Cardiac Arrest (1994–1996): Season 1, Episode 2 - Doctors and Nurses - full transcript
(Laughing, shrieking)
(Girl) When we're playing,
the boys say the girls have to be nurses.
But / want to be a doctor
(Siren)
The barium enema shows what looks to be
a growth in the large bowel.
Mr Betancourt intends to remove
this growth in theatre tomorrow.
Because you're a diabetic,
ILL ensure you're first on the list
and I've written you up for a drip
that will give you sugar and insulin.
— So, any questions?
— Yes, Nurse.
When's the doctor going to see me?
(Pager)
Dr Broome. Thank you.
The hernicolectomy's sorted for tomorrow.
Could you see the other TCl
while | chase up Mr Orton's X-rays?
I'm already late for theatre.
I'm a coiled spring.
— What's she so miserable about?
— Primary coming up.
Doctor, Mr Orton's temperature
is up again.
Then don't measure it.
If we don't know his temperature,
we shan't have a fever to worry about.
Who's the slapper? Phwoar.
That's the legendary Nurse White Coat,
just transferred from Geriatrics.
Why do they call her White Coat?
— Ah. Dr Broome.
— Morning, Mr Betancourt.
There are admissions not clerked,
test results gone astray,
patients inadequately prepared for theatre.
You cannot expect your houseman
to do all the work himself.
Pull your socks up, Monica,
or I'll K-wire them to your kneecaps.
And | want this ward kept quiet from
new admissions for the next couple of weeks
so that | can get my waiting—list patients in
and the management off my back.
Monica! Theatre!
He's like a father to me.
My father's a bastard too.
Keep the ward quiet. What are we meant
to do? Tell people to stop getting ill?
If Betancourt wants quiet,
he should try Mengele ward.
They've got an outbreak of MRSA.
Hello, my love. Sorry to disturb you.
— You're here for my leg, aren't you?
— Yes.
Just need to take some more samples.
They've told me that all this to—do
is because of this dangerous germ
I've got in my leg.
Just a few more swabs for some tests.
Oh...
(Laughs demonically)
For heaven's sake, Peter, I'm at work.
They are your kids, too.
You're right. I'm sorry. julian
has invited us for dinner on Friday night.
— I'm on take Friday.
— Any chance of swapping?
I'LL do my best, but | doubt I'll be able to.
Terry’s wife always seems to manage.
Terry's wife is a nurse.
Well, maybe | should have married
a nurse instead of a doctor.
Where the hell's that dobutamine
| asked for ten minutes ago?
(Pager)
Claire, it’s Dr Turner.
Phone Crippen ward, please.
You go on the ward round. I'll stay here
till this chap's more stable.
OK. Thanks for your help.
Dr Maitland, this is your mess, too,
you know.
You should be in bed
with a hot-water bottle.
Mrs Carmichael's monitor
from this morning.
I'm sure you have this effect on all
our female patients, Charge Nurse Scrivens.
Dr Maitland, we're having terrible trouble
with Mrs Khan over iron—chlorpromazine.
Then you have my permission
to use your initiative.
None of us are happy to give the injection,
so you'll have to do it.
I'm not happy, either, to do something
that you do every day and I've never done.
— That's a fine attitude.
— Nursing problems are for nurses.
I'm not gonna stick a needle
in someone's arse
just cos you want to dump your work
on a doctor.
— Did you catch much sleep yourself?
— None.
The life of a house dog, eh?
In my day, we were house dogs.
| can remember having to caddy
for the prof at weekends
and dance with his wife at the hospital ball.
So | know what it's like.
Listen to the nurses. They'll help you
hugely if you treat them well.
And if you do have any worries,
rest assured my door is always open.
Thank you, Dr Turner.
OK.
— / don't think one...
— Peter, | have tried!
(Click, dialling tone)
All right, then, dear,
I'LL see you tonight. Bye.
Microbiology just phoned. We have
three cases of MRSA on the ward.
Right.
— Hi.
— Hi.
(Pager)
(Woman) 3-4-5...
Andrew, you couldn't rewrite
these drug charts, could you?
Having them spread over
more than one sheet is so untidy.
I'd like to get a coffee first, Sister.
I'll be ten minutes.
— Sister, can | have the drug key?
— Oh, here.
| would have thought you would have had
the day off, with being up all night.
(Laughs hollowly)
Sister, | think it's gone time
for me and Sally to go for break.
Off you go, love. Could you just stay
and do those charts, please?
Look, Andrew, there'll be plenty of time
for coffee Later.
Oh, also, er...you don't mind doing
the IV drugs for me this morning, do you?
Sister, | thought the nurses did the IVs.
| would do, only |'m on the bleep
for the whole hospital.
Andrew, | was doing this
while you were still filling your nappy.
— Just remember that.
— Yes, of course. Sorry, Sister, you're right.
(Pager)
Please call Casualty, on 3090,
— You're doing an exam soon, aren't you?
— Primary FRCS.
Must be hard work,
studying and working as well, eh?
Oh, it's not that bad.
All I've done for three months
is work, study and sleep.
| can't help thinking that when | die
the maggots that eat my corpse
won't show it any more respect if | was
a Fellow of the Royal College of Surgeons.
Mr Betancourt's on the phone, screaming
blue murder about a missing cross—match.
Thank you.
— Hello.
— Hello. I'm Dr Turner's houseman.
Karen Teller, Cas Sister.
Right, an old patient of Dr Turner's,
55-year-old man, brought in collapsed.
His GP note.
"Collapse. BP 150 over 90. Query CVA.
Please see and do the needful”
(Pager)
Please cali 26456.
I'm busy in Casualty.
I'LL be with you when | can.
Could you leave us alone just for
a few moments, please, Mrs Burrows?
— His name is Ted Burrows.
— Hello, Ted.
I'm Dr Collin.
We're gonna take a little Look at you.
— Erm...
— His BP is 260 over 140. Pulse 50.
According to his wife, it started
with a headache, then vomiting.
His conscious level
has progressively deteriorated all day.
Thanks.
He'll need an urgent CT scan. That
has to be ordered by an SHO or above.
So you've got your excuse
for calling Claire.
— (Pager)
— Thanks.
Andrew, could you call Crippen ward,
please?
How is he? Please, Doctor.
It's a little early to tell. | need to organise
some tests and then we'll know more.
Sister, | don't mean to sound rude,
but you bleeped me about this
a minute ago. I'll be there when | can.
It isn't serious, is it, Doctor?
Claire...
Andrew, pass a big Venflon and
take blood for urgent FBC, U&E, LFTs,
glucose, clotting and calcium profile.
— Karen, could you set up a...
— 20% mannitol? On its way.
100 grams over ten minutes.
If this is a CVA, I'm Hilary Jones.
— Sister Teller's good, isn't she?
— Mm.
Married to a complete tosser.
Mind you, | can talk. Ace female that | am
and I've had some real losers.
Yeah, | can bet. Ow!
We'll look pretty bad if he curls up his toes
before a word's been written in his notes.
What d'you understand by ERCP?
Endoscopic retrograde
cholangio—pancreatography.
If | ask you to do an ERCP, Andrew,
what I'll mean is an emergency
retrospective clerking of patient.
Saves your bacon at the inquest.
Read out his drugs, will you?
The GP didn't even bother
to mention his medication.
Er, Atenolol 50 once daily. GTN, PRN.
I'm sure Dr Turner could make a complaint
on a matter of principle like this.
GPs refer private patients.
I'm afraid Dr Turner's principles
stop where his income starts.
And yours?
First, get through the day.
Then allow yourself the Luxury of principles.
That's a left-sided subarachnoid
with considerable midline shift and oedema.
— Your man's not far off coning.
— Thanks.
I'LL admit to Crippen ward
and then arrange transfer
— to the neurosurgeons at the general.
— (Pager)
— Please call Crippen ward...
— That's the third time
they've bleeped me for something trivial.
It's been made plain we're busy.
Stop nagging us about this crap.
I'm a genius, me. Infection Control
have already got the nurses giving out
bucketfuls of Bactroban.
"Dear Dr Sex, | have a U-shaped willy
and fluorescent testicles.
"Is this normal? Signed, Raj."
Problem is, the woman on Mengele ward
has been on it for weeks.
And they still haven't eradicated
her MRSA.
"Dear Dr Sex, my bionic lover transports
me to the Planet Ecstasy every time.
— "Signed, any one of James's chicks.”
— This could run for ages.
— The bloody IVs aren't done.
— | promised Sister.
You need a cuppa. I'll take care of the IVs.
Oh, OK. Thanks.
(Giggling) Pinky and Perky!
Dr Maitland, | understand
we're shortly to receive an admission.
— We're not on take today.
— Nor are the doctors.
Yet we've just spent
an hour and a half with him.
Old patient of Dr Turner's,
massive subarachnoid.
Just put him in a bed and
he'll pop his clogs soon enough.
Sister, | notice the IVs haven't been given.
Er, Andrew said he'd find time.
My houseman's busy enough without
being burdened with nursing chores.
He offered to help because
I'm on the bleep for the hospital.
Then what the hell's this?
Erm, I'm afraid | got a bit tied up
at Casualty, Sister.
I'll do those IVs now.
(Andrew) Getting on with the nurses
will make my job easier, OK?
It looks to me like
getting on with the nurses
means you have to do chores
you're not trained for
while they sit gassing about clothes,
hairdos and the bloody Chippendales.
Dr Turner...
Dr Turner said
that the nurses will help you loads
and promised that his door
will always be open?
He heard that speech on Casualty
a couple of years ago
and now he gives it to all his housemen.
You see, most of all, you'll learn
that no one's door is open for you.
— Mrs Burrows wants to speak to a doctor.
— OK, I'll talk to her.
| don't need you to mother me through this
any more than to tick off nurses.
The boy may have balls, after all.
Mm.
— I've put Mrs Burrows in Sister's office.
— Thanks.
Claire's a bitch that hates nurses.
Doctors have it easy compared to us.
Who does all the physical work on these wards?
Not to mention all the dirty jobs.
Yeah, you may work longer hours than us
but it's only mental work.
— How hard can that be?
— (Wearily) | suppose you're right.
You're up shit creek. Get in there.
Do you realise the chaos you've caused?
Alerting the infection—control team,
shutting down the ward, isolating patients.
Swabs being taken from
every nook and cranny
from anyone who's been
within a mile of this ward.
I've not caused anything.
Mr Betancourt tells us
to keep the ward quiet.
You go off, half—cocked, if cocked at all,
and shut it down.
You went to Mengele ward yesterday.
You contaminated swabs with MRSA,
then exchanged them for clean swabs
off our patients.
Who are you, Hercule Poirot?
How am | supposed to whittle away
my waiting list if | can't admit my patients?
And why do | bother to perform surgery
in aseptic conditions
when all you can do
is smear infection into my patients?
Mr Betancourt, the epidemiology of MRSA
is such that it couldn't b...
All of a sudden, you're an expert on MRSA.
| doubt you even know what it means,
having already failed
your primary fellowship twice.
Just because surgery
involves a bit of sewing
doesn't mean it's any career
for a housewife.
(Mouths)
| appreciate you doing that for me, Andrew.
Oh, you're welcome.
Erm, Sister... About Mrs Burrows.
| was wondering if you had any advice
on how | should handle it.
You're the doctor. You'll have to make
that decision yourself.
Our examination suggested
that Ted's problems might be due to
the raised pressure inside the skull.
The brain scan has told us that Ted has
experienced a subarachnoid haemorrhage.
This is due to the bursting of a vessel,
so blood collects round the lining of the brain,
causing pressure and swelling.
Dr Maitland has referred Ted to
the brain surgeon at the general hospital.
Why hasn't my husband
been taken straight to the general
if there's nothing you can do for him here?
No, there are things
we could do for him here. Erm...
The neurosurgeon
will need to look into Ted's case
to see if surgery
will be the right thing to do.
What will surgery involve?
Well, erm, they'll try to...
It's a very specialised field, Mrs Burrows.
Erm, | really couldn't tell you for sure.
...| understand. So, what sort of treatment
is he receiving here?
Erm...
He will..get better, won't he, Doctor?
— Please tell me he'll be all right, Doctor.
— | erm...
He's all I've got. Please don't let him die.
| won't.
(Snoring)
Neurosurgeons won't budge
until they've reviewed the CTs,
by which time
this bloke'll be deader than Elvis.
At the time, giving her some hope
seemed the thing to do.
You haven't the power
to promise life or death.
A patient has a disease, you try and treat it.
The rest is fate.
House jobs, eh? (Laughs)
Pretty daunting to start off with.
Still, you'll soon get on top of the job.
And on top of a few of the nurses.
| tell you, when | was
a cocksure young houseman,
| must have pulled every nurse
within about a half—mile radius.
Torch.
Mm-—hm.
We need Dr Turner's decision before | can
go on to paralyse and ventilate this fellow.
Allow me, dear.
Please, Doctor, there's no need.
Nonsense, dear.
ILL have that mark out in a jiffy.
Looks clean to me now.
I'll write a few words in the notes, shall I?
You've got a witness to support
your charge of sexual harassment.
A friend of mine was assaulted
by a bloke in her set.
When she told the tutors, they said
that she'd misinterpreted a friendly gesture.
In the end, she got transferred.
| don't want to be transferred.
| like it here.
Come with me.
You can do better than girls like that.
Drop your trousers.
(Scrabbling)
Underpants, too,
(Grunts)
Oh, James, you've made a mess.
(Laughing)
(Continuous bleep)
CPR terminated and
patient pronounced dead...5:35pm.
(Monitor off)
Dead.
Dead.
If he isn't, he sure will be after a couple
days in an airtight bag down the morgue.
Oh...
Andrew, take comfort that
in medicine the worst that can happen
is that someone else dies.
Well, you may find this
hard to accept, Claire,
but | don't particularly
want to adopt your attitude.
His wife's in Sister's office.
Go and tell her, then.
(Whispers) I'm sorry, Mrs Burrows...
OK, Mrs Burrows.
Come on.
Death certificate's in the nurses’ station.
It's to be filled in.
Raj, we've opened for
an emergency admission.
— Mr Betancourt's in surgery.
— Monica's in Casualty.
— So you'll have to deal with this.
— The patient is HIV positive.
(Laughter)
All right?
— Dr Maitland.
— Oh, thanks.
These gases are much better
on aminophylline.
| think we'll be fine
continuing as we're doing. OK?
OK. Thanks.
— Any more coming in?
— No.
— Really?
— Really.
Looks like an early night for the physicians.
Let's go.
You better hang on.
Massive upper—Gl bleed on its way.
ETA one minute.
(Retching)
Andrew, two Venflons and
make them big ones.
Cross—match 12 units.
Full blood count, U&Es, LFTs, clotting.
Karen, I'll try and pass a central line.
We'll start with saline and Haemacell,
but if someone could go to the blood bank
and get some O negative.
OK, we've got access on this side.
Karen, can you run that in, please?
This bloke's bleeding like a stuck pig.
Andrew, vitamin K. Can you get onto the
blood bank about a couple of units of FFP?
Don't worry. It's not the easiest thing
in the world.
— Can you...?
— Yeah.
Blood pressure’s 60 over nothing.
We really need that O neg, OK?
OK, haemoglobin 10.2.
White cell count 14.8.
Platelets 145.
Thrombin time, 25 seconds control.
14 seconds.
— Is this guy a boozer?
— Lord knows. We don't even have a name.
— Do us a catheter, Andrew, please.
— Right.
Aha. We'll probably be needing
the surgeons tonight.
— Not me. I'm only second on.
— You shouldn't be in the neighbourhood.
Raj, you do the catheter for us, will you?
Andrew, you go to the blood bank, please.
0 negative,
as much as you can get your hands on.
— On my way.
— Thank you.
BP 80 over 50.
Whoops.
Raj, will you get onto the blood bank about
that FFP | ordered nearly an hour ago?
I'LL phone Dr Turner at home.
Sorry to wake you, Dr Turner. I've got
a massive GI bleeder here in Cas.
Looks like he'll need a scope tonight,
I'm afraid.
Thanks. Bye.
Hm.
| don't see varices.
He's gushing blood from the gastric
mucosa but I'm darned if | can see where.
What | can say with confidence
is that he won't survive
unless someone goes in
and stops that bleed.
This is just Simon Betancourt's cup of tea.
Go on, please!
Graham Turner put me in the picture.
Looks like there's quite a night ahead.
Thank you for coming in, Mr Betancourt.
We've yet to get his systolic over 90,
but he has got a healthy tachycardia.
You physicians and your blood pressure.
If we don't operate, | can tell you
what it will be tomorrow.
— Nothing over nothing?
— Right. James, any worries?
Well, if Claire can keep him alive this long
and you can stop his bleed,
— | don't see why | can't put him to sleep.
— OK, let's get on with it.
Raj, I'll need you to scrub.
Dr Maitland, you're welcome to join us.
You'll need me.
(Monitor beeping)
(Suctioning)
Damn!
Now come back...on!
BP is down still.
It's now 50 over diddly.
Located bleeder.
Bugger to get at. More suction.
More suction, more suction.
— He's lost his output.
— EMD. Adrenalin, one milligram, please.
All this digging about
doesn't make my job any easier.
There's no point in operating
on a dead man, Mr Betancourt.
Which is what he is right now,
Can you get those next couple of units
in here as quickly as you can, please?
We have an output.
He's back. All yours again, Mr Betancourt.
Thank you, Dr Maitland.
Raj, your suctioning abilities
have improved dramatically.
— Just saturate it down, me.
— Like a vacuum cleaner.
— First time I've seen you work, James.
— Isn't that a fiver you both owe me?
No, | said by the end of the day.
If he's still alive by the end of the day.
This is what surgery is all about.
Like driving a racing car
or flying a jet plane.
Now, when you make that first incision,
there's always the unknown waiting inside.
My father said he couldn't understand
anybody wanting to do anything else
and he was a surgeon, a damn good one.
Any relatives
to whom | can give the good news?
We don't even know his name yet.
I've come in from home, in the middle
of the night and saved that fellow’s life.
I've earned a room full of grateful relatives.
— Yeah.
— Yes.
— Well, that's me turning in.
— Yeah, me too. Cheers, Mr B. See you.
— Night.
— Well done. Excellent work.
(James) You were crap, Raj.
Bedtime.
| thought you'd never ask.
(Girl) When we're playing,
the boys say the girls have to be nurses.
But / want to be a doctor
(Siren)
The barium enema shows what looks to be
a growth in the large bowel.
Mr Betancourt intends to remove
this growth in theatre tomorrow.
Because you're a diabetic,
ILL ensure you're first on the list
and I've written you up for a drip
that will give you sugar and insulin.
— So, any questions?
— Yes, Nurse.
When's the doctor going to see me?
(Pager)
Dr Broome. Thank you.
The hernicolectomy's sorted for tomorrow.
Could you see the other TCl
while | chase up Mr Orton's X-rays?
I'm already late for theatre.
I'm a coiled spring.
— What's she so miserable about?
— Primary coming up.
Doctor, Mr Orton's temperature
is up again.
Then don't measure it.
If we don't know his temperature,
we shan't have a fever to worry about.
Who's the slapper? Phwoar.
That's the legendary Nurse White Coat,
just transferred from Geriatrics.
Why do they call her White Coat?
— Ah. Dr Broome.
— Morning, Mr Betancourt.
There are admissions not clerked,
test results gone astray,
patients inadequately prepared for theatre.
You cannot expect your houseman
to do all the work himself.
Pull your socks up, Monica,
or I'll K-wire them to your kneecaps.
And | want this ward kept quiet from
new admissions for the next couple of weeks
so that | can get my waiting—list patients in
and the management off my back.
Monica! Theatre!
He's like a father to me.
My father's a bastard too.
Keep the ward quiet. What are we meant
to do? Tell people to stop getting ill?
If Betancourt wants quiet,
he should try Mengele ward.
They've got an outbreak of MRSA.
Hello, my love. Sorry to disturb you.
— You're here for my leg, aren't you?
— Yes.
Just need to take some more samples.
They've told me that all this to—do
is because of this dangerous germ
I've got in my leg.
Just a few more swabs for some tests.
Oh...
(Laughs demonically)
For heaven's sake, Peter, I'm at work.
They are your kids, too.
You're right. I'm sorry. julian
has invited us for dinner on Friday night.
— I'm on take Friday.
— Any chance of swapping?
I'LL do my best, but | doubt I'll be able to.
Terry’s wife always seems to manage.
Terry's wife is a nurse.
Well, maybe | should have married
a nurse instead of a doctor.
Where the hell's that dobutamine
| asked for ten minutes ago?
(Pager)
Claire, it’s Dr Turner.
Phone Crippen ward, please.
You go on the ward round. I'll stay here
till this chap's more stable.
OK. Thanks for your help.
Dr Maitland, this is your mess, too,
you know.
You should be in bed
with a hot-water bottle.
Mrs Carmichael's monitor
from this morning.
I'm sure you have this effect on all
our female patients, Charge Nurse Scrivens.
Dr Maitland, we're having terrible trouble
with Mrs Khan over iron—chlorpromazine.
Then you have my permission
to use your initiative.
None of us are happy to give the injection,
so you'll have to do it.
I'm not happy, either, to do something
that you do every day and I've never done.
— That's a fine attitude.
— Nursing problems are for nurses.
I'm not gonna stick a needle
in someone's arse
just cos you want to dump your work
on a doctor.
— Did you catch much sleep yourself?
— None.
The life of a house dog, eh?
In my day, we were house dogs.
| can remember having to caddy
for the prof at weekends
and dance with his wife at the hospital ball.
So | know what it's like.
Listen to the nurses. They'll help you
hugely if you treat them well.
And if you do have any worries,
rest assured my door is always open.
Thank you, Dr Turner.
OK.
— / don't think one...
— Peter, | have tried!
(Click, dialling tone)
All right, then, dear,
I'LL see you tonight. Bye.
Microbiology just phoned. We have
three cases of MRSA on the ward.
Right.
— Hi.
— Hi.
(Pager)
(Woman) 3-4-5...
Andrew, you couldn't rewrite
these drug charts, could you?
Having them spread over
more than one sheet is so untidy.
I'd like to get a coffee first, Sister.
I'll be ten minutes.
— Sister, can | have the drug key?
— Oh, here.
| would have thought you would have had
the day off, with being up all night.
(Laughs hollowly)
Sister, | think it's gone time
for me and Sally to go for break.
Off you go, love. Could you just stay
and do those charts, please?
Look, Andrew, there'll be plenty of time
for coffee Later.
Oh, also, er...you don't mind doing
the IV drugs for me this morning, do you?
Sister, | thought the nurses did the IVs.
| would do, only |'m on the bleep
for the whole hospital.
Andrew, | was doing this
while you were still filling your nappy.
— Just remember that.
— Yes, of course. Sorry, Sister, you're right.
(Pager)
Please call Casualty, on 3090,
— You're doing an exam soon, aren't you?
— Primary FRCS.
Must be hard work,
studying and working as well, eh?
Oh, it's not that bad.
All I've done for three months
is work, study and sleep.
| can't help thinking that when | die
the maggots that eat my corpse
won't show it any more respect if | was
a Fellow of the Royal College of Surgeons.
Mr Betancourt's on the phone, screaming
blue murder about a missing cross—match.
Thank you.
— Hello.
— Hello. I'm Dr Turner's houseman.
Karen Teller, Cas Sister.
Right, an old patient of Dr Turner's,
55-year-old man, brought in collapsed.
His GP note.
"Collapse. BP 150 over 90. Query CVA.
Please see and do the needful”
(Pager)
Please cali 26456.
I'm busy in Casualty.
I'LL be with you when | can.
Could you leave us alone just for
a few moments, please, Mrs Burrows?
— His name is Ted Burrows.
— Hello, Ted.
I'm Dr Collin.
We're gonna take a little Look at you.
— Erm...
— His BP is 260 over 140. Pulse 50.
According to his wife, it started
with a headache, then vomiting.
His conscious level
has progressively deteriorated all day.
Thanks.
He'll need an urgent CT scan. That
has to be ordered by an SHO or above.
So you've got your excuse
for calling Claire.
— (Pager)
— Thanks.
Andrew, could you call Crippen ward,
please?
How is he? Please, Doctor.
It's a little early to tell. | need to organise
some tests and then we'll know more.
Sister, | don't mean to sound rude,
but you bleeped me about this
a minute ago. I'll be there when | can.
It isn't serious, is it, Doctor?
Claire...
Andrew, pass a big Venflon and
take blood for urgent FBC, U&E, LFTs,
glucose, clotting and calcium profile.
— Karen, could you set up a...
— 20% mannitol? On its way.
100 grams over ten minutes.
If this is a CVA, I'm Hilary Jones.
— Sister Teller's good, isn't she?
— Mm.
Married to a complete tosser.
Mind you, | can talk. Ace female that | am
and I've had some real losers.
Yeah, | can bet. Ow!
We'll look pretty bad if he curls up his toes
before a word's been written in his notes.
What d'you understand by ERCP?
Endoscopic retrograde
cholangio—pancreatography.
If | ask you to do an ERCP, Andrew,
what I'll mean is an emergency
retrospective clerking of patient.
Saves your bacon at the inquest.
Read out his drugs, will you?
The GP didn't even bother
to mention his medication.
Er, Atenolol 50 once daily. GTN, PRN.
I'm sure Dr Turner could make a complaint
on a matter of principle like this.
GPs refer private patients.
I'm afraid Dr Turner's principles
stop where his income starts.
And yours?
First, get through the day.
Then allow yourself the Luxury of principles.
That's a left-sided subarachnoid
with considerable midline shift and oedema.
— Your man's not far off coning.
— Thanks.
I'LL admit to Crippen ward
and then arrange transfer
— to the neurosurgeons at the general.
— (Pager)
— Please call Crippen ward...
— That's the third time
they've bleeped me for something trivial.
It's been made plain we're busy.
Stop nagging us about this crap.
I'm a genius, me. Infection Control
have already got the nurses giving out
bucketfuls of Bactroban.
"Dear Dr Sex, | have a U-shaped willy
and fluorescent testicles.
"Is this normal? Signed, Raj."
Problem is, the woman on Mengele ward
has been on it for weeks.
And they still haven't eradicated
her MRSA.
"Dear Dr Sex, my bionic lover transports
me to the Planet Ecstasy every time.
— "Signed, any one of James's chicks.”
— This could run for ages.
— The bloody IVs aren't done.
— | promised Sister.
You need a cuppa. I'll take care of the IVs.
Oh, OK. Thanks.
(Giggling) Pinky and Perky!
Dr Maitland, | understand
we're shortly to receive an admission.
— We're not on take today.
— Nor are the doctors.
Yet we've just spent
an hour and a half with him.
Old patient of Dr Turner's,
massive subarachnoid.
Just put him in a bed and
he'll pop his clogs soon enough.
Sister, | notice the IVs haven't been given.
Er, Andrew said he'd find time.
My houseman's busy enough without
being burdened with nursing chores.
He offered to help because
I'm on the bleep for the hospital.
Then what the hell's this?
Erm, I'm afraid | got a bit tied up
at Casualty, Sister.
I'll do those IVs now.
(Andrew) Getting on with the nurses
will make my job easier, OK?
It looks to me like
getting on with the nurses
means you have to do chores
you're not trained for
while they sit gassing about clothes,
hairdos and the bloody Chippendales.
Dr Turner...
Dr Turner said
that the nurses will help you loads
and promised that his door
will always be open?
He heard that speech on Casualty
a couple of years ago
and now he gives it to all his housemen.
You see, most of all, you'll learn
that no one's door is open for you.
— Mrs Burrows wants to speak to a doctor.
— OK, I'll talk to her.
| don't need you to mother me through this
any more than to tick off nurses.
The boy may have balls, after all.
Mm.
— I've put Mrs Burrows in Sister's office.
— Thanks.
Claire's a bitch that hates nurses.
Doctors have it easy compared to us.
Who does all the physical work on these wards?
Not to mention all the dirty jobs.
Yeah, you may work longer hours than us
but it's only mental work.
— How hard can that be?
— (Wearily) | suppose you're right.
You're up shit creek. Get in there.
Do you realise the chaos you've caused?
Alerting the infection—control team,
shutting down the ward, isolating patients.
Swabs being taken from
every nook and cranny
from anyone who's been
within a mile of this ward.
I've not caused anything.
Mr Betancourt tells us
to keep the ward quiet.
You go off, half—cocked, if cocked at all,
and shut it down.
You went to Mengele ward yesterday.
You contaminated swabs with MRSA,
then exchanged them for clean swabs
off our patients.
Who are you, Hercule Poirot?
How am | supposed to whittle away
my waiting list if | can't admit my patients?
And why do | bother to perform surgery
in aseptic conditions
when all you can do
is smear infection into my patients?
Mr Betancourt, the epidemiology of MRSA
is such that it couldn't b...
All of a sudden, you're an expert on MRSA.
| doubt you even know what it means,
having already failed
your primary fellowship twice.
Just because surgery
involves a bit of sewing
doesn't mean it's any career
for a housewife.
(Mouths)
| appreciate you doing that for me, Andrew.
Oh, you're welcome.
Erm, Sister... About Mrs Burrows.
| was wondering if you had any advice
on how | should handle it.
You're the doctor. You'll have to make
that decision yourself.
Our examination suggested
that Ted's problems might be due to
the raised pressure inside the skull.
The brain scan has told us that Ted has
experienced a subarachnoid haemorrhage.
This is due to the bursting of a vessel,
so blood collects round the lining of the brain,
causing pressure and swelling.
Dr Maitland has referred Ted to
the brain surgeon at the general hospital.
Why hasn't my husband
been taken straight to the general
if there's nothing you can do for him here?
No, there are things
we could do for him here. Erm...
The neurosurgeon
will need to look into Ted's case
to see if surgery
will be the right thing to do.
What will surgery involve?
Well, erm, they'll try to...
It's a very specialised field, Mrs Burrows.
Erm, | really couldn't tell you for sure.
...| understand. So, what sort of treatment
is he receiving here?
Erm...
He will..get better, won't he, Doctor?
— Please tell me he'll be all right, Doctor.
— | erm...
He's all I've got. Please don't let him die.
| won't.
(Snoring)
Neurosurgeons won't budge
until they've reviewed the CTs,
by which time
this bloke'll be deader than Elvis.
At the time, giving her some hope
seemed the thing to do.
You haven't the power
to promise life or death.
A patient has a disease, you try and treat it.
The rest is fate.
House jobs, eh? (Laughs)
Pretty daunting to start off with.
Still, you'll soon get on top of the job.
And on top of a few of the nurses.
| tell you, when | was
a cocksure young houseman,
| must have pulled every nurse
within about a half—mile radius.
Torch.
Mm-—hm.
We need Dr Turner's decision before | can
go on to paralyse and ventilate this fellow.
Allow me, dear.
Please, Doctor, there's no need.
Nonsense, dear.
ILL have that mark out in a jiffy.
Looks clean to me now.
I'll write a few words in the notes, shall I?
You've got a witness to support
your charge of sexual harassment.
A friend of mine was assaulted
by a bloke in her set.
When she told the tutors, they said
that she'd misinterpreted a friendly gesture.
In the end, she got transferred.
| don't want to be transferred.
| like it here.
Come with me.
You can do better than girls like that.
Drop your trousers.
(Scrabbling)
Underpants, too,
(Grunts)
Oh, James, you've made a mess.
(Laughing)
(Continuous bleep)
CPR terminated and
patient pronounced dead...5:35pm.
(Monitor off)
Dead.
Dead.
If he isn't, he sure will be after a couple
days in an airtight bag down the morgue.
Oh...
Andrew, take comfort that
in medicine the worst that can happen
is that someone else dies.
Well, you may find this
hard to accept, Claire,
but | don't particularly
want to adopt your attitude.
His wife's in Sister's office.
Go and tell her, then.
(Whispers) I'm sorry, Mrs Burrows...
OK, Mrs Burrows.
Come on.
Death certificate's in the nurses’ station.
It's to be filled in.
Raj, we've opened for
an emergency admission.
— Mr Betancourt's in surgery.
— Monica's in Casualty.
— So you'll have to deal with this.
— The patient is HIV positive.
(Laughter)
All right?
— Dr Maitland.
— Oh, thanks.
These gases are much better
on aminophylline.
| think we'll be fine
continuing as we're doing. OK?
OK. Thanks.
— Any more coming in?
— No.
— Really?
— Really.
Looks like an early night for the physicians.
Let's go.
You better hang on.
Massive upper—Gl bleed on its way.
ETA one minute.
(Retching)
Andrew, two Venflons and
make them big ones.
Cross—match 12 units.
Full blood count, U&Es, LFTs, clotting.
Karen, I'll try and pass a central line.
We'll start with saline and Haemacell,
but if someone could go to the blood bank
and get some O negative.
OK, we've got access on this side.
Karen, can you run that in, please?
This bloke's bleeding like a stuck pig.
Andrew, vitamin K. Can you get onto the
blood bank about a couple of units of FFP?
Don't worry. It's not the easiest thing
in the world.
— Can you...?
— Yeah.
Blood pressure’s 60 over nothing.
We really need that O neg, OK?
OK, haemoglobin 10.2.
White cell count 14.8.
Platelets 145.
Thrombin time, 25 seconds control.
14 seconds.
— Is this guy a boozer?
— Lord knows. We don't even have a name.
— Do us a catheter, Andrew, please.
— Right.
Aha. We'll probably be needing
the surgeons tonight.
— Not me. I'm only second on.
— You shouldn't be in the neighbourhood.
Raj, you do the catheter for us, will you?
Andrew, you go to the blood bank, please.
0 negative,
as much as you can get your hands on.
— On my way.
— Thank you.
BP 80 over 50.
Whoops.
Raj, will you get onto the blood bank about
that FFP | ordered nearly an hour ago?
I'LL phone Dr Turner at home.
Sorry to wake you, Dr Turner. I've got
a massive GI bleeder here in Cas.
Looks like he'll need a scope tonight,
I'm afraid.
Thanks. Bye.
Hm.
| don't see varices.
He's gushing blood from the gastric
mucosa but I'm darned if | can see where.
What | can say with confidence
is that he won't survive
unless someone goes in
and stops that bleed.
This is just Simon Betancourt's cup of tea.
Go on, please!
Graham Turner put me in the picture.
Looks like there's quite a night ahead.
Thank you for coming in, Mr Betancourt.
We've yet to get his systolic over 90,
but he has got a healthy tachycardia.
You physicians and your blood pressure.
If we don't operate, | can tell you
what it will be tomorrow.
— Nothing over nothing?
— Right. James, any worries?
Well, if Claire can keep him alive this long
and you can stop his bleed,
— | don't see why | can't put him to sleep.
— OK, let's get on with it.
Raj, I'll need you to scrub.
Dr Maitland, you're welcome to join us.
You'll need me.
(Monitor beeping)
(Suctioning)
Damn!
Now come back...on!
BP is down still.
It's now 50 over diddly.
Located bleeder.
Bugger to get at. More suction.
More suction, more suction.
— He's lost his output.
— EMD. Adrenalin, one milligram, please.
All this digging about
doesn't make my job any easier.
There's no point in operating
on a dead man, Mr Betancourt.
Which is what he is right now,
Can you get those next couple of units
in here as quickly as you can, please?
We have an output.
He's back. All yours again, Mr Betancourt.
Thank you, Dr Maitland.
Raj, your suctioning abilities
have improved dramatically.
— Just saturate it down, me.
— Like a vacuum cleaner.
— First time I've seen you work, James.
— Isn't that a fiver you both owe me?
No, | said by the end of the day.
If he's still alive by the end of the day.
This is what surgery is all about.
Like driving a racing car
or flying a jet plane.
Now, when you make that first incision,
there's always the unknown waiting inside.
My father said he couldn't understand
anybody wanting to do anything else
and he was a surgeon, a damn good one.
Any relatives
to whom | can give the good news?
We don't even know his name yet.
I've come in from home, in the middle
of the night and saved that fellow’s life.
I've earned a room full of grateful relatives.
— Yeah.
— Yes.
— Well, that's me turning in.
— Yeah, me too. Cheers, Mr B. See you.
— Night.
— Well done. Excellent work.
(James) You were crap, Raj.
Bedtime.
| thought you'd never ask.