Episode 24 Casualty


Episode 24

Under-pressure Ethan makes a decision that exposes the weaknesses of the ED and gives ammunition to the anonymous blogger. It is Gem's first day as a porter.


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Transcript


LineFromTo

It's over, Iain, I'm going to go hand myself in.

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I promise I'll do you proud.

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As of today, I am Clinical Lead of the department

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You weren't my first choice but we were short of candidates

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The hospital is officially full.

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HTC and Resus only for those who absolutely need it.

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We're going to have to put him in the corridor for now,

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just for a minute. I'll get it sorted.

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What has to happen before people start listening?

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I'm doing my best.

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Yeah, well, it's not good enough

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Welcome to Holby FM.

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Today, we are talking about Rage in Resus,

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the controversial blog everyone is talking about.

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The NHS is broken.

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I'm quite surprised a doctor is talking like this about their own department.

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News just in, the hospital in question has just been

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revealed as Holby City Hospital.

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I just cant believe this is happening in Holby, I use that hospital.

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I'm not using Holby City any more, I'm going to St James'.

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It really feels like the NHS is at breaking point now.

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-Virgin.

-Sorry?

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Heads of Department meet. Your first?

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-It's that obvious, is it?

-Yes.

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This is bad timing for you.

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I assume you have a response to this?

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-Something to answer the accusations.

-Not answer, no.

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But I have been looking at ways to increase department capacity and flexibility.

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Really? But I thought you were already over budget?

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Actually, this doesn't need any extra funding

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and I think it could have a positive effect on the take wards.

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It's a Clinical Decision Unit. Run by the F1s.

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F1s! Ha! May as well hand toddlers some hammers and saws.

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You're announcing the start of that today, are you?

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Uh, no. Not yet.

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It's not ready. I haven't finished the protocols and I haven't secured any more beds.

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Well, there are no more beds. You know that.

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If there were, you wouldn't be resorting to stunts like this.

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Protocols can be written up afterwards.

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I think the nursing staff might object.

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Of course they will. Especially the fat ones.

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But that's what being Clinical Lead means, Ethan, not always being popular.

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Yes, well, I'm getting good at that part.

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You know, I have some reclining chairs that I could send your way...

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They wouldn't be missed.

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What would I have to do in return...?

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Take on some of my cases.

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Maybe the troponin tests.

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We're full, too, Ethan.

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I'm losing surgical beds to patients waiting for blood tests.

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I have a couple of patients in HDU, they both need diagnostic angios.

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I can't get them moved, they're about to breach.

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-If you were able to help?

-Sounds like a deal.

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It's certainly something I could look into.

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Yes, great.

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After you.

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Thanks.

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Morning.

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Right, Gem, we need to leave. Oi! We're going to be late.

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You will be. I'll be 45 minutes early.

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-Oh, there's my top.

-Yeah, I've ironed it for you.

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Thanks, Mum.

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-Might need help with my laces too.

-Come on.

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You're not dressed yet.

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I couldn't.

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Someone had my top.

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-Come on, then.

-Go!

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What a mess.

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This isn't right.

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What do you mean? It's completely right.

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That's not what I meant...

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About time someone spoke up.

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-You think?

-I think they're bang on.

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It is broken. We saw that.

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But this isn't the way to change things.

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It will put the trust on the defence.

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They have no more money.

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Attack the government, not the trust.

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What, you don't think this is?

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They should prioritise.

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I mean, it's always us that get squeezed.

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Speaking truth to power. That can't harm can it?

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-Just my opinion.

-Ugh!

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Drinks tonight.

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Hope and Anchor. Please!

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-For once, I am thirsty and fancy free.

-Sounds good.

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Hiya, this is Matilda Dunford...

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Do not call her Mattie...

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-It's not my name.

-It's not her name. Right, she's 79 years old.

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Oh, please! Shush.

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She's been suffering from chest pains and shortness of breath for the past 48 hours.

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But she didn't like to complain. Her BP 180/90.

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Sats of 95%. Pulse 85.

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We've done an ECG which shows T wave inversion in the anterior leads.

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We've got a list of meds from Burwell Park

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and she is on medication for angina.

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I'm a mother. I was a wife.

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I used to be a chef.

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I like roses, sticky puddings and crosswords.

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I'm not just numbers on a little screen.

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-Quite right, Matilda.

-Shall we get her booked in?

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Matilda, I'm Dr Munroe.

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Is there anyone we can call for you?

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Well, my daughter lives abroad.

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But you can give me this young man's number.

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Right. Dr Masum.

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What should we do?

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Duffy, have you seen my little sister, Gemma?

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-She's started as a porter today.

-Sorry, no.

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And in here are the cubicles.

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Now, Gem, let me be very clear.

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I'm all for giving people second chances.

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Especially when they're as young as you.

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-But one thing I won't tolerate...

-No stealing drugs?

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-Humour's not against the rules, is it?

-Not when it's funny, no.

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This department is running at full capacity, as you can see.

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We can't afford for any slip ups. This is a trial period.

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You get no special treatment.

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Because of my brother? Well, let me be clear...

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I meant because of your background.

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You're here as a paid member of staff in my department.

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This isn't a hand-holding programme.

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Sorry. Nerves.

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Let me find Glen. He can show you around.

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LAUGHTER

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One eyebrow's too high. I've done you all Roger Moore.

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LAUGHTER

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-Having fun, girls?

-Her name's Bond.

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-Here, let me have another go.

-No. She looks great.

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-Don't be such a perfectionist, Valerie.

-Hello, ladies!

-Morning!

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Oh, you look smashing.

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You've outdone yourself, Val.

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Just got off the phone. Matilda's fine, the hospital says.

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They think it's just her angina flaring up.

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They're going to keep her in for some checks but she should be back with us today.

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Good. We all love Matilda.

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I wish she'd said something earlier.

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She looked so poorly this morning.

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I really thought...

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I would have gone with her but...

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We need you here.

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Right, well, we can let everyone know she's OK.

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They're all a bit worried. Especially Val.

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-Found this in the kitchens.

-Oh, not again! I'll call the agency.

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It's OK. This is a pork chop, I think.

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-Not a dead rat this time.

-Oh, that's OK, then.

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-Can't we get another firm in?

-Magda, you know my cleaning budget.

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They think if the place is grubby, we'll make up the shortfall.

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-We do! That's how I found that.

-I'm sorry

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Kitty, you next.

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Then you, Colin.

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SHE CHUCKLES

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-Ah!

-Whoa!

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You nearly knocked me over!

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-Jacob, I'm so sorry. It's all my fault.

-Sorry.

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Where are you lot taking these anyway?

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Old training room, Ethan said.

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CDU, he called it.

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-New area in the department.

-CDU?

-Mm-hm.

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Oh, really.

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That's a good start.

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Come on, then.

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Are you serious?

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I cannot have a repeat of what happened with Kam Kainth.

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It's winter, it's our busiest time.

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My hands are tied with staff and budgets.

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If you can think of a better way to introduce some departmental

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flexibility, for no additional spend...

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I'm all ears.

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It's not a vanity project, Jacob.

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Maybe not, but I bet no-one's tried to stop you.

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I mean, ED holding patients for longer, off the clock.

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What's not to love? For them.

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We cannot have any more trollies queuing in the corridors. OK?

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-Turning away ambulances.

-With respect,

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-I think you're trying to make an impression with senior colleagues.

-No, that is not I'm trying to do.

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No, no, I get all that.

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Duffy, Duffy!

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Ethan has decided to open up a CDU! The F1s will manage the patients.

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-You've done what?!

-It's a holding area.

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It helps us. It adds capacity.

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More capacity with the same staff.

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And where are the beds?

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There are no beds, its trollies and chairs.

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Patients still need nursing, whatever position they're in.

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And I know what position you're putting us in.

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So who looks after them? They'll need water?

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And will you be out collecting pizzas?

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OK, I'm sensing some resistance...

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Because it doesn't work, Ethan.

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-We've tried it.

-Actually no, you haven't.

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Not with me in charge.

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So you know better than Mrs Beauchamp?

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Oh, excuse me. Dr Dashing...

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Not Dash. It's Rash.

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Rash. Like a rasher.

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A sizzling rasher.

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Ooh. I could kill a bacon sandwich.

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I haven't had my breakfast. Anyway.

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I want to check.

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You will look after me, won't you?

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Because this doesn't fill me with confidence.

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And you do seem rather busy...

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Oh, don't worry, the papers have exaggerated.

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You're definitely in safe hands here.

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-And your ECG is fine.

-Right.

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We might be able to send you back to the care home soon then, Matilda.

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Oh!

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Could I get two minutes with anyone who's free in the staff room, please?

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All right, won't be long.

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Thank you.

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Hey, have you heard?

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Uh, no. Can it wait? Sorry.

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Sure.

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I just thought you'd want some good news.

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Yeah. What is it?

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Kam Kainth. He's much improved.

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Right, OK. Thank you.

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Uh, OK. I'm going to keep this super brief because we're all very busy.

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We're going to be trialing a new arrangement for the next couple of weeks, OK?

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I want to establish a Clinical Decision Unit

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up in the old training room as a means of increasing capacity,

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but also taking some pressure off all of us.

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And I'd like the F1s to look after it.

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It's chairs and trollies.

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No beds and it's effective immediately.

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-What? No, no.

-What? No, no, no!

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I know it'll be a struggle

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but it's imperative that we make some changes now.

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Ethan... We don't have protocols in place.

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I want to see what works and then we'll write it up afterwards.

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We'll keep talking and work it out together.

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Yeah? Can I have quick word?

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I can say with some certainty that this...

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Well, the CDU is designed to be boring.

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If it turns out it's fun, then something's gone drastically wrong.

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Sorry, but let's call it educational. Yeah? Thanks

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Nearly done, Colin.

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SHE CHUCKLES

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I've gone and made you all One Direction.

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Ooh. Ah.

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Val! Where's the pain? Magda, call an ambulance!

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I've got you, it's all right, Colin.

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Go and sit down, here you go, here you go. That's it

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Iain! Good.

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-It's gone. Where can I get another?

-Slow down. What's gone?

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My wheelchair! I'm meant to be moving this old lady.

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I put it outside the toilet because sometimes you've got to pee.

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Came out and someone's nicked it.

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Well, welcome to the fully funded NHS.

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Schoolboy error. Wheelchairs are rare.

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-So other porters hide them.

-Don't be daft.

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-Because if they don't, somebody nicks them.

-This is a hospital.

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I'm on my lunch soon, if you want a hand...

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-with your quest.

-No! No. I'm fine, I just...

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Control to 3006. Please respond, over.

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3006. Go ahead.

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RTC on Auborn Way. One female injured still in vehicle.

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There it is. Oi! You!

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Received and en route. Over.

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Thanks very much. Uh, Valerie Clerk.

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Non-smoker. No history of cardiac problems.

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-Nothing in the family.

-So this isn't a heart attack...

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See the man in the ambulance said...

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I don't think it's a heart attack, Valerie,

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but we'll do a troponin test... A blood test, to be sure.

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What then? Angina? I've never had angina.

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Try not to worry, Val. I'm sure it'll be fine.

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Could be musculoskeletal?

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Let's repeat ECG, wait for the bloods

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and keep her on half-hourly obs.

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Possibly a candidate for CDU.

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-Frees up a bed.

-Shouldn't we treat the patient first?

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That's why I said possibly.

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You have a Matilda Dunford here, one of our ladies.

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-Your ladies?

-Burwell Nursing Home. I'm the Nurse Manager there.

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We were told to expect Matilda back but she hasn't turned up yet.

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-Ah.

-I'm really sorry. I'm not quite sure what's happened.

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-Let me find out.

-Thank you.

-Yeah, all right, thanks.

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Oh! I forgot my magic bag, Maxie.

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She means her make-up bag.

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-Our resident beautician here

-Former life.

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I'm sure you don't need it, Val.

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Some of us need to gild our God-given, Maxine.

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Don't all have your bone structure.

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-Maybe you could just pull the curtains a tad then, hey?

-Sure, yeah.

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Oh! Is that blood?

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Sorry, I'll get a cleaner.

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As bad as Burwell Park! No offence, Maxine.

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I'll be damned if I'm skivvying for the company as well.

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I give them enough free shifts as it is.

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-Oh, no, I didn't mean...

-I'm just going to get a coffee, Val.

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She'd do anything for you, that one.

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Lovely girl.

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Where's the transfer ambulance, Noel? I've been waiting there 20 minutes.

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There you are! They've called to say they got fed up of waiting.

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-They've gone.

-What? But I was there. How could they have missed me?

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That's exactly what I'm wondering.

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I was at the Ambulance Station.

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Well, you should have gone to the main entrance.

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-No-one said!

-For a transfer? Isn't it obvious?

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-Obviously her brother wasn't around to ask.

-Mm-hm.

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What? Well, I don't need to ask him.

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I rather enjoyed the fresh air.

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Outside. For 20 minutes? Are you sure you're OK, you're not cold?

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I'm fine. Well.

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-Maybe a little short on my breath.

-Right. Well.

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Best to get you checked over, just in case.

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Porters are meant to make our life easier, Gem,

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-and you're not doing that so far.

-Oh, come on. It's her first day.

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They never told us where we should wait anyway.

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This is Emma Edmonds, 24.

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She's suffered a previous spinal injury which left her

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paralysed from around T6.

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About 20 minutes ago, she was driving an adapted car which was

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hit side-on by another driver - not a big impact - but a glancing blow.

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First lesson.

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It wasn't my fault though.

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Emma was complaining of a headache on scene.

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But there's no injuries found.

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We didn't board her as she couldn't tolerate it.

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No other history.

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-Mum says she's on medication and has written down and she has no allergies.

-OK.

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Hi, Emma, I'm Doctor Gardner.

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I'd like to examine your spine, so hopefully,

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we can remove those blocks and make you more comfortable.

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1g of paracetamol, IV, please.

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That won't touch this. It's a seven.

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I know about pain scoring, yeah.

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-Are you OK with morphine?

-Hook me up!

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Let's get 5mg of morphine instead.

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Robyn, she has also has a suprapubic catheter that she's a little

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sensitive about.

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I've checked the bag and it's only half full.

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OK, thank you.

0:16:440:16:45

I'm sure everything will be fine, Emmy.

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-That's what you said last time!

-Last time?

0:16:470:16:50

Emma was paralysed in a car accident.

0:16:510:16:54

I was driving.

0:16:540:16:56

And texting.

0:16:560:16:58

-You've got something to say?

-Me?

0:17:000:17:03

No, I was just thinking how difficult it must be for both of you.

0:17:030:17:06

-You think? It's OK, Mum.

-Course it's not OK.

0:17:060:17:12

I wasn't driving this time, though.

0:17:130:17:15

First lesson and I get shunted.

0:17:150:17:17

-And now my mother will freak out every time.

-It's OK.

0:17:170:17:21

We're not lost, we're taking the scenic route!

0:17:210:17:25

But I need to be able to drive.

0:17:250:17:28

I've been accepted by Cambridge to read Natural Sciences.

0:17:280:17:31

And I am not taking my mother.

0:17:310:17:33

Congratulations, young lady.

0:17:330:17:36

-That's very impressive.

-Thanks.

-Cambridge, yeah?

0:17:360:17:39

-It's brilliant.

-Bye-bye.

0:17:390:17:42

I'm off to the CDU.

0:17:420:17:44

I'm hoping it's a bit like a seedy bar.

0:17:440:17:46

LAUGHTER

0:17:460:17:48

I'll see you there if it is. Is everything all right?

0:17:480:17:50

-Yeah, fine. Stop asking.

-I'm only trying to help.

0:17:500:17:53

Yeah, well, I don't want people thinking I need your help.

0:17:530:17:56

If we could have some focus please!

0:17:560:17:58

Iain, can you take Emma's head so we can remove the blocks.

0:17:580:18:00

-Emma, I need to do a full examination, OK?

-Mum,

0:18:000:18:03

-go get a coffee or something.

-I'm staying, I'm fine

0:18:030:18:06

There she is, hands all over my beau.

0:18:080:18:12

You what?

0:18:120:18:13

It's just us oldies having a bit of fun, sweetie.

0:18:130:18:16

-Hey, less of the "old", you.

-Well, back off the boyfriend then.

0:18:160:18:20

Mrs Dunford, in this chair, if you can.

0:18:200:18:23

Hello, Matilda, love.

0:18:230:18:25

Maxie. Nice to see you.

0:18:250:18:27

-How are you feeling?

-Better.

0:18:270:18:30

I'm glad I missed my ride though.

0:18:300:18:32

This is Matilda Dunford...

0:18:330:18:35

Yeah, I know. We've met.

0:18:350:18:37

I'm sorry Matilda. I had no idea.

0:18:370:18:40

I'll withdraw gracefully.

0:18:400:18:42

You take your best shot.

0:18:420:18:44

He's not interested in the fuller-figured lady.

0:18:440:18:48

I need more of your Slender and Lovely programme, Val.

0:18:480:18:51

Drop a few more pounds.

0:18:510:18:52

"Slender and Lovely programme"?

0:18:520:18:54

Ooh, 'ark at big ears here.

0:18:540:18:57

Hey, a lady doesn't reveal her beauty secrets.

0:18:570:19:00

There's only so much you can cover up with make-up, ladies.

0:19:000:19:03

Believe me, I've tried.

0:19:030:19:04

It's like sausages.

0:19:040:19:06

You wouldn't touch 'em if you knew how they were made.

0:19:060:19:09

THEY LAUGH

0:19:090:19:10

-She's right, you know.

-You're new, right?

-I am.

0:19:100:19:14

-Gem.

-Rash.

0:19:160:19:18

First day. Still finding her feet.

0:19:180:19:21

-Jen?

-Gem.

0:19:210:19:24

-Like the stone.

-Ah. Gem...stone.

0:19:240:19:28

Like a...rough diamond.

0:19:280:19:30

You know me already.

0:19:330:19:34

Oh, you really need to work on your smooth talk, Dr Dashing.

0:19:340:19:38

Hey why don't you practice on me?

0:19:380:19:40

-See you.

-See you.

0:19:440:19:46

Thanks.

0:19:490:19:50

I know we're being all flexible with protocols

0:19:520:19:54

but could you tell me what we do when the department's full,

0:19:540:19:56

CDU's full and we have waiting trollies?

0:19:560:19:58

-What do you mean full?

-What do you think I mean, Ethan?

0:19:580:20:01

CDU?

0:20:010:20:03

Two that would normally go to Jac Naylor.

0:20:030:20:05

Then Valerie Clerk and Matilda Dunford from Burwell Park.

0:20:050:20:07

Oh, and another one that's just arrived by the way.

0:20:070:20:09

So that's three in three hours, what's that about?

0:20:090:20:12

Matilda Dunford?

0:20:120:20:13

She missed her transport.

0:20:130:20:15

This stuff happens every day.

0:20:150:20:17

Or did you forget?

0:20:170:20:18

Let me guess, boys, Burwell Park?

0:20:180:20:20

We should fit a trailer. Save some diesel.

0:20:200:20:22

-Tell me about it.

-You went to Burwell Park?

0:20:220:20:24

-Yeah.

-Why?

0:20:240:20:25

Thinking of buying a country pile? Match the new job?

0:20:250:20:27

I wouldn't get that place.

0:20:270:20:29

Heard they failed their CQC.

0:20:290:20:30

Really?

0:20:300:20:32

-Just don't accept the free lunch, that's all I'm saying.

-OK, thanks.

0:20:320:20:36

-Duffy...the two free beds in HDU?

-Free?

0:20:360:20:39

Do you want me to tell the patients currently occupying them or will you?

0:20:390:20:43

Not the same ones? No, Jac Naylor should have taken them.

0:20:430:20:46

Jac Naylor should do many things.

0:20:460:20:49

Then they've breached!

0:20:490:20:51

PEOPLE TALK OVER EACH OTHER

0:20:510:20:56

BP's 105/60. Pulse is 55.

0:20:560:20:59

-How's the headache now?

-Better, I think.

0:21:010:21:03

My hands are feeling a bit cold though.

0:21:030:21:07

And what would you have done if you'd been on your own when this happened?

0:21:070:21:10

I am not playing "what if" game, Mum. It never ends well.

0:21:100:21:13

-Do you have kids?

-I do.

0:21:130:21:15

Is it always so hard to get them to do what's best for them?

0:21:150:21:18

-Assuming you know what that is.

-Ha!

0:21:180:21:21

I'm just saying going to the local college would not be awful.

0:21:210:21:24

Gets you a degree.

0:21:240:21:25

Doesn't get you a Cambridge degree! Can we go now?

0:21:250:21:28

I'm feeling better.

0:21:280:21:30

-I might have overreacted.

-If you don't mind,

0:21:300:21:33

1I'd like to keep you here a little bit longer.

0:21:330:21:35

-I hate hospitals. Sorry. No offence.

-None taken.

0:21:350:21:40

There's days, I'm not so keen myself.

0:21:400:21:43

Your BP is normal.

0:21:430:21:44

I'd just like to establish why your heart rate is so low.

0:21:440:21:48

-Low heart rate!?

-Mum. It's just the accident, surely?

0:21:480:21:51

Adrenaline or something. I'm OK.

0:21:510:21:54

That would normally have the opposite effect.

0:21:540:21:57

So it's best to check. I won't be long.

0:21:570:21:59

I'm concerned about that headache and now these obs.

0:22:010:22:04

I'm going to speak to a spinal specialist.

0:22:040:22:07

-Will you keep an eye on her?

-Yeah, sure thing.

0:22:070:22:09

I still have patients in my HDU!

0:22:110:22:13

Miss Naylor, you said you were going to take my diagnostic angios.

0:22:140:22:17

-No.

-No? We had a conversation about it a couple of hours ago.

0:22:170:22:22

I said I'd look into it. I did.

0:22:220:22:24

We can't.

0:22:240:22:26

The deal's off. You can do your own assessments.

0:22:260:22:28

Flip-flopping on department policy within hours,

0:22:280:22:31

throwing the system into chaos.

0:22:310:22:32

Not something I'd recommend especially with the Trust breathing down your neck.

0:22:320:22:36

Oh, haven't you heard? It's your job to find out who the anonymous blogger is? Tick tock.

0:22:360:22:41

Now, if there's nothing else you'd like to consult me on?

0:22:410:22:44

-Maxine, isn't it? Can I have a quick word please?

-Of course.

0:22:550:22:59

Um, I think there's a public health issue in your care home.

0:22:590:23:02

An issue?

0:23:020:23:03

I'm not exactly sure what at the moment.

0:23:030:23:05

But there's been too many cases in too short a time.

0:23:050:23:08

Too many? From a care home?

0:23:080:23:09

-In winter? It's norovirus season.

-There's no norovirus.

0:23:090:23:13

This is three cases in three hours. They're all cardiac.

0:23:130:23:15

You can't just start throw accusations around like that.

0:23:150:23:17

It could well be a coincidence.

0:23:170:23:19

Yes, but another possibility is it's the misadministration of drugs.

0:23:190:23:22

-I'm not pointing fingers. This kind of thing happens.

-No.

0:23:220:23:26

No? You seem awfully sure...

0:23:260:23:29

-I understand you've been having your own problems.

-Excuse me?

0:23:290:23:31

There's no need to project them onto me.

0:23:310:23:33

I hope for your sake it's not an infection control problem?

0:23:330:23:35

-I know that you failed your CQC.

-Ethan, maybe not the time and place?

0:23:350:23:39

And I've been reading some pretty disturbing things about your department!

0:23:390:23:42

I am trying to help you understand that another bad report will close your care home.

0:23:420:23:46

There's nothing going on in Burwell Park that I'm not on top of.

0:23:460:23:49

Shame I can't say the same about you.

0:23:490:23:51

You do your job, Doctor.

0:23:510:23:53

I'll do mine. Sorry about that, Valerie.

0:23:530:23:57

Toilets aren't as clean as I'd like.

0:24:030:24:05

Thanks for sharing.

0:24:050:24:07

Can you go outside and call the driving school to rearrange?

0:24:070:24:09

-I can't use my phone in here.

-Oh, but...

0:24:090:24:12

But what? They hit me.

0:24:120:24:14

I did nothing wrong.

0:24:140:24:16

I can't let somebody else's driving put me off.

0:24:160:24:18

But why so soon? Give yourself some breathing space.

0:24:180:24:20

That's exactly what I'm trying to do!

0:24:200:24:23

Don't you mean get away from me?

0:24:230:24:24

That's kind of what independent means, Mum.

0:24:240:24:27

Yeah, I know! It's just...

0:24:270:24:29

Oh, you're too young to understand.

0:24:310:24:34

It's called empty nest syndrome.

0:24:340:24:37

I understand well enough.

0:24:370:24:39

But this is worse because of..

0:24:390:24:41

Because of your guilt.

0:24:430:24:45

But I shouldn't suffer because of it.

0:24:450:24:47

Suffer?! That is so unfair.

0:24:470:24:49

You are still my baby girl.

0:24:490:24:51

I would do anything for you.

0:24:510:24:52

How about we start with you doing nothing at all?

0:24:520:24:56

-What are you doing?

-Dress rehearsal!

0:24:560:24:58

-Is everything OK?

-Not really.

0:24:580:25:01

My mother thinks she knows what's best for me.

0:25:010:25:03

OK. I do think it's best that you stay here.

0:25:030:25:06

-Dr Gardner was very...

-I'm fine. Excuse me.

-Where are you going?

0:25:060:25:09

-To be on my own.

-Have you got your phone? Emmy!

0:25:090:25:13

KNOCK ON DOOR

0:25:180:25:20

-Hi.

-Hey.

0:25:220:25:23

I heard.

0:25:260:25:28

Right, professional, wasn't it? Wonder if that'll make the blog?

0:25:280:25:34

Clinical Lead shouts at a room full of old ladies.

0:25:340:25:37

It doesn't.

0:25:370:25:39

Has there been a new entry?

0:25:390:25:41

Ethan, it doesn't criticise you personally.

0:25:420:25:45

Moving sick people into a CDU won't help systemic problems.

0:25:500:25:54

Like moving deck chairs on the Titanic.

0:25:540:25:56

The NHS is sinking.

0:25:560:25:58

That was my initiative.

0:26:000:26:02

That is a direct criticism.

0:26:020:26:05

It doesn't mention you, it's talking about the department.

0:26:050:26:08

Yeah, that I'm running.

0:26:080:26:09

This all started when I took charge.

0:26:100:26:12

The blog started in winter, the worst time for the NHS.

0:26:120:26:17

I know you senior medics think that the world revolves around you.

0:26:170:26:20

But maybe there's a bigger picture?

0:26:200:26:22

It's only my bit they're writing about.

0:26:220:26:23

You've just skimmed it. I read it.

0:26:230:26:26

I think it's about staff trying their hardest.

0:26:260:26:30

And failing.

0:26:300:26:32

We all have bad days, Ethan.

0:26:370:26:39

Bad days...

0:26:400:26:42

..bad weeks, bad months.

0:26:430:26:46

-Hey. Can I smoke out there?

-No, I don't think so.

0:27:010:27:04

SHE SIGHS

0:27:320:27:34

So how's it going?

0:27:400:27:42

I'm going to go see if there's a recently painted wall I can watch.

0:27:420:27:46

-Hello, ladies.

-Hello.

-Hello.

0:27:480:27:51

So, Matilda, how you feeling?

0:27:530:27:55

-Terrible.

-Really?

0:27:550:27:57

One left.

0:27:570:27:59

I never managed to finish a cryptic.

0:27:590:28:01

OK. Try me.

0:28:010:28:03

Ooh, don't say that to a girl!

0:28:030:28:05

THEY LAUGH

0:28:050:28:06

-I meant the clue!

-Right. OK. Six down.

0:28:060:28:10

Exhausted postman.

0:28:100:28:11

What, exhausted postman? Is that it?

0:28:110:28:14

That's what it says. Exhausted postman.

0:28:140:28:16

Exhausted postman? How many letters?

0:28:160:28:19

-Millions!

-That's why he's exhausted!

0:28:190:28:22

That's terrible!

0:28:220:28:24

Oh...

0:28:260:28:27

Come on, Mrs Dunford.

0:28:290:28:30

I'm not on the menu...

0:28:300:28:32

Duffy! Duffy, her pulse is irregular.

0:28:340:28:37

We need an ECG. Resus now!

0:28:370:28:39

-Just lay back.

-That's it. Easy does it. That's it. Slowly.

0:28:390:28:42

It's Pearl. She has chest pains. I've called an ambulance.

0:29:160:29:19

-What happened?

-It's Matilda Dunford.

-She just went off, Doctor Hardy.

0:29:210:29:24

Her pulse is irregular. She's struggling to breathe.

0:29:240:29:26

OK, bay three, please.

0:29:260:29:27

-Maybe if we weren't doing blood tests for Jac Naylor, we'd have had time to ...

-OK, thank you. Not now.

0:29:270:29:32

Do ABCs before we transfer her.

0:29:320:29:34

I'm sorry. I have to, um...

0:29:380:29:40

OK. I'm just going to have a listen to your chest.

0:29:420:29:45

SHE BREATHES HEAVILY

0:29:560:30:02

Yes, thank you, where's Emma? I need to talk to her.

0:30:180:30:22

I've been calling her for ages. But it's just going to voicemail.

0:30:220:30:25

-She went to be on her own for a bit.

-Well, we need to find her...

0:30:250:30:28

-Why? What's the matter? You said everything...

-Mrs Edmunds,

0:30:280:30:30

-have you heard of something called autonomic dysreflexia?

-Maybe...

0:30:300:30:34

-When she was in the Spinal Unit...

-I think it matches Emma's symptoms.

0:30:340:30:37

The headache, the cold hands, low heart rate.

0:30:370:30:41

If untreated, it can be very serious but it's fairly simple to...

0:30:410:30:44

-But she said the headache was better...

-I know she did.

0:30:440:30:47

But I think the morphine may have masked it.

0:30:470:30:49

And her BP... In spinal injury patients, it's often lower.

0:30:490:30:54

What looks normal is elevated for her.

0:30:540:30:56

She seemed OK when she left.

0:30:560:30:59

Just stay here, she'll probably come back.

0:30:590:31:02

We need to find her.

0:31:030:31:05

Anything I can help with?

0:31:070:31:09

Um, yes, please

0:31:090:31:11

Great. Something educational happens and...

0:31:130:31:16

I am out of the room.

0:31:160:31:17

You mean Matilda collapsing? Careful what you wish for, doctor.

0:31:170:31:21

Oh, come on, I didn't mean I want stuff to happen.

0:31:210:31:24

Sounded a bit like that.

0:31:240:31:25

Valerie.

0:31:280:31:29

I think she's arrested! Jacob! Jacob!

0:31:340:31:40

SHE GASPS

0:31:440:31:46

Valerie, are you OK?

0:31:460:31:48

Hello? HELLO? I need some help.

0:32:170:32:21

SHE BREATHES HEAVILY

0:32:290:32:34

I've just arrived with another resident. Same symptoms.

0:32:500:32:53

-OK, that's four now.

-But to confirm...

0:32:530:32:55

Not only has there been no admin cockup,

0:32:550:32:57

none of these patients have any medications in common.

0:32:570:32:59

And Valerie isn't even on anything.

0:32:590:33:01

Maxine, I didn't mean to make things personal.

0:33:010:33:03

Really, it felt like you did.

0:33:030:33:05

We've moved Colin to the ward.

0:33:050:33:07

Valerie and Matilda are in Resus.

0:33:070:33:09

OK, they both suffered severe cardiac events.

0:33:090:33:12

Now, Valerie's condition seems stable.

0:33:120:33:14

But, Matilda, her condition is very poor.

0:33:140:33:17

-What is this?

-I don't know but it must be exposure to something common.

0:33:170:33:23

-Could be chemicals? Have they been spraying the fields round you?

-No.

0:33:230:33:27

-Could be something in the water?

-We're connected to the mains like the rest of Holby.

0:33:270:33:31

OK. Something that interferes with their electrolytes,

0:33:310:33:34

that affects their cardiac rhythm...

0:33:340:33:36

I know that sounds daft but is there anything you think it could be?

0:33:360:33:41

No. Can I see them?

0:33:410:33:44

Yes, of course, just briefly.

0:33:450:33:48

-So um, you've checked the ladies, obviously?

-Just did.

0:33:520:33:55

Nah, I haven't seen her. But, then again, if she's sat in a wheelchair,

0:33:550:33:59

-and I'm sat behind my desk... You get my drift?

-OK, thanks, Noel.

0:33:590:34:02

Call security? Get them to check the CCTV?

0:34:020:34:05

Right guys, now, listen up.

0:34:050:34:08

We're looking for a patient.

0:34:080:34:09

Emma Edmonds, 24.

0:34:090:34:10

She's a wheelchair user. This is serious.

0:34:100:34:12

-She's wearing a purple hoodie.

-We start from outside then move in.

-Jacob?

0:34:120:34:17

Gemma, that's not the right direction.

0:34:200:34:23

Yeah, well I told her she couldn't smoke out there.

0:34:230:34:25

-I'm sure she turned around...

-Come on, they asked you to check outside.

0:34:250:34:28

-Yeah, and she could die.

-Possibly. If you stand here arguing.

0:34:280:34:30

I'm going to the basement. That's where I'd go.

0:34:300:34:32

-Gemma, you can't just get to do whatever you want.

-And you don't get to tell me what to do.

-I didn't.

0:34:320:34:36

-Your boss did.

-Yeah, well, I don't care. She could die.

0:34:360:34:40

Gemma! Where you going?

0:34:400:34:42

-How you feeling?

-Oh, I'm OK.

0:34:450:34:47

-How is she?

-They're not saying much. Try not to stress about it.

0:34:490:34:53

I bet I look a sight! Oh, is that my bag?

0:34:530:34:57

-Pass my compact, would you?

-What now?

0:34:570:35:00

It's in the pocket. Oh. No! Not that one.

0:35:000:35:04

-What are these?

-No idea.

-They're in your bag, Val.

0:35:060:35:09

Oh. Nothing. Just slimming pills.

0:35:090:35:13

-This is your "slender and lovely" programme?

-Yeah

0:35:130:35:15

So Matilda's on these? Who else?

0:35:150:35:17

-It's really none of your business.

-Of course it is!

0:35:170:35:20

Hey. What are these?

0:35:200:35:22

Slimming pills.

0:35:220:35:24

Sibutramine? Has Matilda taken these?

0:35:240:35:27

Yes. And Colin.

0:35:270:35:29

And Pearl? The paramedics just brought her in.

0:35:290:35:32

-Pearl?! We've been taking them for months.

-Months!

-In a care home?

0:35:320:35:39

We're not so mobile so it helps keep the weight off.

0:35:390:35:43

They're from a good company.

0:35:430:35:44

They came guaranteed safe.

0:35:440:35:47

Right, Jacob.

0:35:470:35:48

Can you check Toxbase, please, for Sibutramine?

0:35:480:35:51

I think they were withdrawn for causing cardiac problems.

0:35:510:35:54

-She's asystolic.

-OK, let's get the arrest trolley

0:35:540:35:57

Start compressions...

0:35:570:35:59

No? Well, where the is she, then?

0:36:070:36:09

We have all the security and the porters out looking for her.

0:36:090:36:11

But what if she's collapsed? What if she's unconscious?

0:36:110:36:15

Hello? Emma?!

0:36:190:36:21

Emma? Hello?

0:36:350:36:37

-DISTORTED:

-Emma. It's Gem.

0:36:390:36:42

-Right, we're going to have to get you upstairs.

-Ah...

0:36:420:36:46

I'm trying to help you. OK?

0:36:460:36:48

Shall I take over?

0:36:540:36:55

It's been two minutes since adrenaline.

0:37:010:37:03

Can we do a pulse check, please?

0:37:030:37:05

MACHINE BLEEPS

0:37:060:37:09

She's still asystolic and hasn't responded to CPR or adrenaline.

0:37:090:37:14

We've covered all the reversible causes.

0:37:140:37:15

-Still no output.

-I think we should call it.

0:37:150:37:18

-Everyone in agreement.

-Yeah.

-Yeah.

0:37:180:37:21

-Sister Duffin.

-Time of death 14:53.

0:37:210:37:25

No! No, no, no.

0:37:250:37:29

BELL RINGS

0:37:430:37:45

Come on!

0:37:460:37:47

BELL RINGS

0:37:470:37:49

There's no way I can carry you, Emma, sorry.

0:37:510:37:53

Come on, Emma. Hang in there.

0:38:000:38:01

BELL RINGS

0:38:040:38:05

-How many more?

-Nine.

0:38:090:38:12

-Including the four here?

-Nine more.

0:38:120:38:14

It's been confirmed that Sibutramine causes cardiac problems

0:38:160:38:19

and interferes with meds.

0:38:190:38:20

-You said there wasn't a drugs issue.

-What about you?

0:38:200:38:23

Moving elderly patients on reclining chairs!

0:38:230:38:26

No proper monitoring.

0:38:260:38:27

They've been taking it for months.

0:38:270:38:29

Would it have made any difference?

0:38:290:38:31

-I don't know but I have to inform the authorities.

-Of course.

0:38:310:38:34

Can I get some help, please?!

0:38:340:38:38

-This is Emma, she's really sick.

-OK. Bay one, please.

0:38:380:38:41

-Elle's missing patient.

-Her pulse is really slow.

0:38:410:38:44

-That's all I know.

-You checked her pulse?

0:38:440:38:45

-Wouldn't you?

-OK. Can we get her on to the bed?

-Yeah.

0:38:450:38:49

-But why is no-one telling me anything?

-We've just had a call.

0:38:520:38:55

Gem found her. She's in Resus.

0:38:550:38:57

Oh, well done, Gem!

0:39:010:39:02

OK, let's get a gown on, the monitors on.

0:39:020:39:05

-IV access...

-Do you know what's causing this?

0:39:050:39:06

Yeah, there it is. Look, the T6 boundary.

0:39:060:39:09

That confirms it. She has autonomic dysreflexia.

0:39:090:39:13

It's a hypertension caused by the involuntary nervous system

0:39:130:39:16

overreacting to external or bodily stimuli.

0:39:160:39:19

OK, what's the trigger?

0:39:190:39:20

Any number of things. Most commonly the bladder.

0:39:200:39:23

Her catheter bag is only half full.

0:39:230:39:25

How long ago was it last changed?

0:39:250:39:26

I didn't get a chance before she left.

0:39:260:39:28

Not since this morning, then.

0:39:280:39:30

Her bladder feels distended. Must be a blocked catheter.

0:39:300:39:32

OK, I need a bladder syringe and some sterile water, please.

0:39:320:39:36

-Thanks, Elle.

-I told you not to go off! I told you to stay.

0:39:360:39:41

Doctor, you can't blame her. She didn't know.

0:39:410:39:44

-If you can't manage then...

-Shouldn't be a manager?

0:39:460:39:49

I'm so sorry. I didn't realise.

0:39:500:39:55

And she was fine this morning.

0:39:550:39:57

-She didn't say a word.

-OK.

-I didn't know...

-It's all right.

0:39:570:40:04

Can we keep up the cardiac monitoring, please?

0:40:070:40:09

-I'll be back in a minute.

-Yeah.

0:40:130:40:15

There we go. It's flowing again.

0:40:170:40:20

We should start to see some improvement very quickly.

0:40:200:40:24

-Mum?

-Oh, sweetheart!

0:40:260:40:29

Ethan, there was nothing more we could have done

0:40:400:40:41

and I will fight anyone who says different.

0:40:410:40:44

-Maybe Duffy was right.

-About what?

0:40:470:40:51

What's the blog going to say?

0:40:550:40:57

Who do you think is behind it?

0:41:010:41:03

I have no idea.

0:41:050:41:07

-Gem, thank you so much.

-Can I?

-No. That's not necessary.

0:41:160:41:21

-I was just doing my job.

-Doing it well.

-Please take it.

0:41:210:41:25

-It was just lucky.

-No. I know what you did.

0:41:250:41:28

Couldn't tell my boss that, could you?

0:41:280:41:31

I've been telling everybody.

0:41:310:41:33

Yeah. Lucky.

0:41:350:41:38

So this could happen any time now?

0:41:390:41:42

Well, we'll have to look after you better.

0:41:420:41:45

Be a bit stricter about cleaning your catheter for a start.

0:41:450:41:48

Thought I was going to die, Mum.

0:41:480:41:50

Oh, Emmy, love. You're safe now.

0:41:500:41:54

-I'm not going. Don't worry.

-What? Where?

0:41:550:41:58

Anywhere. Cambridge.

0:41:580:42:01

-I'll stay at home. You were right.

-But...

-It's just not safe, is it?

0:42:010:42:04

Oh, love.

0:42:050:42:07

You were right,

0:42:220:42:23

I should have known what was going on and I owe you an apology.

0:42:230:42:28

No, you don't.

0:42:280:42:29

I'm sure you were doing your best.

0:42:310:42:33

But I'm still going to lose my job.

0:42:330:42:35

They'll shut us down.

0:42:350:42:37

-We won't survive this.

-I'm sorry.

0:42:370:42:39

I don't mind working hard...

0:42:410:42:44

but sometimes it feels like they want us to fail.

0:42:440:42:46

-Hi, Gem.

-Look.

0:42:570:43:00

I know it's not for me to say but...

0:43:000:43:03

Emma, what happened today only happened

0:43:030:43:06

because you didn't know about your condition.

0:43:060:43:08

I'm not even going to try and pronounce it.

0:43:080:43:10

But now you do you can research it, take proper precautions.

0:43:100:43:13

I only didn't die because you found me.

0:43:130:43:16

I only found you because you made a way of being found.

0:43:160:43:19

She's a very clever girl.

0:43:190:43:20

Woman, Mum. Remember?

0:43:200:43:22

Exactly.

0:43:220:43:24

And clever women should not turn down Cambridge.

0:43:240:43:28

Your mum's had a fright.

0:43:280:43:29

She loves you so she wants to hold you close.

0:43:290:43:32

To be honest, I wish I had a mum like her.

0:43:340:43:36

But you can't give in to it. You can't waste it.

0:43:360:43:40

You can't live your life without taking some risks.

0:43:400:43:44

Yeah, like taking a pee.

0:43:440:43:45

And what happens when I'm not around? I won't be forever.

0:43:450:43:49

-I thought you wanted me home?

-I do.

0:43:490:43:52

But you know what? When you're pushing to get away...

0:43:520:43:55

it's so easy to try and hold on.

0:43:550:43:58

But when you said you didn't want to go...

0:43:580:44:00

That's not right.

0:44:000:44:02

I can't do that to you.

0:44:020:44:04

No, you are going to go to Cambridge.

0:44:040:44:07

I'm going to Cambridge.

0:44:070:44:10

Well done.

0:44:160:44:18

-And I'm sorry...

-No problem.

0:44:180:44:20

You were doing what you thought was best for me, I know.

0:44:200:44:23

-What's wrong?

-I'm moving out, Iain.

0:44:260:44:29

-I know you're just trying to protect me and that but...

-I know.

0:44:290:44:33

It was always going to be difficult, work, home,

0:44:330:44:35

living in each others pockets

0:44:350:44:37

but we're still trying to work things out.

0:44:370:44:39

We kind of fix each other to the past.

0:44:390:44:41

And I don't want to go back there.

0:44:410:44:43

I want to stick with new Gem.

0:44:430:44:45

OK, so when are you going?

0:44:480:44:50

Not tonight or nothing. Not doing a flit.

0:44:500:44:53

I'm actually want to get something that I can afford by myself.

0:44:530:44:56

All right, it might be a ditch

0:44:560:44:59

but if you ever want you can come round and do some ironing, though.

0:44:590:45:02

You can get lost!

0:45:020:45:04

I know this feeling.

0:45:180:45:20

I'm not sure you do.

0:45:230:45:24

Look, there's no point dwelling.

0:45:260:45:28

Yeah, there's no point but...

0:45:300:45:32

But there is a PINT...for you.

0:45:340:45:38

If you want it. Elle's invite.

0:45:380:45:40

Drink - yeah, but...

0:45:470:45:49

-Company - no. Sorry

-Hey.

0:45:500:45:54

First do no harm.

0:45:580:46:00

Tomorrow is another day, Ethan.

0:46:020:46:04

For some of us.

0:46:090:46:10

Shall we see what Rage in Resus has to say about this?

0:46:170:46:20

Look...

0:46:210:46:23

What about just me and you then?

0:46:250:46:27

A garlic crust and a bad film?

0:46:290:46:32

You haven't changed.

0:46:380:46:40

I'd really like that, yeah.

0:46:430:46:44

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