Episode 24 Casualty

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

I promise I'll do you proud.

As of today, I am Clinical Lead of the department

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

The hospital is officially full.

HTC and Resus only for those who absolutely need it.

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

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

What has to happen before people start listening?

I'm doing my best.

Yeah, well, it's not good enough

Welcome to Holby FM.

Today, we are talking about Rage in Resus,

the controversial blog everyone is talking about.

The NHS is broken.

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

News just in, the hospital in question has just been

revealed as Holby City Hospital.

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

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

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

-Virgin.

-Sorry?

Heads of Department meet. Your first?

-It's that obvious, is it?

-Yes.

This is bad timing for you.

I assume you have a response to this?

-Something to answer the accusations.

-Not answer, no.

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

Really? But I thought you were already over budget?

Actually, this doesn't need any extra funding

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

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

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

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

Uh, no. Not yet.

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

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

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

Protocols can be written up afterwards.

I think the nursing staff might object.

Of course they will. Especially the fat ones.

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

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

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

They wouldn't be missed.

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

Take on some of my cases.

Maybe the troponin tests.

We're full, too, Ethan.

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

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

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

-If you were able to help?

-Sounds like a deal.

It's certainly something I could look into.

Yes, great.

After you.

Thanks.

Morning.

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

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

-Oh, there's my top.

-Yeah, I've ironed it for you.

Thanks, Mum.

-Might need help with my laces too.

-Come on.

You're not dressed yet.

I couldn't.

Someone had my top.

-Come on, then.

-Go!

What a mess.

This isn't right.

What do you mean? It's completely right.

That's not what I meant...

About time someone spoke up.

-You think?

-I think they're bang on.

It is broken. We saw that.

But this isn't the way to change things.

It will put the trust on the defence.

They have no more money.

Attack the government, not the trust.

What, you don't think this is?

They should prioritise.

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

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

-Just my opinion.

-Ugh!

Drinks tonight.

Hope and Anchor. Please!

-For once, I am thirsty and fancy free.

-Sounds good.

Hiya, this is Matilda Dunford...

Do not call her Mattie...

-It's not my name.

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

Oh, please! Shush.

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

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

Sats of 95%. Pulse 85.

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

We've got a list of meds from Burwell Park

and she is on medication for angina.

I'm a mother. I was a wife.

I used to be a chef.

I like roses, sticky puddings and crosswords.

I'm not just numbers on a little screen.

-Quite right, Matilda.

-Shall we get her booked in?

Matilda, I'm Dr Munroe.

Is there anyone we can call for you?

Well, my daughter lives abroad.

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

Right. Dr Masum.

What should we do?

Duffy, have you seen my little sister, Gemma?

-She's started as a porter today.

-Sorry, no.

And in here are the cubicles.

Now, Gem, let me be very clear.

I'm all for giving people second chances.

Especially when they're as young as you.

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

-No stealing drugs?

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

-Not when it's funny, no.

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

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

You get no special treatment.

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

I meant because of your background.

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

This isn't a hand-holding programme.

Sorry. Nerves.

Let me find Glen. He can show you around.

LAUGHTER

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

LAUGHTER

-Having fun, girls?

-Her name's Bond.

-Here, let me have another go.

-No. She looks great.

-Don't be such a perfectionist, Valerie.

-Hello, ladies!

-Morning!

Oh, you look smashing.

You've outdone yourself, Val.

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

They think it's just her angina flaring up.

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

Good. We all love Matilda.

I wish she'd said something earlier.

She looked so poorly this morning.

I really thought...

I would have gone with her but...

We need you here.

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

They're all a bit worried. Especially Val.

-Found this in the kitchens.

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

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

-Not a dead rat this time.

-Oh, that's OK, then.

-Can't we get another firm in?

-Magda, you know my cleaning budget.

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

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

-I'm sorry

Kitty, you next.

Then you, Colin.

SHE CHUCKLES

-Ah!

-Whoa!

You nearly knocked me over!

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

-Sorry.

Where are you lot taking these anyway?

Old training room, Ethan said.

CDU, he called it.

-New area in the department.

-CDU?

-Mm-hm.

Oh, really.

That's a good start.

Come on, then.

Are you serious?

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

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

My hands are tied with staff and budgets.

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

flexibility, for no additional spend...

I'm all ears.

It's not a vanity project, Jacob.

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

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

What's not to love? For them.

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

-Turning away ambulances.

-With respect,

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

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

No, no, I get all that.

Duffy, Duffy!

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

-You've done what?!

-It's a holding area.

It helps us. It adds capacity.

More capacity with the same staff.

And where are the beds?

There are no beds, its trollies and chairs.

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

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

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

And will you be out collecting pizzas?

OK, I'm sensing some resistance...

Because it doesn't work, Ethan.

-We've tried it.

-Actually no, you haven't.

Not with me in charge.

So you know better than Mrs Beauchamp?

Oh, excuse me. Dr Dashing...

Not Dash. It's Rash.

Rash. Like a rasher.

A sizzling rasher.

Ooh. I could kill a bacon sandwich.

I haven't had my breakfast. Anyway.

I want to check.

You will look after me, won't you?

Because this doesn't fill me with confidence.

And you do seem rather busy...

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

You're definitely in safe hands here.

-And your ECG is fine.

-Right.

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

Oh!

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

All right, won't be long.

Thank you.

Hey, have you heard?

Uh, no. Can it wait? Sorry.

Sure.

I just thought you'd want some good news.

Yeah. What is it?

Kam Kainth. He's much improved.

Right, OK. Thank you.

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

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

I want to establish a Clinical Decision Unit

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

but also taking some pressure off all of us.

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

It's chairs and trollies.

No beds and it's effective immediately.

-What? No, no.

-What? No, no, no!

I know it'll be a struggle

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

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

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

We'll keep talking and work it out together.

Yeah? Can I have quick word?

I can say with some certainty that this...

Well, the CDU is designed to be boring.

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

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

Nearly done, Colin.

SHE CHUCKLES

I've gone and made you all One Direction.

Ooh. Ah.

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

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

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

Iain! Good.

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

-Slow down. What's gone?

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

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

Came out and someone's nicked it.

Well, welcome to the fully funded NHS.

Schoolboy error. Wheelchairs are rare.

-So other porters hide them.

-Don't be daft.

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

-This is a hospital.

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

-with your quest.

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

Control to 3006. Please respond, over.

3006. Go ahead.

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

There it is. Oi! You!

Received and en route. Over.

Thanks very much. Uh, Valerie Clerk.

Non-smoker. No history of cardiac problems.

-Nothing in the family.

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

See the man in the ambulance said...

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

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

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

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

Could be musculoskeletal?

Let's repeat ECG, wait for the bloods

and keep her on half-hourly obs.

Possibly a candidate for CDU.

-Frees up a bed.

-Shouldn't we treat the patient first?

That's why I said possibly.

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

-Your ladies?

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

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

-Ah.

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

-Let me find out.

-Thank you.

-Yeah, all right, thanks.

Oh! I forgot my magic bag, Maxie.

She means her make-up bag.

-Our resident beautician here

-Former life.

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

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

Don't all have your bone structure.

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

-Sure, yeah.

Oh! Is that blood?

Sorry, I'll get a cleaner.

As bad as Burwell Park! No offence, Maxine.

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

I give them enough free shifts as it is.

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

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

She'd do anything for you, that one.

Lovely girl.

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

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

-They've gone.

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

That's exactly what I'm wondering.

I was at the Ambulance Station.

Well, you should have gone to the main entrance.

-No-one said!

-For a transfer? Isn't it obvious?

-Obviously her brother wasn't around to ask.

-Mm-hm.

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

I rather enjoyed the fresh air.

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

I'm fine. Well.

-Maybe a little short on my breath.

-Right. Well.

Best to get you checked over, just in case.

Porters are meant to make our life easier, Gem,

-and you're not doing that so far.

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

They never told us where we should wait anyway.

This is Emma Edmonds, 24.

She's suffered a previous spinal injury which left her

paralysed from around T6.

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

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

First lesson.

It wasn't my fault though.

Emma was complaining of a headache on scene.

But there's no injuries found.

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

No other history.

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

-OK.

Hi, Emma, I'm Doctor Gardner.

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

we can remove those blocks and make you more comfortable.

1g of paracetamol, IV, please.

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

I know about pain scoring, yeah.

-Are you OK with morphine?

-Hook me up!

Let's get 5mg of morphine instead.

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

sensitive about.

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

OK, thank you.

I'm sure everything will be fine, Emmy.

-That's what you said last time!

-Last time?

Emma was paralysed in a car accident.

I was driving.

And texting.

-You've got something to say?

-Me?

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

-You think? It's OK, Mum.

-Course it's not OK.

I wasn't driving this time, though.

First lesson and I get shunted.

-And now my mother will freak out every time.

-It's OK.

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

But I need to be able to drive.

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

And I am not taking my mother.

Congratulations, young lady.

-That's very impressive.

-Thanks.

-Cambridge, yeah?

-It's brilliant.

-Bye-bye.

I'm off to the CDU.

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

LAUGHTER

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

-Yeah, fine. Stop asking.

-I'm only trying to help.

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

If we could have some focus please!

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

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

-Mum,

-go get a coffee or something.

-I'm staying, I'm fine

There she is, hands all over my beau.

You what?

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

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

-Well, back off the boyfriend then.

Mrs Dunford, in this chair, if you can.

Hello, Matilda, love.

Maxie. Nice to see you.

-How are you feeling?

-Better.

I'm glad I missed my ride though.

This is Matilda Dunford...

Yeah, I know. We've met.

I'm sorry Matilda. I had no idea.

I'll withdraw gracefully.

You take your best shot.

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

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

Drop a few more pounds.

"Slender and Lovely programme"?

Ooh, 'ark at big ears here.

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

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

Believe me, I've tried.

It's like sausages.

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

THEY LAUGH

-She's right, you know.

-You're new, right?

-I am.

-Gem.

-Rash.

First day. Still finding her feet.

-Jen?

-Gem.

-Like the stone.

-Ah. Gem...stone.

Like a...rough diamond.

You know me already.

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

Hey why don't you practice on me?

-See you.

-See you.

Thanks.

I know we're being all flexible with protocols

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

CDU's full and we have waiting trollies?

-What do you mean full?

-What do you think I mean, Ethan?

CDU?

Two that would normally go to Jac Naylor.

Then Valerie Clerk and Matilda Dunford from Burwell Park.

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

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

Matilda Dunford?

She missed her transport.

This stuff happens every day.

Or did you forget?

Let me guess, boys, Burwell Park?

We should fit a trailer. Save some diesel.

-Tell me about it.

-You went to Burwell Park?

-Yeah.

-Why?

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

I wouldn't get that place.

Heard they failed their CQC.

Really?

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

-OK, thanks.

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

-Free?

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

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

Jac Naylor should do many things.

Then they've breached!

PEOPLE TALK OVER EACH OTHER

BP's 105/60. Pulse is 55.

-How's the headache now?

-Better, I think.

My hands are feeling a bit cold though.

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

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

-Do you have kids?

-I do.

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

-Assuming you know what that is.

-Ha!

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

Gets you a degree.

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

I'm feeling better.

-I might have overreacted.

-If you don't mind,

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

-I hate hospitals. Sorry. No offence.

-None taken.

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

Your BP is normal.

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

-Low heart rate!?

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

Adrenaline or something. I'm OK.

That would normally have the opposite effect.

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

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

I'm going to speak to a spinal specialist.

-Will you keep an eye on her?

-Yeah, sure thing.

I still have patients in my HDU!

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

-No.

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

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

We can't.

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

Flip-flopping on department policy within hours,

throwing the system into chaos.

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

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

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

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

-Of course.

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

An issue?

I'm not exactly sure what at the moment.

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

Too many? From a care home?

-In winter? It's norovirus season.

-There's no norovirus.

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

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

It could well be a coincidence.

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

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

-No.

No? You seem awfully sure...

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

-Excuse me?

There's no need to project them onto me.

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

-I know that you failed your CQC.

-Ethan, maybe not the time and place?

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

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

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

Shame I can't say the same about you.

You do your job, Doctor.

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

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

Thanks for sharing.

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

-I can't use my phone in here.

-Oh, but...

But what? They hit me.

I did nothing wrong.

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

But why so soon? Give yourself some breathing space.

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

Don't you mean get away from me?

That's kind of what independent means, Mum.

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

Oh, you're too young to understand.

It's called empty nest syndrome.

I understand well enough.

But this is worse because of..

Because of your guilt.

But I shouldn't suffer because of it.

Suffer?! That is so unfair.

You are still my baby girl.

I would do anything for you.

How about we start with you doing nothing at all?

-What are you doing?

-Dress rehearsal!

-Is everything OK?

-Not really.

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

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

-Dr Gardner was very...

-I'm fine. Excuse me.

-Where are you going?

-To be on my own.

-Have you got your phone? Emmy!

KNOCK ON DOOR

-Hi.

-Hey.

I heard.

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

Clinical Lead shouts at a room full of old ladies.

It doesn't.

Has there been a new entry?

Ethan, it doesn't criticise you personally.

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

Like moving deck chairs on the Titanic.

The NHS is sinking.

That was my initiative.

That is a direct criticism.

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

Yeah, that I'm running.

This all started when I took charge.

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

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

But maybe there's a bigger picture?

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

You've just skimmed it. I read it.

I think it's about staff trying their hardest.

And failing.

We all have bad days, Ethan.

Bad days...

..bad weeks, bad months.

-Hey. Can I smoke out there?

-No, I don't think so.

SHE SIGHS

So how's it going?

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

-Hello, ladies.

-Hello.

-Hello.

So, Matilda, how you feeling?

-Terrible.

-Really?

One left.

I never managed to finish a cryptic.

OK. Try me.

Ooh, don't say that to a girl!

THEY LAUGH

-I meant the clue!

-Right. OK. Six down.

Exhausted postman.

What, exhausted postman? Is that it?

That's what it says. Exhausted postman.

Exhausted postman? How many letters?

-Millions!

-That's why he's exhausted!

That's terrible!

Oh...

Come on, Mrs Dunford.

I'm not on the menu...

Duffy! Duffy, her pulse is irregular.

We need an ECG. Resus now!

-Just lay back.

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

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

-What happened?

-It's Matilda Dunford.

-She just went off, Doctor Hardy.

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

OK, bay three, please.

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

-OK, thank you. Not now.

Do ABCs before we transfer her.

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

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

SHE BREATHES HEAVILY

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

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

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

-Well, we need to find her...

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

-Mrs Edmunds,

-have you heard of something called autonomic dysreflexia?

-Maybe...

-When she was in the Spinal Unit...

-I think it matches Emma's symptoms.

The headache, the cold hands, low heart rate.

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

-But she said the headache was better...

-I know she did.

But I think the morphine may have masked it.

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

What looks normal is elevated for her.

She seemed OK when she left.

Just stay here, she'll probably come back.

We need to find her.

Anything I can help with?

Um, yes, please

Great. Something educational happens and...

I am out of the room.

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

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

Sounded a bit like that.

Valerie.

I think she's arrested! Jacob! Jacob!

SHE GASPS

Valerie, are you OK?

Hello? HELLO? I need some help.

SHE BREATHES HEAVILY

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

-OK, that's four now.

-But to confirm...

Not only has there been no admin cockup,

none of these patients have any medications in common.

And Valerie isn't even on anything.

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

Really, it felt like you did.

We've moved Colin to the ward.

Valerie and Matilda are in Resus.

OK, they both suffered severe cardiac events.

Now, Valerie's condition seems stable.

But, Matilda, her condition is very poor.

-What is this?

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

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

-No.

-Could be something in the water?

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

OK. Something that interferes with their electrolytes,

that affects their cardiac rhythm...

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

No. Can I see them?

Yes, of course, just briefly.

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

-Just did.

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

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

-OK, thanks, Noel.

Call security? Get them to check the CCTV?

Right guys, now, listen up.

We're looking for a patient.

Emma Edmonds, 24.

She's a wheelchair user. This is serious.

-She's wearing a purple hoodie.

-We start from outside then move in.

-Jacob?

Gemma, that's not the right direction.

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

-I'm sure she turned around...

-Come on, they asked you to check outside.

-Yeah, and she could die.

-Possibly. If you stand here arguing.

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

-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.

-Your boss did.

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

Gemma! Where you going?

-How you feeling?

-Oh, I'm OK.

-How is she?

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

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

-Pass my compact, would you?

-What now?

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

-What are these?

-No idea.

-They're in your bag, Val.

Oh. Nothing. Just slimming pills.

-This is your "slender and lovely" programme?

-Yeah

So Matilda's on these? Who else?

-It's really none of your business.

-Of course it is!

Hey. What are these?

Slimming pills.

Sibutramine? Has Matilda taken these?

Yes. And Colin.

And Pearl? The paramedics just brought her in.

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

-Months!

-In a care home?

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

They're from a good company.

They came guaranteed safe.

Right, Jacob.

Can you check Toxbase, please, for Sibutramine?

I think they were withdrawn for causing cardiac problems.

-She's asystolic.

-OK, let's get the arrest trolley

Start compressions...

No? Well, where the is she, then?

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

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

Hello? Emma?!

Emma? Hello?

-DISTORTED:

-Emma. It's Gem.

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

-Ah...

I'm trying to help you. OK?

Shall I take over?

It's been two minutes since adrenaline.

Can we do a pulse check, please?

MACHINE BLEEPS

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

We've covered all the reversible causes.

-Still no output.

-I think we should call it.

-Everyone in agreement.

-Yeah.

-Yeah.

-Sister Duffin.

-Time of death 14:53.

No! No, no, no.

BELL RINGS

Come on!

BELL RINGS

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

Come on, Emma. Hang in there.

BELL RINGS

-How many more?

-Nine.

-Including the four here?

-Nine more.

It's been confirmed that Sibutramine causes cardiac problems

and interferes with meds.

-You said there wasn't a drugs issue.

-What about you?

Moving elderly patients on reclining chairs!

No proper monitoring.

They've been taking it for months.

Would it have made any difference?

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

-Of course.

Can I get some help, please?!

-This is Emma, she's really sick.

-OK. Bay one, please.

-Elle's missing patient.

-Her pulse is really slow.

-That's all I know.

-You checked her pulse?

-Wouldn't you?

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

-Yeah.

-But why is no-one telling me anything?

-We've just had a call.

Gem found her. She's in Resus.

Oh, well done, Gem!

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

-IV access...

-Do you know what's causing this?

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

That confirms it. She has autonomic dysreflexia.

It's a hypertension caused by the involuntary nervous system

overreacting to external or bodily stimuli.

OK, what's the trigger?

Any number of things. Most commonly the bladder.

Her catheter bag is only half full.

How long ago was it last changed?

I didn't get a chance before she left.

Not since this morning, then.

Her bladder feels distended. Must be a blocked catheter.

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

-Thanks, Elle.

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

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

-If you can't manage then...

-Shouldn't be a manager?

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

And she was fine this morning.

-She didn't say a word.

-OK.

-I didn't know...

-It's all right.

Can we keep up the cardiac monitoring, please?

-I'll be back in a minute.

-Yeah.

There we go. It's flowing again.

We should start to see some improvement very quickly.

-Mum?

-Oh, sweetheart!

Ethan, there was nothing more we could have done

and I will fight anyone who says different.

-Maybe Duffy was right.

-About what?

What's the blog going to say?

Who do you think is behind it?

I have no idea.

-Gem, thank you so much.

-Can I?

-No. That's not necessary.

-I was just doing my job.

-Doing it well.

-Please take it.

-It was just lucky.

-No. I know what you did.

Couldn't tell my boss that, could you?

I've been telling everybody.

Yeah. Lucky.

So this could happen any time now?

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

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

Thought I was going to die, Mum.

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

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

-What? Where?

Anywhere. Cambridge.

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

-But...

-It's just not safe, is it?

Oh, love.

You were right,

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

No, you don't.

I'm sure you were doing your best.

But I'm still going to lose my job.

They'll shut us down.

-We won't survive this.

-I'm sorry.

I don't mind working hard...

but sometimes it feels like they want us to fail.

-Hi, Gem.

-Look.

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

Emma, what happened today only happened

because you didn't know about your condition.

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

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

I only didn't die because you found me.

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

She's a very clever girl.

Woman, Mum. Remember?

Exactly.

And clever women should not turn down Cambridge.

Your mum's had a fright.

She loves you so she wants to hold you close.

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

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

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

Yeah, like taking a pee.

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

-I thought you wanted me home?

-I do.

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

it's so easy to try and hold on.

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

That's not right.

I can't do that to you.

No, you are going to go to Cambridge.

I'm going to Cambridge.

Well done.

-And I'm sorry...

-No problem.

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

-What's wrong?

-I'm moving out, Iain.

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

-I know.

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

living in each others pockets

but we're still trying to work things out.

We kind of fix each other to the past.

And I don't want to go back there.

I want to stick with new Gem.

OK, so when are you going?

Not tonight or nothing. Not doing a flit.

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

All right, it might be a ditch

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

You can get lost!

I know this feeling.

I'm not sure you do.

Look, there's no point dwelling.

Yeah, there's no point but...

But there is a PINT...for you.

If you want it. Elle's invite.

Drink - yeah, but...

-Company - no. Sorry

-Hey.

First do no harm.

Tomorrow is another day, Ethan.

For some of us.

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

Look...

What about just me and you then?

A garlic crust and a bad film?

You haven't changed.

I'd really like that, yeah.

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