Hail Caesar Holby City

Certain senior consultants have been invited to

interview for the post of Acting CEO.

I need to keep my personal life separate form work.

You're dumping me?

-Stay.

-No, I will hurt you.

Er, who are you?

Lilah Birdwood, your new CT1. Nurse, could you get me scrubs?

Lilah, how does Monday sound to you?

-Monday?

-To start working with me on Keller?

External Acting CEO, I mean really?

Letting us make fools of ourselves like that, I'm spiting feathers.

Have you got any idea who they appointed?

A real dragon, stickler for the rules, loves power,

lacks insights.

-What else you heard?

-Take a guess.

-Used to be a nurse.

-Bingo.

Well, look at it this way -

we loose a brilliant clinician and surgeon and gain a nurse manager.

-Just what we need.

-Abso-freaking-lutely.

So when's the grand unveiling?

Oh, I imagine I'll get an e-mail any second now.

Whoever it is better not try to tell me how to run my ward.

Hail Caesar.

I'm not having some jumped up nurse manager trying to

stick their nose into...

Look at this backlog.

Ahh. I take it we've got Dr Birdwood.

Ah, yes, she's joining us. I should have mentioned it earlier.

-Morning.

-But anyway we need all the help we can get.

Two emergency laparotomies. Going to have to cancel half the rota.

GI bleed from an endoscopy to theatre, two enhanced HDU patients.

I'm dealing with the bleed and HDU patients.

He's being transferred and the coagulation is under control.

So you can crack on in theatre.

Sorry, we're chocka. Can't fit anyone in, OK?

-Sorry.

-No rush.

Sent your lecture to the medical students,

contacted Plastics for tissue viability for Mrs Gregg

and submitted your list for tomorrow.

So what time did you get in this morning?

So, the rounds. Small cases first and major second?

Finally. Madhouse. How can I help?

Actually, I'm just waiting to talk to Mr Griffin.

I just didn't want to disturb.

It so great to finally meet you.

Imelda Cousins. Acting CEO.

I was just thinking I might tag along for the rounds.

You don't mind, do you?

Oh, this is too good. OK.

Head Of Nursing at Royal Chiswick,

Consultant Nurse For Special Projects at Nottingham City Council.

I've certainly never come across her.

What hole did they drag her out of?

Oh, I know, a nurse. The lowest form of human existence.

Joking. I know you love us really.

Anyways, whilst I've got you both together we have an urgent referral.

Billy Lovell, 16, congenital transposition of the great arteries.

Had a Baffle Procedure at two months and has been in and out of Paeds ever since

but now that he's come of age we've inherited him.

Count me out. I'm in theatre all day.

All yours.

Professor Hope, Mrs Gemmel's been prepped.

-Ah, thank you.

-Is tonight's still on?

Oh, yeah, baby.

-You do know half the hospital's coming, right?

-Don't look at me.

I mentioned it to, like, three people and the whole thing just suddenly got out of hand.

What's that? The Annual Freemason Society Assembly?

No. My birthday.

-It's just drinks. You're welcome to join us.

-I can't. I've got plans.

-So has our great leader made an appearance yet?

-Nope.

Been a while since I've been told what to do

by some anal control freak who knows nothing about my job.

Really? I'm quite used to it.

Whoa, what's the matter with you today?

You lost your sense of humour?

Oh, yeah...the kid.

He has Asperger's. Quite high up on the scale. Thought you'd want to know.

Cheer up, mate.

Knock-knock.

Day 201 of my captivity. Daylight is but a long forgotten dream.

Food is scarce so I eat my shoes.

So, breaking news.

There's a new girl in town. I've heard.

So you planning on emerging at some point?

What?

No, I've got too much to do.

A conference call from Brussels coming in about the funding application.

Look, she's sending me e-mails already.

Maybe it's time for a break, you know, I mean,

-you've been cooped up in here ever since Eddi...

-Is this some kind of joke?

"As fascinating as the research deems itself to be,

"extensive efforts have yet to yield any results.

"I'm sure you'll appreciate in the current economic climate

"we have to tighten budgets... blah-blah-blah-blah.

"current state of finances." Right, she wants to park it.

And she tells me in an e-mail. Over my dead body.

You've forgotten your...

Mrs Endokuwe is fully prepped and all bloods are back.

She had a mild heart murmur on examination

but I've discussed this with the cardiologists who feel

it's not of any significance, and are happy to go ahead.

Excellent. Well, we'll see you in theatre.

So, thank you, Dr Birdwood, what's next?

Sorry, Mr Griffin, I know we're up to our ears.

but the ED really think you should take a look at this.

Gabriel Vaughan. 42. Collapsed at a train station.

Mr Vaughan, you had a fall?

Stumble, really.

It looks like you've been unwell for some time. Abdominal pain,

-weakness, fatigue, dizziness.

-The GP said it's just a virus.

If you're taking Mr Enright in right away, we've a spare bed.

-Go.

-Do you want me to take this?

I'm quite awed.

Well, I think you can see what we're up against.

But, er, we have a great team.

And now that we have Dr Birdwood with us.

Er...yes. I was hoping to have a quick chat about that.

-Square root of X plus PX plus Q.

-I don't know, yesterday he suddenly got much worse.

Billy, can you stop a minute, please?

So, Leyton Orient fan, are we?

When one wears a strip one is usually a fan, yes.

Hey, be nice. Is Professor Gleeson coming?

-Why would he be?

-Well, he's the one we've always seen,

he did the Baffle on Billy when he was a baby.

This isn't Paediatrics. I'm afraid we'll have to do.

Shhh! Can you be quiet?

-Quadratic equations. Billy's a...

-A maths prodigy.

And I'll go to Oxford next year.

If I can get this supporting materials in on time.

Well, good for you. I'll just have a little listen.

Excuse me. Have I not been clear? Or are you hard of hearing?

Billy !

Right. Let's get some fresh bloods and book an echo and an MRI.

When he's ready to co-operate talk to the nurse.

Excuse me. Ms Naylor, did you say your name was?

Could I just have a word with you two?

I don't understand. Has someone complained?

Look, I'm not quite sure how this move came about.

No doubt it was done with the best of intentions

but Dr Birdwood's placement was supposed to be on AAU.

What does it matter?

You can see, we're buckling under, she's obviously thriving.

I'm not quite sure THEY see it that way.

-Mr Malick, you're clinical skills tutor, you know what I mean, don't you?

-Well, I um...

So someone has complained. Ms Campbell.

I really don't want to get into that. In all honesty,

I do think there's a point to be made.

There's a way of doing things and this isn't quite it.

So what are you saying, that she has to go back?

It's frustrating, I know.

But let's just start as we mean to go on, eh?

Ms Cousins? Sorry to interrupt. I'm Mr Hemingway. Can I have a word, please?

Mr Hemingway! It's so good to finally meet you. Excuse me.

Are you going to tell her?

The thing is, he's been under a lot of pressure recently.

-Self induced.

-That's neither here nor there.

Actually, it is. You're treating him so you should know.

This Oxford thing.

He's got it into his head he's going and it's gone way out of control.

He keeps going on and on about it in a loop.

Ever since he's done the aptitude tests, it's...

it's making him so anxious,

God knows the last time he had a full night's sleep.

-Must be fun and games for you.

-It's party central.

When he gets anxious, you get the vile brat act

but, really, he's a lovely boy. He couldn't do enough for you.

Hey, you should meet some of the other people we have to deal with around here.

Well, now we know. Thank you. Get the bloods going.

Excuse me one second.

So, is there any particular reason why you've just been so lovely to this woman(?)

Excuse me?

Or is it the whole CEO thing that's derailed you. I mean, come on. You expected an interview, didn't you?

-Wow, Jonny that is some dazzling insight. You really read me like a book.

-Whatever.

Look, just because he's a genius, it doesn't mean he can behave like that.

Pot, kettle - you join the dots.

Tell you what, why don't you give your wit a rest

and get on with what you SHOULD be good at?

Hey, hey. Don't talk to me like that.

Just to remind you. I don't sleep with you anymore,

so I don't have to take any more of your crap.

And nor should anyone else.

But if we get the Brussels Foundation on board

we could be looking at a £100,000 grant.

Golly. That would be marvellous.

Exactly. So that why it's a little ridiculous to suspend...

It's frustrating, I know, but so far, correct me if I'm wrong,

it seems there's no sign of, well, results.

-Of course not. Research takes years.

-And no volunteers.

-We're a little short.

-Which is crucial. No volunteers, no results.

-But I think you're missing the point.

-Maybe.

But I'm afraid the board expects these boxes to be ticked.

The board will have to be reminded that I'm a fellow

and, as such, my contract clearly states that I must be allowed

-to complete my research otherwise I am under no obligation...

-I'm afraid the board will point out,

not without reason, that your contract also states that you must work on the wards.

And, if truth were told, you are currently in breach of this.

-I don't think...

-So unless you can produce evidence of a significant step forward,

you'll just have to muck in like everyone else.

This won't take long. We've got our daughter's birthday tomorrow

and she's waiting for us at my sister's.

Naomi. Her name's Naomi.

-Oh? How old is she?

-She's, er...

-She's ten.

That's tender, right?

I'd like to run some more tests.

-What tests?

-Bloods, ECG, chest and abdo x-ray...

-Hang on. Why so many?

I suspect the reason that you've been unwell for a while

is that you may have a blockage to one of your arteries.

-I need the toilet.

-Just, in a minute, darling...

-I need the toilet now.

-OK.

It's just through the double doors and...

OK, how about I get a nurse to take you?

Nurse Lane? Could you take, Mrs Vaughan to the toilets? And back?

-I'm... I'm OK, I can...

-Of course, just this way.

I don't mean to pry but... your wife. Is she...?

She's got early dementia.

-BREATHING HEAVILY:

-Simultaneous movement as centre back moves forward

and reaches position in a 4-4-2 permutation.

Hi breathing's laboured. Er, Ms Naylor?

Billy? I'm sorry.

This is the only thing that helps him wind down.

Billy, don't make me take it off you. Cue World War III.

-His legs are swelling up.

-I am going to complete this half,

so you're going to have to wait until half-time.

-I really need to examine him, so...

-Yes, I know that. I am trying.

Right. Sorry about this.

You want this back?

You need to understand this - you are not well.

Forget Oxford. You won't make it round the corner if you don't let us do our jobs.

Thank you.

Yeah. There's a strong crackle. I think he's developed an SVT.

Let's have a loading dose of Amiodarone.

Skip the echo, let's go straight for an MRI. Can you call them, please?

Sure.

They took five years to diagnose her?

I had to make myself a total pain.

She was shunted from one consultant to another.

They mooted a nervous breakdown because of marital difficulties.

Ludicrous.

A pianist doesn't forget how to play the piano

because of marital difficulties.

-She's a pianist...? Is that...?

-Muscle memory.

I kept saying to them. I know her. We spend all our time together,

we play together, we perform together.

Must be hard... With a little girl.

No, she keeps us going. We can't miss tomorrow.

I understand. But if we don't deal with this now,

your daughter will remember this birthday for all the wrong reasons.

I...

Look. No offence but you're not going to disappear

-and leave your junior doctor here to chase after you.

-Absolutely not.

Mr Griffin is only a corridor away and I'll keep him in the loop at all times.

Got that MRI slot.

Great.

That was good back there. The way you handled him.

Wow! Good, thank you, please. Careful, you almost sound nice.

Oh yeah, I better watch it.

Don't worry I won't tell anyone.

Anyway, don't want to miss that slot.

Hold on. I'm, er, going to come with you.

Really? Don't have to.

And wait for them to e-mail the result?

We'll be here all year. Could just analyse on the spot.

Sure.

Mr Griffin?

See, I was thinking we could go for an immediate blood gas,

check the pulses in his legs, that would give us a clearer picture sooner.

-Great. Go for it.

-Er, really?

-Is there a problem?

-No. There's no problem.

I've ruffled some feathers when I moved you up here, that's all.

Nothing for you to worry about. Or you for that matter.

I run this ward and I know what I'm doing. Putting patients first.

So carry on with what you're doing.

Think of it as an executive decision.

Any problems, you know where I am.

Come on, come on. Some of us are on a tight schedule.

If she got a move on, I could still make this call.

Ah. Count Luc. Daylight hasn't extinguished you yet.

Maybe a nurse is exactly what this place needs.

Absolutely.

Yeah, all right, let's get this over with.

Evalyn Slate. Transferred from radiology outpatients.

Hello, right, so you're suffering from recurring ulcers.

Oh, they're troublesome things. I don't drink, I don't smoke,

I never have coffee, I'm a strict vegan.

Fresh set of bloods, cross match and save and set up some fluids.

-And we'll get on with the gastroscopy.

-Well, how long will I be here?

-Er, well...

It's just, the... The cats will need to be fed.

Right. Elsie's away, Mary's got the grand-kids.

-I'll leave you with that, shall I?

-Oh, it's not that simple, you see there are 21 of them.

-21?

-Well, they can feed on each other then, can't they?

No, Claire, don't. Don't tell her anything yet.

Invent something. Look, I've got to go. Yes, yes, as soon as I know.

No point...until we know.

'Course.

Is that for Naomi?

Yes, a new one. She takes after me.

I give her lessons when I can.

You still perform?

Oh, no. I give that up ages ago.

It wouldn't really work with anyone else. Us two click.

Not enough hours in the day anyway.

-You sole carer then?

-Of course. I want to be.

And it is cheaper.

OK. Sharp scratch coming.

Sorry, sorry. Sorry, that radial artery can be a slippery little bugger.

OK, let's have a look. Nah, you haven't got it.

Let me see.

And here we go.

Easy peasey.

Cheers.

Stickybeak. I'll get the lab to fast track these.

An MRI machine is known as the doughnut of death.

I had 40 of these in the last 16 years.

I don't mind them one bit apart from the fact I detest the noise.

Right, I'll go through.

I've got you.

Well done. Well done.

That's it.

And the ball goes to Carrol...

And the ball goes to Carrol...

Jonathan Tehoue.

Hmmm...heart's dilated. A lot of fluid on his chest.

I think this is becoming acute heart failure.

And it's Jonathan Tehoue! And the equaliser for Leyton Orient!

Not looking too bad. Should be able to just keep the fluids going.

Brussels rescheduled the call so I should be fine.

Oh, good.

Wait a minute. What have we got here?

What is that? A lesion?

Angiodysplasia.

That, my friend, is what we call a breakthrough moment.

I might just e-mail Imelda Marcos right now.

-What's the jubilation for?

-Angiodysplasia of the greater curve.

The stomach does not stop bleeding, because of the thin blood vessels.

So she's a perfect candidate for his trial.

Exactly. The Belgians will wet themselves with excitement.

-You might show her more interest then.

-What?

-A little of charm wouldn't go amiss

cos right now she's more likely to run a mile than have anything to do with you.

So she struggled with the arterial bloods.

-That can happen to the best of us.

-Absolutely.

But I'm just concerned she doesn't put herself under pressure to run before she can walk.

Mr Griffin, I was just about to call you.

What we got?

An absence of femoral pulses.

Together with the atrial fibrillations, the sats and BP,

I'd say Aortic saddle embolus.

Just tell me.

I'm afraid that we're going to have to take you into theatre.

-An operation?

-Yes.

-When?

-Well...

I can't fit you in now right but hopefully later today.

-I... I can't get this round.

-I'll help you in a minute, darling.

Isn't there anything else you can do?

I really think that we need to put your welfare first.

We could try for an angioplasty.

Blast the clot with a guide wire. Now.

I can do it. I've done it before.

Would you just excuse us for a moment, please?

Look, I appreciate you trying to push the boat out for them.

I'm sorry if I got carried away but we could at least give it a go.

-Theatre is groaning. This would work for everyone.

-PAGER BEEPS

All right, check his clotting, speak to Radiology.

And, erm, keep an eye on the wife.

-I know he's keen to play it down but...

-Yeah, absolutely.

Mr Griffin? You trust her with all this?

She's put up a very good argument. Plus you need to give people room to grow.

-You should know that better than anyone.

-Exactly. I know what it's like trying to impress a consultant.

I think I'm old enough and ugly enough to see past that.

With all due respect, are you sure this has nothing to do

with trying to prove a point to the new CEO?

So... fancy your chances of relegation?

We were outstanding mid season.

Three points in the first ten games stuck us bottom

and the play-offs became a mere fantasy when we came crashing with 12 points in the last 17 games.

And then if it weren't for Wycombe running out of steam,

-we'd have been relegated immediately.

-Wowza.

-You really know your stuff.

-I do. Shame I can't play.

Well, at least you can always get off to see a game.

I've never been.

But that will all change when I'm going to Oxford.

I'm going to get a student loan and live on my own

and buy my own tickets

and study all night if I want to and Mum can't stop me.

-But don't tell her.

-Mum's the word.

She thinks I can't make it on my own.

I know I have the social skills of a potato

but I'm very clever and I want to be someone.

Of course you do.

Here he is.

Billy! Look who's here.

-Hey, you.

-Professor Gleeson.

Eamonn Gleeson. Good to meet you.

Could I have all latest stats, bloods, echo and get them

-to e-mail the MRI images as soon as possible.

-Sure.

Let's have a proper look at you.

Before you say anything. I called him.

I figured something like this might happen.

You two haven't exactly been getting on.

Thanks for your support, Jonny.

-Angiodysplasia?

-Mmm-hmm. Could have gone unnoticed for a long time.

And that's why I've been getting ulcers?

It's also why you're anaemic. It's a form of chronic bleeding.

I see. So, what can you do?

Well, most physicians would say not very much.

They'd pack you off home with some medication.

But, if you stick around, there's an innovative new technique

called endoscopic coagulation therapy...

Oh, let me stop you right there. I don't want any of this.

I want to talk to Rosie first. My healer.

-Your healer?

-Reiki healer. She's wonderful.

-When Petite Fleur had her tumour.

-Petite Fleur?

-My eldest.

-Daughter?

-No. Cat.

-Right.

Well, you can of course talk to your healer, see your healer

-and we'll carry on with the...

-I don't think so, no.

You see treatments might interfere with each other.

They don't always flow together. And you said yourself, doctors think there's not much you can do.

-Well, that's not exactly what I said...

-I know that you're a young man in a hurry

but I like to think these things through

so maybe you could get me some literature to take home.

I'll be in touch.

It's a classic bilateral pleural effusion.

-BREATHING HEAVILY:

-Young... adults...who have gone through the Baffle

-Ms Naylor.

-Thank you.

Complications...such as...

-coronary artery problems...

-A mathematician and a cardiologist.

Look at all the fluid here. I think the Baffle is potentially causing an obstruction. We need to take him in.

Another operation?

I think we should try and hold on. Let's just put him on a combo

of dopamine, dextrose infusion and frusemide, see how we go.

BILLY COUGHS AND SPLUTTERS Excuse me.

We need to drain the fluid now.

So I've put in a call to Angioplasty

but I think the heparin might just do the job.

I don't know how to thank you.

Where's Ellie?

That nice nurse took her to the shop to get a card.

Best to do is keep her busy.

It's just that this is a very busy ward.

-You may want to call someone to...

-Someone?

There is no-one. Only me.

-Let go.

-It's mine!

No, it's not.

Mrs Vaughan, this is Mrs Mallow's, let go.

No, I.

-SOBBING:

-I...thought it was mine I... I was hungry.

It's OK. It's OK. It's nearly lunchtime.

She's just a bit tired, that's all.

I could see what I could rustle up.

The nurse found one with a fairy on it.

-I'm going to write it. Right now.

-OK.

To...

Dr Birdwood?

N...

Is this a heparin infusion?

-Yes, of course.

-Have you seen these latest stats?

I mean, Petite Fleur. What kind a name is that for a cat anyway?!

I really am beginning to think there's something wrong with you.

I mean, why didn't you go on about your Shamanic experiences eating lava worms in Thailand?

I mean, she'd be eating out of your hands by now. Softly softly catchy monkey.

While we're treading softly softly,

the monkey might die of internal bleeding.

-ALERT BEEPS

-That's my conference call from Brussels.

-This could make or break my funding. I can't miss it. Can you talk to her, please?

-What?

Just get her to stick around, agree to the endoscopic coagulation therapy. I'll do the rest.

-I must have doormat tattooed on my...

-Bonjour.

..forehead.

It's OK, sweetheart.

You're going to feel much better in a minute.

-You're being very brave here.

-Heart beat fast and irregular.

-I don't think we can wait.

-Siobhan?

-Can you finish up, please?

-Sure.

We can go for a straightforward procedure.

Just widen the Baffle, and remove the obstruction.

-Er, to be fair, we'll only know that when we open him up.

-And afterwards?

Carry on as you are.

Keep the medication going, continual checkups, close observation.

But who'll be operating? Can you be there?

If Ms Naylor would have me.

I'd really like that.

Right. Shall we go tell Billy?

No, it's OK. I'll do that.

I need to make some calls. Juggle my timetable.

Why are we not talking to him? Directly? He is 16.

In here maybe. But not in here.

But still, we should be honest with him.

He thinks he's going to Oxford.

It's typical of his condition, repeating things in a loop.

That doesn't mean he's not serious about it.

The Asperger's is bad enough without a heart condition.

He needs constant care. It's never going to happen.

Heparin? You aware of the risk?

-In case he does have to go into theatre.

-But why would he?

This is an aortic saddle embolus,

the heparin might well dissolve it on its own.

Look at these.

It may have started as an embolus but it's an occlusion by now.

And if you need to take him in, he could bleed out on you because of the heparin.

If. OK, let's just wait and see.

And exactly how much experience have you had dealing with this condition?

-Well...

-Right, take him off the heparin immediately

and we'll try to delay radiology while it gets out of his system.

I want to know when they call you back.

No, Alex, just your latest data.

Yup. Yeah, I got it. Cheers.

Secret stash.

Mmm. Nectar. Do you want to...

Arterial Switch. That's a tricky one.

Pull it off and your patient gets a new lease of life.

-However... This for your boy?

-Mmm.

You must be feeling brave today.

Today?

Brand new world.

KNOCK ON DOOR

Now, what are the chances of finding two fantastic heart surgeons

in one room at the same time?

Can you spare five minutes for a chinwag?

-That's Petite Fleur.

-Oh, that's Petite Fleur. Oh, my gosh,

Oh, I love them.

Just to say again, this endoscopic, you know,

coagulation therapy is actually quite ingenious.

I mean, it may not be 100% fool proof but it is less invasive

and I know that's what Mr Hemingway thought you might prefer.

And it might get rid you of those pesky ulcers, you know.

Do you know what? He's not quite the ogre he appears to be.

He does appear quite thorny. Bound flow, you see.

Oh. I know, I know.

But actually that's to cover up the fact that he's quite soft in the middle.

Right.

Anyway, I must say it's very nice to put names to the faces.

Maybe we can make a time to chat some more?

Absolutely. I'm due in theatre.

Yes, me too.

Indeed. But I just wanted to dispel any, well, fears

and assure you that I believe in letting people get on with what they're good at.

I'm not a clinician, I wouldn't dream of telling the medics how to do their job.

Darwin has been doing sterling work.

I'd hate to think my arrival would derail you in any way.

Absolutely, thank you.

Don't worry. It won't.

Thing is, she rushed into offering him a procedure.

She rushed into putting him on heparin.

She is not as experienced as she likes to make out.

It's an easy mistake to make. It did present as a clot.

That's not the point. Plus I don't like people trying to tell me half truths.

-Bit heavy, isn't it?

-She's not just your responsibility.

-OK, I get it.

Erm, Dr Birdwood?

It's about the heparin, right?

See, I felt it was worth initially trying to heparise him

as it could dissolve some of the blood clot

before any radiological intervention.

It may have even alleviated the need for a further action.

True. Possible but unlikely.

That really only works on a venous thrombosis,

not in an arterial case.

It was an understandable call and worth a try

but probably irrelevant.

I know that you may think that you have adequate experience.

Oh, that was just a misunderstanding.

I never said I had experience with the exact same cases.

I mean, they do vary enormously.

Precisely.

Which is why you should have run it by me

or another more experienced member of the team before proceeding.

Of course.

Obviously, I have taken Mr Malick's diagnosis

and taken the patient off heparin.

I'm still confident he won't need full surgery.

IMELDA: Golly, that would be marvellous. >

Look, I really appreciate everything that you've done. Especially today.

I know what politics can be like and maybe I've been a bit insensitive.

Insensitive?

Maybe I might have ruffled a few feathers

when I made no secret of how much I look up to you.

-Look, why don't you take five. Page me when you take him in.

-OK.

It would certainly jolly up the place.

Nurse Lane's just been telling me about her New Year charity ball.

I think it's a super idea.

I'll e-mail you.

I was just coming to see how everyone's coping. Hope I'm not...

Oh, no. Not at all, not at all. In fact, your timing is perfect.

I was just coming to find you.

An Arterial Switch? That's, er, a bit bonkers.

Why?

It's superseded the Baffle Billy had. Look at this data.

The prognosis is miles better.

But if we're looking at a simple patch obstruction,

why take the risk?

You're looking at hemodynamic issues, neoaortic regurgitation

or even LV systolic dysfunction from myocardial infarction.

It could transform his life.

He could go to Oxford, he could play football, he could...

End up on the transplant list. If we don't lose him on the table.

-Should we at least give him the option?

-No.

No, I think it would be very unfair.

You're talking someone whose cognitive abilities are impaired.

He's not able to make that call.

It might be right for some people but it's not right for him.

Let me know when we're taking him in.

Right.

He might be right, you know.

He has known him since he was a baby.

Might want to try listening for once.

For once?

Look, if this is about you not liking being sidelined...

-I didn't mean like that.

-I really don't care what you mean.

She's an exceptionally talented physician.

She should be allowed to stay where she's most needed. Where's she's vital.

Now, if that's putting someone's nose out of joint

or not quite protocol, then so be it.

-I'm sorry but I'm not here to win a popularity contest.

-OK.

You've put forward a very compelling case. I admire your passion.

Right. Well that's... That's great.

You don't know me yet but when you do you'll realise I'm no fan of the cloak and dagger routine.

So I really appreciate your honesty. I mean it. It's rare.

You and I may have more in common than you think.

-Oh, sorry.

-No, no. I think we're done here.

So?

Yeah, well, I think we can put that one down to

a misunderstanding between you and Lilah.

Is that what she said?

Look, she's passionate, she's opinionated, she's committed.

Kind of reminds me of someone.

Hey. I busted my balls to earn people's respect round here.

-She's no different.

-Absolutely. I'm sure she's well aware of that.

I hope so. Cos otherwise she's going to crash and burn in no time.

Thanks. And we'll be the ones having to explain why.

-She's reconsidering?

-She's not as impenetrable as she looks.

Do you know what, I could hug you.

If I went in to the human contact stuff, I honestly could hug you.

Do you know what, I might e-mail our charming CEO right now.

If there's anyway I can repay this favour, Sacha...

Well, actually. Um, Chrissie's been on at me, you know, for a while

-to...further myself.

-Oh, yeah?

I was just thinking, if there was anything kind of low maintenance I can do on your research...

Oh, there's nothing low maintenance involved really.

You can't just dabble in it.

I wasn't suggesting dabbling in it.

They're a very serious business. Time consuming, too.

OK.

Just make sure you get your patient on board.

Absolutely.

I mean, we have been on a second date so maybe I should just ask him.

Or do you think that's too soon?

Although, New Year's is round the corner.

I can't turn up to MY ball on my own.

-Do you reckon he's going tonight? Maybe I should try and suss him then.

-Poor Rhys.

Joke. Joking.

Chantelle, could you check on Mr Vaughan's stats for me please?

-Sure.

-And Mrs Vaughan?

Mrs Vaughan. There's only so many times I can take her for a walk.

Can you get her a magazine or something?

Erm...'course.

You know Nurse Lane will never say no to anything.

Mrs Vaughan's care is not really her remit.

-Well, they've got no-one else.

-I understand but you need to be straight with him.

We can't look after her here. That's what the Intermediary Care Team is there for so...

I'd get on to them if I were you.

Erm, Mr Vaughan. I think you should come have a look.

BP 90 over 40, sats dropping.

Legs are cold and clammy. The blood supply is getting more and more compromised.

Get me five milligrams of morphine and call Angioplasty, tell them we're on our way.

Where are you going?

-Ellie, sit down, please. You'll have to wait here.

-Ellie can't...

-No, she'll be good.

-She'll just sit here, won't you?

-Look, if there's no-one you can...

No, I don't want any of these people round her. ..Ellie, sit down.

Now, listen. I promised her that she would never ever have to go

to one of these places. I swore. Look I'm not going anywhere

unless she can wait for me here. I mean it.

Ellie, Ellie. Promise me you'll stay here and do everything you're told.

Yes? There you are.

Oh, come on, it'll only take a couple of hours.

Page Mr Griffin. I'm taking him to Angioplasty.

It'll make you better, sweetheart.

Well enough to go to Oxford?

We'll see.

What? What will we see? Will this make me better?

-Or will I stay the same?

-Billy, please, don't upset yourself.

I want the truth.

-If I'm not going to get better then I don't want to go ahead.

-Billy.

Has anyone ever discussed an Arterial Switch with you?

I don't want to get your hopes up, it's a big procedure

and not without it's risks. The results can be life changing.

Patients' quality of life... unrecognisable.

They can be independent, they can exercise, they can...

-Go to a football match?

-If they're mad enough to like football, yes.

I don't believe you.

What the hell do you think you're doing?

Why would you want to give him any false hope?

Why false?

You want him to give up the hope of being self-sufficient?

Self-sufficient? Do you even know what that means?

Billy can't boil an egg.

He can't sort out his pills. He has to be lulled to sleep every night.

But at some point, you're going to have to let him try.

And maybe you could do with a break too.

He's my son - I don't want a break.

-Perhaps that's the problem.

-Excuse me?

Look, I know that caring for Billy means exhaustion and stress,

but it's companionship too, isn't it?

If Billy goes off to Oxford or wherever else, for that matter,

that's you on your own.

-SHE LAUGHS

-Oxford, Oxford, Oxford.

This is exactly what I mean. It's a fantasy,

it's la-la-land. And you're encouraging it!

What's going on?

It's potentially ground-breaking. This drug can help clot bleeding

-with patients who've suffered massive blood loss...

-No.

-You have bleeding issues so you're perfect.

-No.

-All we need is some blood samples which I can apply these tests to...

-No!

I don't want poked and prodded.

And...and trials involve experimenting on animals, no?

-No, not necessarily.

-Yeah, but it might.

I don't agree with that.

There's a higher power at work. We must promote harmony with others.

-Oh, for goodness sake.

-Sorry, sorry, what's the problem?

Oh, look at you two. Butter wouldn't melt!

All that talk about coagulative thingy -

that was just to get me to stay, wasn't it,

because of his trial?

-SHE SIGHS

-I should have known better.

I'm discharging myself. Now.

-I don't understand you. I thought we agreed.

-Agreed?

You mean, you made a decision and walked off.

Look, you know as well as I do

there's another option on the table here

-and he deserves to know what that is.

-He is a vulnerable patient, and on balance...

Exactly! He's vulnerable, so he needs someone to stand up for him

and stop patronising him. Now, this is my ward and he is my patient.

Jac...

Absolutely. You want to deal with this on your own?

Be my guest. Let me know when you do.

When are you going to learn?

This is not how you bring people round.

-You've just painted yourself into a corner.

-I'm doing what is right for him.

You're not the only person who cares for him.

Billy! Billy!

Excuse me.

LABOURED BREATHING

All right, let's start him on dopamine, 50-50 dextrose,

IV furosemide, one milligram per kilo.

His heart's struggling to cope with this. BILLY MURMURS

Billy, keep the oxygen on, please. Can we page theatre?

-Billy, enough!

-No! I want the...

I want the arterial... I want what you talked about - the arterial switch.

I want the arterial switch. Or I'm not going in.

BILLY STRUGGLES FOR BREATH

Are you sure there's nothing I can do make you stay?

OK. Then you must take these. Take these with you.

There really is no talking to her. She won't stay.

Oh, well, you win some, you lose some.

Or in your case you lose some and then you lose some more.

Oh, come on. It was like talking to a brick wall.

How would you know? You hardly even bothered to talk to her.

Because you are so utterly, majestically, up yourself

that you end up losing everything -

Eddi, your research,

and now you've got a patient thinking I've actually deceived them,

and I'm your friend!

Well, that was pretty comprehensive.

I mean, if you don't get it now...

-How do you mean?

-We can't seem to get the guide wire in.

How many tries?

About three. It's just that...

he's bleeding quite profusely and we can't seem to get on top of it.

MONITOR BEEPS

I need your back-up, Mr Griffin.

I'm needed here. You're going to have to call Mr Malick.

'Now.'

BEEPING CONTINUES

Ms Slate! Ms Slate, hang on.

Can we get some help here, please?

-No. No, don't touch me.

-Come on, come on.

-Not you.

Come on. I think you need a blood transfusion.

That's it. All right, all right.

Mr Malick!

What's happening?

Please, try to stay calm.

This isn't going to work. The aorta is probably too occluded.

-Get onto theatre and tell them we're coming over now.

-He doesn't want to go in to theatre.

-Call Mr Griffin and tell him to meet us.

-He's in surgery...

Dr Birdwood, focus and listen! This man has severe limb ischaemia.

If we don't get him in now, he'll lose both legs or bleed out on us.

OK?

-You tell her that...

-You mean you haven't called the intermediary?

-It's OK, I'll sort it out

Shall we go for a midline incision, do an aortobifem graft?

No, it wouldn't work. Axillobifem graft is the only option.

-Right, let's cancel the rest of the list for today.

-What, all of it?

-The state he's in, this will take at least six hours.

-He's still bleeding?

We've been trying to stem it. It's because of the Heparin, right?

Now's not the time. Come on, let's get a move on.

You have to understand, there's no guarantee.

But if you try...

-I could go next year. I could...

-Stop it! Just stop it!

There is no Oxford!

You failed your last aptitude test.

You haven't got an interview.

No, no, no, no.

-MONITOR BEEPS

-Oh, Billy.

Billy, I'm so sorry.

Just help him! Do something, anything.

-So I have your consent?

-Yes, yes, whatever.

Right, let's go.

-Do you want me to page Gleeson?

-No.

What? Why not? Are you crazy?

You heard me. Prep him. I'm taking him to theatre now.

BILLY STRUGGLES TO BREATH

Please, listen. You can't send her anywhere.

You know what these places are like. She'll be scared.

You promised me she could stay here and wait for me.

I'm sorry.

-Mr Griffin.

-I'll deal with this.

Well, I've been hoping for some advice on the theatre rota.

As you can see, we've got an emergency here.

-I want to go! I want to see Gabriel!

-Ellie? Stop!

-Gabriel's just having some treatment. We've been through this, remember?

-Ellie. Ellie?

It's OK.

It's OK.

Now, listen, I need to have an operation.

Now, you do what these people say,

and when I come out, we'll go and see Naomi, OK?

We really need to make a move. Sort this out.

Could I have a look at his notes, please?

-Right, nice and easy...

-Don't touch me!

-OK, all right. All right, it's OK.

-Where's Gabriel?

-Where have you taken Gabriel?

-He's gone for his operation, remember?

-Naomi. Where's Naomi?

-She's not here. She's with Gabriel's sister.

Who are you?

I'm Dr Birdwood.

No, no, you can't...

ELLIE WHIMPERS

Come with me now.

Where's Gabriel?

How we doing?

Scalpel.

I'll be just a second.

-What's this?

-Nice work.

-Did you actually think I would abandon my patient?

-That is not the point

-Don't bother.

-Let's be clear.

You so much as try and stop me going in there, I'm escalating this,

all the way to the CEO. And you know as well as I do, you won't have a leg to stand on.

Mask.

He deserves the best chance. That means both of you

I can't believe you would do this to me.

I did this FOR you, Jac.

-If this goes wrong, you're going to land yourself in a lot of trouble.

-MONITOR BEEPS RAPIDLY

You better get in here.

Suction.

OK, thank you. Must have been some scene.

All in front of Cousins.

Anyway, they finally called the intermediary care team.

Right.

Well, we've got this to get on with.

Can we get the Dacron graft ready, please?

Yes, yes. I'm well aware this is all my responsibility.

Don't know about that.

Like you said, there was logic to what she did.

We were just unlucky.

We're not fortune tellers.

GRIFFIN SIGHS

Long night ahead, ladies and gents.

Where... What happened?

You're bleeding. It got out of control. You collapsed.

Mr Hemingway brought you back and we took you into theatre.

Oh. Him.

Don't worry, you've been reassigned to Mr Levy. I...um...

I just wanted to say...um...

I apologise for the way I behaved

and I hope you feel better soon.

It's the right atrium. He has severe right ventricular failure,

it's not a patch obstruction, we can't widen the baffle, there's no point.

But can you make the arterial switch?

He has severe heart failure, it's not viable.

This has gone far enough. Just do it, we'll put him on the transplant list.

-It's the only way...

-Are you a surgeon?

-I know it's beyond you to ever admit that you're wrong, but...

-Out.

-What?

-You heard me. Get out of my theatre now.

-Right.

-OK, so...

-TCPC.

-What?

Total cavopulmonary procedure. We attach the vein draining the blood

from the upper part of the body to the upper part of the lung.

We don't have any other option, do we?

-OK.

-Clamps.

We've sedated her. She's sleeping now.

The intermediary care team are on their way

and we might be able to find her a bed on a ward for a night, so she won't have to go to a home.

I'm sorry.

-BP dropping.

-Suction. Must be a minor artery bleed.

-Minor?

Clamp. 40 Prolene. Let's start on adrenaline. 100% oxygen, please.

Keep the pressure there.

Just do it.

OK. Release the clamp.

Gently does it.

Holding nicely.

Right, where were we?

Ready to make the incision in the right atrium.

Stand by with the prosthetic for the lateral tunnel.

Hey, Naylor...

-Yeah?

-Drink later?

You're not out for my blood anymore, then?

Ah, consultants always rip each other to bits - wouldn't be any fun otherwise.

I don't mind a bit of Napalm.

And I've got a thing for exceptionally talented heart surgeons with red hair.

Irish heritage, you see. Swab.

Clamping the subclavian.

50 Prolene, please

Suturing.

Release the clamp, let's test the blood flow.

Yes.

Knock-knock.

-Packing up?

-No volunteers, no trial.

I've talked her round.

What?

Well, as you said, the...

the problem will be ongoing,

so I explained to her that if she does the trial

she'll get constant attention.

And that, you know, we'll only use bloods we would have taken from her anyway,

and that no animals will be harmed by your good self.

What, and she went for that?

LEVY SIGHS

I've also sorted her out with Mama Levy's psychic healer, Linda,

who lives in Southend and who has a two-year waiting list.

Why would you do that for me?

Well, I've always had a soft spot for the socially dysfunctional and the offensive.

That's very kind, thank you.

Well, that's perfectly all right.

Sacha, um...the...

With regard to the proposition you made earlier,

I could probably use all the help I can get.

Thank you, ladies and gentlemen. That was a heroic effort.

Look, if you hadn't got him to stay this morning,

he probably wouldn't even be alive now.

But I should have known better.

I should never have left you to it.

I'll deal with this.

Could this possibly wait? We've just come out of theatre.

I know. Six hours! Lordy. Two minutes.

Dr Birdwood, take a break.

Actually, if you wouldn't mind sticking around.

I've just been looking at his notes, you see.

I suppose, considering you had to resort to a subcutaneous axillofemoral bypass,

it could have been a lot worse.

However, I'm just trying to ascertain - just for my records -

was it really...inevitable?

Inevitable?

He was rushed to theatre after a catastrophic bleed

which was a direct consequence of Dr Birdwood previously putting him

-on a Heparin infusion, right?

-Well...

And it is the case, is it not,

that if Mr Vaughan had been booked in for a conventional aortic bypass

to start off with, we could have bypassed this massively risky,

time-consuming and costly procedure we ended up with?

Excuse the pun.

Unless I've got this all back to front?

No, you haven't.

Not to mention the unfortunate incident with the patient's wife,

-whom I believe you were aware was suffering from...

-Can I just stop you there?

Dr Birdwood kept me in the loop throughout.

I take full responsibility.

-I'm very relieved to hear you say that.

-My point is...

Granted, your circumstances are very challenging,

as you pointed out to me this morning.

Which is why I see no point in penalising one particular person.

After all, I'm here to lend support.

So I think, in everyone's interests,

rather than your good self mentoring Dr Birdwood,

I'd like to see her directly under Mr Malick's supervision.

Relieve the pressure, as it were.

Excellent. Onwards!

Hi.

See you've got your top back on. Got you a present.

Don't look at me, I'm not going.

But you will be fit to go.

And just to be on the safe side, you'll be in a box

and you'll have a cardiac nurse with you.

26th of January.

Kick-off 3pm.

That's 66 days, 18 hours and nine minutes.

I suppose it's got to happen sometime.

Thank you.

My pleasure.

By the way, I never got into Oxford.

St Barts is where it's at.

Jac...

Yeah, I know. You had to.

But so did I.

Um...look, you know, tonight -

offer still stands.

Like I said, I've got plans.

Happy birthday.

Thank you.

I thought you might want this with you.

She's never done anything like that before.

She's not going to get any better, you know.

You can't do this on your own anymore.

Next time she hits someone, it could be you.

Or Naomi.

It's not like you're betraying her. You have to accept it -

Ellie needs full-time care now.

Come in.

Mr Griffin. What are you still doing here?

I'd have thought a well-earned drink was in order.

Can we just dispense with the sympathetic tone?

Was that really necessary?

Talking to me in that way in front of my team?

Putting Mr Malick in charge of Dr Birdwood?

Bit of an overreaction, don't you think?

But you did say you were responsible, didn't you?

-Yes, but only in the sense...

-And actions carry consequences for everyone.

Even consultants.

I have to seem to be fair. I'm sure you understand.

Anyway, that was today, and tomorrow is another day.

Onwards!

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