure you'll make wonderful parents.

OK. Good.

If you want to just rest here for a little while...

I'll be back shortly, OK?

I hid his wallet.

I just...

I just wanted it all to be perfect, right from the start.

Both of us there when the baby came.

I just thought I'd turn it into this stupid romantic gesture -

just take the wallet to the station, jump on the train and go with him.

Sorry.

No, it's OK.

It's all right, you know?

Everything will be all right.

Look at that, somebody's bet 50 quid against.

Hey! I've been looking for that everywhere!

-Who was it?

-AN Other. Ahh! So what do they know that you don't?

That he won't lose his job, he's far too well connected.

But he's arrogant. That's how errors are made.

-Well, I think he's rather wonderful.

-ELLE SCOFFS

-With the patients, I mean!

-Uh-huh!

He makes them feel safe and at home. In good hands.

-After that, they're putty in his.

-Mm. I could do with some of that.

She's right. You should've seen him today.

I'd trust him with MY life.

I can't believe you're defending him.

Well, I guess that's just another difference

between me and you, isn't it?

-What's that supposed to mean?

-Forget it.

-DAVID:

-Ah, yes, hello. Sanjeedah Patel.

P-A-T-E-L...

Yes, I was wondering if you had any contact details for her children?

No, no, no, she, uh... She does.

What, none at all?

I-I see. I see... No, no, no, that's fine, that's fine.

Um, no, thank you. Thank you... Uh, sorry for troubling you.

Can somebody please tell me what is going on?

Steven is his name, Steven Crompton. Why can't I see him?!

Noel, is everything all right?

Um, this is Judith. Um, she wants to see Steven.

There was an accident at the train station.

The news said they'd brought him here.

-Yes, are you a relative?

-I'm his wife.

Sorry, his...ex-wife?

No! I'm his WIFE wife, so can I see him, please?

Where is he?

Um, I'm sorry, could you just...?

I'll need to ask you for patient security, um...

Do you happen to have any identification on you?

My name's Judith Crompton.

I'm not just some random nutter, I'm his wife.

Please, where is he?

He's being treated and, uh...

In fact, Noel, would you mind taking Mrs Crompton to the relatives' room?

And I'll find out what's going on.

Finally! Thank you.

-Sorry. Um, this way, please.

-Come on, girls.

It's just through here...

-If, um, you need anything, just give me a shout.

-Thank you.

Hi.

-Where is she?

-I've sent her to the relatives' room.

Her husband wants to see her.

It's a lovely necklace. Where d'you get it?

Oh, it was a gift from my husband.

Oh.

I hope they don't keep you waiting much longer,

especially not in your condition.

-Are you here to have a baby?

-Oh, not today.

Our daddy's poorly.

Oh, sorry to hear that. What's the matter with him?

-He fell off a train.

-A train?! Well...

Oh... Um, Helen, he's-he's asking for you.

-Bye.

-Bye!

HEART RATE MONITOR BLEEPS STEADILY

Any news?

Um... Well, uh, doesn't seem to be any sign of any kidney dysfunction,

your, uh, cholesterol's normal.

No MI, no kidney dysfunction, no heart problem.

Not a good day for you, Doctor, eh?

Well, I've had worse.

Um... Oh. Sorry. Should I...?

No, come in, come in, come in.

Right, um...

Sanjeedah...

I've spoken to your GP.

I know your children... won't be coming.

But I'm here for you.

You had no right!

But wait, I'm sorry, look, hang-hang-hang on.

I want to make a complaint about this nurse.

First of all, he can't say boo to a goose and then he snoops on me!

-Well, you seemed like you needed company.

-I don't need your pity.

And as for this doctor... he's useless, hopeless!

Wait, wait-wait a... Just wait a minute.

I'm tired of waiting!

You don't know what's wrong with me, do you, eh?

-I could die waiting.

-Dr Keogh?

-Is that what you want?

-Dr Keogh?

-You want me to die, huh...

-Dr Keogh!

-Is that what you want?

-Dr Keogh?

-You want me to die?!

-Oh, no, no, no, it's all right, it's all right, it's all right. You just...

-Wait a minute...

-Oh.

-On the bed...

-Dr Keogh?

-I was... I'm... I'm so sorry.

No, no, wait, wait, Dr... Dr Keogh!

Was anyone else injured on that train?

Train? Uh, why?

Well, it's just that that little girl, she said that her dad had...

Yes, yes, I-I think she was confused, you know.

Um, had seen it on the news

when that man was there with his phone, taking mobile phone footage.

Right.

-Hm.

-Helen.

-Steve!

You're famous now, you're on the telly!

Am I?

HE CHUCKLES NERVOUSLY

Listen, could you keep everyone else away?

I don't want any visitors.

Just want it to be you and me.

Really? Just talk me through it.

Sanjeedah Patel, 70 years old, presented with central chest pains,

tachycardia and a lightness of breath.

-So WHERE is Dr Keogh, then?

-Like I said, I don't know!

OK, she's in VT, BP's dropped, she's compromised.

We need to cardiovert her. Nurse, find me Dr Keogh - now, please.

Let's move her to HDC.

HE PANTS

PHONE RINGS, HE EXHALES DEEPLY

PANTING CONTINUES

PHONE CONTINUES TO RING

Oh... Thanks.

I hear you're having quite a day of it.

Mm, I wouldn't know where to begin.

Try me.

Well, for one, I'm keeping something from a patient.

-Ah. The doctor's dilemma.

-Mm.

How much should we tell them?

It's not a simple one, that.

It's a question of your own judgment in the end, isn't it?

One thing I have learned over 30 years is...

honesty really is the best policy.

Good luck.

What's going on?

Oh, sorry, Helen, you... You shouldn't be in here.

What aren't you telling me?

Uh, I think you need to speak to your husband.

Oh, for goodness' sake, I'm just about to have his baby.

Tell me!

He's married to someone else as well.

What are you talking about?

He's got two wives, Helen.

Another wife?

Yes, her name's Judith. She's here, you... You've met her.

SHE GASPS

A train accident.

No...

No! Oh!

-Um...

-Oh!

Uh, whoa, whoa. SHE PANTS

Sanjeedah? Sanjeedah, I'm right here.

Dr Gardner's just going to sedate you for a little while,

but don't worry, you won't feel a thing.

That's 5ml IV propofol in.

-Good. You ready?

-Mm.

Start with 150, please.

Stand clear for 150 synchronised shock, please...

-ELECTRIC PULSING

-And shocking...

-Come on.

-She's still in VT.

SHE YELLS IN PAIN OK, that's it, that's right, deep breaths!

-What the...?

-Just deep breaths. Look, hold my hand.

-What's going on?!

-She's in labour!

Clearly, but why are you dealing with it in here on your own?!

Uh... Because... Look, it's under control. It's just happened.

SHE YELLS Whoa, whoa, whoa. OK.

So you've called Obstetrics?

No, isn't that what you do?

SHE PANTS Um, OK, that's it.

Yes, just concentrate on your breathing.

-ELECTRIC PULSING

-And again, stand clear at 150 and shocking...

And again.

-ELECTRIC PULSING

-Stand clear at...200 and shocking...

HEART RATE MONITOR BLEEPS STEADILY

And we have sinus rhythm. Well done. Repeat the 12 lead, please.

Nice work, David.

Uh, any sign of Dr Keogh?

OK.

Well, wherever he is, let's hope it was really important.

How long has she been in labour?

-Uh, 20 minutes? I know as much as you do.

-I thought you'd checked her over.

Yes, and you discharged her to the relatives' room.

Stay out! Let's give her some Entonox, please.

-What's happening, is the baby coming?

-HELEN GROANS WITH PAIN

It's fine, she'll be fine. Right, we need to get you up on the bed.

-All right? I'm just going to check you over.

-Helen?

-Easy as you can, that's it.

-There we go.

-Hels?

SHE PANTS

HELEN WAILS

OK. Nice, deep breaths. That's it, you can hold it.

Right, she's fully dilated.

Uh, let's get onto Obs, tell them we have a precipitous delivery.

It's too late to transfer, so we'll deliver the baby here.

But we have an experienced midwife leading. All right? I'll assist.

-Are you sure?

-Yep.

OK. Um, she's booked in at St James's,

so let's have the notes sent over - QUICKLY, please.

Helen? Helen? It's time for you to push for me, OK?

On three. One, two...

SHE GROANS

HE PANTS

KNOCKING ON CUBICLE DOOR

Everything OK?

Is she dead?

No! No, no, Dr Gardner's with her, she's in safe hands.

Safer than mine!

No, no, that's, um, that's not what I meant.

Um...

You know...

Cal's death...

It wasn't your fault.

You're a good doctor.

One of the best.

But there wasn't anything you could have done...

to save him.

Not you, not...

Not anyone.

I-I just wanted you to know that.

That's all.

That's it. One more push for me. Nearly there.

-SOBS:

-I can't! I can't!

-You can, I know you can.

What, you mean like Judith did?!

What?

Helen... Helen, it wasn't something I planned.

-How could you do it?

-YELLS:

-Get him away from me!

-Shhh, shhh, shhh.

-HELEN GROANS

That's baby's shoulders, Helen, almost there.

10 IU of IM oxytocin, please.

All right, just one last push for me.

HELEN GROANS

Yeah!

-That's it, well done.

-BABY WAILS

Is it a boy? HELEN PANTS

He's right here.

Oh, hello!

Hello!

There he is!

-CONNIE:

-Aw!

That was fast.

All right, let's keep an eye on mother and baby.

Once the placenta's been delivered,

let's have IV oxytocin and obs every ten.

-OK.

-All right, congratulations.

All under control.

No thanks to you.

BABY WAILS

Right, how are we doing?

I feel wretched.

Well, come on, there's got to be something else going on here, hasn't there?

Um... Have you eaten or drunk anything unusual?

-Dr Keogh?

-Yeah?

-The fasting.

-Oh, yeah, the fasting.

Hang on, hang on. Just...wait a minute.

-May I?

-Well, you know all my secrets.

What are you looking for, David, drugs?

-Hah! Doctor, I'm 70 years old.

-You'd be surprised.

-What's that, then?

-Liquorice.

Liquorice... Oh, hang on...

Potassium - 2.5.

-OK, um, how much of that have you drunk?

-I don't know, why?

Because if you've drunk enough of it,

I might suggest that you've got liquorice poisoning.

Is that real?

Yes, David, of course it's real. It's an appetite suppressant.

Were you using it to help you fast, yeah?

It can elevate blood pressure, it can cause hypokalemia,

cardiac arrhythmia...

Sometimes even death.

I'm a little surprised I didn't notice it, but...

better late than never, I suppose.

So, what are you going to do about it?

Well, potassium, that's what you need, isn't it?

20 millimoles in a litre of saline over three hours, please.

-Sure thing. High five?

-Ah, no.

-Ah, now that sounds much more like it.

-Yes.

Hm.

BABY CRIES

So all those times you were away, you said you were at work,

but you had another wife.

Why couldn't you just have an affair like a normal person?!

It's not like that.

I couldn't believe someone like you would even look twice at me.

What, so it's my fault?!

I just wanted someone to have a proper family with,

someone who'd look after us.

-I should've known. I'm so stupid.

-It's not your fault, Helen.

Oh...

Oh, she's bleeding out, Duffy. We need to lie you back down.

-Let's get the lines in.

-What's happening?

-Pulse 123, BP 105/55.

OK, let's cross-match four units, get some O-neg. Line and fluids up.

We'll start with the IV oxytocin. Wait, I'll do it.

Oh, Mr Strachan!

-While you call Mrs Beauchamp back. I need some help.

-Good!

So, what's the prognosis?

It's very good. I anticipate you'll make a full recovery.

But you'll be keeping me in for a while?

Uh, no, I wouldn't have thought so. Once your blood pressure comes down, we'll send you home.

Um, tomorrow, in all likelihood.

Oh. As soon as that?

You know, it takes an awful lot of liquorice to poison yourself.

What made you drink so much?

Every evening I make a big pot.

Right, well, you don't have to drink it all!

There's no-one to share it with.

Thank you.

-Steve...

-It's all right, you don't need him.

-I can't do this alone.

-I'm still here, Helen.

I can't see him, I can't...

Helen, you're going to be all right, it's OK.

You listen to me, you focus on yourself, OK?

You can do this all by yourself.

-I'm dizzy.

-DUFFY:

-Heart rate climbing.

-Helen?

-Airway's clear. BOTH:

-Continue the massage.

-Helen. Helen?

-Let's get the bed - head down, please.

What's happening?

-DUFFY:

-Pressure - 84/40.

Thanks.

Let's put up the two units of cross-match straightaway, please and, uh...

0.5mg of Ergometrine, please.

-DUFFY:

-OK, Helen.

Once this goes in you'll start to feel much better.

Sanjeedah.

Hi. I-I thought I'd just pop in and...see how you are.

I've carried this book for 51 years and it's been a good friend to me.

Now it is yours.

Really?

Thank you.

Turn to page 112.

11... 112.

Liquorice, excessive consumption of,

can lead to hypokalemia and its attendant complications.

I thought I knew the book backwards.

Tell your Dr Keogh we keep learning every day.

Yes, we do, don't we?

Although... I'm a very slow learner.

Perhaps you could talk me through the book?

We-We could start this Sunday, if you like? Uh, 2pm, say?

I'll make a pot of tea!

Though perhaps not liquorice.

DAVID LAUGHS

Thank you.

Tell them we'll be another minute.

Can't hold Judith off for ever, Steven.

Tell her I can't see her.

You coward.

What do you know about my life? What could you POSSIBLY know?

You tell me, Steven, because I'm dying to hear -

when were you thinking of telling Helen that you're a bigamist?

-Five years from now? Ten?

-Stop it!

Bring her in, she deserves to know the truth.

Please, don't.

BABY WHINES

HE SIGHS

-Daddy!

-Hey! Amy.

Don't worry, girls, Daddy's going to be just fine.

I was so worried about you!

What were you doing in Holby? I thought you were in Kettering.

Um...

Oh, sorry, love.

You don't have to explain, I'm just so glad that you're OK.

Hm. Yeah, you've done well. I mean, not just with the patient.

What about love?

-Yeah, what about it?

-That's next on the list.

How on earth am I ever going to tick that box?

Any... Any ideas? Any...thoughts?

Right, girls, Daddy needs to get some rest,

so we'll see him again tomorrow, OK?

-Will you call me if you need anything?

-Yeah.

-I love you.

Say it back, then.

Love you, too.

I'm about to take Steve up to theatre,

is there anything you'd like to say first?

Bye, Daddy!

Bye, good luck.

Why didn't you say anything?

The girls.

-Thank you.

-Don't you thank me. Don't you ever dare.

Can I hold him?

-It's OK.

-BABY WHINES

Oh!

Oh, look.

Oh, look, he's so perfect.

I mean, this is all I've ever wanted.

Was any of it real?

The love, Helen.

-I love you!

-I don't believe you.

I don't believe you.

-Sorry, we need to take you up to theatre, so...

-Oh... OK.

OK.

Thanks.

Cherish that memory, Steve...

..cos it's the last time you're ever going to see him.

We don't need you.

-I'd rather live alone than live a lie.

-Helen, please...

I'll be watching you.

You'd better be nice to that family,

cos if I ever find out that you've pulled the same stunt again,

I won't hesitate to tell her AND the police.

-Do you understand?

-I'm sorry.

Don't worry, little one. Mummy's here. Yeah.

SHE SOBS

Mummy's here.

Come in.

I imagine that's a memo to Hanssen,

telling him I took an unnecessary risk...

..then I breached patient confidentiality and...

May I?

"Mr Strachan's lack of professionalism

"has left the Trust open to complaint and litigation."

Have you sent it?

Not yet, no.

Connie, if you agree not to send it...

..I'll move on.

Quietly.

You frustrate me, Sam, you really do because you're a good doctor.

I mean, there's no question about that.

But you have always overestimated your ability

and underestimated the risk - always.

Having said that...

..this department is lacking your certain skill set, so...

..you can stay.

On one condition.

-Which is?

-Leave your ego at the door.

Understand?

Right, I need my office back now, go on.

Sam?

Don't expect an easy ride.

Noel.

Actually, guys, you can put my winnings into a kitty for the pub.

YOUR winnings?

Drinks are on AN Other.

Well done, you.

LAUGHTER

Doctor.

Thanks!

Jacob.

Fresh start?

OK.