Cardiac Arrest (1994–1996): Season 2, Episode 2 - A Cold Heart - full transcript
Cubicle three, PFO — Pissed, Fell Over.
Cubicle four, PGT — Pissed, Got Thumped.
Cubicle five, PDE — Pissed, Denies Everything.
(Phone)
— So, where you from?
— Leicester.
No — where you from?
Sweden.
India...
| reckon.
(Laughter)
Not all Pakis come from India though.
Hello. My name's Raj.
— You've got a headache?
— Yes, Doctor,
— All day.
— Any sickness or drowsiness?
— No.
— And how bad is your headache?
Just pain down the side of my head.
— Nagging.
— (Raj) Nagging?
Raj, in 12, tib and fib of the compound variety.
| honestly don't think this is anything to worry
about, take paracetamol and see your GP
if it's no better in the morning.
(Muttering) Silly cow!
And what appears to be the problem?
— Claire.
— Oh, I'm sorry!
Listen, I'm RMO today. There's only
Dr Turner's blasted outpatients,
could you hold the bleep
for a couple of hours?
— Yeah, sure..
— Oh, thanks, ta.
Oh, Raji, | saw this out shopping,
and | knew it'd be just right for you.
Let's put it on your tie.
Right.
(Giggles)
(Humming cheerful tune)
— So when was it that you and...
— During my house job.
Bloody hell, a year ago!
When was the last time you had
a bit of how's your father?
(Both) A year ago.
(Gasps)
Yes!
Now she gains a full-scale deflection
on Raj's babe—o—meter.
Babe alert, Casualty!
Repeat, babe alert, Casualty!
Hello.
Sprained wrist?
Let me have a look at that for you.
Mm-—hm.
So, what's a joint like this...
doing in a nice girl like you?
(Beeping)
Claire, 17-year old lad,
fell off a bridge into a Lake.
Clear!
His mates took 20 minutes to fish him out,
there's been no output since.
The pillock.
Someone find a low—reading thermometer, then.
Clear!
Rectal temperature’s only 25 degrees.
Put the defib away.
OK, Phil, | want blood gases, full blood count,
U&Es, glucose, amylase, LFTs, clotting,
a chest X-ray and a 12—lead ECG. James,
where's the nearest place with access to ECC?
(James) Mm, nowhere within 30 miles.
OK, well, he stays with us. Wrap him up. I'LL
pass a central line and run in some warm fluids,
— James...
— Warm humidified oxygen.
— May as well ventilate him after.
— OK.
It's a different doctor
every six months | come here.
Dr Turner's given up on me.
He thinks I'm a medical mystery.
The first time | had this problem
was in London in 1977...
— The thing is, Doctor, I've noticed this ache...
— I'm very pleased with your progress.
Thank you. Discharge back to GP, Staff.
You wanted to see me, Dr Turner?
Yes, Nurse tells me you're taking
too long with your consultations.
Ten minutes is all we have.
Well, I'm finding it difficult to cover
all the patients’ problems in that time.
The managers tell us we can see people
in ten minutes, so we see them in ten minutes.
Acquainting oneself with a patient's background
and recent investigations —
one minute.
Calling the patient in —
perhaps as long as a minute,
if they're old, disabled and need assistance.
The patient being taken through to
the examination room and having to undress —
as long as two minutes...
if they're infirm
and have many Layers of clothing.
Examining the patient — two minutes.
Patient getting dressed again — two minutes.
Phoning the laboratory for a very important
result which hasn't been filed yet —
one minute. Ah!
Thank you, Staff.
Completion of audit forms, so the management
can see how we're doing —
30 seconds.
Booking new appointment and ushering out —
30 seconds.
How many minutes is that, Andrew?
Ten.
The system doesn't allow
for the most important thing —
talking to people.
| don't make the rules, Andrew.
Thank you, Dr Turner.
Oj!
Time for some more adrenaline.
Right, that's a quarter of a milligram there.
Aren't his lungs are gonna be full of water
if he spent 20 minutes drowning?
The X-ray showed no evidence
of pulmonary oedema.
A lot of victims of near—drowning have no water
in their lungs due to laryngeal spasm.
This lucky lad is a dry drowner.
Forgive the delay. My outpatients
is horrendously overbooked again.
Thank you for coming, Dr Turner.
We've got a 17 year—old boy here
involved in a dry drowning.
— Mm-hm.
— Core temperature on arrival of 25.
He's been in ventricular fibrillation
now for two hours.
We're providing basic life support
and occasional low—dose adrenaline,
| don't anticipate successful cardioversion until
the core temperature's at least 30 degrees.
Quite right. | suggest we accelerate
re—warming with a peritoneal lavage.
| try to feed the line
in one of the pericolic gutters.
Yes.
The principle is...
that we bathe the abdominal cavity
in the warm saline,
so that the heat is transferred
to the central circulation.
Thank you, Sister.
| advise that you exchange the fluid at intervals
of 30 minutes to one hour.
— Yes, Doctor.
— You do the next one, OK?
What did you say
his last temperature was, Staff?
— 27, Dr Turner.
— Good.
Keep going. I'll be in Outpatients
if I'm needed.
— | think he's changed, you know.
— (Woman) Who?
— Mick.
— Why, what's changed about him?
Well, | think he thinks
it's the right time to settle down.
(Toilet flushes)
We've set a date in the spring.
Ooh!
And we can practise
you catching that bouquet if you like.
— Oh, hardly!
— About time you had a fella.
Yeah, but there's still not
much better contraception
than having a 12 year-old son at home.
As you know, in the Accident & Emergency
department,
we have been actively seeking
a locum consultant
until a permanent appointment can be made.
Now, while our efforts continue in this regard,
the present situation will obtain,
in that the consultant surgeon on take
will cover Accident & Emergency.
General surgeons shoulder enough responsibility
without the added burden of A&E.
The second item pertains to the changes
to the surgical specialities on-call rota.
Now, unfortunately, there aren't sufficient funds
to finance an arrangement for ENT.
It has therefore been proposed that one of the
on-call SHOs in General Medicine cross covers.
Physicians doing surgery!
It's been a long time
since | heard owt so daft!
The vacancy in ENT cover coincides
with the on-call days of your firm, Dr Yates.
And Dr Turner's firm.
Barry's SHO is Claire Maitland.
A second-year SHO with full MRCP.
If asked to cover ENT, | have no doubt
she could obtain a post elsewhere.
— Your SHO, Dr Turner?
— Andrew Collin.
New to the rotation. Lucky to gain a place,
considering his mediocre academic background.
— | see.
— Gentlemen, this proposition is Lunacy.
To have our junior doctors under training
in one discipline,
then to give them clinical duties in another,
unrelated discipline,
with no previous experience,
with inadequate senior staff cover,
is a monstrous abdication
of our responsibilities.
This white stuff here is fluid around your Lung.
| need to take some of the fluid off,
to make your breathing easier.
(Clears throat)
So you want do one, teach one,
that's what they tell you.
There isn't time for proper supervision.
But that's not how it should be!
I've heard of junior doctors asking patients
to talk them through procedures
because the patient's had it done before
and the junior doctor's only read about it
in some textbook.
No, no. If you're not sure, get help.
If you can't get help, talk to me.
This is on 24 hours a day.
All right?
Did you get your wrist slapped?
What | do with my wrist is my business...
Hm.
(Rattling)
(Man) Mrs Trimble!
(Bicycle bell rings)
| don't believe it!
(Bicycle bell)
Look, Mrs Trimble! One hand!
(Knock on door)
| was hoping to speak to Mr Docherty.
He's just popped out of the hospital
for a few moments.
He's, erm...advising on an urgent case
at the general.
(Docherty) Mrs Trimble! Look, no hands!
In your three theatre lists per week,
erm, two general, one urology,
you perform fewer operations
than any other of our consultants.
And | can't help feeling that it might be
a more efficient use of our resources
to restrict you to two lists per week,
freeing a list for another surgeon.
| find medicine abounds with Lists.
The divisions of the facial nerve —
er, temporal...
zygomatic, er, T-Z, Twelve Zulus...
Buggered My Cat.
Perhaps I'll leave it in your hands, Mr Docherty.
They want me out, Mrs Trimble.
Adrian DeVries aims to do
more vascular surgery.
He wants my list, then it'll be a clinic.
Shortly thereafter, early retirement beckons.
— Oh, Mr Docherty, | am sorry.
— Don't be, Mrs Trimble.
They haven't got my list yet.
— Thanks.
— Just chatting to some bloke in the canteen
who's going on about how he would have got
his operation if this were a trust hospital.
Have to confess | didn't know
if we were one or not!
— Buggered if | know.
— | think we are.
No. | don't know.
There's an easy way to tell.
If you're not in a trust,
the patients wait for ages,
the nurses are short—staffed and the doctors
work ridiculous hours for too little pay,
but in a trust, the patients wait for ages,
the nurses are short—staffed,
and the doctors work ridiculous hours
for too little pay.
— Seems I've, er, dumped on you, Claire.
— Yeah.
I've accepted three patients for you.
Only one that's here yet
is the query temporal arteritis.
— You got the bleep?
— Yeah.
Three and a half hours you've been going now,
you know, Claire.
Continue CPR, please.
| feel obliged to point out
that you're occupying the resus room
while we're open to critically ill patients.
julie, you know that victims of hypothermia are
capable of survival after prolonged resuscitation.
Well, let's hope
that no one else's chances of survival
are jeopardised
by not having access to the room.
Also, it's taking one of my nurses
permanently out of circulation.
All right then, I'll take over.
OK, we could do with an extra pair of hands
in the plaster room.
Can you just cover your eye, please?
How many fingers do you see?
| didn't realise it was so blurred.
FB, right eye, cubicle seven, thank you.
Julie, 200 milligrams
of IV hydrocortisone stat, please.
OK, Mr Gillespie,
if you'd just like to hop on the bed...
Mr Docherty, consultant.
Me John Thomas is playing up.
You know, Percy.
He means his one-eyed trouser snake.
Me winkle.
Me meat and two veg.
His todger.
What seems to be the problem, my boy?
This fella's catheter’s stuck.
We can't get the balloon to deflate.
lf the catheter is cut above the valve,
the balloon will deflate spontaneously.
— Uh!
— Ow!
Oh. Dear me.
What are you going to do now?
Now, don't panic, my boy.
All we do is wheel you round to ultrasound
wherein we drive a long needle
through your abdominal wall,
and, er, pop the balloon...
inside you.
(Whimpers)
"Ellie May could not believe that those hands,
"which had guided a fighter plane so pitilessly
through the skies of Vietnam,
"now were caressing her yielding body
sO sensuously."
— (Microwave beeps)
— "Oh, Chuck,” she breathed...
It's like an oven in here.
Carry on.
It makes me want to chuck.
A building worker's fallen off some scaffolding,
multiple injuries. They're bringing him here.
I'd like to continue this resus.
Well, we're gonna need a room this size
if we're gonna do X-rays on our new patient.
It also sounds like
we'll be wanting an anaesthetist.
We'll move him into one of the cubicles.
James, you join me when you're done.
— You need a hand for a few minutes?
— Thank you.
Trolley coming through!
Mind out!
— OK, first left.
— OK, OK.
— All right?
— Gently!
Straight in.
Frank, Mrs Dobson, room two, please,
we transferred her.
— Do you want a coffee?
— I'm going to have a word.
(Sigh) You'll have to excuse me.
I've had Dr Shaver on the phone.
— Do you know who that is, Raj?
— No.
Personal friend of mine who happens to be
chairperson of the local medical committee.
She also happens to be the GP of the patient
you saw last night and told to go home,
who has come back in today
with temporal arteritis.
What the bloody hell
do you think you're playing at, boy?
Dr Shaver also phoned me, Adrian,
in my capacity as consultant in charge
of A&E at the time.
Raj, my understanding is
that you were only given a vague history
at a time when you had
a number of pressing clinical duties.
| suggest that you and | meet in private
to discuss the lessons
that can be learned from this case.
Yes, Mr Docherty.
Thanks, Mr Docherty.
Ernest, | sincerely hope
that's not him off the hook.
— Lou Shaver has warned me...
— Dr Shaver is a profoundly silly woman.
You might care to remind her
that by informing you of this case,
because of a close acquaintance,
when you have no direct involvement
in the patient's care,
constitutes a breach of confidence.
If | hear of any further discussion,
the matter will be referred
to the General Medical Council
Coming through! This way.
— My patient.
— Patient is in here!
Raj...
It is mandatory that you take a complete history
and perform the appropriate clinical examination,
if you are to make the diagnosis
of temporal arteritis.
If untreated, Raj,
the result can be permanent blindness.
Yes, Mr Docherty.
I'm sorry.
Yes, | agree, Sir Maurice,
it probably is nothing to worry about,
but perhaps it would be more reassuring
for all concerned
if | were to see Her Ladyship
at my rooms this evening.
My pleasure, Sir Maurice.
— Do have a chest X-ray?
— Yes, Dr Turner.
Thank you.
His sodium is 12%.
| was wondering if his hyponatraemia
might be due to a syndrome
of inappropriate ADH secretion.
Do you think it might be due to...
Mitotic lesion, yes.
Let's see what's thrown up
in the pleural aspirate.
We should check plasma and urine osmolarities
if we're suspecting SIADH.
Was that you | saw the other day having
a knock in the nets at the medical school?
— Could have been.
— You want to use your feet more,
get to the pitch of the ball, there.
| should talk.
| was more of a bowler really.
Medium pace, over the wicket.
Though now it's more snail's pace over the hill.
Perhaps if we get the weather again,
the consultants would take on
the juniors one weekend.
What a marvellous idea!
— Do you play the beautiful game, Andrew?
— No, | never really...
Oh, dear, never mind.
— Do you smoke, sir?
— Oh, no, no, no, no.
— Gave it up this morning.
— You've been losing a bit of weight recently.
— | think I have, yes.
— We mustn't forget to culture the tubercle.
Though the most likely pathology
is neoplastic, isn't it?
Eh up, what's... | mean, what's the verdict?
Er, we're doing some more tests, sir,
and we'll have a good idea soon.
Good man.
— That's all, isn't it, today?
— Yep.
Actually, Andrew, | want a word before | go.
I've been asked to inform you that from now on,
when you're on call, you're to cover ENT.
Dr Turner, on top of the fact that as RMO,
I'm busy enough,
I've never done any ENT.
A reluctance to accept responsibility
does not dispose one's seniors towards
providing a favourable reference, Andrew.
But | am not trained for it.
No one wants to have a reputation
as a troublemaker. Mm?
There's a line been drawn for me.
Cross it one more time
and there'll be a poster in every hospital
saying "DO NOT EMPLOY THIS MAN".
(Beeping)
(Sighs)
This is Dr Collin, hello.
— it’s me.
— Oh, hi, Alison.
What time will you be home?
— I'm on take tonight.
— You didn’t tell me that!
Well, | think | did tell you.
Oh, it's not going to make any difference,
just hang on.
— Can you do a form for this MSU, please?
— Yeah.
— Your wife again?
— Yeah.
Alison's concerned I'm not showing enough
commitment to church activities.
Fascinating.
"His powerful hand unbuttoned her blouse,
which clung to her ripe breasts.
"| don't care about your flashbacks to Nam,”
she husked. 'Take me now, Chuck."
— "When he entered her...”
— (Curtain)
Dr Maitland?
— Yes?
— Are you aware that Dr Yates's
outpatient clinic started over an hour ago?
If you could hand this case to another doctor,
so you might attend.
| think doctors on call for emergencies
should be excused routine duties.
— Can't be in two places at once.
— Well, what | wanted to bring to your attention
is that without your contribution,
patients will be kept waiting.
As you well know,
we are committed to seeing patients
within 15 minutes of their appointed time.
I'm committed here.
— 50.2.
— Yes!
Clear!
(Defibrillator whines)
Nothing.
We'll cook his heart this way.
Continue re-—warming
and shock every half hour.
Sounds sensible to me.
I've arranged to see
one of my private patients this evening,
but I'll be available on my mobile,
should you need me.
I'm told the family
have been tracked down.
I've just enough time to speak to them.
Perhaps now would be a good time
to hand over to the on-call team
so that you can get off home.
Thanks, Dr Turner.
To hand over to the first or second?
— We're staying.
— Yeah, course we are.
At low temperatures, the heart is relatively
unresponsive to drugs or electrical stimulation,
so we can only give supportive treatment
until your son's body temperature increases.
After being like this for so long,
isn't there a risk of brain damage?
Hypothermia results in a relatively low
metabolic demand,
so the likelihood of lasting damage
is much reduced.
But at the moment we can't say
how things will go.
It really is far too early to say.
We understand.
Thank you so much for everything you're doing.
That's what we're here for.
— How are your eyes now?
— Oh, no problem at all, thank you, Doctor.
Good.
Alf, | thought | might have a quick word.
— [Ul wait up.
— Sorry | didn't get a chance
to talk to you properly earlier.
Never get a chance to talk to anyone in this job.
They remind you that every minute you spend
with one patient is a minute longer
you keep the next one waiting.
Don't worry about it, lad,
| know what you're on about.
Just as | knew that first doctor
put the needle in the wrong side.
Well, I'm not as daft as | look, tha knows.
Well, he'd been up all night.
He seemed a decent enough fella.
| didn't want to cause any trouble for him.
| just wanted to confirm
what you suspect already.
The most likely cause of your problems
is Lung cancer.
— | thought so.
— It could be something else.
— There are tests that need to be done, but...
— Well, you do what you have to do, son.
I'm not going anywhere.
— OK. I'll see you, Alf.
— Aye aye, I'll see you, Doc.
Ah, just the, er...
My secretary passed on your letter
regarding your application for the, er...
for the... hm—mm.
Still, I'd be happy to provide you
with a reference.
Thank you, Mr Docherty.
Keep it to yourself, my boy.
Otherwise all the no—hopers
will be beating a path to my door.
Dr Yates, you're not on tonight, are you?
Well, if my SHO can find something to do when
she should be at home, I'm sure | can too.
| bet Graham Turner wouldn't mind
the old buffer looking after the shop.
Now then.
— What's this young fella's temperature doing?
— Er, 33, wasn't it?
— 200s.
— OK.
Clear.
When are the interviews
for that registrar's post at the General?
| didn't apply for it.
Graham Turner seemed convinced you'd dance it.
More long hours?
Some poxy research project
of absolutely no importance whatsoever.
There's no climbing out of this cesspit.
Aye.
You find that as you climb the Ladder,
all that changes is the droppings from above
get a bit warmer.
(Beeping)
Excuse me.
Look, he’s been dead for ten hours,
his temperature's near normal,
and he hasn't come out of it yet,
can we move on?
If that's what you think,
then call off the resuscitation.
Just say, “Stop"
and sign your name in the notes.
— It's not my responsibility...
— Exactly.
It's easy to make decisions when you don't have
to carry the can. | do.
Every day.
If there's no joy in an hour,
we should stop.
We carry on!
(Whirring)
Hold it!
Sinus brady.
(Beeping)
Good output on that.
Time for the old buffer to fade away.
(Retching)
Our lad'‘s trying to breathe on his own now.
Let's see if there's an ITU bed
just in case.
Must be joking, it's full of Bosnians out there!
As you know, we've been working hard
for quite a few hours now...
I'm supposed to be meeting the lads
for a drink. You're welcome to come, Claire.
Maybe next time.
— | think he's gonna pull through.
— He's gonna be all right?
— He'll pull through, yes, I'm sure.
— That's marvellous! Oh, thank you!
— It's all part of our job.
— | can't...
Actually, James, maybe | will.
Cubicle four, PGT — Pissed, Got Thumped.
Cubicle five, PDE — Pissed, Denies Everything.
(Phone)
— So, where you from?
— Leicester.
No — where you from?
Sweden.
India...
| reckon.
(Laughter)
Not all Pakis come from India though.
Hello. My name's Raj.
— You've got a headache?
— Yes, Doctor,
— All day.
— Any sickness or drowsiness?
— No.
— And how bad is your headache?
Just pain down the side of my head.
— Nagging.
— (Raj) Nagging?
Raj, in 12, tib and fib of the compound variety.
| honestly don't think this is anything to worry
about, take paracetamol and see your GP
if it's no better in the morning.
(Muttering) Silly cow!
And what appears to be the problem?
— Claire.
— Oh, I'm sorry!
Listen, I'm RMO today. There's only
Dr Turner's blasted outpatients,
could you hold the bleep
for a couple of hours?
— Yeah, sure..
— Oh, thanks, ta.
Oh, Raji, | saw this out shopping,
and | knew it'd be just right for you.
Let's put it on your tie.
Right.
(Giggles)
(Humming cheerful tune)
— So when was it that you and...
— During my house job.
Bloody hell, a year ago!
When was the last time you had
a bit of how's your father?
(Both) A year ago.
(Gasps)
Yes!
Now she gains a full-scale deflection
on Raj's babe—o—meter.
Babe alert, Casualty!
Repeat, babe alert, Casualty!
Hello.
Sprained wrist?
Let me have a look at that for you.
Mm-—hm.
So, what's a joint like this...
doing in a nice girl like you?
(Beeping)
Claire, 17-year old lad,
fell off a bridge into a Lake.
Clear!
His mates took 20 minutes to fish him out,
there's been no output since.
The pillock.
Someone find a low—reading thermometer, then.
Clear!
Rectal temperature’s only 25 degrees.
Put the defib away.
OK, Phil, | want blood gases, full blood count,
U&Es, glucose, amylase, LFTs, clotting,
a chest X-ray and a 12—lead ECG. James,
where's the nearest place with access to ECC?
(James) Mm, nowhere within 30 miles.
OK, well, he stays with us. Wrap him up. I'LL
pass a central line and run in some warm fluids,
— James...
— Warm humidified oxygen.
— May as well ventilate him after.
— OK.
It's a different doctor
every six months | come here.
Dr Turner's given up on me.
He thinks I'm a medical mystery.
The first time | had this problem
was in London in 1977...
— The thing is, Doctor, I've noticed this ache...
— I'm very pleased with your progress.
Thank you. Discharge back to GP, Staff.
You wanted to see me, Dr Turner?
Yes, Nurse tells me you're taking
too long with your consultations.
Ten minutes is all we have.
Well, I'm finding it difficult to cover
all the patients’ problems in that time.
The managers tell us we can see people
in ten minutes, so we see them in ten minutes.
Acquainting oneself with a patient's background
and recent investigations —
one minute.
Calling the patient in —
perhaps as long as a minute,
if they're old, disabled and need assistance.
The patient being taken through to
the examination room and having to undress —
as long as two minutes...
if they're infirm
and have many Layers of clothing.
Examining the patient — two minutes.
Patient getting dressed again — two minutes.
Phoning the laboratory for a very important
result which hasn't been filed yet —
one minute. Ah!
Thank you, Staff.
Completion of audit forms, so the management
can see how we're doing —
30 seconds.
Booking new appointment and ushering out —
30 seconds.
How many minutes is that, Andrew?
Ten.
The system doesn't allow
for the most important thing —
talking to people.
| don't make the rules, Andrew.
Thank you, Dr Turner.
Oj!
Time for some more adrenaline.
Right, that's a quarter of a milligram there.
Aren't his lungs are gonna be full of water
if he spent 20 minutes drowning?
The X-ray showed no evidence
of pulmonary oedema.
A lot of victims of near—drowning have no water
in their lungs due to laryngeal spasm.
This lucky lad is a dry drowner.
Forgive the delay. My outpatients
is horrendously overbooked again.
Thank you for coming, Dr Turner.
We've got a 17 year—old boy here
involved in a dry drowning.
— Mm-hm.
— Core temperature on arrival of 25.
He's been in ventricular fibrillation
now for two hours.
We're providing basic life support
and occasional low—dose adrenaline,
| don't anticipate successful cardioversion until
the core temperature's at least 30 degrees.
Quite right. | suggest we accelerate
re—warming with a peritoneal lavage.
| try to feed the line
in one of the pericolic gutters.
Yes.
The principle is...
that we bathe the abdominal cavity
in the warm saline,
so that the heat is transferred
to the central circulation.
Thank you, Sister.
| advise that you exchange the fluid at intervals
of 30 minutes to one hour.
— Yes, Doctor.
— You do the next one, OK?
What did you say
his last temperature was, Staff?
— 27, Dr Turner.
— Good.
Keep going. I'll be in Outpatients
if I'm needed.
— | think he's changed, you know.
— (Woman) Who?
— Mick.
— Why, what's changed about him?
Well, | think he thinks
it's the right time to settle down.
(Toilet flushes)
We've set a date in the spring.
Ooh!
And we can practise
you catching that bouquet if you like.
— Oh, hardly!
— About time you had a fella.
Yeah, but there's still not
much better contraception
than having a 12 year-old son at home.
As you know, in the Accident & Emergency
department,
we have been actively seeking
a locum consultant
until a permanent appointment can be made.
Now, while our efforts continue in this regard,
the present situation will obtain,
in that the consultant surgeon on take
will cover Accident & Emergency.
General surgeons shoulder enough responsibility
without the added burden of A&E.
The second item pertains to the changes
to the surgical specialities on-call rota.
Now, unfortunately, there aren't sufficient funds
to finance an arrangement for ENT.
It has therefore been proposed that one of the
on-call SHOs in General Medicine cross covers.
Physicians doing surgery!
It's been a long time
since | heard owt so daft!
The vacancy in ENT cover coincides
with the on-call days of your firm, Dr Yates.
And Dr Turner's firm.
Barry's SHO is Claire Maitland.
A second-year SHO with full MRCP.
If asked to cover ENT, | have no doubt
she could obtain a post elsewhere.
— Your SHO, Dr Turner?
— Andrew Collin.
New to the rotation. Lucky to gain a place,
considering his mediocre academic background.
— | see.
— Gentlemen, this proposition is Lunacy.
To have our junior doctors under training
in one discipline,
then to give them clinical duties in another,
unrelated discipline,
with no previous experience,
with inadequate senior staff cover,
is a monstrous abdication
of our responsibilities.
This white stuff here is fluid around your Lung.
| need to take some of the fluid off,
to make your breathing easier.
(Clears throat)
So you want do one, teach one,
that's what they tell you.
There isn't time for proper supervision.
But that's not how it should be!
I've heard of junior doctors asking patients
to talk them through procedures
because the patient's had it done before
and the junior doctor's only read about it
in some textbook.
No, no. If you're not sure, get help.
If you can't get help, talk to me.
This is on 24 hours a day.
All right?
Did you get your wrist slapped?
What | do with my wrist is my business...
Hm.
(Rattling)
(Man) Mrs Trimble!
(Bicycle bell rings)
| don't believe it!
(Bicycle bell)
Look, Mrs Trimble! One hand!
(Knock on door)
| was hoping to speak to Mr Docherty.
He's just popped out of the hospital
for a few moments.
He's, erm...advising on an urgent case
at the general.
(Docherty) Mrs Trimble! Look, no hands!
In your three theatre lists per week,
erm, two general, one urology,
you perform fewer operations
than any other of our consultants.
And | can't help feeling that it might be
a more efficient use of our resources
to restrict you to two lists per week,
freeing a list for another surgeon.
| find medicine abounds with Lists.
The divisions of the facial nerve —
er, temporal...
zygomatic, er, T-Z, Twelve Zulus...
Buggered My Cat.
Perhaps I'll leave it in your hands, Mr Docherty.
They want me out, Mrs Trimble.
Adrian DeVries aims to do
more vascular surgery.
He wants my list, then it'll be a clinic.
Shortly thereafter, early retirement beckons.
— Oh, Mr Docherty, | am sorry.
— Don't be, Mrs Trimble.
They haven't got my list yet.
— Thanks.
— Just chatting to some bloke in the canteen
who's going on about how he would have got
his operation if this were a trust hospital.
Have to confess | didn't know
if we were one or not!
— Buggered if | know.
— | think we are.
No. | don't know.
There's an easy way to tell.
If you're not in a trust,
the patients wait for ages,
the nurses are short—staffed and the doctors
work ridiculous hours for too little pay,
but in a trust, the patients wait for ages,
the nurses are short—staffed,
and the doctors work ridiculous hours
for too little pay.
— Seems I've, er, dumped on you, Claire.
— Yeah.
I've accepted three patients for you.
Only one that's here yet
is the query temporal arteritis.
— You got the bleep?
— Yeah.
Three and a half hours you've been going now,
you know, Claire.
Continue CPR, please.
| feel obliged to point out
that you're occupying the resus room
while we're open to critically ill patients.
julie, you know that victims of hypothermia are
capable of survival after prolonged resuscitation.
Well, let's hope
that no one else's chances of survival
are jeopardised
by not having access to the room.
Also, it's taking one of my nurses
permanently out of circulation.
All right then, I'll take over.
OK, we could do with an extra pair of hands
in the plaster room.
Can you just cover your eye, please?
How many fingers do you see?
| didn't realise it was so blurred.
FB, right eye, cubicle seven, thank you.
Julie, 200 milligrams
of IV hydrocortisone stat, please.
OK, Mr Gillespie,
if you'd just like to hop on the bed...
Mr Docherty, consultant.
Me John Thomas is playing up.
You know, Percy.
He means his one-eyed trouser snake.
Me winkle.
Me meat and two veg.
His todger.
What seems to be the problem, my boy?
This fella's catheter’s stuck.
We can't get the balloon to deflate.
lf the catheter is cut above the valve,
the balloon will deflate spontaneously.
— Uh!
— Ow!
Oh. Dear me.
What are you going to do now?
Now, don't panic, my boy.
All we do is wheel you round to ultrasound
wherein we drive a long needle
through your abdominal wall,
and, er, pop the balloon...
inside you.
(Whimpers)
"Ellie May could not believe that those hands,
"which had guided a fighter plane so pitilessly
through the skies of Vietnam,
"now were caressing her yielding body
sO sensuously."
— (Microwave beeps)
— "Oh, Chuck,” she breathed...
It's like an oven in here.
Carry on.
It makes me want to chuck.
A building worker's fallen off some scaffolding,
multiple injuries. They're bringing him here.
I'd like to continue this resus.
Well, we're gonna need a room this size
if we're gonna do X-rays on our new patient.
It also sounds like
we'll be wanting an anaesthetist.
We'll move him into one of the cubicles.
James, you join me when you're done.
— You need a hand for a few minutes?
— Thank you.
Trolley coming through!
Mind out!
— OK, first left.
— OK, OK.
— All right?
— Gently!
Straight in.
Frank, Mrs Dobson, room two, please,
we transferred her.
— Do you want a coffee?
— I'm going to have a word.
(Sigh) You'll have to excuse me.
I've had Dr Shaver on the phone.
— Do you know who that is, Raj?
— No.
Personal friend of mine who happens to be
chairperson of the local medical committee.
She also happens to be the GP of the patient
you saw last night and told to go home,
who has come back in today
with temporal arteritis.
What the bloody hell
do you think you're playing at, boy?
Dr Shaver also phoned me, Adrian,
in my capacity as consultant in charge
of A&E at the time.
Raj, my understanding is
that you were only given a vague history
at a time when you had
a number of pressing clinical duties.
| suggest that you and | meet in private
to discuss the lessons
that can be learned from this case.
Yes, Mr Docherty.
Thanks, Mr Docherty.
Ernest, | sincerely hope
that's not him off the hook.
— Lou Shaver has warned me...
— Dr Shaver is a profoundly silly woman.
You might care to remind her
that by informing you of this case,
because of a close acquaintance,
when you have no direct involvement
in the patient's care,
constitutes a breach of confidence.
If | hear of any further discussion,
the matter will be referred
to the General Medical Council
Coming through! This way.
— My patient.
— Patient is in here!
Raj...
It is mandatory that you take a complete history
and perform the appropriate clinical examination,
if you are to make the diagnosis
of temporal arteritis.
If untreated, Raj,
the result can be permanent blindness.
Yes, Mr Docherty.
I'm sorry.
Yes, | agree, Sir Maurice,
it probably is nothing to worry about,
but perhaps it would be more reassuring
for all concerned
if | were to see Her Ladyship
at my rooms this evening.
My pleasure, Sir Maurice.
— Do have a chest X-ray?
— Yes, Dr Turner.
Thank you.
His sodium is 12%.
| was wondering if his hyponatraemia
might be due to a syndrome
of inappropriate ADH secretion.
Do you think it might be due to...
Mitotic lesion, yes.
Let's see what's thrown up
in the pleural aspirate.
We should check plasma and urine osmolarities
if we're suspecting SIADH.
Was that you | saw the other day having
a knock in the nets at the medical school?
— Could have been.
— You want to use your feet more,
get to the pitch of the ball, there.
| should talk.
| was more of a bowler really.
Medium pace, over the wicket.
Though now it's more snail's pace over the hill.
Perhaps if we get the weather again,
the consultants would take on
the juniors one weekend.
What a marvellous idea!
— Do you play the beautiful game, Andrew?
— No, | never really...
Oh, dear, never mind.
— Do you smoke, sir?
— Oh, no, no, no, no.
— Gave it up this morning.
— You've been losing a bit of weight recently.
— | think I have, yes.
— We mustn't forget to culture the tubercle.
Though the most likely pathology
is neoplastic, isn't it?
Eh up, what's... | mean, what's the verdict?
Er, we're doing some more tests, sir,
and we'll have a good idea soon.
Good man.
— That's all, isn't it, today?
— Yep.
Actually, Andrew, | want a word before | go.
I've been asked to inform you that from now on,
when you're on call, you're to cover ENT.
Dr Turner, on top of the fact that as RMO,
I'm busy enough,
I've never done any ENT.
A reluctance to accept responsibility
does not dispose one's seniors towards
providing a favourable reference, Andrew.
But | am not trained for it.
No one wants to have a reputation
as a troublemaker. Mm?
There's a line been drawn for me.
Cross it one more time
and there'll be a poster in every hospital
saying "DO NOT EMPLOY THIS MAN".
(Beeping)
(Sighs)
This is Dr Collin, hello.
— it’s me.
— Oh, hi, Alison.
What time will you be home?
— I'm on take tonight.
— You didn’t tell me that!
Well, | think | did tell you.
Oh, it's not going to make any difference,
just hang on.
— Can you do a form for this MSU, please?
— Yeah.
— Your wife again?
— Yeah.
Alison's concerned I'm not showing enough
commitment to church activities.
Fascinating.
"His powerful hand unbuttoned her blouse,
which clung to her ripe breasts.
"| don't care about your flashbacks to Nam,”
she husked. 'Take me now, Chuck."
— "When he entered her...”
— (Curtain)
Dr Maitland?
— Yes?
— Are you aware that Dr Yates's
outpatient clinic started over an hour ago?
If you could hand this case to another doctor,
so you might attend.
| think doctors on call for emergencies
should be excused routine duties.
— Can't be in two places at once.
— Well, what | wanted to bring to your attention
is that without your contribution,
patients will be kept waiting.
As you well know,
we are committed to seeing patients
within 15 minutes of their appointed time.
I'm committed here.
— 50.2.
— Yes!
Clear!
(Defibrillator whines)
Nothing.
We'll cook his heart this way.
Continue re-—warming
and shock every half hour.
Sounds sensible to me.
I've arranged to see
one of my private patients this evening,
but I'll be available on my mobile,
should you need me.
I'm told the family
have been tracked down.
I've just enough time to speak to them.
Perhaps now would be a good time
to hand over to the on-call team
so that you can get off home.
Thanks, Dr Turner.
To hand over to the first or second?
— We're staying.
— Yeah, course we are.
At low temperatures, the heart is relatively
unresponsive to drugs or electrical stimulation,
so we can only give supportive treatment
until your son's body temperature increases.
After being like this for so long,
isn't there a risk of brain damage?
Hypothermia results in a relatively low
metabolic demand,
so the likelihood of lasting damage
is much reduced.
But at the moment we can't say
how things will go.
It really is far too early to say.
We understand.
Thank you so much for everything you're doing.
That's what we're here for.
— How are your eyes now?
— Oh, no problem at all, thank you, Doctor.
Good.
Alf, | thought | might have a quick word.
— [Ul wait up.
— Sorry | didn't get a chance
to talk to you properly earlier.
Never get a chance to talk to anyone in this job.
They remind you that every minute you spend
with one patient is a minute longer
you keep the next one waiting.
Don't worry about it, lad,
| know what you're on about.
Just as | knew that first doctor
put the needle in the wrong side.
Well, I'm not as daft as | look, tha knows.
Well, he'd been up all night.
He seemed a decent enough fella.
| didn't want to cause any trouble for him.
| just wanted to confirm
what you suspect already.
The most likely cause of your problems
is Lung cancer.
— | thought so.
— It could be something else.
— There are tests that need to be done, but...
— Well, you do what you have to do, son.
I'm not going anywhere.
— OK. I'll see you, Alf.
— Aye aye, I'll see you, Doc.
Ah, just the, er...
My secretary passed on your letter
regarding your application for the, er...
for the... hm—mm.
Still, I'd be happy to provide you
with a reference.
Thank you, Mr Docherty.
Keep it to yourself, my boy.
Otherwise all the no—hopers
will be beating a path to my door.
Dr Yates, you're not on tonight, are you?
Well, if my SHO can find something to do when
she should be at home, I'm sure | can too.
| bet Graham Turner wouldn't mind
the old buffer looking after the shop.
Now then.
— What's this young fella's temperature doing?
— Er, 33, wasn't it?
— 200s.
— OK.
Clear.
When are the interviews
for that registrar's post at the General?
| didn't apply for it.
Graham Turner seemed convinced you'd dance it.
More long hours?
Some poxy research project
of absolutely no importance whatsoever.
There's no climbing out of this cesspit.
Aye.
You find that as you climb the Ladder,
all that changes is the droppings from above
get a bit warmer.
(Beeping)
Excuse me.
Look, he’s been dead for ten hours,
his temperature's near normal,
and he hasn't come out of it yet,
can we move on?
If that's what you think,
then call off the resuscitation.
Just say, “Stop"
and sign your name in the notes.
— It's not my responsibility...
— Exactly.
It's easy to make decisions when you don't have
to carry the can. | do.
Every day.
If there's no joy in an hour,
we should stop.
We carry on!
(Whirring)
Hold it!
Sinus brady.
(Beeping)
Good output on that.
Time for the old buffer to fade away.
(Retching)
Our lad'‘s trying to breathe on his own now.
Let's see if there's an ITU bed
just in case.
Must be joking, it's full of Bosnians out there!
As you know, we've been working hard
for quite a few hours now...
I'm supposed to be meeting the lads
for a drink. You're welcome to come, Claire.
Maybe next time.
— | think he's gonna pull through.
— He's gonna be all right?
— He'll pull through, yes, I'm sure.
— That's marvellous! Oh, thank you!
— It's all part of our job.
— | can't...
Actually, James, maybe | will.