Episode 26 Casualty


Episode 26

Dylan struggles to keep his alcoholism a secret from his colleagues. Bea pushes herself to greater heights to impress Ethan.


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Transcript


LineFromTo

-What if she remembers?

-We'll cross that bridge when we get to it.

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

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-You're new, right?

-Gem.

-Rash.

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Who do I have to sleep with to get into Resus?

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I wouldn't know, I'm doing all I can to stay out of there.

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Can we let this voicemail serve as my official resignation

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from the post of acting clinical lead of the ED?

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I've been under a little bit of stress.

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I think I could do with taking a few weeks off.

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I've let you down today, I've let everybody down.

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It rather defeats the point of being here, doesn't it?

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I mean, OK, let's say for example that you...

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You're a doctor working in a hospital and... I don't know...

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a helicopter crashes into the side of the building.

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There's chaos, carnage everywhere,

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and you're in the middle of it, trying to do what you can to help.

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No-one's going to stop and ask you, "Who are you, why are you here?"

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It's damned obvious who you are and why you're there.

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Of course. You don't have to say anything until you're ready.

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My name's Joseph and I'm an alcoholic.

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-ALL:

-Hi, Joseph.

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This is my 24th day without a drink.

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I'm still a newbie.

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It's better than me. I'm still on day one.

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Hi.

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I'm Ciara and I'm an alcoholic.

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-ALL:

-Hi, Ciara.

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24 hours sober now.

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Though I think I'm just genetically blessed and able to drink

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loads of decent Chablis without it really troubling me.

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Well done.

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You've earned yourself one of these - a sobriety coin.

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It represents the AA's commitment to you, not your commitment to us.

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Do they work in vending machines?

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Hello. You look interesting.

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I'm really not.

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What's your name?

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What is it about Alcoholics Anonymous,

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everybody seems to want to know your name?

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Fine. Dark and mysterious. I like that.

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-I can work with that.

-Yeah, I don't think so.

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So what are you doing for the next 12 hours or so?

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Right, yeah, I'm going home. Going home on my own, all right?

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Night.

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-Joseph, wasn't it?

-Yeah.

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Come on, you only live once.

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Men.

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Dispatch, I'm clear at the Reshton building. Where to next?

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Four-five, pick up at Shelby Estate Agents, 24 Mountview Drive.

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On it. Just making my way through town...

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TYRES SCREECH

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Jacob, the patient in cubicle two. Is she for real?

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I'm afraid so.

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She was an audience member brought on stage and put under by a hypnotist last night.

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Then he managed to fall off the stage and concuss himself before he could bring her round.

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-Right, where's the hypnotist?

-He's gone to St James.

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-Can we just transfer her there?

-He's still in ICU, I'm afraid.

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We'll just have to keep her cooped up here!

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-Oh!

-What?

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I've seen this before.

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It's not possible that she's really still under hypnosis.

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She just thinks she is, she's seeking attention.

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What we have to do is get a doctor to say that within her earshot,

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give her a few minutes and she'll snap out of it.

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-Right, well, can I leave that with you?

-Sure.

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OK. Erm, Acute porphyria, awaiting diagnostic test results.

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-I bagsy that patient.

-Erm... No. Dr Monroe, can you take him?

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Dr Kinsella, there's a skateboarding injury.

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Distal radius and ulnar fracture.

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Thank you.

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Dr Keogh. Welcome back.

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Is everything all right?

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-Yes, all good, thanks.

-Good.

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Well, if you need anything, I'll be...

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-Right.

-Right.

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Right you are.

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What is it, Dr Kinsella?

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I just wanted to ask if I could have

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some more interesting patients sometimes, please.

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OK, I'm up to here in minors and sprains and suturing.

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We have to take the patients as they come.

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That's the only way it can work.

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I became an ED doctor because I can be interested in the first hour

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of just about anything.

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But I mean, that porphyria case -

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how many times in my career am I going to get another chance at that?

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I'm just trying to learn, is all I'm saying.

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How long have you been with us now?

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Four weeks.

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I started on the 3rd of February.

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-Are you enjoying it?

-Yes, of course.

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The NHS can be a frustrating place to work.

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You only have to look at this Rage and Resus blog to see that.

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There's a junior doctor out there somewhere

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very unhappy with their lot.

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I haven't seen it.

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OK.

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I understand your frustrations.

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And actually, my job is exactly like yours

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when it comes to resus and cubicles.

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We examine the patients, we treat them,

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we discharge them or we refer them for specialist care.

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We're starting to fill up,

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so I would appreciate it if you could get back out there, please.

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Yes, Dr Hardy.

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Examine, treat, discharge.

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Right, police will be over in a second to take a statement.

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Hello, mate. We're the paramedics.

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We're just going to try and get you on to your back, all right?

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One, two, three.

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There we go. I know. We just have to get this helmet off.

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All right, mate. I know it's uncomfortable.

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-There you go. My name's Iain. what's your name?

-Amber.

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-Oh, sorry, love.

-It's not the 1970s. Mate's just fine.

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-Can you tell me where it hurts, Amber?

-Everywhere.

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My back, my leg.

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Hiya, lads. Can one of you support this neck for me?

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We'll need to get a pelvic splint on as well, Sam.

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Got it? Right, Amber. I'm going to get you some pain relief as soon as I can.

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-Do you have any allergies?

-No.

-Tell me if this hurts.

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Ah!

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Take nice, deep breaths into that.

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Looks like an open fracture femur.

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Can we check her pedal pulse?

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Amber, I'm just going to take this boot off, all right?

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You're doing really well, Amber.

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I've got a pedal pulse, but it's weak.

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We're going to need to manipulate the leg or she could lose her foot.

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-Straight away?

-Yeah, let's do it now.

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I'll set up the TXA and co-amoxiclav afterwards.

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OK, Amber. I'm not going to lie, this is going to hurt.

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But you'll feel much better in a few moments.

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On three. One, two, three.

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SHE SCREAMS

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Are you awake? I need coffee.

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Do you want coffee? We can get them to send some up.

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How many did we have anyway?

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Did you sleep well?

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I slept like a log.

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That would have been the red wine, then.

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Could be doing with a few hours, mind you.

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Look at me. Covered in bruises, you brute.

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Don't worry. Not your fault. I tend to bruise awful easy these days.

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Now, where is my other shoe?

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Don't tell me I left it in the bar.

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I'm afraid you'll be in plaster for around six weeks

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once orthopaedics fixes the bones in theatre.

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I'll get one of the nurses to see to you.

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-So bored. Just a broken bone.

-I don't mind that, as long as they're not open fractures.

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So, I installed that dating app like you said.

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-I've had three likes so far.

-Let's see.

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-Cat pictures. Bin her.

-Yeah, but she's cute.

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Too pouty. Delete.

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-I would.

-You think?

-Yeah, she looks...

-Hot.

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Intelligent. Message her.

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-That's going to cost me £8.

-Do it.

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-OK, what am I supposed to say to her?

-Start with hello.

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And make sure to get in that you're a doctor. Anything good?

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Poor Mr Hyatt here slipped while using a hedge-trimmer and managed to cut into his thigh.

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Blood and gore, I like it. Cubicle three.

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Hello, Mr Hyatt. I'm Dr Kinsella and I'm just the woman for you.

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VOMITING

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You don't say much, do you?

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Though, I know I talk a lot.

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I basically only have an on and an off switch from the moment I open my eyes to the moment I fall asleep.

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There's no in-between.

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Shall we swap numbers?

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Are you all right?

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Joseph? What's happening?

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Oh, my God!

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No, I can't. You understand?

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I can't... Erm...

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The ambulance, the police... You're married...

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Right. This is Amber Wilson, 27 years old.

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Involved in a high speed collision, motorbike versus van, approximately 50 minutes ago.

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She's got an open fracture to her right femur which has had traction and is now in a splint.

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We manipulated it at the scene with no circulatory compromise.

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Helmet removed at scene, and haemodynamically stable throughout.

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Cross on lift, please. Ready, steady, lift.

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Right, she wasn't KO'd. GCS 15.

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Complaining of thoracic, back and pelvic pain.

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She's been fully immobilised, pelvic binder in situ.

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Meds wise, she's had 15mg of morphine, one gram of TXA,

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1.2 grams of co-amoxiclav, one gram of paracetamol

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and four milligrams of Ondansetron.

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There's no known medical history, allergies or regular meds.

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Biker chick. Love it.

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Good luck, Amber.

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-Hi, Amber. I'm Dr Kinsella.

-Is my bike OK?

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Let's check on your bodywork first, then we'll see about your wheels.

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Airway clearly fine.

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Can I get a pregnancy test plus a full trauma CT

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and an X-ray of the right femur?

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You like bikes, huh?

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I compete. County level. Looking good for national.

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-I'm impressed.

-It's just a bump.

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-I've had spills before.

-Let us be the judge of that.

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And can I get bloods for crossmatch,

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FBCs, U&Es and a venous blood gas?

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Let's clean and dress the wounds and check tetanus status.

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That's about it, isn't it, Dr Hardy?

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I'd recommend orthopaedics come and have a look as well.

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Right. Yes.

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Orthopaedics, please.

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Your distal radial and ulna fracture is ready for you in cubicles.

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-I just need you to finish your notes.

-Erm... Yes.

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I've sutured Duffy's patient. He's ready for discharge.

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-Oh, great.

-I need the cubicle back.

-Yeah, yeah, just, erm...

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Dr Kinsella, let somebody else do that.

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Prioritise.

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And breathe.

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Ah, Dr Keogh. Welcome back! Nice holiday?

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It's like I've never been away.

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Watch out, watch out, watch out.

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Hello. Try not to run any more doctors over!

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Nice to see you again, too.

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-She ran a doctor over?

-Yes.

-She did.

-What? With a trolley?

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-No. With a car.

-Of all the accidents...

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Yeah, it's one of many, I'm afraid.

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Poor girl's been in and out of remand all her life.

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Did not know that.

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Right. We're referring your son to orthopaedics for further care.

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He will have a pretty cool scar at the end of it to make up for it.

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One free cubicle, as requested.

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Thank you.

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-Dr Kinsella?

-Yes. On it.

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-Remind me...

-You were going to sign off Mr Hyatt.

-Yes.

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Notes?

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I left them in Resus. Sorry, back in a minute.

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He's here, just come this way.

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-Can you tell me your partner's name?

-Oh, he's not my... Erm, Joseph.

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Hi, Joseph. My name's Iain.

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Can you tell me what happened?

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Can you raise your arms for me?

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FAST positive. We'd best get the Acute Stroke Team waiting on arrival.

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-He's had a stroke?

-When did he start to feel ill?

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I don't know. He was asleep when I woke up, I think.

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And then I was in the shower,

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-and then when I was getting ready to leave, he just...

-OK.

0:14:420:14:45

-3006 to Control, over.

-Control responding. Go ahead.

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Got a pre-alert for you.

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FAST positive male, mid-30s, we're unsure of the onset time.

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-GCS is 12, BP...

-Is 210 over 110.

-..210 over 110.

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ETA 15 minutes, over.

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Joseph, mate, we think you might have had a stroke.

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So you're going to have to come into hospital.

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Stay nice and calm while I go and get a chair for you. Good man.

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Those bruises look pretty nasty. Can I take a look at them?

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It's nothing. I just bruise easily.

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Right, well, if you want to come along in the ambulance with your...

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-He's not... Yes, all right.

-We need to get him to hospital fast.

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If you could come with us and answer a few questions

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about what happened to him, that would be a big help.

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Yeah, Of course.

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Dr Keogh, we have a stroke patient en route. Are you free?

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I'll make it a priority. That's for you.

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Right, I will call a stroke registrar and nurse.

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-That's mine, thanks.

-I was wondering.

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-Why were you going through it?

-To find out whose it was.

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You're welcome!

0:15:570:15:58

Well, you've got form, haven't you?

0:15:580:16:01

-What?

-I had no idea you were an offender.

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You just left it by the nurses' station.

0:16:040:16:07

No. I put it down at the nurses' station.

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It wasn't an invitation for you to nick it, OK?

0:16:090:16:11

-Everything all right?

-She had my wallet.

0:16:120:16:14

No. I didn't know it was your wallet. It was a wallet, and it was just sat there.

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And you took it. You're the one who told me she ran that doctor over.

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Do you want to tell anyone else?

0:16:210:16:23

Gem. Gem!

0:16:250:16:27

You can understand why I'd be suspicious, right?

0:16:280:16:31

I think we'd better just let it go, mate, all right?

0:16:310:16:33

-Oh, no.

-Are you OK?

-Yeah, I'm fine.

0:16:400:16:42

-Dr Keogh?

-Yes.

-I'm Dr Kinsella, new F1.

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Well done.

0:16:480:16:50

Bea.

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Be? What do you mean, be? What does that mean?

0:16:510:16:54

-Bea is my name.

-Oh, right. OK.

0:16:540:16:57

Excuse me. If you want to observe, you can.

0:16:570:16:59

Any sign of the stroke reg or nurse?

0:16:590:17:01

-They said they'd be here as soon as they can.

-All right.

0:17:010:17:04

-Ready?

-Yes.

-Joseph Moors, 35, suspected stroke.

0:17:040:17:07

Unsure of exact onset time, but he woke up with symptoms.

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GCS 12, due to incomprehensible sounds,

0:17:100:17:13

but he is maintaining his own airway.

0:17:130:17:15

Heart rate is 70. BP is 205 over 115.

0:17:150:17:18

Resps 16. SATS 100% on air.

0:17:180:17:21

Pupils are unequal, even though there's no apparent head injury.

0:17:210:17:24

His BM is 4.8.

0:17:240:17:26

-OK, you say airway's all right, yeah?

-Yeah.

0:17:260:17:28

Joseph, are you able to talk?

0:17:290:17:32

Right, OK. If you can hear me, can you squeeze my hands, please?

0:17:340:17:37

Definite neurological impairment on the right side.

0:17:380:17:41

Let's get him to CT, please. Quickly as we can.

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Every second is valuable brain tissue.

0:17:430:17:46

I have a patient in CT.

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Right, OK, thanks.

0:17:480:17:50

Joseph...

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..you're in Holby City Hospital.

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If you can hear me and if there's anyone you want me to call...

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Ciara, this lady here, was with him when he woke up.

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What are you doing here?

0:18:020:18:04

Right. You're not related, are you?

0:18:050:18:07

-No.

-Can somebody show Ciara where she can wait, please?

0:18:070:18:11

-What? You work here?

-Yes. Just let me do my job.

0:18:110:18:14

Dylan, this is the patient's wallet and she has bruises on her wrists

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and could do with strong coffee.

0:18:180:18:21

Right, yeah, I'm sure she's fine.

0:18:210:18:23

-No...

-I tell you what, Charlie, would you mind taking Ciara somewhere she can get a coffee?

0:18:240:18:29

No, no, it's all right. I'll just let you get on with looking after Joseph.

0:18:290:18:33

-He's in very good hands.

-I can take a look at her.

0:18:330:18:35

Are you not with a patient that just went back to Resus?

0:18:350:18:38

I'll tell you what, I'll have a look at you. For now, can you just go with Charlie, please?

0:18:380:18:42

Your bedside manner better be worth it.

0:18:420:18:44

Louise?

0:18:450:18:47

He's obviously not compos mentis and she is not related,

0:18:480:18:51

so can we dig out any old records that we might have for him?

0:18:510:18:54

Great to have you back, Dr Keogh, but do you remember that chat

0:18:550:18:58

we once had about please and thank you?

0:18:580:19:00

Yes. Please never mention it again. Thank you.

0:19:000:19:04

I can't believe Rash having a go in front of everyone.

0:19:050:19:08

Things are going well for me here, right?

0:19:080:19:10

-Yeah, yeah, yeah.

-We adore you.

0:19:100:19:13

I mean, how does that make me look in front of the patients?

0:19:130:19:16

If somebody reported that, I could have lost my job.

0:19:160:19:19

Rash needs teaching a lesson, don't he?

0:19:190:19:21

What sort of lesson?

0:19:210:19:23

That he needs people like us to help him do his job, for a start.

0:19:230:19:26

He couldn't cope without us backing him up.

0:19:260:19:29

I think it's time Dr Rashid felt the full force and fury

0:19:290:19:32

of mistreated ancillary staff.

0:19:320:19:34

Joseph's scans. He's on our records.

0:19:360:19:40

Joseph Moors, DOB - 2nd of February 1983.

0:19:400:19:44

Wow, really?

0:19:440:19:46

Yeah. We have treated him before for alcohol related problems,

0:19:460:19:50

including the time he wrapped his car around a lamppost.

0:19:500:19:53

We're trying to contact his ex-wife.

0:19:530:19:55

Right, yeah, this isn't good.

0:19:560:19:58

He's had a massive haemorrhagic stroke, as we thought.

0:19:580:20:01

OK. Let's contact the regional neurosurgical team for assessment,

0:20:010:20:07

and can we get the neurosurgical registrar's number ASAP?

0:20:070:20:10

OK.

0:20:100:20:11

I've got to go and... Do you know what? No, I can't be bothered.

0:20:110:20:14

-Do you know her or something?

-No. Not really. No.

0:20:140:20:19

I joined an AA group. She's one of those.

0:20:200:20:23

-Good for you.

-There's nothing good about it.

0:20:230:20:25

They're dreadful people. Boring, boring, boring.

0:20:250:20:27

Neurosurgical team. Now. Please, please.

0:20:270:20:31

Is there anyone we can call for you, Amber?

0:20:310:20:33

No.

0:20:330:20:35

I only have distant family.

0:20:350:20:37

I just moved here a couple of weeks ago.

0:20:370:20:39

Starting a new life.

0:20:390:20:41

Relationship meltdown?

0:20:410:20:43

-You're sure you don't want me to contact...

-No.

0:20:430:20:46

I don't want him to know where I am.

0:20:460:20:48

-Am I going to be OK?

-I just need a second opinion on these.

0:20:480:20:51

Can you move your toes for me?

0:20:520:20:54

No.

0:20:560:20:57

-I can't be paralysed, I just can't!

-Look, we don't know that yet.

0:20:590:21:02

I have no-one. I couldn't live like that.

0:21:020:21:05

You're getting way ahead of yourself. We haven't finished examining you yet, OK?

0:21:050:21:09

OK.

0:21:110:21:13

-Let's log roll her.

-There's only two of us.

0:21:130:21:15

-Are her scans clear?

-Yeah, I think so.

0:21:150:21:18

But what I do know is that a blocked airway will kill her.

0:21:180:21:21

OK, three, two, one.

0:21:220:21:25

OK, suction.

0:21:270:21:29

OK, good. Very good.

0:21:300:21:32

-What's happened?

-She was in danger of asphyxiating.

0:21:320:21:34

And the scans were clear?

0:21:340:21:36

I'm still waiting for orthopaedics to take a look.

0:21:360:21:39

OK. That's good. Three, two, one.

0:21:390:21:42

Dr Kinsella, if you're not sure,

0:21:430:21:46

then it's extremely dangerous to have log rolled her.

0:21:460:21:48

-She'd have choked if I didn't.

-You should have hit the emergency call button and asked for help.

0:21:480:21:53

-There wasn't time...

-There's always time to raise the alarm.

0:21:530:21:56

Even if you still had to proceed until help arrives.

0:21:560:21:59

-OK. Regular obs until the orthopaedics get back to you.

-Of course.

0:21:590:22:02

Please try not to do everything on your own.

0:22:030:22:05

Don't you look all dashing with your sleeves rolled up and a stethoscope round your neck?

0:22:140:22:19

-I'd never have guessed you were a doctor.

-Well, that's reassuring.

0:22:190:22:22

I had you down as an accountant, actually.

0:22:220:22:24

How's Joseph?

0:22:240:22:26

I can't discuss his condition with you, it's patient confidentiality.

0:22:260:22:31

I'm his friend.

0:22:310:22:32

-How long have you known him?

-I don't know...

0:22:340:22:37

..about 14 hours.

0:22:380:22:40

-We're trying to contact his wife at the moment.

-They're separated.

0:22:400:22:44

I know that, because he told me, because I'm his friend.

0:22:440:22:47

Nevertheless, we need to contact her, she's his next of kin.

0:22:470:22:49

Have you got a wife?

0:22:490:22:51

-Oh, you do!

-It's not relevant.

-Current or ex?

0:22:510:22:54

Right, I want to run some tests on you to determine

0:22:540:22:56

what damage you might have done to yourself with alcohol.

0:22:560:22:59

Don't worry, I don't have anything communicable.

0:22:590:23:02

-The bruises that you came in with...

-That's nothing. I bruise easily.

0:23:020:23:05

They may be symptomatic of something else,

0:23:050:23:07

so I'd like to take some blood run some liver function tests,

0:23:070:23:10

check for cirrhosis, things like that.

0:23:100:23:12

I'm in AA. You know that. I'm getting better.

0:23:120:23:15

OK, yesterday was your first meeting, as I understand it.

0:23:150:23:18

After which you picked up one of the other attendees

0:23:180:23:21

and didn't so much encourage him off the wagon as push him underneath it,

0:23:210:23:25

as a result of which you both ended up in hospital, him, seriously so.

0:23:250:23:28

-So you need help, Ciara.

-Oh, don't go all holier-than-thou on me.

0:23:280:23:31

You know perfectly well all the most interesting people are drinkers.

0:23:310:23:35

I have a full-time job, I work out three times a week,

0:23:360:23:39

I don't smoke, I eat well.

0:23:390:23:41

I just happen to have a personality that needs...

0:23:410:23:43

..tempering.

0:23:430:23:45

With alcohol.

0:23:450:23:46

-You self-medicate.

-I'm enjoying life!

0:23:460:23:49

Pretty sure it's all going to go horribly wrong one day, so I might as well enjoy it while I can.

0:23:490:23:53

-Dr Keogh.

-Yeah.

0:23:530:23:55

The neuro reg is on the phone for you.

0:23:550:23:59

Right, OK. Stay here.

0:23:590:24:00

OK, offer another 2,000, see what they say.

0:24:040:24:07

All right. Let me know. Bye.

0:24:090:24:11

Wish me luck.

0:24:130:24:15

-Looks like you're making a major purchase.

-A house. I hope.

0:24:150:24:18

-Look at you, doing adulting.

-I know, I don't feel like an adult.

0:24:180:24:21

Not like him.

0:24:210:24:23

I think he was born grown-up.

0:24:230:24:25

I don't think he likes me. He makes me feel like a useless teenager.

0:24:250:24:28

I know what you mean, but honestly, it's not you.

0:24:280:24:31

It's the job. I think he's just finding his feet.

0:24:310:24:34

You need to take a look at Amber.

0:24:340:24:36

My...fingers...toes...tingling.

0:24:420:24:45

Pins...and needles.

0:24:450:24:47

Is...it...my...spine?

0:24:470:24:50

No. It's just hyperventilation.

0:24:500:24:52

-Do you want me to call Dr Hardy?

-No.

0:24:520:24:55

But chase up orthopaedics, OK?

0:24:550:24:57

Tell them I really need an opinion on Amber's scans

0:24:570:25:00

and if they speed it up, there's a pint in it for the consultant.

0:25:000:25:03

Nice, big, slow, deep breaths for me.

0:25:040:25:07

Hyperventilation's just a big word for a panic attack.

0:25:080:25:11

It means you're exhaling more than you're inhaling.

0:25:110:25:14

I don't blame you.

0:25:140:25:16

If I'd crashed my bike and ended up in hospital,

0:25:160:25:18

I'd be pretty wound up myself.

0:25:180:25:21

That's it, very good.

0:25:230:25:25

Will...I...walk...again?

0:25:270:25:30

Are the pins and needles going?

0:25:320:25:34

-Yes.

-That's a good sign.

0:25:350:25:37

Let me just chase up orthopaedics now myself.

0:25:380:25:41

Dan... "Dang-ger"?

0:25:520:25:54

"Dang-er"?

0:25:540:25:56

Dan Danger. Let's get on with it, Doc.

0:25:580:26:02

Is that your real name?

0:26:020:26:04

-What's it to you?

-Right.

0:26:090:26:11

-Come on, son, I haven't got all day.

-No, of course. This way, sir.

0:26:130:26:16

Martha Moors. My husband...

0:26:200:26:22

My ex-husband has been admitted. Someone called me.

0:26:220:26:25

Just one sec, please.

0:26:250:26:27

He's suffered a catastrophic bleed.

0:26:270:26:29

The neurosurgeon says the scans show very extensive damage.

0:26:290:26:32

OK, he's coning.

0:26:320:26:34

Let's give him some suction and Hyoscine, I think.

0:26:340:26:37

-Should we ventilate him?

-Well, no.

0:26:370:26:39

I mean, he's bradycardic, he's hypertensive, it's Cushing's triad.

0:26:390:26:43

It's a non-reversible pathology. Are we all agreed? Yeah?

0:26:430:26:45

Let's get a red form. Can we turn the monitor off?

0:26:450:26:48

Don't attempt CPR. Let's just make him as comfortable as possible.

0:26:480:26:51

-There's nothing more we can do for him.

-No!

0:26:510:26:54

-Ciara, you can't be in here.

-You're just going to let him die?

0:26:540:26:57

He's suffered irreparable brain damage. It's just a matter of time.

0:26:570:27:00

-What about your hypocritic oath?!

-Hippocratic oath.

0:27:000:27:03

Hypocritic sounds good to me just now.

0:27:030:27:05

-Can we turn the monitors off, please?

-Help him.

0:27:050:27:07

Louise, would you take Ciara back to cubicles for me, please?

0:27:070:27:10

Please! Do something to help him!

0:27:100:27:13

Argh! I told you what I'd do if you hurt me!

0:27:180:27:21

Sir, you're the one who refused local anaesthetic.

0:27:210:27:23

-I need to keep my wits about me. Have you ever had a death threat?

-Only from you.

0:27:230:27:27

Excuse me, cleaner, can I get a little help, please?

0:27:280:27:31

-It's Dr Rashid, isn't it?

-Yes. Can you stay still, sir?

0:27:310:27:34

-I'm Cymon, with a C-Y.

-Great. Can you mop up in here?

0:27:340:27:37

-I can't, sorry.

-Why not?

0:27:370:27:40

You can have my bodily fluids kit, if you want.

0:27:400:27:43

-I don't know how to use that.

-Just read the packaging.

0:27:430:27:46

Hello, darling.

0:27:460:27:48

Did he just call me darling?

0:27:490:27:51

Yeah, he's dead.

0:28:010:28:03

-Dr Keogh?

-Yeah.

-Joseph's wife is here.

0:28:030:28:07

She's in the relatives' room.

0:28:070:28:09

OK, great. Let's clean him up. I won't be long.

0:28:090:28:13

SHE CRIES

0:28:200:28:22

Hello. Everything all right?

0:28:280:28:30

Clearly not.

0:28:320:28:33

Can I help?

0:28:360:28:37

They just let him die.

0:28:370:28:39

-Who what now?

-That doctor, Keogh. He just...

0:28:400:28:43

He just let Joseph die.

0:28:450:28:48

Well, I'm sure he did everything he could.

0:28:480:28:50

He was fine last night.

0:28:500:28:52

We had a good time.

0:28:530:28:55

Right.

0:28:550:28:57

And then that drunken colleague of yours pulls the plug.

0:28:570:29:00

You know he's an alcoholic, right? He shouldn't be working here.

0:29:040:29:07

I...

0:29:070:29:08

It's fine. I'll take it from here, thanks.

0:29:080:29:11

Right. OK.

0:29:110:29:12

What? So you just let him die? Is that what we do on the NHS now?

0:29:140:29:17

No, it's not policy. It's just nature, isn't it?

0:29:170:29:20

It's nature taking its course, I'm afraid.

0:29:200:29:22

What are you going to tell his wife?

0:29:220:29:24

I'm going to tell her the truth, which is that he died of a massive haemorrhagic stroke.

0:29:240:29:28

What are you going to tell her about me, I mean? About last night.

0:29:280:29:32

Oh, all right, I see.

0:29:320:29:34

The reason you wanted him to live was so you wouldn't be cast a scarlet woman.

0:29:340:29:37

Dylan?

0:29:370:29:39

Yeah, Louise. Can we start Ciara's tests, please?

0:29:390:29:42

Let's get an ECG, liver function and an ultrasound to check for ascites.

0:29:430:29:47

-No way.

-Ciara...

-You think I'm going to trust him after watching him do what he just did?

0:29:470:29:52

I'm amazed they let an alcoholic practise medicine.

0:29:520:29:55

Yeah, I said it.

0:29:550:29:56

Well, you're not laying a finger on me, Dr Death. Goodbye.

0:29:560:29:59

-She needs help.

-Let her go.

-You of all people should understand that.

0:30:010:30:05

Just let her go, just let her go. OK, some people are beyond help.

0:30:050:30:08

-Dylan...

-I have to go and break the news to Joseph's wife.

0:30:080:30:11

May I?

0:30:230:30:25

Why don't you come back inside?

0:30:310:30:33

No, thank you.

0:30:340:30:36

You don't have to see Dr Keogh.

0:30:360:30:38

I'll find you someone else.

0:30:380:30:40

I already have a support group.

0:30:400:30:42

It's called everybody, and they meet in the pub.

0:30:420:30:44

There they are now.

0:30:440:30:46

Excuse me.

0:30:470:30:49

-In a hotel room?

-Yes.

0:30:560:30:59

He had a bedsit across town.

0:31:010:31:03

He swore to me he'd stopped drinking.

0:31:030:31:06

I wouldn't let him see the kids if he'd been drinking.

0:31:060:31:08

Well, he must have had a lapse.

0:31:080:31:11

-But a hotel?

-Yeah.

0:31:130:31:16

Was he alone?

0:31:160:31:18

As far as we know.

0:31:200:31:22

I'm sorry for your loss.

0:31:240:31:27

We lost him a long time ago.

0:31:270:31:29

An X-ray of the right hand, please.

0:31:340:31:36

-That patient's a complete nutjob.

-Oh, yeah.

0:31:400:31:43

He once bit a nurse's ear off at St James,

0:31:430:31:45

so they won't let him back in there any more.

0:31:450:31:48

He has to come to us.

0:31:480:31:50

Reception usually dig up a security guard to accompany you when you treat him.

0:31:500:31:54

-Great. Now you tell me.

-Or Gem.

0:31:540:31:56

Yep. He loves Gem.

0:31:560:31:58

Met her last time he was here. She put him right in his place.

0:31:580:32:01

He'd do anything for her now really. Anything.

0:32:010:32:04

Just so you know.

0:32:050:32:07

Can we talk?

0:32:210:32:22

I know I can.

0:32:240:32:25

Sorry, were you expecting someone?

0:32:270:32:29

No.

0:32:290:32:31

I just always ask for two glasses.

0:32:310:32:33

Yeah, yeah, I've done that.

0:32:340:32:36

So they didn't think it was all for me.

0:32:370:32:40

Well, since it's here, and if you're going to lecture me,

0:32:440:32:49

then you have to drink with me.

0:32:490:32:51

That's the rule.

0:32:520:32:54

No, thanks.

0:33:010:33:03

It'll make you more interesting.

0:33:030:33:05

No, it won't. It'll just make me less me.

0:33:050:33:08

I don't trust people I haven't been drunk with.

0:33:110:33:14

It's a bit flinty for my palate.

0:33:280:33:30

I'm more of a whiskey man.

0:33:300:33:31

Irish whiskey, with an E.

0:33:310:33:33

Dylan Keogh, you know.

0:33:330:33:35

Classy drunk. Love it.

0:33:350:33:37

It's got legs though, I'll give it that.

0:33:370:33:40

You see how it just trickles down the glass?

0:33:400:33:42

In exactly the way that water doesn't.

0:33:440:33:46

-That means it's got a high alcohol content.

-Don't we all?

0:33:470:33:51

I suppose one glass might actually do me some good.

0:33:520:33:55

It could increase my HDL blood cholesterol

0:33:560:33:58

and lower my chances of developing bad cholesterol.

0:33:580:34:01

The tannins would supress blood clotting,

0:34:010:34:04

reduce my risk of having a heart attack.

0:34:040:34:06

Cheers.

0:34:080:34:09

The trouble is, I wouldn't just have one glass, though.

0:34:090:34:12

I'd have the whole bottle. Then I'd probably have another one.

0:34:120:34:15

Then I wouldn't sleep very well

0:34:170:34:19

because my body would be full of stimulants,

0:34:190:34:22

alcohol inside every single cell of my body,

0:34:220:34:24

depressing cellular activity.

0:34:240:34:26

In time, I would develop high blood pressure,

0:34:260:34:29

increased triglycerides, irregular heartbeat.

0:34:290:34:31

Basically, heart disease.

0:34:310:34:33

That's not to mention what it would do to the pancreas, liver and kidneys.

0:34:330:34:37

At least you're a woman.

0:34:370:34:39

You don't have to think about erectile dysfunction.

0:34:390:34:42

You see what you're doing right there? Classic denial.

0:34:420:34:46

How is it denial? They're just medical facts.

0:34:460:34:48

You're telling me what alcohol does to your body. You're not telling me why you drink.

0:34:480:34:52

-I don't drink.

-Why you want to drink, then.

0:34:520:34:54

Do you want to know what I think?

0:34:560:34:58

-Be my guest.

-I've seen you at work today.

0:35:010:35:04

You have this whole grumpy, misanthropic thing going on

0:35:040:35:07

and I see your colleagues are all going, "Oh, that's just Dr Keogh."

0:35:070:35:10

But what they don't realise

0:35:100:35:12

is that grumpiness isn't your dominant emotion.

0:35:120:35:15

There's something else going on underneath.

0:35:170:35:19

I bet you can't maintain relationships with women.

0:35:200:35:23

Was it your ex-wife? I bet she was the final straw.

0:35:260:35:30

I bet you can hardly bear the idea of seeing her again.

0:35:300:35:33

-I work with her, I see her every single day.

-Oh...interesting.

0:35:330:35:37

So, you're trapped in a world of unresolved issues...

0:35:370:35:40

-That's nonsense

-So, you dislocate yourself from polite society

0:35:400:35:43

as it's the only way you can cope.

0:35:430:35:45

And every now and then, you need to binge drink to let off steam...

0:35:450:35:48

Half the world does that, it's perfectly normal.

0:35:480:35:50

Because you can't admit you're an alcoholic.

0:35:500:35:52

Physician, heal thyself.

0:35:540:35:55

How am I doing?

0:35:590:36:00

I came here to try and help you.

0:36:020:36:04

I can see for the time being, I'm wasting my time.

0:36:060:36:08

Wait!

0:36:110:36:13

Did I kill Joseph?

0:36:180:36:20

No, no, no, no, no.

0:36:220:36:25

A bleed on the brain killed Joseph.

0:36:250:36:28

I think that the alcohol he had last night

0:36:280:36:31

was a contributing factor, but it would have happened anyway.

0:36:310:36:34

I've seen his medical records - he had plenty of warnings

0:36:340:36:37

about what would happen if he didn't stop drinking.

0:36:370:36:40

I've got one of these, too.

0:36:400:36:43

I've got a red one.

0:36:430:36:44

It's a battle I fight every single day

0:36:470:36:50

and I will do for the rest of my life.

0:36:500:36:52

Some days are easier than others, but...

0:36:520:36:55

..I have a decision to make and I choose to say no.

0:36:570:37:01

What if I can't be cured? What if it's too late?

0:37:030:37:07

If it's already damaged my body, I'd rather not...

0:37:070:37:10

I'd rather not know.

0:37:100:37:11

You don't look to me like somebody who's gone over the top just yet.

0:37:140:37:17

SHE SCOFFS There'll be some internal damage, of course,

0:37:170:37:20

but, you know, we can fix most of it. Maybe all of it.

0:37:200:37:22

That's not the difficult bit. The difficult bit is up here.

0:37:220:37:25

It's the choices you make once we've repaired the damage.

0:37:250:37:29

It's not a one-time offer, Ciara.

0:37:310:37:33

There will always be help available

0:37:350:37:37

when you decide that you want to ask for it.

0:37:370:37:40

But for now,

0:37:400:37:41

for me...

0:37:410:37:43

..this is your last call.

0:37:440:37:46

Don't have that drink.

0:37:470:37:49

Thought you said you hadn't seen it?

0:38:220:38:25

I just wanted to see what all the fuss was about.

0:38:250:38:27

Whoever is writing it, it will ruin their career.

0:38:280:38:31

Wait, do you think it's me?

0:38:310:38:33

No.

0:38:330:38:35

OK.

0:38:370:38:39

Hey. The orthopaedic surgeon got back to us about Amber.

0:38:400:38:43

-What did he say?

-He said he'd like to see a photo of the doctor

0:38:430:38:47

offering a pint before he says yes.

0:38:470:38:49

I'm joking. Take a look for yourself.

0:38:490:38:51

OK.

0:38:550:38:57

It'll be a pretty tricky operation on your femur -

0:38:570:39:00

but if you do as you're told,

0:39:000:39:02

you stand a good chance of making a full recovery.

0:39:020:39:05

-TEARFULLY:

-Thank you.

0:39:050:39:06

That's enough crying for one day. Here, let me.

0:39:060:39:09

If you're on your own,

0:39:130:39:14

we can look into getting you some help.

0:39:140:39:17

Do you think I'm weird, moving to a town where I know no-one?

0:39:180:39:22

No. Doctors and nurses do it all the time.

0:39:220:39:24

-SHE LAUGHS

-Oh, and by the way,

0:39:240:39:27

your bike is in the police pound.

0:39:270:39:29

But don't go try to ride it for a while, OK? Promise?

0:39:290:39:33

Doctor's orders?

0:39:330:39:34

One of the perks of the job.

0:39:340:39:36

Here you go, Peter. This should keep you a bit warmer.

0:39:410:39:44

FLATLINE TONE

0:39:440:39:47

Rash! Something's wrong! I pulled a lead out

0:39:470:39:50

He's got no output...

0:39:520:39:54

-What does that mean?

-There's no pulse.

-I've killed him!

0:39:550:39:59

Can you not give him the kiss of life or something?

0:40:010:40:03

We don't actually do that! You stitched me up, right?

0:40:030:40:05

Dodgy patient, cleaner not helping...

0:40:050:40:07

-It was just a joke! Can you help him?

-It wasn't very nice.

0:40:070:40:09

Yeah, well, neither is being accused of something that I didn't do.

0:40:090:40:12

I need this job - people accept me here

0:40:120:40:15

and I can't go round killing patients!

0:40:150:40:17

OK.

0:40:170:40:19

Don't worry. He was never in any danger.

0:40:220:40:24

MONITOR BEEPS STEADILY

0:40:240:40:26

So, truce?

0:40:260:40:28

-Truce.

-SHE SPITS

0:40:300:40:33

Seriously? You're in a hospital!

0:40:330:40:35

THEY CHUCKLE

0:40:400:40:42

-Dr Keogh.

-Yeah.

0:40:530:40:56

-Ciara's test results.

-All right.

0:40:560:40:58

The drinking's taken its toll on her all right.

0:40:580:41:01

But nothing that'll kill her today.

0:41:010:41:03

I've referred her for counselling

0:41:030:41:05

and they'll put her onto a community withdrawal programme.

0:41:050:41:07

OK, well, let's discharge her.

0:41:070:41:10

Could you emphasise to her

0:41:120:41:14

the importance of attending the AA meetings?

0:41:140:41:16

Can I ask you a question?

0:41:260:41:28

Yeah, yeah.

0:41:280:41:29

As long as it's medical.

0:41:290:41:31

Yeah, it is.

0:41:310:41:32

Kind of.

0:41:320:41:34

Why did you not tell Joseph's wife

0:41:340:41:37

the truth about the circumstances leading to his stroke?

0:41:370:41:41

Because it wouldn't have benefited her, I mean, estranged or not.

0:41:420:41:45

So, it wasn't because you were trying

0:41:450:41:47

to protect that patient, was it?

0:41:470:41:49

-No, why would it be?

-Because you know her.

0:41:490:41:52

-I don't know her.

-Or she knows you.

0:41:520:41:54

I'm not having a go, I'm just trying to learn the ethics.

0:41:540:41:58

She's an alcoholic, isn't she?

0:41:580:41:59

We all have our secrets.

0:41:590:42:02

Look, don't take this the wrong way,

0:42:020:42:05

but do you want to have a drink after work?

0:42:050:42:08

Coffee, I mean.

0:42:080:42:09

Um, I have other plans.

0:42:100:42:12

Thank you. No.

0:42:140:42:16

Dr Kinsella, can I have a word, please?

0:42:180:42:20

You've treated a lot of patients today.

0:42:250:42:29

-That's what you told me to do.

-Yeah.

0:42:290:42:31

And I understand orthopaedics have cleared Amber Wilson

0:42:330:42:37

-of spinal injury.

-Yeah, she'll likely make a full recovery

0:42:370:42:41

if the femur heals properly.

0:42:410:42:42

How would you have felt if she'd been paralysed

0:42:420:42:44

because you decided to log roll?

0:42:440:42:46

She'd have been a lot more paralysed if I'd let her choke to death.

0:42:460:42:49

I just need to be sure that you can handle

0:42:490:42:51

everything that's thrown at you.

0:42:510:42:53

I can and...I did.

0:42:530:42:56

Excuse me, Dr Hardy,

0:42:560:42:57

I know that you have a lot more experience than me,

0:42:570:43:00

but I haven't exactly felt supported by my clinical lead today.

0:43:000:43:03

Yeah, I had to make a tricky call

0:43:030:43:06

on whether or not to log roll Amber,

0:43:060:43:08

but I made my decision and I made it fast,

0:43:080:43:10

and it turned out to be the right one.

0:43:100:43:12

And just because I was reading that blog doesn't mean I wrote it,

0:43:120:43:15

or endorse it, or anything else.

0:43:150:43:16

-You know, there's no law to say that I can't read it.

-No.

0:43:160:43:20

The NHS has its faults, but I just thought that, after today,

0:43:200:43:23

you would see the commitment that I make to it.

0:43:230:43:25

And I did.

0:43:250:43:27

I do.

0:43:270:43:29

Which is why I've decided to recommended you

0:43:290:43:32

for a major trauma course.

0:43:320:43:34

Oh.

0:43:340:43:35

Until then, please try not to treat every patient

0:43:380:43:41

-that comes through our doors single-handedly.

-Noted.

0:43:410:43:45

That's all.

0:43:460:43:48

Unless there's anything else you wish to suggest

0:43:480:43:50

about how I can do my job better?

0:43:500:43:52

No, I'm good.

0:43:520:43:54

Thank you.

0:43:570:43:59

ENGINE SPLUTTERS

0:44:300:44:34

ENGINE RATTLES

0:44:360:44:38

KNOCK AT WINDOW

0:44:380:44:40

Need a lift?

0:44:400:44:41

SHE CHUCKLES

0:44:410:44:43

Just take a right here, please.

0:44:480:44:50

This is your area? Bea, you live in the best part of town!

0:44:500:44:54

Are you living with your parents?

0:44:540:44:56

Oh! You should invite Dr Kinsella to the jumble sale on Saturday.

0:44:560:44:59

Oh, Mum, I don't think that's quite Bea's thing.

0:44:590:45:01

It's for the old people's home.

0:45:010:45:03

Rash helps every year.

0:45:030:45:05

-He's a good boy.

-He is.

-All the other mothers ask me

0:45:050:45:07

-when he's going to meet a girl and leave home.

-Mum...

0:45:070:45:11

Do you have a boyfriend, Dr Kinsella?

0:45:120:45:15

Um... Um, we're here, so...

0:45:150:45:18

Er, just drop me anywhere, thanks.

0:45:180:45:21

See you tomorrow.

0:45:320:45:33

-Yeah.

-Bye.

-See you tomorrow.

0:45:330:45:35

-TO HERSELF:

-Please go, please go, please go...

0:45:380:45:41

CAR DRIVES AWAY

0:45:440:45:46

DOOR OPENS

0:46:010:46:03

Would anyone like to open the meeting?

0:46:130:46:16

Yes?

0:46:170:46:19

DOOR OPENS

0:46:200:46:21

Sorry.

0:46:240:46:25

My name's Dylan. I'm an alcoholic.

0:46:280:46:31

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