0:00:04 > 0:00:07Ethan, if you know something, will you please speak up?
0:00:07 > 0:00:11She has a left atrial leiomyosarcoma.
0:00:16 > 0:00:18We have to transfer you to HDU.
0:00:36 > 0:00:38Let's take a moment to honour all
0:00:38 > 0:00:41those who donated their body to science.
0:00:42 > 0:00:44White Caucasian female.
0:00:44 > 0:00:48Cause of death - multi-organ failure due to infective endocarditis.
0:00:50 > 0:00:53Today we'll be making a longitudinal sternal incision to gain
0:00:53 > 0:00:56access to the mediastinum and thoracic cavity.
0:00:58 > 0:01:02Passing from the dip between the clavicles, the suprasternal notch,
0:01:02 > 0:01:05we dissect in the mid-line, along the sternum, as far as
0:01:05 > 0:01:09the xiphisternum, then bilaterally along the lowest of the ribs.
0:01:11 > 0:01:15Grab your scalpel - let's begin.
0:01:15 > 0:01:16BUZZING AND BEEPING
0:01:16 > 0:01:18Hey. It's OK.
0:01:18 > 0:01:22It's all right, it's OK, it's all right.
0:01:22 > 0:01:24MACHINES BEEP
0:01:24 > 0:01:26Don't worry, it's not you.
0:01:27 > 0:01:32You're OK, OK? OK. It's OK.
0:02:22 > 0:02:23OK, thank you. It's done.
0:02:31 > 0:02:33It's fine, leave it.
0:02:39 > 0:02:41That bad, huh?
0:02:44 > 0:02:48So...it's grown?
0:02:48 > 0:02:49I'm afraid so.
0:02:49 > 0:02:52- The valve is now incompetent- Yes.
0:02:56 > 0:02:58When have they scheduled theatre?
0:02:59 > 0:03:01Well, they've got to take it out...
0:03:01 > 0:03:03Yes, but not yet, not straight away.
0:03:03 > 0:03:06You're still in atrial fibrillation
0:03:06 > 0:03:08with a poorly controlled ventricular rate.
0:03:08 > 0:03:11You're anaemic. Your white cell count is depressed
0:03:11 > 0:03:13and your renal function is impaired.
0:03:13 > 0:03:15Yes, but...
0:03:15 > 0:03:16No. No, "Yes, but..."
0:03:18 > 0:03:21The tumour needs excising, but the vegetations need to be removed
0:03:21 > 0:03:22and the valve needs to be repaired.
0:03:22 > 0:03:25This needs a specialist mitral valve surgeon.
0:03:25 > 0:03:29Even if you did survive, there's a high chance of acute renal failure.
0:03:32 > 0:03:35Come on. Would you operate on you right now?
0:03:38 > 0:03:40So what are they proposing?
0:03:40 > 0:03:42They'll restore sinus rhythm
0:03:42 > 0:03:46and improve renal function with careful fluid balance.
0:03:46 > 0:03:50- A few more days' antibiotics... - A few more days'? A few days'...
0:03:52 > 0:03:54What if I don't have a few days?
0:03:57 > 0:04:00PHONE RINGS
0:04:11 > 0:04:15- Charlie.- Hello, Dylan. The exec team are doing a safety round.
0:04:15 > 0:04:18Are they? When?
0:04:18 > 0:04:19About half an hour ago.
0:04:20 > 0:04:23- Right, nobody told me. - Have I woken you up?
0:04:23 > 0:04:25No, no, no, no. I'm on my way in.
0:04:27 > 0:04:30OK, right. I'm off to see Connie now.
0:04:30 > 0:04:31OK, see you soon, bye.
0:04:45 > 0:04:47They're waiting to discharge someone
0:04:47 > 0:04:50and then you can have a private room.
0:04:50 > 0:04:52So where are we at with everything else?
0:04:52 > 0:04:56That's...still under discussion.
0:04:56 > 0:04:59SHE RETCHES
0:05:00 > 0:05:01Vomit bowl, someone.
0:05:04 > 0:05:06All right, all right, Connie.
0:05:07 > 0:05:10Has she been prescribed Ondansetron?
0:05:10 > 0:05:13No. No more drugs.
0:05:13 > 0:05:15Connie, for heaven's sake...
0:05:15 > 0:05:19I think we should leave it for today. OK, she's very tired.
0:05:34 > 0:05:36Oh, come on, come on, come on.
0:05:56 > 0:05:58I just don't understand how could you let her keep it
0:05:58 > 0:06:00a secret for so long?
0:06:00 > 0:06:02- Charlie!- OK.
0:06:02 > 0:06:05You know as well as I do she has a right to confidentiality.
0:06:05 > 0:06:08Well, you could have told her that there are people around her
0:06:08 > 0:06:11who care about her who might just want to help.
0:06:11 > 0:06:12I think she knows that.
0:06:12 > 0:06:15But then of course she pushes people away when she needs them most.
0:06:15 > 0:06:17And it's only a matter of time
0:06:17 > 0:06:20before you get your marching orders, chum, believe me.
0:06:22 > 0:06:24You look exhausted.
0:06:24 > 0:06:25Yeah, yeah, I...
0:06:25 > 0:06:28I think I'm going to go home and get a few hours' kip.
0:06:28 > 0:06:32- Make sure you do. Look after yourself, OK?- Yeah.
0:06:32 > 0:06:35PHONE RINGS
0:06:35 > 0:06:37Mrs Beauchamp?
0:06:37 > 0:06:39You've what, sorry?
0:06:41 > 0:06:44Mrs Beauchamp? What are you doing?
0:06:47 > 0:06:49You're driving me to London.
0:06:55 > 0:06:59I'm fine, it's fine. This ankle's always a bother. Where's Waffle?!
0:06:59 > 0:07:01Where is he? What's happened to Waffle?!
0:07:01 > 0:07:03The dog? He's just here, he's fine.
0:07:03 > 0:07:07Ah. There you are. Dear Waffle. There you are.
0:07:07 > 0:07:11- I said I'm OK. Off you go! - All right, fine.
0:07:11 > 0:07:13Argh!
0:07:13 > 0:07:15Right. No, no, no.
0:07:15 > 0:07:17OK. This ankle needs looking at, trust me.
0:07:17 > 0:07:18Oh, how would you know?
0:07:18 > 0:07:21I'm a doctor, I work in A&E, that's how I know.
0:07:21 > 0:07:24Are you? Well, you should think about your driving.
0:07:25 > 0:07:29- Right, OK. What's your name? - Gloria. Why?
0:07:29 > 0:07:32Gloria, you need to come with me.
0:07:32 > 0:07:34Come on, nice and easy.
0:07:35 > 0:07:37Have you been drinking?
0:07:37 > 0:07:39Of course I haven't been drinking.
0:07:39 > 0:07:41- Your eyes are all bloodshot. - Are they?
0:07:41 > 0:07:44Well, so would yours be if you worked the hours I do.
0:07:46 > 0:07:48Please tell me you're joking.
0:07:48 > 0:07:50You didn't really think I was going to sit there
0:07:50 > 0:07:52for a couple of days in limbo, did you?
0:07:54 > 0:07:58I sought a second opinion from St Eugene's,
0:07:58 > 0:08:02director of interventional heart valve surgery.
0:08:03 > 0:08:06She's a friend, well, was.
0:08:08 > 0:08:11But she's all set, so let's go. Come on.
0:08:11 > 0:08:14- Does she know how poorly you are? - Oh, I'm not dead yet.
0:08:14 > 0:08:18- No, I know. - This is my tumour, my decision.
0:08:18 > 0:08:19I know, but anything could happen!
0:08:20 > 0:08:23OK, you could have heart failure on the motorway...
0:08:23 > 0:08:24Oh, don't be so melodramatic.
0:08:24 > 0:08:29I can make it through the next couple of hours.
0:08:29 > 0:08:30Please, Ethan.
0:08:30 > 0:08:32If you were in my situation,
0:08:32 > 0:08:36would you not explore every possible option?
0:08:42 > 0:08:45Oh, well, go on, then. I'll do it myself.
0:08:45 > 0:08:47- I'll get a taxi.- No, just...
0:08:51 > 0:08:53It was either these or chocolates.
0:08:53 > 0:08:55I think Mrs B would prefer these.
0:08:55 > 0:08:56Right, cards.
0:08:56 > 0:08:59Puppies or flowers? Hello?
0:08:59 > 0:09:00That's a bit much.
0:09:00 > 0:09:04Oh, mate, don't be jealous. It'll come to you eventually.
0:09:04 > 0:09:06Every pot's got a lid.
0:09:06 > 0:09:11Max! Could we fit this lady through to cubicles, please?
0:09:11 > 0:09:15In the avoidance of doubt, I'm aware there is a dog on her lap.
0:09:15 > 0:09:17Maybe not every pot.
0:09:17 > 0:09:20Dylan, the urgent care project manager from the CCG called again.
0:09:20 > 0:09:21Again, right.
0:09:21 > 0:09:24And the conflict resolution trainer.
0:09:24 > 0:09:26When they can't get hold of you, they call us.
0:09:26 > 0:09:30Have you got any aspirin? I've got a terrible, terrible headache.
0:09:30 > 0:09:32For Mrs B?
0:09:32 > 0:09:33Flowers, I guess?
0:09:33 > 0:09:35Oh, come on, puppies.
0:09:35 > 0:09:39Who's this for? Mrs Beauchamp? Puppies all the time.
0:09:39 > 0:09:42Speaking of which, the lady with the dog you nearly ran over
0:09:42 > 0:09:44is in cubicle five.
0:09:44 > 0:09:47- You nearly ran over a dog?! - That happened to my dad once. Bleak.
0:09:47 > 0:09:48No, I did not.
0:09:48 > 0:09:50Must have been the lady then.
0:09:50 > 0:09:52You know, the lady not the dog he nearly...
0:09:52 > 0:09:54You nearly ran over a lady trying to dodge a dog?
0:09:54 > 0:09:57No. I didn't run over a lady, didn't run over a dog.
0:09:57 > 0:09:58OK, can we forget about this
0:09:58 > 0:10:00and concentrate on what we're here to do?
0:10:00 > 0:10:03You, come with me, we're going to treat...Gloria.
0:10:10 > 0:10:13- SHE GASPS - Do you want me to stop?
0:10:13 > 0:10:18- No, no, no, no. Just...let's get there.- OK.
0:10:29 > 0:10:32SHE COUGHS AND RETCHES
0:10:32 > 0:10:34No, no, I'm going to stop. Just give me a second.
0:10:41 > 0:10:44SHE VOMITS
0:10:44 > 0:10:48Maybe I should call an ambulance.
0:10:53 > 0:11:00It's fine, it's just travel sickness. Happens all the time.
0:11:01 > 0:11:03Let's just get there.
0:11:05 > 0:11:07Is this really necessary? Argh!
0:11:07 > 0:11:09OK, it's quite badly bruised.
0:11:09 > 0:11:11All right, let's book her in for an X-ray.
0:11:11 > 0:11:16- An X-ray? How long will that take? - We'll go as fast as we can.
0:11:16 > 0:11:19BP 104/60. Ain't that a bit low?
0:11:19 > 0:11:22Yes, but it's nothing to be too concerned about.
0:11:22 > 0:11:25Are there any pre-existing medical conditions we should know about?
0:11:25 > 0:11:27Are you on any medication at the moment?
0:11:27 > 0:11:30High blood pressure. Here.
0:11:30 > 0:11:32OK, all right. Beta blockers, yeah.
0:11:32 > 0:11:34Is there anyone we can call for you?
0:11:34 > 0:11:38Call? No, there's no-one. Let's just get on with it.
0:11:38 > 0:11:40Dylan, we have a visit from the executive nursing team.
0:11:40 > 0:11:42Yeah, I'd heard.
0:11:42 > 0:11:45It's just...dogs aren't really allowed in an emergency department.
0:11:45 > 0:11:47But he's very well behaved.
0:11:47 > 0:11:49Yeah, but what if he has an accident?
0:11:49 > 0:11:51It's not Waffle's fault! It's his fault.
0:11:51 > 0:11:53He's the only reason we're in here.
0:11:53 > 0:11:55- OK. I-I wouldn't go that far. - Of course you wouldn't.
0:11:55 > 0:11:57I tell you what - why don't I see
0:11:57 > 0:12:02if I can find somebody who can take him outside? How about that?
0:12:02 > 0:12:03Lucky there's a dog involved.
0:12:03 > 0:12:07He's not usually so nice. Either that or he must be feeling guilty.
0:12:26 > 0:12:29Professor Arianne Cornell - room 1124.
0:12:31 > 0:12:33- You OK?- Yeah.
0:12:33 > 0:12:36How do you two know each other?
0:12:36 > 0:12:37Long story.
0:12:41 > 0:12:43Connie Beauchamp. We spoke earlier.
0:12:43 > 0:12:47Hold on one moment, please. Yes. I spoke to the Professor.
0:12:47 > 0:12:49Unfortunately...
0:12:49 > 0:12:51Can you just give her these, tell her I'm here?
0:12:51 > 0:12:54- I'm sorry, but... - Don't be sorry, just do it.
0:12:54 > 0:12:55I thought you spoke to her.
0:12:55 > 0:12:58Oh, you know what? I haven't got time for this.
0:12:58 > 0:12:59Excuse me.
0:12:59 > 0:13:00Go away!
0:13:09 > 0:13:11Yes!
0:13:14 > 0:13:17- Mrs Beauchamp.- Professor Cornell.
0:13:17 > 0:13:18It's all right, Liz.
0:13:22 > 0:13:26I know. Got to keep the old hand-eye coordination going.
0:13:26 > 0:13:30Certainly original. You haven't changed much, have you?
0:13:30 > 0:13:34Neither have you. You always did like to make an entrance.
0:13:36 > 0:13:37You're kidding.
0:13:37 > 0:13:40You're not doing it for me, you're doing it for a little old lady.
0:13:40 > 0:13:41You trying to keep her sweet?
0:13:41 > 0:13:44No, what happened was, I swerved to avoid the dog
0:13:44 > 0:13:47- and she came out of nowhere.- OK.
0:13:47 > 0:13:48SPLASHING
0:13:54 > 0:13:56- Dr Keogh.- Yeah.
0:13:56 > 0:13:59Oh, the conflict resolution thing. Um...
0:13:59 > 0:14:00Conflict resolution? No, it's um...
0:14:02 > 0:14:04Oh, right, what are they doing here?
0:14:04 > 0:14:06They were called to the scene of the accident
0:14:06 > 0:14:08and they want to talk to you.
0:14:08 > 0:14:10Dylan, Mrs Roades has just gone up for her X-ray now.
0:14:10 > 0:14:13OK, right, I better see what that says.
0:14:13 > 0:14:15They'll have to wait, that needs clearing up.
0:14:18 > 0:14:20And your last cycle of chemo?
0:14:21 > 0:14:23No affect on the tumour. It's growing as we speak.
0:14:25 > 0:14:28Stubborn, like its host.
0:14:32 > 0:14:35Did you really think you could turn me away?
0:14:35 > 0:14:37Did you really think you could just barge into my office?
0:14:38 > 0:14:41You're better than anyone else I know.
0:14:41 > 0:14:42What was I supposed to do?
0:14:45 > 0:14:49Resection of tumour, repair of interatrial septum.
0:14:49 > 0:14:51Careful resection of mitral valve vegetations.
0:14:51 > 0:14:53Repair of mitral valve with replacement,
0:14:53 > 0:14:54if repair is not possible.
0:14:56 > 0:15:00No wonder no-one would rush to cut you open.
0:15:00 > 0:15:02I didn't want to waste your time.
0:15:02 > 0:15:03You can do it, I know you can.
0:15:03 > 0:15:07You'd almost certainly push up my mortality rates.
0:15:07 > 0:15:11Either that or increase your phenomenal success rates.
0:15:11 > 0:15:13You're too kind.
0:15:13 > 0:15:16I have a big ego, but maybe not that big.
0:15:18 > 0:15:21Elliot Hope, he said no, did he?
0:15:21 > 0:15:23He's... He's in Pakistan.
0:15:23 > 0:15:25Ah.
0:15:28 > 0:15:32Look at it this way - I'm putting my heart in your hands.
0:15:33 > 0:15:35Bet you never thought that would happen.
0:15:37 > 0:15:39We've moved on from med school, you know.
0:15:53 > 0:15:57As you can see, I can't really wait much longer.
0:15:57 > 0:16:01If the tumour blocks a valve, it's all over like that.
0:16:06 > 0:16:07Any blood in your vomit?
0:16:07 > 0:16:09No.
0:16:10 > 0:16:14No fracture. That's good, isn't it?
0:16:14 > 0:16:16And there's obviously quite a lot of bruising
0:16:16 > 0:16:18and some soft tissue damage.
0:16:18 > 0:16:23What it needs is rest, ice if you can get it, and elevation.
0:16:23 > 0:16:24We'll be in touch with your GP.
0:16:24 > 0:16:27If you pop along there in the next few days, that should do it, OK?
0:16:27 > 0:16:29See? I told you.
0:16:29 > 0:16:31Are you sure you can manage? With a dog as well?
0:16:31 > 0:16:34We could get a community nurse practitioner to assess you at home.
0:16:34 > 0:16:38No way. I been through all this with Ted when he had Alzheimer's.
0:16:38 > 0:16:41- We'll talk when I'm incontinent and drooling.- Yeah, but still...
0:16:41 > 0:16:44It was only last October I managed a bunch of unruly teens,
0:16:44 > 0:16:47- I think I can manage a limp and a mutt.- You're a teacher?
0:16:47 > 0:16:51Was. Hung up my cane this year. Only joking.
0:16:51 > 0:16:53Didn't need a cane to scare them off.
0:16:53 > 0:16:55Here, give us the stick.
0:16:55 > 0:16:58RTC coming in. Should I ask Dr Munroe?
0:16:58 > 0:17:01No, no, I'll come now. Good to discharge. Thanks, Louise.
0:17:01 > 0:17:05Sweetheart! Come to Mummy! Who's a clever boy?
0:17:13 > 0:17:16- I ran all the way.- Me, too.
0:17:16 > 0:17:19This is Connie Beauchamp - self referral from Holby City Hospital -
0:17:19 > 0:17:23ECG, chest X-ray, full blood count, clotting screen, LFT's,
0:17:23 > 0:17:27renal function, an echo and repeat the blood cultures.
0:17:27 > 0:17:31Flush out the PICC line in and continue the antibiotics.
0:17:31 > 0:17:32Your carriage awaits.
0:17:33 > 0:17:36- Oh, no, that won't be necessary. - I'm the boss here.
0:17:40 > 0:17:42And I should add that Mrs Beauchamp used to be
0:17:42 > 0:17:45a cardiothoracic consultant before becoming
0:17:45 > 0:17:48the clinical lead of A&E at Holby City Hospital,
0:17:48 > 0:17:50so watch your step, kids.
0:17:50 > 0:17:52They'll show you to the ward.
0:17:52 > 0:17:56- If you could take my things.- Yes.
0:17:59 > 0:18:03- So you're the resident lapdog.- Oh. - Enjoy it while it lasts.
0:18:05 > 0:18:06This way, sir.
0:18:13 > 0:18:15- Dr Keogh.- Yep.
0:18:15 > 0:18:17Dylan!
0:18:17 > 0:18:20Just to let you know, I contacted Mrs Roades' GP about the referral.
0:18:20 > 0:18:24- She isn't registered with them. - OK, I'm afraid I'm going to have to leave it with you.
0:18:24 > 0:18:26I've got a finance report due in about...
0:18:26 > 0:18:27I don't know what happened.
0:18:27 > 0:18:30She just took a wrong turn and fell again.
0:18:30 > 0:18:32OK, let's get you back to cubicle five, eh?
0:18:34 > 0:18:37I keep telling you, I'm fine.
0:18:37 > 0:18:39OK, well, it's happened twice in a day now.
0:18:39 > 0:18:41Does it happen a lot? Falling over?
0:18:41 > 0:18:43Just a...a momentary lapse of attention.
0:18:43 > 0:18:47- You had one this morning. - I did tell you her BP was low.
0:18:47 > 0:18:49OK, yeah. Thanks, Louise.
0:18:49 > 0:18:52Let's get some bloods then. We'll need FBC, U&E and a bone profile,
0:18:52 > 0:18:55- and send her for an ECG as well.- OK.
0:18:55 > 0:18:58Now we need your medical records and it seems that the GP that
0:18:58 > 0:19:02you gave us earlier on, I don't think you are registered there.
0:19:02 > 0:19:04I'm sure I gave you the right name.
0:19:04 > 0:19:08OK, well, I mean, if you give us your address, we can do it that way.
0:19:08 > 0:19:09Yeah?
0:19:09 > 0:19:10You remember where you live?
0:19:10 > 0:19:14Of course I do. I'm never going back there.
0:19:28 > 0:19:31You lied to me. She didn't tell you to come.
0:19:31 > 0:19:33It's irrelevant, it'll all be done by tomorrow.
0:19:33 > 0:19:36It's not irrelevant. You got me here under false...
0:19:36 > 0:19:40Professor. Got everything you need?
0:19:40 > 0:19:42Yes. I think I have.
0:19:42 > 0:19:44- Good, when are you taking me in? - I'm not.
0:19:49 > 0:19:54Liver function, blood count and clotting are deranged, chest X-ray
0:19:54 > 0:19:59shows two pleural effusions, renal function has deteriorated further.
0:20:00 > 0:20:03And aside from everything else, you still require a CT coronary
0:20:03 > 0:20:07angiogram and an endoscopy, which would take a few days to organise.
0:20:11 > 0:20:16I'm afraid I can only concur with my colleagues at Holby.
0:20:16 > 0:20:18It's just too risky at present.
0:20:22 > 0:20:25You should carry on with the antibiotics
0:20:25 > 0:20:28and conducting the outstanding investigations.
0:20:28 > 0:20:31Hopefully the pleural effusions can be cleared with diuretics...
0:20:31 > 0:20:32Yes, enough.
0:20:36 > 0:20:38Connie...
0:20:39 > 0:20:44I know, for people like us, acceptance is a dirty word,
0:20:44 > 0:20:46- but sometimes...- Yeah, OK.
0:20:51 > 0:20:54I can arrange for a transfer by ambulance back to Holby.
0:20:55 > 0:20:57That won't be necessary.
0:21:01 > 0:21:03Thank you.
0:21:05 > 0:21:07Our GP said that we could move somewhere together.
0:21:07 > 0:21:09That was to a care home, was it?
0:21:09 > 0:21:12They swore that they'd let us keep Waffle,
0:21:12 > 0:21:13so we gave up our flat.
0:21:15 > 0:21:19But then Ted passed away and they brought in new management.
0:21:19 > 0:21:21Right.
0:21:21 > 0:21:24And now he's a "health and safety risk"!
0:21:24 > 0:21:30They came in this morning and said they're taking him to a shelter.
0:21:32 > 0:21:35Oh, right, so that's what was happening this morning,
0:21:35 > 0:21:38you were running away. Where were you going to go?
0:21:38 > 0:21:42I don't know... Oh, maybe you could help?
0:21:42 > 0:21:46- Me?!- You could say I have to keep him for health reasons.
0:21:46 > 0:21:47Hang on a second...
0:21:47 > 0:21:50You could get in touch with the liaison team, the council,
0:21:50 > 0:21:54find us somewhere else - a flat, sheltered accommodation.
0:21:54 > 0:21:58- I...- Seeing as we're only here because of you.
0:21:59 > 0:22:01OK, let's not start all of that again.
0:22:01 > 0:22:03I know what I smelt this morning.
0:22:05 > 0:22:08Sheltered accommodation?! Do you think I've got a magic wand?
0:22:08 > 0:22:09I know, I know.
0:22:09 > 0:22:12First things first, can we do something about...?
0:22:12 > 0:22:13You've got to be joking.
0:22:13 > 0:22:17OK, well, let's get in touch with the advanced discharge team,
0:22:17 > 0:22:20- let's see what they can do. - Not much, I bet.
0:22:20 > 0:22:24It's not like she's homeless. Don't get me wrong, I feel for her, but...
0:22:24 > 0:22:26OK, shall we give it a go before we just give up?
0:22:26 > 0:22:29I'd do it myself, I've got a million and one things...
0:22:29 > 0:22:31- Make that a million and two - Dr Keogh?
0:22:31 > 0:22:34- I'm sorry, I'm a little bit busy at the moment.- No worries.
0:22:34 > 0:22:36We just need to take a few details and a quick breathalyser.
0:22:36 > 0:22:39Right. Breathalyser? Is that essential, is it?
0:22:39 > 0:22:42Standard procedure after an RTC. Only takes two minutes, though.
0:22:42 > 0:22:45- Your office? - Yeah, fine. Through there.
0:22:57 > 0:22:59As you said, you had to try.
0:23:00 > 0:23:03It's probably a good thing.
0:23:03 > 0:23:05In a few days, you'll feel a lot stronger.
0:23:14 > 0:23:15Have you spoken to Grace?
0:23:17 > 0:23:18Grace?
0:23:19 > 0:23:23Yes. She deserves to know, doesn't she?
0:23:25 > 0:23:28And the point of that would be?
0:23:28 > 0:23:31That you shouldn't be going through something like this on your own.
0:23:33 > 0:23:36- You're here.- Yeah, yeah, because you need a chauffeur.
0:23:36 > 0:23:38Sorry if I'm not grateful enough.
0:23:38 > 0:23:42- I don't want you to be grateful. - What do you want then?
0:23:42 > 0:23:44A tiny bit of respect wouldn't go amiss.
0:23:44 > 0:23:46- Oh, please.- Trust.- Please!
0:23:46 > 0:23:49You go round barking orders at me, you lie to me, you dismiss me.
0:23:49 > 0:23:52Can we just not do this now? Your little tantrums.
0:23:52 > 0:23:54Tantrums? Do you see what you do?
0:23:54 > 0:23:56Do you really believe everybody else is an idiot?
0:23:56 > 0:23:59Forgive me if I don't look for a shoulder to cry on and pitiful...
0:23:59 > 0:24:03- For someone who's scared of dying alone, you're doing a damn good job.- What would you know about it?!
0:24:03 > 0:24:06You're not the one with the ticking time bomb inside you!
0:24:06 > 0:24:07I have Huntington's!
0:24:14 > 0:24:15Keep going,
0:24:15 > 0:24:17keep going,
0:24:17 > 0:24:19keep going and stop.
0:24:21 > 0:24:23BEEPING
0:24:24 > 0:24:26What's that? Is that a good sign?
0:24:26 > 0:24:27Yep, all fine.
0:24:27 > 0:24:29KNOCKING Sorry.
0:24:29 > 0:24:32I've got Gloria's ECG here. You need to take a look.
0:24:32 > 0:24:34Oh, all right. If you'll excuse me.
0:24:34 > 0:24:37Of course. We just need a quick word with Mrs Roades.
0:24:37 > 0:24:39OK. She's undergoing a few tests at the moment,
0:24:39 > 0:24:41so probably not the best time.
0:24:41 > 0:24:42Oh, no worries. We'll wait.
0:24:44 > 0:24:47How could he test you without your knowledge? Well, it's Cal.
0:24:49 > 0:24:52Yeah, in his inimitable fashion.
0:24:52 > 0:24:53And I tested positive.
0:24:58 > 0:25:00Not often I see you lost for words.
0:25:02 > 0:25:03There it is.
0:25:05 > 0:25:07I'm not as fragile as I look.
0:25:09 > 0:25:11You're certainly not.
0:25:15 > 0:25:19All I meant was, you can cry on my shoulder...
0:25:21 > 0:25:23..metaphorically speaking.
0:25:26 > 0:25:28OK, let's get going.
0:25:28 > 0:25:32No. Not yet.
0:25:33 > 0:25:36Holby City Hospital will still be there tomorrow.
0:25:40 > 0:25:42Bradicardia.
0:25:42 > 0:25:44Well, I mean, it explains why she's falling over.
0:25:44 > 0:25:47But she's on beta blockers, isn't she?
0:25:47 > 0:25:50Yup. Atenolol - 50mg a day.
0:25:50 > 0:25:53The care home e-mailed her notes over.
0:25:53 > 0:25:56Oh, and I've been up to the advanced discharge planning office,
0:25:56 > 0:25:58there's no-one there as usual.
0:25:58 > 0:25:59Give me those pills.
0:25:59 > 0:26:03These are 25mg... That would do it, wouldn't it?
0:26:03 > 0:26:05That would do it.
0:26:06 > 0:26:10I know full well how much I should be taking - 50mg.
0:26:11 > 0:26:14But you're telling us you take three a day,
0:26:14 > 0:26:16- they're 25 milligrams each. - Exactly!
0:26:16 > 0:26:18Gloria, that's 75.
0:26:18 > 0:26:20Yeah, that's very important. If you take too many, you're going
0:26:20 > 0:26:23to lower your blood pressure and lower your heart rate
0:26:23 > 0:26:25and you run the risk of falling.
0:26:25 > 0:26:28Maybe I got confused. I know I should be taking four.
0:26:28 > 0:26:29Four?
0:26:29 > 0:26:34I-I know, arithmetic was never my strong suit.
0:26:37 > 0:26:38What a view.
0:26:38 > 0:26:41Hmm.
0:26:41 > 0:26:43Have you been on the London Eye?
0:26:43 > 0:26:45- No.- No?
0:26:45 > 0:26:46Not really my thing.
0:26:46 > 0:26:49Don't tell me you're scared of heights.
0:26:49 > 0:26:50It's not really the height.
0:26:50 > 0:26:53It's being trapped in a capsule 500 feet above ground
0:26:53 > 0:26:54with loads of people you don't know.
0:26:54 > 0:26:57Claustrophobia with a slight control issue then.
0:26:57 > 0:26:59What makes you say that?
0:26:59 > 0:27:01Have you ever been on it?
0:27:01 > 0:27:03Please. I don't do queues.
0:27:08 > 0:27:11This place is...quite something.
0:27:14 > 0:27:17Sorry, you're going to have to sleep on the sofa.
0:27:17 > 0:27:19I think it'll do.
0:27:19 > 0:27:23Traditionally, the chauffeur should sleep in the car, so...
0:27:23 > 0:27:24Right.
0:27:32 > 0:27:37No IV bags, no medication, no nothing.
0:27:37 > 0:27:41If I go, on Egyptian cotton it will be.
0:27:44 > 0:27:48I always intended to do something like this.
0:27:48 > 0:27:52Obviously I envisaged a different circumstance.
0:27:52 > 0:27:54Maybe for Grace's birthday.
0:27:54 > 0:27:56A special one, you know, a 16th or something,
0:27:56 > 0:27:58so she could legally drink champagne.
0:28:02 > 0:28:04Champagne.
0:28:04 > 0:28:06- Mmm.- Mmm.
0:28:09 > 0:28:11Oh, Fleurs Du Bois.
0:28:12 > 0:28:15What a shame chemo's destroyed my taste buds.
0:28:15 > 0:28:17Yours are still intact. There you go.
0:28:20 > 0:28:22OK, no worries. Let's try again.
0:28:22 > 0:28:24Which finger am I pressing now?
0:28:26 > 0:28:28Er... My thumb?
0:28:29 > 0:28:31OK, um. This one?
0:28:33 > 0:28:34Little finger?
0:28:35 > 0:28:39Can you put your left hand to your ear for me?
0:28:40 > 0:28:44Right, OK. I'm going to ask you to write your name.
0:28:44 > 0:28:45If you could just...
0:28:45 > 0:28:48Anywhere in that box is fine.
0:28:48 > 0:28:49Sorry, there you go.
0:28:55 > 0:28:57What is all this nonsense?!
0:28:58 > 0:29:00Let's book her in for a head CT.
0:29:00 > 0:29:02I've got to make a quick phone call, all right?
0:29:04 > 0:29:07Don't let me drink all this on my own.
0:29:07 > 0:29:09I think you've finished it anyway.
0:29:12 > 0:29:14Well, at least I can feel the bubbles on my tongue,
0:29:14 > 0:29:16if I can't taste them.
0:29:16 > 0:29:18Let memory do the rest.
0:29:25 > 0:29:29- £352 for a bottle of champagne.- Mmm.
0:29:29 > 0:29:31That is a first for me.
0:29:32 > 0:29:34Well, probably be the last for me, so...
0:29:34 > 0:29:38Come on, I'm the patient, I can say what I like.
0:29:38 > 0:29:42I certainly wouldn't be having chips if I didn't have cancer.
0:29:42 > 0:29:44You should always have chips.
0:29:44 > 0:29:45Yeah, you should always have chips.
0:29:47 > 0:29:50Do you know what? I love this place.
0:29:50 > 0:29:53It really is the best skyline in the world.
0:29:53 > 0:29:55Spoken like a true Londoner.
0:29:55 > 0:29:58Absolutely. I was born half an hour from here in Peckham.
0:29:58 > 0:30:01- You were? - Yeah. Don't tell anyone.
0:30:03 > 0:30:07Yeah, I did my first cardiac surgical rotation in King's College,
0:30:07 > 0:30:11down the road, so, yeah, my town...
0:30:11 > 0:30:15I can't really imagine you like that, as a junior doctor.
0:30:15 > 0:30:17Come on, I wasn't always old, thank you very much.
0:30:17 > 0:30:19I didn't mean it like that.
0:30:19 > 0:30:22- You're not old!- Well...
0:30:22 > 0:30:24You're not. Far from it.
0:30:28 > 0:30:31You and Cornell - there's a history there.
0:30:33 > 0:30:36- That obvious, is it?- Yes.
0:30:36 > 0:30:39Do you know what? From the off, she was my nemesis.
0:30:39 > 0:30:42She was posh, she was brainy, she was a bit of a looker.
0:30:42 > 0:30:46- Ah, rival.- Yeah, I mean, it was strange.
0:30:46 > 0:30:50We intensely disliked each other from the start and there was
0:30:50 > 0:30:53competition between us.
0:30:55 > 0:30:57Why did you choose her?
0:30:57 > 0:31:00She's good. Seriously good.
0:31:01 > 0:31:05I mean, sharp mind and sharp hands too.
0:31:07 > 0:31:10Honestly, I'm surprised she passed up the chance to cut me up.
0:31:12 > 0:31:16- Why?- Well, let's just say there was a man involved.
0:31:16 > 0:31:18Oh, right.
0:31:18 > 0:31:21Which...you got?
0:31:21 > 0:31:23Maybe.
0:31:24 > 0:31:28Of course. So, actually, nothing's really changed.
0:31:33 > 0:31:39You know, I would never, ever have told anyone about Scott Ellison,
0:31:39 > 0:31:40if that's why you're doing this.
0:31:41 > 0:31:44- No, it's not.- Why then?
0:31:50 > 0:31:54Because I've never met anyone like you before.
0:31:54 > 0:31:56I probably never will.
0:31:57 > 0:31:59That's why.
0:32:04 > 0:32:06Mrs Beauchamp.
0:32:13 > 0:32:16- I-I didn't mean it like that.- No. - Mrs Beauchamp...
0:32:16 > 0:32:17- No.- Connie!
0:32:17 > 0:32:19Stay away from me.
0:32:19 > 0:32:21Please, don't go.
0:32:21 > 0:32:23Don't come near me ever again.
0:32:41 > 0:32:43Well, I've booked a head CT just to be sure.
0:32:43 > 0:32:45Yes, OK, all right, bye.
0:32:45 > 0:32:47Dr Keogh, I don't know how to tell you...
0:32:47 > 0:32:48To be honest,
0:32:48 > 0:32:51it's probably too late for sheltered accommodation.
0:32:51 > 0:32:53Never mind all that. We've lost the dog.
0:32:55 > 0:32:57I only took my eye off him for a second and...
0:32:57 > 0:32:59I gave the two of you one job - could you not keep it together?
0:32:59 > 0:33:02- Hang on!- It's fine. We'll find the dog and
0:33:02 > 0:33:04there are charities that foster them until she can...
0:33:04 > 0:33:07You don't understand, that lady has to go back to a care home.
0:33:07 > 0:33:10- Yes, I did try to tell you that.- No! She has to go back to a care home
0:33:10 > 0:33:12because she's got Gerstmann syndrome!
0:33:12 > 0:33:15That means that all of the things that we saw in there,
0:33:15 > 0:33:18- they're not getting any better. - Well, don't take this out on us.
0:33:18 > 0:33:20First of all, you couldn't wait to get rid of her,
0:33:20 > 0:33:22then you dump her dog on us and then you make promises that
0:33:22 > 0:33:25no-one can keep. And when things don't work out, you blame us!
0:33:25 > 0:33:27I'm sorry, I'm done.
0:33:27 > 0:33:30- I'll...find the dog. - Yeah, find the dog, Max.
0:33:44 > 0:33:47SHE BREATHES HEAVILY
0:33:50 > 0:33:52PHONE RINGS
0:34:35 > 0:34:39Can I have another bottle of champagne, please?
0:34:39 > 0:34:41Thank you.
0:35:10 > 0:35:12Gerstmann syndrome, what's that?
0:35:12 > 0:35:14Well, it's a neurological condition.
0:35:14 > 0:35:20A collection of symptoms, some of which we saw you exhibit earlier on.
0:35:20 > 0:35:22It's normally brought on by a minor stroke.
0:35:22 > 0:35:24- Stroke?- The CT picked it up.
0:35:24 > 0:35:26This is probably why you were mixing up your doses
0:35:26 > 0:35:28and obviously we know that's why you fell.
0:35:28 > 0:35:31But apart from that, I'm-I'm fit and well.
0:35:31 > 0:35:34Unfortunately, the symptoms extend beyond what we've already seen.
0:35:34 > 0:35:37I think it's unlikely you'll be able to live on your own.
0:35:37 > 0:35:40That will include sheltered accommodation. I'm really sorry.
0:35:40 > 0:35:43No, no you're wrong. I want to see someone else.
0:35:43 > 0:35:45- All right.- Why should I take the word of a drunkard?
0:35:45 > 0:35:48- I know you're upset... - I know what state you were in!
0:35:48 > 0:35:51- I would ask you to keep your voice down...- Call yourself a doctor?
0:35:51 > 0:35:55You're a disaster, you won't get away with this. Waffle!
0:35:55 > 0:35:58Waffle, Waffle!
0:35:58 > 0:35:59There you go.
0:35:59 > 0:36:00Waffle.
0:36:02 > 0:36:04I want to be left alone.
0:36:04 > 0:36:07Do you not hear me? Leave us alone!
0:36:19 > 0:36:21Connie!
0:36:24 > 0:36:25KNOCKING
0:36:28 > 0:36:30Connie, can you let me in, please?
0:36:31 > 0:36:34Connie, can you please open the door?
0:36:39 > 0:36:41GLASS SMASHES
0:36:49 > 0:36:50KNOCK AT DOOR
0:36:50 > 0:36:52Yeah, yeah, come in.
0:36:55 > 0:36:57Mrs Roades' neurology follow-up appointment.
0:36:57 > 0:37:00We can discharge her back to the care home.
0:37:00 > 0:37:03Those places, they're so cynical. Do you know what they said to me
0:37:03 > 0:37:05when I told them she'd been wandering the streets on her own?
0:37:05 > 0:37:08"She's not down for one-on-one nursing care.
0:37:08 > 0:37:09"We don't run a prison here".
0:37:11 > 0:37:12What?
0:37:15 > 0:37:18- They're allowing me to keep him? - They are.
0:37:18 > 0:37:21There's a member of staff on their way here to pick you up as we speak.
0:37:21 > 0:37:22But how did you wangle that?
0:37:22 > 0:37:25Well, um, I started out by pointing out, as you suggested,
0:37:25 > 0:37:27the many therapeutic benefits of keeping pets.
0:37:27 > 0:37:30- That wouldn't work with them. - You're quite right, it didn't.
0:37:30 > 0:37:32So I then went on to point out
0:37:32 > 0:37:35a little bit more forcefully that, seeing as you were in their care,
0:37:35 > 0:37:38they were responsible for you taking the correct medication
0:37:38 > 0:37:41and I thought the Care Quality Commission might be interested
0:37:41 > 0:37:44to know they hadn't noticed you'd gone missing until we told them,
0:37:44 > 0:37:48so I said I'd come to an understanding that they had to do their bit.
0:37:48 > 0:37:52Hear this, Waffle? Now wasn't that worth nearly getting run over for?
0:37:55 > 0:37:58I wouldn't have said anything, you know, to the police.
0:37:58 > 0:38:00But I know a mess when I see one.
0:38:00 > 0:38:02Get help.
0:38:13 > 0:38:14KNOCKING
0:38:14 > 0:38:16Housekeeping.
0:38:22 > 0:38:25WATER GUSHES
0:38:25 > 0:38:28SIREN WAILS
0:38:35 > 0:38:38SHE MUMBLES
0:38:52 > 0:38:54Welcome back to St Eugene's.
0:38:57 > 0:38:59What happened?
0:38:59 > 0:39:04I suspect your tumour transiently blocked your mitral valve.
0:39:04 > 0:39:08It moved out of the way when you passed out,
0:39:08 > 0:39:10otherwise you wouldn't be with us now.
0:39:14 > 0:39:19You're in heart failure, but you got your own way in the end.
0:39:19 > 0:39:22- We have to operate now.- Good.
0:39:22 > 0:39:25My team will prep you, we've got a slot in an hour.
0:39:27 > 0:39:29Good luck.
0:39:29 > 0:39:31Where's your friend?
0:39:31 > 0:39:32SHE SIGHS
0:39:33 > 0:39:35I see.
0:39:35 > 0:39:37We're born alone, we live alone...
0:39:37 > 0:39:38But we don't have to die alone.
0:39:41 > 0:39:44You have a daughter, right?
0:39:44 > 0:39:49I must admit I was surprised when I heard. Does she know you're here?
0:39:51 > 0:39:52She's with her father.
0:40:00 > 0:40:01See you on the other side.
0:40:08 > 0:40:10Dr Keogh, I heard about your great triumph today.
0:40:10 > 0:40:14Just off to the Hope and Anchor, you fancy it?
0:40:14 > 0:40:16Um, no, I've got rather a lot of paperwork to catch up on.
0:40:16 > 0:40:19Oh, come on. Today, of all days, you deserve a drink.
0:40:19 > 0:40:20Just one!
0:40:24 > 0:40:27Actually, go on, then. Yeah, all right. Just the one.
0:40:54 > 0:40:57- VOICE MAIL:- Hi, this is Grace. You know what to do.
0:41:13 > 0:41:14Charlie?
0:41:14 > 0:41:16Count back from ten for me, please.
0:41:17 > 0:41:23Ten, nine, eight...
0:41:30 > 0:41:34Yes, I need to speak to Connie Beauchamp, please - room 131A.
0:41:36 > 0:41:37I'm a work colleague.
0:41:39 > 0:41:41Why?
0:41:41 > 0:41:42What?
0:41:44 > 0:41:46Yes, please!
0:41:48 > 0:41:50Stop!
0:41:51 > 0:41:53Thank you. St Eugene's Hospital, please.
0:41:59 > 0:42:02CLASSICAL MUSIC PLAYS
0:42:25 > 0:42:26OK to begin.
0:42:28 > 0:42:31I'm going to be making a mid line sternal incision
0:42:31 > 0:42:37from below the sternal notch to the xiphoid. I am separating
0:42:37 > 0:42:42the underlying soft tissue from the sternum, exposing the bone.
0:42:47 > 0:42:48Drive safely.
0:42:49 > 0:42:52- I'll give you a ring as soon as I know anything.- OK.
0:42:52 > 0:42:54Bone saw.
0:43:02 > 0:43:04Stop ventilation.
0:43:09 > 0:43:11SAW WHIRS
0:43:33 > 0:43:34Forceps.
0:43:36 > 0:43:38Scissors.
0:43:42 > 0:43:45Opening the pericardial sac.
0:44:19 > 0:44:21Removing the tumour.
0:44:25 > 0:44:28Now, let's repair the valve.
0:44:28 > 0:44:31And we need a patch to repair the atrial septum.
0:45:10 > 0:45:13She's come off bypass easily enough.
0:45:13 > 0:45:16Prepare to remove the vena caval cannulas.
0:45:16 > 0:45:19Can you stop a moment? Pressure's dropped.
0:45:19 > 0:45:21- Severe mitral reflux on TOE. - What, leaks?
0:45:21 > 0:45:24It's severe. She's throwing off multiple PVCs.
0:45:24 > 0:45:25She's gone into VF.
0:45:25 > 0:45:28- BEEPING - One of the stitches must have cut through.
0:45:28 > 0:45:30Start cardiac massage.
0:45:30 > 0:45:31Get her back on bypass.
0:45:31 > 0:45:35Let's restart cardioplegia. We have to go in again.
0:45:41 > 0:45:42Morning, Ethan.
0:45:43 > 0:45:45Ethan.
0:45:48 > 0:45:50OK?
0:45:54 > 0:45:56So...they don't know if she'll come through?
0:45:56 > 0:45:59Of course she's going to come through.
0:45:59 > 0:46:01Charlie will call as soon as he knows.
0:46:02 > 0:46:04Have you heard about this?
0:46:04 > 0:46:07Connie...being operated on in London last night.
0:46:07 > 0:46:09Was she? Was she? Good for her.
0:46:10 > 0:46:13Or not? No? Not good?
0:46:13 > 0:46:16HR called, they need your conflict resolution update ASAP.
0:46:16 > 0:46:19The finance office needs your recommendations from yesterday
0:46:19 > 0:46:22and here's that clinical guideline committee report.
0:46:22 > 0:46:25Great, all right.
0:46:25 > 0:46:26Oh, man!
0:46:29 > 0:46:32- You all right? - Yeah. Thank you. Thanks.
0:46:37 > 0:46:40Well, you gave us a run for our money.
0:46:40 > 0:46:44I had to remove the entire interatrial septum and repair
0:46:44 > 0:46:46the defect with a Dacron patch.
0:46:47 > 0:46:49But the tumour is gone.
0:46:51 > 0:46:55Now, before you go planning your conquest of the Wild West,
0:46:55 > 0:46:57I want to be very clear -
0:46:57 > 0:46:59you're going to stay put.
0:46:59 > 0:47:04We're going to keep you on IV antibiotics, Amiodarone, diuretics,
0:47:04 > 0:47:08and there's no getting away from at least two more cycles of chemo.
0:47:08 > 0:47:11- That's fine, that's fine. I've got it.- Good.
0:47:12 > 0:47:14Arianne.
0:47:15 > 0:47:16Thank you.
0:47:22 > 0:47:24Hello, it's me.
0:47:24 > 0:47:28I-I-I'm sorry to call so early, late...
0:47:28 > 0:47:34I-I don't know what's happening, I don't know what
0:47:34 > 0:47:40I'm doing and suddenly it's just all falling apart.
0:47:42 > 0:47:43Hmm.
0:47:50 > 0:47:51Arianne...
0:47:51 > 0:47:56- CHARLIE:- She'll never change. She can't stand people seeing her weak.
0:47:56 > 0:47:58Sorry, can I ask you one thing?
0:47:58 > 0:48:01- Well, she'll just have to get used to it.- Yeah.
0:48:05 > 0:48:06You can go in now, but not for long.
0:48:09 > 0:48:12Just Mr Fairhead, I'm sorry, that's what she said.
0:48:21 > 0:48:23Hiya, Charlie.