Prince Among Men Holby City

Actually, Dr Copeland,

I'm the most senior doctor on the ward at the moment

so if you wouldn't mind stepping aside, please, thank you.

He shouldn't be doing that, so why are we letting him?

She's been through a lot

and we're going to have to keep a close eye on her

over the coming weeks,

but there's absolutely no reason not to be optimistic.

What are you doing here?

We needed someone for the flat and...

Ta-da! She twisted my arm.

Do you feel a tingle down your spine?

I've waited 20 years for this.

I've got goose bumps.

I've waited twenty years - he's waited 2,000!

So boring!

It's amazing.

The mechanics of a Spiral Cone Tomography scanner?

We're looking at something no-one's ever seen before.

What? The insides of a shrivelled old man?

I first read about Prince Karnak two decades ago.

It's been like a long, unrequited love affair.

First I wrote letters, to his curator.

They sent me a photograph.

-You must have been very persuasive.

-I tried everything.

Finally, the National Museum of Albania

granted me four days with him.

Twenty years, for just four days.

Actually, I think it's very romantic.

We can go in now.

Except we're the poor plebs that have to be up at 6am

in order to "enhance our Spiral Tomography skills".

Ah, to think, I could still be sleeping.

Looks like he's sleeping.

I haven't slept for days.

-Really?

-Too excited.

What do you hope to discover?

What his life was like. How old he was.

How he died. He's been so closely guarded, for so long,

he's a complete mystery to Egyptologists.

The real story here is not the mummy. It's her.

Mummy-mad Mary?

She was probably quite hot once...

you know, like a hundred years ago.

If you ask me, I think Sacha still feels her heat.

Ee-yuk. Don't, I haven't even had breakfast yet.

To devote your life's work to a dead man...

I love it when you talk all psyche...

MONITOR BEEPS

Morning. Is Mummy having trouble?

Not everyone finds it easy to connect.

I always say - fake it to make it.

Even if you don't know, or don't entirely believe...

I'm not "Mummy". I'm "Ms Naylor".

By comparing the Harris lines here between the diaphysis and epiphysis

of the long bones, we should be able to identify dietary deficiencies...

even childhood diseases.

Now, I am all of a tingle.

I know it's mad, to be so excited, but I've been preparing so long.

I'm just happy we can be of service.

Feels like my wedding day.

Is there a Mr Tinsley?

Married to my work.

Yes, quite right.

Neither of you two find this is a life-sucking waste of time?

Learning to analyse the finer points of a CT scan

is a great diagnostic tool.

That's what radiologists are for.

We clone a special breed of nerd for that.

She intrigues me... "married to a mummy"?

I mean, wouldn't you rather be elbows deep

in some hot, wet surgery?

And you, wouldn't you rather have your face-buried in a book

or in some patient's head?

Arthur's right. CT analysis skills are very useful.

Can explain a whole range of neurological issues.

You must think me quite mad.

No, no. Not mad, just... passionate.

Right, well. Is there anything else you'd like to ask, Mr Griffin?

Erm, no. No.

That's um, that's all clear. Thank you.

Thank you.

And your career ambition is...

"the exemplary and expedient delivery of optimum quality care"?

OK. Well, um... thank you very much. We'll be in touch.

Um... Sorry, you are?

Raffaello Di Lucca. Raf.

What is that?

It's my lunch. And these... are my clogs.

I assume you guys provide scrubs.

This is just a preliminary interview to find...

Your new registrar. To work alongside Mr Griffin.

In the Acute Admissions Unit.

Yes.

Well, that's me.

And, as soon as this "interview" is finished,

I'll be going straight down to AAU, to start my new job.

Like I said, it really is just...

What makes you think that we'd hire you?

Well, because Mr Self here needs me...

to help you make Holby City into the most cutting-edge

Acute Admissions Unit in the country.

What do you think you could...

Long way to go to catch up with Newcastle, of course,

or Leicester for that matter...

But with the Pri Def initiatives that Mr Griffin studied in the US,

and my two years' experience of new style resus

and ECMO techniques around the Pacific Rim...

It's a piece of cake.

You're very sure of yourself, aren't you?

Very.

Six months in Japan with Nozomi Fugusaki...

six months in the Philippines,

six months in Hong Kong...

And, the next year - in Holby City.

Maybe two - if you're lucky.

Why would you assume that...?

Read the small print.

He's been a locum for six months, plus a Fellowship

and research-funding from the NHS.

In other words, I'm already paid for. Except overtime.

Why Holby?

Because when it comes to AAU, Mr Griffin has a vision.

And Henrik Hanssen had one.

He's no longer here.

Yeah, I know. But I'm kind of gambling on you having a vision too.

Old dog, new tricks.

-You're referring to...?

-To you. Yes.

-Charmed.

-Come on, Ric.

You've been Clinical Director,

Head of Surgery, head of every ward in Holby.

You are our most senior and respected consul...

Now, you're just blowing smoke up.

I'm not going to tell you who you can hire.

But you're going to suggest.

No buts. It's your registrar.

Your ward. Your choice.

-My neck?

-Your words.

Look, you've seen his experience.

Yes. And I can read between the lines.

Not exactly a "team player".

Well, I like him.

Do you think he meant what he said about starting today?

Ah, there you are. Mr Griffin has just confirmed you.

So how long have you been here?

For ever. Think I started here when I was about eight.

Well, new boy needs nurse-of-the-world insight.

Holby City? Well it's like a cross between a secondary school

and a safari park.

-Tell me.

-Ask me.

Ric Griffin?

Have you seen The Lion King?

Guy Self?

Too early to say.

Could be in the gift shop on the cuddly toy shelf,

-could be lurking in the reptile house.

-Darwin Ward?

Oh, they're like sixth formers - they all think they're so clever.

Keller?

The aquarium. Lots of pretty fish.

No sharks.

And AAU?

Monkey World - no question.

< Quickly!

Come on, quickly!

I'm going to call it.

We've been going 21 minutes.

Resus stopped. Time of death - 12.01. Thank you, guys.

What do you call that?

-Sorry, who are you?

-What - do - you - call - that?

CPR? What do you call it?

-Ha! That, you call CPR?

-What do you call it?

A waste of time. Maybe even a waste of a life.

I don't know who you think you are, coming in here telling me...

-Your new boss.

-Well, I know for a fact that that is cobblers,

because the new guy who is coming in...

This is Mr Raffaello Di Lucca, Mr Griffin's new registrar.

This is Dr Harry Tressler.

That is the single worst example

of cardiopulmonary resuscitation I've ever seen.

You are never to perform CPR on my watch again

until I've personally retrained you.

Seriously, you must be...

OK. This is my one speech. CPR is my big, gnarly passion.

So listen,

in my opinion, CPR in this country is done badly.

A junior doctor has a frenzied pump at a patient's chest.

Stop at 20 minutes - ish. Game over.

"Junior doctor"? I'm a...

Other countries I've worked, Japan, Korea, America,

you have a 33% chance of being resuscitated after cardiac arrest.

Here - in Holby today - the percentage is somewhat less.

Things around here are about to change.

It's fascinating.

The skull alone gives us a whole catalogue of information.

Tell me everything.

Well, there's an unusually enlarged nasal cavity.

That'll be his embalmers, making room to fit a funnel.

PAGER BEEPS

Sorry. Excuse me. I'm going to have to call the ward.

-Your prince was an adult. Probably over 45.

-Really?!

Most Egyptologists believe he died when he was a teenager.

No. Not the skull of a teenager.

-The fontanels...

-Babies have big fontanels.

Big gaps between the bones in the skull.

At a certain age, those gaps begin to close.

People shrink as they get older.

Mary, I'm so sorry. I'm going to have to go back upstairs.

We have an emergency appendisectomy and only me to whip it out.

-Can I assist?

-Me too?

Well, you all need this on your rotation list.

So yes, you can all observe.

-But what about...?

-I can stay and help Mary analyse the CT scans.

Zosia, you of all people need to spend time in theatre.

It would be great, if Dr March could possibly stay.

OK, make it up next week. OK.

Double-bubble in theatre. Come on, guys.

And, this is Adele Effanga, HCA.

-Are you texting?

-Are you asking?

-Yes.

-Guilty.

Who are you?

-New registrar.

-Ah! Adele.

Your new registrar.

-Ri-ight.

-Your phone.

Er, what? Nah...

You'll get it back at the end of the day.

I ever see you using it on the ward again,

I'll make sure you're disciplined.

Are you serious?

And I'll microwave it.

He a strippogram?

No.

Who's your patient?

OK, ED have called it in.

With palpitations and shortness of breath.

This is Tay. Tay Simons.

He said he was named after the river.

But, like, what river?

OK, notes also say he was treated before at Queen's Hospital.

I think he's in some play or something. Are you in a play?

It's my school uniform.

Tay, what treatment were you in hospital for before?

Fashion bypass?

Kidney transplant.

Hi.

Ah, bless.

How's she doing?

Blood pressure is 60 over 40. Oxygen sats are good.

Up by 10%.

She's still on the ventilator?

Coming off it for a while, today.

Good. Great. First step.

-To?

-Taking her home. You must be so excited.

-What have you lost?

-My lupes.

Marvellous.

Busy?

List is chock-a-block.

In the middle, I've got a lung decortication.

Three hours peeling off fibrous membrane. Bummer.

-You?

-No. They're keeping my list light and easy.

Just in case the act of giving birth

has turned my brain to butternut squash.

Right.

I could help with your peel? Leapfrog it. Take turns.

-Free you up?

-I'm not sure I...

I'm being paid £110,000 a year to download my baby pictures!

Tag me later.

Right.

And you had the transplant...?

Nearly two years ago.

Do you mind? Pains around the lower quadrant, around your back?

No.

But I didn't want to come.

House Master insisted because I had a cough

-and so, Matron took my temperature and...

-She was right.

35,000 thousand squids a year!

-What?

-His school.

That's like a Mazda convertible,

a boob job and a week in the Maldives

every single year for, like, ten years.

You're not serious?

Dr Tressler. Thoughts?

TAY COUGHS

Well, X-ray. CT scan. Get hold of his previous medical notes...

Better still, send him up to Keller, general ward,

where they can do a full assessment of FBCs, LFTs, U&Es.

Rule out problems with renal system, rule out infection.

Problems with his lungs, then send him up to Darwin.

In other words, ship him out?

We're AAU. That's kind of what we do.

When you cough, do you sometimes see blood flecks in the mucus?

Get me those notes.

Mr Levy, could I bend your ear a minute?

-We need a chest X-ray.

-Right.

If there's a queue - bump him.

OK.

"Matron" e-mailed over his list of his medications.

Have you been taking your medication regularly, as prescribed?

Always. Matron is very strict.

-Like the sound of that.

-Really?

You'd want to be treated like a six-year-old all the time?

Any side-effects?

Dry mouth, hot flushes.

Bit of a Nazi, is she?

Whole school's like a prison camp.

Mostly, it's because everyone's scared my dad'll sue them.

Your dad?

Know what litigious means?

Not really.

He likes to sue people.

Is he a lawyer?

Was...

"School for Boys" - does that mean, there's no...?

Distractions?

Girls?

Bummer.

Major.

Got the Queen's Hospital notes. OK.

Details of transplant.

List of treatments and medics. And on the list is a name...

One we know really quite well.

-Hi, Ms Effanga, pleased to meet you.

-Mr Di Lucca.

I just caught up with his ED file.

Vomiting blood or coughing blood? Makes a big difference.

I do know that. He was coughing. Which is why we sent for...

A cardiothoracic surgeon. Yeah. Sorry, I didn't mean to sound...

-Patronising?

-Tay's father's just arrived.

-You prescribed Zoptholex.

-Yes.

-Anti-rejection drug.

Well, not me, not personally. It was my consultant.

His chest pains are getting more severe. He's tachycardic at 110.

And he's going the wrong way.

His films are just up.

-This here...

-Could be...

-..a lesion.

-Which could indicate...

-..an infection.

Which may have been exacerbated by anti-rejection medications.

Let's not jump to conclusions.

Let me do an echo, listen to his lungs, then I can get a better idea.

This is your fault. You made him sick.

-This is Mr Simons.

-I don't want this woman anywhere near my son.

You know what I love about your style of teaching, Sacha?

The warmth.

Oh. Thank you. I try.

The warmth and the care.

You care about the patients and you care about your pupils.

Well, I like to create an environment of...

The first consultant I ever reported to was an absolute monster.

Well, there are a few.

Most horrible human being who ever drew breath.

But, you know, I can honestly say to this day - hand on heart

he's also the best surgeon that I have ever worked with.

-Wow, that's...

-I mean, he taught us like we were scum.

But he taught us. Again and again.

I take it this is about...?

Zosia.

Right.

I mean, you know and I know,

that she's not exactly enamoured with hands-on,

knife and fork surgery.

She asked to be let out of this.

"One step up from plumbing".

She can be quite dismissive.

If she fails this surgical rotation, then she fails her F1 year.

That's 12 months wasted. Her medical career potentially over...

There is only so much cajoling I can do.

Maybe teaching isn't where your real talents lie after all?

What was that about?

I have no idea.

This is doctor-to-doctor.

Nothing. On my life.

So, why's Tay in hospital again?

A hundred different reasons.

The boy's just had someone else's kidney fitted in his belly!

That doesn't come without consequences.

But complications due to surgery two years down the line is unlikely.

Last chance. What went wrong?

Nothing.

So why request you keep away?

He's a control freak?

A surgeon calling a civilian a control freak!

You don't smell the irony?

Bleeding's worse.

-Do something!

-Sit him up. Let's get him to theatre.

OK, Tay, just sit up for me.

HACKING COUGH

What have you done to him?

I need to know exactly what you people have done to my son!

Quickly, please.

COUGHING CONTINUES

So you opted to do a decortation rather than be with Emma?

Our baby is in the NICU with three monitors and five full-time staff.

What am I supposed to do?

-Just be with her.

-I've been with her!

-I've no choice, right...

-Look, we've bonded. OK? It was awesome.

-I have to be here.

-And we'll bond again later.

But you - you could be getting her room ready.

Nest building?

Preparation for...

-Pandas or giraffes?

-What?

You want me to go home, stencil a jungle scene over her cot,

so tell me, pandas or giraffes?

Do we even have a cot?

What I want is for you not to be at work...

Or, at least not as much.

And for you to stop acting like nothing has changed in your life.

Well, it has.

How, exactly?

I'm online shopping on sites I've never used before.

Wait a minute, what is this?

He obviously had a hard life.

The compression of the upper spine and arthritic nodules

suggest he carried heavy weights in his youth.

Maybe he wasn't always of high bearing.

Maybe he worked his way up. Some sloves did become free men.

"Sloves?"

Did I say, "sloves"? I mean...

Slaves?

Yes.

You mentioned parasites.

Yes. Intestinal worms.

Probably Guinea worm or some kind of tapeworm.

So he'd have suffered diarrhoea, dehydration, anaem... Oh!

Ohh!

Mary?

So you just went and bought everything?!

Days-of-the-week bibs, steriliser, car seat.

And a baby monitor, so sensitive I'll be able to hear her hair grow.

And you didn't think... It just never occurred to you...

that this might be something nice for us to do together?

I thought you wanted me to bond?

I do. But...

I got you a present...

in bland, to match your girlfriend.

Has this happened before?

I just fainted.

-Has it?

-I don't know when I last ate.

Has it happened before?

-Never.

-That is a lie.

Once.

Have you got tingling feelings down your left arm?

Bad circulation.

Eyesight comes and goes?

I spend far too much time in front of a computer screen.

Words. You get some words wrong?

I... I...

I will give you three words.

I'm fine.

Transient Ischemic Attacks.

Really... I'm just so very happy that the prince remained unhurt.

TIAs, do you know what they are?

Please, I just want to get back to the CT scan.

Mini strokes.

-So what've we got?

-Bay three - cholecystitis.

-Good, let's go.

Four - ileostomy reversal.

Possible.

Leg ulcers.

Varicose veins.

Ah, varicose veins.

-Really?

-Really.

Mr Tindal, good morning. Today is your lucky day.

Right, let's get you prepped and ready for theatre.

And I'm going to get Zosia.

No-one dodges surgical training on my team.

Zosia agreeing to do a varicose "nip and rip".

You really see that happening?

Did you see the look on her dad's face

when she wasn't in the appendisectomy? Not a happy bunny.

You have to let me take you upstairs.

No!

-And the mummy can't come.

-Then definitely no.

Mini strokes are a warning. They lead to bigger strokes.

I only have him for four days.

You might not have four days.

All the stress and excitement could blow...

I don't want any fuss!

So you'd rather be paralysed?

I know something is wrong. I've felt it for weeks. My arm...

PAGER BEEPS

But while I've got him here I am not being ill.

That is my choice.

A blood clot could choose for you.

You could be upstairs removing an appendix. That was your choice.

That doesn't float my boat. That's not the point.

No, no, but this floats mine.

This...unravelling the mystery,

this makes me feel more alive than anything else.

Until a clot lodges in your brain and pow!

-So, you don't answer your pager any more?

-Mary just...

Choose your own curriculum. Decide what modules you think relevant...

-..collapsed!

-What?

Weakness in left arm. Slurring words. Elevated pulse...

I'm fine.

She won't let me examine her.

Nonsense. You'll let me.

Come on. Sit down. That's it.

Let's have a look.

Right. You're going to come up to the ward.

OK? So we can take a proper look at you.

I'm not going anywhere without my prince.

OK, that's it.

Mr Solis wants us. Now!

Oh, I'm so sorry. I didn't mean you to rush.

The pager message should have said not urgent. It's good news...

But as always here, it comes with a side-order of caution.

We have had a movement.

Of?

A bowel movement. Baby's first nappy!

You called us here - we ran all the way here for that!

This is massive. Not the bowel movement - that's tiny.

It's like a sparrow. But it's massive in terms of her progress.

Because of the hernia?

A percentage of babies with CDH

are readmitted with bowel obstruction as a result of surgery.

But Emma's...

The poop speaks volumes.

She pooped!

Isn't that great?

Us neonatal doctors, we get obsessed with bowel movements.

Nothing makes us happier than a soiled nappy!

-So can we...?

-You can!

Hold her?

It started with a poop. Ended with a cuddle.

-Where's the father now?

-Gone to phone the mother.

-She's where?

-On a yoga retreat - hard to reach.

Anything from the drains.

Pumping blood.

The lungs are filling up.

A kidney transplant presenting with bleeding lungs?

It's not necessarily connected.

-No.

-If I was married to him, I think I'd be at a yoga retreat too.

Actually, we're divorced. The stress caused by Tay's condition.

Which it appears was entirely your fault.

You and your incompetent team.

Look, I'm really sorry for any stress that Tay's been under.

Ms Effanga. How many heart/lung transplants

have you been involved in?

I don't know exactly.

Ball park?

More than fifty. Less than a hundred.

OK. I want you in here, now.

No. She's not putting a hand on my son.

Now, Ms Effanga, means now.

I don't want her operating on my son!

And I don't want him to die.

I'm going to complain to your superior.

Do what you have to do. We'll do our job.

It's far too warm in here. Where's my meter?

Never mind your meter. We need to get you an angiogram

and an ultrasound to check your blood flow.

I can't stay here.

Look, just to run some tests.

What if she's right, and I have had a mini stroke?

Then you're going to want to shove me into some bed.

No, no. We can cross that bridge when we come to it.

I can't stay. He can't stay.

Statistics show that within three to seven days of a TIA

there is a vastly increased risk of a full stroke.

I don't care.

I've only got Prince Karnak for three more days, and nothing is...

A bed. A chair.

-A box.

-Zosia, please.

Those are the three options after a full stroke. A bed.

A chair. Or a box.

Do you really want to risk your life over a shrivelled relic?

All right, I'll get you another doctor to run those tests.

Zosia.

I'll do the angiogram and ultrasound.

You are in theatre as of ten minutes ago. Varicose veins.

"Nip and rip"? Thanks, but I think I'll pass.

You're in theatre now. Or you're off my team.

-Come on.

-I mean it.

OK, so I may have oversold it slightly.

It's not so much a cuddle. More of a cradle.

I've wanted to hold her so much.

It's frustrating, I know.

-But she looks so fragile.

-Now's your chance.

Will you do the honours?

Sit down, and I'll pass her to you.

Keep everything very slow.

It's a bit like reversing a strange car for the first time.

Got to watch out for all the corners.

BABY WHIMPERS

That's it.

Gently support the head.

I have had guinea pigs bigger than she is.

Sit down. I'll pass her to you.

-Jac?

-You go first.

No, she's your wee girl, you gave birth to her...

You hold her.

I'm sorry, she's not...

There's only one thing that matters.

Do you think I should go and get her?

I think you should hold your daughter.

-There we go! You got her?

-Yeah.

Oh, hello!

I know, I know.

BABY SQUAWKS

Why did you do that?

Perform a thoracotomy?

Ignore the wishes of a young patient's parent.

You like being told what to do

by people who aren't qualified to make the call?

-Obviously not.

-Me neither. So?

There's an awful lot of pus. More suction, please.

The poison he ingested

that messed up his kidney in the first place - what was it?

Said he accidentally ate a death cap mushroom.

How did he "accidentally" eat a death cap?

Teenage experimentation, I guess. Picking magic mushrooms...

Big mistake.

Why did you ask me in here? I mean,

you could have just sent me upstairs. Let the boss sort it out.

I wanted to see how good you are.

You never really know a surgeon

until you've seen them with a knife in their hand.

Oh. Graced us with your presence in theatre, at last.

Shouldn't we be honoured(!)

Shut up, Dom. I had no choice.

Sacha got all on my case.

-Maybe because someone rattled his cage.

-Who?

It's a train wreck... Blood vessels around both lobes are haemorrhaging.

Tissue's mushy.

-So?

-So, this is a 17-year-old boy

with the lungs of a 70-year-old asbestos worker.

Well, can we save them?

I really don't know. Honest answer - probably not.

-Way forward?

-The only option is pneumonectomy.

Why did this happen?

-Infection.

-Linked to the kidney transplant?

No, the mushroom toxin wouldn't affect his lungs,

not this long after.

No, but the anti rejection meds would compromise his immune system.

Yeah. That's what they're meant to do.

After transplant, we have to shut down the body's responses,

otherwise it'll attack that big old lump of meat

that we've grafted into him.

It's Mr Self.

Tell him I'm in theatre.

I think he knows. He's called you on the theatre phone.

Mr Self, can we update you later? Thank you.

You some kind of rebel against authority?

Do you like your job?

-Transplant?

-Yeah.

-I love it.

Except on days like these.

You don't like it when things go wrong?

Do you?

I love it.

Oooh!

Oh, Jac, she's so beautiful.

Do you want to hold her?

I think that's enough. We don't want to tire Emma out.

Jac, she's so light. Jonny's right,

like a little guinea pig.

I wouldn't know.

You've never had a guinea pig?

B/P's dropping. Push more fluids and FFPs.

-Adrenaline's going in.

-Volume's still dropping.

Lungs like a sieve.

Saturations falling down to 82.

We can't wait for the antibiotics to kick in,

just in case they might work.

We need to get more oxygen into his bloodstream, or he'll die.

Rack the PIP up to 45 and the PEEP to 15.

We need to get him on ECMO.

VV would be ideal, but as he's so unstable, VA's the only option.

Yeah. That'd be great but we don't have one. The nearest one's probably...

Leicester. There's two in Newcastle.

In Japan, ECMO is standard.

Yeah, well, not here.

If it was me and my son had to have a transplant,

I'd be climbing the walls too. Fingernails in the plasterboard.

It's not your son. And you have no idea what it's like.

OK. Well, I understand your...

I did not give permission for her to operate on him.

And I want to make an official complaint.

It was an emergency procedure.

Your son's welfare was seriously compromised.

He's a very sick young man.

Because of the kidney they gave him.

No, we don't know there's anything wrong...

-Or the drugs they put him on.

-..with the donor kidney or the schedule of medications that he was put on.

Someone has to shoulder the blame!

I'm sorry, what blame?

Look, I'm just trying to get up to speed here.

Why did he have the kidney transplant in the first place?

What was it that caused the damage?

There was an incident with... wild fungi.

-Right.

-The mushrooms were... PHONE RINGS

-..that he ate, they...ah...

-Excuse me one minute.

Yes. I'll be right there.

You're not going anywhere until you've answered my questions.

I'm afraid your son has stopped breathing.

How dare you let her hold my baby before I've had a chance to!

I offered. You didn't want to.

-I wasn't...

-Ready? Yep. Jonny was. Bonnie was.

Most important of all, Emma certainly was.

I'm her mother.

Who chose to be the busy consultant rather than hold her own baby.

Has it ever occurred to you that I might find the first time...

-Difficult?

-Difficult? Yup. That's not my concern.

What goes on inside your head it's not my remit.

I can't let it make any difference.

I have to put Emma first.

I have been in Neonatal ITU for 16 years.

It's the most singularly depressing and uplifting unit in any hospital.

Do you know how many babies I've watched die?

What's this - mine's-bigger-than-yours?

1,334.

You count?

I count. Every. Single. One.

In here, we measure lives in minutes.

Every single one of those mothers would rip her own heart out

for a chance to hold her baby.

So this is Holby City's fault? Is that what you're saying?

You're telling me this hospital doesn't have the right equipment?

No, he really is not saying that.

-He's like this because you don't have an...?

-ECMO.

Oh, for God's sake, what is...?

Extracorporeal Membrane Oxygenator. It's a special pump.

It takes the blood out of the heart,

fills it full of oxygen and puts it back into the body,

but without the lungs having to do any work.

His lungs have been badly damaged, due to infection.

ECMO is rare in emergency departments in the UK.

Then get him to a hospital that has one.

I'm afraid he won't survive being moved.

He's going to die?

At this stage, it's impossible to predict the outcome.

-This was me.

-Sorry?

-I did this.

Mr Simons, fault is not something we...

Wild food foraging.

You picked the death cap?

Woodland mushroom risotto.

I thought any idiot can identify a mushroom.

I mean people have been living off the land for thousands of years.

Could we get an ECMO team helicoptered in with their kit?

Unlikely. It would still take too long.

His lungs are so shot. Like soggy tissue paper.

OK, so how do we rest his lungs without ECMO?

We build it!

Surgical stores. Show me.

There. Ligation and stripping of the varicose vein.

Nip and strip.

Oh, sweet joy.

Listen, don't knock it.

This may not be the pinnacle of surgical glamour,

but the skills you hone during varicose vein removal

will translate directly to many more exciting operations,

-such as, Arthur?

-Ooh, aortic aneurysm.

-Yep.

-Ileostomy, pancreatic duct deviation.

Good. Excellent, excellent. All the same basic techniques.

Joining pipes. Or removing pipes?

-No.

-Plumbing, in other words.

Right. This is how it's going to go. Show one, do one, OK?

I've shown you three - now you do.

Yes, yes.

Things to remember?

-Tie the junction.

-Insert guide wire.

Double tie the junction.

Sorry, double tie the junction.

I've done the ultrasound on Museum Mary's carotid.

-And?

-You should take a look.

OK. You two. Continue, right?

Take out these other three short tributaries.

Remember, take it slow and keep it neat.

So you nip and I'll rip. And then we'll change over.

I'll nip. You rip.

You make it sound so inviting.

OK, we tied off?

-Yes.

-Double tie?

Yes!

Nearly ready to rip.

You do know the real reason Sacha arm-twisted you into here, now?

Illuminate me.

Your father.

Had a massive go at Sacha about not pushing you into theatre.

My father spoke to Sacha about me?

OK. Ripping on three.

One. Two. Three.

-You said you tied it!

-I did!

Yes, quickly, hurry. We need to stem the bleed.

OK, we've got access to the median sternotomy.

So we just need to bodge up a simple circuit.

One tube through his vena cav. One through his aorta.

One cav. One aorta. Check.

You are not seriously going to build this?

I'm open to alternative suggestion? But it's this, or we lose him.

We could use a normal CPB cannula

-and a big two-stage for the right atrium.

-Nice.

An 18-French for the aorta.

Do you actually know how to build it?

Not exactly.

If this doesn't work...

On my own head? Deal?

OK. Well, you're going to need a VAD pump.

Three-eighth pump head?

Check.

Three-eighths tubing and half inch for the venous line.

Pigtail connectors.

We need an oxygenator and a heat exchanger.

Defunct.

OK. So if we don't have a heat exchanger...

Maybe we could just use...

-A bucket.

-A bucket!

-Right, push more units.

-More blood!

Push more blood. Hold it fast, tightening the stitches.

Folding it over.

OK. OK, yeah, I can get through there.

-Yeah?

-Yeah.

-OK?

-Yeah. Just...

-Oh, sorry.

We need more suction and I want two bulldog clips and some sloops.

OK. I told you to tie off the vein.

I did, I double tied it.

Yeah, but you tied the wrong vein.

Right, sats are 40%.

Bradycardic. He's going to arrest any minute if we don't do this.

Heparin in.

Dividing lines.

-Circuits ready.

-What about the venous line in the right atrium?

It's in. Clamps are off.

Pumps at 2,000 revs.

Got flow.

OK, increase revs to one third flow.

Looking good.

OK, let's go to half. Sats to 71.

All right, let's go up to two thirds flow.

Sats are 98!

Houston, we have lift-off!

Slick, guys. Very, very slick.

Are you hungry? Surgery always makes me hungry.

Starving!

Jac.

I'm sorry.

I feel terrible about...

Can we talk?

I would rather have my eyes pecked out by seagulls.

I didn't know you hadn't held her. Jonny never said.

I went with him to see Emma

and before I knew it she was in my hands.

Look, I can coo and cluck and sound like I love babies

but the truth is, I know nothing about them.

I'm 29!

What I want most in my life is a car that actually works

and a snowboarding holiday.

Lots of necks get broken snowboarding.

You gave birth to that beautiful little girl. To Emma.

Don't! I hate it when I hear you say her name.

Good. You should.

When I saw you holding her...

I wanted to reach across that cot and rip your throat out.

So why didn't you hold her?

So you still just bully anyone who doesn't do exactly what you want?

Directly interfering in my training? Telling my tutor...

That's my job.

Just because you chose to come and work in the same hospital where I...

Work? Darling, I run this hospital.

You forced Sacha Levy to put me in theatre.

Keller is a surgical rotation.

I don't want to be a surgeon.

I don't want to be anything like you.

No, you don't even want to use my name. "Dr March?"

What is that all about?

You can talk to her, you know.

Yeah. She's going to hang on my every word?

She knows your voice better than anyone.

She's heard it every day.

Don't you think that might be comforting now?

Hello.

Hello, Emma. I'm your...

-I want to hold her.

-Sorry?

-I want to hold her.

Now's not a good time.

She's just come off an O2 top-up and a small feed.

If you come back in, I don't know, um...

No. I want to hold her now.

I'm so sorry, Jac. In terms of her care cycle,

this wouldn't be an appropriate time.

Let me hold my baby.

-Cronut?

-Yep. Cross between a croissant and a donut.

All the rage in New York.

Your wife makes these from scratch?

No recipe. Nothing.

My wife can do just about anything she sets her mind to.

-Nearly anything.

-She wouldn't be interested in leaving you

and marrying me, would she?

She comes with two neurotic Persian cats,

and a mother like a pit-bull on crack.

-Could just as easily have been Dad who ate it.

-Yep.

Could be him lying in there, fighting for his life.

You don't think he wishes it was?

Melted cheese!

-Don't try and stop me.

-Melted mozzarella cheese.

-A couple more days is all I need.

-Like on a pizza.

If we did a CT scan on your brain right now,

that's exactly what we'd find.

Little tiny lesions that look like melted cheese.

-I don't care.

-The artery in your neck

is starving your brain of blood, OK?

Your vessels will rupture and fuse your synapses.

Listen, I'm really grateful for everything you've done...

Dr March... Dr March was right.

A bed, a chair or a box. That's how this could end.

In three days' time, you could be deader than that.

I know this doesn't make sense to you...

It does, I promise you, Mary. It does.

I understand passion, obsession, compulsion.

What I don't understand is how a beautiful,

-intelligent woman would waste her life on a lie.

-Lie?

Lots of these mummies were switched around by Victorian collectors, yes?

Some of the tombs that were grave-robbed lost their bodies.

Yes, and some of the bodies ended up in empty sarcophagi,

to make them more collectable.

-That's great. Right. Look at this.

-No, no, don't...

We didn't get a chance to get into this before your short circuit.

Look. Look at the prince's pelvis.

See? See the way it's broad across there. And just look, look.

There, there's a parting. OK. A split?

Battle wound?

Childbirth. The pelvis opens

to allow the baby's head to be pushed through.

You mean?

Prince Karnak was a woman.

I... I...

So you see, you're going to need so much more time

to unravel this particular mystery.

But I...?

Come on. Come on.

Now. What do you think she smells of?

-Toast.

-Toast.

This is just a temporary ECMO circuit.

The mobile team is on its way with one to last him a few weeks.

All we're really doing is giving his lungs a rest.

Without the risk of damaging them with a mechanical ventilator.

ECMO will do the work of the lungs.

Giving the antibiotics a chance to fight the infection.

And the tissue time to regenerate.

I'm sorry. I...I behaved like a jerk.

We see all sorts here.

I just feel so guilty about...

I lash out.

I try to make it other people's fault.

It's no biggie. Honest.

We'll leave you to sit with him.

I can't forgive myself - I poisoned my own son.

It was an accident.

I poisoned my only son.

Can I ask you - does Tay blame you?

He... I...

He... Never.

Not a word. Not a single recrimination.

He's never said anything.

So you beating yourself up about it, how does that help things?

I think he blames me more for sending him to that school...

He didn't sound too chuffed about it being all boys.

It's the best education money can buy.

-Maybe.

-The best.

He'd rather just live with me at home.

Go to the local comp, hang out with girls at youth club.

Sometimes "best" isn't always...best.

Zosia.

I am sure that one day, you are going to be a great psychiatrist.

But today - today you are a very poor, very dangerous surgeon.

This is a surgical rotation and if you're a rubbish surgeon,

then that makes me a rubbish teacher.

If the cap fits.

I am the Clinical Skills Teacher.

Me. This is the Sacha Levy School of Surgery...

and I know that you have it in you to be a brilliant surgeon,

-but if you don't want to be, you know what you can do?

-What?

Get. Out. Now!

Tomorrow morning. 8am.

I want you all in the wet lab,

and you are going to perform a femoral venous stent,

and to make it appropriate,

an open artery fold suture.

-Tomorrow?

-Yes. Tomorrow. 8am sharp.

And if any of you fails the test,

then you will all fail this rotation.

-That's not fair.

-No, it's not fair. But that's how it's going to be.

You can't just...

I will accept nothing less than 100%.

And if that is a problem, then there is the door.

Use it!

Jac, I've got a patient with a mitral valve replacement...

No. Busy. Go away.

Elliot!

So you want me to commit my AAU department

to buying a £90,000 extracorporeal membrane oxygenator pump?

It would be the first in the southwest.

Look, our patient today would have died

without the one we cobbled together.

-In the future...

-You performed a procedure

that's never been performed at Holby City before.

Never in the UK, sir. I checked.

Holby City made medical history.

And you did all this without the guidance of the consultant who,

I have to say, took a big risk in appointing you.

If it'd been left up to me...

Just imagine how much more I could do with Mr Griffin.

So now, you want me to pat you on the back and say,

"Good first day. Keep up the good work"?

To be honest - I couldn't have done it without Mo Effanga.

That is one registrar I'd fight to keep, if I was you.

Oh, right, so now you're trying to tell me how to do my job as well?

Sorry. I'd love to. But I can't... Not right now.

Have to go pick up my wife. She doesn't do waiting.

I could discuss it with you tomorrow if you like?