Going It Alone Holby City


Going It Alone

A focused Sahira is determined to make the first day of her trial a success. Faced with critical challenges, her leadership and surgical skills are tested to the max.


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Transcript


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I walk out of here now, it would be the biggest mistake you ever make.

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They are going to keep one senior Cardiothoracic surgeon.

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Keep your mouth shut and it will be your name on the door.

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We will take only elective patients.

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All other patients must be referred to St James's.

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-Don't laugh at me.

-I pity you.

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-Sister Williams says you were fighting.

-She's mistaken.

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-What happened then?

-I tripped.

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I've got to apologise to Malick.

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I think we should leave him some space. Give him time to calm down.

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PHONE RINGS

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Cardiac Trauma. ..Right.

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Let's go.

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AMBULANCE SIREN BLARES

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CLOCK TICKS

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Cardiac arrest. Three minutes.

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-Where's Ms Naylor?

-Morning.

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LIFT DOOR PINGS

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Cardiac arrest. No output for two minutes. Bag and compress.

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OK. Keep bagging.

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No output, check his rhythm.

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That's a shockable rhythm.

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Charging to 150. Clear.

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-Can you hear me in the back?

-Clear.

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Patient stabilised. Right. Thank you, team.

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Any feedback? Ms Naylor? Happy?

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Can't feel nether regions, lights so bright!

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-Shut up, Michael.

-Don't pretend you didn't try to grab the goods.

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I caught you. Don't worry, it's our little secret.

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-Thank you for the cabaret, Mr Spence.

-Pleasure.

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Indeed. Well, the system's in place.

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Let's make it work for the real patients, please.

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I declare the Holby Cardiac Trauma Facility Trial open.

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Thank you, team. That was great.

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But it was just a taster.

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Things will get a lot more hectic, so we need to focus!

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Yes, all is well. Excuse me.

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Oh, erm, Ms Naylor, do you have a sec?

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Right, the phone's been installed.

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I've checked the line and our first patient, well, real patient

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should be arriving any minute soon.

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Oh, my gosh. No, it's cool, it's cool.

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-Are you nervous?

-No, no. We're on it.

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Look, it's great to have you on board.

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-If we can make this work, it would just...

-Yes, well, I am on board.

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And can you ask the guys to keep this gangway clear?

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It's just there was this monster triffid I had to move and it was...

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-Right.

-Thank you. Right.

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Aw, what the hell?

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Have you seen my oriental lily?

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Oh, she's outlawed it. Gangway hazard.

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Is she the sheriff of my ward now?

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Why could she not have just asked Hanssen for a pony? Erm, your ward?

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Turn of phrase. Anyway, good luck to her.

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-Maybe Sahira's vanity project will be such a success she'll end up sharing your ward?

-Steady on.

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Seriously though, just make sure she doesn't humiliate herself.

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I'm the Nominal Consultant on her Cardiac Trauma Facility, not her mother.

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Mmm... Hanssen has cancelled all of your electives today

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so you can man the Bat Phone. Have fun. And find my lily!

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I hope you don't mind your list being cancelled,

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-with it being our first day at Cardiac Trauma.

-It's fine.

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PHONE RINGS

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-Cardiac Trauma.

-Help! My guts are on fire.

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This line is to be kept clear at all times. Do you understand?

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-BEEPING

-Flash call, HDU.

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Sahira, your poster has fallen again.

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Erm, allow me.

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-Thank you.

-My pleasure.

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Obviously, once we get our rhythm going, you know...

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Honestly, it's fine.

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27, 28, 29, 30, bag.

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BEEPING

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Come on. We'll get there.

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One, two, three, four, five, six...

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Did I say I wanted paddles?

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11, 12, 13, 14,15,

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-16, 17, 18...

-BEEPING

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-Paddles.

-We don't need them.

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26, 27, 28, 29, 30, bag.

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-Let's do it!

-Malick?

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-One, two, three, four, five, six, seven, eight...

-Mr Malick, you need to shock him.

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You think sending a charge through an old man is trivial?

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-You're the doctor.

-Is 200 joules an aspirin to you?!

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26, 27, 28, 29, 30. Bag!

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OK, you're going to kill him.

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One, two, three, four, five, six, seven, eight, nine, ten, eleven...

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BLIP, BLIP...

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There it is! Now that's what I'm talking about!

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All right, let's get him to ITU.

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Thank you very much.

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Great, cheers.

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Mr Levy, the new F1.

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-Shirley Hoffman...

-Hauffman.

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-Shirley. Doctor Levy. Welcome.

-Pleasure. I've been following

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your department's transition into a surgical emergency ward. I saw a similar unit in Warsaw.

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-Really?

-I spent my summer working on my dissertation

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into comparative EU emergency medical systems. Have you read the Hansang report?

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The Hansang...? No.

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There's some observations the report made, and some of my own, you may find interesting.

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Doctor Levy? I'm Lulu. Your new F1.

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Hello there.

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It's wonderful to meet you. Is there somewhere I can hang my pashmina?

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I was told there was only one vacancy and I've got that job.

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-Are you sure you're meant to be on AAU?

-Yes, I am.

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I was definitely told to start here today.

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Mr Levy?

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-Can you check on Mrs Talbot for me, please?

-Sure.

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-What time drinks?

-8 o'clock. Albi's.

-Excellent.

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Yes, Mr Malick, what can I do for you?

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Time management. I need your nurses to co-ordinate radiology lists a lot quicker.

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If I can juggle six things at once, so can they.

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Thank you. I'll pass on your comments.

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You're kidding me(!) What the...?

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Is that...? Hey, why isn't my name on any theatre list today?

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-Working OK?

-Perfect.

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Oh, good. My 82-year-old aortic aneurysm didn't die.

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Oh, meant to say, love your hair. Very Marianne Faithful.

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Nice shoes. Black ones...

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Hey, shall I grab a maxi pad and join in the girly fun?

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-Guess not.

-I need to check the progress of my patient. Everything is under control, right?

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Mind your backs, coming through.

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BP 90 over 50. Pulse weak and thready. Stats 95.

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Let's get her to theatre, please.

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Morag Morgan. Impaled whilst out on a shout.

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Watch the palm.

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They didn't call.

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Mr Hanssen, I've completed ward rounds. I've completed a pneumothorax audit and...

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-And what?

-Why don't I have any theatre ops today?

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I imagine it's because you were not scheduled to be in theatre.

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Is this because of that thing with Mr Hamilton?

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There was no evidence of wrongdoing.

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Keeping me out of theatre's your way of punishing me.

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Are you implying that in lieu of evidence I have taken it upon myself to punish you informally?

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-Feels like it.

-Feels like it?

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The purpose of punishment is to inflict a clear detriment on the wrongdoer, is it not?

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Uncertainty over whether I am punishing you is a near perfect guarantee of your non-punishment.

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-You don't have anyone like me here.

-A statistic I am satisfied with.

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I'm an exceptional surgeon. This... This is my life and you know it.

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Later I will perform a laparoscopic abdominal aortic aneurysm repair

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-using the Howard technique.

-Using a 6mm Dacron graft. I've been studying the technique.

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Several eminent colleagues from the Aneurysm Research Foundation will be there.

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Professor Bhattacharya and Professor Rubens and I'd give my back teeth to observe.

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In which case I shall see you in theatre, 11.30.

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Make sure you finish your ward rounds first.

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Thank you.

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No output for four minutes. Defibrillate.

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I stemmed the bleed as best I could.

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There was a gas explosion on an industrial estate.

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Her paramedic number's 1317.

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Is there anything I can do?

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Charging to 150... Clear!

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No output. Charging to 150...

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Clear!

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65 over 10.

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She's my work colleague. We were on the shout together.

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-The roof collapsed...

-No output. Why didn't you call ahead?

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-Is there a plan for systemic failures?

-Charging to 150.

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-We had a back-up team. They cut her out.

-Intubation on stand-by. Clear!

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A second para team cut her out?

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-I froze.

-Let's concentrate on the job in hand.

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No output. Charging to 150.

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Brilliant. That's just brilliant(!)

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I was led to believe the job had already been offered to Shirley Hauffman.

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It had. Circumstances have changed.

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-So, Shirley doesn't have the job?

-No, but she made it to the final round of selection.

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But they had offered her the job.

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But circumstances have...?

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-Changed.

-Quite.

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Now it's your responsibility to select one of the two candidates to replace Dr Valentine.

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-My responsibility?

-Mm-hm.

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-What do I do?

-Select one.

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-Can I pick Shirley?

-You may.

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For my second wish, a bowl of chocca-wocca fudgey ice-cream...

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Between you and me, Lucinda is Sir Fraser Anderson's daughter.

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I was never a fan of the old boys' club.

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Shirley had already won that job fair and square, hadn't she?

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But connections trump talent, it seems.

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It is entirely within your power to offer the job to Ms Hauffman rather than Sir Fraser's daughter.

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Sorry, you mean Lulu?

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Yes, Lulu.

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I shall oversee a trial and my decision will be based on merit alone.

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As is your want.

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Case reports. File.

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As quick as you can please. I need to be in theatre.

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Yep, they're mine. Thank you.

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Hey, three a day at regular intervals.

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Any problems contact your GP.

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You're free to go.

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Four down. William Franks.

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Mr Malick. Laceration to the upper arm.

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Ooh, sterile procedure required.

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20 minutes in the treatment room with me and you'll be free to go.

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-Any questions?

-May I have a leaf of nice paper, please?

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A leaf of nice paper for Mr Franks. Is the treatment room free?

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-It's occupied.

-Let me know when. My laceration patient's next.

-We have a rota.

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Look, I hit your boyfriend. You don't like me. I'm gutted.

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-But we've got to work together.

-You hit my boyfriend.

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But apparently he was acting like an idiot and deserved it.

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I'm not happy about the situation but I can move on if you can.

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No output. Can someone chase up the patient's notes?

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Again, charging at 150. Clear.

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-Come on, come on!

-No output. Again.

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They didn't call ahead. I don't have notes... Clear.

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-Emergency medicine. You can't rely on notes.

-I can't work miracles if I don't have prep time.

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You asked for this facility. Deal with it.

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Have the surgical scars checked by your GP in a week

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or before if they're causing you discomfort. Nurse. Mrs Dubek for reception.

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Take care, Mrs Dubek.

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Right, let's get your arm sorted.

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-I don't like this bed.

-You're going to another room for stitches anyway.

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Then I'll be sent back here. The ventilation's poor.

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It's affecting my polyposis.

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I want that bed there.

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Just there? Look, you're the last patient on my list.

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Why don't you think of it as an adventure?

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My polyposis. I can hardly breathe.

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The nurses, they keep coughing loudly into my ear.

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I'll think about getting you a new recovery bed, once you've had your laceration stitched.

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I'm not going anywhere until I can breathe properly!

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-Nurse, is the treatment room free?

-Yes, it is.

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Charging to 100... Clear.

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-150.

-Sorry 150. Clear.

0:15:020:15:05

No output and can you tie your hair back!

0:15:050:15:08

We're in resus with a patient, not backstage with the Quo.

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OK. Again at 150. Clear.

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No output. My first patient is not going to die. No way.

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Well?

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200.

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Charging to 200 - clear.

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BEEPING

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We've got a rhythm.

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Well done. Now what are we going to do about that?

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Oh, are you OK? Are you feeling better?

0:15:370:15:39

No, Sahira, not that. That.

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Dr X Factor! Think you're Louis Walsh now?

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We test them. The most deserving gets the job.

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-Coffee shop runs all day? Brilliant.

-I need you to be my independent witness.

0:15:540:15:58

-I may have to prove my findings.

-You're taking this too seriously.

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Too many doctors get their jobs through the back door. Not today.

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Yeah, nurses too. The things I had to do to Hanssen.

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Oh, come on. What's bothered you?

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It's Lulu. She's Sir Fraser's daughter.

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And this job is Shirley's.

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Wow, what happened, Sacha? Did all the thick, posh boys copy your homework at med school?

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Why do we need a trial? I was given the post by the Dean.

0:16:250:16:30

Once again, I'm sorry about the mix up.

0:16:300:16:32

But look, just do your best and everything will be OK. OK?

0:16:320:16:38

LAUGHTER >

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How much longer will you be?!

0:16:510:16:52

I'm in the middle of a ruptured Achilles tendon.

0:16:520:16:55

Sore foot? That sounds really complex(!)

0:16:550:16:57

Sorry, I'm with a patient. I have to get back to him.

0:16:570:16:59

I'll let you know when I'm finished.

0:16:590:17:01

Is sir enjoying his new bed?

0:17:120:17:14

-What is this?

-We'll do the sutures here.

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If you'd like to take your arm out of your gown so I can get better access to the cut.

0:17:180:17:22

What?! What a suggestion!

0:17:220:17:24

-Give me a break. I can't fix your arm unless I can get access it.

-Impudent.

0:17:240:17:28

-I forbid. No.

-OK. OK. We won't do the sutures on the ward.

0:17:280:17:33

There may be damage to the aorta. We can proceed with removing the pole

0:17:350:17:39

or do a portable chest X-ray to determine the exact position.

0:17:390:17:43

-This is your trial. I'll support whatever decision you make.

-Right.

0:17:430:17:47

-She is losing a lot of blood.

-Yes, I do know that. Give me a second.

0:17:470:17:50

If this is a decision you feel uncomfortable making, I can always take over from here.

0:17:500:17:55

It's up to you.

0:17:550:17:56

BEEPING

0:17:580:18:01

First thing's first, let's deal with this.

0:18:020:18:04

-Right. My colleague Nurse McKee will be an impartial observer.

-Is drinking allowed on the ward?

0:18:070:18:12

No points for nit-picking, I'm afraid.

0:18:140:18:16

Right, ward rounds. Just think of today as a practical interview.

0:18:160:18:20

-The Deanery have never needed to interview students before.

-How odd.

0:18:200:18:23

I wonder what the mix-up was?

0:18:230:18:25

-I wonder too.

-Yeah, I wonder too.

-You bet I wonder more.

0:18:250:18:28

Can we concentrate, please?

0:18:280:18:30

Right, patient number one.

0:18:320:18:34

You know, princess is going to start thinking you fancy her

0:18:390:18:42

if you keep being mean.

0:18:420:18:43

And what will Sir Fraser say about that -

0:18:430:18:45

his beloved daughter discriminated against by a sex-mad predator?

0:18:450:18:49

-I just want a fair contest.

-Be mean to both of them then.

0:18:490:18:52

I'm not being mean. I just have a natural rapport with Shirley.

0:18:520:18:56

Don't lie. Her own reflection doesn't have rapport with her.

0:18:560:19:00

Hypotensive. 90/70 and falling.

0:19:030:19:05

-Hypovolemia?

-90/60.

0:19:050:19:07

Are there signs of internal bleeding?

0:19:070:19:09

No evidence.

0:19:090:19:11

80/60. Still falling.

0:19:110:19:13

Right, so the ECG rules out heart failure, atrial fibrillation.

0:19:130:19:17

-She's convulsing.

-Oh, come on. Think, think!

0:19:170:19:21

Your call, Sahira.

0:19:210:19:23

-I fainted in resus?

-Sure did, and the charming Ms Naylor kicked you out of theatre.

0:19:250:19:30

-I need to get back out on the shout.

-No, no you're not allowed to work with an injury.

0:19:300:19:34

You feeling a little dizzy?

0:19:340:19:36

All right, here, why don't you have some of your packed lunch?

0:19:360:19:40

How does someone who's afraid of blood become a paramedic anyway?

0:19:400:19:45

You're needed. Come with me.

0:19:450:19:48

What's that, a letter of complaint?

0:19:480:19:50

-Don't!

-All right, all right.

0:19:500:19:54

I can smell oatmeal. Everywhere I turn. It's hurting the polyposis in my nose.

0:19:540:19:58

-OK, calm down, yeah?

-You calm down. Hopping around me.

0:19:580:20:02

Right, we're on, I'm going to get you a wheelchair.

0:20:020:20:05

-I'm not going.

-What do you mean?!

0:20:050:20:07

-I said my neck's really sore. Listen.

-You listen to me. I've really got to get...

0:20:070:20:12

My name's William. W-I-L-L-I-A-M. William P Franks.

0:20:120:20:17

William P Franks, I've really got to get you treated quickly. OK?

0:20:170:20:21

I'll go to the treatment room if you pass my letter on...

0:20:240:20:29

to that lady.

0:20:290:20:32

OK. May I?

0:20:320:20:36

-Is it a good letter?

-Yeah.

0:20:400:20:44

It's brilliant.

0:20:440:20:47

Amy?

0:20:590:21:00

-Are you comfortable?

-I'm fine.

-Any problems, give me a shout, yeah?

0:21:030:21:10

Cheers.

0:21:120:21:14

Hey, I need psych to take a look at Mr Franks.

0:21:240:21:27

No excuses and I need them here before my 11.30 theatre.

0:21:270:21:31

Please, Chrissie.

0:21:310:21:33

OK, as long as I can use the treatment room next.

0:21:330:21:38

-What meds did you prescribe at the scene?

-Adrenalin?

0:21:480:21:51

The paramedics will get back about the pick-up.

0:21:510:21:54

They're up to their eyes.

0:21:540:21:55

How much Adrenalin? Were there other drugs? Warfarin? Morphine? Anything else?

0:21:550:22:00

I don't think so?

0:22:000:22:01

Well, think harder! Does she have any allergies?

0:22:010:22:04

I don't know. I'm trying!

0:22:040:22:06

The other team took over. I don't know their names.

0:22:060:22:09

Can I sit down, please?

0:22:090:22:11

Oh, here we go. Someone get her a chair. How on earth did you make it through basic training?

0:22:110:22:15

Try the paras again.

0:22:150:22:18

Hypoglycaemic?

0:22:200:22:23

Let's do a blood sugar test.

0:22:230:22:25

Best piece of advice I ever got?

0:22:250:22:27

Look after the nurses and the nurses will look after you.

0:22:270:22:30

-Right.

-Because the thing is, if the nurses think you're not respecting them, they can make life difficult.

0:22:300:22:35

Do you understand?

0:22:350:22:37

-OK.

-It's all about teamwork, being friendly.

0:22:370:22:41

-Test confirms.

-50% glucose IV.

-I'm on it.

0:22:460:22:50

Patient stabilised.

0:23:000:23:01

-I need to get back to the shout.

-Look, you've signed off.

0:23:030:23:07

Stay here. Right now, you're the only one who has a clue about the patient. You're more use here.

0:23:070:23:12

There's still the matter of the pole sticking out of her chest.

0:23:120:23:16

-I know.

-OK, so do we wait for the chest X-ray or surgery?

0:23:160:23:18

-Your team need an answer.

-Why are you being like this?

-Like what?

0:23:180:23:22

-You're the consultant. You're meant to advise me.

-I was under the impression this is your project.

0:23:220:23:27

I want a chest X-ray. We need to establish any potential damage to the aorta before any surgery.

0:23:280:23:36

-MAN:

-Mind your backs, mind your backs.

0:23:370:23:40

Priority. We need some help here!

0:23:400:23:43

Any ideas?

0:23:470:23:49

-Liver abnormality. Possibly a tumour.

-Correct.

0:23:490:23:52

Are we just shouting out then?

0:23:520:23:54

Maybe they should take turns.

0:23:540:23:56

Is that how real medicine works? Everyone waiting their turn.

0:23:560:23:59

-Yes. I believe it is.

-That's enough, thank you.

-What have I said?

0:23:590:24:02

Give it the big, sad eyes, Princess.

0:24:020:24:04

-Let's not get personal, girls.

-Girl?

0:24:040:24:07

-Interview or not, I'm a doctor and you'll address me as such, thanks.

-I'm trying to help you out here.

0:24:070:24:13

-I didn't mean...

-Excuse me.

0:24:150:24:19

Lulu.

0:24:190:24:21

My love, queen of all my heart...

0:24:220:24:26

Come through to X-ray, please.

0:24:300:24:32

Yes!

0:24:320:24:34

OK, chop, chop. Deal's a deal.

0:24:390:24:41

Come on, time waits for no man.

0:24:410:24:46

-Ah, ah, I don't think so!

-Beat them, Mr Malick.

0:24:480:24:51

Swift like the wind. Beep-beep!

0:24:510:24:53

Woohoo! He-hey! You loved it too.

0:24:530:24:58

-Admit.

-"Hair soft, unrepugnant in every way?"

0:24:580:25:03

What is this?

0:25:030:25:04

That's private.

0:25:040:25:05

William!

0:25:080:25:09

I want St James's co-ordinator on the phone.

0:25:090:25:12

-We don't have the capacity.

-Can I help?

0:25:120:25:15

You should have been prepared for a glitch.

0:25:150:25:18

Stay with the pole patient. Don't touch the pole. Don't let her bleed out.

0:25:180:25:21

You're going to have to do something, Sahira.

0:25:210:25:24

Do you want this trial to succeed?

0:25:240:25:26

One in five nurses have been cut and Hanssen has handed you a 50 grand project

0:25:260:25:29

after you insisted you could lead it. So lead it, or go!

0:25:290:25:34

Right, the pole patient takes precedence. Jac, yours too.

0:25:340:25:40

Porters, please, Darwin.

0:25:400:25:42

-Alex.

-Ms Naylor?

0:25:420:25:45

-I'm on it.

-Yeah, what's the problem please?

0:25:450:25:48

BEEPING

0:25:480:25:50

Tension pneumothorax. His lung's collapsed.

0:25:500:25:53

-You'll have to aspirate the right.

-Yes, I am aware!

0:25:530:25:56

Someone get me a doctor. Any doctor. I don't care.

0:25:560:25:59

-Would you like me to help?

-No, stay there!

-B/P is through the floor.

0:25:590:26:04

-Go on then.

-Shall I suture?

-Keep your finger on the bleed!

0:26:040:26:07

I shouldn't have left a private letter lying around.

0:26:070:26:11

It's OK.

0:26:110:26:12

You don't have to like me. We don't have to speak.

0:26:140:26:17

But you do need your arm seen to.

0:26:170:26:19

It's OK.

0:26:190:26:20

Mr Hanssen...

0:26:330:26:34

Mr Malick, our theatre date has been brought forward, eleven o'clock.

0:26:340:26:39

-Problem?

-No. I'm just about to take my final patient, Mr Franks, into suturing now.

0:26:390:26:45

They had a bit of a backlog in the treatment room.

0:26:450:26:47

Yes. Tell me, how do you intend suturing an imaginary patient?

0:26:470:26:51

-28fg tube...

-I'll be two seconds, Jools.

-OK, feeding in the tube.

0:26:590:27:04

-Mine's bleeding out. I can't stop it!

-Patch it. Hurry!

0:27:040:27:06

No air's draining...

0:27:060:27:08

Applying the TachoSil patch.

0:27:080:27:10

Cardiac output is going down...

0:27:100:27:13

Passing the patch over my finger and over the rupture zone...

0:27:130:27:17

Gases are better. Saturation's going up, pressures going up - 80/40.

0:27:170:27:20

-It won't hold!

-What's the matter with you?

0:27:200:27:24

-Pulse...

-You're not fit to treat - just sit down.

0:27:240:27:27

Nancy, I ordered those chest X-rays five minutes ago.

0:27:270:27:30

Why aren't they in front of me?

0:27:300:27:33

Where are we going to put them now?

0:27:330:27:35

OK, thank you, Mrs Buchey. See you in a week.

0:27:440:27:46

-Thanks, bye-bye.

-Bye-bye.

0:27:460:27:48

Blood, blood, more blood. Let's get this cleaned. It's not a good look.

0:27:480:27:52

Whoa! Take your monsters back to the lab!

0:27:520:27:54

They're cardiac patients. They need to go somewhere.

0:27:540:27:57

-The ward is full, right?

-Yeah.

0:27:570:27:58

-HDU isn't.

-That is not part of your trials territory.

-It's not plastic's either!

0:27:580:28:03

-Squeeze two patients in there?

-Shall I chuck the other in a skip?!

-I have plastics patients arriving.

0:28:030:28:08

No-one wants a five grand boob job in the middle of a CSI scene!

0:28:080:28:12

Has anyone got anything useful to say today? Anyone?

0:28:120:28:16

No?! My patients are going into HDU.

0:28:160:28:19

Power hasn't gone to her head at all.

0:28:220:28:24

That is quite a mini me you've created, Naylor.

0:28:260:28:30

Let the GP have her fun.

0:28:300:28:32

I hear she just stabilised three lives - simultaneously.

0:28:320:28:35

One second.

0:28:520:28:53

You're...you're un-repugnant.

0:29:000:29:04

Thanks, team.

0:29:110:29:13

Not even lunchtime yet.

0:29:130:29:15

-Still a long way to go.

-Yep. As soon as we get the X-ray we'll operate.

0:29:150:29:20

Nancy, where is it?

0:29:200:29:22

Agh!

0:29:220:29:24

Agh!

0:29:240:29:26

Hold her down.

0:29:260:29:28

I'm due in theatre in 30 minutes - do you know that?

0:29:320:29:34

Bully for you. I declare you're not my doctor any more.

0:29:340:29:38

-What, you're sacking me?

-I'm discharging myself early.

0:29:400:29:43

I'm sure it's not a rarity.

0:29:430:29:45

It's clear from the body language of your colleagues that you're detested.

0:29:450:29:50

Early discharge? Fine by me.

0:29:500:29:52

HE SOBS

0:29:540:29:55

-I'm sorry - what can I do?

-She's losing too much blood, we need to operate.

0:30:050:30:09

-Just go!

-No, I'm staying with her.

0:30:090:30:11

Sahira - it's grazed her aorta.

0:30:130:30:16

Morag, listen to me. You have to stop moving.

0:30:190:30:23

If you do not stop moving, that pole will rupture your aorta

0:30:230:30:26

and you'll die within minutes. It's this close.

0:30:260:30:31

-Don't move.

-Oh, no.

-Let's get her anaesthetized.

0:30:310:30:33

Stop.

0:30:330:30:35

I don't consent. I don't want you to operate.

0:30:350:30:40

Your arm must be really hurting.

0:30:420:30:45

Let me fix it.

0:30:450:30:47

OK, how about I get another doctor to treat you?

0:30:500:30:52

-I'll page a colleague?

-No!

0:30:520:30:54

What's your problem? Move.

0:30:570:31:00

What is it, mate?

0:31:020:31:04

I won't tell anyone, I promise.

0:31:040:31:07

You mustn't tell the lady.

0:31:070:31:09

-I...I don't enjoy heights.

-OK, lift...

-No, no!

0:31:110:31:15

No! I despise lifts, despise lifts!

0:31:150:31:17

What a suggestion, doctor!

0:31:170:31:19

-What an impudent suggestion!

-All right, no lifts, it's cool, pal... I'm sorry, William.

0:31:190:31:25

William P Franks?

0:31:250:31:28

It's cool.

0:31:280:31:30

I don't mind if you call me pal. I may well die up here.

0:31:310:31:35

I wouldn't mind a facade in these

0:31:350:31:39

deathly circumstances.

0:31:390:31:41

No facade.

0:31:410:31:43

I'm your pal, OK?

0:31:430:31:44

And I'm going to get you down these stairs.

0:31:440:31:48

Come on.

0:31:500:31:52

Doctor - the juices in my ears will spin.

0:31:580:32:00

Cover your ears - and close your eyes. You can trust me.

0:32:000:32:04

It's all right. Just a few steps.

0:32:040:32:08

A vertigo sufferer who doesn't like lifts?

0:32:080:32:12

What are you like?

0:32:120:32:13

Well done, that was... that was great.

0:32:190:32:21

Look, I know what that must have sounded like.

0:32:240:32:26

Sounded like you admitting you were trying to help my competitor get the job.

0:32:260:32:30

Yes, I can see how that could be the interpretation.

0:32:300:32:34

I take it you know who my father is?

0:32:340:32:37

I have three young children. Please don't end my career.

0:32:370:32:42

You're not the first person to think I need a handicap.

0:32:420:32:45

I've survived six years at medical school. No-one sat idly by as I killed patients or anything.

0:32:450:32:51

-And, er, just to quote back to you - we are being graded purely on the results of practical tests...

-Yes.

0:32:510:32:59

And on the results alone - HR have been made aware?

0:32:590:33:03

-Yes.

-I'll need a copy of all test results, thank you.

0:33:030:33:06

OK.

0:33:060:33:08

Right, OK, test study.

0:33:090:33:14

Buzz in when you know the answer.

0:33:140:33:17

40-year-old woman, waves of excruciating pain beginning in

0:33:170:33:20

the flank and radiating inferiorly and anteriorly. Nausea...

0:33:200:33:23

BOTH: Renal colic!

0:33:230:33:24

Any differentials?

0:33:240:33:26

BOTH: UTI, pelvic inflammatory disease, appendicitis.

0:33:260:33:30

You still have a chance if we operate now. Surgery is your only hope!

0:33:320:33:36

I'll bleed out the second you touch it.

0:33:360:33:41

I just want to see my kids one last time.

0:33:410:33:44

For what it's worth, I would have operated immediately.

0:33:440:33:49

You can't wait. She can't, can she?

0:33:490:33:52

It's arguable the patient's not fit to consent.

0:33:520:33:55

Well, she's not. Look at her.

0:33:550:33:58

Just 20 minutes to see my girls.

0:33:580:34:01

I need you to concentrate on maintaining her blood pressure, not questioning my judgment.

0:34:080:34:12

We'll wait.

0:34:150:34:16

The notoriously overworked NHS nurse?

0:34:240:34:27

I'm standing guard, don't ask.

0:34:270:34:28

Are you sure she can be trusted not to peek?

0:34:320:34:36

-You've my word. She's a lady.

-I don't wish the list of ladies

0:34:360:34:39

who have seen my hidden flesh to rival Byron.

0:34:390:34:42

I promise you I won't let any ladies here catch a glimpse.

0:34:420:34:47

William, I can announce that you are in a state of absolute discharge.

0:34:470:34:53

They're so neat. Thank you.

0:34:530:34:55

It's my pleasure.

0:34:550:34:58

Can I tell you a secret?

0:34:580:35:00

-I haven't had lots of girlfriends.

-Neither have I.

-A despicable lie!

0:35:020:35:06

It's the truth. Take it or leave it.

0:35:060:35:08

I wouldn't lie to you.

0:35:080:35:10

My polyposis - it kills!

0:35:140:35:16

William - have you tried just talking to women?

0:35:160:35:20

You don't need to write letters.

0:35:200:35:23

Look, I'm sorry to have to ask, but how did you injure yourself, William?

0:35:260:35:32

-I fell.

-Fell?

0:35:320:35:34

You sure?

0:35:340:35:36

-Hey, where's psyche?

-They're busy.

0:35:430:35:46

Hanssen's assembling theatre.

0:35:480:35:49

Right.

0:35:530:35:54

Is there somewhere I can get spruced up?

0:35:540:35:57

OK. Can you discharge Mr Franks for me, please?

0:35:570:36:01

-Where are my girls?

-Nearly here.

0:36:070:36:09

I don't know how much longer we can delay the operation.

0:36:090:36:12

-We're going to have to proceed very soon or not at all.

-We need to proceed now.

0:36:120:36:16

Five minutes.

0:36:160:36:17

Right, team, five minutes.

0:36:190:36:21

No, no, no.

0:36:210:36:24

B/P's dropping. 75/38. More units, please, Sahira, we need to move.

0:36:240:36:28

-She is losing blood faster than we can get it in.

-Five minutes.

0:36:280:36:31

-Don't just stand there, do your job and operate!

-Do my job?

0:36:310:36:35

If you had done your job at the scene, she wouldn't be in this state.

0:36:350:36:40

Get out of my theatre. Go!

0:36:400:36:41

-Right, I'm overruling the patient. Intubate her.

-It's too late.

0:36:500:36:53

We are doing this operation now! Let's get her flat.

0:36:530:36:57

It's too late, Sahira!

0:36:570:36:58

You waited and now the patient's cardiac function has failed.

0:36:580:37:02

She's got virtually no output and without the B/P under anaesthetic,

0:37:020:37:06

she's not getting it back.

0:37:060:37:07

You should have operated when you had the chance.

0:37:070:37:11

I said keep still. Nurse, nurse!

0:37:440:37:47

Stay there...

0:37:470:37:48

Right, that's one crying nurse and Mr Lawson has demanded that that bulldog doesn't speak to him again.

0:37:500:37:55

-Right.

-It's a shame that Doctor X-Factor doesn't take into account horrendous personalities.

0:37:550:38:00

I've complied a full case history on Mrs Wallace.

0:38:000:38:04

What, the silent lady?

0:38:040:38:06

-We got chatting.

-How did you manage that?

0:38:060:38:09

My USP. Daddy paid her. (LAUGHS)

0:38:090:38:11

That was HR. There's been a complaint made

0:38:130:38:16

against your lack of impartiality in the selection process.

0:38:160:38:19

How long?

0:38:340:38:35

Maybe half an hour.

0:38:350:38:38

Do we just wait?

0:38:380:38:41

-What shall we tell her daughters?

-I don't know.

0:38:430:38:47

You don't have to tell them anything, I'll do it.

0:38:470:38:50

She was under this metal thing.

0:38:520:38:54

Morag's like effing and blinding and...

0:38:560:38:59

I just stood there.

0:38:590:39:02

I'm sure you did your best.

0:39:020:39:04

She picked the short straw having me as her protege.

0:39:040:39:06

Useless.

0:39:060:39:09

Not great, as first days go.

0:39:090:39:10

This is your first day?

0:39:120:39:14

If you don't mind, I'd like to break the news to the family.

0:39:140:39:18

It's not a nice job.

0:39:180:39:20

I'd like to take responsibility for something today.

0:39:200:39:23

What was I thinking waiting for an X-ray?

0:39:230:39:27

Some people just freeze.

0:39:290:39:31

Are you enjoying day one?

0:39:400:39:42

One in five nurses made redundant, Henrik?

0:39:420:39:45

None of whom was indispensable.

0:39:450:39:48

£50,000.

0:39:480:39:49

It's a worthy project.

0:39:490:39:52

I think Ms Naylor should take over the Cardiac Trauma Unit -

0:39:520:39:58

if you should you wish to continue with it. It's understaffed.

0:39:580:40:02

She's more experienced.

0:40:020:40:04

Very well.

0:40:040:40:06

I see you've worked to the best of your medical ability.

0:40:060:40:10

It's too late to save her.

0:40:100:40:13

According to whom?

0:40:150:40:17

You or Ms Naylor?

0:40:170:40:19

A half report, no good to me at all.

0:40:230:40:26

Quick as you can.

0:40:260:40:29

-Is there anything else I can do for you?

-No, thank you.

0:40:290:40:31

OK, I'll see you later then.

0:40:310:40:33

-Do you know what? I want Lulu to win. There. I've said it.

-Well, give Lulu the job then.

0:40:370:40:41

-On what merit?

-For not doing everyone's head in?

0:40:410:40:44

This isn't a popularity contest.

0:40:440:40:46

It should be. We spend most of our lives in this confined space.

0:40:460:40:49

There is nothing wrong with hiring somebody just because they're tolerable, trust me.

0:40:490:40:53

I know. I know,

0:40:530:40:55

but... look, I promised HR a test.

0:40:550:40:57

I can't suddenly move the goal posts now.

0:40:570:40:59

If only there was some test that Lulu would win for sure?

0:40:590:41:03

Polo or something?

0:41:030:41:06

I'm operating.

0:41:290:41:31

-I'm the nominal consultant here.

-Bit late for your input now.

0:41:310:41:34

-She's a lost cause.

-She's still alive, isn't she?

0:41:340:41:37

She's as good as dead. You can't stick knifes in a corpse just for the sake of it.

0:41:370:41:40

You think this is a vanity project to me, don't you?

0:41:400:41:43

-I can save her.

-Her B/P is untenable, she won't survive the anaesthetic.

0:41:450:41:49

Let her die in peace, not cut to ribbons in a freak show.

0:41:490:41:53

Just give me some support!

0:41:530:41:55

Give your patient some dignity.

0:41:550:41:57

Intubation complete, preparing to open.

0:41:590:42:01

-I was prepared to give this facility my full backing.

-No, you weren't! My trial, my call.

0:42:010:42:06

Unless of course you want to tell Hanssen that you've reneged on your duty?

0:42:060:42:09

This is Mr Malick, one of our young surgeons.

0:42:130:42:17

He'll be joining us in theatre.

0:42:170:42:19

Er, excuse me, Mr Hanssen, a patient...

0:42:220:42:26

-One second.

-Certainly.

0:42:260:42:28

Follow me, please.

0:42:300:42:33

-What are you doing here?

-I'm taking your advice. Where is she?

0:42:350:42:40

Amy...was discharged.

0:42:440:42:46

She's...she's gone?

0:42:460:42:48

A few minutes ago. I'm really sorry, mate.

0:42:480:42:52

Perhaps you'd like to share these amongst the nurses.

0:42:550:42:59

-There's only two - but they're quite big.

-They'll...

0:42:590:43:02

They'll love them.

0:43:020:43:05

Thanks for trying.

0:43:050:43:09

William...

0:43:120:43:13

Before she left, she said,

0:43:150:43:18

er, you had a nice smile.

0:43:180:43:20

And nice eyes.

0:43:200:43:23

So, four incisions will be made,

0:43:420:43:43

necessary to allow for the introduction of one trocar in the umbilicus.

0:43:430:43:47

Mr Malick, do you feel equipped to proceed with the first stage?

0:43:470:43:50

-Absolutely!

-Good. Proceed ladies and gentlemen, please.

0:43:500:43:54

Ah, thank you.

0:43:570:43:59

Mr Malick, a patient in your care has caused some difficulty on the ward.

0:43:590:44:02

The ward sister has requested your intervention.

0:44:020:44:04

Inform the ward sister I'm about to enter theatre.

0:44:040:44:06

OK.

0:44:060:44:08

Let us hope that the patient in question is not experiencing any

0:44:080:44:12

difficulties which the doctor entrusted with his care would be best place to deal with.

0:44:120:44:17

Get that little freak away from me! Who does he think he is? Get out!

0:44:240:44:28

-Get out!

-Amy, calm down, please!

-But you said you liked my smile?

0:44:280:44:33

Someone escort this gentleman out.

0:44:330:44:35

Just leave me alone! Get the freak out.

0:44:350:44:38

-Hey, that's enough!

-You said she'd gone?

0:44:380:44:40

He only wanted to say hello, there's no need for hysterics.

0:44:400:44:44

-Listen, William, just...

-Liar.

0:44:440:44:47

-We should have waited for psyche.

-Look, can you ask Hanssen to wait?

0:44:480:44:51

I'll be a couple of minutes - please, Chris.

0:44:510:44:54

-You mustn't take what that woman said personally.

-Mustn't I?

0:45:010:45:05

Mustn't I?! You lied to me.

0:45:050:45:08

You said she'd gone.

0:45:080:45:09

You said she liked my smile.

0:45:090:45:11

You bully! You big liar!

0:45:110:45:14

I'm sorry.

0:45:140:45:15

You're not a health care professional.

0:45:150:45:18

Regard your lack of care at once. Regard your lies.

0:45:180:45:22

-Fine, I've failed.

-You pretended to be my friend.

0:45:220:45:25

You're a bully!

0:45:250:45:27

Look, I've missed enough theatre time as it is, all right?

0:45:270:45:31

-Mr Malick, see?!

-No!

0:45:310:45:35

Ugh!

0:45:350:45:37

Don't leave me, my friend.

0:45:400:45:43

Please sit down, make yourself comfortable.

0:45:450:45:48

Now, I'm aware that someone here - I'm not naming names -

0:45:480:45:51

is concerned that impartial process is not being observed.

0:45:510:45:55

I have to assure you, this is not the case.

0:45:550:45:57

My notes on today's practical interview will be made available to HR for scrutiny.

0:45:570:46:01

Right, the final tie-breaker...

0:46:010:46:04

30 minutes, a test on the trust's equality policy.

0:46:060:46:11

OK, ready? Question one...

0:46:160:46:19

Is theatre prepped?

0:46:190:46:21

On-call surgeon's been paged.

0:46:210:46:23

Don't. You're embarrassing him. He doesn't like being exposed.

0:46:230:46:26

You'd better get to theatre, Hanssen's waiting for you.

0:46:260:46:31

Tell Hanssen I'm busy.

0:46:310:46:33

Wow, that's very close to the aorta.

0:46:350:46:38

Too close. The valve will rupture when you remove the pole.

0:46:380:46:42

OK, get ready, everyone.

0:46:440:46:47

Swab...

0:46:470:46:49

-The aorta's holding.

-It's holding.

0:47:340:47:37

-Swabs.

-Swabs.

0:47:400:47:42

She's bleeding out. Her B/P's through the floor. Swabs.

0:48:010:48:05

We'll suture as best we can. We must clamp the aorta.

0:48:050:48:08

It'll compromise cerebral profusion. She'll be brain dead.

0:48:080:48:12

Look, Sahira, you tried.

0:48:120:48:15

Just give it up.

0:48:150:48:17

Let's close her up.

0:48:200:48:22

Prepare to clamp the aorta. We'll clamp either side of the aortic tear.

0:48:250:48:28

Keep her pressure up to mean 60.

0:48:280:48:30

Jools, is it?

0:48:380:48:40

Morag's daughters, obviously very upset.

0:48:410:48:44

-I hear you want to speak with them?

-Right.

0:48:440:48:46

You were on the shout with their mum, right?

0:48:460:48:50

I know, I know.

0:48:500:48:52

I froze.

0:48:520:48:55

It's OK. They train us to speak to the relatives. I'm on it.

0:48:560:48:59

No-one's going to force you.

0:48:590:49:01

Could you just tell them,

0:49:050:49:07

I did try my best.

0:49:070:49:10

Yeah.

0:49:100:49:12

Your independent adjudicator says - Lulu, 19, Bulldog, 20.

0:49:160:49:21

Nice one, Sacha.

0:49:230:49:26

What was he thinking? Perhaps we should have waited for the psyche referral.

0:49:390:49:44

Suction... Come on, William.

0:49:440:49:47

The patient's close to bleeding out.

0:49:470:49:50

He's 80 over 55.

0:49:500:49:52

I can barely see a thing.

0:49:520:49:54

No, a consultant should take over.

0:49:560:49:58

-He trusted you.

-I know he did - and I just palmed him off and lied to his face.

-So fix it then.

0:49:580:50:03

OK.

0:50:090:50:11

Clamps both holding. Increase the flow.

0:50:130:50:17

Scissors. Moving quickly. Suction.

0:50:170:50:22

Graft, please, 3.0 prolene.

0:50:220:50:24

I can fix the aorta from here.

0:50:340:50:36

We've reached a decision.

0:50:390:50:41

I'm a fast learner. And I'm hungry.

0:50:410:50:43

I will be here every day.

0:50:430:50:47

I know how to run a tight ship, I can make improvements here - you need someone like me here.

0:50:470:50:54

Oh, just give me the job! I'm better than her.

0:50:540:50:57

I'm afraid we've decided to offer the job to the other candidate.

0:50:570:51:01

-I see.

-Please, don't be upset.

0:51:010:51:04

It was so, so tight.

0:51:040:51:06

Yeah, I know how things work.

0:51:060:51:09

There were just unforeseen circumstances.

0:51:090:51:12

Ah-ha, yeah! One of her connections put her in the running?

0:51:120:51:15

-No.

-I know her type. The right public schools, uncles on the board.

0:51:150:51:18

I spent six years at med school surrounded by them.

0:51:180:51:22

-That's why I insisted on a transparent trial.

-It was my job!

0:51:220:51:27

I work so hard.

0:51:290:51:32

You failed to arrive for my theatre.

0:51:380:51:40

-A patient's less exciting operation had to take precedence.

-Are you a martyr?

0:51:400:51:44

No, I just...

0:51:440:51:46

-The injury was self-inflicted?

-Yeah.

0:51:470:51:51

So, the injury might have been avoided, had a psychiatric referral been sought?

0:51:510:51:55

Do you know how long it takes for a psyche nurse to show up these days?

0:51:550:51:59

Listen,

0:51:590:52:01

I do realise how serious this is.

0:52:010:52:03

And yeah, I could have handled the case a lot better.

0:52:030:52:07

Learn to make humility a habit, will you?

0:52:070:52:11

Consultants don't exist to undertake exciting cases.

0:52:110:52:14

Their primary function is to take responsibility for the dull ones.

0:52:140:52:19

I do have my reasons for wanting to get in your surgery.

0:52:190:52:24

Thinking of my patients in those terms...

0:52:240:52:27

isn't one of them.

0:52:270:52:28

You did well today.

0:52:500:52:51

It was a team effort.

0:52:530:52:54

You pick your moments to shine.

0:52:580:53:00

Hey, erm, I'm sorry about snapping earlier.

0:53:000:53:02

I must have sounded like a total monster.

0:53:020:53:05

You better watch out, Naylor, you'll be the only senior staff member without a niche soon.

0:53:050:53:09

-It was a team effort.

-Glad it's not gone to your head.

0:53:090:53:13

There's already rumours going around about you making a paramedic resign.

0:53:130:53:17

Jools!

0:53:260:53:28

What are you resigning for?

0:53:280:53:30

-I'm just thinking about it.

-Oh, forget it.

0:53:300:53:33

Look, I panicked, I was stressed.

0:53:330:53:35

I had no right.

0:53:350:53:37

Come on, don't do this, I'll not be able to sleep at night.

0:53:370:53:41

-Morag survived. It's over.

-Really?

-Yeah.

0:53:410:53:46

We saved her.

0:53:480:53:50

I watched you in surgery.

0:53:500:53:53

You love it, don't you?

0:53:530:53:55

I don't have that in me.

0:53:550:53:57

Come on, with a bit of practice, you'll be fab.

0:53:570:53:59

Would you want me treating your kids?

0:53:590:54:02

Be happy for me. I'll find something I'm good at.

0:54:050:54:09

-You OK?

-I've just had an operation.

0:54:190:54:24

You tell me, doctor.

0:54:240:54:26

I know a good pub. We could go tomorrow and other days.

0:54:260:54:31

Sure we can.

0:54:310:54:33

Just so you know,

0:54:330:54:35

a guy from the psyche team will be paying you a visit.

0:54:350:54:38

No! I hate them.

0:54:380:54:40

You can't go around here stabbing yourself.

0:54:400:54:42

I won't speak to them.

0:54:420:54:45

Fair enough.

0:54:450:54:47

I'll wait here till you're ready then.

0:54:500:54:52

A bulldog makes a lovely pet - in your face, yapping, every day.

0:55:200:55:27

Come on.

0:55:270:55:28

Your performance went some way to remind me of the skill I once perceived.

0:55:340:55:38

Do not let the smog descend again.

0:55:380:55:41

Ms Naylor was central to today's success. I have to make that clear.

0:55:410:55:45

So can we continue with the trial?

0:55:450:55:47

Unless Ms Naylor has any concerns?

0:55:470:55:51

-Not as yet.

-Good, continue.

0:55:520:55:56

Thank you.

0:55:590:56:01

Don't try and join in. No-one likes the boss.

0:56:020:56:06

Mind your backs, coming through!

0:56:060:56:08

B/P 80/40, pulse 125...

0:56:110:56:14

Subtitles by Red Bee Media

0:56:320:56:37

With the future of cardiothoracics on Darwin resting heavy on her shoulders, Sahira must ensure the success of the trial. But when she is forced to contend with a less-than-supportive Jac, as well as a series of severely critical cases, Sahira's leadership begins to fracture.

Malick, removed from all theatre lists, is convinced he is being informally punished for his run-in with Dan. Confronting Hanssen, Malick is overjoyed to be offered the chance to assist in an important operation. Racing through his ward round, Malick is up against it if he is to make it to theatre in time, especially when a vulnerable patient resorts to extreme tactics in his desperation.

Looking for a new doctor to replace Penny, Sacha has to choose between pitbull Shirley and sweet-natured Lulu. But when Hanssen explains Lulu's privileged connections, as the daughter of Sir Fraser, Sacha's objectives are blighted by politics. Despite the running of his 'Doctor Idol' contest with sidekick and fellow judge Eddi, Sacha struggles to maintain an impartial contest.


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