Unsafe Haven - Part 1 Holby City

Tara Lo, I'm a new F1.

I can see you two are going to get along famously.

I don't understand you.

Good.

# If you wanna be my lover

# You gotta get with my friends... #

Maybe next time.

# If you wanna be my lover... #

LAUGHTER

-It's rather reckless and unprofessional behaviour.

-He asked me for a drink, Luc!

That is what normal people do when they like each other!

LUC: 'I did a lot of travelling as a child.'

'Dragged from here to there, always on the move.'

'My mother was...

'My mother was complicated.'

'So, for a variety of reasons, I spent a lot of my time in and around hospitals.'

'They became so familiar - long corridors,

'the smell of antiseptic, soap.'

'And comfort.

'That's what I remember the most - a hospital was a place

'where people made things better.'

'A hospital was my safe place.'

HACKING COUGH

'My haven.'

CONTINUOUS COUGHING

Basic standards of respiratory hygiene suggest

source control measures to prevent patients with respiratory infections

from transmitting their infection to others.

Hello? If she won't cover her mouth with her hand,

perhaps you could persuade her to cover it with a mask.

Thank you.

-Where's Eddi when you need her, eh?

-I don't know. Not here.

It was a rhetorical question.

Well, it shouldn't be, she should be here and she's not.

-You could call her.

-Why would I do that?

-Well, if you're worried.

-I'm not, I'm annoyed.

-What, that she's not here?

-That she's late, yeah.

Do you want me to call her?

It's a bit early to panic, isn't it?

Probably.

Need some help here!

'Coffee.

'The aqua vitae of the junior doctor.

'Also plays a vital role in the mating ritual

'of this most fascinating of creatures.'

Witness the opening manoeuvres of the lesser-spotted CT1

as he makes his offering.

The female of the species takes the offering.

But the act of drinking doesn't necessarily imply

an acceptance of the mating ritual.

-WHISPERS:

-Valentine and T-Lo? I don't think so.

20 quid says he's passing the gravy.

Who says romance is dead?

-WHISPERS:

-OK, you're on.

They're sharing a muffin.

-It's worse than we thought.

-Doesn't mean anything.

-It means you owe me 20 quid.

-SHE STIFLES A LAUGH

What do you think that's all about then?

-What?

-Mo and Jonny - just good friends?

Of course - Ms Effanga, at least,

isn't silly enough to jeopardise her professionalism

-by carrying on a doomed workplace relationship.

-Yeah.

COUGHING

Pulse 105. 38.8, burning up.

Get off me.

That's a nasty cough you've got there, Mr...?

Can we get some oxygen please?

-Does he have a name?

-I dunno.

Any identification?

Did you even look?

What's the point? Look at him, he's a tramp.

Phone.

Well, how was I supposed to know? He smells like a brewery and hasn't seen a bath in weeks.

-Cash, cards...

-I think the battery's dead.

Here we go - Joe Harling.

Found him in the visitor's car park, I thought he was taking a kip,

I was going to sling him out until I saw the blood.

Blood?

Mr Harling? You have blood on your shirt.

RETCHING COUGH

Try and relax.

We've got you.

There's fluid on the lungs. Nurse? FBCs, U&E, LFT.

Try and get him a chest X-ray as soon as possible.

He's not well, is he?

Neither will you be if you keep re-infecting with that handkerchief.

-What have we got?

-This is Donna Shale.

She's 46, cardiac failure with assist device.

B/P 110 systolic, pulse 100.

Assist device? What for?

Dilated Cardiomyopathy. It was fitted just before Christmas last year.

Here?

St James's - she's on the transplant list.

-And you are?

-WOMAN: Marcus?

-ALARMS BEEP

-It's going to be OK, I'm right here.

OK, she's in VF, let's go.

Oxygen, please.

Ahem.

Joe Harling's personal medical records.

It's not good I'm afraid - first stage COPD.

-Emphysema?

-Diagnosed two years ago.

Oh, another stunning victory for personal responsibility.

-So is it time to panic?

-What?

Why don't you just call her?

Who?

There was a next of kin - Sandra, his wife.

-Anyway, I've left a message.

-Good.

So, I'll take him to X-ray, shall I?

Leave you to do whatever it is you're doing.

Or not doing.

You are the man with the camper van?

Keith, isn't it?

Shouldn't you be off... securing something?

Your van - it's causing an obstruction.

There's no permit, it's a fire hazard.

I have an understanding with...

Look, is this conversation going anywhere?

Look, I've been feeling rough for the last couple of days.

I was wondering if you could sort me out?

Rough, how?

Hot, bad cough, aches and pains, you know...

Yeah, I do know.

So, can you help me out then, Doc?

I can.

I can tell you you're either going to live or you're going to die.

But in the meantime, go and see your GP.

And get rid of that handkerchief!

Charging to 200.

Clear.

No sinus rhythm.

-Charge to 200 again.

-I gave her aspirin, called an ambulance...

This isn't meant to happen.

-Doctor Lo, can you take Marcus to the relatives' room?

-No!

In a minute.

Clear.

REGULAR BEEPING

-Sinus rhythm!

-She's back, but she's not stable.

We'll need an IV with 200 milligrams of dopamine in 50 of saline, and a 12 lead.

Dr Lo, a minute of your time.

-Ms Effanga, I...

-Sssst!

Phew...

Is it...the baby?

No, it's gas.

Course it's the baby, you pillock.

Tell me, Dr Lo, which part of your training taught you

to ignore a direct order from a Registrar?

-I'm really sorry, I... I wasn't thinking.

-No, you weren't.

It was a slip of the tongue.

I don't remember inviting you to this party.

I'll order FBCs, blood cultures, clotting and CT scan - she wasn't disobedient, only...

Eager.

-You make her sound like a puppy.

-Well...

I'm not a puppy, and if Dr Valentine is ordering tests

he might want to consider an echocardiogram.

Transthoracic or transoesophageal?

Transthoracic.

Transoesophageal.

One-nil to the puppy.

Right, run your tests, come back to me with your conclusions.

Jog on.

Five pints of lager, four vodka lime and soda,

or one very decent bottle of St Emillion.

What?

What I can buy with the 20 quid you owe me.

Nothing's been proved yet.

After that display of rampant flirtation?

What, arguing over types of echo tests is considered flirting, is it?

All the young kids doing it?

All the young cardiothoracic doctors.

One minute it's echo tests, the next, sweaty bodies

grinding to Barry White tunes up against the ECG machi...

La-la-la-la, not listening...

-DEEP VOICE:

-We got it together, didn't we?

Still not listening.

Morning.

Just.

Have I missed anything interesting?

One accidental stabbing, a couple of alcohol-related falls,

a 30-a-day man with emphysema, a couple of suspected flu cases,

oh, and a senior staff nurse not turning up for work -

that was exciting.

If you've got anything to say, Mr Hemingway, don't.

Not today, OK?

I'm Sandra Harling, I was told my husband was here.

Yeah, Mr Harling's been taken for a chest X-ray.

Shouldn't be too long, these are his things.

-But he's OK?

-Well, he's stable.

He suffered a collapse due to complications with his emphysema.

-Collapsed where?

-Hospital car park, as far as I know.

Nurse McKee can show you somewhere to wait.

-Was he drunk?

-Almost certainly, I'm afraid.

Is he a heavy drinker?

Used to be. Seven years sober.

-I'm sorry.

-I'm just glad he's been found.

-Found?

-He's been missing for a week.

I reported it to the police yesterday.

At least now I know what he's been doing all this time.

'Unfortunately,'

the tests have confirmed that it's the LVAD,

the device itself, which is infected.

It could be any infection you've been exposed to since it was implanted, we just don't know.

What we do know is that vegetation is clustering around the connectors to your heart.

The LVAD needs to be removed and replaced.

Another operation?

The infection almost certainly caused an electrolyte imbalance

leading to your cardiac failure this morning.

It's a ticking bomb.

Mrs Shale, it's a fairly quick and simple procedure.

You'll be back home with your son before you know it.

Marcus isn't my son.

I'm her boyfriend.

Oh...

How nice.

Well, the good news is

your emphysema doesn't seem to have got any worse.

The bad news is, you appear to have contracted pneumonia.

HE COUGHS Pneumonia? How?

Well, heavy smoking probably doesn't help.

I've tried cutting down. Didn't go quite as I'd hoped.

The six day alcohol binge did you no favours either.

-Don't judge me. You don't know me.

-You're right, I don't know you.

But I do know a dying man when I see one.

-Dying?

-Uh-huh.

What I think Mr Hemingway's trying to say is that...

What Mr Hemingway's trying to say is that

a couple more days without treatment and you'd almost certainly be dead.

So, for your own sake, lay off the booze, cut out the cigarettes.

Your wife's here. She's worried about you, Joe.

With good reason.

What happened?

You look terrible.

Just got a bit of a cough, that's all.

HACKING COUGH

Who is she?

What? Zoe? Who's Zoe?

Your phone, Joe, 30-odd missed calls - who is she?

No one.

Just leave.

Get her out of here, please!

OK, she can have you.

What's left of you.

LAUGHTER

No way! That's brilliant!

What's so funny?

The boys were telling just me about their night out.

Night out? Again?

Yeah, pure jokes - speed-dating night at the Fluffy Duck.

-And did you find true love?

-Um, no, not exactly.

They went round the whole room, only to find

they were best matched to each other - isn't that funny?

Hilarious. Someone paged me for a consult?

Yeah.

Adam Barry, ED referral, possible acute transient synovitis.

AKA irritable hip.

My dude's seriously uptight.

Right up your alley.

Been feeling pain on and off for the past few days now but...

HE COUGHS

..never anything bad enough that Ibuprofen couldn't fix.

-Until now.

-Until last night.

Could barely walk. Luckily Mum was happy

to help with the packing, otherwise I'd never be ready.

Careful with that.

I get this, like, ear infection sometimes.

Holiday?

Trip of a lifetime.

Flight leaves at midnight, I can't wait.

I'm just going to have a look at the old leg.

Ah!

-Haven't touched you yet.

-Anticipation.

38.9.

You're burning up.

Sometimes I get these hot flushes when I'm nervous.

-Dos that happen a lot?

-Beta blockers help.

Are you taking any other medication?

Malaria pills. And I came in recently for my travel jabs.

-Where are you going?

-Central and West Africa.

Volunteer aid worker.

-It's my gap year.

-Right.

Well, let's see what the X-ray shows up.

Try not to worry.

We'll see if we can get you on that flight.

West Africa?

He wouldn't survive West Hampstead.

Well, you never know, it might be the making of him.

'How nice?'

Oh, don't.

What was I supposed to say?

I guess "how nice" is better than "Yuck, creeparama."

Creeparama? I've never used that word in my life.

Think you might have just made it up.

Besides, it IS nice.

What's wrong with a May/October relationship?

Nothing, I guess, it's just not going to last forever, is it?

Well, nothing lasts forever. It just has to last long enough.

Donna and I have talked.

She's ready for the operation.

Great, I'll grab the consent forms.

Something wrong?

Put it this way - there's not a lot right.

Look, what happened with my wife...

None of my business. What is my business

is that your antibiotics don't seem to be making much headway.

So it's this stuff that's keeping me alive?

Well, it's meant to, uh...

It's meant make you feel a little better.

It's early days, of course, but... Nurse McKee?

Can we push more broad spectrum antibiotics for Mr Harling, please?

Two milligrams of co-amoxyclav.

Of course. Nurse? Can you assist Mr Hemingway please? Thank you.

-Have I done something to offend her?

-Is this a rhetorical question?

She's probably just busy.

If you hadn't noticed, we have been filling up.

-That's three ED referrals with flu symptoms in the last...

-It's not flu season.

Am I supposed to know what it is I've done to upset her?

She's probably just tired.

-You know, a bit wrung out from the trip back from Leeds.

-Leeds?

Liam's court appearance.

She didn't tell you?

I'm not afraid of the pain.

I'm not even afraid of dying.

I'm afraid of being a burden.

I'm sure Marcus doesn't see it like that.

No, he wouldn't.

How did you two meet?

His mother was my best friend.

I know how that sounds.

Then she died, two years ago - MS.

He nursed her through that, and I was there for her.

Then I was there for him.

Swelling in the soft tissue.

You're thinking septic arthritis?

-Yeah...

-But?

There's a whole range of other symptoms that

don't quite support the diagnostic picture.

Shortness of breath, fever, nasty rash developing on his neck...

Basically, he's a walking germ factory.

What are your thoughts?

Lyme disease. Osteoarthritis. Systemic lupus erythematosus.

Or it could be septic arthritis and a dose of the flu.

Either way, poor guy's not going on a gap year trip any time soon.

Maybe not such a bad thing. He's hardly Bear Grylls, is he?

-Adam Barry's test results.

-Cheers.

Hmm, elevated CRP, elevated ESR...

Supports the septic arthritis diagnosis.

Or any of the others.

Only one way to make sure.

You want to do what to my what?

An ultrasound guided needle aspiration.

It's a diagnostic test allowing us to take a small amount of fluid

from the joint and send it away for analysis.

-OK, But when you say "needles"...?

-Look, don't worry.

Dr Dan here has the safest hands in the business.

Trust me.

See? All it takes is a little encouragement.

And a little obfuscation.

You moved very quickly away from the subject of needles.

One step at a time, yeah?

Is that how you and Simon do things, one step at a time?

Woah!

Are you jealous?!

Don't be ridiculous, I'm nothing of the sort.

The green-eyed monster with Dr Dan, lovin' it, lovin' it, lovin' it.

Now you're just being childish.

All right, I'm sorry, I will stop being childish,

-if you stop being a coward.

-What?

If you like him, you like him - just ask him out.

He won't bite.

Unless you ask.

Whose are those?

-You see it, too.

-See what?

-The difference.

-Of course.

This heart is smaller, right?

Stronger.

And the ejection fraction on that one is better than that one.

Yes, of course.

What's all this about?

It's the same heart.

This is the echo of Donna Shale's heart this morning.

-This is from the three weeks after the LVAD was implanted.

-And?

There's a significant reduction in dilation.

-As you'd expect - the LVAD's doing its job.

-Maybe it's done its job.

Maybe her heart has recovered.

I'm listening.

There are documented cases of LVAD providing enough support

to the heart to let it rest and effectively recover.

Even if that's the case, what are you suggesting?

-The LVAD's infected, we have to remove it.

-Yes, but not replace it.

We need to give the heart the chance to function on its own.

Give her a whole new life. A normal life.

KNOCKING

Time to take your blood pressure.

-No, there's not enough evidence.

-Consider the ejection fraction -

it's significantly improved, not just in the post LVAD case,

but in the weeks prior to the device being fitted.

OK, I'll speak to Mr Hope.

Ejection fraction, huh?

That's a good catch.

Well done.

HE SIGHS

Why didn't you tell me about Liam's court appearance?

If you'd have kept in touch with him,

he'd have been able to tell you himself.

I HAVE kept in touch.

What is wrong with you?

I mean, sending the occasional link to O-Negative newsletter

does not constitute staying in touch.

You know what? I promised myself I wasn't going to do this.

So I won't.

Listen, you've got every right to be annoyed, OK?

This isn't about me. It's about Liam.

I know, I know. I was his nominated mentor,

and, um, I just thought they'd call if they needed me.

They didn't need you.

Liam needed you.

You're not supposed to be his friend.

And I'm not annoyed, Luc, I'm not. I'm...

I'm just tired.

Of you.

And of us, and of this... stupid thing.

If this is about when...

If this is about when we kissed, you have to understand...

I'm tired of trying to understand you, Luc.

Of wanting to understand you.

I don't want to do it anymore.

-Eddi, I didn't mean that I...

-Don't.

OK? Please, just don't.

KNOCKING

Not now!

-It's Joe Harling.

-What about him?

He's refusing treatment.

Mr Harling.

Something wrong?

Put it this way - there's not a lot right.

Well, there certainly won't be

unless we get that IV drip back in your arm.

Not gonna happen.

I'm not sure you understand the consequences of this action.

Oh, I think I do.

Without treatment the pneumonia will cause your lungs

to slowly fill with fluid.

This is not only exceedingly painful,

it's also almost invariably fatal.

That's the plan.

There's a chance - a slim chance -

that the LVAD has allowed your heart to recover

and it now has the strength to function on its own.

But her heart was damaged. It stopped this morning.

How can you now say it's recovered?

The cardiac failure was caused by an LVAD infection.

It's separate to the cardiomyopathy.

Dr Valentine chased up your echoes from St James's.

-They were enough to convince me that we should at least give this a shot.

-Him?

He's just a kid.

DONNA: Marcus, it's OK. This is a good thing.

It's reckless.

There are risks, as with any surgery.

But we won't leave there until we're sure

that the heart is functioning on its own.

And if there's any problems we'll pop you back on bypass

-and attach a new LVAD.

-What if something goes wrong?

Who'll picks up the pieces?

Him?

At least now we know where we stand. We can manage the risks.

Please, don't rush into this.

There's no rush. I've been dreaming about this for over a year.

Let's do it.

Good job, Valentine.

Mr Hope's looking forward to seeing you in theatre at 2:30.

-Really?!

-Your catch, your game. He was very impressed.

You?

I'm so jealous. Well done.

PHONE RINGS

Yeah, thanks.

You won.

He's not tuning her ECG machine.

-How do you know?

-The ejection fraction get? That was Tara's.

He had a chance to fess up, and he didn't.

I'm afraid that just ain't very Barry White.

Disappointing.

Yeah, it is.

-Aren't you going to do something?

-About what?

About him.

-Oh, I am.

-What?

-I'm waiting.

Until he dies?

I'm hoping he'll see sense a little before then.

-Look, you need to talk to him.

-I have.

Oh, well, if you've described his impending death to him

in great detail, then that's not talking.

You need to listen.

Where are you going?

-To find Sandra.

-His wife? Why?

What?!

What do you want?

To listen.

What good's that going to do?

I don't know.

I was told to do it by someone whose opinion I value.

Yeah, well, it's too late for that.

Mr Harling, I have no idea what's going on up here, or in here.

What I do know is that what you're doing -

committing suicide via hospital - is not very pleasant.

For me, for my staff or for my patients.

I know.

And I'm sorry.

But it's not about you.

You just have to take my word on that, it's just...

COUGHING

It's just how it has to be.

Why?

Please, we want to help. That's what we do.

No, not always.

You say you do, but you don't.

I'm sorry but rules are rules.

This is a designated fire exit route, you can't just sit here...

-Sandra?

-Do you know this lady?

-Yeah.

Well, will you tell her?

How is he?

SHE SIGHS

He needs you.

HE COUGHS VIOLENTLY

Are you all right?

Why don't you get yourself over to AAU and ask for Mr Levy?

Needle?

How we going?

-Great.

-Nervous again?

Yeah, just a bit.

Tell me...

..do you know much about Central Africa?

This and that.

I read Heart of Darkness, by Conrad.

Actually, I just watched the film Apocalypse Now.

It's based on Heart of Darkness.

Right.

You do understand that this trip is...

Oh!

Oh.

Let's face it makes our lives easier.

Like putty in your hands.

-How you settling in?

-Pretty good.

You and Malick seem to be getting on very well.

Yeah, he's great. He showing me a few places to hang out.

We haven't really had a chance to catch up, have we?

No, we haven't.

-Sorry about that.

-That's all right.

-You're busy.

-It's not that. I mean, I am busy, but...

Maybe we should get a beer.

Maybe we should. Any place in mind?

Not really.

Probably not the sort of places you and Malick have been going.

-Meaning what?

-You know.

Fluffy Duck. The mind boggles.

Hmm.

Well, it's just a bar, Dan, like any other.

Well, it's not really, though, is it?

Yes, it is, actually.

Look I've got stuff I should be doing so...

Mr Hanssen, please.

Yes, I'll hold.

Tell me what's going on?

I can't explain.

Please go, I don't want you seeing me like this.

Not until you start talking to me.

Hello.

Are you stalking me?

-I've been told to ask for Mr Levy, all right?

-Levy.

Well, he's not under the desk, ergo, he's not here.

You're still here.

Look, I feel like hell, aches, pains, headache...

OK, just take this.

It should make you feel a bit better.

Go home, get some rest.

Look, I can't just leave work.

Doctor's orders.

Go!

Come on, come on, come on... This is ridiculous.

Did she say anything to you about him coming here as an outpatient?

-No. Here?

-Well, not here-here, on Keller.

-He's on Hanssen's list.

-For what?

I don't know. I'm going to find out.

COUGHING WEAKLY

How exciting to be in theatre with Mr Hope.

-Not that exciting.

-The procedure is.

-Yeah, I suppose so.

-Now you're just rubbing it in.

Mr Hope, Ms Effanga.

Dr Valentine, I expect you're looking forward to seeing this through.

Very much so.

I was wondering if it would be possible for Dr Lo to scrub in.

Mmm, she's very junior, even for an F1.

-Did she put you up to this?

-No, not at all.

Truth is, she deserves to be included in this as much as me.

If not more so.

She spotted the connection to the Ejection Fraction.

I put it together, but...

Look, she deserves this.

She can have my place.

I don't see why we can't fit another one in.

As long as she's seen and not heard, understood?

Yes, of course.

-He fessed up?

-Yep.

-Faith restored.

-Yep.

Where's the rest?

No, the bet's still on.

Just cos he's honest doesn't mean he's hot to trot.

Yes, here it is. Joe Harling. Outpatient. Mr Henrik Hanssen.

Yeah, I've got that bit. Could you tell me what was here for?

OK. Tests.

OK, lung function test.

ABO blood group compatibility.

-HLA blood grouping compatibility.

-Hang on...

He was in for transplant compatibility testing?

That's right. For possible kidney donation.

There's nothing wrong with his kidneys.

No. He was testing to be a donor.

Can I help you?

-I'm looking for Joe Harling.

-He's in that bed there.

You must be Zoe.

WHEEZING Zoe, what are you doing here?

I called her.

I can't believe this is your girlfriend.

She's not his girlfriend. Is she?

She's my daughter!

You know, I never had a gap year. Wasn't really done when I was at Uni.

What made you choose West Africa?

I met this girl.

She's already out there. We got chatting. I got carried away.

-Before I knew it...

-You'd donated a year to charity.

-Yeah.

I just hope it's worth it.

Sorry about earlier.

-Needles, yeah.

-It's all right.

-We got what we needed.

-It's bad, isn't it?

I wouldn't say it's bad. But it is urgent.

-You have septic arthritis.

-Arthritis? I'm only 20!

Septic arthritis is caused by bacteria,

-it's not quite what you're thinking.

-What kind of bacteria?

We won't know until we get the results. We took a sample of the pus

during the aspiration.

Well, the details aren't important right now.

What is important is that we get you into theatre ASAP.

I'm not going to make my flight, am I?

No, Adam, you're not going to make your flight to deepest darkest Africa.

Tell you what, mate, give me your tickets and info

and I'll see if they'll change your dates.

-Really? That's...

-Oh, come on.

Can we just drop the whole Africa thing? Let's be real here.

You're not going to Africa. Not now. Not ever.

You can't stand pain, needles or minor skin irritations.

There couldn't possibly be a less suitable place on this earth for you to go.

-You're not an intrepid explorer. You're a geek.

-Mr Hamilton!

-You're donating a kidney to your daughter?

-Correction.

WAS donating a kidney.

-Seems to have gone off the radar.

-Let's just slow down.

Do you want a potted family history?

Dad gets mum pregnant.

Zoe gets born. Zoe gets sick.

Dad leaves Mum.

Mum dies.

Zoe gets sick again.

Zoe finds Dad.

Dad promises to help.

Dad doesn't.

-What happened?

-I don't know.

Mr Hanssen, my consultant,

just said that Dad had "proved an unreliable and unsafe candidate".

Unreliable and unsafe.

-Perfect.

-Joe!

It was the fags!

Hanssen said I had to quit.

Cos of the emphysema.

I tried!

HE SOBS

I didn't know what to do, so I...

You had a drink.

Well, hate to break the reunion up, but I've got to go.

He's all yours. Have a nice life.

Wait! You can't just walk away.

I can and I will.

If he wants to kill himself, fine.

None of this, whatever's going on here, has anything to do with me.

That isn't true, I'm afraid. This has everything to do with you.

-Doesn't it?

-What are you talking about?

Your father was refused donor status

because of the risk to his own health in the event of a transplant.

That obstacle is overcome if he's dead.

It's the only way.

No...

No.

This time, I'm going to talk. You're going to listen.

Boy, that was some speech you made back there.

Attempting to remove all the infected material.

-Yeah, you really showed him.

-All right, you've made your point.

Not as forcefully as you just made yours.

MONITOR ALARM BEEPS Sats are dropping.

Push fluids.

BEEPING CONTINUES

I just wanted him to see reason, face facts.

Yeah, right.

-He's congested.

-What do you mean?

His lungs are filling up with fluid.

Something is going on here! SECOND ALARM BEEPS

I don't know what you've done.

What pain you caused your daughter,

what guilt you feel. What I do know is this finishes now.

It's not going to work.

Even if you died today, there is no way Zoe would accept this...gift.

It's a poisoned chalice. Surely you have to see that?

Joe?

All right, I'm going to restart your treatment.

Hopefully that will save your life.

And if your family come back,

I suggest you do whatever it takes to earn their forgiveness.

That's entirely up to you, of course.

Nurse McKee, I need an IV push of Amoxicillin.

Let's get him on some steroids.

HE WHEEZES AND COUGHS

I know there's always a risk of bacterial infection

with devices like these,

but...I've never seen it quite this bad before.

-Was it a problem with the device itself, do you think?

-Hmmm.

Not likely. It's possible Ms Shale has been

taking incorrect doses of her antibiotics and furosemide.

Check with her GP, will you? This really shouldn't happen.

OK, it's clear.

4.O Prolene. Thank you.

Replacement device standing by.

Dr Valentine, what do you think?

Should we give this heart a second chance?

BP's dropping steadily.

Why isn't he responding?

Excuse me.

Um...you're right not to try and understand me.

I know I kissed you, but I have no idea why.

So you're right to keep things distant...professional.

It's better for both of us.

OK.

-COUGHING AND WHEEZING

-Dad?!

-Shouldn't he be getting better by now?!

-Yes, he should.

-Then why isn't he?

-I have no idea.

So...you did it.

You healed her.

She healed herself. I just helped spot it.

Mr Hope was concerned about bacterial level on the LVAD.

He wanted me to follow up on medication through Donna's GP.

Have you got a contact number I could have?

Of course. I'll just get it for you.

Thank you.

It's turned into some sort of day.

What's that?

Joe Harling's liver function test results.

That's unusual.

-I've never seen results like that for pneumonia.

-Neither have I.

-TB?

-No, I don't think so.

Tell me, you've been handing out flu treatment all day, haven't you?

-Yeah.

-Any effect?

Some.

Actually, very little.

Apart from pain relief.

COUGHING IN THE BACKGROUND

SHE COUGHS

-What's wrong?

-Liver's enlarged.

I want sputum tests for all patients exhibiting flu-like symptoms.

-The lab has to drop everything else.

-Where are you going?!

Theatre was amazing, I'm so glad I was there.

-Here you go. Name's Dr Raja. It's all on there.

-Thank you.

-What's next?

-For me, a phone call to a GP.

For you, post-op meds. Cardiac output needs to be monitored.

-We need to push prophylactics. But be careful with the penicillin.

-PAGER BEEPS

Just wait for me. Check her vital signs, OK?

She'll come round soon.

Shouldn't you be getting on with the post-op meds?

-Chance of infection.

-Yes. We're going to mitigate

any post-op infection with a course of antibiotics.

Sometime this week?

One moment, please, Mr Hemingway.

Thank you.

SHE GROANS WEAKLY

SHE GASPS

Yes, I'm holding for Dr Raja.

About Donna Shale. Thank you.

Anything I can help you with?

GASPING

ALARM BEEPS

-Excuse me.

-She's tachycardic.

She just woke up choking!

Larynx is constricted. Oxygen, please.

-What did you do?

-What you told me.

-I told you to wait.

SHE GASPS AND GROANS

-Prophylactic antibiotics.

-Benzylpenicillin?

-She's hypotensive.

-She's allergic.

-SHE GASPS

-Do something!

What the hell is going on?!

Mr Harling presented with pneumonia,

complicated by his existing conditions.

Broad spectrum antibiotics had no effect whatsoever.

Come to the point, please, Mr Hemingway.

I ordered a liver function test. The result was deranged.

-I palpated his abdomen.

-Enlarged?

We have a ward full of patients presenting with flu-like symptoms.

I've ordered sputum tests.

-You suspect Legionnaire's Disease?

-Yes, sir.

An outbreak.

ALARM BEEPS IV adrenaline.

-I'm sorry.

-Not now.

-It was my fault.

-I said be quiet.

Hydrocortisone?

Well, if her heart can cope with this little incursion...

ALARMS STOP

OK, the shots are doing the job.

Keep her on oxygen. Ten minute obs.

-Half hourly gases.

-That's it? She's going to be OK?

-She'll be fine.

-How do you expect me to trust you after that?

There WILL be an investigation.

These two don't come anywhere near her again. Understand?

Mr Hope's office, end of the day.

We will remain calm at all times.

An outbreak is not official until two or more notifications are linked

in place and time, and the history is consistent with Legionnella.

I can cross check FBCs.

I'll call a major incident. Inform the other wards, please.

Let's test everyone with pulmonary symptoms.

Sputum tests are on their way to the lab.

Good.

It's imperative that we locate the source of the infection.

Clearly it's linked to the Borough.

We'll need continuity of movement for all confirmed cases.

Excuse me, there's something really wrong.

HE GASPS AND WHEEZES

-Sats are dropping.

-Dad! Come on, Dad!

-ALARM BEEPS

-He's tachycardic.

Nurse McKee, will you take the family members to the waiting area, please?

The first rule - always check the notes. What have I done?

-Made a mistake, that's all.

-I could have killed her.

-What am I going to do?

-Nothing. Let me do the talking.

-You can't keep protecting me.

-I'm not protecting you, I'm protecting both of us.

What is it?

These prescriptions haven't been collected.

-Donna Shale's LVAD medication, hasn't been taken in weeks.

-Why?

That doesn't make any sense. That would just make her ill.

-Adrenaline given.

-BP 50 systolic. Sats 78%.

Defib. Charge 200.

OK.

Charged. Stand clear.

-Charge to 360.

-Charging again. Stand clear.

Come on, come on!

Donna Shale hasn't been taking her medication. Marcus is her carer.

You need to be very careful what accusations you're making.

-You think he's hurting her? Why?

-I think he loves her.

Can't bear the thought of losing her. How better to control someone than to have them utterly dependent on you?

-Valentine...

-Just think about it.

Think about his reaction to her being free of the LVAD.

Compare that with how perfectly happy he was

-when we were simply replacing it.

-It makes him a bit needy.

-Maybe a bit weird. But not dangerous.

-OK.

When you gave Donna her post-op meds, Marcus was there, right?

-Yeah. What...?

-Did he say anything to you? Speak at all.

-No.

-Actually, he kind of...hurried me up.

-And he saw you. He saw the meds.

-He saw the penicillin.

-Yeah.

So a carer who controls her medication...

With an encyclopaedic knowledge of his girlfriend's condition.

Would know she was allergic to penicillin.

Call security.

-MONITORS BEEP

-Charge 360.

-Clear.

Come on! Come on! Come on!

-Come on!

-Luke...

-Luke.

-Come on.

-Luke.

-HEART MONITOR FLATLINES

You've spoken to Dr Raja.

Donna and I made the decision together.

To come off the meds.

-It was what she wanted.

-It's what you told her she wanted.

The beta blockers made her dizzy.

They were keeping her alive, protecting her.

Why?

Her hands were always cold. She couldn't taste her food.

We reduced the doses gradually.

Furosemide 40mg, two times daily after breakfast and after lunch.

Amiodarone 200mg, one times daily.

Bisoprolol 2.5mg.

She hated the taste of that one.

We kept her on the Warfarin.

The diuretics.

Kept her monitored. The nausea stopped.

-The nightmares.

-Well, one nightmare's going to stop.

You won't keep us apart.

She needs me.

You might not understand that, but she does.

Yuck! Creeparama.

Couldn't have said it better myself.

I'll give you some space.

The sputum test results are starting to come back.

Joe Harling and another patient have been confirmed.

It's definitely Legionnaire's.

-So he's OK?

-Well, the septic arthritis is fine.

-But...?

-We don't know. His lungs are full of fluid.

-He's stable...

-for now.

-Maybe it's this mystery disease.

There's all sorts of rumours about some disease sweeping through AAU.

This is not West Africa!

What's that supposed to mean?

Ladies and gentleman, a word, please.

I'm afraid to report there's been an outbreak of Legionnaire's disease,

many of the victims of which are turning up here at Holby.

Told you it was that mystery disease!

There's nothing mysterious about it, Nurse Lane.

The general public has an understandable, if often erroneous,

negative view of the legionella bacillus. But let's not create a major panic.

I would however advise you, Mr Hamilton, to check all your patients.

-Just as a precautionary measure.

-Adam.

-Chills...cough...fever.

Poor guy. Only been in hospital twice.

First time for holiday jabs. The second to be told

-he's got Legionnaire's.

-When was he here for the first time?

-About six days ago.

-That's three people.

-Possibly four.

Er, the security guard, Keith, I sent him home.

That's four cases - two confirmed.

They all have at least one location in common

-during the incubation period.

-Which is?

-Here.

Holby could be the source.

So...the small matter of Donna Shale going into anaphylactic shock.

-If anyone's to blame, it's me.

-I didn't really listen...

I suggest you get your stories straight.

I didn't read the notes. I wasn't paying attention.

Distracted by your heroics in theatre.

What if the patient wants to make a complaint?

Anything to add, Dr Lo?

Go on, get out.

Not so fast, blue eyes. We're not finished.

I'll need you to fill in an incident form.

-This is going on record?

-I can't pretend it didn't happen.

You know, an F1 makes mistakes. The rest of us can't afford to.

Keep personal feelings off the ward. They compromise professionalism.

Legionnaire's disease?

I know it must come as a shock

but you should know that it's treatable.

Legionnaire's disease?

I did try to sort out your ticket, but it just wasn't possible.

Legionnaire's disease.

Sorry.

It's OK. You were right.

Been dreading it, if I'm honest.

The food. The flies.

The heat.

I wouldn't last five minutes.

-I don't know about you, but I could use a drink.

-Or ten.

-It's a date.

A date?!

OK.

Just give me five minutes.

-So...what did she say?

-Oh, you know, nothing.

Donna Shale's obs.

Should have been done five minutes ago.

Did you see something I didn't?

I just saw a guy hurt someone he wants to protect.

He might not know it yet,

but if that isn't love, I don't know what is.

There have been three more confirmed cases in the last hour.

The hospital is the suspected source of the outbreak,

so all precautions for staff and patients need to be taken, please.

We're prescribing macrolide and fluoroquinolone

and following Mr Hanssen's major incident protocols.

Anyone with flu-like symptoms

is to be given a sputum test immediately and given lab priority.

He's taking it very badly.

-I know.

-And he won't want to talk about it.

No.

I don't want to talk about it.

I know.

-That's not why I'm here, Luc.

-Then why are you here?

Hm?

-HE SIGHS

-I'm sorry.

I did a lot of travelling as a child. Dragged from here to there.

Always on the move. My mother was...

HE SIGHS

My mother was...complicated. So, for a variety of reasons,

we spent a lot of my time in and around hospitals.

They became so familiar to me. The long corridors.

The smell of disinfectant, soap.

And comfort.

That's what I really remember.

A hospital was a place where people made things better.

Where strangers helped you.

A Hospital was my safe place.

A haven.

And now?

It's not a safe place for these people, is it?

I didn't help them.

Luc, this isn't your fault. It's no-one's fault.

They haven't found him, you know, Keith. The security guard.

They've tried his home. Everything.

Luc... One man's dead. A father, a husband.

All because I didn't see it, I wasn't good enough.

-It's not your fault.

-I need to fix it.

-OK.

-I need to fix it.

-Tomorrow. Huh?

-I need to...

-Tomorrow.

-I need...

-So do I.

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