Go Ugly Early Holby City

I am willing to ask the board for funds for a complete overhaul of the trauma system on AAU.

-How you feeling?

-Excited, terrified, wondering what I've got myself into.

Is this where you tell me you want to go on a sabbatical?

Something like that.

Any room for me in your future plans?

Congratulations, Mr Self.

Thank you, Henrik. Looking forward to working with you again.

I think congratulations are in order.

-You know he's the real deal.

-Oh, please.

Either give him a chance or back off.

-What was that?

-I just felt that...

-Felt what?

That it was a moment between us.

-Stop swinging your hips like a catwalk model.

-Sorry, er...headlights?

Headlights! Imagine there are headlights on both of your hips.

-You've got to keep the beams going forwards at all times.

-Right.

-And swing your arms!

-OK!

-Almost looks like running to me.

-Sprint to the van!

-OK, cool!

Sprint to the van!

Seriously, you're looking great, guys.

Is this all for the half marathon?

LAUGHTER

-Feeling all right?

-Oh, God.

You want me to do it?

No.

I think I should do it. Two reasons.

One, I haven't had to exercise any authority down there yet.

You'd like this to be your introduction, would you?

And two, it keeps you clean.

I could be the fall guy. Keep you out of the blast zone.

Why would you do that?

-In case we need you to be good cop later.

-Good cop?

There's no point both of us being bad cop. Is there?

Wait!

THEY LAUGH

You can't quite get to that perfect wedding weight.

Hey! If I said that I'd be called a sexist.

-Why don't you talk to my fine, firm, peach-like...

-Zoshy!

-..bum.

Dad. I'm late.

About your wedding.

SHE SIGHS Not again.

If you haven't finalised things I'd still like to help.

What, sewing on sequins?

I'd like to pay for it. All of it.

Really?

OK.

I promised your mother.

You are joking me?

-No. Sorry.

-Mitch and Jimmer?

Woke up pierced with a pair of cow ear tags after me stag night?

Before my time.

Swallowed an electronic dog zapper?

-Were these suicide attempts?

-Rampisham Young Farmers.

So today you have a large lipoma under your armpit that needs

-to be surgically...

-You want to do your homework, bud.

Ask Jac Naylor, ask Jonny what's-his-face up on Dartmoor.

Darwin?

I'm a frequent flyer, me. Loyalty card, got all me stamps.

The lipoma?

One of them two, the knife juggler.

-The knife juggler?

-Billy the butcher?

The Wolverine? Sshht!

-Oh, you mean the surgeon.

-Duh!

-Both.

So which'd you trust most waving a blade around your googlies -

Cheech or Chong?

I really need to see your lipoma, please.

Mitch's work.

It's a Smurf.

Hello!

Just because you have some weird obsession with strange food...

Vegan is not strange food.

-Yes, it is.

-Yeah, it is.

He's James Maryfield, the Vegan Warrior.

Do you have any idea what eating that many lentils does

to your personal air quality?

His wife. Bay two. Chest pain and recurring migraine.

OK. Well, speaking of headaches... Lost again, Valentine?

Hanssen wants Matteo to run the Hertzig software. So I'm your cover.

Ah-ha. I get asked to solve Henrik's problems once again.

HE SPEAKS IN ITALIAN

-Sorry?

-Don't ask.

-No, what did that mean?

Again, it is Matteo who is chosen to take the chestnuts from the fire.

Try not to break anything.

You're on Darwin!

-Yay! So we get to talk about the wedding all day...

-Oh! Get off.

Right, so where are we going?

Olive oil?

Extra virgin olive oil. Cold-pressed.

Very rich in antioxidants and monounsaturated fats.

Yes, yes, all right, Grandad, but wine gets you drunk.

Did she say where she is?

Er, Northern Rhone.

French Shiraz country. She misses Marmite.

Next season she's thinking of leasing a vineyard.

Guzzling herself into an early grave, more like it.

Now, that looks like quality olive oil.

Extra virgin olive oil, from..."Aglandau".

French or Italian?

French. Our consultant, Ms Campbell, moved to the south of France.

-Living the dream.

-Yeah.

Was there something specific? Or can I give you the tour?

Do you think we might have a word? Ms Wolfe, will you join us?

If it's just admin-related, Ric's your man.

-I want to do a patient transfer.

-It isn't.

-Sorry to miss the talk of wedding plans.

-I hate weddings.

I can see a little ancient thatched church, marquee by a lake...

Bride sets marquee alight with a flame thrower.

I think Zosia's more London Hotel. Chilled champagne, rooftop terrace.

-Am I?

-The logo on the salad bags looks like a dope leaf.

Yes, I know it's supposed to look like a nettle but...

Ah.

Hi, guys. James Maryfield.

So Jammy's pain encircles her ribcage

and radiates downward into her abdomen.

-Jammy?

-Jemima, it's...

Oh, short for Jemima, her nickname.

It's from when we first got together. Everyone calls her it.

-Would you like

-us

-to call you...

-Jemima's fine.

Sadly I have to go.

-But just wanted to say I love Way Of The Vegan Warrior.

-Oh!

Fantastic recipes.

I tell everyone this.

The Vegan Warrior is not just a recipe book,

it's a way of life.

Heart sounds normal. There's a slight systolic murmur

-and click in the pulmonary area, though.

-OK, echo and ECG.

Order a cardiac enzyme run.

When does your head hurt the most?

The migraines are worst in the evenings, when I get home.

Oh, I'm treating her migraines with cayenne pepper and water.

Almonds, obviously, for their salicin content. Oh, and feverfew.

Migraines hurt so much.

OK, right. We'll run those tests. Let's start with oxygen,

-50mg of Tramadol.

-Ooh, let me just check those first.

Oh, you wouldn't believe how many pharmaceuticals

are still tested on animals.

Well, I was seriously hoping I'd never have to say these words again,

-but let's get Guy in here.

-Guy? Why's that?

For a full neuro consult for the migraines.

They all say it's the adrenaline hit they miss most of all.

-Who, sorry?

-Army surgeons. Civvy street.

The NHS doesn't quite match the buzz.

-Do you know a lot of army surgeons?

-Not as many as I'd like.

But, hands down, they are the best A&E and trauma surgeons

-you'll ever hope to find.

-Training's pretty intense.

It's not just their surgical skills. It's their attitude,

sense of responsibility.

Why do I get the feeling you're blowing warm smoke up my...

You personally initiated Holby City's trauma unit.

With a lot of help from others.

Army surgeons. Always think in terms of the team.

I'm saying it wasn't just me that made it happen.

Won't believe the narcissism and God complexes

I deal with in some surgeons.

Is it just me, or do you feel a "but" coming?

The model of your trauma unit is something that the trust

admires very much.

-The way it functions is very...

-If it's coming, it's coming soon...

At some point in the future they hope to roll out the model

in other hospitals.

Well, it makes sense.

It takes a lot of pressure off AAU and ED.

In the future, yes.

-But, for now, I'm afraid...

-Ah...there it is.

-There it is.

As of this morning, because of a very real threat

of departmental closure and imposition of special measures,

Holby City's trauma unit has been closed...permanently.

Me mum had a lipoma. Twice this size.

Practically see it on Google Earth.

-This paint, does it...

-Not paint. Ram dye.

-Ram dye.

-From Rambo's raddle.

From his raddle. You know, mark his ewes.

Show's you which ones he's covered.

-Am I being really dense?

-I get it. It's one of those things.

-Thing you strap onto a boy sheep so when he...

-..does his bizzo.

-..mounts the girl sheep, the dye from the...

-..raddle...

..leaves a mark on her back.

And that's the way you know which one has...?

Does it come off? We need to clean it off.

-Nah. Not this side of Christmas.

-So it doesn't come off?

Wouldn't be much good if it did, would it?

How'd you know who'd been tupped and who hadn't?

You've got to think about these things.

We need FBCs, LFTs, U&Es and group and save.

That's insanity!

We have no choice, but if we did...

The choice is that you don't roll over every time they cry closure.

-You fight.

-Clinical Care Group inspection shows that Trauma

is eating up £750,000 of AAU's total annual budget

-in staffing costs alone.

-Yes, by saving lives!

The alternative is that we close the whole department

and use the beds for Care patients awaiting placement.

Become a bed and breakfast for patients who should already

-have been discharged?

-But if we fight, we will lose.

Sorry, where's the "we" in this? It's us and them.

-And you, Ms Karnik, appear to be them.

-I am not the problem.

-Don't tell me you're the solution!

-What happens to the trauma patients?

That is not your concern.

Patients are my concern.

A redirect has already been issued. Patients will no longer be sent

-to Holby City Trauma.

-Sorry to interrupt. Ms Wolfe, red phone.

Air ambulance scoop from Warwick Downs Army Base.

Severe leg fractures, blast injuries.

Ms Wolfe, we are not done here!

As head of this department

I think you know what you have to do.

Go and treat our patient?

Well, have you had words? Does he seem a bit off to you?

Well, maybe it's cos of the running. He's taking it very seriously.

It's only cos he wants to raise as much money as he can.

My idea of exercise is jogging home from the chippy

so my saveloy doesn't get cold.

But I'll be honest, I'd quite like to get involved.

Well, do it.

I've kind of dropped a few hints already.

Is everything OK?

You look like you've got the hump about something.

I'm absolutely fine, so you can stop giving me those worried eyes.

I just don't appreciate patients making our jobs harder

with their infantile practical jokes, that's all.

So was it with or without anaesthetic?

What, the lipoma?

-No, your sense-of-humour by-pass.

-Ha-ha.

-I meant hump with Lofty.

-No.

-It's just, you seem a bit...frosty.

-No.

He keeps dropping hints about joining our training

-and you're all...

-Well, if he wants to join, he can ask.

And, no, I'm not being frosty.

They send me a soldier?

-Who?

-They're trying to shut us down and they send me a soldier.

Do you see any irony in that?

I didn't think we did irony any more.

OK, Sergeant Jerry McKee, Tank Unit. Age 25, leg fracture...

live ammunition wound.

-Hello, Jerry, I'm Bernie Wolfe.

-You the boss?

-I am.

How's the pain, Jerry?

-Let me tell you, morphine is amazing.

-Yep.

You ever seen anything like this before?

More times than you can imagine.

Live tank round. Faulty percussion plate.

As workplace accidents go, this is a bloody peach, eh?

-You're in good hands.

-Don't chop this leg off, though, all right?

-We need to get plasma and crossmatch.

-Did you hear what I said?

-We'll do our best.

-Mobile X-ray and vascular CT.

-I need this leg. I need both of them.

-I've become very attached to both.

-All right, Jerry. Just try and relax.

-Did she just say that?

-Breathe for me, please.

-Tell me what you need.

Check for genital injury and gain initial proximal control of the blood vessels in the groin.

When I think of relax, I think of a cold beer. Sunday footie.

Bad choice of words.

Might need to do a vertical midline to clamp the vessels in the groin.

Everything above the thigh is yours.

Blood. I'm going to need blood. Lots of it.

We need to manage a massive transfusion.

O-positive blood and plasma.

Fletch, in charge of checking blood products and feeding them

-through a Level One blood warmer.

-On it like a car bonnet, boss.

Morven, take blood for a TEG. Test for coagulopathy

-and we can tailor blood replacement.

-Yep, I'm already on it.

You know that Nina Karnik was just the messenger,

-and you just shot her.

-So bite me.

-If you bite her you've got to bite me and all.

-Easy, tiger...

OK, lovely.

Look right.

Look left.

Follow my finger.

BP's consistently low. Migraines fluctuate.

There's no specific pattern.

BOTH: What triggers them?

Noises. Strip lighting.

When I'm tired.

Are you two related?

-Why?

-I'm her father.

There's something similar about you both. Not looks so much, but...

There's an affinity.

-HE LAUGHS

-Do you have children?

Two. Small. Eldest is just about to start school.

Already reading a bit.

-Remember reading Jack And The Beanstalk?

-Of course.

-Loved fairy tales.

-My two, as well.

-Always used to get irate about that one.

-Why?

Because it's fundamentally racist. Or sizeist at least.

-The giant?

-Just because he's big,

this Jack-the-lad thinks he can steal his chickens and his gold.

And then when the poor man finally gives chase...

-..Jack chops down the beanstalk.

-..and the giant falls to his death

-and all the villagers think this little thief is a hero.

-Dr March?

What made you think of that?

Oh, it's just that I found the old copy.

You should drop by, pick it up.

I think we should get Jemima downstairs for a full CT scan.

-How bad is it, boss?

-Well, we won't know until we've seen the scans.

You're stalling.

-Haemoglobin's six, BP is dropping.

-We're losing too much blood.

I can see bits of bone from here!

-Just, please, tell me the truth.

-All right, honestly, Jerry...

-BEEP Jerry... Jerry... Jerry...

-OK, pressure's tanking...

-Come on.

Tourniquet's not holding.

Pressure. I need something to press down here hard.

We need to reinforce the tourniquet. Scan, please.

Right, four more units. Packed cells, platelets and plasma.

You need to get rid of the trousers.

Oh, crap.

Ever since you were little, you've known exactly what you wanted -

-exactly.

-Yes, but there are two of us now.

I'm just saying, if ever you get cold feet

or need a listening ear, I'd never judge you.

-Er...!

-Hey, I'm your dad. Proudest man alive.

It'll be an honour for me to pay for your wedding.

I promise to keep my nose out, unless I'm asked, of course,

Oh, yeah, it's going to have to be a traditional three-day

Polish wedding. I know this amazing Podhale folk band

we can bring over from Zakopane.

I blame Brexit. And Trump.

And Greek yoghurt.

-For...?

-Milk prices. Bottle of water costs twice as much.

Don't need cows to make water.

-That's why you're not just farming?

-Diversification.

The future is bright. The future is canine.

Dogs?

Breeding, grooming?

Cardiovascular aerobic stimulation.

-Which is?

-Mitch's idea. Let you into a little trade secret.

Right, Mr Victor, you're booked in on today's list

for a large lipoma excise under general anaesthetic.

Just waiting on your pre-op blood tests.

-You the butcher or the butcher's dog?

-I beg your pardon.

I think he means will you doing the procedure, or Mr Levi?

You's learning, bud.

It's not yet confirmed but I will probably be leading.

-And what time is Smurf o'clock?

-I don't know yet.

Know what an entrepreneur is?

-Yes, I believe I know what...

-Cos you're looking at one.

Farmer-turned-entrepreneur.

And time is money, bud. Places to see, people to be.

So put Jimmer in pole position.

Can you get him consented? And ask pharmacy what's in that dye.

Also make sure he stays nil by mouth.

Do a lot of sheep fencing, your mate?

I don't think Dom would know a sheep or a fence

if it came up and bit him.

Just wondered how he managed to get a fence post stuck so far up his...

Dom's OK. He's a good guy.

He's just quite stressed at the moment.

A man who doesn't laugh at a painted lipoma

-is not all right.

-Seriously.

He a mate?

Yeah.

Yes.

You want to find out what's bugging him before the wind changes

and his face stays looking like that.

OK, I'm just going to come out and say this. There's a ship,

moored on the Thames. Built in 1918.

It's got a ballroom and a presidential suite.

What do you think?

-Well, it sounds...presidential.

-Do you think he'd go for it?

-My dad?

-Hm.

Yeah, maybe I should have a word with him. Talk it through a little bit. Bond.

I went through that whole disapproving father-in-law thing

with Tara. I really don't need to go through it again.

Something leaping out at you?

Something like an aneurysm on the septal atrium.

-No, is that a...

-Yes, it's a patent foramen ovale.

-How bad do you think it is?

-It's a stroke waiting to happen.

Bud as in real bud or bud as in,

wave from one tractor to another on the top road, kind of bud?

-Real bud.

-Real bud?

Well, you know. More than just a tractor wave.

-Then you've got to front it, bud.

-You think?

Definitely. Over a pint, game of skittles.

Hog roast. Whatever doctors...

Cocktail party! "Got to say, bud. What's bugging you, bud?"

Yeah?

It's food for thought. Thanks.

Don't mention it. Always got free advice for my doctor man.

I'm a nurse, actually.

Jonny up on Darwood, he was a nurse.

-Oh, right. Good.

-And he was a bloke too. See, and I'm OK with that.

Man of the world, eh?

Seeing as I done you a favour, mano-a-mano,

there is something you could do for me.

HE HUMS

Something maybe you wanted to ask?

Hm? No...

Are you sure?

Yeah.

Actually, um... There is one thing...

..Mr Self.

I know this is going come out in the wrong order, a bit post facto,

but I'd like to ask for your blessing.

My blessing?

For Zosia's hand in marriage.

Know what Zosia's grandfather made me do

when I asked if I could marry Anya?

-Zosia's mother? No.

-Help him skin a roe buck.

A deer?

Shot in the forest that morning.

Oh! Yeah, like a male-bonding thing?

He had a frying pan and a charcoal burner

and we cooked the liver straight from the bloody carcass.

-OK.

-We ate the liver. Then he offered me the kidneys.

Very generous of him.

What do you think he would've said if I had refused?

I don't know.

No, nor do I.

But I knew I didn't want to risk finding out.

Sorry, um...

Do you want to eat kidneys with me?

Pretty sure Albie's has an all-day breakfast

and they've got black pudding. Pretty sure of that.

Love black pudding.

Great. Good, yeah.

That kidney thing, was it true?

So the reason I didn't ask your permission before was that

Zosia and I were kind of in a bad patch, so it happened on an impulse.

It was a good impulse. Morning.

Um, and... Yeah, I mean...

I kind of seized the moment and asked her to marry me.

-Mm-hm.

-It was...rather lovely, really.

Tell me, what kind of bad patch, exactly?

Well, maybe something you should talk to Zosia about.

Oh, come on, Ollie. I mean, we're practically family now.

We need to be on the same page in case Zosia needs our help.

We are in this together.

So what kind of a bad patch?

She was pregnant.

Was?

She miscarried?

She had a termination?

Your child?

My grandchild.

In the field we have a maxim.

Remove the hamburger. Cut back to the fillet steak.

The mush, the mince. All it's ever going to do is attract infection.

-Can we mend the breaks?

-No.

Well, it doesn't look like we're getting any more consultants

down here. This isn't really coagulating.

Can we check the TEG, please?

OK, it's low on the functional fibrinogen read-out.

The only pertinent question is where to start sawing.

-Go ugly early.

-What?

With blast damage the blast forces particles -

earth, dirt, shrapnel - deep into the tissue.

There's an ortho team on the south coast that can take him.

Ms Karnik says we can have a chopper in 20 minutes.

He could be on their table in an hour.

You think a normal ortho unit knows blast damage?

You think they ate, breathed and slept this for four tours solid?

Give me a full vascular set, please.

He's not going anywhere.

Um, Ms Wolfe. Next of kin.

-He's 100% behind us, whatever we choose.

-OK.

-So let's choose!

-Or not.

-No, I want to... I just...

-No pressure. This is us.

We only have ourselves to please.

Once we've opened up we'll expose and excise the aneurysm.

What do you mean by "excise"?

Effectively we cut open the atrial septum and suck out the contents

so they don't spill out everywhere.

-And then we sew a patch onto the...

-A patch?

It's just a simple bovine patch to cover the hole.

-In time the heart tissue'll grow into the patch.

-Sorry, bovine?

-As in beef animal?

-Yes.

Bovine, as in related to sub family bovini

which includes cattle, buffalo and kudus?

-It's a surgical scaffolding patch.

-Made from a cow?

-It's the best way...

-You are not putting a piece of dead animal

inside my wife.

-It's...

-Is that absolutely clear?!

Girlfriend.

Technically fiancee, I suppose.

To be fair, I did give the ring back.

Er, we found it in his pocket.

Not so much "give".

Chucked it at his head, to be more accurate.

-Sorry.

-Don't be silly.

He'll lose his leg?

-Die?

-He's young. He's fit.

-We're trying to control the bleeding.

-That a yes or no?

We're doing everything we can. The next hour is critical.

-Can I see him?

-Not yet.

I'll let you know when he's stable.

If he wakes up, tell him...

Tell him, if he dies, I'll bloody kill him.

Will do, Corporal.

Military?

Major, Berkshire Rifles.

Always tell. Can take the girl out the military...

..can't take the military out of the girl.

Where is he? We're ahead of schedule and I have a slot available now.

-Lofty's looking after him. Bathroom?

-Looked.

-Visitor's room?

-Looked.

Call Lofty. He'll know where Jimmer is.

-BEEPING

-Otherwise I'm just going to take in Mr Harman's hernia.

Just call him.

Right, Mr Harman.

Do you even know who I am?

-To be perfectly honest, I couldn't...

-The Vegan Warrior.

It would be the same procedure no matter who...

"Warrior" as in I battle to protect my principles.

-I protest against man's abuse of the animal kingdom.

-I understand.

You see, I wouldn't suggest it if there was a viable alternative.

Are you seriously telling me, 2017,

and the best thing that you can come up with to repair my wife's heart

is a leather patch?

-There are alternatives.

-Finally, someone with ethical perspective.

Number one is a porcine patch.

-Porcine?

-Yes, a patch made out of pig tissue.

-It's not as effective as cow.

-That is not an alternative

-if it's derived from an animal.

-Then there's Teflon.

-Teflon?

Why didn't you mention that before? The obvious choice.

The body tends to reject it.

The argument for using bovine patches over Teflon ones

is there's no need to take anticoagulation.

There's also a greater risk of infection and possible embolism.

With all due respect, Mr Maryfield,

the patch isn't to be fitted inside YOUR body.

So it's a decision your wife will have to make.

Well, there is no way that she will allow you

to sew a piece of animal inside her. No way!

-There's no question. I'm having the bovine patch.

-You can't.

Well, what if I find I can't...love you any more?

What, because I've got a bit of bovine membrane inside me?

Yes.

What if I can...sense it?

Feel it?

-Thursday nights, yoga...

-What?

-..with Suzie.

-So?

After I've dropped her off

I sit in my car at Beaminster Market Square,

listen to the Red Hot Chili Peppers and I eat a sausage roll.

You do...what?

Yeah. Every Thursday for the last...ooh, two to three years.

I can't believe you could...

And I've got to be honest with you, James,

it's the highlight of my week.

I've had four inches of pig mince inside me every Thursday

and you never knew.

So I can hardly see how a slice of beef will make any difference.

I'm all yours. Let's go.

Hello.

Thought you might like a cup of tea.

I...

I had a fella in the Cumberland Artillery.

-He lost his leg in Afghanistan.

-Sorry.

No, I'm just saying

I have a lot of sympathy for what you're going through.

Did he ask you to marry him?

Yeah, he did, actually.

And how'd that work out?

-I think if you love someone...

-Did he want you to stop being a nurse?

No, not at all.

Did you tell him to stick his ring where the sun don't shine?

-Not exactly, no...

-Were you pregnant?

No.

No, I wasn't.

More suction, please.

I need this area clear.

It provides a gold-standard service,

excellent training for our junior surgeons...

None of that is in question.

All clinicians would agree this is exactly how trauma care

-should be delivered.

-So I came to observe how morale

is faring now that people have heard

that the Trauma Unit is closed...

Ms Wolfe's reaction was hardly surprising.

..and in all truth I can't really say

that I've ever seen it more busy.

She continues to admit patients.

Ms Wolfe is now treating a blast victim.

Denial, the first stage of grief.

There's another patient there on their way to theatre

from the defunct Trauma department?

I can't physically stop her.

So how's the bad-cop thing going?

She's refusing to listen.

And the reluctance of other consultants to rush to the aid

of Trauma today? Is that part of the bad-cop plan, too?

I would never endanger a patient.

It doesn't exactly help the patient, though, does it?

Ah. Where have you been?

I had to see a man about a dog.

-Well, you've missed your theatre slot.

-What?

Grumpy doc said one o'clock.

No, what he said is theatre times are fluid

-according to priorities.

-I'm ready now.

You've missed it. Why are you so hot?

I'm not used to being cooped up. Outdoors man, see?

-Where have you been?

-Bog.

-Just checked.

-Downstairs bog.

Laying a cable. You know the saying, "Never dump where..."

-Where's Nurse Chiltern?

-Who?

-Lofty?

-Oh, right, he...

Where were you? You missed your slot.

-You lot ask a lot of questions.

-Where's Nurse Chiltern?

-I've just asked him that.

-She just asked that.

Well, do you know where he is?

YOU'RE his bud, right?

Do you know where he is?

-He said you were his bud.

-Did he now?

-Deffo. Big. But...

there's something he's been keeping from you.

-Couldn't bring himself to tell you.

-And what would that be?

-Just came out. Schoom! Like a ferret out a badger sett.

-What did?

-His dog...

-What dog?

..died.

Loss of soft tissue over the anterior aspect of the ankle

with loss of the tibial pilon and exposed fragments of bone distally.

No palpable pulses.

Preferred treatment is amputation. Agreed?

I'll need to clamp the vessels on the groin upstream of the wound.

-Just give me the word.

-Principles of amputation are...?

To preserve the limb length.

Below the knee much better long term than above the knee. And?

Aim to ensure that the amputated stump is as painless as possible?

Painless, well-padded and easy to fit into a prosthetic.

No use preserving limb length if the stump's going to be agony.

Where shall we cut?

Well, perhaps our corporate assassin would like to give us her opinion.

Ms Karnik, you're good at chopping things off.

30% overlap at least.

None of you got dogs, do you?

See, takes one to know one. Speak the same language.

Why did he tell YOU about his dog?

Like... It's like...Albanians.

An Albanian could talk to another Albanian all day,

but put him in a room with a...a...Danish...

nothing.

-So he told you his dog had died?

-Whole story. Heartbreaking.

-Was this recent? Cos he's not said anything.

-Today.

About an hour ago.

-So an hour ago his dog died?

-He told me.

When did it die, the dog?

See, what you don't understand is how to talk to him about it.

He never once mentioned that...

See you... This, bud. All snappy and vinegar-faced at work...

"Do this, Nurse, do that, Nurse."

He's never going to open up to you.

What, he mentioned me specifically?

Where, if you sat down,

two pints of cider, two bags of pork scratchings...

Did he say he wanted to talk to me?

Come to think of it, might need some pies, too.

If it's a session, like.

I just... I don't understand why he never mentioned anything,

-that's all.

-Everything all right?

Yeah, er... He missed his slot.

Yeah, it was brought forward.

Oh, no. I'm so sorry.

-It's fine. We'll fit him in.

-It's OK, there'll be another slot.

It's no big deal.

What just happened?

-The bleeding is...?

-Shrapnel damage to the superficial femoral artery.

-Dealing with that now or later?

-Which would you suggest?

Quickest way would be to tie off the femoral artery.

Which I would not want to do because...?

It would starve the whole limb of blood

and we would prefer to amputate below the knee.

I think anyone would prefer to amputate below the knee.

So that's a no to tying-off. Knees are good.

If it was me, I'd perform a embolectomy,

-restore the blood flow to the SFA with a shunt.

-Would you?

Then we would feed the catheter into the artery

-to extract the clot distally.

-Ever done one of those, Ms Karnik?

Pass the scalpel, please.

This could get messy.

OK, now the moment of truth.

-Release the clamp?

-Yep, this is just to check for leaks.

We need to be quick to close the right atrium. Prepare to perfuse.

Clamp off.

Well, that's got to feel good.

-Not a single drop.

-No leaks.

-No stretch.

All it takes is the right kind of patch.

Very nearly....

-That is your clot, I believe.

-And we have circulation.

Neat work, Ms Karnik.

And it looks like the artery is back to normal.

Suture, please.

Be my guest.

Saw.

Two knees are better than one.

ELECTRIC SAW WHIRRS

There's absolutely no reason why you can't walk.

-He's looking this way.

-Is he?

All worried about you and everything.

He seriously believed I had a dog and the dog died?

-They all did.

-I love it.

Genius or what?

I've got to tell him the truth.

You've got to milk it like a nanny goat.

It just doesn't feel right.

Come on.

I know you hate grapes.

Thanks.

"Like crunching little monkey eyeballs."

How can anyone hate grapes?

What am I going to do?

-About the pineapple?

-This.

This doctor told me, halfway through the operation they found this.

Jammed up your loading hatch.

You know that's not true.

If you had it your way they'd be surgically removing it

from my eye socket.

Nah. Loading hatch is about right.

I thought I was doing the right thing.

Asking me to marry you? You were.

It was the bit after that you messed up.

Expecting you to quit your commission and leave the Army?

Bull's-eye.

-You're going to be a mum.

-You're going to be a dad.

Most mums don't want to spend their days getting shot at.

You saying I'm like most mums?

Most definitely am not.

So, are you still asking me to marry you, or not?

Why? Do you want me to be asking?

-Do you want to ask?

-If I was asking, what would you be answering?

-Oh, for God's sake! Ask her.

-I'm asking.

Well, if you're asking, I'm saying yes.

Really?

No, mate. I'm just pulling your leg.

Too soon?

Better get used to it, I suppose.

Right, so...this is how it goes.

No marquee. No big dress.

No stupid shoes. No speeches.

No cake. Profiterole volcano.

And it happens on Borth beach,

A 15-minute service followed by a two-day piss-up. Any questions?

None, Corporal.

Good, now just hold up your hands for me like you're holding a tray.

OK, that's very good, Jemima. I'll see you later.

Cerebral profusion normal on both sides.

-OK, thanks for helping out.

-Pleasure.

-Hey, what do you think?

-Of...?

Commissioning an exact copy - in silk, of course.

-You're not serious?

-Ivory rather than white?

Sorry, you want to dress me to look exactly like my mother did

when she got married?

Everyone said how gorgeous she looked.

No strings, remember?

You're doing exactly what I asked you not to do.

-Or are you finding excuses to delay your wedding...

-What?

..because you have doubts about what you're about to do?

CRASH

Well, every single one is different

and they flip-flop from day to day.

-He's tough, Jerry.

-It's often the tough that take it hardest.

They feel like they've lost the most.

He'll adapt. Change direction. You'll see.

If nothing else, Army prepares you to be flexible.

And you?

-Sure. I'm flexible, so long as I get my own way.

-Ha!

What you were talking about earlier...

About me wanting to go back to the Middle East, after....

I was in Kandahar when my kids were in Cheltenham.

And?

Well, it was definitely harder on them than it was on me.

I defuse bombs. I remove land mines.

Combat engineer?

I stop people - many of them children - from getting hurt.

Thing is, you get shot at, too..

It's what I'm trained for. Humanitarian initiative.

-Save lives, not take them.

-And you love what you do?

Nothing else comes near.

So far.

Are you saying that when I become a mum, that'll be better

than anything else ever and I'll just want to stay home and bake?

Well, it didn't happen like that for me.

Anyway, if he's as good a dad as he is a soldier, should be no problem.

Good luck.

-You ever miss it?

-The Army?

Like you wouldn't believe.

What?

-It's over.

-It's so not over.

However we play it, Trauma's going to close.

Over my dead body.

Let it go, Bernie. Just give it time.

We'll think of something new.

Is that it?

Is that all the fight you've got?

Sometimes it takes more than just fight.

Sometimes you have to know when to step back.

Do you know what you sound like?

An old man.

A sad, weak old man.

You've just closed my unit.

Ms Wolfe. I was rather expecting a visit, I must say.

Pick your fights, Ms Wolfe.

You of all people must know how important that is.

-Would you like some green tea?

-You closed my unit.

-You think

-I

-did that?

-Well, you rubber-stamped it.

-I had to comply

because I, like you, like everybody in the NHS of today,

-learns to fight the fights we can win.

-So you rolled over?

-Have you never cut off a foot to save a leg?

-All the time.

-A septic finger to save a hand?

-Yes, I get the point, Henrik!

The trauma unit was haemorrhaging money, draining funds from the AAU

to the point there was a danger the whole department

would have had to close.

So that's it. That's why Ric Griffin just caved.

He was scared of losing his department.

Ric Griffin caved, did he?

There was a time when our job was treating human beings,

was mending bodies, not brown-nosing bureaucrats.

Well, I'm quite sure I shouldn't tell you this

but Mr Griffin just came to me and offered his resignation

if by so doing the salary saving would secure your job.

Ric offered to leave to save me?

And I told him that we could of course find you another role

on an equal pay grade.

What other role? What another ward?

I'm trained to do trauma.

Yes, but there are departments within the hospital that could use

-your tremendous expertise.

-Name one.

Er, I'd have to just check the list of...

Name one!

Well, the hospital is now of course a centre of excellence

for hip-replacement revision.

And, um, they are planning an expansion of the...

FOOTSTEPS, DOOR SLAMS

Did you dream of bacon butties and chipolatas?

Oh, I'm sorry, James, I didn't...

Anyway, since your operation, I've thought of a new nickname for you.

Je-moo-mah.

Oh...

I think I did have a dream.

Something about a princess making a terrible mistake.

You're doing fine.

Better than that, the scan looks very good.

Ooh, I've got a surprise for you.

Jumbo sausage roll.

Why are we here?

Canine aerobic stimulation.

Dog walking.

Right, so this is what you were doing when you missed your slot?

Well, someone had to walk 'em.

Can't let my clients down. These dogs belong to busy people.

Judge, bank manager, chef, nurse, pole dancer.

Air conditioned, too. It's great, innit?

You both really, really like dogs?

Well, who doesn't?

Sorry, what are those?

I run, they chase. Just trying to reawaken a little bloodlust

in all those pampered city dogs.

I suppose you know what you look like in those.

-Rabbit, yeah.

-Yeah...

Look, Lofty, I'm sorry... I didn't know about your dog dying.

Yeah, er.. That's why I brought you here.

-You see, Jimmer was, um...

-Jerking your chain, bud. Big time.

Well, I'm sorry about charging in trying to rescue your wedding...

-That's it, you see.

-..and your relationship.

It doesn't need rescuing!

It's just that I know you've been going through

a tough time recently.

So sorry to hear about the abortion.

It's not something for you to be sorry about. We...

My grandchild, no, sure. And Ollie's affair with Jasmine.

I mean, these are very difficult things to have to deal with.

It was not an affair. It was when we were on a break.

We were on a definite break.

Was this before or after the abortion?

Don't do this.

Don't judge my relationship

by your weird view of what a relationship is.

Don't you think I know a thing or two

-about papering over cracks?

-I'm not papering over any cracks!

You are scared to your core about marrying Oliver Valentine.

I am not scared. You're jealous!

Of what? A life of mediocrity settling for second best?

-Ollie is not second best.

-Who said I was talking about Ollie?

-Well, then who are you...

-He's the one who's already lost

the love of his life.

Tara?

-You're saying I'm second best?

-I don't know, Zosia. You tell me.

You seem to be frightened of something.

So, Dr Copeland, can you take me through the procedure, please?

Sure. First we will make an incision through the epidermis,

the dermis and the fatty layer until we reach the fibrous capsule

-and we will shell it.

-Great.

HE LAUGHS

THEY ALL LAUGH

Ric, I...

You didn't have to rip it all out before the last patient's

even left the building.

Do you know how much those machines cost to lease,

-even just for one day?

-Nope. But I'm sure you do.

I do. Mr Griffin, I know exactly where every single pound is spent

and it scares me. It scares me the running of this department,

even the running of this hospital, is fast becoming untenable.

So you're doing us a service?

You think I'm the grim reaper?

-If the cap fits...

-Believe me, I am the fairy godmother.

There are shadows above me that would close Holby in a blink.

They'll never close Holby.

The amount of talent under this one roof...

It's not about talent, Mr Griffin. It's not about innovation

or even medicine. It is about targets and money.

You succeed or fail as a hospital on these. Nothing else.

If you believe that, then you have absolutely no right running...

-Leave it. Leave it, Ric.

-No, no.

-She's right.

It's a shame for you, a surgeon...

And if she is half as good an administrator as she is a surgeon,

she's exactly what you need.

-Exactly what

-I

-need?

We're all going to go and do a fun run after work today,

-pre-marathon.

-Cool, I'd love to join in.

Yeah, well, it's a dress rehearsal before the main event.

Good.

So we're going to keep him in for 24 hours and as long as there's no

major fluid leakage, then he can go.

On it.

Dress rehearsal?

Yeah.

Yeah, so people can try out their costumes.

Well, it's a charity thing.

-People like to dress up as silly things.

-Course, yeah.

Star Wars characters, animal costumes, that kind of thing.

Well, don't worry if you're the only one that hasn't got a costume.

-No...

-Bunny ears.

-Yes!

-Yeah, that could work.

-Got a bunny tail, too.

-Great. Can I...?

-Natch.

Right, save the date. 19th September is our wedding

and you're all invited.

I hate weddings.

-Che bello. Congratulations.

-Thank you.

Congratulations. Great photo.

-Congratulations.

-Don't think I don't know what you're doing.

Trying to get your hooks into me. It won't work.

I only want you to be happy,

-and if you think you can be happy with him...

-With Ollie?

Yes, and I will be marrying him.

So stop trying to force your memories of my mother onto me -

I have my own. And I have future memories to make with Ollie.

Well, good luck.

You've just forfeited any right to be a part of that.

Remember, everyone, it's just for fun, so don't go mad, yeah?

All your fivers need to go in the Holby marathon bucket.

And remember to stretch before and after.

-Hey, Lofty!

-LAUGHTER

I thought we were all wearing silly costumes.

It's game on, OK?

Serena said to show you this...

I take it that you're not going to hip replacement, then?

..and get back to us...

So...

where are you going?

Eurostar. South of France. Tomorrow morning.

Grape picking? That's brilliant.

And then Sudan.

Not the front line?

Military field hospital.

Humanitarian medicine.

Going soft?

Heading back to a war zone with a piece of Holby in my heart.

Helping with civilians who need help the most.

It's like a little bit of Ric Griffin rubbed off on me.

HORN

-We're off!

-Come on, then.

Hello!

Oh...

This is where I... This is where I go.

Aren't you going to say goodbye?

Think we've had enough of goodbyes.

Serena wants you to come, too. Pick some grapes.

Do a proper day's graft for once in your life.