Episode 26 Casualty

-What if she remembers?

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

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

-You're new, right?

-Gem.

-Rash.

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

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

Can we let this voicemail serve as my official resignation

from the post of acting clinical lead of the ED?

I've been under a little bit of stress.

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

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

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

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

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

a helicopter crashes into the side of the building.

There's chaos, carnage everywhere,

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

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

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

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

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

-ALL:

-Hi, Joseph.

This is my 24th day without a drink.

I'm still a newbie.

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

Hi.

I'm Ciara and I'm an alcoholic.

-ALL:

-Hi, Ciara.

24 hours sober now.

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

loads of decent Chablis without it really troubling me.

Well done.

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

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

Do they work in vending machines?

Hello. You look interesting.

I'm really not.

What's your name?

What is it about Alcoholics Anonymous,

everybody seems to want to know your name?

Fine. Dark and mysterious. I like that.

-I can work with that.

-Yeah, I don't think so.

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

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

Night.

-Joseph, wasn't it?

-Yeah.

Come on, you only live once.

Men.

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

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

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

TYRES SCREECH

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

I'm afraid so.

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

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

-Right, where's the hypnotist?

-He's gone to St James.

-Can we just transfer her there?

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

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

-Oh!

-What?

I've seen this before.

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

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

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

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

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

-Sure.

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

-I bagsy that patient.

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

Dr Kinsella, there's a skateboarding injury.

Distal radius and ulnar fracture.

Thank you.

Dr Keogh. Welcome back.

Is everything all right?

-Yes, all good, thanks.

-Good.

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

-Right.

-Right.

Right you are.

What is it, Dr Kinsella?

I just wanted to ask if I could have

some more interesting patients sometimes, please.

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

We have to take the patients as they come.

That's the only way it can work.

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

of just about anything.

But I mean, that porphyria case -

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

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

How long have you been with us now?

Four weeks.

I started on the 3rd of February.

-Are you enjoying it?

-Yes, of course.

The NHS can be a frustrating place to work.

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

There's a junior doctor out there somewhere

very unhappy with their lot.

I haven't seen it.

OK.

I understand your frustrations.

And actually, my job is exactly like yours

when it comes to resus and cubicles.

We examine the patients, we treat them,

we discharge them or we refer them for specialist care.

We're starting to fill up,

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

Yes, Dr Hardy.

Examine, treat, discharge.

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

Hello, mate. We're the paramedics.

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

One, two, three.

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

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

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

-Amber.

-Oh, sorry, love.

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

-Can you tell me where it hurts, Amber?

-Everywhere.

My back, my leg.

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

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

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

-Do you have any allergies?

-No.

-Tell me if this hurts.

Ah!

Take nice, deep breaths into that.

Looks like an open fracture femur.

Can we check her pedal pulse?

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

You're doing really well, Amber.

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

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

-Straight away?

-Yeah, let's do it now.

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

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

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

On three. One, two, three.

SHE SCREAMS

Are you awake? I need coffee.

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

How many did we have anyway?

Did you sleep well?

I slept like a log.

That would have been the red wine, then.

Could be doing with a few hours, mind you.

Look at me. Covered in bruises, you brute.

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

Now, where is my other shoe?

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

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

once orthopaedics fixes the bones in theatre.

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

-So bored. Just a broken bone.

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

So, I installed that dating app like you said.

-I've had three likes so far.

-Let's see.

-Cat pictures. Bin her.

-Yeah, but she's cute.

Too pouty. Delete.

-I would.

-You think?

-Yeah, she looks...

-Hot.

Intelligent. Message her.

-That's going to cost me £8.

-Do it.

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

-Start with hello.

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

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

Blood and gore, I like it. Cubicle three.

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

VOMITING

You don't say much, do you?

Though, I know I talk a lot.

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

There's no in-between.

Shall we swap numbers?

Are you all right?

Joseph? What's happening?

Oh, my God!

No, I can't. You understand?

I can't... Erm...

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

Right. This is Amber Wilson, 27 years old.

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

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

We manipulated it at the scene with no circulatory compromise.

Helmet removed at scene, and haemodynamically stable throughout.

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

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

Complaining of thoracic, back and pelvic pain.

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

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

1.2 grams of co-amoxiclav, one gram of paracetamol

and four milligrams of Ondansetron.

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

Biker chick. Love it.

Good luck, Amber.

-Hi, Amber. I'm Dr Kinsella.

-Is my bike OK?

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

Airway clearly fine.

Can I get a pregnancy test plus a full trauma CT

and an X-ray of the right femur?

You like bikes, huh?

I compete. County level. Looking good for national.

-I'm impressed.

-It's just a bump.

-I've had spills before.

-Let us be the judge of that.

And can I get bloods for crossmatch,

FBCs, U&Es and a venous blood gas?

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

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

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

Right. Yes.

Orthopaedics, please.

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

-I just need you to finish your notes.

-Erm... Yes.

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

-Oh, great.

-I need the cubicle back.

-Yeah, yeah, just, erm...

Dr Kinsella, let somebody else do that.

Prioritise.

And breathe.

Ah, Dr Keogh. Welcome back! Nice holiday?

It's like I've never been away.

Watch out, watch out, watch out.

Hello. Try not to run any more doctors over!

Nice to see you again, too.

-She ran a doctor over?

-Yes.

-She did.

-What? With a trolley?

-No. With a car.

-Of all the accidents...

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

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

Did not know that.

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

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

One free cubicle, as requested.

Thank you.

-Dr Kinsella?

-Yes. On it.

-Remind me...

-You were going to sign off Mr Hyatt.

-Yes.

Notes?

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

He's here, just come this way.

-Can you tell me your partner's name?

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

Hi, Joseph. My name's Iain.

Can you tell me what happened?

Can you raise your arms for me?

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

-He's had a stroke?

-When did he start to feel ill?

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

And then I was in the shower,

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

-OK.

-3006 to Control, over.

-Control responding. Go ahead.

Got a pre-alert for you.

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

-GCS is 12, BP...

-Is 210 over 110.

-..210 over 110.

ETA 15 minutes, over.

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

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

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

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

It's nothing. I just bruise easily.

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

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

-We need to get him to hospital fast.

If you could come with us and answer a few questions

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

Yeah, Of course.

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

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

Right, I will call a stroke registrar and nurse.

-That's mine, thanks.

-I was wondering.

-Why were you going through it?

-To find out whose it was.

You're welcome!

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

-What?

-I had no idea you were an offender.

You just left it by the nurses' station.

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

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

-Everything all right?

-She had my wallet.

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

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

Do you want to tell anyone else?

Gem. Gem!

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

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

-Oh, no.

-Are you OK?

-Yeah, I'm fine.

-Dr Keogh?

-Yes.

-I'm Dr Kinsella, new F1.

Well done.

Bea.

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

-Bea is my name.

-Oh, right. OK.

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

Any sign of the stroke reg or nurse?

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

-All right.

-Ready?

-Yes.

-Joseph Moors, 35, suspected stroke.

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

GCS 12, due to incomprehensible sounds,

but he is maintaining his own airway.

Heart rate is 70. BP is 205 over 115.

Resps 16. SATS 100% on air.

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

His BM is 4.8.

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

-Yeah.

Joseph, are you able to talk?

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

Definite neurological impairment on the right side.

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

Every second is valuable brain tissue.

I have a patient in CT.

Right, OK, thanks.

Joseph...

..you're in Holby City Hospital.

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

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

What are you doing here?

Right. You're not related, are you?

-No.

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

-What? You work here?

-Yes. Just let me do my job.

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

and could do with strong coffee.

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

-No...

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

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

-He's in very good hands.

-I can take a look at her.

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

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

Your bedside manner better be worth it.

Louise?

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

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

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

we once had about please and thank you?

Yes. Please never mention it again. Thank you.

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

Things are going well for me here, right?

-Yeah, yeah, yeah.

-We adore you.

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

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

Rash needs teaching a lesson, don't he?

What sort of lesson?

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

He couldn't cope without us backing him up.

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

of mistreated ancillary staff.

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

Joseph Moors, DOB - 2nd of February 1983.

Wow, really?

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

including the time he wrapped his car around a lamppost.

We're trying to contact his ex-wife.

Right, yeah, this isn't good.

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

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

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

OK.

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

-Do you know her or something?

-No. Not really. No.

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

-Good for you.

-There's nothing good about it.

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

Neurosurgical team. Now. Please, please.

Is there anyone we can call for you, Amber?

No.

I only have distant family.

I just moved here a couple of weeks ago.

Starting a new life.

Relationship meltdown?

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

-No.

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

-Am I going to be OK?

-I just need a second opinion on these.

Can you move your toes for me?

No.

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

-Look, we don't know that yet.

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

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

OK.

-Let's log roll her.

-There's only two of us.

-Are her scans clear?

-Yeah, I think so.

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

OK, three, two, one.

OK, suction.

OK, good. Very good.

-What's happened?

-She was in danger of asphyxiating.

And the scans were clear?

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

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

Dr Kinsella, if you're not sure,

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

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

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

-There wasn't time...

-There's always time to raise the alarm.

Even if you still had to proceed until help arrives.

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

-Of course.

Please try not to do everything on your own.

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

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

-Well, that's reassuring.

I had you down as an accountant, actually.

How's Joseph?

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

I'm his friend.

-How long have you known him?

-I don't know...

..about 14 hours.

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

-They're separated.

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

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

Have you got a wife?

-Oh, you do!

-It's not relevant.

-Current or ex?

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

what damage you might have done to yourself with alcohol.

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

-The bruises that you came in with...

-That's nothing. I bruise easily.

They may be symptomatic of something else,

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

check for cirrhosis, things like that.

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

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

After which you picked up one of the other attendees

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

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

-So you need help, Ciara.

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

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

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

I don't smoke, I eat well.

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

..tempering.

With alcohol.

-You self-medicate.

-I'm enjoying life!

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

-Dr Keogh.

-Yeah.

The neuro reg is on the phone for you.

Right, OK. Stay here.

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

All right. Let me know. Bye.

Wish me luck.

-Looks like you're making a major purchase.

-A house. I hope.

-Look at you, doing adulting.

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

Not like him.

I think he was born grown-up.

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

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

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

You need to take a look at Amber.

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

Pins...and needles.

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

No. It's just hyperventilation.

-Do you want me to call Dr Hardy?

-No.

But chase up orthopaedics, OK?

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

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

Nice, big, slow, deep breaths for me.

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

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

I don't blame you.

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

I'd be pretty wound up myself.

That's it, very good.

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

Are the pins and needles going?

-Yes.

-That's a good sign.

Let me just chase up orthopaedics now myself.

Dan... "Dang-ger"?

"Dang-er"?

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

Is that your real name?

-What's it to you?

-Right.

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

-No, of course. This way, sir.

Martha Moors. My husband...

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

Just one sec, please.

He's suffered a catastrophic bleed.

The neurosurgeon says the scans show very extensive damage.

OK, he's coning.

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

-Should we ventilate him?

-Well, no.

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

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

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

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

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

-No!

-Ciara, you can't be in here.

-You're just going to let him die?

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

-What about your hypocritic oath?!

-Hippocratic oath.

Hypocritic sounds good to me just now.

-Can we turn the monitors off, please?

-Help him.

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

Please! Do something to help him!

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

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

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

-Only from you.

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

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

-Yes. Can you stay still, sir?

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

-Great. Can you mop up in here?

-I can't, sorry.

-Why not?

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

-I don't know how to use that.

-Just read the packaging.

Hello, darling.

Did he just call me darling?

Yeah, he's dead.

-Dr Keogh?

-Yeah.

-Joseph's wife is here.

She's in the relatives' room.

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

SHE CRIES

Hello. Everything all right?

Clearly not.

Can I help?

They just let him die.

-Who what now?

-That doctor, Keogh. He just...

He just let Joseph die.

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

He was fine last night.

We had a good time.

Right.

And then that drunken colleague of yours pulls the plug.

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

I...

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

Right. OK.

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

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

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

What are you going to tell his wife?

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

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

Oh, all right, I see.

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

Dylan?

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

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

-No way.

-Ciara...

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

I'm amazed they let an alcoholic practise medicine.

Yeah, I said it.

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

-She needs help.

-Let her go.

-You of all people should understand that.

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

-Dylan...

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

May I?

Why don't you come back inside?

No, thank you.

You don't have to see Dr Keogh.

I'll find you someone else.

I already have a support group.

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

There they are now.

Excuse me.

-In a hotel room?

-Yes.

He had a bedsit across town.

He swore to me he'd stopped drinking.

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

Well, he must have had a lapse.

-But a hotel?

-Yeah.

Was he alone?

As far as we know.

I'm sorry for your loss.

We lost him a long time ago.

An X-ray of the right hand, please.

-That patient's a complete nutjob.

-Oh, yeah.

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

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

He has to come to us.

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

-Great. Now you tell me.

-Or Gem.

Yep. He loves Gem.

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

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

Just so you know.

Can we talk?

I know I can.

Sorry, were you expecting someone?

No.

I just always ask for two glasses.

Yeah, yeah, I've done that.

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

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

then you have to drink with me.

That's the rule.

No, thanks.

It'll make you more interesting.

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

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

It's a bit flinty for my palate.

I'm more of a whiskey man.

Irish whiskey, with an E.

Dylan Keogh, you know.

Classy drunk. Love it.

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

You see how it just trickles down the glass?

In exactly the way that water doesn't.

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

-Don't we all?

I suppose one glass might actually do me some good.

It could increase my HDL blood cholesterol

and lower my chances of developing bad cholesterol.

The tannins would supress blood clotting,

reduce my risk of having a heart attack.

Cheers.

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

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

Then I wouldn't sleep very well

because my body would be full of stimulants,

alcohol inside every single cell of my body,

depressing cellular activity.

In time, I would develop high blood pressure,

increased triglycerides, irregular heartbeat.

Basically, heart disease.

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

At least you're a woman.

You don't have to think about erectile dysfunction.

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

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

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

-I don't drink.

-Why you want to drink, then.

Do you want to know what I think?

-Be my guest.

-I've seen you at work today.

You have this whole grumpy, misanthropic thing going on

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

But what they don't realise

is that grumpiness isn't your dominant emotion.

There's something else going on underneath.

I bet you can't maintain relationships with women.

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

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

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

-Oh...interesting.

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

-That's nonsense

-So, you dislocate yourself from polite society

as it's the only way you can cope.

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

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

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

Physician, heal thyself.

How am I doing?

I came here to try and help you.

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

Wait!

Did I kill Joseph?

No, no, no, no, no.

A bleed on the brain killed Joseph.

I think that the alcohol he had last night

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

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

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

I've got one of these, too.

I've got a red one.

It's a battle I fight every single day

and I will do for the rest of my life.

Some days are easier than others, but...

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

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

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

I'd rather not know.

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

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

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

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

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

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

There will always be help available

when you decide that you want to ask for it.

But for now,

for me...

..this is your last call.

Don't have that drink.

Thought you said you hadn't seen it?

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

Whoever is writing it, it will ruin their career.

Wait, do you think it's me?

No.

OK.

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

-What did he say?

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

offering a pint before he says yes.

I'm joking. Take a look for yourself.

OK.

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

but if you do as you're told,

you stand a good chance of making a full recovery.

-TEARFULLY:

-Thank you.

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

If you're on your own,

we can look into getting you some help.

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

No. Doctors and nurses do it all the time.

-SHE LAUGHS

-Oh, and by the way,

your bike is in the police pound.

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

Doctor's orders?

One of the perks of the job.

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

FLATLINE TONE

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

He's got no output...

-What does that mean?

-There's no pulse.

-I've killed him!

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

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

Dodgy patient, cleaner not helping...

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

-It wasn't very nice.

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

I need this job - people accept me here

and I can't go round killing patients!

OK.

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

MONITOR BEEPS STEADILY

So, truce?

-Truce.

-SHE SPITS

Seriously? You're in a hospital!

THEY CHUCKLE

-Dr Keogh.

-Yeah.

-Ciara's test results.

-All right.

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

But nothing that'll kill her today.

I've referred her for counselling

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

OK, well, let's discharge her.

Could you emphasise to her

the importance of attending the AA meetings?

Can I ask you a question?

Yeah, yeah.

As long as it's medical.

Yeah, it is.

Kind of.

Why did you not tell Joseph's wife

the truth about the circumstances leading to his stroke?

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

So, it wasn't because you were trying

to protect that patient, was it?

-No, why would it be?

-Because you know her.

-I don't know her.

-Or she knows you.

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

She's an alcoholic, isn't she?

We all have our secrets.

Look, don't take this the wrong way,

but do you want to have a drink after work?

Coffee, I mean.

Um, I have other plans.

Thank you. No.

Dr Kinsella, can I have a word, please?

You've treated a lot of patients today.

-That's what you told me to do.

-Yeah.

And I understand orthopaedics have cleared Amber Wilson

-of spinal injury.

-Yeah, she'll likely make a full recovery

if the femur heals properly.

How would you have felt if she'd been paralysed

because you decided to log roll?

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

I just need to be sure that you can handle

everything that's thrown at you.

I can and...I did.

Excuse me, Dr Hardy,

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

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

Yeah, I had to make a tricky call

on whether or not to log roll Amber,

but I made my decision and I made it fast,

and it turned out to be the right one.

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

or endorse it, or anything else.

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

-No.

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

you would see the commitment that I make to it.

And I did.

I do.

Which is why I've decided to recommended you

for a major trauma course.

Oh.

Until then, please try not to treat every patient

-that comes through our doors single-handedly.

-Noted.

That's all.

Unless there's anything else you wish to suggest

about how I can do my job better?

No, I'm good.

Thank you.

ENGINE SPLUTTERS

ENGINE RATTLES

KNOCK AT WINDOW

Need a lift?

SHE CHUCKLES

Just take a right here, please.

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

Are you living with your parents?

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

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

It's for the old people's home.

Rash helps every year.

-He's a good boy.

-He is.

-All the other mothers ask me

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

-Mum...

Do you have a boyfriend, Dr Kinsella?

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

Er, just drop me anywhere, thanks.

See you tomorrow.

-Yeah.

-Bye.

-See you tomorrow.

-TO HERSELF:

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

CAR DRIVES AWAY

DOOR OPENS

Would anyone like to open the meeting?

Yes?

DOOR OPENS

Sorry.

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