Got No Strings Holby City

-I'm leaving.

-I'm not entirely sure what you expect me to do, Mr Douglas.

I expect you to do whatever it takes.

-So if I apply for Clinical Lead?

-May the best man win.

This is your doing, isn't it?

Rafi's been offered another anaesthetist job with higher pay than Nottingham.

I'm supposed to believe that's just a coincidence.

So, you're going to Ibiza for fortnight is more important

than living with me?

And you don't think I'd like to spend more time with my kids.

What's stopping you?

-I hope you're not too disappointed?

-What? That I didn't get a job I deserve?

I think it'd be a good idea to appoint a second lead.

Really? Like a second in command?

Yeah.

HEART MONITOR BEEPS

CLASSICAL MUSIC PLAYS

ROCK MUSIC PLAYS

-Are you listening to a single thing I say?

-You said clamp the ileocolic vessel.

Yeah, clamp it. Not clamp it then hide it

where not even a crack-team of Navy Seals could find it!

This guy's heart's like a diesel pump. Right, there. There. Clamp it!

Clamp it!

All right. Now, now, clamp it! Clamp it!

-Got it?

-Yeah.

-OK. Ready?

One, two, three...

For the love of God! Come on.

OK, there. Here, here, here. Clamp it. You got it?

OK, here we go. Here we go. One, two, three.

Ooh! Hey, hey! All right.

OK, let's suture this bad boy and we're home and dry.

Nowhere in the log does it say you're booked in this theatre now.

Well, believe it or not,

this actually started in the Treatment Room,

it was just a simple wound suture until this guy decided to have a full scale graft blow out.

-Really?

-But luckily we were here to rise to the occasion. Right?

-Most certainly were.

-Had your patient been properly sutured in the first place,

he wouldn't have needed to be re-admitted,

let alone to suffer further complications requiring theatre.

Are you kidding me?

-I'm so sorry.

-OK. You made it.

Thank you. It's like a madhouse in there.

You still need a break.

Yeah. I know. But, you know what it's like.

Do you remember when we used to sit outside

St Thomas's feeding the squirrels?

Yeah. You used to call them "Rats with fancy tails and good PR."

Yeah, that's exactly what they are!

We do need to make time to be together.

Yeah, I know.

-It doesn't happen naturally now. Not with us both working.

-HER BEEPER GOES OFF

And then, there was Hanssen...

I'm sorry.

Bye.

Mr Thorne, septic leg ulcer. Yesterday, you...

..Debrided it. Yep. OK, that looks good.

You're going home. Next.

Mrs Coolidge. You removed her gall bladder.

All right. Show me.

Mrs Coolidge.

That's exemplary. You're going home. Next.

Miss Quinn, broken ribs. She slipped in the shower.

-Right.

-You sutured her pretibilal laceration.

You slipped on your shower gel bottle. How could I forget?

All right, let's take a look.

-How does that feel?

-It feels fine.

OK, you're going home.

Just no kick boxing for next couple of weeks. Promise?

Now, Mr McPhee's pancreatic ductal-type adenocarcinoma.

Ms Broadhurst would like to handle this one.

All right, why am I getting all the dog cases,

while she cops all the interesting work?

Well, she is the boss. And a fellow.

Authority loves an academic.

Right. There's a repatriation medical insurance case arriving.

-Doctor attending landed at the airport and called it in.

-From where?

Gambia. Patient has impaired consciousness. Mystery illness.

-Age?

-Young girl, 19.

-Tropical infection?

-Possibly. Arriving in Wyvern in ten minutes.

-This one's mine.

Thanks.

You look like how I feel.

Cream-crackered. My shop.

Double shifts.

Tell me about it.

Need the cash.

What is it - drug habit? Gambling debts?

Owe money to the Mafia?

Ibiza.

-Nice.

-Saturday the seventh. Eleven days' time.

This is me...

Would madam care for another Margarita?

-Big news!

-What?!

We have a moving in date! I've signed the papers.

We take up residence on Saturday the seventh!

Yay!

SHE SCREAMS

Primal screaming.

Reiki healing. Faith healing. Hopi ear-candling. Applied kinesiology.

Bio-resonance therapy.

Crystals. Fasting and urine therapy, you name it,

Annabelle Taylor has tried it.

She's a bit young to have thyroid cancer.

-She had lung cancer when she was 17.

-What?

Totally unrelated.

These two cancers have no connection or link to each other whatsoever.

That's terrible. What're the odds of that?

33.7 million to one.

Approximately. Miss Taylor should do the European lottery.

She'd have more chance of winning that

than she had contracting those two cancers in her short life.

So, you're proposing a thyroidectomy?

A retrosternal mass, compromising the trachea, with limited access.

Thank you.

So without a sternotomy,

a standard thyroidectomy makes it a very challenging procedure. But one,

if it were executed correctly, that should rid Annabelle Taylor of her tumour permanently.

I expect I will need cardiac cover, because of that.

That's some mass behind the sternum! Goes all the way into the chest.

Quite a novelty, don't you think? She'll be very testing.

Would you like to take a look at her for me?

Gosh, yes, I'd love to, but my schedule today is already...

I paged, because I value your opinion. And I think you'll enjoy Miss Taylor.

-She is something of an eccentric.

-All the alternative medicines?

Yes, and her rather original relationship with her illness.

-Really?

-She calls her cancer "Raymond."

One of my old team became a repatriation doctor.

Left the NHS to join a big international medical agency.

In case it's an infection, let's clear the side room. She'll need to be isolated.

Flew all over the place, First Class, bringing sick Britons back to Blighty. Aspen, Seychelles...

What was she presenting with at the hospital out there?

-They didn't say.

-OK, can you liaise with the Infectious Diseases Unit?

Get any tropical infection updates for West Africa.

Said it was like being the James Bond of the medical world.

International jet-set GP. Another day, another continent.

Ten nights with his own personal butler! My ex-registrar,

looking after some businessman stroke-victim.

Then a private jet home.

I mean, how jammy is that?

Doctor Jeremy Summerville, thank you so much for meeting us.

Mike Spence.

So, Louisa Tindle, 19, student from Gloucestershire.

Was on a voluntary placement thing in Gambia.

Collapsed and admitted to hospital four days ago.

-Breathless, high temperature, dizzy and abdo pain.

-Why'd she collapse?

No idea. The abdo pains became progressively worse.

Hospital never reached a verdict, pretty basic facilities out there. Luckily she had top-line insurance.

-She was conscious when collected?

-Weak, but yes, lost consciousness on the plane.

Agitated, a lot of pain. Out like a light.

Breathing's normal, 94% Sats but hasn't regained consciousness.

-Any vomiting? Diarrhoea?

-Just shut down.

Well, she seems stable, breathing on her own. Let's find out what's wrong.

Doctor Summerville, Alex Broadhurst, Head of Department of the Acute Admissions Unit.

Right. Good. Pleased to meet you.

-I can take this case from here,

-It's OK. We took the call, we made the catch.

I'll take over now, thank you, Mr Spence.

OK, right. Well, sorry to bother you, old fruit. My mistake.

I just assumed you were in charge.

This is Mr Brodrick.

Owen.

Phosphorous burns to his posterior. I've debrided them in theatre,

but he will need hourly obs and dressings changed twice daily, minimum.

Notes, where are the notes?

Ooh, that sounds painful.

Go on. Get it over with. Have a laugh. Chuckle-away, ladies.

-Then we'll call it a day, shall we?

-Laugh?

-Lads who did this are still laughing now.

Somebody did this on purpose?

I should never have turned me back. Lesson One when teaching poxy little beam-trawler deck hands

in the correct use of a hand-held rescue flare.

Do not turn your back. My own fault.

I'd have had you down as a miner.

I was. 22 years in Cwmbargoed Pits.

Now I'm teaching trawler boys safety at sea. It's murder.

Must make a nice change, the wide ocean to being underground.

Give me underground, any day.

-Is there anyone you'd like us to call?

-Only my mother.

Shall I give her a ring, tell her you're all right? Maybe she wants to visit?

Joking, aren't you? I'd rather have another flare up my whatsit

-than get mother in here.

-She a bit scary?

You've seen what's in the middle of the Welsh flag.

-They used my mother's head for the profile.

-Really?

No mates you want us to call?

Nah. Only pub-mates. Pub-mates don't do hospital visits.

Excuse us a sec.

-Um, Lleucu...

-The van.

-What?

Your job, sort the van with your uncle's friend.

Do it tonight. Don't forget.

Well?

Hanssen wants me to have a look at a case.

-I ate your Danish.

-Malignant thyroid tumour, she's only 25.

That is young.

-Yeah, and it's huge.

-Why does he want you?

Well, it reaches right down her neck into her chest.

-So he wanted my input.

-Doesn't he always?

I'm only trying to do my job.

You do about four peoples' jobs.

I can't say no. She's already had lung cancer.

Jeez. How much bad luck can one person have?

Exactly. So Hanssen wants me to consult on the cardio aspect.

-There's no-one else?

-Consult. Not operate.

-It's not going to make you late tonight?

-No.

No. Look, if it looks like it's running late,

I'll have a word with him. I'll sort it out, OK?

Sometimes it feels like there's three of us in this marriage.

Let's review, shall we?

Did she have vaccinations prior to travel?

-Yellow Fever, Diphtheria, Typhoid.

-Tetanus?

Yes. Hep A and rabies. Broad cover.

-This is the sum total of her notes?

-I know they're not extensive.

But I always say the same thing, please don't shoot the messenger.

From some countries, notes, legible, comprehensible notes,

can be a rarity. I do have my own observations recorded in transit.

-OK.

-I'd like a quick word.

-Excuse me.

You cannot just swoop in and steal my patient.

-I'm sorry, I have to.

-Really?

NHS guidelines stipulate in the event

of an intercontinental repatriation from a high risk country, the senior consultant should attend.

-And I'm a senior consultant.

-And I'm the lead.

This is in no way a reflection upon your abilities, Michael. Simply routine protocol.

Michael. That sebaceous cyst in bed seven needs your attention.

Can you believe I spent £75 on a crystal consultant,

for her to find a crystal

that resonates sympathetically with my body rhythms?

So, why Raymond?

Why Raymond, or why give my cancer a name like Raymond?

-Either. Both. I don't know.

-If you had cancer, what would you call it?

I'm not sure if I'd call it anything.

You got children?

-Yes. Two boys.

-And when they were inside you?

-Blob and Flipper.

-Sweet.

-But I don't understand the...

-It helps. To give it a name.

When I had lung cancer, first time round,

in a children's ward, we had art therapy.

They made us visualise our diseases and paint pictures of them.

And what did you paint?

Raymondo. They even suggested I write a letter to my cancer.

What happened?

Raymond wrote back. Wanted to be my friend.

You know this cancer is totally different.

The goitre on your thyroid isn't connected

in any way to the tumour you had on your lung.

Still Raymond, believe me.

Who is that?

That is Doctor Valentine.

-Yum.

-You like?

Sorry, I've been in and out of cancer wards since I was 16,

-I think I've developed a bit of a thing for doctors.

-Yes. So have I.

Not that one. Another one.

The one I married.

Doctors and nurses. Nurses and nurses. Doctors and doctors.

They're all at it, you know.

I bet you've seen some hot goings on in this place.

We need to run another test.

Oh, come on! Now, you're just changing the subject.

I'll see you later.

-Is there a Mrs Brodrick?

-Apart from my mother? No.

-On your own then?

-Blissful. Can do what I want, when I want.

Doesn't get lonely?

I live six doors from the Butcher's Arms.

I'm captain of the darts team,

co-compiler of the monthly pub quiz and treasurer of the Cwmbargoed Rugby Supporters Club.

How am I going to get lonely?

Imagine reaching that age and still living by yourself.

Does seem a bit sad.

-Oh, it's going to be such a laugh.

-What?

-Sharing. You and me.

-Yeah, Um Lleucu...

-Shared-house mates aren't friends.

-No?

-Not really.

You live together, but mostly you just try and not fall out.

Not like us?

No. We're friends who want to live together, because we're friends.

-Lleucu...

-You know, you look really tired.

What? No. Well, yes, knackered. But...

-Why don't you go get a coffee? I can look out up here.

-No. No, I...

Go on. Get some caffeine in you!

When she was conscious, did she give any indication of what she thought was wrong?

Just abdominal pains.

This looks like an old operation scar.

-She mention any gynaecological surgery?

-She didn't.

Did you ask?

All the information I have is in the envelope.

I have to say,

I've seen more comprehensive paperwork for a hiatus hernia.

I'm sorry.

I was being cheeky saying you're all at it at the whole time.

-Bit stir-crazy bored.

-Oh, it doesn't matter.

But I appreciate you taking the time to talk.

Lot of doctors just want to see my test results and pat me on the head.

So is there a Mr Annabelle?

Not any more. Raymond came between us.

Shame.

His loss.

Right, I'm going to have to see more test results.

And, I'll need to get some blood, right? So I'll get the nurse over.

-Can you do it?

-Yes. Of course I can.

I'd like that.

-You know what?

-What?

Let's go out tonight. Get a baby sitter. Catch a movie.

We could even do a proper adult sit-down,

face each other over a glass of wine, type dinner.

What, you mean in a proper restaurant?

-One that doesn't have high-chairs and colouring crayons?

-Yep.

Could you possibly sign my hand-over papers and I'll be out of your hair.

No, not until I'm satisfied you've provided

all the information I require. I will let you know when that is.

Some people get the wrong idea about repatriation doctors.

Assume we're all just about Air Miles and Happy Hours.

Really? I can't think why.

Your boss always so warm and engaging?

Well, she didn't get to become a fellow by being one of the lads.

How's the patient?

Temperature's still rising. Breathing's a bit bated.

Swelling around the abdomen. Anyway, the Snow Queen's booked her in for a scan.

-She say what she thinks it is?

-Possible tumour, is her guess.

Really? May I?

Knock yourself out.

Hang on a minute. You still haven't told her you're flying to Spain

the same weekend she expects you to be lumping boxes?

She's so excited about moving in. Making lists...

Come on, are you really thinking about cancelling the holiday?

No way! Can you imagine what it'd be like if they all went without me?

They all had all this much fun without me.

For weeks, for months, for ever, I'd be all like,

"Oh, what about when we went to Ibiza? Shaz did this,

"and Lexi did that, Lucy got trollied and snogged a lifeguard."

Oh, my God, Seriously, I'd rather die.

-OK. I get it. You don't want to miss out. So, tell Lleucu, then!

-Do you think?

She's a mate, right? She'll understand.

'Postpone?!'

Just for a week.

No! Why? Why pay rent for a week on a flat we're not living in?

-That's crazy.

-It's just, I can't do...

-Is this about money?

-No.

Is that why you've been doing double shifts?

No. Well, yes. It's the money. But not because...

Don't worry about the money.

I've already written a cheque for the advance-rent. Pay me later.

-No, I can't.

-End of story.

I have to say, I admire your tenacity,

working with a Valley Girl.

Welsh women, they can boss the spots off a leopard.

Let's see, what do you think?

Pulse is a little raised,

heart is fast, this mass in the pelvis, on the pubic bone.

Dense mass, difficult to categorise. Could certainly be a tumour, desmoid, maybe?

-They do so like to grow in old operation scars.

-Desmoid tumour?

-Come on!

-Do you not have patients of your own?

Last time I looked, our ward was full to capacity.

Does the fact that she's just travelled extensively through West Africa not figure in your diagnosis?

She was very well vaccinated. Her insurance documents clearly...

I've a good friend who works in the Infectious Diseases Department of Addenbrooke's.

-Let me call him and get his opinion, before you...

-I don't think that's necessary.

Temperature, raised Y-count and CRP, sweats, history of foreign travel,

if this was an exam question, the obvious answer would be malaria or another tropical disease.

And all those symptoms would go with a tumour too.

Particularly if it had an inflammatory component or had perforated.

Exam questions are simple logic. As you and I are aware, real life isn't.

-I've got to be somewhere.

-I'm taking her to theatre.

-What if that mass is caused by infection?

-Then we can drain it.

-Not if it's TB, it may not heal.

-Thank you, Michael.

So, that's Raymond?

That is your thyroid gland. And the shadowy mass is your tumour,

pushing against your trachea, which is what's making you breathless.

-So he's trying to strangle me.

-Oh, he is, indeed.

But what concerns me is exactly how far the tumour

-extends down behind the sternum into your chest.

-Mr Hanssen?

Which coincidentally is exactly where Ms Shah comes in.

We were just discussing the crossover between my area,

the tracheal obstruction, and yours, the heart.

I do trust that Ms Shah has been looking after you satisfactorily?

-Can I have a word?

-Yeah. She's cool. We like her.

I thought you might. Excuse us, please.

I've looked over her scans, it occurred to me that you could

go through the neck and do a standard low collar incision.

That's very interesting.

-But would the position of the mass not preclude that approach?

-No.

I know it compromises the trachea,

but I am completely confident that you could get access to it.

It's less invasive, there's no need to crack the chest

and put her on bypass, so a shorter post-op stay.

Very good. We'll do it together. That's why I asked you to assist.

No, you asked me to consult. I can't assist.

-Sorry, you can lead on the cardiac procedure, of course.

-My schedule today is jammed.

Well, then I suggest you unjam it.

-I've arranged something after work.

-And this is work.

If I asked you if you were in any pain, I bet you're the sort of bloke who would say...

Nothing I can't handle, thank you very much.

Which is why, I want you to take these. Take them!

You're really quite good at your job.

-I try...

-Chantelle.

Excuse me.

Put that in your pocket.

-What is it?

-£65.

-What?

For the van. We said we'd pay half up front. I know you don't have it.

No. I do.

You've got a really good mate there.

Not many friends in this world you can trust with money stuff.

Can I ask you something, hypothetical?

Like a "what if?"

Yeah, like what if a group of your mates, right,

were going to a rugby match, and you couldn't go?

What was I doing that I had to miss the match?

Um, housework?

Housework? Big match and I'm stopping home to hoover?

-Are you taking the...?

-No, honest. I want your advice.

-How?

-Lleucu thinks I'm moving into a flat with her in a couple of weeks.

I'm meant to be arranging a van.

But actually I'm going to Ibiza with some other mates, old mates,

-school mates.

-So?

I don't want her to get the hump.

But I'd be gutted not to go. I don't know,

-should I cancel, or...

-Are you soppy?

You could be hanging out in the Balearics or packing your sock drawer!

Talk about youth being wasted on the young! Carpe diem, duchess.

Seize the day.

-Hey, I'm not trying to prove a point here.

-Of course.

I talked through every detail of the journey with Dr Summerville.

On the flight, her vitals dropped very rapidly.

If this was a tumour the decline would have been far more gradual.

I've seen test results, CT scans, ultra sounds, bloods.

I have all the empirical evidence I need to make my decision about my patient.

I think you need to watch and wait.

I think we should relieve a girl of a tumour that left untreated

could affect her chances of ever becoming a mother.

A desmoid tumour? You don't you think that's a huge leap?

Patient's B/P is in her boots, 70 over 40. Temperature's raised,

she's tachycardic.

That's all the evidence I need. Now is the time to operate. Waiting is not an option.

If you're genuinely so concerned then

please feel free to scrub in and assist me.

I spend my life hustling to try and get interesting theatre time.

-I know.

-So, why would you voluntarily give up an amazing thyroidectomy?

I assisted lots when I joined Mr Hanssen at St Barts.

For a while, he specialised in thyroid.

It would be a great notch on your belt if he let you do the excision.

-Sure.

-And I really think you can do it.

Especially with Mr Hanssen leading the procedure.

It's the most secure safety net you could wish for.

The most scary safety net.

Challenging, yes, but fascinating theatre.

And, you'd be doing me a favour.

I have to be somewhere on time. And she likes you.

-Who?

-Annabelle Taylor, she thinks you're cute.

And that's a good reason to go digging around her thyroid?

Believe me, Ollie, if I wasn't sure you could do it,

I wouldn't ask. And Hanssen will be there.

I will start by excising the old scar.

CLASSICAL MUSIC PLAYS

OK, some blood here. Suction, please.

SUCTION MACHINE

Now, deepening the wound.

What's with the commentary?

Increasing the depth of incision.

You do this when you're cooking?

MACHINE ALARM BEEPS

Could do with an extra pair of hands here, Mr Spence.

All right. Pack it. I'm going to make the wound bigger.

Give me a little room.

I can't take it.

-I don't want it back. You need it.

-No.

Some months it might be me who's short, and you'd help me out.

That's how sharing works, right?

I've got plenty of money, Lleucu. I'm doing double shifts!

I lied.

About the money?

About Ibiza. When I said I'd cancel it.

I didn't.

Oh.

That's why I can't move in on the seventh. I'm flying.

You told me you'd cancelled it.

That's why I've been doing extra work, to pay for the trip.

I didn't know the dates would clash.

You lied to me.

I just wanted to go and have some fun with my mates.

I thought I was your mate?

-Lleucu...

-No.

There's an enterotomy in the bowel! Retractor. Clips.

The bowel's blown. It's just falling apart!

-B/P's crashing.

-I can't stop the bleed!

No way! It's a rectal sheath haematoma.

We were both wrong! All right, let's adjust those lights.

And kill the music.

I'm going to recommend morphine and for the pre-op hyoscine,

which will calm you before you go in.

All those chemicals.

Believe me, I would love to just give you a camomile infusion,

but I don't think you'll thank me when they start doing their stuff.

Miss Taylor, I am very glad that I asked Ms Shah

to have look at your case,

because she's come up with a ingenious alternative treatment.

I know you've been through a lot of surgery

and hospital time before with your lung operation...

So, this time, she's suggesting we make a tiny incision in your neck and excise the tumour.

You're going to pull Raymond out my neck? Sounds freaky!

That way, much less time in hospital after the op.

Don't want to sound ungrateful, but the sooner I'm out of here, the better.

I won't be in theatre but my colleague,

Dr Valentine, will be assisting.

Ooh, lovely.

I've already discussed in detail exactly how to take Raymond out without...

Ms Shah, I was under the impression that you would be with me in theatre.

Um, shall we?

Let's keep the suction. Clips and 2-0 Prolene.

-It's a write-off.

-No. I've seen worse.

We'll have to resect the entire bowel.

She's 19-years-old, she does not need to lose it. We can save this.

It's just disintegrating in my hands.

Somehow I think you've never been to Mecklenburg County,

West Virginia, in the fall.

I won't be there. I did tell you earlier.

Really?

Dr Valentine will be assisting.

I have a previous engagement. Something arranged some time ago.

You see, what I really don't understand is why you think

this kind of behaviour will in any way benefit your patient.

Your patient. You asked me for my opinion.

I already told you today was...

Are you confident Dr Valentine is up to the job of assisting?

Yes. I am. He's been fully prepped.

Very well.

Silk sutures, please.

Now, Mecklenburg County is the wild turkey hunting capital

of West Virginia.

And while you were studying for all your PhDs,

I was doing an internship at Mecklenburg County General.

As my tobacco-chewing Senior Consultant used to say to me,

"Mikey-Boy, you wanna learn

"how to fix gun-shot wounds,

"then you're going to need to learn how to crochet."

You work your way around here.

Look, and if you need to use an endoscope

to get the remaining part out, then you can.

Wouldn't it be much simpler just to zip open the chest?

Yeah, simpler for you. Not for her.

Thank you. What if I can't do it?

You can. And with Mr Hanssen's guidance, you'll be fine.

This is not my territory. You and Hanssen have a lot of previous.

I'd be happy to do it if you were there.

But if you were there, I wouldn't be doing it, would I?

Are you nervous, Dr Valentine?

Because my colleague seems to think I have every reason to trust you.

She's very kind.

Ms Shah and I together have performed many thyroidectomies.

Have you accomplished the procedure before?

On a living patient?

So shall we all just put our faith in Ms Shah's faith in you?

Just doing your obs.

I know that look.

What?

The face my mother had when she was about to explode to my dad.

We saw that look in our house, we'd run a mile.

Well, excuse me, if you'd made plans to move into a new flat

with a friend and you'd arranged everything - agents, landlords, keys

and all she had to do was book the van,

then - THEN says she wasn't going to do it, cos she was going on holiday with her stupid friends

with their stupid tangerine-tanned legs and their stupid smartphones,

you'd want to explode too.

Well, I guess your word is your bond, but...

Maybe she didn't want to say anything to you

because she was scared you might bite her head off.

Really?

I know that's why I never told my mum nothing.

REGULAR BEEPS

Swabs and suction, please.

Thank you.

So you've never removed a thyroid before, Dr Valentine?

Only from a cadaver.

Such a disappointing little gland, the thyroid, I always think.

Scissors. Thank you.

Lacking in any real power of its own.

Like a puppet to the pituitary gland.

You see, that's where the real power lies. Without the pituitary gland controlling its every move,

the thyroid doesn't know what to do.

The tumour wraps right around the back?

Reaching right down is the world of the cardiothoracic surgeon.

Your chance to slay the mighty Raymond.

Scissors, please. Thank you.

-Have you seen Rafi?

-Sorry, no.

I was wrong.

Yes, you were.

Bet you haven't said that a lot in your life.

Kind of stings, doesn't it?

Rectus sheath haematoma, and the small bowel must have stuck

to the scar tissue from the old operation.

Mm. Well, what are the odds, huh?

I could've lost her.

Yup. But, well, luckily Michael Spence was there.

Ah, hey, there's no way you could've known before you went in.

I could have waited.

Well, all right, if it helps, I was wrong too.

There's no sign of tropical infectious diseases

so it's no-one's fault.

I should've been more careful.

Hey, you are the most careful surgeon I have ever met.

Hey.

I enjoy a moment of victory as much as the next guy

and believe me I would like nothing more

-than to lord it over you right now but not if you're going to cry about it.

-I don't cry.

OK. Look, it was a ticking time bomb.

OK, if you hadn't gone in when you did,

it could've blown and she would have bled out.

So in that way, you were right. OK?

LOUDER, SLOWER BEEPING

BP's dropping, pulse is rising. It's safe to say we have a bleed.

-Dr Valentine...

-Swabs, please.

-..I think you've have sliced through a vessel in the tumour.

-Fluids, cross-match bloods.

Start her on adrenaline.

It's riddled with its own blood vessels like it's its own separate living thing.

The main supply for blood is direct to her aorta.

We'd all rather you didn't slice through that one.

-We may have to in order to get at the root of the tumour.

-You think so, do you?

I'm going to investigate further. Scalpel, please. Thank you.

That better, Owen?

Lovely, ta.

Real friends don't lie to each other, do they, Owen?

What? Er, no, no.

Come on, Lleucu, be reasonable.

Huh! I'm being unreasonable?

Yeah. And it's not just me who thinks so.

-Who else?

-Malick.

-Malick!

-And Owen.

Owen does not agree with you, he agrees with me. Don't you, Owen?

He doesn't, do you? "Seize the day," that's what you said, isn't that right?

Oh, really? What about, "Your word is your bond," huh, Owen?

-BEEPING CONTINUES

-Airway pressure going up, the SATS are down.

Peak airway pressure greater than 30...

60, and there's extensive pressure on the trachea. Bag her, please.

We're not getting enough oxygen in. I'm sorry, we'll need to crack the chest.

We need to get her onto bypass, now.

It would seems Raymond is getting the better of you.

-You may need the help of your esteemed colleagues.

-Page the on-call perfusionist.

And call Ms Shah.

What? No, she had to leave...early.

-Page Mr Hope or Ms Naylor.

-Call Ms Shah, please. Tell her it's an emergency.

Wow.

Well, you've got to make an effort, right?

Bit overdressed for the all-you-can-eat, but...

Kidding! I booked the Korean BBQ.

PAGER RINGS

-Don't do it.

-I have to.

What's happened?

When?

OK, I'm on my way.

-No!

-I've got to.

No, you don't. That's the whole point.

That's what this is all about. Why you said no to Hanssen.

If you give in now...

This is not about Hanssen.

It is, it always is.

This is about a 25-year-old woman, a girl, for God's sake.

Sahira, there will always be some woman, or girl, or boy,

or little old man.

You are not the only surgeon at Holby.

-It's not fair on Ollie.

-Ollie?!

Yeah, I put him up to this. It's not working. I'm sorry.

Wait for me.

Hey. All good? Can I go now?

My discharge papers, sign me out? I've got a rather nice suite at the Merchant

and a very long, very cool drink, requiring my full attention.

-Unfortunately I can't let you go until we find out what went wrong.

-Wrong? In surgery?

What happened?

Rectus sheath haematoma above the inferior epigastric artery.

Which means as soon as we opened her up...

-What caused it?

-I don't know. I was hoping you could tell me.

-You gave her pain relief on the plane?

-Morphine, 10 milligrams intra-muscular.

-It's in the notes.

-Where'd you give it to her?

-Lower abdomen.

Sitting or standing?

-Sitting.

-Was she reclining?

No, she was in a lot of pain, so doubled-up.

-Prefilled syringe?

-Yeah, I just popped it straight in.

Above the right iliac fossa?

You don't know that for certain.

Your needle nicked the artery, caused the RSH.

Could've killed her.

The tumour's too far in, we need to crack the chest.

-Let me have one go.

-Bypass is ready to go.

One more try. Two minutes. If I don't get it, we stop.

If the pressure doesn't come up, we use the rapid infuser.

-It's a big one.

-Come on, Raymond.

-All the way in, around and down.

Scissors.

In by my index finger, 20 degrees.

OK, cut.

-Hello, Raymond.

-And the beast is slain.

I want a jar for this one.

Well done, Ms Shah.

I know it hurts, but you're going to need another dressing change.

Can't keep wounds too clean. I'll send the nurses over.

No!

-It has to be done.

-Can't you do it?

-Yes, but they'll do a much better job...

-Please.

Is there a problem?

I...put my foot in it, a bit, as usual.

Women. They've always been a bit of a mystery, see.

I called my mum and she said she'll move my stuff in, help get the place straight.

-And Uncle Jerry's mate will still bring the van.

-So I've got to do all the moving-in with your mum?

-She's great at cleaning and arranging...

-But I won't be living with your mum, will I?

-I'm really sorry.

-It doesn't matter. Just...

Petty domestic squabbles have no place on this ward.

I expect total clinical professionalism at all times.

Is that understood? Now, you will both apologise to Mr Brodrick.

You WILL be courteous to each other,

and I don't want to hear another word of this.

Thank you, Dr Valentine. And excellent work, Ms Shah.

Just what I'm looking for, I think.

In a consultant.

You see, it's not just skills at the table.

You're developing leadership qualities. You know when to assert, step in.

Don't do the consultancy carrot thing. It's getting really old.

Have you seen my husband, Dr Raza?

No, sorry.

Abandoned in your hour of victory?

Don't pretend you can wave a magic wand and make me a consultant.

This is the NHS. Riddled with protocol and regulations.

And besides, there is no consultancy at Holby. All posts are filled.

Really? You keep a score, do you?

You do this every time you want to bring me back in line. Well, not this time!

The consultancy post is new, actually. It's a unique opportunity.

One appropriate for a surgeon with specialist Trauma Unit experience.

Cardiac Trauma Unit experience, really.

I don't really know many doctors with that experience. Do you?

How's she doing?

She's still hypotensive. Have we done post-op haemoglobin?

Yeah. What are you still doing here?

Thought you'd be off getting a drink and room service.

Everyone, everywhere, every hospital,

just assumes my job is a breeze.

Fly down to Rio, check out the carnival.

Bring home an errant diabetic.

I'm sure it is harder than it looks.

I took this job because I was sick of the system.

Heard that.

But I'm still a doctor. I still want to help my patients.

This could ruin me.

It was an accident.

But I caused it.

Personally, I don't see any reason to blame anyone.

It's just an accident.

You know...

I know that Hanssen has me labelled as the miscreant.

I get it.

But do you know what I really am?

A liability?

Fallible. I'm fallible. I messed up. But I got back up.

And I know that tumour diagnosis of yours was a complete fantasy,

but you didn't cause the rectal shear haematoma.

Dr Air Miles did.

Dr Summerville did?

Mm-hmm, so you can give yourself a break.

Dr Summerville caused it. How?

Accident. Pain relief injection.

Thought he was doing the right thing. Doesn't matter.

Important thing is how you do this job.

And...as much as it pains me to see you doing the job I should be doing,

I'd like to see it done properly. With some balls.

If he pierced the inferior epigastric artery then,

why did she collapse so fast?

She was weak. Her immune system was compromised.

That's kind of irrelevant now. What matters is that we move forward.

Hi Rafi, it's me. I've been looking for you. Where are you?

I'm in Darwin.

She practically never sees her boys.

What are you doing in my...?

She's in theatre till midnight on some days. Many days. With you.

I haven't been on a night out with her till midnight

since as long as I can remember.

Are you in the habit of barging into other people's offices?

You already see more of my wife than I do.

That may be so, but that...

But still, you want more.

If you'd like to discuss working hours,

I suggest you contact HR and make an appointment.

We will take it from there.

What goes on in your head, Henrik? Really?

I fail to see what you are referring to, I'm afraid.

Nottingham. I had a perfectly good job on offer in Nottingham...

Chief Anaesthetic Consultant. Lovely city. 120 miles of cycleways.

I love cycleways, you might not know that about me.

Well, I fail to see how this...

No. Suddenly, I have a better job offer from Holby.

From you.

Here. So why should we move away, when we can stay?

I think you should consider very carefully what it is

you are saying to me.

Doesn't it get boring? Controlling our lives?

Aren't you bored with it yet? Because I am.

What is it about her?

What is it about my wife that is so special to you?

That you couldn't bear to let her go?

As a matter of fact, I was entirely ready to let her go.

I was perfectly happy that she should throw away her career

and follow you to Nottingham.

There were others who...

Others?

One close colleague on Darwin who persuaded me that she

was an essential asset to the ward.

Which colleague?

Mr Douglas was particularly insistent, I remember.

I've signed your discharge form. You're free to go.

That's OK. I'll stay until Louisa's mother arrives.

I'd rather you left now.

We'll be filing an untoward incident report on you.

You're going to report him?

It's my job to report all findings in every repatriation case

-to avoid...

-Being sued. I know that. What about his job?

-He's obviously not very good at it.

-If you write that report, he will get fired.

That is an issue for his employers.

It was an accident.

-One in a thousand chance of nicking that artery.

-It was a clinical error.

-We all make them. Remember?

-I'd like the report on my desk in an hour, please.

-I'm not writing it.

-You conducted the surgery.

You have the most insight as to how it led to trauma.

I'm not hanging him out to dry for the sake of some insurance company.

-He does not deserve to be made a scapegoat.

-I'll write it.

It's my duty to the Trust and the insurers.

-To end his career?

-To be transparent.

-To be insipid.

What is it with that woman?

It's obvious.

What?

You know. When you two are going at it like that, hammer and tongs,

there's this...thing coming off you both.

This chemistry, this frisson.

I'm just putting it out there.

It was all her idea.

Oh, big deal. She's attracted to me.

Who said it was that way round?

I shouldn't have said anything to you.

Or asked you anything personal.

I'm sorry. I won't say another word.

No. No. That's not right. It was my fault. I'm sorry.

Nobody ever asks me anything about anything, see?

Not really.

I just wanted to say the right thing when you asked, that's all.

So I went along with you. Went along with both of you.

Seemed the right thing to do.

Have me crying in a minute.

Well, that you bloody can do elsewhere!

-I was thinking about what you said about me mates and the rugby match.

-That was just me being hypothetical.

I got a lot of pub mates, see...

but times like this, I wish I had real friendships.

Like you've got with the Valley vixen.

I don't think she thinks I'm much of a friend.

What you were saying earlier... here's another hypothetical.

If say, God forbid, one of my mates was into football...

and he was off to see a big match with all his football mates,

and he didn't ask me to bob along

cos he thought I wouldn't enjoy the footy, like.

Yeah, I would be right put out.

Even if I didn't like football, I'd still liked to be asked.

You mean...

Lleucu might like to be asked

if she wants to go to the...football.

MACHINE BEEPS

Louisa...Louisa!

LOUD BEEPING

What's going on here?

Between me and you. All the fighting,

the clashing swords, locking horns...

Locking horns? We're senior surgeons, not rutting bucks.

Is that what's going on here?

I'm sorry, you've lost me.

OK, I'm going to be honest with you right now.

There is something about you that I cannot reconcile.

There's something about the way you are - something about the way

that WE are. Maybe this isn't just professional tension.

Maybe it's physical? Biological?

I may be wildly off base here, and hope that I am,

but, is there something unresolved between us we need to resolve to move on and work together?

What are you talking about?

I don't know. It's just what the others are saying...

What others?

What the others see between you and me.

Is it real?

You and me?

Quick, Louisa's fitting!

What are you doing? What did you give her?

Naloxone. Soon as she was given pain relief, she crashed.

Opiate intolerance.

That's why she went down so quickly on the plane.

-Good work.

-Heart rate's improving.

I'd like to see you in my office, Mr Spence. Now, please.

"Maybe this is just physical, biological."

OK.

"Something unresolved that we need to resolve."

Look, I was just...

Firstly, I would like to point out that your suggestion

and your over-familiarity provide me

with perfectly legitimate grounds to pursue a case of sexual harassment.

No. Come on!

Secondly, I'd never in any way jeopardise my professional integrity

by having intimate relations with a colleague.

No. Of course. Accepted. That was way out of order.

If I were looking for a relationship,

you would possibly be the last man on the entire planet...

OK. Totally, I totally get it.

That was way out of line.

-But...

-And I apologise.

But?

But...

I would, however, accept an invitation for a drink.

A glass of wine, perhaps. Purely on a platonic understanding.

Right.

Great.

Fine.

Good.

So...what about Summerville?

That's not your call.

No. Of course.

You're in charge.

You made it.

Did you get him?

You're going to find it hard to talk for a few days.

Take it easy. Do you want to see him?

I don't know...do I?

Sometimes it helps. You know, face our demons.

It's like your art therapist. I thought seeing it,

him, would help you visualise.

Help you understand that now it's gone from being inside you,

it's over.

Thank you.

Pleasure.

But...how do I know that's Raymond, that's really him?

Who else could it be?

What if he's still hiding inside me, like the last time?

This is Raymond. He's gone.

Had us worried there for a bit.

Raymond was a tricky customer. Had me foxed.

You were very lucky that Ms Shah came back.

It was a team effort.

We're both very lucky Ms Shah decided to ditch her night out.

Hey. She's stable now,

so you're free to go drink your bodyweight in Margaritas.

No. I'm going to wait for her mother to arrive.

Her flight's been delayed again.

Where you off to next?

Madeira.

Elderly hiker overdid it on a mountain walk. Popped a valve.

Certainly beats working for a living, right?

If you're interested,

there's a bunch of repatriation agencies

I'm sure would snap up a frontline doctor like you.

Thank you, very flattering. But I think I'm happy where I am.

I just thought I'd let you know, I've decided against filing

an untoward incident report on what happened with Louisa Tindle.

Good to see you. Good to see you.

Hey. Where were you?

Went for a walk.

You just changed your mind about Dr Summerville?

On reflection, I may have been a little bit...hard.

So I was right again?

Goodnight, Michael.

You want to get that drink?

Maybe next time.

Night, boss.

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