Know Yourself, Know Your Enemy Holby City


Know Yourself, Know Your Enemy

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There's somebody from the Coroner's Office who wants to talk to me

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-about Elaine Warren.

-The coma patient that died?

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What do they want to know?

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I can't operate this kit.

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You wanted this to happen. You wanted Amira to fail.

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I wanted you to stop it from happening.

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I've forwarded an e-mail outlining the details for this year's

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Junior Doctor Award and I'm asking all consultants

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if they would kindly offer their services as supervisors.

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You'll need to get your pitches in shape if you both want to impress.

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Her name was Elaine Warren, not Lillian.

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Sorry, who are you?

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I'm her son, Jeremy.

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And, er, what are you doing here?

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Looking for answers.

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Looks like I've found some.

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Shouldn't you guys be in school?

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Trick or treat!

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All right.

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One for you.

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All right? Have a good day.

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I'm not really sure about you encouraging truancy.

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Nice wheels.

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I know I should have gone into law.

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My post-divorce mid-life crisis.

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And how is Nigel?

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Happily shacked up with his 25-year-old lap-dancer,

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but you know me, I'm not bitter.

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I thought she was his intern?

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She is. I made the lap-dancer bit up.

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OK, I might still be a tiny bit bitter.

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So what are you doing here anyway?

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I thought the hearing wasn't until this afternoon?

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Another case. The morgue beckons.

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Before you read me the riot act and throw away the key?

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I shouldn't even be talking to you, never mind discussing your case.

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Stop with the fishing, Ric.

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You know, Louise, if I didn't know better, I'd think that

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you enjoy putting us poor humble medics through the mill.

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Well, someone's got to keep the wolf from the door.

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-What have we got?

-RTC.

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He's hypotensive and tachycardic with suspected internal bleeding.

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Let's order an abdominal CT scan. Don't think we've got time for that.

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Prep him for emergency exploratory laparotomy, please.

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Here, I...want you to read this.

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You want me to give you my opinion on your presentation?

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No.

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I was just giving you a heads up on the quality of your competition.

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I'm sure it's an excellent read.

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The successful treatment of pancreatic cancer has long been

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the sought-after Holy Grail of modern medicine.

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Indeed it has, so good luck with that.

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So what have you got then?

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Hanssen wants to go through the proposals today.

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Yes, I'm well aware of that, thank you very much.

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Then I look forward to your imminent downfall.

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Well, as Fredrik apparently doesn't need my help, is there something

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you want me to look over before your presentation?

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No, not needed.

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So what's this work of genius that you've been hiding?

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It's more a work of fiction, to be honest.

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I've got nothing

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and every time I try to think of more ideas,

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I come up with fewer and fewer.

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-Creative block.

-Something like that.

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Well, I need your help in theatre

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so maybe we can come up with something together?

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Maybe I should just give up on the whole thing.

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No, no, no, that's not the attitude, Dominic, because

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I don't think either of us could deal with Mr Johanssen's smugness.

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Thanks. It felt weird picking up her things

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after what happened last week. Sorry about that, by the way.

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It's fine. You'd just lost your mum.

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You know, not taking care of yourself,

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you know it's not going to help anyone, right?

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What's that supposed to mean?

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I'm just saying, a bit of deodorant wouldn't go amiss.

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Well, I guess I've let things get on top of me.

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I'm sure your mum wouldn't want to see you like this,

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-that's all I'm saying.

-Is this your bedside manner?

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You know me. Caring and sharing at all times.

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Well, thanks for the kick up the backside.

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-I'll be sure to spruce myself up for the hearing.

-Good.

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Then my work here is done. I'll see you later.

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All this is a waste of time, isn't it?

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You lot look after your own.

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The Coroner's Court is there to find out if there was anything more

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we could have done for your mum, if we missed anything.

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And is there?

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You need to understand that we do all we can for the patients here,

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-but...

-But you're only human.

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Yeah, it's OK. Don't worry, I get it.

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How can I run a ward if I've got no-one to shout at?

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So many nurses have gone bank to work sensible hours for better pay.

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-Sounds like you're up a creek without a paddle.

-Care to join me?

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-We can go over the waterfall together?

-You're on your own.

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You need to understand that Darwin has a certain reputation

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-for burning staff out.

-What's that supposed to mean?

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If you ran your ship any tighter, you'd be popping rivets.

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And you have a problem with that?

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Spit it out, Fletch!

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I've had three senior nurses refuse to work on your ward

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since you've taken back control.

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-You give them a choice?

-Or I could just watch them move to St James's.

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Look, I know I've taken on a poison chalice here

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but I am doing my best.

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I just want someone senior with surgical experience

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or I'm going to hang you out to dry!

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Do you know what, mate, there was a time when just the sound

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of your voice would send me borderline tachycardic.

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Whereas now, your little rants I find amusing.

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I think that new suit has gone to your head...mate.

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Let me know when you're back in the real world.

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The bleed is coming from somewhere in the pelvic area.

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Blood pressure's dropping. Can we get some colloid in him, please?

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He's going to bleed out before we can restore haemostasis.

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I think we should pack the abdomen, go in again when he's more stable.

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I agree. It will give us time for a CT angiogram.

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Find out where this bleed's coming from and consider embolisation.

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-My call, pack the patient.

-Your call?

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-I just...

-Please don't spare my blushes, Mr Di Lucca.

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Your patient, Mr Griffin.

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-I will need you to cover my list this afternoon.

-Of course.

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OK, let's get him stabilised.

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Oh, I'm surprised to see you in today.

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I thought that you'd be preparing for Coroner's Court.

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What's there to prepare for? Turn up, say my piece and go.

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-You're not worried?

-No, I've been there before.

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I mean, the mere matter that it's gone this far...

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Stop fretting. They always do this with a sudden death.

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-I've never been to one before.

-You say that like it's a bad thing?

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Must be really fascinating, you know,

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going over the forensic details piece by piece.

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-Donna?

-Hmm.

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Do you think that maybe I could have a little look at the file, please?

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Seriously?

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It took me four hours just to write the statement.

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-I'm just really curious.

-You're such a loser, you know that?

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Here you go, Miss Marple, knock yourself out.

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I will be on Tinder.

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Jane Doe, collapsed at a food bank.

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CT scan from the ED shows likely ischemia in the bowel

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which we're about to see for ourselves.

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Wow, certainly not her first time at the rodeo.

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Colon is attached to the abdomen wall.

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Large clamp, please. Thank you.

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Right, let's start by mobilising the hepatic flexure, shall we?

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Looks like she's had multiple bowel resections.

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-Question is, what's causing them? Clamp, please.

-Possibly Crohn's?

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Well, there's no sign of any ulceration.

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Could be previous, I suppose.

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-There's a perforation in the bowel just here.

-OK.

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Scissors, please.

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-What do we do next?

-A stoma would be standard procedure,

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but she's so young that I would probably suggest removing

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all the ischemic areas and then resetting again.

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Good. How would you like to proceed?

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Well, we need to cut the proximal part of the bowel

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at the ileocecal junction,

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then dissect up to the distal at the beginning of the transverse colon.

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Excellent. I may yet be in the presence

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of a winner of a Junior Doctor prize.

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Come on. Something will grab you.

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-So where's your mojo gone recently?

-I don't know.

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Popped out for a pint of milk and never came back.

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Are you missing a certain someone?

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-What?

-Well, AAU's not far.

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I think we're all missing Lofty these days.

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-Ugh, no, not him.

-Who then?

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All this talk of the Junior Doctor Prize...just makes me think

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that Arthur would have been all over it, doing anything to win.

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Guess I'm just trying to do it for him.

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I know that sounds stupid.

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The goal is to be able to go home knowing you've done

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everything you can for the patient.

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That's all we can ask for ourselves.

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Take this girl, for example.

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You could have gone for the easy option,

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but you chose the harder route to give her a better quality of life.

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How's he responding to the inotropes and clotting agents?

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BP is low, but holding. Be good to have his notes?

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Find out why that bleed was so heavy.

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Well, let's take the guesswork out of it, shall we? Test results?

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Scans and CT on order.

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FBC have been delayed as the lab have only just received it.

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Let's keep him on 15-minute obs.

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And perhaps, Donna, you could use your legendary charm

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to chase up the FBC results?

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No need to ask. Already on it.

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Bit bleary-eyed today. Heavy night, was it?

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Amber was up all night with bad dreams, thank you very much.

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-Feel guilty now, don't you?

-Ouch!

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It's not the best prep for an inquiry.

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-You've given your statement?

-Have you chucked him to the wolves?

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Of course. You're so doomed!

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In which case, Ms Jackson, I shall be taking you down with me!

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SHE LAUGHS

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-How many times is that now?

-In the Coroner's Court?

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This will be the fifth time.

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I've had two myself.

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Stressful for you, even if you know you did everything that you could.

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Necessary evil, Mr Di Lucca.

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Weeds out the bad eggs.

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Keep me posted on Mr Willis, please.

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-Good morning.

-Amira, good to see you.

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-To what do we owe the pleasure?

-Director of Nursing sent me.

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I am the cavalry, apparently, here to save the day.

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-You're serious? After last time?

-I'm the new and improved version.

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Done my MIMS module and everything.

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Dr Ford, would you mind showing Amira a locker, please?

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It's OK, I'm good.

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Which way's the staff room again?

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Down the corridor.

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-What are we going to do?

-Hope Jac didn't see and tell Fletch

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we have a serious diplomatic incident on our hands.

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-Good morning, Ms Naylor.

-What is she doing here?

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Fletch's answer to our staffing problems, apparently.

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-Batten down the hatches?

-Prepare for Def-Con 4.

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Nurse Zafar. I didn't expect to find you on my ward.

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I was hoping I'd speak to you before my shift started, Ms Naylor.

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I want to reassure you that I'm up to speed

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and I'm confident that I can do a job for you here.

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Well, that remains to be seen.

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I'm only asking for the opportunity and your support.

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I'm not inclined to give you either.

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I know I didn't exactly cover myself in glory, but...

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I'll get that.

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Elaine Warren died from the overwhelming spread of sepsis?

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End of, as far as I can see from these notes.

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Well done, Sherlock. Tell me something I don't know.

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I mean, maybe the amputation could have happened sooner

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if the CT angiogram had been done earlier,

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but we're just talking about a few hours.

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-And it's not Mr Griffin's fault.

-It's all in the file.

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Radiography were snowed under after a major accident.

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At that point, Elaine wasn't a priority,

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as the sepsis hadn't shown up in her FBC.

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No blame, no claim.

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Did he ask for anti-coagulants to be administered to her?

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What are you talking about?

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Nothing, I mean...

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It would just be standard practice, given her condition.

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Well, then it must have been done.

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There's no annotation of the drugs being prescribed.

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It just would have improved her circulation,

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stopped the sepsis from setting in so quickly.

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Yeah, I'm sure there's a reason why.

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An effect on the angiogram result or whatever.

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-You know what, ignore me.

-Do you really think he might...

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Who am I to question Mr Griffin? I'm sure he had his reasons.

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I would perfectly understand if you took a leave of absence

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until this matter is resolved.

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You don't think that we're already over-stretched?

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Your dedication is appreciated.

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All the same, this inquest comes with unfortunate timing, doesn't it?

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Your point being? The hospital is at a critical juncture.

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Our every move is being examined and cross-examined.

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We are under severe pressure to present this hospital

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as a perfect NHS model.

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-So that marks me as an embarrassment?

-No, no, not at all.

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I consider you one of our finest.

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but if we're to weather the oncoming storm,

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then we're going to need all our key players.

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-Duly noted.

-Mr Griffin, you have Holby's full support.

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Representatives from management will be present at the Coroner's Court.

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Let's hope that I don't need them.

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-Are you stealing from patients now?

-There's nothing to steal.

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Just this and some pocket change.

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-Any idea who she is yet?

-Nope.

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A search on that might give you a head start.

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Let me save you some time.

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It's Romanian for "Offer Me Peace".

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How's that presentation prep going?

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Now doesn't that silence speak volumes?

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Don't you think you're letting your intuition get away with you

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-a little bit?

-Not when my father's been enquiring

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if and when you intend to hand your proposal in.

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Have you managed to work your magic on the guys in the lab yet?

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Batting eyelids, damsel in distress. You know the drill.

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And the CT scan for the suspected peritonitis, bed four?

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It's on order. He's also had pethidine and a drip

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as he was severely dehydrated.

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He's awaiting transfer to Keller and he's on hourly obs.

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Well, when I checked on him, his temperature was up and his BP too.

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Really?

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Oh, er, I'll check on him again then.

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I want him on 15-minute obs as of now.

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It's a bit overkill, isn't it, if you don't mind me saying?

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I do mind you saying.

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PATIENT SHOUTS IN ROMANIAN

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I'm sorry, I'm really...

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-Just...

-What's going on?

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Sorry, sorry!

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I think we'll have to get a translator once we work out

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-where she's from.

-She's Romanian.

-How do you know that?

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Linguistics. It's one of my many skills.

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Well, better get someone up from HR, OK?

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-Can I leave her with you?

-Well, I was hoping...

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I know. I know you want to do your research project

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but I'm due in theatre and we still have a ward to run, OK?

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-Then I guess I'm multitasking, aren't I?

-Thank you very much.

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Hi, I'm Mr Copeland. I'm one of the doctors who operated on you today.

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Now, I'm going to try and translate this conversation

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using an app on my phone.

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Now, don't you smell nice?!

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Do you wear cologne for all the girls or is this especially for me?

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Right, OK, so you do speak English?

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You can speed up now. I'm quite fluent.

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Why were you giving my boss such a hard time in your native tongue?

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His hands were cold.

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He very grimly and solemnly told me he had to remove some bowel.

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Needs to improve his bedside manner.

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So...

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..when can we discuss how you're going to save my life, sexy man?

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OK, there we go.

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Ah, there you are. Are you sure that you're good to cover my list

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while I'm at the inquiry?

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Yeah, I just wanted to talk through Mr Willis's case before you go.

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I managed to track down his file and get his daughter in.

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She confirmed that he suffers from arterial fibrillation

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and has had a TIA in the past.

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-What medication is he on?

-Clopidogrel and aspirin.

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That would explain the unusually heavy bleed.

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Do you want me to take him off the anti-platelet agents?

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No, I think the benefits outweigh the risk of a bleed.

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His daughter's with him now if you've got time to see her?

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Hello, I'm Mr Griffin.

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I'm your father's consultant. I know who you are.

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You do? Yeah, I looked you up on the internet.

0:18:250:18:28

One of this hospital's most respected and senior surgeons.

0:18:280:18:31

Your stats are amazing.

0:18:310:18:32

You do realise that your father is in a critical condition?

0:18:350:18:39

He's going to require further surgery.

0:18:390:18:42

He is going to live, isn't he?

0:18:420:18:44

So Amira's just going to get paid to sit in the staff room all day?

0:18:460:18:48

It's Fletch's problem, not mine. I've requested a replacement nurse.

0:18:480:18:53

OVER INTERCOM: Is this thing on?

0:18:530:18:55

Apologies for the interruption,

0:18:550:18:56

but this seems to be the only way I can get an audience.

0:18:560:18:59

We have a very busy list today, don't we, Mr Valentine?

0:18:590:19:02

-Nurse Zafar...

-You have my instructions.

0:19:020:19:05

I know she's not an ideal choice,

0:19:050:19:07

but you're fully aware that we're struggling

0:19:070:19:09

so we have to work with what we've got.

0:19:090:19:11

I told you I needed a competent, bomb-proof scrub nurse.

0:19:110:19:14

-She will be.

-Then she can stay, but she's not working under me.

0:19:140:19:17

-On what grounds?

-My authority is sufficient.

0:19:170:19:20

Don't you think you're making a rod for your own back

0:19:200:19:23

wasting a scarce resource like this?

0:19:230:19:25

Don't you think you're bringing a knife to a gun fight, Adrian?

0:19:250:19:28

I want to give you an opportunity to come to your senses,

0:19:280:19:31

because you will give her a chance today, and if you don't,

0:19:310:19:34

I'll report your behaviour to the powers-that-be.

0:19:340:19:37

Well...that went well.

0:19:390:19:42

So were you suitably evasive? Lots of contradictory evidence?

0:19:440:19:47

-What are you talking about?

-When you wrote your statement.

0:19:470:19:49

-Stitched up Mr Griffin.

-You're not even funny.

0:19:490:19:52

-Are you good?

-What if Ric did make a mistake?

0:19:520:19:55

I was there, Morven. Anticoagulants were never even mentioned.

0:19:550:19:58

-Are you sure?

-Pretty much, yeah.

0:19:580:20:01

Do you think I should bring it up with him

0:20:010:20:03

before he leaves for the hearing?

0:20:030:20:04

I think you'd be opening up a can of worms there.

0:20:040:20:07

You should just wait to see how it all pans out.

0:20:070:20:09

But what would happen to him if he didn't prescribe anticoagulants?

0:20:090:20:13

Mr Griffin knows what he's doing.

0:20:130:20:15

I'm sure there's nothing to worry about.

0:20:150:20:18

You've been neglecting me.

0:20:220:20:23

Apologies. I've had lives to save and you are no longer an emergency.

0:20:230:20:27

Anyway, I would like to take a detailed history from you,

0:20:280:20:32

just so I can try and work out why you've had so many operations.

0:20:320:20:36

I give you medical, but nothing personal.

0:20:360:20:38

Right, OK. What are you, some sort of international jewel thief?

0:20:380:20:42

-It's on my to-do list.

-Right, OK.

0:20:420:20:47

Well, then, for the record, I shall refer to you as "Patient A".

0:20:470:20:51

Really, though, why are you so secretive?

0:20:540:20:57

Hit woman.

0:20:580:21:00

I have my reasons.

0:21:030:21:05

OK, well, if it's anything to do with paying for your treatment,

0:21:070:21:11

then I can always speak to the Overseas Patient Officer.

0:21:110:21:14

They can talk you through a payment plan.

0:21:140:21:16

I have British citizenship.

0:21:160:21:20

Oh...I'm sorry. That's embarrassing.

0:21:200:21:24

-I just assumed.

-Never assume.

0:21:240:21:26

You just make an ass out of you and me.

0:21:260:21:29

So, what now?

0:21:310:21:33

You recover and you go home.

0:21:330:21:35

But I need you to find out what's wrong with me.

0:21:350:21:38

I'm assuming that you are undergoing treatment from other hospitals?

0:21:400:21:45

I've spent a lifetime being passed from one specialist to another

0:21:450:21:50

without a sniff of a diagnosis.

0:21:500:21:52

Have you any idea what that has done for me?

0:21:520:21:54

-How long have you been doing this?

-Eight years.

0:21:560:21:59

Well, look, if you would just give me your name

0:22:010:22:03

I can at least look for your medical history.

0:22:030:22:05

No, that would be a waste of time. All those quacks were wrong.

0:22:050:22:08

I want a different perspective from a new person.

0:22:080:22:11

OK.

0:22:130:22:16

Well, um, can you at least tell me things that I could rule out?

0:22:160:22:20

You're going to need a bigger notebook.

0:22:200:22:22

I don't understand. Why can't you just operate on him?

0:22:220:22:26

I'm sorry, Emily, until we can correct his clotting factors

0:22:260:22:29

any further surgery would be highly risky.

0:22:290:22:32

So what does that mean? You're going to do nothing?

0:22:320:22:34

He's stable and he's in the best place.

0:22:340:22:36

-We'll continue to monitor him...

-But how long can you keep him like this?

0:22:360:22:40

That's for the doctors to decide, not me.

0:22:400:22:43

-This is Mr Griffin's call?

-Hmm.

0:22:430:22:45

Watchful waiting is all we can do right now.

0:22:450:22:47

Are you OK?

0:22:490:22:51

Lost my mum not so long ago.

0:22:520:22:54

Don't look at me like that!

0:22:560:22:58

I spent the last two years with people going, "Ah, bless!"

0:22:580:23:01

OK. I'll, um, bear that in mind.

0:23:020:23:05

I'm sorry.

0:23:070:23:09

I shouldn't be having a pop at you.

0:23:090:23:11

So, what happened?

0:23:130:23:15

Went in for a routine op and died on the table.

0:23:160:23:20

I can understand why you must be worried.

0:23:220:23:24

Do you trust Mr Griffin?

0:23:240:23:27

I have worked with him for years.

0:23:270:23:29

He's a safe pair of hands.

0:23:290:23:31

-Is there anyone else I can call?

-It's just me and my Dad.

0:23:320:23:35

Right.

0:23:360:23:38

Well...

0:23:400:23:42

-Is Mr Griffin around?

-He's left for the hearing.

0:23:460:23:49

Is there nothing more we can do for Mr Willis?

0:23:490:23:51

-His daughter's very distressed.

-CT angiogram is inconclusive.

0:23:510:23:54

We simply don't know where the bleed's coming from

0:23:540:23:56

or if it's stopped.

0:23:560:23:57

I've seen patients like him who have been packed before and left.

0:23:570:24:00

It's finding a balance, Donna.

0:24:000:24:01

We go in too soon and he may well bleed out

0:24:010:24:03

if we don't find and fix it fast enough.

0:24:030:24:05

Yeah, but if you don't do anything, he'll die anyway.

0:24:050:24:07

Is the patient currently stable?

0:24:070:24:08

-Yes.

-Then get back to me if anything changes.

0:24:080:24:11

I'm trying to hold down the whole ward here.

0:24:110:24:12

We have emergencies coming in and there's only so much I can do.

0:24:120:24:15

Take it up with Mr Griffin when he gets back.

0:24:150:24:18

-You're in my spot.

-And?

0:24:270:24:30

I get 30 minutes a day to retune my chakra

0:24:300:24:32

and I'm not going to let you ruin it.

0:24:320:24:34

-The thought never crossed my mind.

-Right.

0:24:340:24:37

So you're prepared to play footy with me in no-man's-land, are you?

0:24:370:24:41

Pipes of Peace and all that?

0:24:410:24:43

Oh, come on, it was Christmas number one for weeks!

0:24:440:24:47

Never mind, I'll get my coat. Sit down, Fletch.

0:24:480:24:51

So, what you got?

0:24:550:24:57

I've developed a worrying addiction to Pulses' chicken salad.

0:24:570:25:00

Salt beef nudger man myself with optional crinkle cut crisps.

0:25:020:25:05

Bacon, obviously.

0:25:050:25:08

So how's life at the top?

0:25:080:25:10

If it wasn't for the money, I'd jack it all in tomorrow.

0:25:100:25:12

Well, I hear good things. Performing miracles with scant resources.

0:25:120:25:16

Have you settled your differences with Amira?

0:25:180:25:22

I'm musing on giving her a chance, as you so rudely requested.

0:25:220:25:26

Well, if you didn't have such a rod up your backside

0:25:260:25:28

you wouldn't have to...

0:25:280:25:30

-What's so funny?

-Thought you were going to have a stroke in theatre.

0:25:300:25:33

So did I!

0:25:330:25:35

Took me an hour to build up the courage to come in and say that.

0:25:350:25:38

Truce?

0:25:380:25:40

Truce.

0:25:420:25:43

So how's things at home?

0:25:460:25:47

Why do you ask?

0:25:470:25:49

It's just you've been a little bit tetchier than normal lately.

0:25:490:25:52

Well, Jonny's having to pull double shifts

0:25:530:25:55

because of the nursing shortage.

0:25:550:25:57

He's barely seen Emma these last two months.

0:25:570:25:59

I thought that would suit you. I'm practically a single parent.

0:25:590:26:03

Welcome to my world.

0:26:030:26:05

Not to mention trying to run a ward on a shoestring.

0:26:050:26:07

I'll say it again - welcome to my world.

0:26:070:26:09

Look, I've raised all your issues over staffing levels with the Trust.

0:26:120:26:15

Believe me, you're not on your own on this...

0:26:150:26:17

..and I'm sorry if I was a bit heavy-handed with you earlier.

0:26:170:26:20

It's been a very long time since someone spoke to me like that.

0:26:200:26:24

All I want is for you to make an effort to give Amira a chance.

0:26:240:26:28

You never know, she might surprise you.

0:26:280:26:30

Halvsies?

0:26:330:26:36

I'll pass.

0:26:360:26:38

Can you prep Ms Knight for theatre?

0:26:480:26:49

We need to get that appendix out ASAP.

0:26:490:26:51

Just give me two minutes.

0:26:510:26:53

If this is about Mr Willis, you've got 30 seconds. Thanks.

0:26:530:26:55

-When did you get all God complex on me?

-All right. One minute.

0:26:550:26:59

-Ceraclydin, Petumoledin or Chlorothropid?

-Sorry?

0:26:590:27:02

I worked on this case recently where a girl was packed just like Gareth

0:27:020:27:05

and I'm sure they used one of the three to...

0:27:050:27:07

If he's still stable, then this isn't urgent, is it?

0:27:070:27:09

I've got no-one else to speak to.

0:27:090:27:11

All right. Run the bloods past haematology.

0:27:110:27:13

Get their take on things ready for Mr Griffin's return.

0:27:130:27:15

-Progress! Thank you, Mr Di Lucca.

-Close the door.

0:27:150:27:18

So our Romanian speaks English, does she?

0:27:210:27:23

Indeed she does and she apologises for her earlier behaviour

0:27:230:27:26

but you had freaked her out a little bit.

0:27:260:27:28

What did I say?

0:27:280:27:30

She's had to have several emergency laparotomies for numerous reasons

0:27:300:27:33

over the past eight years and it seems every time she comes to

0:27:330:27:36

from surgery, that something else has been taken from her body.

0:27:360:27:40

Any idea what's wrong with her?

0:27:400:27:41

No, there's no triggers, no real rhyme nor reason for the attacks,

0:27:410:27:44

apart from the fact that that she's got elevated creatinine levels.

0:27:440:27:47

So that suggests a renal issue.

0:27:470:27:49

Well, yeah, but then there's the list of unrelated symptoms,

0:27:490:27:52

which is as long as your arm

0:27:520:27:54

and ranges from arthritic joint pain through to pleuritis.

0:27:540:27:57

So, your thoughts?

0:27:570:28:00

Maybe it could be an immune system issue where the white blood cells

0:28:000:28:04

are randomly attacking the host,

0:28:040:28:06

but I think it's probably more the case that it's systemic lupus.

0:28:060:28:09

I think someone has finally found their research project.

0:28:100:28:13

-You don't mind me working on this?

-No, not at all.

0:28:130:28:16

I haven't seen you this enthused for ages.

0:28:160:28:17

I think you've finally got your mojo back.

0:28:170:28:20

How's "Nursegate" going?

0:28:220:28:24

I'm guessing you're in full retreat given that she's still here?

0:28:250:28:29

Just put her to work, Mr Valentine.

0:28:290:28:30

Oh, I have and she's doing admirably so far.

0:28:300:28:34

Mr Bale, mitral valve regurgitation.

0:28:340:28:37

-Dr Ford has asked for a post-op chest X-ray.

-Thank you.

0:28:370:28:40

-Can I get you a coffee, Ms Naylor?

-I'm fine, thank you.

0:28:400:28:44

Oliver? It's Mr Valentine to you and you're not here to wait on us.

0:28:440:28:47

Just get that X-ray sorted.

0:28:470:28:49

I'm guessing your spat won't be over any time soon then?

0:28:520:28:55

I've just been up to haematology and they're looking into the drugs

0:28:580:29:02

I recommended for Mr Willis's clotting issue.

0:29:020:29:04

I thought Raf said just to get their take on things?

0:29:040:29:07

Well, yeah, I did, with a little input from me.

0:29:070:29:10

Do you think it's wise going over Mr Griffin's head like that?

0:29:100:29:13

-What harm is it doing?

-Donna.

0:29:130:29:15

I'm just trying to lighten the load before he returns.

0:29:150:29:18

Look, I was thinking about what you said

0:29:180:29:21

and he'd have read the case notes.

0:29:210:29:23

If he thought there was an issue, surely he would have spoken to me.

0:29:230:29:26

-Yeah, that's exactly where I'm coming from too.

-Good.

0:29:260:29:30

Well, I guess we just have to wait it out

0:29:300:29:32

and see what he says when he gets back.

0:29:320:29:34

I hope he's OK.

0:29:340:29:36

So we have established that the patient was admitted with

0:29:360:29:39

an ischemic leg which led to an amputation.

0:29:390:29:42

And that, during treatment, sepsis developed, leading to her death.

0:29:430:29:47

Do you agree, Mr Griffin?

0:29:500:29:52

I would.

0:29:520:29:54

And what started that chain?

0:29:540:29:57

A delayed angiogram.

0:29:570:29:58

The on-call radiologist that day was...

0:30:000:30:02

Was very stressed because she was very overworked.

0:30:020:30:07

Would you care to explain?

0:30:080:30:09

It was around 11am

0:30:110:30:14

when I placed the call to request a CT angiogram.

0:30:140:30:19

And her response to your request?

0:30:190:30:21

It wasn't considered a priority.

0:30:210:30:23

There'd been a MAJAX that day and so, if we wanted the angiogram done,

0:30:230:30:29

we were looking at a wait of several hours.

0:30:290:30:32

Leading you to reach the conclusion

0:30:320:30:35

that Mrs Warren was at insufficient risk

0:30:350:30:38

and that the CT angiogram can wait until later that day.

0:30:380:30:41

Did you take any further action?

0:30:440:30:46

Such as?

0:30:460:30:48

Run another doppler or prescribe a blood-thinning agent?

0:30:480:30:52

Yes, it's standard procedure to prescribe either heparin

0:30:520:30:56

or warfarin, so, yes.

0:30:560:30:59

Should that prescription have been put in

0:30:590:31:02

the patient's medical records. Of course.

0:31:020:31:05

Then why wasn't it in her notes?

0:31:060:31:08

I'll let you into a little secret

0:31:110:31:13

but if you tell anyone, I'll have to kill you.

0:31:130:31:15

I'm starting to believe that.

0:31:150:31:17

It's the accent. I sound like a Bond villain.

0:31:170:31:21

My name is Adina.

0:31:210:31:23

Well, I shall also let you in on a little secret.

0:31:250:31:28

My name used to be Darren but I changed it to Dominic,

0:31:280:31:32

although I've always really fancied being called Stefan.

0:31:320:31:36

Your secret's safe with me.

0:31:360:31:39

Pleased to meet you, Stefan.

0:31:390:31:40

So who's the gorgeous kid?

0:31:430:31:45

-My daughter. Take it you've been through my stuff?

-Absolutely.

0:31:450:31:49

I also drew on your face during surgery. Took some amazing selfies.

0:31:490:31:53

So, how do my insides look?

0:31:560:31:57

Like a patchwork quilt if I'm perfectly honest.

0:31:570:32:00

But you can fix me?

0:32:000:32:03

I'm not going back to die in front of my daughter.

0:32:030:32:06

She's young enough not to remember me

0:32:060:32:08

and well taken care of if push comes to shove.

0:32:080:32:10

So this is the interesting case study you've been hiding from me?

0:32:130:32:17

-Mr Levy seems to think you've backed a winner.

-Excuse me, Adina.

0:32:170:32:20

What do you think you're playing at? I haven't mentioned that to her.

0:32:200:32:23

Just curious to see what I'm up against as you've been so secretive.

0:32:230:32:26

Dominic!

0:32:260:32:28

OK, Fredrik, can you get someone from ENT up here, please,

0:32:280:32:31

to help cauterise this?

0:32:310:32:33

Thank you. Has this happened before?

0:32:330:32:36

Cathy, can we tell Mr Levy we might have a vascular issue here

0:32:360:32:39

and can I get an ANCA test and some cross match just in case

0:32:390:32:42

we need to go to theatre?

0:32:420:32:44

-What does all that mean?

-Just means that you're a big wuss.

0:32:440:32:47

Now keep your head tilted forward, OK?

0:32:470:32:49

Charging at 150. Stand clear.

0:32:520:32:54

Shocking.

0:32:540:32:56

-Still no output.

-OK, let's go with adrenaline.

0:32:560:32:59

Is sodium bicarbonates being administered through that cannula?

0:32:590:33:03

Right, OK. Keep up the compressions. I'll flush the cannula with saline.

0:33:030:33:07

Good catch.

0:33:070:33:08

Adrenaline and sodium bicarbonate don't play well together.

0:33:080:33:11

They form solid matter.

0:33:110:33:13

-That's right, isn't it?

-Indeed. Charging at 200.

0:33:130:33:16

Stand clear.

0:33:160:33:17

Shocking.

0:33:170:33:19

OK, he's back in sinus.

0:33:190:33:21

Good job someone knows what they're doing.

0:33:210:33:24

No, she got to the nub of it pretty quickly.

0:33:260:33:29

Do you think she's going after you?

0:33:300:33:32

She's just doing her job.

0:33:330:33:35

There's clearly an issue here

0:33:350:33:37

and she's just trying to get to the bottom of it.

0:33:370:33:40

The thing is, I had to be somewhere that day

0:33:420:33:47

and, because of the delay on the CT angiogram,

0:33:470:33:50

I made sure to order tests and anticoagulants before I left.

0:33:500:33:55

And can you remember who you asked?

0:33:570:33:59

Unfortunately, yes.

0:33:590:34:02

PHONE RINGS Excuse me.

0:34:020:34:04

Haematology.

0:34:060:34:08

Griffin.

0:34:080:34:10

-Are you OK?

-Not really, no.

0:34:130:34:17

Did they give you a hard time?

0:34:170:34:19

I had a call from haematology.

0:34:190:34:21

It's OK. There's no need to thank me. I'm happy to help.

0:34:210:34:23

What do you think you're doing speaking to them on my authority?

0:34:230:34:27

Petumoledin or any of the drugs you mentioned for that matter,

0:34:270:34:31

will not help Gareth Willis whatsoever.

0:34:310:34:34

-But I...

-Clopidogrel reduces platelet count

0:34:340:34:37

but it's not a blood thinner like warfarin.

0:34:370:34:39

Look, you know the protocol.

0:34:410:34:44

There's a chain of command and it's there for a reason.

0:34:440:34:46

I was trying to give you options.

0:34:460:34:48

So today of all days you decide to stick your neck out?

0:34:480:34:50

I really don't need this, Donna!

0:34:500:34:52

I don't think I've done anything that wrong.

0:34:520:34:54

I'm sorry. I'm sorry.

0:34:570:34:59

I just...

0:34:590:35:00

Sitting back isn't really an option for me,

0:35:000:35:03

you should know that by now.

0:35:030:35:04

It's not normally an option for you either.

0:35:040:35:07

Well...

0:35:110:35:13

..no harm done.

0:35:130:35:15

Except I told his daughter we might be able to help him.

0:35:190:35:23

I can fix that.

0:35:270:35:29

But there's something else that we need to discuss.

0:35:310:35:34

There he is. My saviour.

0:35:430:35:46

How long will I be nil by mouth? You're starving me to death here.

0:35:460:35:49

Well, we do need to let your bowel have a bit of time to heal.

0:35:490:35:52

Just teasing. Been here several times before, remember?

0:35:520:35:55

Could murder a big, fat, juicy T-bone, though!

0:35:550:35:58

No banter, sexy man? What's up with you?

0:36:000:36:02

-I think I know what's wrong with you.

-Are you serious?

0:36:030:36:06

OK, let's have it then.

0:36:080:36:10

Dominic, I'm not scared of dying.

0:36:120:36:15

I just really want to know what's killing me.

0:36:150:36:18

The ANCA test that we did today looks for a certain type of antibody

0:36:250:36:28

in the blood which is a marker for vasculitis.

0:36:280:36:31

Your test came back positive.

0:36:330:36:36

Now, that, in conjunction with what I know about your medical history,

0:36:360:36:41

leads me to believe that you are suffering with something known as

0:36:410:36:44

Wegener's granulomatosis,

0:36:440:36:45

which has now been more conveniently renamed GPA.

0:36:450:36:49

What does that all mean?

0:36:490:36:50

What it means is that your own immune system

0:36:520:36:55

is attacking small blood vessels all over the body.

0:36:550:36:59

On doing so, it causes inflammation

0:36:590:37:03

which then leads to blood not being able to get to certain other organs.

0:37:030:37:09

It's an extremely rare condition...

0:37:110:37:13

..and, in chronic cases, is incurable.

0:37:150:37:20

So that's it, no silver bullet?

0:37:210:37:24

We can manage it once we get it under control.

0:37:260:37:30

You'll still be probably looking at

0:37:300:37:32

a lifelong intensive treatment programme,

0:37:320:37:35

but survival rates have come a long way over the last few years.

0:37:350:37:38

I really don't think that you're going to be a million miles away

0:37:380:37:41

from leading a perfectly normal life.

0:37:410:37:44

The best bit?

0:37:440:37:45

It's not hereditary.

0:37:470:37:48

Hey...

0:37:550:37:56

..at least we now know what we're dealing with.

0:37:570:38:00

You have no idea what you've done for me today.

0:38:020:38:04

You've finally given me peace...

0:38:060:38:08

..Stefan.

0:38:100:38:11

I'm not going to lie to you.

0:38:140:38:16

Your body has been through a lot over the last few years,

0:38:160:38:18

so you're going to need some intensive monitoring.

0:38:180:38:21

Or we could just fly to Vegas, go nuts? I'm totally up for that.

0:38:210:38:26

On one condition.

0:38:260:38:28

That you would agree to be my case study for a research project?

0:38:290:38:34

-Can't get enough of me?

-Something like that.

0:38:340:38:37

You should expect a rough ride at the inquiry.

0:38:390:38:42

Your testimony is going to be key.

0:38:420:38:45

-Right.

-There's no easy way to ask you this.

0:38:470:38:51

Did you arrange for anticoagulants to be ordered as I instructed?

0:38:520:38:58

It's not in the notes.

0:38:580:39:00

As you instructed?

0:39:000:39:02

Donna.

0:39:020:39:04

Ric, you didn't order any.

0:39:040:39:05

It's all I've been able to think about all day.

0:39:050:39:08

So you knew there was a problem, but you didn't speak to me about it?

0:39:080:39:12

I know that I was in a hurry to get away that day,

0:39:140:39:19

but you KNOW me.

0:39:190:39:21

I would NEVER leave a patient in that condition and put them at risk

0:39:210:39:26

by NOT ordering an anticoagulant.

0:39:260:39:29

I simply don't make those kinds of mistakes.

0:39:290:39:31

Neither do I.

0:39:330:39:34

Well, as Mrs Warren's Consultant,

0:39:420:39:47

the buck stops with me.

0:39:470:39:50

So...what do I say?

0:39:500:39:52

Tell the truth as you see it.

0:39:550:39:58

You've spoken to Amira about this?

0:40:020:40:04

I thought I'd speak to you first, given the circumstances.

0:40:040:40:06

I ordered the chest X-ray over two hours ago.

0:40:060:40:08

-You've checked with Radiology?

-No receipt of request.

-The patient?

0:40:080:40:11

Currently stable, but wondering why he can't go home.

0:40:110:40:14

OK. Reorder the X-ray and get to Radiology pronto.

0:40:140:40:17

I'll head her off at the pass.

0:40:170:40:18

-Hi.

-Got anything for me?

-No news from the front.

0:40:180:40:22

Why would you lie to me?

0:40:220:40:23

-What?

-Mr Bale's overdue X-ray?

0:40:230:40:27

OK, look, there was no harm done. The patient's fine.

0:40:270:40:30

Jac...

0:40:310:40:33

..go easy on her.

0:40:330:40:34

So this Junior Doctor of the Year thing

0:40:550:40:58

seems to be pretty much in the bag.

0:40:580:41:00

Rare and exotic conditions do not attract investment

0:41:010:41:05

from pharmaceutical companies.

0:41:050:41:06

Why do you seem to think anybody in their right mind...

0:41:060:41:09

I'd like to thank my mum, my dad, my friends, Mr Hanssen...

0:41:090:41:12

Don't you think you're jumping the gun?

0:41:120:41:15

Apart from the fact I just need to type the presentation up...

0:41:150:41:18

..no.

0:41:200:41:21

-He's got nothing.

-I gave her a chance and now I want her gone.

0:41:310:41:34

I can see that the X-ray was purely precautionary.

0:41:340:41:37

What difference does that make? She's messed up here.

0:41:370:41:40

This time, I'm going to go through the proper chain of command.

0:41:400:41:43

I gave her every chance as you requested.

0:41:430:41:45

And how is me sacking her going to help anything?

0:41:450:41:48

What do you want? Do you want a full NMC enquiry?

0:41:480:41:50

Do you want her career ruined? Do you want her kicked out of nursing?

0:41:500:41:54

Did I not explain to you that we are running on fumes here

0:41:540:41:56

as far as staffing levels are concerned?

0:41:560:41:59

Amira...

0:41:590:42:01

..very proudly told me she stopped Mr Valentine from making

0:42:030:42:06

a catastrophic mistake that would have most certainly led to a fatality.

0:42:060:42:10

Please just sort this out for me.

0:42:100:42:12

Look, pull her up, by all means, OK?

0:42:140:42:16

Record it as an untoward incident,

0:42:160:42:18

but make it part of her learning curve.

0:42:180:42:20

I'm supposed to just chalk this up to no harm done, crack on?

0:42:200:42:24

Jac, I thought we had a truce? It's a two-way street, Fletch.

0:42:240:42:27

I can't believe she hasn't been diagnosed until now.

0:42:310:42:34

-How did she take the news?

-Adina's a happy soul.

0:42:350:42:38

-So is this what you've been working on?

-Yeah.

0:42:380:42:41

The best we can offer her at the moment is plasma exchange and drugs.

0:42:410:42:45

We're just not equipped to deal with GPA-related illnesses here at Holby

0:42:450:42:48

-at the moment.

-So what's the plan?

0:42:480:42:49

Well, there is a professor in Newcastle

0:42:490:42:52

who is currently studying various auto-immune diseases.

0:42:520:42:55

Particularly where auto-antibodies are produced

0:42:550:42:58

against neutrophil proteins

0:42:580:43:00

resulting in blood vessel walls being destroyed.

0:43:000:43:02

So it's the same type of tissue connectivity issue

0:43:020:43:04

-that your patient has with GPA?

-Yeah.

0:43:040:43:07

I'm hoping that he'll share his research

0:43:070:43:09

and work with me on my case study.

0:43:090:43:11

This is really good work, Dominic.

0:43:110:43:14

I just don't think that GPA is the right kind of subject matter

0:43:150:43:19

for your proposal.

0:43:190:43:21

I had a horrible feeling you were going to say that.

0:43:220:43:25

It just isn't Junior Doctor prize territory. It's too specialist.

0:43:250:43:29

So what do I do?

0:43:290:43:30

Just send her up north and kiss goodbye to the Junior Doctor prize?

0:43:300:43:34

I'm going to make it my mission in life

0:43:350:43:37

to find you a fabulously interesting bowel-related cancer.

0:43:370:43:41

Great. Guardians of the colon.

0:43:410:43:43

Oh, come on, you've been so passionate about this.

0:43:430:43:45

I thought you wanted to create a lasting legacy for Arthur?

0:43:450:43:48

How am I meant to do that at the 11th hour?

0:43:480:43:50

You've got to ask yourself what you've learnt today.

0:43:500:43:53

What was it specifically about her case that has inspired you?

0:43:530:43:56

So there is no miracle pill?

0:43:590:44:01

Sadly no, but Nurse Jackson was

0:44:010:44:05

acting with your father's best interests at heart.

0:44:050:44:09

It was only when she checked in with me that she realised her error.

0:44:090:44:13

However, I take full responsibility.

0:44:140:44:17

We do have a complaints procedure

0:44:180:44:20

if you wish to take the matter further.

0:44:200:44:23

No, she was just trying to help.

0:44:230:44:24

MONITOR BEEPS

0:44:240:44:26

We may have a problem here.

0:44:260:44:28

Blood pressure's dropping.

0:44:280:44:30

The bleeding's overwhelmed the packing.

0:44:330:44:35

-We need to get him into theatre.

-Can we get some hands in here, please?

0:44:350:44:39

Dad!

0:44:390:44:41

Dad! You have to save him!

0:44:410:44:43

I can't lose my dad too!

0:44:430:44:45

-Step back.

-Dad!

-Just let them do what they have to do, OK?

0:44:450:44:48

I must say,

0:44:530:44:54

I was extremely impressed by your choice of supervisor.

0:44:540:44:57

Nina chose me actually.

0:44:590:45:00

Chose you or the project?

0:45:010:45:03

The project wasn't on the table when she made her decision.

0:45:030:45:06

Should we continue?

0:45:120:45:14

I don't think Mr Copeland will be joining us.

0:45:140:45:16

KNOCK AT DOOR Come in.

0:45:160:45:18

I'm here. Sorry.

0:45:200:45:22

I got caught short with a burst appendix.

0:45:220:45:25

Shall we begin?

0:45:250:45:27

Thank you.

0:45:290:45:30

More suction, please.

0:45:320:45:34

Do we have cross match and clotting?

0:45:340:45:36

Eight units, but he's bleeding out fast.

0:45:360:45:39

Stand by with some Group O.

0:45:390:45:41

Make sure he's got platelets onboard

0:45:410:45:43

and he's had some tranexamic acid.

0:45:430:45:45

Where's it coming from?

0:45:450:45:46

There. There's a tear in the pelvic sidewall vein.

0:45:480:45:53

We're going to have to under-run the sacral vein. Clamp, please.

0:45:530:45:57

3-0 ready.

0:45:580:45:59

The sutures aren't holding.

0:46:140:46:16

We're going to have to use the staple gun.

0:46:160:46:18

Try and get some staples in the bone.

0:46:180:46:19

This is risky surgery, if you don't mind me saying.

0:46:190:46:22

Do you have an alternative plan?

0:46:220:46:23

Use a patch and hope it holds. Pack him again...

0:46:230:46:25

That's going to be a temporary fix at best,

0:46:250:46:28

plus he might not even make further surgery.

0:46:280:46:31

No. Sitting back is not an option for me, Mr Di Lucca.

0:46:310:46:36

So, in your opinion, you were happy with the care

0:46:390:46:41

Mrs Warren received throughout her stay on the ward?

0:46:410:46:44

She received the same level of care any patient would.

0:46:440:46:47

That's not quite what I asked you, Nurse Jackson.

0:46:470:46:50

Can we keep this specific to the case in question, please?

0:46:500:46:54

I was with Mrs Warren for the majority of her time on the ward

0:46:550:46:58

and I saw nothing untoward.

0:46:580:46:59

Nothing you would class as detrimental to her care?

0:47:010:47:04

I'd have spoken up if I had.

0:47:040:47:06

You would have questioned a doctor?

0:47:060:47:08

Even one as senior as Mr Griffin?

0:47:080:47:10

As a senior nurse, I take patient care very seriously.

0:47:110:47:14

If I'd have thought the patient was at risk, then...

0:47:140:47:17

I see from your statement that you and Mr Griffin are old colleagues?

0:47:170:47:23

That's correct.

0:47:230:47:24

And that you've recently returned to nursing

0:47:240:47:27

after an absence of six years.

0:47:270:47:29

I've had refresher training and consider myself competent,

0:47:290:47:33

if that's what you're getting at.

0:47:330:47:35

That's good to hear.

0:47:350:47:37

So you never felt under unnecessary pressure that day or was asked

0:47:370:47:41

to perform tasks or make decisions that you weren't qualified to do?

0:47:410:47:45

That's never been the case. We're a team, a unit.

0:47:450:47:49

Everyone knows their place and gets the job done.

0:47:490:47:51

But on occasion, mistakes are made?

0:47:510:47:54

Systems are in place to nullify such incidents, but...

0:47:540:47:57

..we're only human.

0:47:590:48:01

OK, I only have one further line of questioning.

0:48:010:48:04

BP is on the rise. Looks like you've got this.

0:48:070:48:10

Let's save the back-slapping for when he's awake in recovery.

0:48:100:48:13

I can close if there's somewhere that you need to be?

0:48:130:48:16

And leave you short-handed again?

0:48:160:48:18

It has been a bit of a learning curve

0:48:180:48:20

but I need to get used to the pressure down here again.

0:48:200:48:23

With great power...

0:48:250:48:26

..comes great responsibility.

0:48:280:48:29

I am really sorry that I didn't put Donna straight today.

0:48:290:48:32

If Emily decides to take things further, I'll come forward.

0:48:320:48:36

You'll do no such thing. He's my patient.

0:48:360:48:39

OK, well, at least let me close up and do the post-op care.

0:48:390:48:43

I believe you're needed elsewhere.

0:48:430:48:45

So having read your portfolios, yours albeit briefly, Mr Copeland,

0:48:500:48:54

I think I am now ready to give you my thoughts, for what they're worth.

0:48:540:48:58

Fredrik, your chosen subject matter

0:48:580:49:01

of Pancreatic Laser Ablation I find fascinating.

0:49:010:49:03

It is a technique that in the future could well extend

0:49:030:49:07

the lives of those with such an incurable cancer.

0:49:070:49:09

So you support my project?

0:49:110:49:13

That's not quite what I said.

0:49:130:49:14

Explain?

0:49:170:49:19

I believe it's a technique that has already been tested

0:49:190:49:22

so that it will support human trials.

0:49:220:49:25

I don't really see what contribution you could make

0:49:250:49:27

given the paltry sum available to you.

0:49:270:49:29

You're simply hitching your star to their wagon.

0:49:290:49:32

I want better than that for you.

0:49:320:49:34

If you wish to continue with the project, I will support it

0:49:340:49:37

but I would urge you to take this opportunity

0:49:370:49:40

of reconsidering your submission.

0:49:400:49:42

So...

0:49:450:49:46

..I suppose Mr Copeland here gets a gold star just because

0:49:460:49:50

some runaway happens to fall into his lap

0:49:500:49:53

with something rare and exotic?

0:49:530:49:55

Actually I'm investigating the study of bowel resection techniques and

0:49:550:49:58

the physiological and psychological effect it has on patients.

0:49:580:50:02

What about your dream patient?

0:50:020:50:04

She might have inspired the idea, but I very quickly realised

0:50:040:50:07

I was out of my depth with her case.

0:50:070:50:09

That takes a certain maturity, Mr Copeland.

0:50:090:50:12

Bowel resection techniques are hardly ground-breaking.

0:50:120:50:15

Yes, well, they might be mundane to you,

0:50:150:50:17

but think of the amount of people that it will help.

0:50:170:50:19

This isn't just about a prize for me.

0:50:190:50:22

This is about more than that. Mr Copeland...

0:50:220:50:24

All right, look, this might not be "sexy" medicine

0:50:240:50:27

but in my time here I have had the opportunity to work with

0:50:270:50:31

some of the best surgeons this hospital has to offer, or has ever

0:50:310:50:34

had to offer, and if there is one thing that I have learned, it's that

0:50:340:50:38

you support each other, you move forward together, always improving.

0:50:380:50:42

If you are looking to pan this project

0:50:420:50:44

because you believe there is a lack of imagination, then...

0:50:440:50:47

Mr Copeland, I was just going to say your soapbox is not needed.

0:50:470:50:50

Your portfolio itself was enough to convince me.

0:50:500:50:53

You have my full support.

0:50:530:50:55

In Mr Griffin's testimony, he has stated that he requested

0:51:000:51:04

anti-coagulants to help Mrs Warren's blood flow to her leg

0:51:040:51:08

whilst she waited for her CT angiogram.

0:51:080:51:10

Do you have any explanation as to why this was not in her records?

0:51:110:51:16

Nurse Jackson, it's a simple enough question.

0:51:180:51:21

As the senior nurse on duty that day,

0:51:220:51:24

do you recall blood thinners being asked for by Mr Griffin?

0:51:240:51:28

It was a busy day and requests were coming in thick and fast.

0:51:290:51:34

Either Mr Griffin didn't ask for the anti-coagulants

0:51:340:51:36

or his request was ignored.

0:51:360:51:38

So, I'll ask you again...

0:51:400:51:42

..do you recall Mr Griffin

0:51:440:51:46

prescribing Mrs Warren's blood thinners?

0:51:460:51:49

I have no recollection of Mr Griffin prescribing anti-coagulants

0:51:590:52:05

to Mrs Warren.

0:52:050:52:07

Thank you for your attendance, Nurse Jackson.

0:52:100:52:13

What's going on?

0:52:170:52:19

Ms Naylor's cancelled all her electives until further notice.

0:52:190:52:22

-Emergency cases only.

-Why?

0:52:220:52:25

She feels we have insufficient experienced staff to safely

0:52:250:52:28

-treat patients. So until that changes...

-Where is she?

0:52:280:52:31

-In her office. Left orders to not be disturbed.

-Good luck with that.

0:52:310:52:35

Amira.

0:52:350:52:36

Amira, hang on.

0:52:380:52:40

Amira?

0:52:400:52:42

What's Jac said to you?

0:52:430:52:44

More like what's she's done to the whole ward.

0:52:440:52:46

It's clear she blames me for what's happened with this missing X-ray.

0:52:460:52:49

-And who told you that?

-She doesn't have to.

0:52:490:52:52

I feel like I've let you down again, Mr Fletcher.

0:52:520:52:54

I...I won't be coming back.

0:52:560:52:59

Congratulations on your ground-breaking entry.

0:53:070:53:10

Bowel surgery - how nouveau.

0:53:100:53:13

Seriously, look, all joking and competitiveness aside,

0:53:150:53:19

do you not just think he was being genuine?

0:53:190:53:23

-You can still pursue it, you just need to find...

-Shut up!

0:53:230:53:25

Don't...

0:53:270:53:29

..patronise me.

0:53:290:53:30

Of course you'd agree with him.

0:53:340:53:35

Jac.

0:53:460:53:48

You're putting patients at risk.

0:53:480:53:50

You think by wasting bed space and theatre time,

0:53:500:53:52

that's actually helping the situation?

0:53:520:53:55

Someone had to make a stand.

0:53:550:53:56

Well, for the record, your stand has just cost this hospital a nurse.

0:53:560:53:59

She was never fit for purpose and you know it.

0:53:590:54:01

You know what, I expected a witch hunt about Amira,

0:54:010:54:04

and I always expect a battle from you, but...

0:54:040:54:06

A strike on electives?

0:54:060:54:07

That's just not like you.

0:54:090:54:11

You always put the patients first, so what's going on?

0:54:110:54:14

This can't all be about Jonny.

0:54:160:54:18

There's more to it, I know there is.

0:54:210:54:23

It's like you've given up.

0:54:290:54:31

And...

0:54:310:54:32

..why are you hiding in here?

0:54:330:54:35

I don't know.

0:54:350:54:37

Look, we've all been going through a pretty grim time of it recently.

0:54:450:54:49

And there were times in my life that I went to some very dark places.

0:54:500:54:53

If I didn't have a friendly ear or 12 to listen to,

0:54:540:54:58

I don't know what I would have done. So, look, Jac, you and me,

0:54:580:55:01

-we've got to stick together more than ever.

-No.

0:55:010:55:03

We're not friends.

0:55:030:55:05

-Jac, just hear me out...

-Just... This conversation is over.

0:55:050:55:08

Come on!

0:55:080:55:10

So you can't fix me but you know a man who can?

0:55:220:55:25

-Hopefully they can.

-Newcastle is so far away.

0:55:250:55:28

You're going to love it, it's a total party town.

0:55:280:55:30

Just no-one to party with.

0:55:300:55:32

Well, post-op recovery is all organised.

0:55:320:55:34

You shall be staying here at Hotel Holby for at least a week,

0:55:340:55:37

three square meals a day.

0:55:370:55:39

Stop it, I'm still nil by mouth. Starving!

0:55:390:55:42

I would quite like to phone your family, if I may.

0:55:420:55:45

I won't be a burden, life goes on.

0:55:450:55:47

OK, well, I guess that's your choice.

0:55:480:55:51

Come here, you've got a little something on your...

0:55:510:55:54

Anything?

0:55:560:55:58

Not even a tingle.

0:55:590:56:01

No point taking you to Vegas then!

0:56:010:56:04

I'm sorry.

0:56:070:56:08

You did what you had to do.

0:56:100:56:12

So where do we go from here?

0:56:120:56:14

Depends if Ms Mensall concludes that Elaine Warren's death was avoidable.

0:56:140:56:21

A first offence, what are we looking at? A slapped wrist, right?

0:56:210:56:25

I saw you talking with her son today.

0:56:250:56:28

Yeah, he came in...

0:56:280:56:30

Please, everyone, do take a seat.

0:56:310:56:34

I'd like to thank everyone involved in this inquiry

0:56:420:56:45

for your cooperation today.

0:56:450:56:48

The law states that unnatural deaths must be investigated...

0:56:480:56:53

..and that is why this inquiry is being heard.

0:56:540:56:56

You didn't kill her.

0:56:590:57:00

I didn't save her either.

0:57:000:57:02

Having taken into consideration all of the evidence given

0:57:030:57:06

over the day...

0:57:060:57:07

..I feel compelled to suspend this case...

0:57:080:57:11

..and refer the matter to the CPS in consideration of

0:57:130:57:17

criminal charges relating to gross negligence manslaughter.

0:57:170:57:22

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