One of Those Days Holby City

Well, you may have heard that there was a suicide attempt.

-The roof - I'm aware.

-Don't you ever, ever, EVER stop?

You don't know me, get that?

You never did, you never will, you know nothing about me!

Hey if we're going to do this we better move fast.

-I won't step inside theatre without Ric as my assistant.

-Sorry Malick.

Don't laugh at me.

-Argh!

-Nice try, you only just missed.

Story of my life at the moment.

Keep practising. Be patient. You'll get there.

I wasn't talking about basketball.

Ah...

-keeping you busy on Keller, are they?

-The opposite.

I spent more time in theatre during sixth form!

So, how are they treating you in AAU?

Oh, it's great! It was difficult at first

but once I got used to the high stakes, high energy tempo...

it's challenging, exciting...

-new experiences each day...

-Yeah, right, hmm.

Sounds nice, yeah lovely.

-The ball?

-Oh... right. Can I?

Huh.

Fancy that?

Have a nice day!

Mr Jolly, Mr Yedif, Mrs Oliyide, Drysdale.

All right. Mr Malick. Now that's what I'm talking about.

Things are looking up...

-Whoa, what are you doing?

-Updating the board.

Yeah, I can see that. Why?

What happened?

I don't know. Mr Hanssen just called to say it'd been bumped.

-Something about a GS/CT crossover.

-What CT crossover?

Mr Webster. Bed two...

-Yeah, what about him?

-He's got a boil that needs lancing.

-He's due in theatre this afternoon...

-Right.

Mr Webster? I'm Mr Malick

and THAT is some boil.

Now, if I'm not mistaken that is a sebaceous cyst

-which needs to be lanced.

-Mr Malick?

How do I know this? Five years of medical school, two years of

foundation training and several years as a surgical registrar, all of which

-lead us to this point in time... Lord have mercy, what is that?

-Ow!

You're welcome.

He's all yours.

Sorry, Mr Malick, but what was that?

-My time and expertise being wasted?

-You just lectured him on cysts.

-Just provided him with some helpful background...

-Mr Webster has Gardner's syndrome.

Oh, so he knows all about sebaceous cysts?

Yeah, probably, seeing as he's suffered with them his whole life.

-Oops.

-You could've just talked to him.

My job is not to talk to patients. It's to fix them.

Show me a surgeon who "gets to know" their patients and I'll show you an accident waiting to happen.

So I'm coming out of the jump, a regulation "nose-grab",

-rotating round and this guy slides in from the right.

-From the right?

Total wipe out. Tail bone slammer...

Totally...

-You have no idea what I'm talking about do you?

-None at all.

But I got the bit about where you banged your head.

-All he told me was he'd had a bit of a tumble...

-Mum!

-Have you seen...?

It's the size of an egg.

-When was that?

-Yesterday. Snowboarding.

-At the indoor run in Plymouth.

-Why didn't you come in straight away?

-It's just a bump.

Ah, Josh, Mrs Cahill, this is Senior Staff Nurse Mckee.

So how do you feel now?

-Bored.

-Josh...

Look, last night I felt fine.

Sore arm, sore shoulder. A few bumps and bruises... nothing I haven't had before.

But he felt a bit queasy this morning so I thought better safe than sorry so I brought him in.

Well, your eye, verbal and motor responses are absolutely fine

but I just want to get some X-rays done just to make sure. Hourly neuro-obs please?

-Louise?

-Hourly? Sorry, how long's this going to take?

-Oh, he'll be on his way soon enough.

-Can you show Josh to bed four?

You just can't help yourself, can you?

-How long did that consult take?

-Too long?

-Uh-huh.

There's nothing wrong with taking an interest in patients. It's called the human touch.

Yeah well, there's nothing wrong with being efficient. It's called being professional.

A word in my office, please, Mr Malick.

Without the wheelchair.

You should really be in bed, you know. The bump. Possible concussion?

S'all right. I'm pretty sure there's nothing wrong with me.

Well, if you're looking to be discharged, I can't until I've seen the X-ray.

I was kind of wondering if maybe you could, um, slow things down a bit. Maybe till after lunch.

-You got somewhere you don't want to be?

-English.

My Mum's got me a tutor cos I'm rubbish...

I only agreed to come down here cos I haven't finished my essay.

-You faked symptoms to get out of doing homework?!

-Does this look fake to you?

I might've exaggerated things...

a bit...to my mum, this morning.

What time's this English lesson?

This afternoon.

Tess of the d'Urbervilles. If I don't get this essay in they won't enter me for my A levels -

not that they're going do me any good anyway.

Easy to say that now.

How much do you think this is worth?

-It's a phone. I have absolutely no idea.

-Three grand. How much did it cost me?

-Nothing. They're one of my sponsors.

-What do they sponsor you to do?

-Snowboarding.

-Oh, so it's serious then?

Yeah, to me and a few others.

-But not your English teacher?

-Nor my mum, if she finds out I'm failing.

What do you say? Lose those X-rays in the system for a bit?

Who's going to know?

-Excuse me.

-Got to split.

-I've had it with being blackballed in this department.

-Blackballed?!

I know I've got a reputation but I've done some things to earn it,

but I'm also a damn good surgeon - too good to be wasting my time cleaning pus out of boils.

-Mr Malick...

-You told me to be patient. You told me my time would come. Well, trust me,

I have been patient. I've been a good little Malick, and what's it got me?

Nothing! I'm in the same place. Doing the same...

For goodness sake, will you shut up!

Sit down.

Open that file and read.

-Who is Richard Slater?

-One of my patients. Acute renal failure.

-He'll need dialysis then...

-Or a new kidney.

And today is his lucky day because we've found him an organ match.

I was going to ask whether you wanted to assist?

Are you serious?

-The question is are you?

-I'm not sure what you mean.

-I heard what happened with Mr Webster.

-The guy with the boil?

-The patient with Gardner's syndrome.

You drained the cyst but it's not just about what we do...

it's about how we do it.

Still got the job done though.

But people don't just need our skill...

they need our care.

Theatre's booked for three thirty. Are you free?

Count on it.

OK, I'll see you there.

Mr Malick.

-Don't let me down.

-Trust me.

Aren't you a bit old for extreme sports?

We're in the midst of celebrity apparently.

Josh Cahill, snowboarding sensation.

Going to represent his country.

-He's a talented kid.

-And a healthy one too.

-Shame...

-What?!

Oh, it's nothing.

-Right, I'll tell him shall I?

-Mm-hm.

Do you want the good news or the bad news?

Your skull is either made of concrete or rubber.

-So he's OK?

-There's no fracture. No sign of concussion. So, yes,

-he's free to go.

-Are you sure?

-Mum...

-It's just, he hasn't eaten.

-Cos I'm not hungry!

-YOU are always hungry.

Look at him, he's really pale. And he just told me he was feeling dizzy.

-This dizziness isn't related to Tess of the d'Urbervilles by any chance?

-What?

Nothing.

Mum, this is good news, c'mon.

Oh-oh...

Josh?

-Josh, it's OK.

-Sorry.

-Thomas Hardy has that effect on me too.

Look up.

Up and across. OK. A bump of the head can sometimes induce nausea.

-Right, can we organise a CT scan, please?

-Yeah.

Now, Josh, earlier on you said your shoulder and your arm hurt. What about your neck and your back?

-My back does a bit.

-What's wrong?

-We're just going to take a look at his back

just to be on the safe side.

-Why?

-It's a process of elimination at this stage. Best to play it safe.

-My treat.

-Why?

Do I need a reason?

So I've discharged Mr Watson in bed six and Mrs Jackson, in bed eight, requires hourly obs...

What's with the sudden outbreak of diligence?

-What has Mr Griffin done to you?

-He gave me an opportunity!

Come on. Follow me.

-Kidney transplant?

-Mm-hm.

It's my first time. I'm popping my cherry today and nothing's getting in the way of it.

-You are busy today.

-How do you mean?

Well, you're in theatre two with Mr Griffin at half three, and with Mr Clarke at four.

Who's Mr Clarke?

The bloke you're operating on this afternoon.

-What is this?

-Bowel resection.

-I can see that. Who is this guy? I've never heard of him.

-He's one of Mr Hanssen's list.

-But I thought they'd all got bumped?

-Local resection to remove bowel tumour.

Nice and easy.

Mr Hanssen must have trusted you to do this one by yourself.

-Josh Cahill?

-Yeah.

Ah...poor kid.

It's a good catch.

-He could have walked out of here with just paracetamol.

-Better page Mr Hamilton.

Josh'll need an orthopaedic consult.

As you can see, he's feeling a lot better.

Just updating my status - "two hours in hospital and I've already puked on myself".

We need to get you flat, Josh, OK? All right?

-What?

-We'll get some blocks that'll help keep your neck and your back supported.

-What's going on?

The initial examination of the CT scan shows a fracture to T10 vertebra.

This is just precautionary at the moment to avoid any further damage.

You've been walking around with a broken back, Josh.

-The problem is the surgeon who was due to perform your procedure has been called away.

-Sorry,

-remind me? Who are you again?

-My name is Mr Malick.

-I'm the registrar here on Keller and with Mr Hanssen gone it's fallen to me.

-Hang on a minute.

This isn't a hair cut, mate. I don't want any Tom, Dick or Harry opening me up.

-You don't want anyone opening you up full stop.

-I'm here aren't I?

-Please. Go on.

-Unfortunately, I've been double booked, so it's a case of working something out.

-What do you mean?

-Well, the way I see it, you have two options.

-Good. I like options.

-One, we postpone surgery,

-put you on Mr Hanssen's list next week.

-That makes perfect sense.

-What's option two?

-Two...

-we find another surgeon to do the procedure.

-Sod it. Why don't you ask him?

Oi, mate, you fancy a challenge...

-The more times you dwell on this the worse it'll get.

-This is different. They've moved the goal posts.

-Leave it another week and you'll be even worse.

-I'm not in a state.

-You do seem a bit anxious.

-I am not "anxious".

-What about option three?

You do Frank's surgery and drop the other one.

-I'm afraid that's not possible.

-Why not?

-Mr Malick. A word, please.

-Excuse me.

-Oh, you listen to me now?

Can you believe that guy? What's this?

This is the fourth time Mr Clarke's rescheduled this procedure.

He's a yo-yo? Well, he's more than welcome to walk out of here today.

You should try and find out why he keeps cancelling.

-That's his problem. Not mine.

-It's your name on the board.

Hanssen.

I bet he landed me with this guy deliberately.

Glad to be of assistance.

Thank you for doing this, Henrik. I do appreciate it.

Not at all. A hiatus hernia is not something to be taken lightly.

-And you're doing the procedure yourself?

-Wouldn't have it any other way.

I understand there's a Board meeting scheduled for later today?

Count yourself lucky, you'll be too busy to attend.

-Terence?

-I thought I'd just pop in, you know.

That's very sweet of you, Terence.

No flowers?

-You remember Mr Hanssen, of course?

-How could I forget? Lovely to see you again, Henrik.

-Mrs Cunningham.

So formal. Besides, I'm travelling incognito.

-We wouldn't want anyone to think we were receiving special attention.

-But we are Terence.

-With Henrik on board.

-Yeah, Ella was excited to know you'd be leading the operation. So no pressure.

I have every confidence in him. Which is why I've decided to have the procedure done laparoscopically.

-That's not a problem is it, Henrik?

-It's unorthodox but not unheard of.

Give your people on Darwin a chance to show what their made of?

Quite. Ms Shah will be with me. I'm certain she's up to the task...

Ms Shah?

And there was I thinking it'd just be the two of us.

I'll think you'll be pleasantly surprised by the skill,

professionalism and discretion of our cardiothoracic registrars.

Eurghh...

Is that paracetamol?

Give! I thought it was supposed to be a swift half?

I was thirsty.

I noticed.

Work hard. Play hard.

Helps to keep my liver on its toes.

That's an interesting approach.

Painful, but it's interesting...

-Partying again? Third time this week. Good night?

-You wouldn't have enjoyed it.

-Really, why?

Dancing...women...

-Whatever floats your boat I guess...

-I overdid it on a school night.

-So what?

-Yeah, I know, but you seem to be doing a lot of that.

-What are you? My mother?!

-No, I've already got two kids, thanks. I don't need another one.

-Ms Shah,

I have a sliding hiatus hernia patient that requires CT oversight.

I wondered if you would you be interested in assisting me?

My workload's rather light at the moment.

I'll see you in the consult.

Do you need to talk?

Chop, chop.

Henrik, you brought a chaperone?

-You cautious thing, you!

-Ella, this is Ms Shah.

-Of course.

-Ms Shah is well versed in laparoscopic techniques.

-I bet she is.

Well, there seems to be a divide.

You've the gung ho brigade who'll do anything laparoscopically...

and then there's others who run a mile at the mention of the word.

Well, I'm not one of those.

-Excellent.

-However, a hiatus hernia isn't exactly the procedure I would have thought

-laparoscopic technique was designed for.

-But it is feasible.

Good.

I very much enjoyed your article in the BMJ last month.

-You subscribe?

-No. I was doing some research.

Into?

You.

There's no need to get into the robe right now, the operation's not for some time.

I've put a lot of time and effort into this.

I really don't want an eight inch scar ruining the effect.

Right.

Well...point made.

-Well, that was fun.

-Not the word I'd use.

-Who is she?

-A patient. No. That was a side show.

-I've got better things to be doing than play chaperone.

-She's married to a trustee.

-I don't care if she's the Queen of Sheba.

-Our chairman, in fact.

-Married to Terence Cunningham?

-I know you shy away from hospital politics, or like to think that you do,

-but this is a golden opportunity.

-I've list full of patients. Real ones.

Then explain to them that the Director of Surgery has requested your help.

-Henrik, I am not playing this game.

-Sorry?

-You say, "Jump," and I say, "How high."

-I'm giving you a chance to make an impression.

-Maybe I don't need you to give me chances any more.

There are plenty of registrars who'd kill to assist you in surgery.

I don't need "other registrars". I need...

..someone good.

Greg's just as good as I am.

-And he could do with a break.

-I seem to remember my last experience with Mr Douglas, it turned pretty ugly.

He's been going through a tough time and last week was particularly difficult.

Something I should know about?

My relationship with Greg is based on trust.

Now that may be an alien concept to you but to me it actually means something.

-Mrs Clarke?

-It's Lauren.

Can I help you?

No. You can help my husband.

-Looks like he's made his own mind up.

-He doesn't know his own mind!

Please, this is the fourth time he's been in to have this tumour removed only to find some excuse.

The only reason we're here is because St James's have refused treatment.

I'm not surprised. In and out of hospital.

Back and forth. He's what we call in the trade a yo-yo.

He's my husband.

And he's the father of my child.

What's he scared of?

Anaesthetic, needles, knives, machines that go beep...

I don't know because he won't talk to me about it.

He won't talk to anybody.

Go stop him from packing.

What are you going to do?

Hurry things up.

Thank you. Thank you.

Get the Theatre Manager on the phone.

Time to call in a favour.

I don't understand. How can he have a broken back? He was walking fine.

Don't go into catastrophe mode, Mum.

It's natural to be upset. People hear "broken back" and it's like the end of the world. In reality,

it's just not as simple as that.

Oh, it's fine. Just try to keep your arms as close to the side of your body as possible, OK?

Josh, I'm going to test the sensation in your limbs.

You tell me what you feel.

One, two, three.

Something sharp. Left foot.

Good.

One, two, three.

Sharp right.

-Perfect.

-What does that mean?

-There's no major damage

-to the spinal cord which is very good news.

-You can fix it?

Well, it's not really for me to say Josh but our Orthopaedic Consultant, Mr Hamilton, is on his way.

-He'll fix it?

-He'll decide the best course of action.

What does that mean?

It means there are two options really -

surgery or the more conservative approach,

which is allowing the break to heal by itself.

I know which one I want.

You're not in the best position to make that call.

I'm the one lying flat on my back staring at the ceiling, aren't I?

Don't you look like the cat that got the cream?

Nope. But I'm the registrar who got the slot.

After some negotiation, string pulling and the calling in favours, I've got your theatre slot moved up.

-Meaning?

-We can have your husband open and shut and back home in time for tea and biscuits.

-This is good news, Frank.

-When?

-When what?

-When am I going under?

-20 minutes.

-That's too soon. I've got things...

-This isn't negotiable, Frank. This a one time offer, mate.

20 minutes ago you couldn't wait to get rid of me.

-I wasn't fully aware of your situation, then.

-What do you mean my "situation"?

-What have you been saying?

-Nothing I couldn't have found out by looking at your notes. Look, Frank.

I don't understand why you're frightened of what is quite a simple procedure.

To be honest, I don't really care. But your wife does and my boss does

so I've gone to some great lengths to get you this theatre slot. So you'd better take it.

Right! We're all good.

Let's get prepping.

Who was that? It was her, wasn't it?

BEEPING

-Oh...

-Are you all right there?

-I'm looking for my boy.

OK. Paediatrics?

He's 43.

Right. What's his name?

-Frank Clarke.

-Oh, OK, he's just over there. Let me help you.

I only carry it for protection.

-Josh Cahill - came third at the under 17's Europeans?

-Was robbed.

I agree. Never trust the Swiss, I always say!

Well, you've got full sensation in your limbs which is marvellous.

I'm not being funny or anything but we've been here for hours and nobody's told me what's going on.

That's the nature of the game. We watch and we wait.

I've had a look at your scan and it's a nice clean break. It may very well heal by itself.

I don't want that. I want an operation to fix it.

That's also an option but no surgeon is anywhere near as adept as Mother Nature.

What's Mother Nature's recovery time?

Six weeks to let the bone knit.

-How long till I can board again?

-Six months.

-Six months?!

-We're putting the cart before the horse.

There's still tests to do. An MRI would be good. And...

-He said an operation could fix it.

-Did he now?

You promised. You said you wouldn't tell her this time.

He's my son. He needs me here.

-So you can talk him out of treatment again?

-Excuse me, what is going on here?

You wanted to know Frank's problem with hospitals? She's right there!

Death trap these places.

MRSA, neglect, disease,

malpractice...

-All right, don't shoot the messenger.

-You're not a messenger, you're a vulture.

-Lauren!

-No, I won't stay silent.

Not this time. She fills your head with this rubbish time after time. This is a hospital.

-They heal people.

-Not all the time.

-No. But most of the time!

His father was in here. Never came home.

-That was 30 years ago!

-OK, family reunion's over.

It's time to get Frank prepped for theatre.

-Prepped? So soon?

-Yes, Mum.

-Frank?

-Here we go(!)

I've got one of my feelings.

-Ooh...

-What was that?

-Nothing.

I knew this was going to happen.

-All this stress.

-Is everything OK?

-I'm fine.

What about the baby?

I'm no obstetrician but I think you're absolutely fine.

I'll get Nurse Tait to get you checked out.

OK, while we get Mr...

No, I'm not going anywhere until I know my wife and child are OK.

As far as broken spines go, it couldn't be much better.

No apparent nerve damage, clean fracture.

It's only initial, but with the findings of your ASIA test,

looks like six weeks bed rest should sort things out.

-Josh won't necessarily understand that.

-No, he won't.

Especially after being encouraged to take the surgical option.

I didn't encourage him.

Good. Because it's not your place.

He needed to hear something positive.

-He needed to hear the truth.

-And the truth is there is a surgical option.

And who's going to perform that? You?

Look, I know where you're coming from but kids like this, athletes, think they're indestructible.

Once I've got the MRI, I'll have another look and draw up a treatment plan.

OK.

Go on say it. "You're getting too involved."

You're getting too involved.

-You weren't supposed to actually say it.

-Sorry to...

-Is everything OK?

It's Josh. He's getting himself really wound up.

I just wondered if you could have a chat with him.

Ms Shah is busy in theatre two.

Ms Naylor's on leave. So, yes, it's just Mr Douglas who's available.

Did I hear my name?

Laparoscopic hiatus hernia, female patient.

I need a registrar to assist. Have you performed the procedure before Mr Douglas?

Not keyhole.

Well, come prepared.

-Good to see I'm second choice round here.

-Actually, you're more like fifth.

What Mr Hamilton is saying is right.

At this stage we don't have enough information to make a decision.

When will you get the information?

When we get the scan results.

-Can you get Mike here?

-No.

Who's Mike?

-His coach.

-Well, if it helps Josh...

No!

I'm not having your future dictated by some sporting fixture.

Excuse me.

She's got a point.

I know.

But so do I.

I've been training for this for eight years.

I don't have anything else. Do you understand?

Josh, that's not true.

You're young. You're still a kid.

Give me your hand.

You trained for around eight years to be a surgeon, right? Well...

just imagine...

that I squeezed...

and squeezed...

till every bone in your hand was broken.

So you could never be a surgeon again. You could never use it.

How would that feel?

Something you want to tell me, Mr Malick?

Er, no. Why?

Would you mind explaining to me why you're down to do a bowel resection

at 4pm when you're supposed to assisting ME on a kidney transplant?

Well, there's been a bit of a mix up, but it's all sorted now.

-Almost.

-Almost?

-I've moved the resection up to 1:30.

I'll be done and dusted well before scrubbing in on the transplant.

1:30? Well, shouldn't you be scrubbing up? It's already gone one.

Well, there's been a couple of delays.

Patient's a bit of a nightmare to be honest, d'you know what I mean?

What did I tell you about blaming patients?

-Look if it's a problem I can always find someone else to assist.

-No! There's no problem.

It's all under control.

I swear.

Is the baby's heartbeat OK?

Just fine. She's perfect.

-You're telling me everything's OK?

-Your wife's fine. Everyone's fine, except for you. Let's roll.

All right, keep your shirt on. What's the rush? I'm not going anywhere.

-No. But our theatre slot is!

-Mum? What's the matter?

She's so beautiful.

So tiny.

So...

-I'm sorry...

-It's OK, Joyce.

Everything's going to be OK.

The smell is horrendous.

-What smell?

-Cabbage and disinfectant.

Smells like decay.

Like death...

Excuse me.

Come on!

We got to go.

Look, can we just slow down a bit?

No! We're late.

-I'm having trouble breathing.

-Can't you hold on?

In a few minutes I'll have you on oxygen on a ventilator.

Look. Please, just stop.

-Better?

-No.

Look, mate, I know you're feeling a bit rough,

but it's probably just a panic attack.

It's all in your head. Through those doors is the theatre.

This will be over within an hour.

You'll never have to come back here again.

God willing.

Right.

No, no, no, no! You can't. That's our slot.

Sorry, we couldn't wait any longer.

Henrik, another protege?

Ms Shah was called away elsewhere.

-This is Mr Douglas.

-But you can call me Greg.

-With that accent you can call me anytime. Sligo?

-Dublin.

-Any Celt's a good Celt in my book.

-A woman after my own heart.

Listen to us go on. It'll make Henrik jealous.

-Oh, I don't mind, really.

-You feeling lost without your protege.

Shall we?

What happened?

We missed our slot.

No, you can't. You've got to go back. They can't do this.

They can. There's nothing anyone else can do about it.

-Mr Malick?

-Where's Mum? Never mind.

We can always try again at four. Right?

-No.

-What do you mean "no"?

-I mean I've had it.

-I've had it with you, your family, your panic attacks and your presence.

-Malick.

From you came in you've been a pain in the backside.

I've bent over backwards for you, and for what?

You want to wait until that tumour grows to the size of grapefruit?

I won't be allowing you to cost me the chance

of doing some real surgery.

Josh asked me for help. I'm going to get a second opinion. That's all.

You'll undermine the orthopaedic consultant. Dan doesn't deserve that.

It's about canvassing opinion. That's all.

Sasha, look.

Are you sure you're not getting too involved?

He'll only be out of action for six weeks.

He'll look back and think of how lucky he is.

-I know.

-And he's only 17.

He's not really old enough or informed enough to make such big decisions.

He's more informed than you might think.

And more determined.

I just think he deserves to be heard.

Of course he does, just don't let him make up your mind for you.

We need to talk.

OK. We have a nice clear view.

So, good friend of yours?

An acquaintance.

The upper 2cms of the greater curve

of the stomach has now been dissected.

An acquaintance.

She seems to want to get well acquainted with you.

-Mr Douglas, please.

-Sorry.

Right.

I can now see the anterior aspect.

In future, I'd appreciate it

if you could keep such speculations to yourself.

Mr Griffin.

I know you're angry.

I'm not angry. I'm...

I don't even know where to start. So I won't. You can go.

Do you want me to...

I don't want you to do anything. Except leave my office.

What about the transplant?

-What about it?

-Do you still need...

Am I still assisting you?

-That depends.

-On what?

This is a teaching hospital, Mr Malick.

It depends on what you think you need to learn.

I believe you still have patients?

Frank's been given another slot.

Hmmm, and the transplant's later.

So I should be able to do both.

How is Mr Clarke?

Worrying.

Well, tell him not to.

We're going to do this... today.

It's not the operation this time.

-It's his mother.

-What about her?

-She's gone missing.

-Go look for her then.

-I think Josh has had a back injury in the past.

-What?

Well, there's a narrowing of the spinal canal.

Suggests he may have slipped a disc, it became herniated.

He didn't mention it?

I suppose it goes with the territory.

My point is it would make surgery a nightmare.

What I don't get is how it's not affecting his sensation?

-He hasn't mentioned anything at all?

-No, not at all.

-And you took a full ASIA test?

-Of course!

-Just curious, that's all.

Boy and scan telling us two different things.

Or maybe Josh isn't telling us the whole story?

He's a teenage boy who's totally focussed

on his recovery.

We need to find out more.

I'll be back to do another ASIA test.

I know I wasn't your first choice for this.

I can understand why.

Is that what's going on?

Have you ever heard of diplocarpon rosae?

It's a fungus a blight that attacks roses.

See, you can spend years nurturing,

caring for, protecting your rose bush.

Then suddenly,

one day, along comes diplocarpon rosae,

and, soon enough, your rose wilts.

It only takes one spore.

Don't suppose you grow roses, do you, Mr Douglas?

-No.

-I do.

They're precious to me.

We've got a bleed. We're going to do the ASIA test again. OK?

You know the score. Tell me what you can feel.

Mum...

OK. Other foot.

Mum...please...

-Don't you feel anything?

-It comes and it goes.

-It'll come back.

-How long have you been losing feeling?

-It's not constant.

-Josh, when did it start?

After the accident.

It's on and off. The feeling will come back.

-What does this mean?

-We don't know yet.

By not telling us, does he realise he's made a bad situation worse?

He's a kid. He was scared. Surely you can understand that?

Course I do. All patients lie.

It's knowing when, where and why that helps us moving forward.

So, what happens now?

We talk to him. Tell him about the increased risks.

Then we give him what he wanted all along.

We operate.

Mr Malick. I'm going to spend my break with my mum.

Oh, and Mrs Clarke is in the relatives room asleep.

Well, why didn't you wake her up?

Mrs Clarke.

Mrs Clarke. Your son's wondering where you are.

Mrs Clarke.

Hey.

You're kidding me.

-Give us fluids and get some blood.

-BP's dropping. Are you OK, Mr Douglas?

-Give me a minute.

-More fluids, please.

-If you're not all right...

-I'm trying to do this. Let me concentrate.

That's it, let's remove the instruments. Gently.

-What are you doing?

-Open surgery.

-She doesn't want that.

-Otherwise she might die. Step aside.

-No.

You're going through a difficult patch, it happens to us all,

-but this would be the moment to step aside.

-Who told you that?

Last week you allowed your emotional baggage to spill over on to one of my wards.

-Swabs and suction!

-I said who told you that?

Your career is on shaky ground, insubordination will not help. Please leave the theatre.

I don't have to ask.

Get me a knife, please.

Hey, thanks. Thanks for coming.

Are you absolutely sure she's dead? I'm just saying.

Given the circumstances and all.

I know I've made some mistakes,

but I still know a dead body when I feel one.

I don't think this is the best way of handling it.

What about her dignity?

We just need to make sure we get her out of here as discreetly as possible.

Just act normal.

What's that?

I'm going to cover her with it.

The whole point of this exercise was to pretend that she's not dead.

Imagine what the average punter's going to feel if they see us

carting dead bodies from the relatives room.

Imagine what Frank's going to feel.

-He can't know.

-What?!

It's his mother. We can't keep it a secret!

-What did you say to him?

-To whom?

-Hanssen. What did you say to him?

-I didn't say anything.

You do not discuss my personal life with anyone in this place.

-I have no idea what you're talking about.

-Why was that snake making comments

about me going through a difficult patch?

I was putting in a good word for you.

-I don't believe you.

-Greg, I was being a friend.

-You were being a therapist!

Listen, get this straight.

I don't need your charity and I don't need to get caught

in-between you and Hanssen and whatever game you're playing.

Keep your cod-psychology to yourself.

-OK, I'm sorry.

-You should probably go back into theatre.

-What?!

-Hanssen kicked me out! He needs you.

I don't.

What happened?

Not sure.

Heart attack, stroke?

They'll do a post-mortem.

I'm sorry.

She always did have to have the last word.

She's not messing things up for us this time.

Right, um, well, obviously we need

to give Frank time to take in the news.

Then we can reschedule his procedure.

No, that's not going to work.

Excuse me?

If he finds out what's happened

there's no way he'll ever have this operation.

You're not going to tell him that his mum's just dropped dead?

I'm not talking about lying.

Just delaying the news.

He's not due in theatre for another two hours, Lauren.

Can you pretend everything's OK till then?

I'm going to have to. We're all going to have to.

I really don't think I can allow...

My baby's just lost her grandmother. I will not lose her father as well.

I thought you said it was better to let nature take its course?

This has been taken out of nature's hands.

The pressure building up on Josh's spine will only increase over time.

-That's why he's been losing the feeling in his legs.

-Is it...

-What are the risks?

-Spinal stenosis essentially leaves us

less room to work around the spinal cord.

-It's a more intricate procedure.

-More dangerous you mean?

I don't have any other option, do I?

I'm afraid not. Not any more.

-What are we waiting for then? Let's do it.

-He's in safe hands.

-You all right?

-Not really.

Just feels wrong to lie.

Even if it's for a good reason?

I don't know? Is it a good reason?

What have you said to my wife?

-Excuse me?

-Don't play games with me.

She went off with that one. And now she's all...different.

-How?

-Nice. Polite.

First my mum goes missing, now this. What's going on around here?

Right, now, come on, concentrate everybody.

Retractors.

I said, retractors. Pay attention, please.

Good, thank you.

Come on, come on, thank you.

Focus. Ms Shah.

-Is there anything I can do?

-Your job.

I need your help. Please.

Right, I'll scrub in.

Second retractor, please.

There's the fracture.

There's fragments of bone in the canal.

-What?

-There's a clot.

Didn't show up on the scan.

If it's cutting off the blood supply to the nerves we're in trouble.

-There must have been bleeding from the lumbar arteries.

-Yep. Suction, please.

Forceps.

Saline please.

Well done.

It doesn't seem real.

She doesn't feel real.

She always said this would happen. The mad old bat. Turns out it did.

If it's any consolation...

..she didn't suffer.

She passed peacefully in her sleep.

Frank? Frank!

Rongeur, please.

-One down.

-No, we've got a bleed from the lumbar artery!

I can't see a thing.

Packs. Keep it 100% oxygen.

-It's not happening.

-We'll need platelets and FFP. How's it looking on the monitor?

-Not great, impaired nerve function.

-More suction!

BEEPING

It's getting ischemic. Dammit.

Nerve functions still off.

So we take our time.

We can take all the time in world.

If the damage has been done, it's been done.

We've done what we can, Sasha.

So that's it? You're running away?

I'm sorry, I just can't go through with it.

Fine. But I'm not explaining it to your family.

Get back up there and do it yourself.

You think I'm an idiot.

Either that or you don't understand what's going on inside you.

Oh, I understand.

My oncologist said if the tumour went untreated,

I might make it to Christmas.

So what? You're happy to settle for that?

Yeah.

-More suction!

-I can see the bleed. Coming from...

Vascular adhesions.

Roberts. 3-0 Vicryl, please.

BP's climbing. Well done. We're almost back on track.

-BOTH:

-Diathermy, please.

Thank you.

Disappointing.

-We need to separate it out.

-And risk uncontrolled bleeding?

-We could try a flexible bronchoscope?

-That's ingenious.

-An elegant solution to a very inelegant problem.

-Thank you.

-BOTH:

-Flexible bronchoscope, please. So nice to have you in here.

-Try telling that to Ms Giles!

-I don't know what you mean.

Seemed she wanted your devoted attention.

-Don't tell me you didn't pick up on it?

-Pick up on what?

She was flirting with you, Henrik.

You do know what flirting is, don't you?

I did wonder when she took her clothes off.

My dad was 48 when he died.

Cancer?

No flies on you.

Look.

You don't have to follow in his footsteps.

He went in for an operation.

Said he'd be home in a fortnight.

Two weeks he still wasn't home.

Everything they did to him to make him better. It made him worse.

It was like watching someone being tortured to death.

What about Lauren? What about the child you're about to have?

I can't put them through all that.

I don't expect them to understand,

but I know I'm sparing them from something worse.

Can you understand that?

Honestly?

No. It's one of the stupidest, most selfish things

I've ever heard in my whole life.

You speak your mind, don't you?

It's a gift.

What about your other surgery? The real one?

My career can wait. You can't.

There were some complications we hadn't foreseen.

Josh's spinal cord is badly damaged.

-How badly?

-We won't know until the swelling has gone down.

He won't be able to snowboard any more?

Kate...

Josh might not be able to walk any more.

You told me it would be all right.

I can't. I'm sorry.

-You OK?

-No.

You need to pull yourself together before Josh wakes up.

I don't mind talking to him by myself if you're not up to it.

Maybe it'd be best coming from you, actually.

No, it'd be better coming from one of us.

Thanks anyway.

OK. Just give me a minute.

I'll do it.

Go, go on. I'll take care of it.

MUSIC: "Calm Me Down" by Port O'Brien

I can see a bright light.

That'll be the theatre lights.

On the off chance you see any other kind of lights,

don't go running towards them, OK?

Deal.

OK, counting from ten.

Nine, eight, seven... Thank you...

You're welcome.

Chrissie?

Don't know why I'm calling, really.

Just...

Just wanted to say hi.

Thanks for doing that.

I didn't do it for you. I did it for Josh.

The last thing he needs is his doctor breaking down on him.

-I could have handled things better.

-Yeah. You really could've.

Does it come easy, being so professional all the time?

No. No, it doesn't.

Which is why you never get involved.

Don't ever put me in that position again.

KNOCK ON DOOR

Mr Griffin,

I know you're not interested and you have no call to be,

but I wanted...

I need to say this.

I'm sorry.

I let you down.

The department down. And myself.

Malick.

Well done on the resection.

Ah, Henrik. We need to talk.

Yes, of course.

There were a few complications and Mr Douglas' behaviour

will be dealt with of course, but all in all it was a big success.

We had to carry out an open procedure,

this will mean a longer recovery period.

What are you talking about?

-Your wife.

-Oh, right.

We've been divorced for years.

I don't want to talk about Ella.

Anyway, the meeting today,

it was a little bit more significant than we anticipated.

Right.

It's not official, but I thought I'd better give you the heads up.

All cardio thoracic procedures are going be transferred

to St James's within the next six weeks.

But the consultation period hasn't come to an end yet?

Not officially, but decisions have been made.

Sir Fraser is pushing for Trust status as soon as possible.

The closure of CT sends out a clear message

that we are getting our finances under control.

It also means we'll lose most of our talented surgeons.

One department. Let's not get this out of perspective.

Yes, a department that has some of our very best...

I am just the messenger.

I have absolutely no influence over these decisions.

Right, of course.

Diplocarpon rosae.

-I beg your pardon?

-Blight.

I thought I'd dealt with an outbreak earlier.

But seems the infestation was larger than I thought.

Hey, you look terrible.

One of those days.

Tell me about it.

But things are looking up!

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