In Good Health Doctors

MEDICAL EQUIPMENT BEEPS

BEEPING ACCELERATES

MONOTONE

HORN BEEPS

Cath? I know you're in there.

DIAL TONE

If you don't want it now then take it with you.

I know you can't talk to anyone about what happened with your dad.

I don't need to talk about Dad.

Then what's keeping you awake at night?

I'm going to be late. Thank you for the sandwich.

Hello?

Cath?

Hello, Cath?

Why didn't you answer me? I was worried.

I'm not going.

Stop being a scaredy cat.

I dreamt I died on the operating table.

It's just an excision, not major heart surgery.

The monitor flat-lined like on the telly,

but there was no big resuscitation scene, no rushing at me

with those electric zappers, the doctors just walked off and left me.

In that case, we'd better sue(!) Ha ha(!)

Hundreds of people have operations every day,

the worst thing is that you'll feel a bit rubbish after the general.

The worst thing is that I'm going to be losing my hair.

It's a biopsy, remember?

But what if it is cancer and I do have to have chemo?

It's not nice, but it's an effective treatment.

I might have to lose a breast.

Stop it, Cath! You don't know you've got anything yet.

Come on, let's get ready.

Have you packed a dressing gown?

I don't have one.

Well, what about one of your crazy kaftans? You'll need one.

As soon as you get there, they put you in a hospital gown

and then they make you wait for hours. It's all hurry up and wait.

I've never had an operation before.

Well, no wonder you're nervous.

THEY LAUGH

Morning. Good morning.

You brought a picnic?

I do not like to eat take away,

so I thought I will bring enough for both of us.

Bless you, that's really sweet.

Goodness. We are going to be here all day.

Seriously, only help out as long as you can, Mrs T.

I appreciate your time, I really do.

No, I'm happy to help.

How are we going to organise all this?

At the church jumble sale, we put things on tables in categories -

houseware, children's toys, children's clothes, books.

There's some folding tables out the back, shall I go and grab them?

Good idea.

You won't forget to pick the kids up at 3.30, yeah? Course not.

Good morning, how are we?

Mr Wythe, Mrs Wythe. Still feeling strong?

Of course. I know I'm in safe hands.

Mum sends her love. How is she?

Pretty good for 73.

She's just started weight training at a gym. Would you believe it?!

She keeps complaining to the staff about the loud music

and the televisions.

I don't blame her. I use it as my excuse not to go.

I'm sure you're just too busy.

Indeed. And Miss Horton?

Cath.

Love the kaftan. My wife tells me everything '70s is cool.

Well, it was my heyday. It's from Morocco.

This is my friend Karen.

Hi. So, how are you doing?

OK. You know, I thought that needle thingy was scary,

but at least I could see what was going on.

I couldn't just face the needle again, could I?

When you get an equivocal result from the needle biopsy,

it's always best to go for an excision.

You don't want to delay or just get the same result again.

So it's not an option?

Stop looking for a get-out-of-jail card.

Don't be nervous, it's a very simple procedure.

Right.

But there's a chance the mass might not be cancerous, isn't there?

Definitely, but the million-dollar question is,

do you want to take the chance of not knowing?

You don't, Cath. It's best to find out what it is early.

Listen to your friend here.

I guess I'm just worrying.

None of this is easy.

BEEPER

Right, I'll see you both down there.

Such a lovely man.

He seems nice.

Well, yes, in a sort of toffee public school sort of way.

They all talk like that. When I first met Heston, I thought

he was like Toad from Toad Of Toad Hall,

but I would trust him with my life.

Dr Bowman operated on my mother very successfully,

and he's top notch at reconstruction.

If you get that far.

Actually I'm quite looking forward to my new set.

Are you having both breasts removed?

Yes, the double whammy.

Wow, that is unlucky, two tumours?

Actually, I haven't got any.

Good morning.

Is it?

Well, it's not raining.

I just had a phone call from Karen, she's going to be late.

Nothing to do with that steak of hers you were brandishing yesterday?

No, a friend of hers is having breast surgery today.

Some sort of minor biopsy, I think.

Karen wants to take her to the hospital in the car,

but now her friend's had cold feet, Karen wants to stay with her.

Calm her down a bit so I'm on reception.

It's usually quiet in the morning, the students are still in bed.

Lucky them.

So you're having a double mastectomy as insurance? Exactly.

Have you got the gene like Angelina Jolie?

She had BRCA1, I've got BRCA2.

But like her, I just don't want to take any risks.

I've seen my mum and aunt go through surgery and chemotherapy.

They both lost a breast and their hair.

luckily not at the same time, so they did get to share a wig.

Actually it got quite a showing in the family photos, that wig.

A family heirloom you'd rather avoid?

It's quite stylish actually.

My aunt's quite wealthy so she had it specially made,

she had it modelled on Purdy from the New Avengers.

But you're not in line for the wig yet.

They haven't found anything, have they?

No, not yet. But I've spent so much time worrying that I'm going to lose my mum.

I don't want my children to go through that.

It's a big call. Do you know what your chances are?

It's hard to say,

but with BRCA2 it's between 45 and 85%

over my lifetime, but when you've been through what

my family's been through, it does seem like the lesser of two evils.

They've survived though. Yeah.

Their tumours were treatable, but I don't want to live in fear.

Anyway, I've always fancied a C cup.

And you will be forever pert.

I'm warming up to this surgery business.

You've changed your tune.

Look at this oil and vinegar set. It's still in its box.

It was probably a Christmas present.

I always keep the packaging of things I do not like.

People will pay a little bit extra, if it is still in its box or

if it has the tag attached.

I think all presents should come with receipts,

there's nothing worse than having to hold on to something that you hate.

All our unwanted gifts,

charity shops would go out of business.

You know, if it wasn't for you, I reckon

I would have just sat back and let this place close down.

You would not have let that happen.

I think I would.

You give me too much credit.

I just encouraged you, the seeds were already there.

You just do things out of the goodness of your heart.

What's up? You haven't found anything, have you?

No, it's not me. I met this woman this morning who was

having a DOUBLE mastectomy, she had one of the genes.

It's a huge decision.

It is. I think because we hear so much about breast reductions

and enlargements in the gossip mags, we forget how major

these operations are for someone to go through.

She's a braver woman than me.

It's a hard choice if you're in a high-risk group.

See, it's got me thinking, you know, as soon as they invite me

for a screening, I'm going.

Do you have a family history?

Thankfully, no.

Then I wouldn't spend too much time thinking about it just yet.

I'm going to go to the screening. Can't hurt, can it?

Well, you'd be surprised.

Some of the latest research suggests that the current practice

of recommending screening mammograms has actually led us into

over diagnosing the problem.

Over diagnosing?

Let's talk about this later.

Mr White?

Toast Thanks.

What are you reading?!

She was looking rather worried before,

maybe it's the company report.

Can you put a slice on for me, please?

Here, have mine.

I helped deliver your baby and I gave you my toast.

Actually, I made that toast.

Thank you. Whatever it is, she doesn't want us to know about it.

Maybe it's performance reviews.

No, they're not out for a few months yet.

Maybe it's a complaint.

That's it.

Cancer treatments are getting better all the time.

The drugs they use now are a lot more effective.

That's reassuring.

I know surgery can be a little scary,

I'm a little scared myself too, to be honest.

It's best not to think about what they do

during the operation, just focus on the outcome.

You're right. No more worrying.

Why would she be reading a report or a patient complaint on her tablet?

I don't know, but it has to be work related.

otherwise she'd be more discrete.

Maybe it's compulsive reading, she's found a really good book.

Maybe she's reading Fifty Shades Of Grey?

You are, aren't you? You disappoint me, Carmichael.

Do I really look like the submissive type?

So is it a complaint?

I can't really say.

Not until I've discussed it with the other partners.

That sounded serious.

I bet it's about me. No, it's me.

Thanks.

What did you mean earlier about over diagnosis?

A lot of abnormalities picked up by mammograms aren't cancerous,

and even if they were, some cancers can be so slow growing

that they wouldn't actually cause harm during your lifetime.

If they weren't found during breast screenings you'd never know they

were there and you wouldn't have to go through the trials of treatment.

But how do you know which is which?

Well, there lies the problem. We don't.

So, currently we treat them all.

Yes, but we do breast screenings to detect cancers before there

are any symptoms, that way, we improve the patient's outlook.

Well, that sounds sensible to me.

It does, in a man-on-the-street sort of way,

but I did research on this at uni.

Some research suggests that, while mortality rates have been dropping,

it's actually advances in treatment that are mainly responsible,

rather than early detection, and that screening mammograms

have generated a lot of intervention that's not always necessary.

Intervention?

Surgery, chemotherapy. The researchers reckon that as many

as one in three cancer treatments aren't necessary, and then

there's all the women who go through the stress of testing and biopsies.

But surely it's better to know, to be safe?

Yes, it is.

But the procedure is invasive, and therefore carries risks.

We need to take that into account... PHONE RINGS

Yes, but we don't know which cancers are harmful,

therefore it would be unethical not to treat all of them.

That is standard practice.

Karen, don't you think you should get that phone?

Yes.

But that's not my point.

I agree when you find something, it's human nature to investigate

and treat it. The issue is whether we go looking for problems

if someone doesn't have any symptoms. Yes,

but Karen's friend is having a breast excision biopsy today

and I don't want her to feel it's the slightest bit unnecessary.

Right. I didn't know.

Good luck. Thanks. I'll see you on the other side.

OK. Goodbye.

I'm really sorry, Karen, I didn't realise about your friend.

That's OK. You just gave me food for thought.

She has no symptoms, she can't feel anything,

and now she's having an operation to find out what it is.

She wouldn't have known anything

if she hadn't had that screening mammogram.

But she did. And you can't always tell from looking

which abnormalities are benign.

So if it does turn out to be one that's cancerous, it might be

one that needs to be dealt with.

I hope not.

An excision biopsy is more definitive

and it's a simple procedure.

She might well be in the clear, but you'll know for sure within a week.

Right, Miss Horton, we'll count down from ten

and when you wake up, it'll all be over.

Ten, nine, eight, seven...

She's out.

KNOCK AT DOOR Yup?

Hi. Hi.

Have you got a minute? Yeah.

I was just wondering if there's something I should know,

about my performance?

No.

It's just that Zara's been absorbed in her Kindle all day,

and when I asked what she was reading

she implied that it was some sort of complaint.

Well, shouldn't that come through me first?

KNOCK AT DOOR Have you got a minute?

I do, but I was hoping to catch up on some paperwork.

It's about Kevin.

He came to you? He thinks he's in trouble,

says you've got some sort of complaint against him.

Good. Have you?

No, I'm just winding him up for being nosy.

He said you'd been reading all day?

Only in my breaks.

It relaxes the mind between patients.

Reading something stimulating between consults

helps to optimise performance.

I agree.

In fact, I'd like you to have a look at my opening address

for the conference on Friday. It'd be good to get some feedback. Oh.

I'll get it to you straight away, so you can have a look over lunch,

and maybe we could meet at the end of the day?

Sure.

Hi.

She's still not back.

Do you know why it's taking so long?

They've only said that she's been taken into intensive care.

Intensive care? Why?

I don't know. I've asked the nurse to page Mr Bowman,

so hopefully we'll have some news soon.

They just said to wait here.

Of course, sit down.

Oh!

If I've done something wrong, I want to know what it is.

Relax. It's got nothing to do with you.

I am simply re-reading one of my favourite novels.

Re-reading? Why? You know what happens?

I always find something new.

Every year, I re-read one of my favourite novels as a treat.

As a treat? What is it then?

It must be bloody good.

I don't think you'd appreciate it.

Try me.

"One half of the world cannot understand

"the pleasures of the other."

Hi, I'm glad you're here.

Miss Horton is fine, but a friendly face is always welcome.

She's currently recovering in intensive care but she's awake

and doing well.

She did have a reaction to the anaesthetic.

It's called malignant hyperthermia. It's very rare but it is dangerous.

Is she going to be OK?

She'll be absolutely fine.

It's an unusual reaction, but we were on it straight away

and she will make a full recovery. In fact, we're going to bring

her down from intensive care and back down here very soon.

Is it serious? Could she have died?

That is the worst-case scenario, but, yes, it does happen.

She'd never had an operation before.

That's right, so we couldn't have known she'd react.

And what about the mass?

She's not going to have to go through this again, is she?

Hopefully not. We'll get the pathology back in a week

and we'll know conclusively then, fingers crossed she'll be clear.

The thought she could have died!

Oh, hello. Miss Horton will make a full recovery, but we'll

keep her overnight for observation just to be sure, don't worry.

You'll see her soon.

I'm sorry you've had to wait so long today, we'll take you down next.

Mrs T, what exactly are these used for?

I believe they use them to count Hail Marys, prayers.

I think the priest sets a sequence at confession as penance.

Penance? Is that like a punishment?

It's more like encouragement to reflect

and grow spiritually from your sins.

You're an Anglican, right? Mm-hmm.

Do you believe that you can say a few prayers and get a clean slate?

I believe in forgiveness.

But what about the Buddhists and karma?

Do you think that God punishes us?

Not in this life, no.

But isn't that the whole point of religion?

That if you do something wrong, you go to hell?

Not necessarily, not if you repent.

God is forgiving, you just have to reach out to him

to receive his love.

But surely he's got some sort of a limit, if you break his rules.

My God has a bottomless capacity for forgiveness.

Bottomless?

(Bottomless.)

What time is it?

About four. How are you feeling?

Rubbish.

Did they tell you what happened?

Mmm.

I know surgery has risks. That's why they make you give consent,

but you never think it's actually going to go wrong.

Luckily my number wasn't up.

You forget these things can happen out of the blue, no goodbyes.

I know. I hardly told anyone I was having surgery.

It would have been quite a shock.

I'm really thirsty.

I think I want to talk to Dr Bowman.

Could you have him paged, please?

Thank you so much for making all this food.

Sit down, have a rest.

There you go. Some tea here.

You seem to have something on your mind today.

You do not normally talk about religion.

Is there something I can help you with?

I don't think anyone can help.

Nothing can be that bad.

I did something, and now I'm being punished.

God will forgive you.

I brought it on myself.

I deserve it, but Mum doesn't.

I don't know how she'll cope, what with losing Dad as well.

As well as who?

Do you mean you?

I'm sorry, but I think I'd rather not go through with it.

Not have the surgery?

Yes, it just feels wrong.

Is this because of what happened to Miss Horton?

I can assure you an allergic reaction to the anaesthetic

is very rare, you mustn't be frightened.

But there are other complications through surgery, infections

or the plastic surgery might not be what I expect.

You said that you were getting sick with worry,

that you needed to do this for your quality of life.

I respect that, and I know that your family history weighs heavily.

Risk-reducing surgery is a legitimate course of action.

Of course it is, and for a lot of people it is the right thing to do,

but I feel like I'm afraid of something that hasn't even happened yet.

It's a big operation and there's a chance I might not even get cancer.

If I do, Mum and Aunt Mags, they're still alive.

They've been treated successfully.

If it happens, I'll deal with it then.

I don't think you should let what happened today influence you.

Why not?

Because it's irrational!

Is it?

Well, not exactly, surgery does have its risks,

but the benefits outweigh them in your case.

But right now, I'm in good health so why tempt fate?

We have limited resources.

Someone else could have been booked in for this afternoon,

this bed's been booked for you for the rest of the week.

I'm sorry to do this so late in the day.

Well, it's your choice.

Sorry.

That was a tough choice.

Giving up those C cups.

Medics are notoriously bad at diagnosing themselves.

I know what it is.

It's my fate.

This is not God punishing you.

I think it is.

Not MY God.

Have you seen a doctor?

Have you done any tests?

All right.

What are you doing?

I am going to make an appointment for you to see Dr Carter.

Knowing is better than fearing the worst.

Mate!

What's your name?

Right, come on now, everyone's at it.

Let's get this party kicked up a notch!

Get down! You'll break your neck!

You ever wonder what a man like me would do to your wife?

To good times!

ALL: Good times.

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