Dark Night of the Soul Holby City

I owe you an apology.

You mean you're not the power-crazed megalomaniac that I took you for?

Maybe we're more alike than you think.

-Sir Dennis hasn't been in the theatre in five years.

-Sabbatical.

Yeah, but voluntary or forced?

You were ready to leave that man on the table untreated?

Was that incompetence or just plain indifference?

Everyone leaves.

My grandmother, who practically raised me, died. And now my dad.

No. You're not rushing me into this like you do with everything else.

The engagement, the big ring, the house...

-I thought that's what you wanted.

-Did you stop for a minute to ask?

-What's wrong?

-It's my mum.

She's dead.

Morning, Mr Hanssen!

Oh, dear. Was it trouble on the night shift?

Have a good day, Mr Levy.

-Night.

-Night.

-I think we should call it a day.

-Straight through please, Tony. Thank you.

-You jinxed it.

OK, this is Billy Salman, 47 years old today, actually.

Today is his birthday.

Our gift to him is surgical intervention for a fractured penis.

Oh. Happy birthday!

Apparently he sustained the injury whilst getting slightly adventurous

with his wife, when he heard a loud crack.

-SHE LAUGHS

-Would you find it so amusing

if it were a female patient with a genital injury?

In fairness, he's finding it quite funny himself.

Which one of you would like it? Or do you want me to call Urology?

I've done it before. I can take him if you want to get off?

I've got paperwork I have to finish anyway.

No, it's all right, I'll take him. You finish your paperwork.

To my wonderful wife.

-To Mum.

-To Joy.

-Joy.

Dad, take it easy, yeah?

So, you all set for the boat tomorrow?

She wanted to be scattered in the Caribbean.

Not some murky shipping canal.

Come on, Dad, that's enough. Let's go back to the flat, yeah?

I'm happy here.

Yeah, but I think Ina and Mo want to get home.

-Thank you for coming.

-It was a lovely service.

-It was lovely.

-Yes.

-Shall I take this to the car?

-Stop fussing, boy. We're OK.

(Sorry about...) LOUD CRASH

-Dad!

-We have significant ecchymosis of the shaft and the scrotum.

-HE GRUNTS

-There's obvious penile angulation.

Two centimetre swelling with...

-..retractable foreskin.

-HE LAUGHS

-Mr Salman...

-Doc, we just went to third base. Call me Billy.

Billy. I don't think you appreciate

the potential seriousness of this injury.

Oh, I do.

-You may have torn your urethra.

-HE GIGGLES

-Why is that funny?

-I don't know.

He's probably had enough nitrous oxide. Let's move him onto morphine.

-Has he passed urine since the injury?

-Yes.

We need to do an urgent urine analysis.

If there's blood in the urine,

then we need to book a retrograde urethrogram ASAP.

Once we've established the full extent of the damage

then we'll take you into theatre.

And, er, many happy returns.

He's a bit of a stiff.

HE GROANS All right, Dad, don't ham it up.

-Jesse.

-Hm?

Right, let's get you home.

Oh, our bags are in Jesse's boot.

-You OK?

-Just need to catch my breath.

-Here.

-Don't fuss, Maureen.

-Let me have a look? Mum!

OK. I think we're just going to take a little trip up to the sixth floor.

-No, we are not. I want to go home.

-Tough. Come on. Come on.

Honestly, the pair of them!

Ms Effanga!

-And who is this?

-Ina Effanga.

Maureen's sister?

What a pleasure. Sir Dennis Hopkins-Clark.

Cardiothoracic consultant.

Mum had a valve replacement about a year and a half ago

and a tamponade last March. She's breathless and tachycardic.

A little unorthodox.

A visit to the GP for a referral tomorrow morning

-would have been more appropriate.

-Hiya, Mo.

-Hey.

I think Mr Valentine might be able to take a quick look.

Please. Allow me.

There, Mum. Nothing Steri-Strips and skin glue can't fix.

Jesse?

Hey, Raf. Dad, this is Mr Di Lucca.

I'm sorry to hear about your wife, Mr Law.

-Thank you.

-Could have been worse.

Mum nearly ended up all over the floor of Albie's, didn't she?

Right. Done.

We'll get you some painkillers

and then we'll get you to X-ray to see how that ankle's doing, OK?

-Just in case.

-Thanks for this. I really appreciate it.

-No problem.

Right, I'm starving. I'm going to get myself something to eat.

Go and get us a kebab. No salad.

-And garlic sauce.

-Dad, I can't bring that kind of food in here.

-Why not?

-That's all right, isn't it?

-I don't see why not.

-You sure?

-Right, kebabs it is.

-Get us a lemonade.

A proper one, none of that diet rubbish.

Yeah, Dad. OK.

Thanks for this. I won't be long. I could do with a break.

-And the tamponade, was that...

-Pacing wire bleed.

Hmm.

An FBC, U&Es and an ECG please, nurse.

And, Mr Valentine, if you'd be so kind as to do an echocardiogram.

-Of course.

-Don't worry, Mrs Effanga. I'll take good care of you.

Excuse us.

I've never met anyone who's been knighted. He must be very good.

-Ah. Ruptured corpus cavernosum.

-Ouch.

There was a small amount of blood in the urine

but the RUG's come back inconclusive.

There was a large clot obscuring our view of the urethra.

-OK. So...

-So we're going to have to do a degloving.

-By we, you mean...

-Sorry, I meant you.

It's a great urology case for your portfolio. It's a quiet night.

I can't think of a single good reason why

you shouldn't take the lead, can you?

Give me a minute, I'm still thinking.

I'll let you explain it to him.

You OK, Mr Law? Is Jesse not back yet?

Oh, no, he'll be halfway across town by now.

The takeaway's just down the road.

He'll have some excuse about why he had to go to so-and-so place.

He's like a shark. He has to keep moving or he'll drown.

-Ah. My chariot, I presume?

-Yes.

HE GROANS

To X-ray. Thank you.

-Are you mad? You're going to peel...

-Shush, shush. Don't say peel.

No, no, no, no. No way.

Mr Salman, if we don't surgically repair this injury, it could lead

to the formation of fibrotic plaques, penile abscesses,

urethrocutaneous fistula, painful penile nodules,

-abnormal penile curvature, erectile dysfunction...

-OK, OK.

Where do I sign?

-Here you go.

-I can't drink caffeine at this hour.

It's redbush. It was Adele's.

-How long has it been open?

-No idea.

-Let's have a look then.

-How are we getting on, Mr Valentine?

Excuse me, please.

Anything on the ECG?

No. But these parameters give a fairly clear picture.

Clear picture of what?

Mrs Effanga. Your heart disease has progressed to what's known

as left ventricular systolic dysfunction, or LVSD.

In a nutshell, it means your left ventricle has weakened

and is causing your heart to pump less effectively.

Now, in some cases this means it could stop quite suddenly.

It's all right, it's treatable.

-Will I have to have another operation?

-No.

-Yes.

No, I wouldn't recommend any further surgical intervention.

-We can treat you with drugs.

-Hang on a minute.

I'll prescribe you some tablets for you to take home.

For now, we'll give you something to slow your heart rate down.

-She needs an ICD.

-Maureen, stop interrupting.

I'll also refer you for an EP study.

That'll give us a better picture of what's going on.

-Thank you.

-You should be fine to go home in the morning.

She's at risk of sudden cardiac arrest, she needs an ICD.

You'd put your mother through cardiac surgery for the third

-time in under two years?

-Yeah. If it means it'll save her life.

You know she's not a suitable candidate for transplant.

Who said anything about a transplant?

It's the only cure for end-stage heart failure.

Everything else is just a sticking plaster.

Look, I'm sorry. I know how difficult this is,

but there's nothing that can't be managed with medication.

Why don't you go and be with your mum?

Can you believe that bloke?

"She's old and she'll die sooner or later, so what's the point?"

What would you do?

I'd give her an ICD. But it is borderline.

And it is his call.

You should show more respect to Sir Dennis.

-Just hear me out.

-No.

I know you think you know everything,

but he has probably been a doctor longer than you've been alive.

Do you really think that you know better than him?

-Right. I'll go call Celia and Adele.

-Don't bother them now, it's late.

They need to know what's going on.

Corpus cavernosum. Sounds like a Harry Potter spell.

Corpus cavernosum!

-How goes Billy's willy?

-I don't want to talk about it.

-He's got to do a degloving.

-Really?

-Mr Griffin? Billy Salman.

-Yes.

-What's wrong with a transverse incision?

-Excuse me?

Well, it's less invasive, more likely to maintain correct organ

function, less likely to reduce sensitivity.

I appreciate that but, well, we can't make his sex life

our only priority in making our decision.

Just because you're not getting any

doesn't mean you have to write him off.

-I beg your pardon?

-I'm just saying...

We need to protect the urethra or he could spend

the rest of his life with an indwelling catheter.

And I don't suppose that's going to do his marriage much good either.

You don't even know if there is urethral damage.

-I don't want to take the risk.

-It's not that risky.

You incise the Buck's fascia, evacuate the clot

and examine the fracture site.

At that point, if the urethra is torn

and you really can't access it, then consider degloving.

Come on, Ric. It's the man's birthday.

Well, thank you for your input, Ms Wolfe. We'll be doing a degloving.

Is he always this uptight?

What does Billy think?

He wasn't really given much of a choice.

-Right.

-What are you doing?

Essie's right. It's the patient's choice, not Griffin's.

Did I say that? I don't think that's what I said.

What do we do? Get involved or...stay out of it?

BOTH: Stay out of it.

Don't question me, please. Just do as I asked. It's not complicated.

Erm, Mr Hopkins-Clarke, sorry. Ina Effanga.

Are you sure that you don't want to consider the ICD?

Yes, Mr Valentine. I'm quite sure, thank you.

Let's see how you get on with this, shall we?

In the meantime, try and get some sleep.

I'm dying, aren't I?

Not today.

How long do you think I've got?

I can't tell you that, I'm afraid. I wish I could.

When the time comes, I don't want to drag things out.

-I want a DNR.

-A DNR?

I know what it is.

I'm not sure we need to be having this conversation just yet.

Maureen thinks that I don't listen to her

when she talks about her work, but I do.

I know how bad things can get.

Mrs Effanga. Nothing's going to happen to you.

-Not tonight.

-No, but it pays to be prepared, don't you think?

If that's really what you want,

I'm perfectly happy to arrange things for you.

-And I can still take the tablets?

-Of course.

What would you do if it was you?

Well, modern medicine is miraculous. But no-one lives forever.

-Ms Wolfe?

-Ah. Ah, Mr Griffin.

I was just outlining the alternative procedure for Billy

-so he can make an informed decision.

-I like this one. She can do it.

Mr Salman, just to be clear...

It's all right, Doc. You don't need to tell me it all again, I get it.

If we do it her way, there's a chance I'll end up peeing

through a tube for the rest of my life.

We do it your way, I'll be able to pee, but not much else.

That's the worst case scenario.

And there are medications that can deal with that.

Yeah, but, how did you put it? Loss of sensation?

There's no pill for that. And, you know, it's just this...

-Degloving.

-It's not a good word, is it?

It's the stuff of nightmares, that.

No, I'd rather give this a go.

OK. Well, in that case, I'll take over from here

and we'll get you into theatre ASAP.

What just happened?

Look, I've seen enough guys with lower torso injuries

to know that nine out of ten of them

would rather lose their legs than the use of their penis.

And I mean that most sincerely.

It can cause genuine psychological trauma.

You'll be going in blind. You have no idea what's behind that clot.

In that case, I'll deal with it.

But let's at least give him a chance.

I offered him a choice. And it is his decision.

You may disagree, but you have to respect the patient's wishes.

Fine. I'll get changed.

Ah. I was beginning to think you'd got lost.

-What's all this?

-Ah, he's got a UTI. Hence the abdo pains.

So I've put fluids up and also put him on co-amoxyclav.

Right. Sorry.

Better to keep on top of it, eh?

How's his general health?

Does he take care of himself? Eats properly?

Listen, that man's been doing all the cooking and the cleaning

-since Mum's first stroke.

-Is that a kebab?

Yeah, why? Do you want some?

Oh, no. I've not long eaten.

I see you've been getting the VIP treatment.

Ah, finally. I could eat a scabby horse.

Well, you might be about to.

Sorry I was gone a while, I went to that place near the flat.

They do the best hot sauce in all of Holby.

You're going to love it.

-Is there anything we've discussed that you want me to clarify?

-No.

-OK.

Are you sure you want me to sign?

Right. Adele has told me to tell you

that she opened that redbush three weeks ago, so...

-What you doing with that?

-Your mother has opted for a DNR.

-No!

-Maureen. People are sleeping.

-Don't sign that.

I don't think you realise just how serious this is.

Until we get things under control, your heart could stop at any time.

Exactly. Do you remember Rosa from my church group?

Covered in wires and tubes, breathing through a machine.

It took months for her to die. I don't want to end up like that.

-You won't. Listen...

-Maureen.

-No, just listen to me.

I want you to have surgery.

There's a device we can put in your chest, it's a tiny defibrillator.

It monitors your heart and if it needs to,

it automatically delivers a small shock so that you don't arrest.

-Like a robot?

-It's just like a pacemaker.

It keeps your heart beating the way it's supposed to.

But not the way the Lord intended.

So what? You're just going to give up, then?

Don't be dramatic. Look, I'm taking my tablets.

I am going to the hospital for my appointments.

But when my time comes, Maureen, I just want to be prepared.

That's all. Sign, please.

OK, clot's out. Right. Let's see what we've got.

-You can't see anything from over there, Dr Copeland.

-I know.

Oh, for heaven's sake, man up.

You think this is the worst thing that can happen to a man's bits?

You should see the poor sods who've stepped on a land mine.

Right, tell me what you can see.

Erm, I can see the fracture and the urethra, which is intact.

Yeah, it's actually not that bad at all.

Yeah. You see? All that worry for nothing. Next step?

We expose the cavity and repair with...three interrupted sutures?

-Using?

-5-0 Prolene.

-Perfect. Off you go then.

So. You seeing anyone?

You can't mope forever.

I'm not moping. Why would I be moping?

I'm back doing a job that I love, I'm making new friends,

I'm enjoying myself. HE LAUGHS

-What?

-Something your mum said, after the "wedding".

-Don't do that.

-What?

That. "Wedding".

Do you want to hear what your mum said or not?

You know what? I'm going outside for some fresh air.

-Isn't digoxin usually prescribed in micrograms?

-Yes, why?

Mr Hopkins-Clarke gave Ina 25 milligrams.

-Micrograms.

-No, milligrams.

What's going on?

What?

OK, get me one milligram of IV atropine, quick as you can, please.

-Need to get her into HDU, Mo. Are you good?

-Yeah.

-What's happening?

-It's all right, Mum,

we're just going to get you into your own room. Just try and relax.

-Oh, Jesse. Hi.

-All right, mate. Isn't it way past your bedtime?

Listen, I heard about your mum. I am sorry.

Yeah. Thanks.

-What happened?

-Another stroke.

-Right. And how's your dad?

-He's on AAU.

Had a few rum shots too many and took a fall.

And you're sitting out here?

Yeah. It's fine, it's nothing serious.

Well, his wife has just died.

Yes, thank you, Guy. I'm aware of that.

I'm just saying. I mean, I remember after Anya died...

Oh, Guy. Come on, please.

Can we have one conversation that doesn't come back

to the fact your wife's dead?

Yeah, OK, Jesse. You know what?

You just sit out here on your own

and pretend that normal human emotion is beneath you.

It's a strategy that's worked out pretty well for you so far.

She grabbed him by his collar and marched him

straight to the nearest policeman.

His face!

-Course, he never did it again.

-I bet he didn't.

She was a spirited woman.

Can you get me another one of those, please? I'm parched.

-There's some water here.

-I'd prefer lemonade.

And maybe a bit of chocolate.

OK. Just bear with me.

Mrs Warren's finally gone off to sleep.

I thought I was going to have to read her a bedtime story.

Mr Law is complaining that he's thirsty, even though he's on fluids.

I think we should run bloods. FBC, U&Es and HbA1cs?

-What does Jesse think?

-Well, I'd ask him if he was here.

-Where's he gone?

-I don't know.

OK then, yeah, yeah. Run some bloods.

This is not your fault. Do you want to take a break?

And can you fill out an untoward incident form, please?

OK. Heart rate's coming back up.

-Can you keep an eye on her?

-Sure.

-I'll go and try find Dennis.

-Ollie. Steth.

Beautiful!

-I meant your suture work.

-Mm-hmm.

-Right. Gittes test.

-Eugh.

-Choose your weapon.

-Do we have to?

Well, simulating an erection is the only way we can test

if everything's back in working order.

Good choice.

OK.

-I say. Ding, dong!

-HE LAUGHS

-We seem to have a winner!

-THEY LAUGH

If you see him can you get him to call me back as soon as possible?

Heart rate's rising, it's over 100, and she's a widening QRS.

And she's struggling to breathe. Where's Dennis?

He left the ITU an hour ago. We can't get a hold of him.

Mr Hopkins-Clark, this is Mr Valentine.

Please can you call me back?

OK, 40 milligrams of furosemide and let's keep paging him.

We can't keep throwing drugs at her, Ollie, she needs stability.

A DNR does not stop us from operating.

-Dennis ruled out surgery.

-Before he made that almighty cock-up.

The picture's changed.

Look, her heart can't take much more of this.

She will arrest if we don't do something.

We both know an ICD's her best chance.

I'm sorry, I can't go against his direct instructions. I'm not Jac.

-Jac! Ollie, you're a genius!

-Mo...

Whoa!

-What's happening?

-Jesse.

KNOCK ON DOOR

Fracture's repaired. No urethral damage.

-He should be fine.

-Good. That's excellent news.

I, erm...

..did it again, didn't I?

I told you I would.

What was it you called me? A power-crazed megalomaniac?

Look, I'm really not interested in playing power games.

I only care about what's in the patient's best interest.

And on this occasion?

On this occasion, you gambled and it paid off.

But don't push your luck. Not with the patients.

Not with me.

All right. Leave it at that?

Still friends?

Let's say colleagues.

Respected colleagues?

I'll take that.

For now.

KNOCK ON DOOR Hey, you.

-How's Thomas?

-Oh, he's all right. It's you we're worried about.

-What's all this about a DNR?

-Has Maureen sent you in here?

No, she told me what was going on.

You don't need to be here, fussing around me.

-You should be with your father.

-Yeah, well,

he's getting on my nerves at the moment.

-You can't hide up here all night.

-I'm not hiding.

I know you, Jesse. You feel guilty.

-You weren't there when Joy died, so you're blaming yourself.

-No.

You've barely looked your father in the eye all day.

You think he blames you as well.

Ina, you're changing the subject. I know you too, remember.

You're being stubborn.

-Takes one to know one.

-Yes, it does.

What if Adele was here?

She'd tell me to get my butt in here and make you see sense.

So, here I am.

Have you spoken to her?

-No.

-So why are you here?

It meant a lot to me that you came to Mum's funeral.

Especially after...you know.

And I don't fancy returning the favour for Mo next week.

You do get how serious this is, don't you?

Jesse. When my time comes, it comes.

Ina, you're talking about this like it's some distant future thing.

And maybe it was when you spoke to Mr Hopkins-Clark earlier.

But things have changed since then.

And I'm not trying to scare you, but you need to revoke the DNR.

Maybe reconsider it further down the line if you want,

but if something happens tonight, we need to be able to put it right.

Do you understand?

-And you're not ready to go just yet, are you?

-No.

Right then, it's settled.

Now, are you going to tell me why you don't want this surgery?

She needs the ICD. It's the only way to get her stable.

Well, Mr Hopkins-Clark obviously disagrees.

Mr Hopkins-Clark just gave her a massive overdose of digoxin.

Drug errors happen, Mo.

-The agency nurse, whoever she is, should have...

-Yeah, she tried.

-But he bit her head off apparently.

-What do you want me to do?

Tell Ollie to take her into theatre.

Without seeing the patient or reading her notes, I can't comment.

Can't you step out for minute?

Oh, that's a good idea(!) Why didn't I think of that?

Here you go, Dave, can you take over for a bit?

-Please, Jac.

-I'm sorry. Find Dennis.

Let's carry on, please. Forceps.

-You found him?

-No. What did Jac say?

Ina's withdrawing the DNR. She's open to the surgery.

-What? How do you manage that?

-MACHINE BEEPS

-Mum?

-Her heart rate's 200.

VT. 200 milligrams of IV lignocaine. Quickly, please.

-She's peri-arrest.

-Mo, you shouldn't be here for this.

-Jesse, the DNR stands until I hear it from her.

-What?

I'm sorry, you're not the doctor on this ward, you're not on duty.

The both of you are here as family and friends.

-Ollie!

-Some space, please. We need to get her back into sinus.

-Come on, come on.

-Don't you dare, Ina.

HIGH PITCHED TONE

-No!

-Come on, Ollie. She's arresting. Start CPR.

-I can't!

-Ollie!

-Are you serious?

-I can't! I'm sorry, Mo.

I'll be struck off. I really am.

-Crash trolley!

-Jesse, wait!

-Stop.

-I've already lost my mum, Mo's not losing hers.

-Move.

-Charge at 150.

-Mo, think about it. This is your mum.

There is documented proof that she doesn't want this.

-Charged?

-Charged!

Stand clear.

Clear!

HIGH PITCHED TONE CONTINUES

-Charge again.

-Mo!

Please, this is not what she wants.

-Don't make it any worse than it already is.

-Mo.

-Mo!

-Charging.

Stand clear!

Shocking!

MACHINE BEEPS

Sinus.

If anyone has any suggestions how we get out of this,

-feel free to speak up now.

-It's on me.

-Yes, too right it is.

As soon as she wakes up, she'll confirm what she told me earlier

-and everything will be fine.

-If she wakes up.

I'm sorry, Mo. I'm just saying it as it is.

-We need to give her an ICD.

-No. We don't have consent.

-It's what she wants.

-That isn't the same thing.

It is the same thing. OK, she didn't sign the consent form.

But she would have done if she had the chance.

-I need to find Sir Dennis.

-He'll never agree to it.

I can't go into theatre and leave the ward without coverage.

-Someone has to be here.

-Tell theatre we're coming.

Please tell me that isn't... Mo!

-Absolutely not.

-The only way, Ollie.

OK, wait. Just wait.

I'll do the surgery. You cover the ward.

That is the least bad version of this.

-No, it's not. I should do it.

-What?

I'm the only one who can say I'm acting on her wishes.

-You're not in enough trouble as it is?

-It can't get any worse, can it?

-I beg to differ.

-I can do it. OK.

So long as Mo doesn't touch her

-then technically she's not breaking any rules.

-He's right. Let's go.

I am really, really not happy with this.

If you see Dennis tell him you tried to talk us out of it.

-I am trying to talk you out of it!

-There you go. You'll be all right.

Mo!

We've just had your blood results back.

I think it may explain why you need to go so often.

It's the diabetes, is it?

-What? You knew?

-Course I knew. My GP told me.

-And were you prescribed any tablets?

-Yes.

-And have you been taking them?

I haven't had a chance to pick them up yet.

I was looking after Joy. And then with the funeral...

Mr Law, you really can't just ignore this.

If I cut out the booze and eat rabbit food

and start exercising, how long will I live then?

There's no reason why you can't keep on going

-for another 20 years or so.

-20 years!

Rattling around the house on my own,

eating lentils and chickpeas. Without scotch?

There are worse things than dying, you know.

Besides, my Joy is waiting for me.

Relax, all right? I've got this. I've seen it done 100 times.

Just talk me through it. OK?

Start by making a two-inch incision, just underneath the left clavicle.

Perfect. Self-retainer.

Self-retainer, please.

-Now, identify the left subclavian vein.

-Clips.

What the hell is going on here?

Close her up and take her back to the ward immediately.

Sorry. No. She needs this.

Look, just stop! I'll scrub in.

If this is happening, it at least needs to be done properly.

If he's refusing treatment, there's not a lot you can do.

It's just, you think of Arthur and everything he's going through

and just how much he wants to live...

It's very different. He's an old man.

His life revolved around caring for his wife and now she's gone.

He probably can't imagine what the future even looks like.

Yeah, I suppose.

And where's Jesse?

You know, my dad drives me mad half the time, but he's not well

and he needs me, so I'm there for him.

-Sorry. It's just...

-Have you tried his mobile?

Three times, it just goes straight to voicemail.

Maybe you should try Darwin?

I think I owe you an apology.

Ms Wolfe was quite right to offer the alternative procedure.

And I'm just glad it was a success.

-Not as glad as me, I can tell you.

-I'm sure.

-Perhaps next time, try something a little less adventurous.

-Eh?

Oh!

No, I made it up.

It was a regular, common or garden effort, I'm afraid.

I just sort of...slipped.

-Right. Erm...

-Guess I'm out of practice.

-Birthdays and Christmas is about the only time we ever...

-I see.

I wasn't going to admit that to the young lad. What's his name? Dominic.

-Say no more.

-You know, back in the day,

-me and the boys used to get to Vegas once a year.

-Yeah?

Blow off some steam. Watch some boxing, play some cards, you know.

-I do.

-Yeah.

Then after we all got married,

it was just cards round Dave's house every now and then.

Kids came along, we stopped playing for money.

And then eventually, we just stopped.

It happens so gradually, you don't even notice.

Do you know what I did for my birthday last year?

-No, what?

-No idea! Can't remember.

Or the year before. Or the year before that.

I can remember what all the kids did on their birthdays.

-Comes with the territory.

-Yeah.

I'm not complaining. I love having a family.

But nobody tells you this is what happens.

You hit middle-age and you just forget how to have fun.

Maybe it's for the best, though.

Look what happens when you try, eh?

Happy birthday, me.

Well, I wouldn't deal yourself out just yet.

Think of it as a bad beat on the river.

So, you're a poker man?

Jac. We had no choice.

I'm not sure the GMC will agree with you, but we'll soon find out.

He's not answering his phone or his bleep.

MOBILE PHONE VIBRATES I looked in there. I did!

-SHE CLEARS HER THROAT

-What?

Oh, there he is. Jesse, it's Morven.

She's wondering when you're going to be back down?

-Not now.

-I want her notes. Now. All of them.

-Jesse, you're suspended. Effective immediately.

-Hang on!

Until we know if there's going to be a formal investigation,

you do not touch another patient.

And you two better get your story straight.

Caesar's Palace, 1981, Sugar Ray Leonard versus Tommy Hearns.

-I was there!

-Tommy "The Hitman" Hearns!

-That was a fight.

After the twelfth round and Sugar Ray's behind on all three scorecards

and his eye is all messed up, and Angelo Dundee gives him that...

"You're blowing it now, son, you're blowing it!"

THEY LAUGH

SHE CLEARS HER THROAT

Yeah. It's his birthday.

Well, is it a private party, or can anyone join in?

-Tell me why you ruled out the ICD.

-Oh, come on, Jac.

She's only 65. She has a good quality of life.

If you define advancing heart disease and LVSD as good quality.

She's already had two operations.

Well, the second was due to a complication

-caused by the valve replacement.

-Exactly.

And what's to say there aren't complications from this

that mean we have to bring her in again and again and again?

And what's to say the ICD doesn't solve the problem

and her condition is stabilised?

If that's what it takes to keep someone alive,

a machine to shock her back into sinus every time she needs it.

Come on, Dennis. An ICD is hardly radical.

Is there a problem here? Are you questioning my judgment?

Because I seem to recall there was a time

when everyone said I was wrong about you.

When I was paying your fees, writing you references,

-mentoring you, supporting you.

-You know how grateful I am.

Then don't bite the hand that fed you.

You wouldn't be where you are today if it wasn't for me.

And look at where that is.

I really am so proud of you.

All right, then.

Hey, I heard about Ina. Is she OK?

Yeah, yeah. She's fine now. Listen, can we get my dad discharged?

-I'd like to take him home.

-Yeah, I'll get the paperwork sorted.

-Did you know he has type 2 diabetes?

-What? No, he doesn't.

He does. He's refusing treatment at the moment.

I've explained what the consequences will be, but...

..I think he feels like he doesn't have anything left to live for.

Thanks.

-Dad?

-Leave me alone, Jesse. That's what you're good at.

HE SOBS

-What happened?

-Hey.

It's all right, just relax. Relax.

Listen, Mum.

When you spoke to Jesse earlier, did you tell him

you wanted to withdraw the DNR?

-Hm?

-This is important. Can you remember what you said?

Word for word.

I swear, that's exactly how it happened.

Now, there's a guy at my boxing gym that I think you'd really

-get on with...

-Boxing gym?

Yeah, well, I go to keep fit.

It's bag work - punch bags, that sort of thing.

-So, boxercise, then?

-I'm not flouncing around in a leotard, no.

Aw, that's a shame.

It's about strength and stamina, reflexes, hand-eye co-ordination.

-How long you been doing that?

-Couple of months.

-Go on, then, Doc. Give us a demo.

-Oh, yes. Come on.

-Erm...no.

-Oh, come on.

-Yeah, go on.

-Oh, come on. Please.

-Just a quick one. Oh, please.

-All right.

THEY BANG TABLE

-Pay attention.

-SHE WHISTLES

First thing is your stance. You've got to keep your guard up.

Protect your head, your body and your...bits.

Right now, you've got to find a balance between mobility,

speed and power.

So you jab, jab, hook...jab, jab.

The greatest exponent of this art was, of course,

The Greatest, Muhammad Ali.

You remember the rope-a-dope when you just draw your opponent in,

wear him out, you do the shuffle, draw him in,

bobbing and weaving, and then you turn and you hit him with the...

Whoa!

Oh, whoops.

Boy, I remember this day.

It was a disaster, but Mum thought it was the best birthday ever.

Of course she did. We were all together.

What did Mum say about the "wedding"?

She said you'll act as if nothing had happened.

Plough on to some new project.

Like going back to surgery?

She wanted grandchildren, you know.

-More than anything.

-Sorry to disappoint.

She blamed me.

Said I pushed you all too hard to be successful.

-To have good jobs, good careers.

-No, that's not true.

Isn't it?

Work. Always work.

But that's not why you stayed away. Is it?

None of us wanted to see her like that, Jesse.

Anyway. What's done is done.

Maybe if I was around more, I might have seen something.

Noticed that she was... I could have...

There was nothing anyone could do.

Hey. Look at me.

It wasn't anyone's fault. It was just her time.

-Let's go to Trinidad.

-What?

Take her back home. Like she wanted.

-You mean that?

-Yeah.

I know it's a bit late and it doesn't make up for anything, but...

..I want to do something for her, you know?

-As long as you still want to?

-Yes.

All right, then.

There's just something that I need to do and then we're out of here.

-I really am so sorry.

-Yes, you keep saying.

It's not even half past six. What are you doing here?

Oh, Ms Naylor called me. There's a situation on Darwin

which requires the attention of senior management.

Can you be in the boardroom in half an hour?

Yes. Yes, of course.

Morning, Mr Hanssen!

Ouch. Was it trouble on the night shift?

Have a good day, Mr Levy.

LIFT: 'Doors closing.'

What have I missed?

SHE MOUTHS

Sorry I'm late.

A statement from Ina Effanga confirming that she verbally

revoked the DNR and consented to surgery.

-How convenient.

-Meaning?

Of course she's going to back him up, he's practically her son-in-law.

-No, he isn't. If anything...

-Silence, please!

Dr Law, yes or no - at the time you performed CPR, the documented

wishes of the patient was that she was not to be resuscitated.

-Yes.

-And you attempted a surgical procedure which was outside

the realm of your experience.

-Yes.

-Mr Hopkins-Clarke.

In your opinion, was the patient's arrest caused by her

underlying condition, or by the overdose of digoxin?

Well, that's difficult to say.

This is the problem with using agency nurses in specialist units.

Don't try to pass the buck. She tried to check with you.

Not very hard, clearly!

So you accept that if it weren't for the drug error...

It's an easy mistake, Mr Griffin. It happens to all of us.

It hardly excuses this sort of deliberate

-disregard for hospital protocol.

-Oh, please!

If it wasn't for you interrupting me every five minutes...

-So, it's my fault?

-Ms Effanga.

The M&M statistics from the CT ward at St Jude's

12 months before he started working there.

And these are from when he was their lead consultant.

Those figures clearly show his appalling mortality rates.

He said the reason he went into research was because his son died.

-That was a load of rubbish.

-That's enough.

His son's Twitter feed.

Lewis Hopkins is alive and well

and living in New York with his new wife.

He lied.

-I can explain.

-Go on, then.

It's complicated. I don't have to answer to you.

You're right, you don't have to explain yourself to me.

-You have to explain yourself to Mr Hanssen.

-Guys, look.

If you're going to be getting into all of this, can I go?

I'm sorry, Dr Law, are we keeping you from something more important?

Yes. Actually.

You do realise, until an investigation into this matter

is concluded, your career at this hospital is hanging by a thread?

Well, let me save you the trouble. I quit.

Effective immediately.

This is unexpected.

Mr Hanssen, Mr Griffin. Mo.

It's been a pleasure.

Jac.

Yeah.

Excuse me.

Jesse. Jesse, wait. What are you doing?

Look, I'm in my 40s, yeah?

And I'm retraining with a bunch of 20-somethings.

I'm single... jilted at the altar.

My only friends are you and...

Guy Self.

I can't go on pretending everything's all right.

Ploughing on regardless.

Adele was right. It doesn't work.

So, what are you going to do?

I'm getting my priorities in order.

Dennis, wait.

It'll happen to you, you know.

You're riding high now, queen of the castle.

But one day it'll all be irrelevant. And so will you.

-You lied.

-I had to. I was being sidelined.

Because you were making mistakes.

Ask yourself this, Jac. When they take this all away...

..what will you have left?

What would you do to hold on to it?

Goodbye, Jac.

Right, who's up for breakfast, then?

There he is. It's Rocky Griffin! You are my new hero.

You have no idea how many times I've wanted to see that man

-get punched in the face.

-Who got punched?

-It was an accident.

-It was amazing.

We're all going for breakfast. You coming?

Well I...don't want to intrude.

Seriously, who got punched in the face?

I'm going to miss you.

All right, OK. Enough of that.

-I'm going to miss you too, Maureen.

-Oi!

-I'll see you later, Jesse James.

-See ya.

Guy!

One second, Dad. Just one second.

I'm sorry, mate. I didn't mean to disrespect Anya.

I know you didn't. Don't worry about it.

-I'm leaving.

-OK, see you tomorrow.

No...I quit.

-What?

-Yep.

Of course. You can't run forever, you know, Jay.

I'm not running anywhere, my friend. Not any more.

I'm going home.

Right. Well, in that case, good luck.

Cheers.

-Take care of yourself.

-Yeah, you too.

# You know how I feel

# It's a new dawn... # How's that?

KNOCK ON CAR/BRAKES SCREECH

-# And I'm feeling good... #

-I left the bags in the boot.

# Fish in the sea, you know how I feel... #

All right, jog on.

See you.

# Blossom in the trees, you know how I feel

# It's a new dawn, it's a new day

# It's a new life for me

# And I'm feeling good. #