Second Life Holby City

This is between me and Tara.

I apologise for what happened in theatre,

I promise that it will not happen again,

but I'd appreciate it if you stayed out of my personal life.

-If that's what you want.

-Thank you.

You worked hard, both of you. Very impressive.

But there has to be a winner.

-Marry me.

-Marry you?

The brain is swelling. Sort the blood pressure.

I need to remove more.

THEY CHEER

Pupils fixed and dilated.

She's gone.

Now, it gives me great pleasure to present

The Foundation Year One Prize to...

..Arthur Digby.

Well done, Digs.

Did anyone speak to Ollie?

No, he sat through the funeral like a stone.

I didn't see him at the wake.

Maybe we should call him? Check he's OK?

Thank you.

Well, I thought the service was rather moving...

Spare me the platitudes, Elliot. The eulogy was bad enough.

Dr Digby's written report is available on our web site.

For those of you who haven't yet read it yet,

I would advise you to do so.

Best F1 in Holby!

You smashed it, Digby Dog.

Great. Stick with The Malick.

In few years from now, you'll be running the ward.

Bearing in mind the events of this morning,

I felt the timing was appropriate to make another announcement.

Dr Lo's parents felt that some sort of legacy

would help keep her memory alive, here, at Holby.

Thanks to their generous donation,

I am pleased to confirm that Keller will now function

as a School of Surgery for Junior Doctors.

We envisage a young, vital ward, with an emphasis on training.

So let's endeavour to follow the example set by Dr Digby.

I suppose the important thing now

is that we all pull together, as a team.

What are we supposed to do with this?

It's called a guk yee. The tissue is to dry your tears...

..the money should be spent before you return home...

It's a bit late for that.

..and the sweet is to take away the bitterness of losing a loved one.

Urgh!

I'll ask Emily to prepare a press release,

now that the endowment is official news.

Why not let me do that? Bearing in mind our conversation this morning.

-Sharing the load?

-Very happy to.

That's if you meant what you said in the car?

I'll leave it in your capable hands.

All these bright young things. Makes one feel rather like a dinosaur.

Does it? I'm sure the feeling will pass.

I noticed you limping into the funeral.

I sprained my back playing squash with Mr Malick.

Oh, do people still play that?

We managed a couple of points.

Mr Spence has been holding the fort on Keller this morning.

Has he now?

He's tied up in theatre with a cholecystectomy.

Yes, which means we're short of cover on AAU.

I was going to ask Mr Malick to step up.

You didn't think of asking me?

I didn't think you'd be interested.

Surely, it's more of a young man's game.

I doubt that I'd be tested by AAU.

Right, well, that's settled then.

I'll tell them to expect you.

Oh, and...no rush -

we wouldn't want to put anything else out.

Please, can you try and keep still.

Still waiting on those tox results.

-Yeah, that would make two of us.

-Maybe you could chase them up?

Or I could always do it myself.

HE BURPS

Look, if you don't start behaving, I will break your other arm.

Wally Briscoe. Abdo pain.

I'll be dead before they find me a bed.

Wally, Hi, I'm Dr Wilde.

I'm Wally to those that know me. YOU can call me Mr Briscoe.

Oliver...you're supposed to be on compassionate leave.

I'd rather be working.

On the day of Tara's funeral?

You were missed at the wake

I think we should discharge our Pulmonary Sarcoidosis.

Tara's parents could have done with your support.

Mrs Tindall's due in theatre -

she's requesting another consultation.

I'm not sure this is such a good idea.

If I don't put in the hours, I'll have to retake my whole year.

So, Keller needed a younger guy?

AAU needs someone to steady the ship.

Well, my team are well-trained, if you need bringing up to speed.

-I spoke to Jas. She passed on the news.

-What news?

Annalese...getting married again.

To Brad the banker?

I assumed she'd told you.

Why would she? I'm only the father to her kids.

Well, I guess we won't be getting an invite.

Mr Spence? I'm Dr Digby...

You're the new star F1, huh? I was expecting someone taller.

Mr Griffin left me a list of specifics.

Three new admissions, two elective operations currently...

-Just start at the top of the pile.

-Ah, well, that's Daniel Butland.

-Severe epigastric pain and recurrent vom...

-OK, surprise me with a quick diagnosis.

-You're asking me to treat him?

-Yeah, I've got a lot of work to do.

Page me if you need me. Which you won't.

This is Karl Dawson, 16, ED referral.

I'm Dr Valentine, I'll be looking after you. This is Professor Hope.

Hello, Karl.

I'm just going to have a quick listen.

Skeletal leg cramps, respiratory distress.

You make it sound so serious.

It's just medical jargon, I'm afraid.

-I'm just a bit out of breath.

-His mum and dad are on their way.

So, when did this breathlessness start, Karl?

Few hours ago...

And the cramps in your legs?

They were there when I woke up this morning.

Any allergies? Asthma?

-No history of illness in the family?

-Not that I know of.

OK, we'll get you settled in and run some tests.

Try not to worry.

-BP's low.

-And there's definitely a murmur.

-I'll sort out an ECG.

Listen, Oliver, I still don't think you should be on the ward.

It's better than being stuck in an empty flat.

Fine. If that's what you really want.

OK, usual bloods, echo, chest X-ray, please.

Make sure you run everything by me.

GRUNTING

You seem to be in some pain.

Of course I'm in bloody pain. Why else would I be here?

May I?

Ooh.

A bit of common courtesy. Is that too much to ask?

I'll find out what's causing the hold-up.

I fought at the Imjin River, you know.

Trust me, Mrs Brindethorpe, no-one is going to steal your cardigan, OK?

Ah, a consultant! Things are looking up.

Perhaps you could tell me why an elderly patient

with abdominal pain and jaundice has been abandoned in the corridor?

I'm afraid we're completely backed up.

I'd like your opinion on Mrs Brindethorpe -

she's 67, nausea, vomiting, abdominal discomfort.

Keep her hydrated, full set of bloods.

-If the symptoms persist, send her for an X-ray.

-X-ray...

great, thank you.

We MUST be able to find him a bed?

He could always slip in with Mrs Brindethorpe.

Our drunk ABH has a fractured cheekbone.

Give him some pain relief and wait for him to sober up.

I'd like a list of current admissions, please, Nurse Carter.

We'll assess each case on its merits.

Look, we are on top of things.

Abdomen's distended...

..superficial oedema...

Bruising around the umbilicus.

A-star med student, I'm three years in.

Ah, Dr Digby's our best junior. He just won the F1 Prize.

-I'm glad he's treating me, then.

-You two should get on well!

Shortness of breath...

His sats are normal...

Full bloods, please, Nurse Lane.

LFTs. Let's request an abdo CT scan...

You don't think I should have an ultrasound?

Er, let's not get ahead of ourselves.

Sorry. Bit over-keen.

I can't wait to get out of the classroom.

Cut my teeth on some real patients.

It's really just a case of applying what's in here.

Neuroscience, that's my passion.

-Ah.

-It's a very interesting field of medicine.

Exploring the brain's potential.

I'm sure I could learn a lot from you.

Er, neuroscience isn't really my thing.

He really shouldn't be here.

Oh, I don't know. At least he's working through it.

He buried his wife this morning.

Which means we're already a doctor down.

If you take a peek out from under the funeral pall,

you'll notice that we still have a ward to run.

(Wow.)

You're all heart, you know that?

Just stating a fact.

And on the day Tara died, you were feeling so vulnerable.

I don't remember you kicking me out of bed.

We made a mistake. That won't happen again.

Well, I'm glad we've clarified things.

So...what are you missing - double maths?

I wish.

It's football today.

I use to play myself - just to stay in shape.

They rang me at the salon. I've been worried sick.

How are you feeling?

-Been better.

-You're going to be fine.

-Dr Valentine's been treating Karl.

-His breathing's still laboured.

He's been a bit anxious, haven't you? Exams and stuff.

And he's not complained of these leg cramps before?

We'd have brought him in.

OK, well...

as soon as we find out what's wrong with him,

you'll be the first to know.

From now on, Nurse Carter, I'd like you to clerk patients in my way.

-Your way?

-Preferably in handwriting that I can read.

Let's get this thing moved, it's an accident waiting to happen.

No room for sloppy nurses - not in the NHS.

I believe you've met Mr Briscoe.

You two should get on like a house on fire.

No respect for their elders.

You know, the best way to diagnose a patient is to talk to them.

I'm doing fine, thank you.

You're the doctor.

Daniel's latest obs. He's not getting any better.

Yes, Digby?

Erm...I was just wondering if you could, er...

take a look at these notes for me?

Ah...the notes for the patient you're supposed to be diagnosing?

Erm, it's a distended abdomen, rigors, headaches and fever...

Bacterial infection, Pyelonephritis...

-visceral intra-abdominal abscess.

-Yeah, they're all on my list...

Digs, I'm due in theatre for back-to-back surgeries.

If you need me to check him over...

No, no, no! No...I'm sure I can work it out for myself.

Good, spoken like a proper doctor.

How long are you keeping him in for?

We'll have to wait and see what the tests show up.

It's just that he's got a trial at the weekend. Inter-schools.

-Football.

-Did he mention it?

-Your son can barely walk.

Thing is, though, we've been waiting for this chance.

He'd be gutted if he missed it.

Maybe we should concentrate on getting him better?

We've got to tell them, Tony.

How's our patient?

Er, tachycardic.

I mean, LFTs are deranged, got facial flushing, pupils are dilated...

We don't have a diagnosis because...?

I just need a bit more time.

You're the guy who beat Gemma, huh?

Well, I've ruled out hepatitis, diverticulitis...

This patient needs an ultrasound.

First point of diagnosis.

Amylase, CRP bloods - you haven't done the right tests.

Certainly don't win any prizes for initiative.

-I'll get onto it.

-Yeah, do that.

We haven't been entirely straight with you.

Well...perhaps you'd like to enlighten us?

Becker muscular dystrophy. It runs in the family.

Sandra's side.

I'm a carrier.

And you didn't think that was worth mentioning?

We don't even know if Karl's inherited the gene.

-You've NEVER had him tested?!

-Well, at least now we're all up to speed.

We made a pact, when I got pregnant,

we'd only ever tell him if he got the symptoms.

50-50 chance. I mean, what was the point?

-This disease can be life threatening.

-We do know that.

My father had it. He was 49 when it killed him.

-We thought it was better to keep it a secret.

-Better(?)

-For who?

-We were looking out for Karl.

Well, maybe Karl deserves to know the truth.

He's 16. How can he be ready for something like this?

We can test for a defect in the dystrophic gene.

A conclusive result will take 48 hours.

Right.

Well, in the meantime, you don't say anything.

So...this passion for neuroscience, sounds intriguing?

I thought you said it wasn't your thing?

Er, no, no. I just don't think I know enough about it, really.

You should read my thesis on lucid dreaming.

The role of hypocretin in episodic memory.

Unlocking the unconscious mind?

Most people only use a tenth of their brain -

they're frightened of its true potential...

There's dilation of the pancreatic duct.

..but the clever people, beautiful minds,

we've tapped into that 90%.

Check out this app.

I never sleep without it.

You key in your dreamscape, it takes you to amazing places.

Ambience dial...

..ocean waves...gentle rain.

Delta, alpha, beta REMs.

Well, that's... It looks like hours of fun, doesn't it? Erm...

-..how long have you had the abdominal pain?

-Couple of weeks.

-And the rigors?

-They come and go.

I think it's pancreatitis.

-Blood test results.

-Thank you.

ALARM BEEPING

Daniel?

-He's fitting?

-It's OK. It's OK, we've got you.

He needs oxygen and diazepam.

OK, take a nice deep breath. Breathe in...

-This shouldn't be happening, I don't...

-OK?

OK.

The fitting, it's completely inconsistent with my diagnosis.

Maybe it's not pancreatitis?

Just monitor him for a sec.

-Dr Digby?

-I just need to do some research.

Better?

He'll get there in the end.

He just needs to think.

Try and get some rest.

I'm not afraid to open my mind...

..that's why I've got special powers.

I'm a bit concerned about Daniel.

Yeah, rapid heart, restlessness, agitation...

He thinks he's got special powers.

..borderline hypotension, but that still doesn't explain the fit!

Don't you find that a bit weird?

It's no more weird than the rest of his half-baked theories, really.

-Maybe we should call psych?

-He doesn't need a psych appraisal.

No-one expects you to know all the answers.

You CAN ask for help sometimes.

I'm supposed to be the best F1 in Holby

and I can't even manage a simple diagnosis.

Doctor?

Where are my mum and dad?

They were talking to Professor Hope.

They're avoiding me.

-It's serious, isn't it?

-We need to run some more tests.

They treat me like a child...

..always trying to smother me.

I just wish someone would tell me straight.

I'm 16, you know, I'm old enough to know the truth.

Maybe we should wait for your parents.

You're just like them.

I thought doctors were supposed to tell you straight.

There is a chance you could have a chronic illness.

What kind of illness?

The symptoms are consistent with a form of muscular dystrophy.

The weakness in your legs, the fatigue, the difficulty breathing.

Is there a cure?

There are ways we can manage your condition.

-I want my mum.

-Karl...

-it is important you don't get stressed...

-I want to see her now!

-All right, sweetheart, I'm here.

-I don't want to be ill!

-I don't want this thing!

-What have you done?!

Dr Wilde, ward rounds, please.

Ah, yes. I thought maybe we could split the load?

Make some inroads into this backlog.

Ward rounds are the cornerstone of hospital care.

Cutting corners is a false economy.

Mr Briscoe.

Oh, finally someone's got time for me.

Stomach pains, raised blood pressure and a temperature.

Could have told him that much meself.

Do you remember when these pains began?

1952...

..I fought in Korea.

So you keep telling us.

Second Lieutenant, Glorious Glosters.

I doubt very much whether an injury that old would cause this much pain.

I'm telling you, I'm not right.

High cholesterol.

It shouldn't be too concerning for a man of his age.

I'm still here, you know.

Let's send him down to radiology for an abdo ultrasound

and see what that tells us.

I thought we should order some auto-immune tests as well.

Let's just work our way through the checklist, stick to the system.

This is my area of expertise.

'No right to tell him!'

He's old enough to consent and I'm treating him.

Not any more, you're not.

You want to lie to Karl? That's your choice, but don't expect me to.

I'd like a word, please, Dr Valentine.

Keep away.

In my office, now.

ALARM BEEPING

HE GASPS

The pain's getting worse.

Just... I'll get some help.

Well, Annalese, the only reason I'm shouting is to make myself heard.

No, do not hang up on me. Listen...

'whatever you do with your life is your own business...'

You should have respected their wishes.

By compromising the patient?

What that family needs now is some considerate pastoral care.

-They've been lying to their son.

-They had their reasons.

And now you're making excuses for them.

I am trying to make the best of a difficult situation.

I can't do that if you're undermining me.

Your judgement isn't sound today, Oliver. For obvious reasons.

Just...

chase up the rest of Karl's test results,

while I try and sort out this mess of yours.

-What have we got?

-Extremities are cold.

OK, he's peripherally shut down. IV adrenaline.

In septic shock. Tachypneic.

Maintaining his airway.

OK, let's push IV fluids and pump some hi-flow oxygen.

Where's Digby?

Mr Briscoe's jaundice is getting worse.

Let's deal with the primary symptoms first.

I checked his bloods again.

Raised bilirubin -

Charcot's triad with fever and right upper quadrant pain.

-Could be cholangitis.

-No. At this stage, that's pure conjecture.

Mrs Brindethorpe's X-ray.

-Has anyone seen my glasses?

-No.

Looks like an incarcerated ventral hernia to me.

I'm amazed you can find anything in this chaos.

She's in a lot of pain, so...

I'll do a laparoscopic repair.

-Great.

-You're taking her into theatre?

-IF I can find my glasses.

-What about Mr Briscoe?

I'm afraid Mr Briscoe will have to wait.

In the meantime, why don't you chase radiology

for the results of his scan?

Dr Valentine wasn't appraised of all the details

when he gave you that diagnosis.

So why would he tell me that?

We're waiting for the results of a dystrophin test.

It's going to take a few days.

So, until we know, there's no point in worrying.

Karl's breathing difficulties are of immediate conc...

-Not now, Dr Valentine.

-You need to see this.

-Arthur?

-Erm, I was just getting some saline.

Daniel crashed!

-Then I'd better get back, hadn't I?

-He's stable now.

I saw you walk off the ward.

What?

It's terrifying leading a resus.

No-one wants a patient to die on them.

I don't know what you're talking about.

You were hiding in the store cupboard.

I wasn't hiding, I was getting some saline.

I'm afraid the echocardiogram has revealed a dilated cardiomyopathy.

-His heart's not working properly.

-His heart?

It's an enlargement of the muscle,

which has been brought on by his underlying condition.

No, no, no, he's a fit, healthy lad.

We'd like to start him on a course of ACE inhibitors.

-This isn't happening.

-The sooner, the better.

He was right as rain this morning

and now you're telling me his heart's packed in!

Cardiac symptoms are often late to present.

If you'd just had him tested then maybe it wouldn't have come to this.

That's enough, Dr Valentine!

He'll need a few things.

Tony...

I can't have you dealing with patients.

The man's in complete denial.

I should have trusted my instincts. Clearly, you're not coping.

-Someone needs to tell Karl about his card...

-I will deal with it!

I'm sure you have some theory to catch up on.

Preferably somewhere away from the patients.

I'm very sorry.

Dr Digby.

Thank you.

Put him in a side room. Give him on IV co-amoxiclav.

-Ah, Digby, there you are.

-How's he doing?

Luckily for you, he's stable.

-I was chasing up his ultrasound.

-So, do you have a diagnosis for me?

All points to an abscess.

There's the pancreatic tissue,

the contrast agent hasn't been taken up.

So, the necrosis has led to the sepsis.

There's a collection in the lesser sac

that's not going to be amenable to radiologic drainage.

All right, let's get a team together.

As soon as theatre is free, we'll book that slot.

Good work, Digby. You just earned yourself a place in theatre.

Oliver, I've got a consult in paediatrics.

I've spoken to Karl and his mother.

Don't stay too late.

Karl's in pieces.

Tony won't answer his phone.

I know you don't think much of me...

I should have stayed out of it, so...

16 years we've has this hanging over us.

There was no prenatal diagnosis, not back then.

I wanted a baby.

We took a chance.

Maybe I was selfish.

I've got to tell him, haven't I?

He's going to find out you're the carrier, sooner or later.

Nothing to do?

Just updating these files for Mr Griffin.

He's prepping a hernia.

Is he indeed?

-I'm just going to go put these on his desk.

-I can do that.

You take the weight off your feet.

Is there a reason you're heading into theatre?

-Laparoscopic hernia repair.

-A routine operation.

-Fortunately.

-Which you could easily kick up to Keller.

One moment, please.

I'm doing what I do best, which is surely the point in my being here.

Your surgical prowess is always reassuring.

However, it doesn't negate the fact that AAU is completely overrun.

Can't find your glasses.

You said you needed them to operate, so...

Take this patient up to Keller, please.

We are working through the backlog.

Then you mustn't let me keep you.

I'll pop back later to see how you're getting on.

Your granddad had it.

-I passed it on to you.

-This illness is hereditary.

I don't understand.

You inherited the gene from your mother.

You knew I might be born with this?

I knew there was a chance.

-I told you to leave us alone.

-He has to know, Tony.

All these years, you never told me.

We thought it was best.

You were too young to deal with it.

So you lied to me?

-We didn't even know if you were going to get ill.

-Well, you do now!

-ALARM BEEPING

-Maybe this wasn't such a good idea.

You should have thought about that before you told him.

I'm going to die, aren't I?

No, son, I won't let that happen.

We'll get you well again, back playing football...

Stop lying to me!

-I'm so sorry, Karl.

-I don't want to talk to you!

-ALARM BEEPING LOUDLY

-What's happening?

-Karl? Karl?

-He's in AF.

-Give me some room, please, guys.

-Sats are 90.

Let's give him some oxygen.

-BP's low...

-OK, we need to get him stabilised.

Let's take him to theatre.

Arthur...I just crosschecked Daniel's records.

The address he gave us is a hostel.

That might suggest he's vulnerable.

How are you feeling?

Lucid dreams can be hard to control. I usually wake up exhausted.

Well, when you've got some strength back,

I just need you to sign some consent forms.

I've been studying the science of sleep.

I've memorised the formulae.

That's pretty complex.

Dopamine is converted to epinephrine...

Oh, yeah, and epinephrine creates homocysteine?

You do know your stuff.

I like to read up on these things.

Really makes you think.

The people at the hostel must be worried about you.

Don't worry, I'll tell them you're safe.

I'll say we're looking after you.

You're the best F1 in Holby.

Erm...

..is everything OK, Daniel?

I could teach you how to access that 90%.

All it takes is practice. I could tell you all my secrets.

I'm...this close to flying.

Gosh...

Well, I'll ask Nurse Lane to get you prepped.

For what it's worth, you're doing the right thing.

Keep busy...stay focussed...

I don't want to talk about it.

Fine by me.

Remember, clamp both veins.

Yes, thank you, Dr Valentine, I have done this before.

I've requested a psych consult.

You called them?

I took your advice and I spoke to Daniel.

I knew you would.

It's the hostel warden. I think you're right to have concerns.

OK, yeah, thank you very much. Yeah, we'll keep you informed.

Risperidone -

Daniel's medication.

So the fit was an OGC!

Sorry, Arthur, you've lost me now.

Sorry. Oculogyric crisis...

so the fixed stare, the difficulty breathing,

the respiratory dyskinesia...

they're all common side-effects of long-term neuroleptic drug treatment.

-Risperidone's an antipsychotic?

-Yes. So it's two separate diagnoses!

We need to find him...quickly.

OK, let's watch the blood pressure.

Lesion's full thickness. There's the line of block.

Everything's looking good. Let's close him up.

There's a mural thrombus.

Let's just concentrate on the arrhythmia, shall we?

We need to remove it.

We'd lose too much of the atrial wall.

He could die of congested heart failure!

The thrombus can be treated with anticoagulants.

-We've got him here on the table.

-He's too weak for major surgery.

Would someone mind telling me what's going on?

According to the hostel, Daniel dropped out of uni.

The pressure got to him, his psychosis kicked in.

Without his meds, he'd find it difficult to differentiate

between fantasy and reality, so he must have stopped taking them.

Arthur, slow down.

He's delusional. Those special powers - he thinks he can fly.

-I'll get Mr Spence.

-No, you can't leave me here.

-Keep him talking.

-Chantelle...

I've tried my best to be understanding today.

He crashed. You were on Paeds.

You are in no fit state to assist in surgery!

-Oliver, I haven't finished talking to you.

-Problem?

Dr Valentine. Slight misunderstanding.

Yes, I heard he was back on the ward.

I did have misgivings.

It seems they were justified.

Which is why I confined him to desk duties.

Well, nobody bothered to keep me in the loop.

Despite my instructions, he went into theatre.

-Emergency mini-maze.

-How's the patient now?

Stable. Which is more than can be said for Valentine.

I really don't think he's dealing with this.

One can hardly blame him.

I'll talk with him again.

Perhaps it would be better

if you discussed the situation with me before I talk to him.

You're only bound by gravity if you believe in it.

I can already fly in my dreams.

They said I was confused...

those sad ten-percenters.

They've got no idea of the mind's true potential.

You need to come with me now.

I know how that feels...to have to live up to expectations.

They want to keep us in our place, but we know better.

Knowledge is power.

I'll prove them all wrong. I'll prove to you I can fly.

I totally believe you, Daniel. You don't have to show me.

-You're humouring me.

-No.

-You don't believe anything.

-No, you can trust me.

-You're scared. I can hear it in your voice.

-Just give me your hand.

-You're as bad as the rest of them!

Daniel, if you jump through that window, you will die.

-I need to concentrate.

-No, you need an operation.

A lightning storm of neurone activity.

That's all it's going to take.

That fall will kill you.

I'm not going to fall... I'm going to fly.

HE GASPS

Come on.

OK.

He's fitting again.

All right, we need to intubate. Nurse Lane, get a crash team. Now!

All right, let's get him in the recovery position.

Dr Digby! Come on!

A cup of sweet tea and two biscuits.

How can I eat with this stomach pain?

No chocolate fingers?

None left.

I'm sure you have very important work to do.

There really is no need to keep checking up on me.

Well, if you're sure you can speed through everything on your own,

I'll be in my office.

Mr Briscoe's ultrasound.

Tiny fragments in the biliary tract?

Inflammation of the gallbladder.

Mr Briscoe...

well, I'm pleased to see you looking a bit more comfortable.

I wouldn't go that far.

We've got your ultrasound scan back

and it seems that you have gallstones.

And they've been causing me all this pain?

Well, an infected gallstone can cause acute discomfort.

Do you think he'll need surgery?

Let's order an MR cholangiogram. It'll give us a clearer picture.

I'm afraid it's back down to radiology for you.

You had no idea this guy was delusional?

-Nurse Lane had some concerns...

-Which you dismissed?

-A psych was booked post-theatre.

-All right, 23 blade.

Well, at least he didn't get to jump, right? Suction.

All right, we're in.

Ah! Great.

All right, we've got to locate a bleed in here somewhere...

I need more pads, more suction, platelets and FFPs.

Come on, don't be shy.

All right, there's a very large pseudo cyst.

It must have eroded the splenic artery.

Anything else you might have missed?

So, how's our grumpy old man?

Mr Briscoe or Mr Griffin?

AAU can take some getting used to.

Mr Briscoe's ultrasound - hard copy.

They've taken him down for an MRI.

-I thought it was quiet in here.

-He fought in Korea, you know.

Hang on, take a look at this...

What would you say those were?

They look like gallstones...

And these? Same scan, original film.

Well, they look more like fragments of metal.

Shrapnel.

St George's Day.

-Yes. Yes, it is.

-PAGER BUZZING

I used to wear a rose, symbol of national pride.

That's all gone now.

An old man in his best suit, starch in his collar, buttonhole lapel...

today, he's a figure of ridicule.

It can be difficult sometimes, adjusting to circumstances.

I open my front door...

I don't even recognise the world outside.

Things move on so fast.

If you're having trouble coping, there are people who can help.

I'm fine as I am.

Thanks for the offer.

I've still got me pride. Still got me dignity.

-Mr Briscoe?

-I'll bring him in.

Watch me hips! I've got brittle bones, you know.

Wait!

Look!

Those gallstones are pieces of shrapnel.

See?

-A magnetic field...

-Could drag them towards a vital organ.

What's she banging on about?

The cyst didn't show up on the ultrasound.

Well, clearly, it was there. You just didn't see it.

Rollers, please.

Yeah, OK, the bleed is under control. Ties, please. More suction.

Come on, Digby, wake up.

Hey, hey, careful, careful.

Ah!

Well, it was a pseudo cyst. Now it's a pancreatic fistula.

-I'm sorry...

-Robinson drain. Just focus on the patient.

-I need to get some air.

-Digby? Digby, get back here.

HE PANTS

-Arthur?

-He was bleeding out.

I couldn't breathe.

You need to calm down.

I think I'm having a heart attack.

What are you doing?

Here you go, breathe into this. Nice deep breaths.

I'm dying.

No, you're not. You're not dying. It's a panic attack, that's all.

Just take nice deep breaths.

Better?

Grief needs to be tackled head on, Dr Valentine.

You lost a sister... now you've lost a wife.

Both under tragic circumstances.

Now, I'm prepared to allow you to continue working.

On condition that you attend counselling.

Counselling?

Well, Professor Hope is very concerned about you.

It's really none of his business.

We both have your interests at heart.

I don't need a shrink.

It's either that, or a period of leave.

I've made you an appointment for you, tomorrow morning, ten o'clock.

He's had these inside him for 60 years.

I should have made the connection.

You were busy. It was easily missed.

Well, maybe if I'd been able to see properly.

Good job I was here.

Mr Briscoe, the shrapnel had caused an infection of the biliary tree.

We're going to do what's called an ERCP.

Sounds intrusive.

It's a procedure which will clear out the infection.

No more pain?

That I can live with!

We'll book you in for tomorrow morning.

By the way, a few of us are going to Albie's later.

-Give Tara a proper send-off. You're welcome to join.

-Erm...

Oi, Irish!

I think that might be you he's after.

Mr Briscoe?

Glass for me teeth, darling. There's a good girl.

I WAS hiding in the storeroom.

I won't tell anyone.

I was on my own, the patient crashed.

It doesn't matter.

It does matter because I'm a fraud, Chantelle.

No, you're not.

I only won that prize because Gemma had a hangover and...

Tara was dying.

You mustn't put yourself down.

I can manage all the exams, the essays...

..but if I can't deal with patients. Real people...

..I don't know what kind of doctor that makes me.

Karl's in HDU and he's been asking for you.

Well, maybe he should be talking to his parents.

Actually, he's refusing to speak to anyone except Dr Valentine.

Still here, then?

I was just leaving.

Wish I could...

They'll keep you in for a few more days.

Might as well get used to the place then.

-You should talk to your mum and dad.

-I've got nothing to say to them.

They were scared...that's all.

I've had these cramps for weeks.

That trial was coming up.

-I didn't want to let my dad down.

-You didn't.

You didn't let anyone down.

What's going to happen?

Well...the steroid therapy will help with the muscle strength.

Worse-case scenario...please?

I want to know.

Your condition will get worse.

In a few years, you'll... probably need a wheelchair...

your heart may well give up.

There's a fair chance you won't live past middle age

but, Karl, listen...

..the important thing now...

..we keep you monitored...

..and you will need your mum and dad.

I'm stronger than they think.

Let me go and find them for you.

Karl's asking for you.

I don't know I can do this.

Just talk to him.

He's so angry.

He'll come round.

We'll manage.

-What are you doing with her things?

-Maintenance emptied Tara's locker.

I brought them in here for safe keeping.

Don't pretend like you've got my back.

You just dropped me in it with Hanssen.

Believe it or not, I am trying to protect you.

It was your protection that led to this.

And what's that supposed to mean?

If you'd told me the truth about Tara's illness...

I wasn't protecting you, that was Tara's decision.

It wasn't my place to...

If you'd told me the truth,

I could have persuaded her to have that surgery earlier.

Oliver, you can't seriously blame me for Tara's death.

Oh, yes, I can.

Digby...

..you should have come to me. The moment you had concerns.

We're a team, remember?

Now Daniel's going to get proper psychiatric support.

All the help he needs.

I suppose you're going to have to mention it to Mr Hanssen?

Well, you will have to fill out an incident report

and he will read that report.

Just like everyone else. All right?

Mr Spence...

..I'm sorry I panicked in theatre. It won't happen again.

OK.

You think too much.

-I think I've been told that before.

-That's your problem.

I, sort of, think I rationalise. That's sensible, isn't it?

People skills we can work on.

In the meantime, I have a solution.

Right, I was afraid you might.

You do the thinking, I'll do the talking.

And what if I panic?

(I'll carry a paper bag. It can be our secret.)

Wow. You'd do that for me? That's...

Are you still here?

I never finish a shift with paperwork outstanding.

We've been employing you on an agency basis for a good few years now.

Doesn't time fly when you're having fun?

It's hardly cost effective.

Well, that depends who you're talking to.

You wouldn't like a job on a permanent basis?

Are you saying there's a job on offer?

It's a permanent position or your P45.

Didn't expect to see you here today.

Well, life goes on.

I am so sorry...about Tara.

Where are you going, all dressed up like that?

Oh, nowhere special.

Just heading to Albie's for a bit of a late drink.

Yeah, you know, being a doctor is fun, but it's hard work.

My main thing's that I want to be a consultant. Excuse me.

Hey, thought I'd been stood up.

My mother's been taken ill.

I'm sorry. Is she OK?

TIA, they sent her home from St James's.

You should be there?

She's asleep. My sister's with her.

I need a drink. Same again?

Yeah.

Two beers, please.

I thought, maybe, we could go for a curry or something...? PHONE RINGING

Rhys!

Now?

Nothing special.

Yeah, yeah, that sounds lovely!

Excuse me a second.

Dominic...New F1.

I had my induction on Keller this morning.

Oh, hope your Health and Safety's up to speed(!)

First proper day tomorrow. I'm looking forward to getting started.

Especially working with you.

-Careful what you wish for.

-Can I get you another?

I'm OK, thanks.

Some other time maybe.

I might hold you to that.

Hey!

Glad to see everyone's having fun.

Listen, no disrespect, OK?

We're just trying to let off some steam.

Well, someone turn the music up.

He's picking me up in 20 minutes. Time for one more.

I think I'm going to head off, actually.

Oh...OK.

Yeah, it's been a bit full-on and I'm shattered, so, erm...

Yeah, I'll see you tomorrow.

See you tomorrow.

Team Keller!

Team Keller. Yeah.

Trying day?

Teething problems.

I know from experience, AAU can be something of a slog.

Especially for old-timers like...us.

Actually, I found the experience rather invigorating.

Well, you know what they say, "A change is as good as a rest,"

and, I can tell you now, there are going to be some big changes.

Meaning?

Mr Hanssen's decided to go back to the floor.

So, as of today, I'm effectively in charge.

CRUNCHING

Maybe I should walk him home?

You never miss a trick, do you?

You're funny.

You OK, Ollie?

Now, that's a question.

And that's not the answer.

-Look, don't you think you've had enough?

-I'm just getting started.

Why don't you leave me to it?

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