0:00:02 > 0:00:04There's somebody from the Coroner's Office who wants to talk to me
0:00:04 > 0:00:07- about Elaine Warren. - The coma patient that died?
0:00:07 > 0:00:08What do they want to know?
0:00:08 > 0:00:09I can't operate this kit.
0:00:09 > 0:00:11You wanted this to happen. You wanted Amira to fail.
0:00:11 > 0:00:14I wanted you to stop it from happening.
0:00:14 > 0:00:17I've forwarded an e-mail outlining the details for this year's
0:00:17 > 0:00:19Junior Doctor Award and I'm asking all consultants
0:00:19 > 0:00:23if they would kindly offer their services as supervisors.
0:00:23 > 0:00:26You'll need to get your pitches in shape if you both want to impress.
0:00:26 > 0:00:28Her name was Elaine Warren, not Lillian.
0:00:28 > 0:00:29Sorry, who are you?
0:00:29 > 0:00:32I'm her son, Jeremy.
0:00:32 > 0:00:34And, er, what are you doing here?
0:00:34 > 0:00:36Looking for answers.
0:00:36 > 0:00:38Looks like I've found some.
0:01:22 > 0:01:24Shouldn't you guys be in school?
0:01:24 > 0:01:26Trick or treat!
0:01:27 > 0:01:29All right.
0:01:30 > 0:01:32One for you.
0:01:32 > 0:01:34All right? Have a good day.
0:01:36 > 0:01:39I'm not really sure about you encouraging truancy.
0:01:41 > 0:01:43Nice wheels.
0:01:43 > 0:01:46I know I should have gone into law.
0:01:46 > 0:01:48My post-divorce mid-life crisis.
0:01:49 > 0:01:51And how is Nigel?
0:01:51 > 0:01:54Happily shacked up with his 25-year-old lap-dancer,
0:01:54 > 0:01:56but you know me, I'm not bitter.
0:01:56 > 0:01:58I thought she was his intern?
0:01:58 > 0:02:01She is. I made the lap-dancer bit up.
0:02:01 > 0:02:03OK, I might still be a tiny bit bitter.
0:02:03 > 0:02:05So what are you doing here anyway?
0:02:05 > 0:02:07I thought the hearing wasn't until this afternoon?
0:02:07 > 0:02:09Another case. The morgue beckons.
0:02:09 > 0:02:14Before you read me the riot act and throw away the key?
0:02:14 > 0:02:18I shouldn't even be talking to you, never mind discussing your case.
0:02:18 > 0:02:20Stop with the fishing, Ric.
0:02:21 > 0:02:25You know, Louise, if I didn't know better, I'd think that
0:02:25 > 0:02:28you enjoy putting us poor humble medics through the mill.
0:02:30 > 0:02:33Well, someone's got to keep the wolf from the door.
0:02:44 > 0:02:46- What have we got?- RTC.
0:02:46 > 0:02:49He's hypotensive and tachycardic with suspected internal bleeding.
0:02:50 > 0:02:54Let's order an abdominal CT scan. Don't think we've got time for that.
0:02:54 > 0:02:57Prep him for emergency exploratory laparotomy, please.
0:03:15 > 0:03:18Here, I...want you to read this.
0:03:20 > 0:03:25You want me to give you my opinion on your presentation?
0:03:25 > 0:03:26No.
0:03:26 > 0:03:29I was just giving you a heads up on the quality of your competition.
0:03:29 > 0:03:31I'm sure it's an excellent read.
0:03:31 > 0:03:34The successful treatment of pancreatic cancer has long been
0:03:34 > 0:03:37the sought-after Holy Grail of modern medicine.
0:03:37 > 0:03:39Indeed it has, so good luck with that.
0:03:41 > 0:03:43So what have you got then?
0:03:43 > 0:03:45Hanssen wants to go through the proposals today.
0:03:45 > 0:03:47Yes, I'm well aware of that, thank you very much.
0:03:47 > 0:03:50Then I look forward to your imminent downfall.
0:03:52 > 0:03:55Well, as Fredrik apparently doesn't need my help, is there something
0:03:55 > 0:03:58you want me to look over before your presentation?
0:03:58 > 0:04:00No, not needed.
0:04:01 > 0:04:04So what's this work of genius that you've been hiding?
0:04:04 > 0:04:07It's more a work of fiction, to be honest.
0:04:07 > 0:04:09I've got nothing
0:04:09 > 0:04:11and every time I try to think of more ideas,
0:04:11 > 0:04:13I come up with fewer and fewer.
0:04:13 > 0:04:15- Creative block.- Something like that.
0:04:15 > 0:04:18Well, I need your help in theatre
0:04:18 > 0:04:21so maybe we can come up with something together?
0:04:21 > 0:04:23Maybe I should just give up on the whole thing.
0:04:23 > 0:04:25No, no, no, that's not the attitude, Dominic, because
0:04:25 > 0:04:29I don't think either of us could deal with Mr Johanssen's smugness.
0:04:29 > 0:04:31Thanks. It felt weird picking up her things
0:04:31 > 0:04:34after what happened last week. Sorry about that, by the way.
0:04:34 > 0:04:36It's fine. You'd just lost your mum.
0:04:38 > 0:04:40You know, not taking care of yourself,
0:04:40 > 0:04:42you know it's not going to help anyone, right?
0:04:42 > 0:04:44What's that supposed to mean?
0:04:44 > 0:04:46I'm just saying, a bit of deodorant wouldn't go amiss.
0:04:46 > 0:04:49Well, I guess I've let things get on top of me.
0:04:49 > 0:04:51I'm sure your mum wouldn't want to see you like this,
0:04:51 > 0:04:54- that's all I'm saying. - Is this your bedside manner?
0:04:54 > 0:04:56You know me. Caring and sharing at all times.
0:04:56 > 0:04:58Well, thanks for the kick up the backside.
0:04:58 > 0:05:01- I'll be sure to spruce myself up for the hearing.- Good.
0:05:01 > 0:05:04Then my work here is done. I'll see you later.
0:05:06 > 0:05:10All this is a waste of time, isn't it?
0:05:10 > 0:05:12You lot look after your own.
0:05:13 > 0:05:16The Coroner's Court is there to find out if there was anything more
0:05:16 > 0:05:18we could have done for your mum, if we missed anything.
0:05:18 > 0:05:20And is there?
0:05:20 > 0:05:24You need to understand that we do all we can for the patients here,
0:05:24 > 0:05:25- but...- But you're only human.
0:05:25 > 0:05:28Yeah, it's OK. Don't worry, I get it.
0:05:32 > 0:05:34How can I run a ward if I've got no-one to shout at?
0:05:34 > 0:05:38So many nurses have gone bank to work sensible hours for better pay.
0:05:38 > 0:05:41- Sounds like you're up a creek without a paddle.- Care to join me?
0:05:41 > 0:05:43- We can go over the waterfall together?- You're on your own.
0:05:43 > 0:05:46You need to understand that Darwin has a certain reputation
0:05:46 > 0:05:49- for burning staff out. - What's that supposed to mean?
0:05:49 > 0:05:51If you ran your ship any tighter, you'd be popping rivets.
0:05:51 > 0:05:54And you have a problem with that?
0:05:54 > 0:05:56Spit it out, Fletch!
0:05:56 > 0:05:58I've had three senior nurses refuse to work on your ward
0:05:58 > 0:06:00since you've taken back control.
0:06:00 > 0:06:04- You give them a choice?- Or I could just watch them move to St James's.
0:06:04 > 0:06:07Look, I know I've taken on a poison chalice here
0:06:07 > 0:06:08but I am doing my best.
0:06:08 > 0:06:11I just want someone senior with surgical experience
0:06:11 > 0:06:13or I'm going to hang you out to dry!
0:06:13 > 0:06:15Do you know what, mate, there was a time when just the sound
0:06:15 > 0:06:17of your voice would send me borderline tachycardic.
0:06:17 > 0:06:20Whereas now, your little rants I find amusing.
0:06:20 > 0:06:22I think that new suit has gone to your head...mate.
0:06:22 > 0:06:25Let me know when you're back in the real world.
0:06:26 > 0:06:29The bleed is coming from somewhere in the pelvic area.
0:06:29 > 0:06:31Blood pressure's dropping. Can we get some colloid in him, please?
0:06:31 > 0:06:34He's going to bleed out before we can restore haemostasis.
0:06:34 > 0:06:37I think we should pack the abdomen, go in again when he's more stable.
0:06:37 > 0:06:39I agree. It will give us time for a CT angiogram.
0:06:39 > 0:06:42Find out where this bleed's coming from and consider embolisation.
0:06:42 > 0:06:44- My call, pack the patient. - Your call?
0:06:44 > 0:06:48- I just...- Please don't spare my blushes, Mr Di Lucca.
0:06:48 > 0:06:51Your patient, Mr Griffin.
0:06:51 > 0:06:55- I will need you to cover my list this afternoon.- Of course.
0:06:55 > 0:06:57OK, let's get him stabilised.
0:06:59 > 0:07:01Oh, I'm surprised to see you in today.
0:07:01 > 0:07:04I thought that you'd be preparing for Coroner's Court.
0:07:04 > 0:07:08What's there to prepare for? Turn up, say my piece and go.
0:07:08 > 0:07:11- You're not worried? - No, I've been there before.
0:07:11 > 0:07:13I mean, the mere matter that it's gone this far...
0:07:13 > 0:07:16Stop fretting. They always do this with a sudden death.
0:07:16 > 0:07:20- I've never been to one before. - You say that like it's a bad thing?
0:07:20 > 0:07:22Must be really fascinating, you know,
0:07:22 > 0:07:26going over the forensic details piece by piece.
0:07:27 > 0:07:30- Donna?- Hmm.
0:07:30 > 0:07:34Do you think that maybe I could have a little look at the file, please?
0:07:35 > 0:07:37Seriously?
0:07:38 > 0:07:41It took me four hours just to write the statement.
0:07:41 > 0:07:44- I'm just really curious. - You're such a loser, you know that?
0:07:45 > 0:07:48Here you go, Miss Marple, knock yourself out.
0:07:48 > 0:07:51I will be on Tinder.
0:07:51 > 0:07:53Jane Doe, collapsed at a food bank.
0:07:53 > 0:07:56CT scan from the ED shows likely ischemia in the bowel
0:07:56 > 0:07:59which we're about to see for ourselves.
0:07:59 > 0:08:02Wow, certainly not her first time at the rodeo.
0:08:02 > 0:08:05Colon is attached to the abdomen wall.
0:08:05 > 0:08:07Large clamp, please. Thank you.
0:08:09 > 0:08:12Right, let's start by mobilising the hepatic flexure, shall we?
0:08:12 > 0:08:16Looks like she's had multiple bowel resections.
0:08:16 > 0:08:19- Question is, what's causing them? Clamp, please.- Possibly Crohn's?
0:08:21 > 0:08:23Well, there's no sign of any ulceration.
0:08:23 > 0:08:25Could be previous, I suppose.
0:08:25 > 0:08:28- There's a perforation in the bowel just here.- OK.
0:08:28 > 0:08:29Scissors, please.
0:08:29 > 0:08:32- What do we do next?- A stoma would be standard procedure,
0:08:32 > 0:08:37but she's so young that I would probably suggest removing
0:08:37 > 0:08:40all the ischemic areas and then resetting again.
0:08:40 > 0:08:42Good. How would you like to proceed?
0:08:43 > 0:08:46Well, we need to cut the proximal part of the bowel
0:08:46 > 0:08:48at the ileocecal junction,
0:08:48 > 0:08:53then dissect up to the distal at the beginning of the transverse colon.
0:08:53 > 0:08:55Excellent. I may yet be in the presence
0:08:55 > 0:08:58of a winner of a Junior Doctor prize.
0:09:01 > 0:09:03Come on. Something will grab you.
0:09:03 > 0:09:06- So where's your mojo gone recently? - I don't know.
0:09:06 > 0:09:08Popped out for a pint of milk and never came back.
0:09:09 > 0:09:11Are you missing a certain someone?
0:09:13 > 0:09:16- What?- Well, AAU's not far.
0:09:16 > 0:09:19I think we're all missing Lofty these days.
0:09:19 > 0:09:21- Ugh, no, not him.- Who then?
0:09:21 > 0:09:27All this talk of the Junior Doctor Prize...just makes me think
0:09:27 > 0:09:31that Arthur would have been all over it, doing anything to win.
0:09:33 > 0:09:35Guess I'm just trying to do it for him.
0:09:35 > 0:09:37I know that sounds stupid.
0:09:37 > 0:09:40The goal is to be able to go home knowing you've done
0:09:40 > 0:09:42everything you can for the patient.
0:09:42 > 0:09:44That's all we can ask for ourselves.
0:09:44 > 0:09:45Take this girl, for example.
0:09:45 > 0:09:48You could have gone for the easy option,
0:09:48 > 0:09:51but you chose the harder route to give her a better quality of life.
0:09:58 > 0:10:01How's he responding to the inotropes and clotting agents?
0:10:01 > 0:10:03BP is low, but holding. Be good to have his notes?
0:10:03 > 0:10:05Find out why that bleed was so heavy.
0:10:05 > 0:10:09Well, let's take the guesswork out of it, shall we? Test results?
0:10:09 > 0:10:10Scans and CT on order.
0:10:10 > 0:10:13FBC have been delayed as the lab have only just received it.
0:10:13 > 0:10:15Let's keep him on 15-minute obs.
0:10:15 > 0:10:18And perhaps, Donna, you could use your legendary charm
0:10:18 > 0:10:21to chase up the FBC results?
0:10:21 > 0:10:22No need to ask. Already on it.
0:10:22 > 0:10:25Bit bleary-eyed today. Heavy night, was it?
0:10:25 > 0:10:28Amber was up all night with bad dreams, thank you very much.
0:10:28 > 0:10:31- Feel guilty now, don't you?- Ouch!
0:10:31 > 0:10:33It's not the best prep for an inquiry.
0:10:33 > 0:10:36- You've given your statement? - Have you chucked him to the wolves?
0:10:36 > 0:10:39Of course. You're so doomed!
0:10:39 > 0:10:42In which case, Ms Jackson, I shall be taking you down with me!
0:10:42 > 0:10:44SHE LAUGHS
0:10:44 > 0:10:48- How many times is that now? - In the Coroner's Court?
0:10:48 > 0:10:50This will be the fifth time.
0:10:50 > 0:10:52I've had two myself.
0:10:52 > 0:10:56Stressful for you, even if you know you did everything that you could.
0:10:56 > 0:10:59Necessary evil, Mr Di Lucca.
0:10:59 > 0:11:01Weeds out the bad eggs.
0:11:01 > 0:11:04Keep me posted on Mr Willis, please.
0:11:04 > 0:11:07- Good morning. - Amira, good to see you.
0:11:07 > 0:11:11- To what do we owe the pleasure? - Director of Nursing sent me.
0:11:11 > 0:11:14I am the cavalry, apparently, here to save the day.
0:11:14 > 0:11:18- You're serious? After last time? - I'm the new and improved version.
0:11:18 > 0:11:20Done my MIMS module and everything.
0:11:20 > 0:11:23Dr Ford, would you mind showing Amira a locker, please?
0:11:23 > 0:11:25It's OK, I'm good.
0:11:26 > 0:11:28Which way's the staff room again?
0:11:28 > 0:11:30Down the corridor.
0:11:30 > 0:11:33- What are we going to do? - Hope Jac didn't see and tell Fletch
0:11:33 > 0:11:35we have a serious diplomatic incident on our hands.
0:11:35 > 0:11:38- Good morning, Ms Naylor. - What is she doing here?
0:11:38 > 0:11:40Fletch's answer to our staffing problems, apparently.
0:11:43 > 0:11:45- Batten down the hatches? - Prepare for Def-Con 4.
0:11:47 > 0:11:51Nurse Zafar. I didn't expect to find you on my ward.
0:11:51 > 0:11:54I was hoping I'd speak to you before my shift started, Ms Naylor.
0:11:54 > 0:11:56I want to reassure you that I'm up to speed
0:11:56 > 0:11:59and I'm confident that I can do a job for you here.
0:11:59 > 0:12:01Well, that remains to be seen.
0:12:01 > 0:12:03I'm only asking for the opportunity and your support.
0:12:03 > 0:12:05I'm not inclined to give you either.
0:12:05 > 0:12:08I know I didn't exactly cover myself in glory, but...
0:12:14 > 0:12:16I'll get that.
0:12:21 > 0:12:25Elaine Warren died from the overwhelming spread of sepsis?
0:12:25 > 0:12:27End of, as far as I can see from these notes.
0:12:27 > 0:12:30Well done, Sherlock. Tell me something I don't know.
0:12:30 > 0:12:33I mean, maybe the amputation could have happened sooner
0:12:33 > 0:12:36if the CT angiogram had been done earlier,
0:12:36 > 0:12:38but we're just talking about a few hours.
0:12:38 > 0:12:41- And it's not Mr Griffin's fault. - It's all in the file.
0:12:43 > 0:12:46Radiography were snowed under after a major accident.
0:12:46 > 0:12:48At that point, Elaine wasn't a priority,
0:12:48 > 0:12:50as the sepsis hadn't shown up in her FBC.
0:12:50 > 0:12:51No blame, no claim.
0:12:51 > 0:12:56Did he ask for anti-coagulants to be administered to her?
0:12:56 > 0:12:58What are you talking about?
0:12:58 > 0:12:59Nothing, I mean...
0:13:01 > 0:13:04It would just be standard practice, given her condition.
0:13:04 > 0:13:06Well, then it must have been done.
0:13:08 > 0:13:10There's no annotation of the drugs being prescribed.
0:13:15 > 0:13:18It just would have improved her circulation,
0:13:18 > 0:13:22stopped the sepsis from setting in so quickly.
0:13:22 > 0:13:25Yeah, I'm sure there's a reason why.
0:13:25 > 0:13:28An effect on the angiogram result or whatever.
0:13:28 > 0:13:31- You know what, ignore me. - Do you really think he might...
0:13:31 > 0:13:35Who am I to question Mr Griffin? I'm sure he had his reasons.
0:13:35 > 0:13:38I would perfectly understand if you took a leave of absence
0:13:38 > 0:13:40until this matter is resolved.
0:13:40 > 0:13:43You don't think that we're already over-stretched?
0:13:43 > 0:13:44Your dedication is appreciated.
0:13:44 > 0:13:48All the same, this inquest comes with unfortunate timing, doesn't it?
0:13:48 > 0:13:51Your point being? The hospital is at a critical juncture.
0:13:51 > 0:13:54Our every move is being examined and cross-examined.
0:13:54 > 0:13:57We are under severe pressure to present this hospital
0:13:57 > 0:13:59as a perfect NHS model.
0:13:59 > 0:14:02- So that marks me as an embarrassment?- No, no, not at all.
0:14:02 > 0:14:04I consider you one of our finest.
0:14:04 > 0:14:06but if we're to weather the oncoming storm,
0:14:06 > 0:14:08then we're going to need all our key players.
0:14:08 > 0:14:14- Duly noted.- Mr Griffin, you have Holby's full support.
0:14:14 > 0:14:17Representatives from management will be present at the Coroner's Court.
0:14:19 > 0:14:21Let's hope that I don't need them.
0:14:31 > 0:14:35- Are you stealing from patients now? - There's nothing to steal.
0:14:35 > 0:14:38Just this and some pocket change.
0:14:38 > 0:14:40- Any idea who she is yet?- Nope.
0:14:44 > 0:14:47A search on that might give you a head start.
0:14:53 > 0:14:55Let me save you some time.
0:14:55 > 0:14:57It's Romanian for "Offer Me Peace".
0:15:05 > 0:15:08How's that presentation prep going?
0:15:12 > 0:15:15Now doesn't that silence speak volumes?
0:15:15 > 0:15:18Don't you think you're letting your intuition get away with you
0:15:18 > 0:15:20- a little bit? - Not when my father's been enquiring
0:15:20 > 0:15:23if and when you intend to hand your proposal in.
0:15:33 > 0:15:36Have you managed to work your magic on the guys in the lab yet?
0:15:36 > 0:15:39Batting eyelids, damsel in distress. You know the drill.
0:15:40 > 0:15:43And the CT scan for the suspected peritonitis, bed four?
0:15:43 > 0:15:46It's on order. He's also had pethidine and a drip
0:15:46 > 0:15:47as he was severely dehydrated.
0:15:47 > 0:15:50He's awaiting transfer to Keller and he's on hourly obs.
0:15:52 > 0:15:55Well, when I checked on him, his temperature was up and his BP too.
0:15:55 > 0:15:56Really?
0:15:56 > 0:15:59Oh, er, I'll check on him again then.
0:15:59 > 0:16:01I want him on 15-minute obs as of now.
0:16:02 > 0:16:05It's a bit overkill, isn't it, if you don't mind me saying?
0:16:05 > 0:16:07I do mind you saying.
0:16:12 > 0:16:13PATIENT SHOUTS IN ROMANIAN
0:16:13 > 0:16:15I'm sorry, I'm really...
0:16:15 > 0:16:17- Just...- What's going on?
0:16:17 > 0:16:19Sorry, sorry!
0:16:20 > 0:16:23I think we'll have to get a translator once we work out
0:16:23 > 0:16:26- where she's from.- She's Romanian. - How do you know that?
0:16:27 > 0:16:30Linguistics. It's one of my many skills.
0:16:30 > 0:16:32Well, better get someone up from HR, OK?
0:16:32 > 0:16:35- Can I leave her with you? - Well, I was hoping...
0:16:35 > 0:16:37I know. I know you want to do your research project
0:16:37 > 0:16:40but I'm due in theatre and we still have a ward to run, OK?
0:16:40 > 0:16:43- Then I guess I'm multitasking, aren't I?- Thank you very much.
0:16:47 > 0:16:53Hi, I'm Mr Copeland. I'm one of the doctors who operated on you today.
0:16:55 > 0:16:59Now, I'm going to try and translate this conversation
0:16:59 > 0:17:02using an app on my phone.
0:17:05 > 0:17:08Now, don't you smell nice?!
0:17:08 > 0:17:12Do you wear cologne for all the girls or is this especially for me?
0:17:12 > 0:17:14Right, OK, so you do speak English?
0:17:14 > 0:17:16You can speed up now. I'm quite fluent.
0:17:16 > 0:17:20Why were you giving my boss such a hard time in your native tongue?
0:17:20 > 0:17:22His hands were cold.
0:17:22 > 0:17:27He very grimly and solemnly told me he had to remove some bowel.
0:17:27 > 0:17:29Needs to improve his bedside manner.
0:17:32 > 0:17:34So...
0:17:34 > 0:17:40..when can we discuss how you're going to save my life, sexy man?
0:17:43 > 0:17:45OK, there we go.
0:17:45 > 0:17:48Ah, there you are. Are you sure that you're good to cover my list
0:17:48 > 0:17:49while I'm at the inquiry?
0:17:49 > 0:17:52Yeah, I just wanted to talk through Mr Willis's case before you go.
0:17:52 > 0:17:54I managed to track down his file and get his daughter in.
0:17:54 > 0:17:56She confirmed that he suffers from arterial fibrillation
0:17:56 > 0:17:58and has had a TIA in the past.
0:17:58 > 0:18:01- What medication is he on? - Clopidogrel and aspirin.
0:18:01 > 0:18:04That would explain the unusually heavy bleed.
0:18:04 > 0:18:06Do you want me to take him off the anti-platelet agents?
0:18:06 > 0:18:08No, I think the benefits outweigh the risk of a bleed.
0:18:08 > 0:18:11His daughter's with him now if you've got time to see her?
0:18:20 > 0:18:22Hello, I'm Mr Griffin.
0:18:22 > 0:18:25I'm your father's consultant. I know who you are.
0:18:25 > 0:18:28You do? Yeah, I looked you up on the internet.
0:18:28 > 0:18:31One of this hospital's most respected and senior surgeons.
0:18:31 > 0:18:32Your stats are amazing.
0:18:35 > 0:18:39You do realise that your father is in a critical condition?
0:18:39 > 0:18:42He's going to require further surgery.
0:18:42 > 0:18:44He is going to live, isn't he?
0:18:46 > 0:18:48So Amira's just going to get paid to sit in the staff room all day?
0:18:48 > 0:18:53It's Fletch's problem, not mine. I've requested a replacement nurse.
0:18:53 > 0:18:55OVER INTERCOM: Is this thing on?
0:18:55 > 0:18:56Apologies for the interruption,
0:18:56 > 0:18:59but this seems to be the only way I can get an audience.
0:18:59 > 0:19:02We have a very busy list today, don't we, Mr Valentine?
0:19:02 > 0:19:05- Nurse Zafar... - You have my instructions.
0:19:05 > 0:19:07I know she's not an ideal choice,
0:19:07 > 0:19:09but you're fully aware that we're struggling
0:19:09 > 0:19:11so we have to work with what we've got.
0:19:11 > 0:19:14I told you I needed a competent, bomb-proof scrub nurse.
0:19:14 > 0:19:17- She will be.- Then she can stay, but she's not working under me.
0:19:17 > 0:19:20- On what grounds? - My authority is sufficient.
0:19:20 > 0:19:23Don't you think you're making a rod for your own back
0:19:23 > 0:19:25wasting a scarce resource like this?
0:19:25 > 0:19:28Don't you think you're bringing a knife to a gun fight, Adrian?
0:19:28 > 0:19:31I want to give you an opportunity to come to your senses,
0:19:31 > 0:19:34because you will give her a chance today, and if you don't,
0:19:34 > 0:19:37I'll report your behaviour to the powers-that-be.
0:19:39 > 0:19:42Well...that went well.
0:19:44 > 0:19:47So were you suitably evasive? Lots of contradictory evidence?
0:19:47 > 0:19:49- What are you talking about? - When you wrote your statement.
0:19:49 > 0:19:52- Stitched up Mr Griffin. - You're not even funny.
0:19:52 > 0:19:55- Are you good? - What if Ric did make a mistake?
0:19:55 > 0:19:58I was there, Morven. Anticoagulants were never even mentioned.
0:19:58 > 0:20:01- Are you sure?- Pretty much, yeah.
0:20:01 > 0:20:03Do you think I should bring it up with him
0:20:03 > 0:20:04before he leaves for the hearing?
0:20:04 > 0:20:07I think you'd be opening up a can of worms there.
0:20:07 > 0:20:09You should just wait to see how it all pans out.
0:20:09 > 0:20:13But what would happen to him if he didn't prescribe anticoagulants?
0:20:13 > 0:20:15Mr Griffin knows what he's doing.
0:20:15 > 0:20:18I'm sure there's nothing to worry about.
0:20:22 > 0:20:23You've been neglecting me.
0:20:23 > 0:20:27Apologies. I've had lives to save and you are no longer an emergency.
0:20:28 > 0:20:32Anyway, I would like to take a detailed history from you,
0:20:32 > 0:20:36just so I can try and work out why you've had so many operations.
0:20:36 > 0:20:38I give you medical, but nothing personal.
0:20:38 > 0:20:42Right, OK. What are you, some sort of international jewel thief?
0:20:42 > 0:20:47- It's on my to-do list.- Right, OK.
0:20:47 > 0:20:51Well, then, for the record, I shall refer to you as "Patient A".
0:20:54 > 0:20:57Really, though, why are you so secretive?
0:20:58 > 0:21:00Hit woman.
0:21:03 > 0:21:05I have my reasons.
0:21:07 > 0:21:11OK, well, if it's anything to do with paying for your treatment,
0:21:11 > 0:21:14then I can always speak to the Overseas Patient Officer.
0:21:14 > 0:21:16They can talk you through a payment plan.
0:21:16 > 0:21:20I have British citizenship.
0:21:20 > 0:21:24Oh...I'm sorry. That's embarrassing.
0:21:24 > 0:21:26- I just assumed.- Never assume.
0:21:26 > 0:21:29You just make an ass out of you and me.
0:21:31 > 0:21:33So, what now?
0:21:33 > 0:21:35You recover and you go home.
0:21:35 > 0:21:38But I need you to find out what's wrong with me.
0:21:40 > 0:21:45I'm assuming that you are undergoing treatment from other hospitals?
0:21:45 > 0:21:50I've spent a lifetime being passed from one specialist to another
0:21:50 > 0:21:52without a sniff of a diagnosis.
0:21:52 > 0:21:54Have you any idea what that has done for me?
0:21:56 > 0:21:59- How long have you been doing this? - Eight years.
0:22:01 > 0:22:03Well, look, if you would just give me your name
0:22:03 > 0:22:05I can at least look for your medical history.
0:22:05 > 0:22:08No, that would be a waste of time. All those quacks were wrong.
0:22:08 > 0:22:11I want a different perspective from a new person.
0:22:13 > 0:22:16OK.
0:22:16 > 0:22:20Well, um, can you at least tell me things that I could rule out?
0:22:20 > 0:22:22You're going to need a bigger notebook.
0:22:22 > 0:22:26I don't understand. Why can't you just operate on him?
0:22:26 > 0:22:29I'm sorry, Emily, until we can correct his clotting factors
0:22:29 > 0:22:32any further surgery would be highly risky.
0:22:32 > 0:22:34So what does that mean? You're going to do nothing?
0:22:34 > 0:22:36He's stable and he's in the best place.
0:22:36 > 0:22:40- We'll continue to monitor him...- But how long can you keep him like this?
0:22:40 > 0:22:43That's for the doctors to decide, not me.
0:22:43 > 0:22:45- This is Mr Griffin's call?- Hmm.
0:22:45 > 0:22:47Watchful waiting is all we can do right now.
0:22:49 > 0:22:51Are you OK?
0:22:52 > 0:22:54Lost my mum not so long ago.
0:22:56 > 0:22:58Don't look at me like that!
0:22:58 > 0:23:01I spent the last two years with people going, "Ah, bless!"
0:23:02 > 0:23:05OK. I'll, um, bear that in mind.
0:23:07 > 0:23:09I'm sorry.
0:23:09 > 0:23:11I shouldn't be having a pop at you.
0:23:13 > 0:23:15So, what happened?
0:23:16 > 0:23:20Went in for a routine op and died on the table.
0:23:22 > 0:23:24I can understand why you must be worried.
0:23:24 > 0:23:27Do you trust Mr Griffin?
0:23:27 > 0:23:29I have worked with him for years.
0:23:29 > 0:23:31He's a safe pair of hands.
0:23:32 > 0:23:35- Is there anyone else I can call? - It's just me and my Dad.
0:23:36 > 0:23:38Right.
0:23:40 > 0:23:42Well...
0:23:46 > 0:23:49- Is Mr Griffin around? - He's left for the hearing.
0:23:49 > 0:23:51Is there nothing more we can do for Mr Willis?
0:23:51 > 0:23:54- His daughter's very distressed. - CT angiogram is inconclusive.
0:23:54 > 0:23:56We simply don't know where the bleed's coming from
0:23:56 > 0:23:57or if it's stopped.
0:23:57 > 0:24:00I've seen patients like him who have been packed before and left.
0:24:00 > 0:24:01It's finding a balance, Donna.
0:24:01 > 0:24:03We go in too soon and he may well bleed out
0:24:03 > 0:24:05if we don't find and fix it fast enough.
0:24:05 > 0:24:07Yeah, but if you don't do anything, he'll die anyway.
0:24:07 > 0:24:08Is the patient currently stable?
0:24:08 > 0:24:11- Yes.- Then get back to me if anything changes.
0:24:11 > 0:24:12I'm trying to hold down the whole ward here.
0:24:12 > 0:24:15We have emergencies coming in and there's only so much I can do.
0:24:15 > 0:24:18Take it up with Mr Griffin when he gets back.
0:24:27 > 0:24:30- You're in my spot.- And?
0:24:30 > 0:24:32I get 30 minutes a day to retune my chakra
0:24:32 > 0:24:34and I'm not going to let you ruin it.
0:24:34 > 0:24:37- The thought never crossed my mind. - Right.
0:24:37 > 0:24:41So you're prepared to play footy with me in no-man's-land, are you?
0:24:41 > 0:24:43Pipes of Peace and all that?
0:24:44 > 0:24:47Oh, come on, it was Christmas number one for weeks!
0:24:48 > 0:24:51Never mind, I'll get my coat. Sit down, Fletch.
0:24:55 > 0:24:57So, what you got?
0:24:57 > 0:25:00I've developed a worrying addiction to Pulses' chicken salad.
0:25:02 > 0:25:05Salt beef nudger man myself with optional crinkle cut crisps.
0:25:05 > 0:25:08Bacon, obviously.
0:25:08 > 0:25:10So how's life at the top?
0:25:10 > 0:25:12If it wasn't for the money, I'd jack it all in tomorrow.
0:25:12 > 0:25:16Well, I hear good things. Performing miracles with scant resources.
0:25:18 > 0:25:22Have you settled your differences with Amira?
0:25:22 > 0:25:26I'm musing on giving her a chance, as you so rudely requested.
0:25:26 > 0:25:28Well, if you didn't have such a rod up your backside
0:25:28 > 0:25:30you wouldn't have to...
0:25:30 > 0:25:33- What's so funny?- Thought you were going to have a stroke in theatre.
0:25:33 > 0:25:35So did I!
0:25:35 > 0:25:38Took me an hour to build up the courage to come in and say that.
0:25:38 > 0:25:40Truce?
0:25:42 > 0:25:43Truce.
0:25:46 > 0:25:47So how's things at home?
0:25:47 > 0:25:49Why do you ask?
0:25:49 > 0:25:52It's just you've been a little bit tetchier than normal lately.
0:25:53 > 0:25:55Well, Jonny's having to pull double shifts
0:25:55 > 0:25:57because of the nursing shortage.
0:25:57 > 0:25:59He's barely seen Emma these last two months.
0:25:59 > 0:26:03I thought that would suit you. I'm practically a single parent.
0:26:03 > 0:26:05Welcome to my world.
0:26:05 > 0:26:07Not to mention trying to run a ward on a shoestring.
0:26:07 > 0:26:09I'll say it again - welcome to my world.
0:26:12 > 0:26:15Look, I've raised all your issues over staffing levels with the Trust.
0:26:15 > 0:26:17Believe me, you're not on your own on this...
0:26:17 > 0:26:20..and I'm sorry if I was a bit heavy-handed with you earlier.
0:26:20 > 0:26:24It's been a very long time since someone spoke to me like that.
0:26:24 > 0:26:28All I want is for you to make an effort to give Amira a chance.
0:26:28 > 0:26:30You never know, she might surprise you.
0:26:33 > 0:26:36Halvsies?
0:26:36 > 0:26:38I'll pass.
0:26:48 > 0:26:49Can you prep Ms Knight for theatre?
0:26:49 > 0:26:51We need to get that appendix out ASAP.
0:26:51 > 0:26:53Just give me two minutes.
0:26:53 > 0:26:55If this is about Mr Willis, you've got 30 seconds. Thanks.
0:26:55 > 0:26:59- When did you get all God complex on me?- All right. One minute.
0:26:59 > 0:27:02- Ceraclydin, Petumoledin or Chlorothropid?- Sorry?
0:27:02 > 0:27:05I worked on this case recently where a girl was packed just like Gareth
0:27:05 > 0:27:07and I'm sure they used one of the three to...
0:27:07 > 0:27:09If he's still stable, then this isn't urgent, is it?
0:27:09 > 0:27:11I've got no-one else to speak to.
0:27:11 > 0:27:13All right. Run the bloods past haematology.
0:27:13 > 0:27:15Get their take on things ready for Mr Griffin's return.
0:27:15 > 0:27:18- Progress! Thank you, Mr Di Lucca. - Close the door.
0:27:21 > 0:27:23So our Romanian speaks English, does she?
0:27:23 > 0:27:26Indeed she does and she apologises for her earlier behaviour
0:27:26 > 0:27:28but you had freaked her out a little bit.
0:27:28 > 0:27:30What did I say?
0:27:30 > 0:27:33She's had to have several emergency laparotomies for numerous reasons
0:27:33 > 0:27:36over the past eight years and it seems every time she comes to
0:27:36 > 0:27:40from surgery, that something else has been taken from her body.
0:27:40 > 0:27:41Any idea what's wrong with her?
0:27:41 > 0:27:44No, there's no triggers, no real rhyme nor reason for the attacks,
0:27:44 > 0:27:47apart from the fact that that she's got elevated creatinine levels.
0:27:47 > 0:27:49So that suggests a renal issue.
0:27:49 > 0:27:52Well, yeah, but then there's the list of unrelated symptoms,
0:27:52 > 0:27:54which is as long as your arm
0:27:54 > 0:27:57and ranges from arthritic joint pain through to pleuritis.
0:27:57 > 0:28:00So, your thoughts?
0:28:00 > 0:28:04Maybe it could be an immune system issue where the white blood cells
0:28:04 > 0:28:06are randomly attacking the host,
0:28:06 > 0:28:09but I think it's probably more the case that it's systemic lupus.
0:28:10 > 0:28:13I think someone has finally found their research project.
0:28:13 > 0:28:16- You don't mind me working on this? - No, not at all.
0:28:16 > 0:28:17I haven't seen you this enthused for ages.
0:28:17 > 0:28:20I think you've finally got your mojo back.
0:28:22 > 0:28:24How's "Nursegate" going?
0:28:25 > 0:28:29I'm guessing you're in full retreat given that she's still here?
0:28:29 > 0:28:30Just put her to work, Mr Valentine.
0:28:30 > 0:28:34Oh, I have and she's doing admirably so far.
0:28:34 > 0:28:37Mr Bale, mitral valve regurgitation.
0:28:37 > 0:28:40- Dr Ford has asked for a post-op chest X-ray.- Thank you.
0:28:40 > 0:28:44- Can I get you a coffee, Ms Naylor? - I'm fine, thank you.
0:28:44 > 0:28:47Oliver? It's Mr Valentine to you and you're not here to wait on us.
0:28:47 > 0:28:49Just get that X-ray sorted.
0:28:52 > 0:28:55I'm guessing your spat won't be over any time soon then?
0:28:58 > 0:29:02I've just been up to haematology and they're looking into the drugs
0:29:02 > 0:29:04I recommended for Mr Willis's clotting issue.
0:29:04 > 0:29:07I thought Raf said just to get their take on things?
0:29:07 > 0:29:10Well, yeah, I did, with a little input from me.
0:29:10 > 0:29:13Do you think it's wise going over Mr Griffin's head like that?
0:29:13 > 0:29:15- What harm is it doing?- Donna.
0:29:15 > 0:29:18I'm just trying to lighten the load before he returns.
0:29:18 > 0:29:21Look, I was thinking about what you said
0:29:21 > 0:29:23and he'd have read the case notes.
0:29:23 > 0:29:26If he thought there was an issue, surely he would have spoken to me.
0:29:26 > 0:29:30- Yeah, that's exactly where I'm coming from too.- Good.
0:29:30 > 0:29:32Well, I guess we just have to wait it out
0:29:32 > 0:29:34and see what he says when he gets back.
0:29:34 > 0:29:36I hope he's OK.
0:29:36 > 0:29:39So we have established that the patient was admitted with
0:29:39 > 0:29:42an ischemic leg which led to an amputation.
0:29:43 > 0:29:47And that, during treatment, sepsis developed, leading to her death.
0:29:50 > 0:29:52Do you agree, Mr Griffin?
0:29:52 > 0:29:54I would.
0:29:54 > 0:29:57And what started that chain?
0:29:57 > 0:29:58A delayed angiogram.
0:30:00 > 0:30:02The on-call radiologist that day was...
0:30:02 > 0:30:07Was very stressed because she was very overworked.
0:30:08 > 0:30:09Would you care to explain?
0:30:11 > 0:30:14It was around 11am
0:30:14 > 0:30:19when I placed the call to request a CT angiogram.
0:30:19 > 0:30:21And her response to your request?
0:30:21 > 0:30:23It wasn't considered a priority.
0:30:23 > 0:30:29There'd been a MAJAX that day and so, if we wanted the angiogram done,
0:30:29 > 0:30:32we were looking at a wait of several hours.
0:30:32 > 0:30:35Leading you to reach the conclusion
0:30:35 > 0:30:38that Mrs Warren was at insufficient risk
0:30:38 > 0:30:41and that the CT angiogram can wait until later that day.
0:30:44 > 0:30:46Did you take any further action?
0:30:46 > 0:30:48Such as?
0:30:48 > 0:30:52Run another doppler or prescribe a blood-thinning agent?
0:30:52 > 0:30:56Yes, it's standard procedure to prescribe either heparin
0:30:56 > 0:30:59or warfarin, so, yes.
0:30:59 > 0:31:02Should that prescription have been put in
0:31:02 > 0:31:05the patient's medical records. Of course.
0:31:06 > 0:31:08Then why wasn't it in her notes?
0:31:11 > 0:31:13I'll let you into a little secret
0:31:13 > 0:31:15but if you tell anyone, I'll have to kill you.
0:31:15 > 0:31:17I'm starting to believe that.
0:31:17 > 0:31:21It's the accent. I sound like a Bond villain.
0:31:21 > 0:31:23My name is Adina.
0:31:25 > 0:31:28Well, I shall also let you in on a little secret.
0:31:28 > 0:31:32My name used to be Darren but I changed it to Dominic,
0:31:32 > 0:31:36although I've always really fancied being called Stefan.
0:31:36 > 0:31:39Your secret's safe with me.
0:31:39 > 0:31:40Pleased to meet you, Stefan.
0:31:43 > 0:31:45So who's the gorgeous kid?
0:31:45 > 0:31:49- My daughter. Take it you've been through my stuff?- Absolutely.
0:31:49 > 0:31:53I also drew on your face during surgery. Took some amazing selfies.
0:31:56 > 0:31:57So, how do my insides look?
0:31:57 > 0:32:00Like a patchwork quilt if I'm perfectly honest.
0:32:00 > 0:32:03But you can fix me?
0:32:03 > 0:32:06I'm not going back to die in front of my daughter.
0:32:06 > 0:32:08She's young enough not to remember me
0:32:08 > 0:32:10and well taken care of if push comes to shove.
0:32:13 > 0:32:17So this is the interesting case study you've been hiding from me?
0:32:17 > 0:32:20- Mr Levy seems to think you've backed a winner.- Excuse me, Adina.
0:32:20 > 0:32:23What do you think you're playing at? I haven't mentioned that to her.
0:32:23 > 0:32:26Just curious to see what I'm up against as you've been so secretive.
0:32:26 > 0:32:28Dominic!
0:32:28 > 0:32:31OK, Fredrik, can you get someone from ENT up here, please,
0:32:31 > 0:32:33to help cauterise this?
0:32:33 > 0:32:36Thank you. Has this happened before?
0:32:36 > 0:32:39Cathy, can we tell Mr Levy we might have a vascular issue here
0:32:39 > 0:32:42and can I get an ANCA test and some cross match just in case
0:32:42 > 0:32:44we need to go to theatre?
0:32:44 > 0:32:47- What does all that mean? - Just means that you're a big wuss.
0:32:47 > 0:32:49Now keep your head tilted forward, OK?
0:32:52 > 0:32:54Charging at 150. Stand clear.
0:32:54 > 0:32:56Shocking.
0:32:56 > 0:32:59- Still no output. - OK, let's go with adrenaline.
0:32:59 > 0:33:03Is sodium bicarbonates being administered through that cannula?
0:33:03 > 0:33:07Right, OK. Keep up the compressions. I'll flush the cannula with saline.
0:33:07 > 0:33:08Good catch.
0:33:08 > 0:33:11Adrenaline and sodium bicarbonate don't play well together.
0:33:11 > 0:33:13They form solid matter.
0:33:13 > 0:33:16- That's right, isn't it? - Indeed. Charging at 200.
0:33:16 > 0:33:17Stand clear.
0:33:17 > 0:33:19Shocking.
0:33:19 > 0:33:21OK, he's back in sinus.
0:33:21 > 0:33:24Good job someone knows what they're doing.
0:33:26 > 0:33:29No, she got to the nub of it pretty quickly.
0:33:30 > 0:33:32Do you think she's going after you?
0:33:33 > 0:33:35She's just doing her job.
0:33:35 > 0:33:37There's clearly an issue here
0:33:37 > 0:33:40and she's just trying to get to the bottom of it.
0:33:42 > 0:33:47The thing is, I had to be somewhere that day
0:33:47 > 0:33:50and, because of the delay on the CT angiogram,
0:33:50 > 0:33:55I made sure to order tests and anticoagulants before I left.
0:33:57 > 0:33:59And can you remember who you asked?
0:33:59 > 0:34:02Unfortunately, yes.
0:34:02 > 0:34:04PHONE RINGS Excuse me.
0:34:06 > 0:34:08Haematology.
0:34:08 > 0:34:10Griffin.
0:34:13 > 0:34:17- Are you OK?- Not really, no.
0:34:17 > 0:34:19Did they give you a hard time?
0:34:19 > 0:34:21I had a call from haematology.
0:34:21 > 0:34:23It's OK. There's no need to thank me. I'm happy to help.
0:34:23 > 0:34:27What do you think you're doing speaking to them on my authority?
0:34:27 > 0:34:31Petumoledin or any of the drugs you mentioned for that matter,
0:34:31 > 0:34:34will not help Gareth Willis whatsoever.
0:34:34 > 0:34:37- But I...- Clopidogrel reduces platelet count
0:34:37 > 0:34:39but it's not a blood thinner like warfarin.
0:34:41 > 0:34:44Look, you know the protocol.
0:34:44 > 0:34:46There's a chain of command and it's there for a reason.
0:34:46 > 0:34:48I was trying to give you options.
0:34:48 > 0:34:50So today of all days you decide to stick your neck out?
0:34:50 > 0:34:52I really don't need this, Donna!
0:34:52 > 0:34:54I don't think I've done anything that wrong.
0:34:57 > 0:34:59I'm sorry. I'm sorry.
0:34:59 > 0:35:00I just...
0:35:00 > 0:35:03Sitting back isn't really an option for me,
0:35:03 > 0:35:04you should know that by now.
0:35:04 > 0:35:07It's not normally an option for you either.
0:35:11 > 0:35:13Well...
0:35:13 > 0:35:15..no harm done.
0:35:19 > 0:35:23Except I told his daughter we might be able to help him.
0:35:27 > 0:35:29I can fix that.
0:35:31 > 0:35:34But there's something else that we need to discuss.
0:35:43 > 0:35:46There he is. My saviour.
0:35:46 > 0:35:49How long will I be nil by mouth? You're starving me to death here.
0:35:49 > 0:35:52Well, we do need to let your bowel have a bit of time to heal.
0:35:52 > 0:35:55Just teasing. Been here several times before, remember?
0:35:55 > 0:35:58Could murder a big, fat, juicy T-bone, though!
0:36:00 > 0:36:02No banter, sexy man? What's up with you?
0:36:03 > 0:36:06- I think I know what's wrong with you.- Are you serious?
0:36:08 > 0:36:10OK, let's have it then.
0:36:12 > 0:36:15Dominic, I'm not scared of dying.
0:36:15 > 0:36:18I just really want to know what's killing me.
0:36:25 > 0:36:28The ANCA test that we did today looks for a certain type of antibody
0:36:28 > 0:36:31in the blood which is a marker for vasculitis.
0:36:33 > 0:36:36Your test came back positive.
0:36:36 > 0:36:41Now, that, in conjunction with what I know about your medical history,
0:36:41 > 0:36:44leads me to believe that you are suffering with something known as
0:36:44 > 0:36:45Wegener's granulomatosis,
0:36:45 > 0:36:49which has now been more conveniently renamed GPA.
0:36:49 > 0:36:50What does that all mean?
0:36:52 > 0:36:55What it means is that your own immune system
0:36:55 > 0:36:59is attacking small blood vessels all over the body.
0:36:59 > 0:37:03On doing so, it causes inflammation
0:37:03 > 0:37:09which then leads to blood not being able to get to certain other organs.
0:37:11 > 0:37:13It's an extremely rare condition...
0:37:15 > 0:37:20..and, in chronic cases, is incurable.
0:37:21 > 0:37:24So that's it, no silver bullet?
0:37:26 > 0:37:30We can manage it once we get it under control.
0:37:30 > 0:37:32You'll still be probably looking at
0:37:32 > 0:37:35a lifelong intensive treatment programme,
0:37:35 > 0:37:38but survival rates have come a long way over the last few years.
0:37:38 > 0:37:41I really don't think that you're going to be a million miles away
0:37:41 > 0:37:44from leading a perfectly normal life.
0:37:44 > 0:37:45The best bit?
0:37:47 > 0:37:48It's not hereditary.
0:37:55 > 0:37:56Hey...
0:37:57 > 0:38:00..at least we now know what we're dealing with.
0:38:02 > 0:38:04You have no idea what you've done for me today.
0:38:06 > 0:38:08You've finally given me peace...
0:38:10 > 0:38:11..Stefan.
0:38:14 > 0:38:16I'm not going to lie to you.
0:38:16 > 0:38:18Your body has been through a lot over the last few years,
0:38:18 > 0:38:21so you're going to need some intensive monitoring.
0:38:21 > 0:38:26Or we could just fly to Vegas, go nuts? I'm totally up for that.
0:38:26 > 0:38:28On one condition.
0:38:29 > 0:38:34That you would agree to be my case study for a research project?
0:38:34 > 0:38:37- Can't get enough of me? - Something like that.
0:38:39 > 0:38:42You should expect a rough ride at the inquiry.
0:38:42 > 0:38:45Your testimony is going to be key.
0:38:47 > 0:38:51- Right. - There's no easy way to ask you this.
0:38:52 > 0:38:58Did you arrange for anticoagulants to be ordered as I instructed?
0:38:58 > 0:39:00It's not in the notes.
0:39:00 > 0:39:02As you instructed?
0:39:02 > 0:39:04Donna.
0:39:04 > 0:39:05Ric, you didn't order any.
0:39:05 > 0:39:08It's all I've been able to think about all day.
0:39:08 > 0:39:12So you knew there was a problem, but you didn't speak to me about it?
0:39:14 > 0:39:19I know that I was in a hurry to get away that day,
0:39:19 > 0:39:21but you KNOW me.
0:39:21 > 0:39:26I would NEVER leave a patient in that condition and put them at risk
0:39:26 > 0:39:29by NOT ordering an anticoagulant.
0:39:29 > 0:39:31I simply don't make those kinds of mistakes.
0:39:33 > 0:39:34Neither do I.
0:39:42 > 0:39:47Well, as Mrs Warren's Consultant,
0:39:47 > 0:39:50the buck stops with me.
0:39:50 > 0:39:52So...what do I say?
0:39:55 > 0:39:58Tell the truth as you see it.
0:40:02 > 0:40:04You've spoken to Amira about this?
0:40:04 > 0:40:06I thought I'd speak to you first, given the circumstances.
0:40:06 > 0:40:08I ordered the chest X-ray over two hours ago.
0:40:08 > 0:40:11- You've checked with Radiology? - No receipt of request.- The patient?
0:40:11 > 0:40:14Currently stable, but wondering why he can't go home.
0:40:14 > 0:40:17OK. Reorder the X-ray and get to Radiology pronto.
0:40:17 > 0:40:18I'll head her off at the pass.
0:40:18 > 0:40:22- Hi.- Got anything for me? - No news from the front.
0:40:22 > 0:40:23Why would you lie to me?
0:40:23 > 0:40:27- What?- Mr Bale's overdue X-ray?
0:40:27 > 0:40:30OK, look, there was no harm done. The patient's fine.
0:40:31 > 0:40:33Jac...
0:40:33 > 0:40:34..go easy on her.
0:40:55 > 0:40:58So this Junior Doctor of the Year thing
0:40:58 > 0:41:00seems to be pretty much in the bag.
0:41:01 > 0:41:05Rare and exotic conditions do not attract investment
0:41:05 > 0:41:06from pharmaceutical companies.
0:41:06 > 0:41:09Why do you seem to think anybody in their right mind...
0:41:09 > 0:41:12I'd like to thank my mum, my dad, my friends, Mr Hanssen...
0:41:12 > 0:41:15Don't you think you're jumping the gun?
0:41:15 > 0:41:18Apart from the fact I just need to type the presentation up...
0:41:20 > 0:41:21..no.
0:41:31 > 0:41:34- He's got nothing.- I gave her a chance and now I want her gone.
0:41:34 > 0:41:37I can see that the X-ray was purely precautionary.
0:41:37 > 0:41:40What difference does that make? She's messed up here.
0:41:40 > 0:41:43This time, I'm going to go through the proper chain of command.
0:41:43 > 0:41:45I gave her every chance as you requested.
0:41:45 > 0:41:48And how is me sacking her going to help anything?
0:41:48 > 0:41:50What do you want? Do you want a full NMC enquiry?
0:41:50 > 0:41:54Do you want her career ruined? Do you want her kicked out of nursing?
0:41:54 > 0:41:56Did I not explain to you that we are running on fumes here
0:41:56 > 0:41:59as far as staffing levels are concerned?
0:41:59 > 0:42:01Amira...
0:42:03 > 0:42:06..very proudly told me she stopped Mr Valentine from making
0:42:06 > 0:42:10a catastrophic mistake that would have most certainly led to a fatality.
0:42:10 > 0:42:12Please just sort this out for me.
0:42:14 > 0:42:16Look, pull her up, by all means, OK?
0:42:16 > 0:42:18Record it as an untoward incident,
0:42:18 > 0:42:20but make it part of her learning curve.
0:42:20 > 0:42:24I'm supposed to just chalk this up to no harm done, crack on?
0:42:24 > 0:42:27Jac, I thought we had a truce? It's a two-way street, Fletch.
0:42:31 > 0:42:34I can't believe she hasn't been diagnosed until now.
0:42:35 > 0:42:38- How did she take the news? - Adina's a happy soul.
0:42:38 > 0:42:41- So is this what you've been working on?- Yeah.
0:42:41 > 0:42:45The best we can offer her at the moment is plasma exchange and drugs.
0:42:45 > 0:42:48We're just not equipped to deal with GPA-related illnesses here at Holby
0:42:48 > 0:42:49- at the moment.- So what's the plan?
0:42:49 > 0:42:52Well, there is a professor in Newcastle
0:42:52 > 0:42:55who is currently studying various auto-immune diseases.
0:42:55 > 0:42:58Particularly where auto-antibodies are produced
0:42:58 > 0:43:00against neutrophil proteins
0:43:00 > 0:43:02resulting in blood vessel walls being destroyed.
0:43:02 > 0:43:04So it's the same type of tissue connectivity issue
0:43:04 > 0:43:07- that your patient has with GPA? - Yeah.
0:43:07 > 0:43:09I'm hoping that he'll share his research
0:43:09 > 0:43:11and work with me on my case study.
0:43:11 > 0:43:14This is really good work, Dominic.
0:43:15 > 0:43:19I just don't think that GPA is the right kind of subject matter
0:43:19 > 0:43:21for your proposal.
0:43:22 > 0:43:25I had a horrible feeling you were going to say that.
0:43:25 > 0:43:29It just isn't Junior Doctor prize territory. It's too specialist.
0:43:29 > 0:43:30So what do I do?
0:43:30 > 0:43:34Just send her up north and kiss goodbye to the Junior Doctor prize?
0:43:35 > 0:43:37I'm going to make it my mission in life
0:43:37 > 0:43:41to find you a fabulously interesting bowel-related cancer.
0:43:41 > 0:43:43Great. Guardians of the colon.
0:43:43 > 0:43:45Oh, come on, you've been so passionate about this.
0:43:45 > 0:43:48I thought you wanted to create a lasting legacy for Arthur?
0:43:48 > 0:43:50How am I meant to do that at the 11th hour?
0:43:50 > 0:43:53You've got to ask yourself what you've learnt today.
0:43:53 > 0:43:56What was it specifically about her case that has inspired you?
0:43:59 > 0:44:01So there is no miracle pill?
0:44:01 > 0:44:05Sadly no, but Nurse Jackson was
0:44:05 > 0:44:09acting with your father's best interests at heart.
0:44:09 > 0:44:13It was only when she checked in with me that she realised her error.
0:44:14 > 0:44:17However, I take full responsibility.
0:44:18 > 0:44:20We do have a complaints procedure
0:44:20 > 0:44:23if you wish to take the matter further.
0:44:23 > 0:44:24No, she was just trying to help.
0:44:24 > 0:44:26MONITOR BEEPS
0:44:26 > 0:44:28We may have a problem here.
0:44:28 > 0:44:30Blood pressure's dropping.
0:44:33 > 0:44:35The bleeding's overwhelmed the packing.
0:44:35 > 0:44:39- We need to get him into theatre.- Can we get some hands in here, please?
0:44:39 > 0:44:41Dad!
0:44:41 > 0:44:43Dad! You have to save him!
0:44:43 > 0:44:45I can't lose my dad too!
0:44:45 > 0:44:48- Step back.- Dad!- Just let them do what they have to do, OK?
0:44:53 > 0:44:54I must say,
0:44:54 > 0:44:57I was extremely impressed by your choice of supervisor.
0:44:59 > 0:45:00Nina chose me actually.
0:45:01 > 0:45:03Chose you or the project?
0:45:03 > 0:45:06The project wasn't on the table when she made her decision.
0:45:12 > 0:45:14Should we continue?
0:45:14 > 0:45:16I don't think Mr Copeland will be joining us.
0:45:16 > 0:45:18KNOCK AT DOOR Come in.
0:45:20 > 0:45:22I'm here. Sorry.
0:45:22 > 0:45:25I got caught short with a burst appendix.
0:45:25 > 0:45:27Shall we begin?
0:45:29 > 0:45:30Thank you.
0:45:32 > 0:45:34More suction, please.
0:45:34 > 0:45:36Do we have cross match and clotting?
0:45:36 > 0:45:39Eight units, but he's bleeding out fast.
0:45:39 > 0:45:41Stand by with some Group O.
0:45:41 > 0:45:43Make sure he's got platelets onboard
0:45:43 > 0:45:45and he's had some tranexamic acid.
0:45:45 > 0:45:46Where's it coming from?
0:45:48 > 0:45:53There. There's a tear in the pelvic sidewall vein.
0:45:53 > 0:45:57We're going to have to under-run the sacral vein. Clamp, please.
0:45:58 > 0:45:593-0 ready.
0:46:14 > 0:46:16The sutures aren't holding.
0:46:16 > 0:46:18We're going to have to use the staple gun.
0:46:18 > 0:46:19Try and get some staples in the bone.
0:46:19 > 0:46:22This is risky surgery, if you don't mind me saying.
0:46:22 > 0:46:23Do you have an alternative plan?
0:46:23 > 0:46:25Use a patch and hope it holds. Pack him again...
0:46:25 > 0:46:28That's going to be a temporary fix at best,
0:46:28 > 0:46:31plus he might not even make further surgery.
0:46:31 > 0:46:36No. Sitting back is not an option for me, Mr Di Lucca.
0:46:39 > 0:46:41So, in your opinion, you were happy with the care
0:46:41 > 0:46:44Mrs Warren received throughout her stay on the ward?
0:46:44 > 0:46:47She received the same level of care any patient would.
0:46:47 > 0:46:50That's not quite what I asked you, Nurse Jackson.
0:46:50 > 0:46:54Can we keep this specific to the case in question, please?
0:46:55 > 0:46:58I was with Mrs Warren for the majority of her time on the ward
0:46:58 > 0:46:59and I saw nothing untoward.
0:47:01 > 0:47:04Nothing you would class as detrimental to her care?
0:47:04 > 0:47:06I'd have spoken up if I had.
0:47:06 > 0:47:08You would have questioned a doctor?
0:47:08 > 0:47:10Even one as senior as Mr Griffin?
0:47:11 > 0:47:14As a senior nurse, I take patient care very seriously.
0:47:14 > 0:47:17If I'd have thought the patient was at risk, then...
0:47:17 > 0:47:23I see from your statement that you and Mr Griffin are old colleagues?
0:47:23 > 0:47:24That's correct.
0:47:24 > 0:47:27And that you've recently returned to nursing
0:47:27 > 0:47:29after an absence of six years.
0:47:29 > 0:47:33I've had refresher training and consider myself competent,
0:47:33 > 0:47:35if that's what you're getting at.
0:47:35 > 0:47:37That's good to hear.
0:47:37 > 0:47:41So you never felt under unnecessary pressure that day or was asked
0:47:41 > 0:47:45to perform tasks or make decisions that you weren't qualified to do?
0:47:45 > 0:47:49That's never been the case. We're a team, a unit.
0:47:49 > 0:47:51Everyone knows their place and gets the job done.
0:47:51 > 0:47:54But on occasion, mistakes are made?
0:47:54 > 0:47:57Systems are in place to nullify such incidents, but...
0:47:59 > 0:48:01..we're only human.
0:48:01 > 0:48:04OK, I only have one further line of questioning.
0:48:07 > 0:48:10BP is on the rise. Looks like you've got this.
0:48:10 > 0:48:13Let's save the back-slapping for when he's awake in recovery.
0:48:13 > 0:48:16I can close if there's somewhere that you need to be?
0:48:16 > 0:48:18And leave you short-handed again?
0:48:18 > 0:48:20It has been a bit of a learning curve
0:48:20 > 0:48:23but I need to get used to the pressure down here again.
0:48:25 > 0:48:26With great power...
0:48:28 > 0:48:29..comes great responsibility.
0:48:29 > 0:48:32I am really sorry that I didn't put Donna straight today.
0:48:32 > 0:48:36If Emily decides to take things further, I'll come forward.
0:48:36 > 0:48:39You'll do no such thing. He's my patient.
0:48:39 > 0:48:43OK, well, at least let me close up and do the post-op care.
0:48:43 > 0:48:45I believe you're needed elsewhere.
0:48:50 > 0:48:54So having read your portfolios, yours albeit briefly, Mr Copeland,
0:48:54 > 0:48:58I think I am now ready to give you my thoughts, for what they're worth.
0:48:58 > 0:49:01Fredrik, your chosen subject matter
0:49:01 > 0:49:03of Pancreatic Laser Ablation I find fascinating.
0:49:03 > 0:49:07It is a technique that in the future could well extend
0:49:07 > 0:49:09the lives of those with such an incurable cancer.
0:49:11 > 0:49:13So you support my project?
0:49:13 > 0:49:14That's not quite what I said.
0:49:17 > 0:49:19Explain?
0:49:19 > 0:49:22I believe it's a technique that has already been tested
0:49:22 > 0:49:25so that it will support human trials.
0:49:25 > 0:49:27I don't really see what contribution you could make
0:49:27 > 0:49:29given the paltry sum available to you.
0:49:29 > 0:49:32You're simply hitching your star to their wagon.
0:49:32 > 0:49:34I want better than that for you.
0:49:34 > 0:49:37If you wish to continue with the project, I will support it
0:49:37 > 0:49:40but I would urge you to take this opportunity
0:49:40 > 0:49:42of reconsidering your submission.
0:49:45 > 0:49:46So...
0:49:46 > 0:49:50..I suppose Mr Copeland here gets a gold star just because
0:49:50 > 0:49:53some runaway happens to fall into his lap
0:49:53 > 0:49:55with something rare and exotic?
0:49:55 > 0:49:58Actually I'm investigating the study of bowel resection techniques and
0:49:58 > 0:50:02the physiological and psychological effect it has on patients.
0:50:02 > 0:50:04What about your dream patient?
0:50:04 > 0:50:07She might have inspired the idea, but I very quickly realised
0:50:07 > 0:50:09I was out of my depth with her case.
0:50:09 > 0:50:12That takes a certain maturity, Mr Copeland.
0:50:12 > 0:50:15Bowel resection techniques are hardly ground-breaking.
0:50:15 > 0:50:17Yes, well, they might be mundane to you,
0:50:17 > 0:50:19but think of the amount of people that it will help.
0:50:19 > 0:50:22This isn't just about a prize for me.
0:50:22 > 0:50:24This is about more than that. Mr Copeland...
0:50:24 > 0:50:27All right, look, this might not be "sexy" medicine
0:50:27 > 0:50:31but in my time here I have had the opportunity to work with
0:50:31 > 0:50:34some of the best surgeons this hospital has to offer, or has ever
0:50:34 > 0:50:38had to offer, and if there is one thing that I have learned, it's that
0:50:38 > 0:50:42you support each other, you move forward together, always improving.
0:50:42 > 0:50:44If you are looking to pan this project
0:50:44 > 0:50:47because you believe there is a lack of imagination, then...
0:50:47 > 0:50:50Mr Copeland, I was just going to say your soapbox is not needed.
0:50:50 > 0:50:53Your portfolio itself was enough to convince me.
0:50:53 > 0:50:55You have my full support.
0:51:00 > 0:51:04In Mr Griffin's testimony, he has stated that he requested
0:51:04 > 0:51:08anti-coagulants to help Mrs Warren's blood flow to her leg
0:51:08 > 0:51:10whilst she waited for her CT angiogram.
0:51:11 > 0:51:16Do you have any explanation as to why this was not in her records?
0:51:18 > 0:51:21Nurse Jackson, it's a simple enough question.
0:51:22 > 0:51:24As the senior nurse on duty that day,
0:51:24 > 0:51:28do you recall blood thinners being asked for by Mr Griffin?
0:51:29 > 0:51:34It was a busy day and requests were coming in thick and fast.
0:51:34 > 0:51:36Either Mr Griffin didn't ask for the anti-coagulants
0:51:36 > 0:51:38or his request was ignored.
0:51:40 > 0:51:42So, I'll ask you again...
0:51:44 > 0:51:46..do you recall Mr Griffin
0:51:46 > 0:51:49prescribing Mrs Warren's blood thinners?
0:51:59 > 0:52:05I have no recollection of Mr Griffin prescribing anti-coagulants
0:52:05 > 0:52:07to Mrs Warren.
0:52:10 > 0:52:13Thank you for your attendance, Nurse Jackson.
0:52:17 > 0:52:19What's going on?
0:52:19 > 0:52:22Ms Naylor's cancelled all her electives until further notice.
0:52:22 > 0:52:25- Emergency cases only.- Why?
0:52:25 > 0:52:28She feels we have insufficient experienced staff to safely
0:52:28 > 0:52:31- treat patients. So until that changes...- Where is she?
0:52:31 > 0:52:35- In her office. Left orders to not be disturbed.- Good luck with that.
0:52:35 > 0:52:36Amira.
0:52:38 > 0:52:40Amira, hang on.
0:52:40 > 0:52:42Amira?
0:52:43 > 0:52:44What's Jac said to you?
0:52:44 > 0:52:46More like what's she's done to the whole ward.
0:52:46 > 0:52:49It's clear she blames me for what's happened with this missing X-ray.
0:52:49 > 0:52:52- And who told you that? - She doesn't have to.
0:52:52 > 0:52:54I feel like I've let you down again, Mr Fletcher.
0:52:56 > 0:52:59I...I won't be coming back.
0:53:07 > 0:53:10Congratulations on your ground-breaking entry.
0:53:10 > 0:53:13Bowel surgery - how nouveau.
0:53:15 > 0:53:19Seriously, look, all joking and competitiveness aside,
0:53:19 > 0:53:23do you not just think he was being genuine?
0:53:23 > 0:53:25- You can still pursue it, you just need to find...- Shut up!
0:53:27 > 0:53:29Don't...
0:53:29 > 0:53:30..patronise me.
0:53:34 > 0:53:35Of course you'd agree with him.
0:53:46 > 0:53:48Jac.
0:53:48 > 0:53:50You're putting patients at risk.
0:53:50 > 0:53:52You think by wasting bed space and theatre time,
0:53:52 > 0:53:55that's actually helping the situation?
0:53:55 > 0:53:56Someone had to make a stand.
0:53:56 > 0:53:59Well, for the record, your stand has just cost this hospital a nurse.
0:53:59 > 0:54:01She was never fit for purpose and you know it.
0:54:01 > 0:54:04You know what, I expected a witch hunt about Amira,
0:54:04 > 0:54:06and I always expect a battle from you, but...
0:54:06 > 0:54:07A strike on electives?
0:54:09 > 0:54:11That's just not like you.
0:54:11 > 0:54:14You always put the patients first, so what's going on?
0:54:16 > 0:54:18This can't all be about Jonny.
0:54:21 > 0:54:23There's more to it, I know there is.
0:54:29 > 0:54:31It's like you've given up.
0:54:31 > 0:54:32And...
0:54:33 > 0:54:35..why are you hiding in here?
0:54:35 > 0:54:37I don't know.
0:54:45 > 0:54:49Look, we've all been going through a pretty grim time of it recently.
0:54:50 > 0:54:53And there were times in my life that I went to some very dark places.
0:54:54 > 0:54:58If I didn't have a friendly ear or 12 to listen to,
0:54:58 > 0:55:01I don't know what I would have done. So, look, Jac, you and me,
0:55:01 > 0:55:03- we've got to stick together more than ever.- No.
0:55:03 > 0:55:05We're not friends.
0:55:05 > 0:55:08- Jac, just hear me out... - Just... This conversation is over.
0:55:08 > 0:55:10Come on!
0:55:22 > 0:55:25So you can't fix me but you know a man who can?
0:55:25 > 0:55:28- Hopefully they can. - Newcastle is so far away.
0:55:28 > 0:55:30You're going to love it, it's a total party town.
0:55:30 > 0:55:32Just no-one to party with.
0:55:32 > 0:55:34Well, post-op recovery is all organised.
0:55:34 > 0:55:37You shall be staying here at Hotel Holby for at least a week,
0:55:37 > 0:55:39three square meals a day.
0:55:39 > 0:55:42Stop it, I'm still nil by mouth. Starving!
0:55:42 > 0:55:45I would quite like to phone your family, if I may.
0:55:45 > 0:55:47I won't be a burden, life goes on.
0:55:48 > 0:55:51OK, well, I guess that's your choice.
0:55:51 > 0:55:54Come here, you've got a little something on your...
0:55:56 > 0:55:58Anything?
0:55:59 > 0:56:01Not even a tingle.
0:56:01 > 0:56:04No point taking you to Vegas then!
0:56:07 > 0:56:08I'm sorry.
0:56:10 > 0:56:12You did what you had to do.
0:56:12 > 0:56:14So where do we go from here?
0:56:14 > 0:56:21Depends if Ms Mensall concludes that Elaine Warren's death was avoidable.
0:56:21 > 0:56:25A first offence, what are we looking at? A slapped wrist, right?
0:56:25 > 0:56:28I saw you talking with her son today.
0:56:28 > 0:56:30Yeah, he came in...
0:56:31 > 0:56:34Please, everyone, do take a seat.
0:56:42 > 0:56:45I'd like to thank everyone involved in this inquiry
0:56:45 > 0:56:48for your cooperation today.
0:56:48 > 0:56:53The law states that unnatural deaths must be investigated...
0:56:54 > 0:56:56..and that is why this inquiry is being heard.
0:56:59 > 0:57:00You didn't kill her.
0:57:00 > 0:57:02I didn't save her either.
0:57:03 > 0:57:06Having taken into consideration all of the evidence given
0:57:06 > 0:57:07over the day...
0:57:08 > 0:57:11..I feel compelled to suspend this case...
0:57:13 > 0:57:17..and refer the matter to the CPS in consideration of
0:57:17 > 0:57:22criminal charges relating to gross negligence manslaughter.