What It Takes Holby City

You should have the surgery, Mills.

Guy...

You told me that the op would work.

I think you need to step away.

I think a leave of absence is in order.

Arthur.

I don't know what you think you saw,

but you've got the wrong end of the stick.

Stealing medication?

..is unforgivable.

You wouldn't accept help with your issues.

I'm not going to stick around and see you kill somebody.

SHIPPING FORECAST ON RADIO

I looked up "counselling" in the dictionary. Oxford English.

Obviously.

"The giving of advice on personal, social and psychological problems."

So far I seem to be doing all the talking.

And if the point's to... to lead me towards some sort of

self-awareness, believe me, I am well aware of my own shortcomings.

Most days, I wish I could be someone else.

I could retrain.

I'm young enough.

I could, erm, move to Australia and, I dunno, take up marine biology.

But it wouldn't make any difference.

I'd still be me.

The truth is, if I'm not a doctor...

I don't know who I am.

This is Walter Dunn, 55.

Car came off the road into a ditch and he was trapped for two days.

Now, he's no obvious injuries, just cuts and bruises,

but he's hypernatremic and clinically dehydrated

so the ED have sent him through for fluid resuscitation.

Nice contacts.

Thank you.

Hello there, I'm Dr Digby.

You're not THE Walter Dunn, are you?

As in Cambridge Professor of stem cell research?

Er... Yes.

Good grief. Um, it's an honour.

I've read all your papers.

-Walter, you never told me you were famous.

-I didn't know.

-He's going to cure Parkinson's.

-Well, I don't know about that,

but I appreciate the vote of confidence, Dr Digby.

Arthur, please.

Well, look, Arthur.

It's been quite a couple of days and I really want to get home.

Of course, of course, erm...

Ah, Dr Digby! Welcome back.

Um, Dr Shreve? Could you take over here, please?

Oh, no, it's fine, we were just, er...I was...

There's something different about you. Have you changed your hair?

-Uh, no...

-Contacts.

-Oh, yes! Suits you.

I think.

Now then, I'm afraid we're a little short-staffed today.

Mr Di Lucca's claimed all his unused annual leave.

As he's about to lose his entitlement to it,

I couldn't really say no.

But it does mean I'm spinning rather a lot of plates this morning.

So I just need to go and check on a patient for a minute.

I'll be back with you as soon as I can.

-Do you want to go and wait in my office?

-Right, um...

Morning, darling. You waiting for someone?

Yes. You. Would you like a coffee before you go in?

Oh, I'll be fine. It's just a formality.

I know. I was here early anyway. I'm hoping to bag some theatre time.

There's a bilateral lung transplant coming in.

Can we get a soya latte, extra shot, extra foam, hazelnut syrup and a...?

-A coffee.

-I'll bring it over to you.

So who's going to be there, do you know?

The usual suspects.

The root cause analysis has been done,

the report's been written, I've had a psych review, which was fine,

so this is just a box-ticking exercise, really.

Good. There's nothing to worry about, then.

No.

18-year-old male.

Found unconscious on a playing field with a GCS of three.

Uh, intubated at the scene.

BP 165 over 70,

pulse 65, sats 98 and ventilation.

No obvious injuries, query neurological event.

Right, FBC, LFTs, U&Es, clotting, group and save, please,

and an urgent head CT.

Thanks, Jamie. Any name on the notes?

Um...can't see anything.

OK, can I have his ID, please? Thank you.

Right, can you see if Mr Self is still in the building?

And then can you call Mr Hanssen and say we've got a situation?

OK.

You're out already. How'd it go?

There's no referral to the GMC and I can resume clinical duties

-whenever I'm ready.

-That's great.

-Isn't it?

-Yeah.

Just a second.

You know what the Clinical Governance Committee are like.

-They choose their words carefully.

-OK...?

They said that there was no negligence but, in hindsight,

said that the judgment call I made

on the Renwick case was the wrong one.

Wow, they actually said that?

Yep. Not in so many words, but you know what they're like.

-Well, we can always make the right decision in hindsight.

-Exactly.

-You're not letting this get to you, are you?

-No. No, no, no.

Darling, I probably shouldn't talk to you about this here.

-I'll go.

-No, no, no. Let's talk about this properly.

Tell me exactly what they said.

Everything all right there, Professor?

Ah, good. I was just coming to find you.

I'd rather we actually kept that in just for a minute.

Honestly, I'm feeling so much better.

Just tired.

So if you don't mind discharging me, I'll get out of your hair.

I just want to make sure that you're definitely OK first. OK?

All I need is a hot shower and my own bed.

Really. Thank you.

Any headache? Dizziness?

No.

Your fluids haven't finished running through yet.

I'll have a drink at home.

-A glass of water won't cut it, I'm afraid.

-I'll have two.

Um, listen, just give me two hours.

We'll finish running the rest of those fluids through.

Check your bloods are back to normal, and then you can go.

Right.

I'll just go and grab another cannula and I'll be right back.

Cara, keep an eye on Professor Dunn, will you?

Just do his obs or something?

Sure.

Walter? How about we see how your blood pressure's doing?

If you insist.

I think you're reading into this much more than you should.

They're not neurosurgeons.

It's not for them to say whether you made the right call or not.

Well, yeah - I don't need them to tell me I got it wrong.

I know. I feel bad enough as it is. I couldn't feel any worse.

I mean, how do they expect me to go to theatre every day

and make these decisions...

I mean, the consequences can spiral out of control at any...

Listen, this is what you do.

Someone has to make these very difficult choices.

And as long as, at that moment, when you're making that decision,

you feel sure you're doing the right thing...

I don't think anyone can ask any more of you than that.

-But they do.

-Well, they shouldn't. You're only human.

Who? What? Me?

Yes, I'm sorry to break it to you, but there it is.

Listen, thanks, darling. I'm sorry to have off-loaded all this on you.

No, no, I'm glad you did. Anyway, I'd better get on.

-Yeah, yeah, of course. I'll head home.

-Good idea.

BEEPING

-Excuse me, Dr March.

-Ah yes, of course, thanks.

So, a bilateral lung transplant, eh?

I was thinking of asking Zosia to scrub in, if you can spare her?

-HE CHUCKLES

-What?

-Oh, she said you'd ask.

-Did she?

She already got me to clear her schedule.

Oh, did she now? Little Miss Presumptuous.

She wouldn't have that much brass with Jac. Am I a soft touch?

Come on. It would be good for her portfolio.

All right, but I'm not going to wrap it up in a bow

-and hand it to her on a silver platter.

-Meaning?

Meaning I've got more work than time to do it in and a very able

and keen junior at my disposal.

Quid pro quo, my funny Valentine. Quid pro quo.

Ms Effanga...

Selfie Junior! You've got a big day with me today.

Ward round in five minutes.

Do you know who's on duty?

No, sorry, Sacha's ringing now.

Good. OK, let's get a central line in. He'll need catheterising.

-Let's get some more fluids up. Do we have an ABG?

-Yes, sir.

OK. Have our anaesthetic team seen this?

-Yes, sir.

-Good. Is his mother here?

-Not yet.

-But she's been informed?

-As far as I know.

-OK, good.

Good morning, Mr Osborne, you're looking perkier.

Let's chase his bloods and do a repeat ECG.

FBC, U&Es, LFTs, and clotting. Run an ECG and organise an echo.

Ah, Mr Iqbal. Nice to see you.

Bay one, please.

We're going to need IV access.

Put a catheter in, run some fluids and do a spirometry test.

Mrs McArdle.

Doctor March here is going to remove your surgical drain,

dress your wound and then we'll see about getting you discharged, OK?

Ah, the lovely Mrs Monroe.

OK, let's do an INR, adjust her warfarin dose,

and then call H-COP and see if they've got a bed free.

Good morning, Mrs Adejoke. Has the nausea subsided?

SHE VOMITS

Guess that's a no, then.

Get a nurse to clean that up, put her on nil by mouth,

increase fluids, give her an anti-emetic.

20 milligrams of metoclopramide should do the trick.

Sorry to have kept you. It's getting a bit hectic out there.

Well, I'm here and ready to roll my sleeves up, so...

Great! Though obviously you can't just pick up where you left off.

Can't I? Why not?

Um, my GP's prescribed me citalopram,

which I've been taking, referred me to counselling,

which I've been attending

and I've been interviewed by HR and occupational health,

and Mr Hanssen...

I appreciate you've already jumped through a lot of hoops

and that medically speaking you've been cleared to come back.

-But that's not all there is to it.

-What else is there?

Well, you don't exist in a bubble, Arthur.

This is a front-line department,

which means we sometimes have to deal with difficult situations

in a professional and diplomatic manner.

No, I understand that...

Hang on there, tiger, I haven't quite finished.

We also have to work as a team.

And as the consultant ultimately responsible for everything that

happens here, I need to be convinced that you have the right attitude.

Of course. Yep. I understand.

And can I just say that I am really sorry for my previous behaviour.

I'm sure you are.

Um, obviously at the time I wasn't myself,

but now I have my condition under control

so I can assure you that nothing like that will ever happen again.

No. It won't.

You're going to be under my direct supervision

until I'm satisfied that there is indeed a place for you on AAU.

Is that really necessary?

I think it is.

You have some bridges to build, Arthur. Don't take that lightly.

I've never really been a people person.

How can I explain it?

Um, I have this...aunt, who, well, she gets very nervous around dogs

because she says she can never tell what they're thinking.

That's how I feel about people.

They change their mind from one moment to the next.

They say one thing when they mean another.

You never quite know where you are.

And throughout school and university it didn't matter, you know.

I didn't need to make friends.

I absorbed myself in my work. In my books. In my exams.

And everyone said "you'll go far" because I was doing so well.

But it's not enough, is it? It's not enough.

OK, thank you.

McKenna is on call but he's been pulled into surgery.

They said he's going to ring as soon as he gets out.

-McKenna.

-Yes.

Well, we're going to have to tread very carefully, Mr Levy.

With the mother's influence,

things could spiral out of control very quickly.

Yes, yes. I understand.

We must ensure that we have the right man for the job.

I can't tell you how grateful I am not to be a neurosurgeon right now.

Indeed. You and me both.

-Where is he?

-Ms Brassvine.

-Where's my son?

-He's in ITU. Guy's with him.

Oh, my God.

Nurse Reynolds, would you escort Ms Brassvine to ITU, please.

Yeah, of course. This way.

Right, well, I'll go and make a few phone calls and you let me know

as soon as McKenna's out of surgery, please.

Yes. Of course.

-Everything all right?

-Yeah, fine, thank you.

I just thought Professor Dunn had already been cannulated in the ED?

That was my fault, I'm afraid. I...I jumped the gun.

Does that happen often, Professor? The tremor?

No, it's just come on. Sorry. I don't know why.

Hey, it's to be expected after the shock you've had.

It's bound to catch up with you.

-May I?

-Sorry.

No, it's my fault. Silly.

I see you've got a cut on your head there.

Was that during the accident?

Just on the air bag. It's fine.

OK, and you didn't hit your head on anything else?

-Miracle, isn't it?

-Sounds like you had a lucky escape.

Just humour me for a minute. Just bend your arms.

And then back down again.

OK, and pull me towards you... And push away...

Just get rid of this.

OK, touch your nose and then touch my finger.

There we go. And then palms,

OK, then pat your head and rub your tummy.

Just kidding.

Um, what's his temperature?

Is all this really necessary? It's just a superficial head injury.

No, I'm sure, I'm sure. It's just I wouldn't want to miss anything.

-The Medical Research Council would never forgive me.

-37.6.

OK, let's do a CRP then,

and just to be on the safe side, can we order a head CT as well, please?

I'd just as soon get home.

-I don't want to cause any trouble.

-Oh, no, it's no trouble at all!

A head CT? Don't you think that's a bit over the top?

No, I don't think so.

He's very fit.

I don't know how this has happened.

What are you doing here, J?

Just here to observe, help out where I can.

Kai's head CT.

Well?

There's a bleed.

In the brainstem, here.

Caused by?

An MRI should answer that.

I'll call down now.

Tell them it's urgent.

Will he need surgery?

One step at a time.

I'm so glad you're here. I wasn't sure you would be after...

everything that happened.

Just so you know, Patsy, once the on-call neurosurgical

consultant arrives, I'll be handing over.

Why?

You're well known to me, as is Kai.

It would be much better to have a fresh pair of eyes,

someone who can be truly objective.

In case there are any... difficult decisions to make.

What do you mean by difficult decisions?

Kai's situation is very serious.

We're not sure what damage there's been...

or whether this is something that he will survive.

Right, Mrs Choudry's back from X-ray when you're ready.

Mr Goodwin's catheter's back in and his bloods have gone off.

Miss Lyons asked for some more pain relief and I said you'd check.

-All right?

-Thanks.

-Now, leave me to it.

-I've got a mountain of paperwork to get through.

-Sure.

-Shout if you need me.

-I will. Do you know when Mr Di Lucca's coming back?

No idea. But that is the luxury of having a holiday with no end date...

-Professor Dunn's blood results.

-Ah, excellent.

Ah, I thought he was Dr Shreve's patient?

Oh, yes. OK.

Thank you.

OK, so CRP's up.

-OK. Has he been for his head CT yet?

-Still waiting for a slot.

You think, because of his tremor, he's got Parkinson's.

Well, not just cos of the tremors.

He's also got signs of muscle wastage,

and he's got poor co-ordination.

He's a single man in his fifties who lives alone,

and he's exhausted and dehydrated from spending two days in a ditch.

Yes, but if they're pre-existing symptoms,

that might be why his car ended up in the ditch in the first place.

The CT won't tell us he's got Parkinson's.

-No, but it will rule out some other things.

-OK.

He wouldn't be the first doctor who's dedicated himself

-to curing his own disease.

-Sure. But why would he keep it a secret?

Well, to stay on his research. It'd be a conflict of interest, surely.

But he retired. Last year.

Listen, I think you might be looking for a mystery where there isn't one.

Most cases aren't as complicated as that.

Sometimes people just crash their car.

Am I missing something?

You are kind of stealing her thunder.

What?

She had everything under control,

then you came in and sort of took over.

No, I was trying to help.

I know. but I think you might have...

What?

Embarrassed her. Maybe. Just saying.

The worst part is, it's as if everyone else instinctively

knows how to navigate these social minefields.

And it's not as if I don't try. I do.

I just always manage to get the wrong end of the stick or...

say the exact wrong thing.

-Dr Shreve. Morven?

-Look, can it wait?

I think we might have had a little misunderstanding.

-I didn't mean to upset you.

-You haven't.

OK, look, I don't want to get off on the wrong foot here.

And I owe you an apology. For before.

OK.

I apologise for what happened. I wasn't myself.

I was suffering from a condition which obviously

affected my behaviour.

So it won't happen again. OK?

Excuse me, Professor. I'm sorry to wake you, I know you're tired.

I've had your blood results back.

I was just thinking about you.

Do you remember when we went to Margate?

-Margate?

-Yes, with Peter and Claire.

You won the roller derby, you remember?

-Yeah. That wasn't me.

-Yes! Silly girl. Ha!

Are you all right, Professor? Do you know where you are?

Of course I do, I'm in the hospital.

What time is my meeting with the board?

Oh. I've lost the stethoscope.

I've lost my stethoscope.

Can I borrow yours?

Not just at the minute.

-I can't lie around here all day, I've got work...

-OK, Professor.

It's OK, Professor, you don't have to work today.

-Everything OK?

-Yes. He's got some confusion. It's just come on.

He's tachycardic and pyrexic. Bloods showed raised CRP.

I think he's septic.

So?

Breathe in for me.

And out again.

And again.

Bilateral basal crackles. Maybe pneumonia?

Suggest we start him on IV tazocin.

Yes, good.

Radiology just called. They're ready for Walter's head CT now.

-What head CT?

-Uh, well, I was concerned

that there was an underlying cause. Possibly Parkinson's.

-And how would a head CT help?

-Well, no, I wanted to rule out...

Cancel it. Get the antibiotics started - let's see

if we can get on top of this infection.

Quick word please, Dr Digby?

It's Guy Self. Is McKenna coming?

Well, can somebody please call and find out what is going on?

Thank you.

What have you found?

Patsy, you really shouldn't be in here.

Someone will come and talk you through everything in a moment.

Don't patronise me, Guy.

If it wasn't for the money I brought in,

this hospital wouldn't even have that scanner.

I want answers.

OK, there's a cavernous malformation in the brainstem.

A cavernoma.

It's a cluster of abnormal blood vessels.

The cells that line them are thinner than they should be

so they're prone to leak blood into the surrounding brain tissue.

Can you fix it?

Well, it is possible for someone to remove a cavernoma with surgery

but it's extremely risky, especially in the brainstem.

And if you don't remove it? Will it keep bleeding?

Or bleed again further down the line?

Well, yes, if he survives this one then it could happen again.

Causing more damage?

Yes.

And potentially...kill him.

Yes.

Better to act then, surely?

What's going on? You've never shied away from a surgery before.

We can't just do nothing and hope for the best.

Look, Patsy, they're taking Kai back to ITU.

Why don't you go and be with him

and I will come and join you as soon as I can.

We're short-staffed and the department's almost at capacity.

Don't you think we've got enough to do without ordering

unjustified investigations?

Not to mention exposing a patient to unnecessary radiation.

Well, I didn't want to miss anything.

I told you to build bridges and be part of a team.

Not start a one-man crusade to diagnose one of the most

notoriously difficult conditions to identify.

Well, he does have...

Please, Dr Digby. Don't argue with me.

I really need everyone pulling together here.

Now, for the rest of the day,

I want you to run all clinical decisions past me first.

Surely that's not practical?

No, it isn't really, but I'd like you to do it anyway.

And I have to say, Arthur, I had expected a little more

humility from you today.

Excuse me? I had a call from someone in A & E.

Apparently my brother's been brought in. Walter Dunn.

Oh, yes. Um...I'll take you to him.

Is he ready to leave?

Oh, I'm afraid not.

-Did A & E explain he'd been in a car accident?

-Yes.

And that he was trapped for some days before he was found?

-This is Professor Dunn's sister.

-Hello. Mary.

Hello, Dr Shreve.

-Professor?

-Walter?

OK, so this isn't from the sepsis.

Go and fetch Ms Campbell, please,

and can I get me five milligrams of diazepam?

-What's happening?

-I'm not sure...

Is there any other medical condition that we might not be aware of?

-Anything neurological?

-Not that I know of.

And it's self-terminating.

What?

I'd move the rest of them if I were you,

before he comes round.

Why don't you take a break?

Go and get some fresh air, then come back and we'll start again.

We need a little help out here, please.

Can you make sure these other bottles are out of reach as well, please?

Torch, please.

It was alcohol withdrawal. Explains the seizure and his earlier tremors.

He's just helped himself to

three-quarters of a bottle of hand gel, which is 85% ethanol.

I've given him 50 milligrams of chlordiazepoxide.

-Good.

-His blood alcohol test did come back negative,

but um, he's been at least two days without a drink.

Hence the reason why he was so keen to leave.

I am worried, though, that his confusion is

the start of Wernicke-Korsakoff's.

I've starting IV pabrinex.

Well, looks like you didn't need me after all, Dr Shreve.

Well done.

When you've sobered him up, tell him to take a taxi home.

I've got to get back to work.

-Well done.

-Thanks.

I really thought that he was...

Yeah. I know you did. Sorry.

Sorry. Force of habit.

I'm heading down to Keller now.

Is there anything I can get you?

No. Thank you. How are you finding your new surgical role?

Yeah, it's great. It's different.

Why are you really observing today, Mr Law? Is Guy OK?

He doesn't seem to be himself.

I know he's been through quite an ordeal but...

is there anything else I should know?

My son's life is at stake here.

Well, McKenna's surgery has run into complications.

He's going to be tied up for the rest of the day.

So who's coming?

Mr Levy is ringing around.

You're not looking at me for this, are you?

Because I'm simply not ready.

Don't worry, your reluctance is patently obvious.

I'd like you to talk me through the options, though, please.

OK well, the bleed does come to the surface of the brainstem,

so surgery is a possibility.

Given his age and general good health, a successful operation

could prevent any further damage and remove the risk of a re-bleed.

-But?

-It's not run of the mill.

There's only a handful of surgeons in the country who would

attempt such a high-risk operation

in such a difficult-to-access part of the brain.

The potential for catastrophic damage is extremely high.

You've done it before, though, I recall.

Yes, and the patient had multiple issues.

Issues which were caused by the initial bleed, though, not the surgery.

I'm not asking you to perform the surgery, Mr Self.

I'm just asking whether or not, in your professional opinion,

you think it should be performed.

That is up to the surgeon who is going to be

responsible for the outcome.

Patsy knows you. She trusts you.

She would value your opinion.

Well, I'm not going to give it.

I'm sorry, I'm not going to responsibility for this. Not right now.

I will tell Patsy I've done everything I can

to make him stable, and that another surgeon will be taking over.

Send them immediately.

-I don't want you treating my son.

-I have no intention of...

You lied to me.

I asked you why you wanted to hand over this case

and you said it was about objectivity.

You never told me you had a nervous breakdown!

-What?

-He told me everything.

Hang on a minute - that's not what I said.

As good as. I've sent his scans to Greg Cawley.

Fine. If you want to go private, that's your prerogative.

I'll leave you to it.

Guy. She's misrepresenting what I said.

It's fine. She's getting Greg Cawley - problem solved.

'Doors closing. Lift going down.'

PHONE BEEPS

-Ms Effanga.

-Selfie Junior!

-Mr Osborne's ECG. Perfectly normal.

-OK.

As were his bloods.

-Get his TTOs done, then get him discharged.

-OK.

Mrs McArdle's drain came out fine,

although the site's still a little unfinished.

Do a CRP and check her inflammatory markers.

If they're all right, then send her home with a course of amoxicillin

and that's two beds cleared. I am on fire. Next!

-Mrs Monroe.

-Please tell me H-COP are taking her?

They're waiting for a hospice transfer.

-There should be a bed this afternoon, though.

-Yes! Hat-trick!

Selfie, with these cleared beds you're really spoiling me!

What about Mrs Adejoke? She still hurling up?

No, actually - she just asked for a jacket potato.

-Excellent! Give the woman a potato!

-Really?

-No.

Start her off on a small amount of fluids and then we'll see how we go.

Right. OK. Sorry.

Anything else? I've got a transplant coming soon...

Yes. Mr Iqbal. I got the catheter in, and his fluids up.

Urine output is normal and that's all fine.

But I did his spirometry test and his FVC is 61%.

He's also complaining of right-sided chest pain

and there are pleural rubs on auscultation.

-Am I all right to send him for a chest X-ray?

-Absolutely.

Ah, there he is! My favourite patient.

Ms Effanga, I wondered if I...

Hey, Charlie. Looking forward to a breath of fresh air? HDU, please.

Hop to it, Selfie Junior.

Mr Iqbal's X-ray's not going to order itself.

-Arthur?

-Mr Self!

I nearly didn't recognise you without your, erm...

Dare I ask...?

Popping candy.

OK...?

It's a mindfulness exercise.

Focusing on a unique sound and sensation blocks out...

unwelcome thoughts. It clears the mind.

Sound good to me.

Would you like some?

Yeah, why not?

-How do they make this stuff?

-I've no idea.

Listen, I hear you've been having a pretty hard time recently so...

Well, if this helps then, eh...

No, it's fine. I'm on top of it.

Actually, that's not true. But I'm trying.

Well, there's nothing to be ashamed of.

I mean, look at Zosia.

If she can overcome, then...

Actually, she uses similar techniques -

mindfulness and so on.

-She was the one who taught me.

-Did she?

As soon as you can would be great, thank you.

All right?

Yes, fine.

Fine. Yes, you seem fine. It's that cheery air that you have(!)

Have you seen this list of jobs Ms Effanga has given me?

How am I supposed to impress if all she ever gives me

-is this menial grunt work?

-Impress her?

You know what I mean.

I'm sure you'll get your moment in the transplant.

I'm not on the transplant.

I haven't even had time to ask her about it!

OK. Breathe.

Right. I'm going to go and get a cup of coffee.

-Good.

-Is this yours?

-Yes.

He's good to go as soon as the lungs arrive.

Good. Um... Is, er, Zosia assisting today?

I don't know, she's pretty busy. We'll have to see if she's got time.

He's a drunk. Of long standing, and he's got early signs of Korsakoff's.

I just can't help seeing wasted potential.

You know, he was top of his class at UCL.

He was a Cambridge fellow. Countless prizes.

Probably would have won a Nobel if he'd have carried on.

And then... pfft. You know, it all just went away.

Hmm. Well, maybe he'd given all he had to give.

You know, sometimes people's expectations are overinflated.

So you think, subconscious self-sabotage rather than

admit that he'd peaked?

It's a bit vain, isn't it?

No, it's fear.

Who wants to admit they're not as capable as everyone thinks?

But how is that not vanity?

Well, what about his sense of identity, of self-worth?

I mean, if he's not this genius curing an incurable disease,

then who is he?

Yeah, maybe I'm being a bit unfair. I just can't help thinking...

it's not a good way to go out.

-I should get back.

-Oh, here.

Oh, no, you keep it. You keep it.

We've got a whole box at home so...

Mr Self? Are you OK?

Yes, I'm fine.

Really? It's just that this was a bit unusual.

You get back to work, Dr Digby.

Hi.

Hi.

I should have listened to you. But, hey, we were both wrong.

You know, there was something more to it.

Look, I know that you're still angry with me

but we do have to work together.

And I really need the rest of this shift to go smoothly.

Uh, I'm not trying to be funny, but... Where's Walter?

Ah, you all right?

Yeah. Can you see a confused man anywhere?

Yes.

SIREN SOUNDS

He could be anywhere.

This is bad. We've got to tell Ms Campbell.

Well, I appreciate the courtesy, Mr Cawley. Thank you.

-Goodbye.

-Is Cawley is on his way?

No. He's not going to take the case.

That was just a heads-up before he breaks the news.

Yes, Mr Cawley?

Well, if Cawley isn't doing it, who is?

Patsy Brassvine is a very powerful woman.

I'm afraid in this case, her influence is working against her.

Nobody wants her son dying on them. It's career suicide, isn't it?

SHE SOBS

When did we all become such bloody politicians?

Excuse me.

Patsy, if you want Kai to have this operation, I will do it.

Look me in the eyes.

Tell me you're up to this.

Yes. I am.

And it's the right decision? To go ahead?

If it was Zosia, would you do it?

Yes, I'd do it.

Don't make me regret this.

Let's prep him for theatre.

I'm sorry.

-Any sign?

-No.

-Where's Ms Campbell?

-OK, just wait, wait, wait, wait.

-What?

-I don't know, just...

-There she is.

-Oi. You lot.

Isn't that your Professor?

-Professor!

-Professor! Whoa! Professor, wait!

Help me! Help me!

Help me! Security! I am a doctor!

Help me!

OK, he's fine. He's not a doctor.

I am a doctor!

Well, yeah, technically he is a doctor, but he's also a patient.

These people are chasing me!

OK, Professor, we just need to get you back to the ward.

Why? What do you want?

-I just want to make you better.

-Liar! I don't know who you are!

-OK.

-No! Don't come near me.

Morven. I don't...

Can you help me, please?

Professor Dunn, we've been trying to bleep you.

A patient has presented with bradykinesia, muscle rigidity

and dystonia. Query Parkinson's.

Book an MRI. And let's do a lumbar puncture.

Right. Um... She's this way.

-You found him, then?

-Yes. Thank you.

Mary?

Mr Hanssen. You're sure about this, yeah?

Because if... if something goes wrong in there,

Guy's not going to get over it. He'll be done.

Mary, wait.

I'm really sorry you had to see that.

Oh, believe me, I've seen all sorts from my brother.

Um, do you wanna...

Are you OK?

You're probably wondering how he could be missing for two days

without me noticing...

but he isolated himself.

You don't have to explain. I'm sure you care about him.

I adored him. I looked up to him.

He always took care of me.

And then suddenly... I was the one taking care of him.

Picking him up when he'd been arrested,

or when he was drunk at work.

I cleaned his house. I cooked his meals.

I tried to help him to stop.

Time and again I kept coming back and he kept pushing me away.

You can only take so much.

Of course.

Is there any family or anyone else that can support you?

No. There's just the two of us.

-Would you like to come back inside?

-No. I don't think so.

OK.

-Is that his chest X-ray?

-Yes.

Thank you.

Mr Iqbal? How are you feeling?

You OK?

Right, mind if I have a listen to your chest for a moment?

OK, there is some air trapped between your lung

and your chest wall which is making it difficult for you to breathe.

Rachelle? Can I get a drain set and trolley, please?

And can you pass me that oxygen?

Thank you.

Rachelle, if you can keep him in position, please.

OK. Now, short, sharp scratch.

You're doing brilliantly.

Now, you're going to feel some pushing.

One, two, three...

AIR HISSES

Well done.

Now pain relief - five milligrams of oramorph, please.

Sit back for me. You can relax.

Uh, Ms Effanga, I'm sorry.

I know I should have come and found you but um...

Early tension pneumothorax. I panicked.

Didn't look like you panicked to me. Good job, Dr March.

OK, Little Miss Presumptuous. You can scrub in. You've earned it.

But next time, just ask, eh?

-Sorry, what?

-Ollie.

He told me that you asked him to clear your schedule

-so you could assist on the transplant.

-Uh, no...

I asked him to clear my schedule because I was hoping

you'd ask me and I wanted to be available just in case you did.

OK, I think there's been a little misunderstanding.

What exactly did Ollie say?

BEEPING

Can we get some help over here, please?

-Where's Ms Campbell?

-She stepped out.

Arthur. I need your help.

He's bleeding from somewhere.

-I-I don't know, his throat or his stomach.

-OK.

Tachy at 130, BP 70 over 40.

-He's peripherally shut down.

-Where's Ms Campbell?

-She's not on the ward.

-OK, can you phone her? Get her back. Quickly, please.

BP 70 over 35. He's going to arrest.

We've got to do something, Arthur.

-OK, I can't, not without Ms Campbell.

-What??

It's...it's literally more than my job's worth, OK?

You did not just say that.

No. OK. Suction. Let's get his airway clear.

-She's on her way.

-Right, we need to transfuse him so can you get O-neg?

-As much as you can, fast as you can.

-Look at this.

-It looks like burns. Chemical burns.

-He must've swallowed something.

What's that?

-It's pure ethanol.

-For god's sake.

Here you go.

OK, well done. Let's get it rigged up.

Thank you.

-OK, look, I had no choice.

-What happened?

-He was peri-arrest.

-It's from our pharmacy.

He had a gastrointestinal bleed. He needs an urgent gastroscopy.

OK, let's get him straight into theatre, quickly please.

Well done, both of you. Good teamwork.

-Scrub in, Dr Digby.

-Um, I think Dr Shreve should scrub in.

He's her patient.

OK. You ready for some hands-on surgical experience, Dr Shreve?

I still see him as a little boy.

I've been away so much with work,

I didn't notice he'd turned into a man.

He's my son...and I don't know him.

I wish that I could tell you it's going to be OK.

I really, really do. What I can say is...

I know what this means to Mr Self, personally and professionally.

And if Kai was my son,

there isn't a surgeon on the planet I'd rather have in there with him.

We're bleeding. Diathermy.

Still bleeding.

I can't stop it.

Surgicell. Quick!

Come on, come on.

Guy, you all right there, mate?

Guy, it was just a small bleed. You're doing great.

Come on, mate, you're nearly there. Let's finish this.

Mr Self, just take a few moments, please, and then you'll be fine.

Micro dissector.

Just let me know, please. Thank you.

Right, then. You ready for your first bilateral lung transplant, Selfie?

-Hey, you're assisting.

-Well, actually, I'm taking the lead.

Yeah, it's true. She's got skills, this one.

And she's impressed all day so I thought...

why not give her have a go?

Give her a go? At a bilateral lung transplant?

Ah, it's a piece of cake.

In fact, I don't even think I need to come in with you.

I've got loads of paperwork to do.

That's fine, I can always give you a shout if I get stuck.

-You sure?

-Yeah! No problem.

-Great.

-Is that such a great...

Ah... Oh, you're joking.

You're an idiot.

What have I done?

I never assumed she'd ask me to assist.

How big-headed do you think I am?

And I gave her hell today because of what you said.

You owe this woman a drink.

And you can buy me one and all. After work. Tonight.

-Fine.

-Good. Come on, Selfie.

Patsy, both the haematoma

and the cavernous angioma have been successfully removed.

His vital signs are good. It couldn't have gone better.

He's going to be OK?

We can't say what damage was caused by the initial bleed, but...

time will tell.

Thank you.

Thank you so much.

-I'm so sorry...

-No, no, please. Thank me when he's awake.

-Where is Kai? Can I see him?

-Yes, of course.

Yeah, he's in recovery. I'll take you through.

Congratulations.

Thank you. For everything.

Multiple necrotic patches.

Here's the perforation.

He's burnt right through his stomach.

We can't repair this. Moving on to a partial gastrectomy.

I should have kept a closer eye on him.

If he hadn't left the ward, this would never have happened.

This is the result of years of abuse.

What happened this afternoon was just the final straw.

You mustn't blame yourself.

Stapler, please.

You go ahead.

That's it. And now the top.

Excellent. Now remove the excised portion of the stomach.

Very good, Dr Shreve. Nerves of steel.

Right, let's close up, shall we?

I suppose some people just have what it takes.

And some people don't.

He's just through here.

Dr Digby?

Please.

He's still sedated, but, er...

She said you took away his stomach?

A good portion of it, yes.

And something about... brain damage?

It's called Korsakoff's Syndrome.

It affects part of the brain that deals with memory.

The symptoms are similar to dementia.

And it's permanent.

Well, it may improve over time with treatment,

but, there is likely to be some permanent damage, yes.

You stupid, stupid...

Why can't you just die if you're going to...

You foolish, selfish...

OK, come on.

SHE SOBS

It's all right.

-I'm sorry.

-Don't worry. It's fine.

I'm sorry.

I've been given so many opportunities.

I've been given so many second chances.

I just keep letting everybody down.

I don't know why I can't change...

but there's no forcing myself to be something I'm not.

OK, so if you just push your hands up against mine as hard as you can.

Good. Now, shrug your shoulders.

Excellent. Open your mouth and go "ahhh".

Stick your tongue right out.

Whoa. Excellent. Good lad.

You get to sleep now and I'll see you first thing in the morning.

Thanks, Guy.

I'll be back in a minute, darling.

Well, the signs are good. Very good.

Obviously we'll keep monitoring him

but there's every reason to be positive.

Thank you. I spoke to my husband.

-You remember Tristan?

-Mm-hm.

He told me to tell you whatever you wanted, it's yours.

Oh, sorry - I don't quite understand.

I hear you've shelved your plans for the Neuro Centre.

Perhaps it's time they were resurrected.

I should never have doubted you, Guy. You're something special.

Don't waste that potential. Money's no object.

I really don't know what to say.

Say yes.

Yes!

Good. Because I've already told Mr Hanssen.

Thank you.

No, thank you.

Hey.

Hi.

I heard you've had quite a day.

Oh, you don't know the half of it.

-Are you OK?

-What time does your shift finish?

I'll tell you all about it over a glass of something cold and bubbly.

Actually, make that a bottle.

OK.

Seriously, well done for that back there.

With Iqbal. That's a tough spot - you did really well.

Thank you, Ms Effanga. That means a lot.

All right, let's get a few things straight, yeah?

Some ground rules for moving forwards.

First of all, you don't have to call me "Ms Effanga" all the time.

"Mo" is usually fine.

Understood.

Second, if you really want in on something, just ask.

I won't bite.

-OK.

-And finally, if you do want to suck up...

mine's a coffee with two sugars.

Unless we're in the pub, then it's a pint.

Right, let's make magic.

Ah, Mr Self. I hear congratulations are in order.

You succeeded in securing the funds for the Neuro Centre

all by yourself, as I predicted.

I look forward to working with you on the plans.

Do you, now?

Because as I recall, you didn't want anything to do with the project.

This is my centre. If I need your help, I'll ask for it.

Goodnight, Henrik.

Goodnight, Mr Self.

You look like you're off to a wedding or something.

Tells you all you need to know about me, doesn't it?

Weddings and funerals.

That's the only time you'll see me

in anything that's not scrubs or jeans.

Yeah, my flatmate, Dom, thought a new look would make me

feel more confident.

Right. Well, that backfired.

Thank you. For the theatre opportunity today.

That was yours. You deserved it.

Not really. You're the one that stopped him from arresting.

Only temporarily. He still would have died without the surgery.

You were amazing in there.

It was pretty mad.

Yeah.

Look, um, I really am sorry.

For everything.

And I should have apologised properly before

but I'm an idiot and I was embarrassed.

I really, really am sorry.

Thank you. Apology accepted.

You're a great doctor, Morven. And a nice person.

I wish you every success.

And that's why I have to go.

Jump before I'm pushed.

Or worse, before I fall and take someone with me.

I don't want that to happen.

Well, I appreciate your candour, Dr Digby, but let me ask you -

from what you know of me,

do you think I would consider myself a "people person", as you put it?

And yet here I sit.

Consultant General Surgeon and CEO of this fine hospital.

I prefer facts to emotions. Brevity to banter. Colleagues to friends.

Do I also lack "what it takes"?

I think it's different if you're the boss.

True. But once upon a time I was an SHO.

I haven't quite given up on you yet, Dr Digby.

Don't give up on me.

I put Dr Digby through the wringer a bit today.

He'll be fine. He's more resilient than he gives himself credit for.

I hope so.

So The Guy Self Neuro Centre?

You built him back up piece by piece,

only to discover you'd created a monster.

Well, it would have been an enormous waste of his talents,

had he hung up his scrubs for good.

However, I am but one man, Ms Campbell.

In the face of Mr Self's renewed ego, I fear that may not be enough.

I shouldn't worry about it too much.

I understand we're looking forward to the imminent return of Ms Naylor.

Mmm.

I can't wait to give her the good news.

HORN HOOTS

Oh, Arthur. Listen, you take this back.

I don't think I'm going to need them after all.