Cardiac Arrest (1994–1996): Season 2, Episode 5 - Factor 8 - full transcript
Did you manage to crash the ball last night?
No. Never even got me head down
for ten minutes.
ls it true that RMOs cover for ENT out of hours?
Believe it or not. Why?
Ten-year-—old. Foreign body stuck in right ear.
(Laughs) Heard it was a good one last night.
I'LL leave Mr Floppy with you.
WelL..
that is well and truly stuck, young lady.
Unfortunately, I'm not specially trained for this.
I'm just a general physician.
And I'm afraid that the proper ear, nose and
throat doctors don't come on till nine o'clock.
Please complain to the managers.
| have, but I'm only a doctor,
— Oh, sh...
— Stiff upper lip now, Raj.
(Laughs) What a night, eh?
James, quick, draw the curtains.
— What's the matter?
— That bird I'm supposed to marry,
whose old man is an Indian Don Corleone...
— Don't ask.
— Yeah?
He's sent the lads to persuade me
not to back out of the arrangement.
What?
No one's injured.
Not yet, anyway.
We're looking for Dr Rajah.
Dr Rajah. Cubicle 5.
SOIry.
Tom Hughes has dropped his peak flow,
so I've restarted nebs.
— We'll get to that later on.
— Andrew.
We'll do the post—take round
after we've attended to last night's business.
You don't mind, do you, Phil?
I've asked Caroline to come in, so we can
find out what happened with Mrs Mansfield.
Oh, it's my half-day today.
| was hoping to be away by one.
Yeah. Fine by me.
— Should get a hospital PM by tomorrow.
— No, coroner's job. Er, what was his name?
James Parker.
Winnie Mansfield dies because someone
puts her oxygen on the wrong setting.
Parker is a perfectly fit 28-year-old
in for tests,
— drops down on the ward last night.
— The coroner's office.
Found by Staff Nurse Charnley
when she came to give him some temazepam.
WiLL you excuse us, please, Andrew?
Arrangements can be made
for a hospital postmortem this afternoon.
We'd avoid dirty linen
if we could keep it in-house, Barry.
No witch—hunts, no scapegoats.
We find out what went wrong and put it right.
Refer it to the coroner
if there are any unanswered questions.
That's what we all want, Barry.
Yeah, | should cocoa.
Mistake. Sorry.
Much obliged, Barry.
Ah.
— You wanted to see me, Mr Tennant.
— Yes, Sister.
Staff Nurse Pam Charnley
who was on duty last night
— and the night Mrs Mansfield died.
— Mm.
Are you aware she had a psychiatric history?
— Don't we vet our staff?
— Beggars can't be choosers.
— I've got an outpatient clinic.
— Yes, of course, Dr Turner.
Andrew.
I'd prefer it if you didn't talk
to other consultants about my patients
unless it's a matter of clinical urgency.
Phil, have you heard the score from Melbourne?
Oh, Joy. You wouldn't just check this with me,
would you?
— It's Mrs Bergin's ten o'clock erythromycin.
— I'm sorry,
| haven't seen for myself
that that's what it definitely is.
But, Joy, you know there isn't always time.
So this goes to waste
and | have to make it up again?
— The way things are at the moment.
— Oh, yeah. No, all right.
— OK.
— Sorry.
Looks like it'll need an MUA.
— Dr Rajah.
— Yeah.
I'm a...business associate of Mr Prasad.
You are to marry Mr Prasad's daughter.
— Am | correct?
— This is an embarrassing misunderstanding.
Mr Prasad would like me to clear up
this misunderstanding.
Look, I've met this...
— On your knees.
— Please don't kill me.
Please don't kill me.
| think | love her!
(Laughter)
That was the most romantic thing ever.
Raj, meet big Kareem from Orthopaedics.
— Do we have a BNF case?
— Yeah, I'LL get it.
— Good news about you coming out, isn't it?
— Oh, grand, grand.
They're going to have my tablets up
from the pharmacy this afternoon, Sister said.
They say what the tablets are for?
Well, they're for the inflammation on me chest.
Oh, right. Doctor.
May | speak with you, please?
I'd prefer it if we all spoke openly together.
— Well, | think we're happy with what we know.
— |'m on a ward round. Excuse me.
— (Pager bleeps)
— (Pager) Please phone Pathology, 2-6-—2-2
It is cancer Dad's got, isn't it?
You know | can't answer that
without your father's agreement.
You don't know what it would do to Dad
to hear that it was cancer.
There's going to come a time
when you're going to have to share this.
That's not gonna be possible
if you're both living a lie.
What was all that about?
| was just asking him
when you could go home, that's all.
Pathology just bleeped me.
The PM must be under way.
Let's go.
Check to see if there's any interaction.
While we're down at the morgue, we might as
well book a slab for your chap with lung cancer.
The funny thing is, Claire,
that Alf Grocott smokes less than you.
Two many young women take up the habit
in the hope that it will keep their weight down.
— It does when it's giving them cancer.
— (Laughs)
Mm.
There are puncture marks on both arms.
— Must have had some blood taken.
— Did you take any blood last night?
— No.
— Pretty sure no one else would have.
OK. Let's make a start.
So, what is your recollection
of Mr Parker's death?
| did the drug round late.
We were short—staffed
what with Caroline...with Staff Nurse Richards
being on suspension,
— SO...
— You were late. What time was it?
— | shouldn't have to remind you not to smoke.
— Sorry.
It was about midnight.
| went to James Parker
to see if he wanted a sleeping tablet.
He was dead.
None of us saw what happened.
Mm.
Which is startlingly similar
to your account of Mrs Mansfield's death.
Why did you not disclose to us that you have
received psychiatric treatment in the past?
Staff Nurse. The cigarettes.
SOIry.
lf this rumour's untrue,
— this is your chance to set the record...
— It's private.
| don't want to discuss it.
That is your right in this informal setting.
However, should a formal inquiry be instituted...
Can | go home now?
Please.
Mm. The lungs are nice and pink.
Certainly wasn't a smoker.
Lungs —
no abnormal pathology found.
Liver —
no abnormal pathology found.
So,..normal coronary arteries.
No evidence of infarction.
I'd be staggered if this wasn't your answer.
Thanking you muchly.
Right. Back to the living.
I'd been hoping to get down
to Twickenham next Saturday,
— but the tickets are like...
— Graham. Have you got a moment?
.of the new deal, of course we have to do
the same work. So do we get them?
Well, I've got a feeling that this ward round
is gonna take alL..
Caroline, we've just got the PM
on James Parker.
Andrew. No.
If the hospital manager sees her here
while she's suspended,
he'll have Security chuck her out.
Mrs Mansfield was prescribed oxygen
at two litres per minute.
That fact is documented in both
the doctors’ notes and the nurses' cardex.
When Phil was called to certify her dead,
she was receiving six litres per minute.
OK.
— Did you turn up the oxygen?
— No.
— Did you see anyone else turn it up?
— No.
— Like Pam Charnley?
— No.
So you saw her deteriorate
and you took no action?
Two people called in sick and there was
just the two of us on for most of the night.
Irrelevant. Two litres, six litres.
Tell me why the difference matters.
Patients with chronic respiratory disease
grow accustomed to low oxygen
in their bloodstream.
Giving them a high concentration of oxygen
abolishes their drive to breathe.
You didn't correct the oxygen flows
because you didn't recognise the dangers.
— That's how this woman died.
— (Pager beeps)
(Pager) Dr Maitland, cali Casuaity.
Dr Maitland.
All right. Send him over to Coronary Care now.
Did Pam say anything to you
about Mrs Mansfield?
What's this about Pam?
People say she has a history of mental illness.
What? She had counselling for depression
when her twin sister was killed, that's all.
(Indian accent) Got you now, Dr Rajah.
— Crap accent, James.
— Oh.
You know, | still don't remember the girl with
the red dress you're supposed to have pulled.
| can't really discuss it because
the lady in question's already spoken for.
It's frustrating getting off with someone
and not being able to brag about it.
The affair between John F Kennedy
and Marilyn Monroe, for example.
Imagine the strain of having bedded
the world's greatest sex symbol,
and being bound by office
to keep it to yourself.
Mm. Got so much for him,
his head simply exploded.
1963, yeah.
| was SR to Professor Sir Quentin Jarvis.
Best damn surgeon | ever knew.
— Except when you look in the mirror, Mr D.
— Ooh.
You and your secretary make a nice couple,
Mr D.
Thank you.
Of course, in my day,
hospital socials were much more of a...
You guys would never have stood the pace.
| remember the ball for the new fellas
at the Royal College in 1959.
| drank 20 pints of beer,
five large vodkas,
drank a pint of sea water,
stuck my fingers down my own throat,
was swung round Barrington—Smyth's head
and ended up sick as a dog.
That was in the day before
we'd invented bleepers, you see.
Each hospital had a kennel of bloodhounds,
and each dog was trained to identify
the particular doctor's scent.
So, when that doctor was required,
the dog was dispatched
to—to—to track him down.
— (Howls) | remember the howl.
— (They laugh)
— Catch you later, Mr D.
— I'll see you, Mr D.
see ya.
Good afternoon, Scissors.
What delights await us?
What's the matter?
Cat got your, er...your tongue?
Mr Docherty, don't you remember
your list has been given to Mr DeVries?
Sorry, Ernest.
No, forgive me.
Force of, erm...
There's this bloke and he's been marooned
on an island for ten years or so.
Hasn't seen a woman or had sex in that time,
well over that time.
Anyway, he's walking along the beach this day,
and there washed up on the shore is a woman.
So he rolls her over. It's Claudia Schiffer.
Can't believe his luck.
So anyway, he gets her up to the hut,
gets a few coconut juices down her neck.
Before you know it, one thing leads to another,
world-class pumpage all night.
But he wakes up in the morning
and he's really, really miserable.
She says to him, "What's wrong?"
He says, "Can you do me a favour?"
She says, "Yeah, sure."
He says, "| was wondering if
you'd cut all your hair off really, really short."
So she says, “Yeah, sure." So she does that.
He says, "| wonder if you'd do one more thing
for me. Put on all my clothes.”
She says, "What? Wear men's clothes?"
He says, "Yeah."
So she puts on all his clothes.
"With this short hair and everything,
| look like a bloke.”
"Great, that's exactly
what | want you to look like."
So he said, "Just do me one more favour,
wander down the beach for about 500 yards."
So she does that.
Anyway, next minute, the bloke goes
screaming up the beach towards her,
beaming, with this huge smile on his face.
He goes, "Oi, mate, you'll never guess
who I'm shagging!" (Laughs)
Ha, ha, ha.
The mess you're making of this fem—distal
shows your true talent for comedy.
— | wasn't aware that | was messing up.
— Just keep your mind on the job.
That's something you can manage.
Being on the job.
OK. We're just moving you to another cubicle
so that the doctor can see you, Mr Crichton.
— Brigadier.
— Oh, excuse me.
A lot of fuss and nonsense about nothing.
A twinge of indigestion after a difficult session
at the magistrate's court.
— Could happen to anyone.
— Oh, dear.
Am | safe here, Nurse?
Well, we do our best, Brigadier.
The first bit of illness in my life
and those private insurance blighters say
I'm not covered because the premium was late.
— How annoying for you.
— | do hope
this is not some sort of ramshackle setup.
— His, erm, STs are up in two, three and AVF.
— What's all this gobbledygook?
The heart tracing suggests that
you may well have had a heart attack, sir.
Well, I'll not be wanting
any black magic remedy.
(Laughs)
James Parker was suffering from
hypertrophic obstructive cardiomyopathy.
An abnormality of the heart muscle
often affecting otherwise fit, young people,
but nonetheless leaving them
at risk of sudden death.
And the puncture marks on his arm
were because the second on-call
sent off some routine bloods.
This doesn't get anyone off the hook
for Mrs Mansfield.
"Off the hook." Now, Look...
| said... You heard me, Graham.
| said no witch—hunts.
| have a list here of seven factors
highlighting staff negligence in this case.
Factor one, poor communication
between staff nurses and doctors.
— Factor two...
— Winnie Mansfield was murdered
by people who cut our costs to the bone,
forcing us to employ too few staff
with too little training.
Factor two, nursing staff's over—indulgence
in sick leave...
Gone private all my life.
The National Health,
well, it might serve Joe Public,
but you lot are too busy
running around like headless chickens
to provide a fellow
with the attention he requires.
What's this contraption here, young lady?
The indications are
that you've had a heart attack.
The drip is to dissolve the clot
in your coronary artery.
Yes, well, I'd prefer a more private room.
And | want to see the consultant forthwith.
What you want right now is bread—and—butter
National Health medicine.
Factor six, duty rotas being altered
without consultation.
Factor seven, note—keeping incomplete
and uncontemporaneous.
Claire, anyone | should see before | go?
No, we're ticking over like a Swiss watch,
Dr Turner.
Good show. Bye.
Dr Maitland. | consider it unprofessional of you
to take beverages while dealing with patients.
Well, I'm too busy with my job
to take a tea break.
| know your schedule is hectic, Doctor,
but you wouldn't want your patients
to consider that your deportment
detracts in any way from
your usual high professional standards.
Would anybody like to register their offence?
You took a pint of milk from the doctor's mess.
If the account is not settled by the end
of the week, further action will be taken.
District managers have expense accounts
that run into thousands of pounds.
The region's just blown ten million quid
on a computer system
that can't add two plus two,
I'm sure Claire's great milk robbery
is gonna undermine the entire NHS budget.
I'm not here.
This is the half-day that keeps my hours
in the limits you keep bragging about.
| must have gone home and not realised it.
Dr Collin, | shall speak to you shortly about your
objections to covering Ear, Nose and Throat.
You will settle your account with hotel services.
Good night.
Alf.
| just came to say goodbye.
Thanks, son, thanks for everything.
Bad luck about Winnie Mansfield, wasn't it?
Yeah. Did you get to know her?
Well, no, not really.
Some nights | used to have a chat
with her niece when she came in to tuck her up.
You know, the one that's the night nurse
on the other ward.
She'd do a few things to make her aunt
more comfortable, wouldn't she?
Save bothering the staff.
Oh, aye. She's a good girl.
Like if Winnie was feeling short of breath,
she'd turn up her oxygen?
Oh, aye. Yeah.
Good luck, Alf.
Don't let me see you back here in a hurry.
Caroline.
Her niece. Her niece.
— You and DeVries?
— Yeah.
Can't believe it.
It's even harder to believe than you and me.
You've got a face on you tonight
like a slapped arse.
| just wonder what it would be like
to have a normal life.
— Not to be tired all the time.
— (Pager beeps)
— Oh, God.
— (Pager) Please contact Coronary Care.
I've got to go.
Thank you.
This potato, barely cooked.
— I'd have been better off at home.
— You can take your own discharge if you like.
But you've had a heart attack.
Part of your heart's dead.
Anything might happen.
You might go into pump failure.
Your lungs will fill up with fluid
and you'll drown.
Or one of the muscle strands in your heart
might snap.
And one of the valves
will just flap open uselessly.
Or part of the heart wall might give way.
You'll have a hole from one chamber to another.
Or the sac around your heart might fill up,
it will squeeze your heart so hard
that it won't be able to work any more.
Of course, there's always the chance
that you might get a blood clot as well.
Could shoot off anywhere, give you a stroke,
make you go blind, lose a leg.
Or the electrical conductivity in your heart
might play up,
give you bizarre heart rhythms.
Then, of course, there's always
the risk of a sudden cardiac arrest.
Just like that.
Yes, I'l... I'll stay.
Good.
Bye.
Er, thank...thank you.
— Oi!
— Sorry.
— Aren't you Sister Periera’s son?
— Yeah.
I'm waiting for her for a lift home.
— What's your name?
— Steven.
— What's yours?
— Mr...
Adrian.
Like your car.
Yeah, she's a beauty, isn't she?
| got her up to 120 last week.
You should get home,
your wife must see nothing of you.
Maybe that's just as well.
Things at home are, er...
Not long after we were married, Alison had her
mentally handicapped sister move in with us.
— She's a lovely girl, but...
— Things are hardly better with me and Mick.
But | shouldn't bore you with my troubles.
Do you want to go for a drink?
OK.
OK, well, if you send her up to Casualty,
I'll have a look at her for you. Bye-bye.
Julie, I've just accepted a query meningitis.
— The details are in the book.
— OK.
The young asthmatic PCO2 5.0, PO2 7.6.
I've just sent off for repeats.
Start aminophylline low with 250mg in 100ml
of normal saline over 20 minutes.
If PCO2 rises, she's going to ITU.
Thank you. Dr Maitland, RMO,
Sorry, can you hold for one second?
Your diabetic's just arrived,
not looking at all well.
Do a BM and dip their urine,
I'll be there as soon as | can.
Yes, Doctor, carry on. Thank you.
Right. OK.
Well, send them up to Casualty immediately.
Thanks, bye-bye.
— That's a possible MI on its way, Julie.
— OK. Claire.
Claire, is Andrew the only RMO
who does ENT as well?
This on-call swapped with Andrew.
It's for you, then, I'm afraid.
Nasal epistaxis in 7.
| don't know bugger all ENT. Besides,
I'm busy enough with my patients.
See if there's an ENT registrar on call.
The results are just in,
she's going to ITU now.
Claire, | know you're rushed off your feet,
but | am concerned about this nosebleed.
— Where's the ENT registrar?
— In transit between here and the General.
Patrick says he's not answering his aircall.
Please?
I'm really sorry to keep you waiting,
it's like a madhouse in here tonight.
I'm Dr Maitland.
Let me take a wild guess, nosebleed?
Mummy, is Daddy ever going to stop bleeding?
Yes, your Daddy's going to stop bleeding
very soon.
I'm a haemophiliac.
Right. Well, let's get you into the resus room
just in case.
Julie, can you get on to the blood bank
for some Factor 8, please.
— Your husband's a haemophiliac?
— Yeah.
We'll try and get hold of some Factor 8,
the blood clotting factor that he lacks,
to help stop the bleeding.
Sorry to bother you,
you must be rushed off your feet.
Blood bank, Factor 8, Mr Cullen, resus.
lll G&S him. Just in case,
there's nothing to worry about.
He should be packed.
I've never packed a nose in my life.
Has the ENT registrar still not answered?
Switchboard say he's at the General,
the General say he left half an hour ago.
| think it's getting worse.
Oh. Erm, let me have a Look.
Oh, dear.
I'm sorry.
Blood bank have just called. No stocks of
Factor 8, they're having to send out for some.
Erm...
Mr Cullen, let's get you down now, sir.
Keep him still! Tricia!
A syringe, please. Now!
We need a Foley cath and a syringe, please.
Mr Cullen, you must try and keep calm.
We're going to try and get
a small balloon into your nose
— to stop the haemorrhage.
— (Coughing and choking)
Hold him still. | can't see to get this in,
we need some suction going, please. Now!
And fluids. Can | also have some O neg
as soon as possible, Tricia, please!
It's coming, it's on. It's on, it's on.
— OK. We're in.
— (Choking)
OK, he's losing consciousness.
Let's intubate him.
(Claire) | can't see this.
Can you try and move his neck a bit?
He's losing output.
You do chest compressions, I'll sort the airway.
Where the hell's that O neg?
Let's get him monitored up now, please.
Quick as you can.
Adrenalin 1mg, atropine 3mg, please.
(Monitor flatlines)
As quick as you can, please,
Still asystole,
| want a large spinal needle
and 5mg of adrenalin.
He's not got enough blood circulating
to get the drugs to where he needs it.
You take over the ambu bag.
(Pager beeps)
Erm, Dr Maitland, RMO.
Erm, send him up immediately.
(Graham) An appatling tragedy.
| shall make a representation
in the strongest possible terms
at the committee meeting tonight.
(Chatter)
(Laughter)
(Laughter)
No. Never even got me head down
for ten minutes.
ls it true that RMOs cover for ENT out of hours?
Believe it or not. Why?
Ten-year-—old. Foreign body stuck in right ear.
(Laughs) Heard it was a good one last night.
I'LL leave Mr Floppy with you.
WelL..
that is well and truly stuck, young lady.
Unfortunately, I'm not specially trained for this.
I'm just a general physician.
And I'm afraid that the proper ear, nose and
throat doctors don't come on till nine o'clock.
Please complain to the managers.
| have, but I'm only a doctor,
— Oh, sh...
— Stiff upper lip now, Raj.
(Laughs) What a night, eh?
James, quick, draw the curtains.
— What's the matter?
— That bird I'm supposed to marry,
whose old man is an Indian Don Corleone...
— Don't ask.
— Yeah?
He's sent the lads to persuade me
not to back out of the arrangement.
What?
No one's injured.
Not yet, anyway.
We're looking for Dr Rajah.
Dr Rajah. Cubicle 5.
SOIry.
Tom Hughes has dropped his peak flow,
so I've restarted nebs.
— We'll get to that later on.
— Andrew.
We'll do the post—take round
after we've attended to last night's business.
You don't mind, do you, Phil?
I've asked Caroline to come in, so we can
find out what happened with Mrs Mansfield.
Oh, it's my half-day today.
| was hoping to be away by one.
Yeah. Fine by me.
— Should get a hospital PM by tomorrow.
— No, coroner's job. Er, what was his name?
James Parker.
Winnie Mansfield dies because someone
puts her oxygen on the wrong setting.
Parker is a perfectly fit 28-year-old
in for tests,
— drops down on the ward last night.
— The coroner's office.
Found by Staff Nurse Charnley
when she came to give him some temazepam.
WiLL you excuse us, please, Andrew?
Arrangements can be made
for a hospital postmortem this afternoon.
We'd avoid dirty linen
if we could keep it in-house, Barry.
No witch—hunts, no scapegoats.
We find out what went wrong and put it right.
Refer it to the coroner
if there are any unanswered questions.
That's what we all want, Barry.
Yeah, | should cocoa.
Mistake. Sorry.
Much obliged, Barry.
Ah.
— You wanted to see me, Mr Tennant.
— Yes, Sister.
Staff Nurse Pam Charnley
who was on duty last night
— and the night Mrs Mansfield died.
— Mm.
Are you aware she had a psychiatric history?
— Don't we vet our staff?
— Beggars can't be choosers.
— I've got an outpatient clinic.
— Yes, of course, Dr Turner.
Andrew.
I'd prefer it if you didn't talk
to other consultants about my patients
unless it's a matter of clinical urgency.
Phil, have you heard the score from Melbourne?
Oh, Joy. You wouldn't just check this with me,
would you?
— It's Mrs Bergin's ten o'clock erythromycin.
— I'm sorry,
| haven't seen for myself
that that's what it definitely is.
But, Joy, you know there isn't always time.
So this goes to waste
and | have to make it up again?
— The way things are at the moment.
— Oh, yeah. No, all right.
— OK.
— Sorry.
Looks like it'll need an MUA.
— Dr Rajah.
— Yeah.
I'm a...business associate of Mr Prasad.
You are to marry Mr Prasad's daughter.
— Am | correct?
— This is an embarrassing misunderstanding.
Mr Prasad would like me to clear up
this misunderstanding.
Look, I've met this...
— On your knees.
— Please don't kill me.
Please don't kill me.
| think | love her!
(Laughter)
That was the most romantic thing ever.
Raj, meet big Kareem from Orthopaedics.
— Do we have a BNF case?
— Yeah, I'LL get it.
— Good news about you coming out, isn't it?
— Oh, grand, grand.
They're going to have my tablets up
from the pharmacy this afternoon, Sister said.
They say what the tablets are for?
Well, they're for the inflammation on me chest.
Oh, right. Doctor.
May | speak with you, please?
I'd prefer it if we all spoke openly together.
— Well, | think we're happy with what we know.
— |'m on a ward round. Excuse me.
— (Pager bleeps)
— (Pager) Please phone Pathology, 2-6-—2-2
It is cancer Dad's got, isn't it?
You know | can't answer that
without your father's agreement.
You don't know what it would do to Dad
to hear that it was cancer.
There's going to come a time
when you're going to have to share this.
That's not gonna be possible
if you're both living a lie.
What was all that about?
| was just asking him
when you could go home, that's all.
Pathology just bleeped me.
The PM must be under way.
Let's go.
Check to see if there's any interaction.
While we're down at the morgue, we might as
well book a slab for your chap with lung cancer.
The funny thing is, Claire,
that Alf Grocott smokes less than you.
Two many young women take up the habit
in the hope that it will keep their weight down.
— It does when it's giving them cancer.
— (Laughs)
Mm.
There are puncture marks on both arms.
— Must have had some blood taken.
— Did you take any blood last night?
— No.
— Pretty sure no one else would have.
OK. Let's make a start.
So, what is your recollection
of Mr Parker's death?
| did the drug round late.
We were short—staffed
what with Caroline...with Staff Nurse Richards
being on suspension,
— SO...
— You were late. What time was it?
— | shouldn't have to remind you not to smoke.
— Sorry.
It was about midnight.
| went to James Parker
to see if he wanted a sleeping tablet.
He was dead.
None of us saw what happened.
Mm.
Which is startlingly similar
to your account of Mrs Mansfield's death.
Why did you not disclose to us that you have
received psychiatric treatment in the past?
Staff Nurse. The cigarettes.
SOIry.
lf this rumour's untrue,
— this is your chance to set the record...
— It's private.
| don't want to discuss it.
That is your right in this informal setting.
However, should a formal inquiry be instituted...
Can | go home now?
Please.
Mm. The lungs are nice and pink.
Certainly wasn't a smoker.
Lungs —
no abnormal pathology found.
Liver —
no abnormal pathology found.
So,..normal coronary arteries.
No evidence of infarction.
I'd be staggered if this wasn't your answer.
Thanking you muchly.
Right. Back to the living.
I'd been hoping to get down
to Twickenham next Saturday,
— but the tickets are like...
— Graham. Have you got a moment?
.of the new deal, of course we have to do
the same work. So do we get them?
Well, I've got a feeling that this ward round
is gonna take alL..
Caroline, we've just got the PM
on James Parker.
Andrew. No.
If the hospital manager sees her here
while she's suspended,
he'll have Security chuck her out.
Mrs Mansfield was prescribed oxygen
at two litres per minute.
That fact is documented in both
the doctors’ notes and the nurses' cardex.
When Phil was called to certify her dead,
she was receiving six litres per minute.
OK.
— Did you turn up the oxygen?
— No.
— Did you see anyone else turn it up?
— No.
— Like Pam Charnley?
— No.
So you saw her deteriorate
and you took no action?
Two people called in sick and there was
just the two of us on for most of the night.
Irrelevant. Two litres, six litres.
Tell me why the difference matters.
Patients with chronic respiratory disease
grow accustomed to low oxygen
in their bloodstream.
Giving them a high concentration of oxygen
abolishes their drive to breathe.
You didn't correct the oxygen flows
because you didn't recognise the dangers.
— That's how this woman died.
— (Pager beeps)
(Pager) Dr Maitland, cali Casuaity.
Dr Maitland.
All right. Send him over to Coronary Care now.
Did Pam say anything to you
about Mrs Mansfield?
What's this about Pam?
People say she has a history of mental illness.
What? She had counselling for depression
when her twin sister was killed, that's all.
(Indian accent) Got you now, Dr Rajah.
— Crap accent, James.
— Oh.
You know, | still don't remember the girl with
the red dress you're supposed to have pulled.
| can't really discuss it because
the lady in question's already spoken for.
It's frustrating getting off with someone
and not being able to brag about it.
The affair between John F Kennedy
and Marilyn Monroe, for example.
Imagine the strain of having bedded
the world's greatest sex symbol,
and being bound by office
to keep it to yourself.
Mm. Got so much for him,
his head simply exploded.
1963, yeah.
| was SR to Professor Sir Quentin Jarvis.
Best damn surgeon | ever knew.
— Except when you look in the mirror, Mr D.
— Ooh.
You and your secretary make a nice couple,
Mr D.
Thank you.
Of course, in my day,
hospital socials were much more of a...
You guys would never have stood the pace.
| remember the ball for the new fellas
at the Royal College in 1959.
| drank 20 pints of beer,
five large vodkas,
drank a pint of sea water,
stuck my fingers down my own throat,
was swung round Barrington—Smyth's head
and ended up sick as a dog.
That was in the day before
we'd invented bleepers, you see.
Each hospital had a kennel of bloodhounds,
and each dog was trained to identify
the particular doctor's scent.
So, when that doctor was required,
the dog was dispatched
to—to—to track him down.
— (Howls) | remember the howl.
— (They laugh)
— Catch you later, Mr D.
— I'll see you, Mr D.
see ya.
Good afternoon, Scissors.
What delights await us?
What's the matter?
Cat got your, er...your tongue?
Mr Docherty, don't you remember
your list has been given to Mr DeVries?
Sorry, Ernest.
No, forgive me.
Force of, erm...
There's this bloke and he's been marooned
on an island for ten years or so.
Hasn't seen a woman or had sex in that time,
well over that time.
Anyway, he's walking along the beach this day,
and there washed up on the shore is a woman.
So he rolls her over. It's Claudia Schiffer.
Can't believe his luck.
So anyway, he gets her up to the hut,
gets a few coconut juices down her neck.
Before you know it, one thing leads to another,
world-class pumpage all night.
But he wakes up in the morning
and he's really, really miserable.
She says to him, "What's wrong?"
He says, "Can you do me a favour?"
She says, "Yeah, sure."
He says, "| was wondering if
you'd cut all your hair off really, really short."
So she says, “Yeah, sure." So she does that.
He says, "| wonder if you'd do one more thing
for me. Put on all my clothes.”
She says, "What? Wear men's clothes?"
He says, "Yeah."
So she puts on all his clothes.
"With this short hair and everything,
| look like a bloke.”
"Great, that's exactly
what | want you to look like."
So he said, "Just do me one more favour,
wander down the beach for about 500 yards."
So she does that.
Anyway, next minute, the bloke goes
screaming up the beach towards her,
beaming, with this huge smile on his face.
He goes, "Oi, mate, you'll never guess
who I'm shagging!" (Laughs)
Ha, ha, ha.
The mess you're making of this fem—distal
shows your true talent for comedy.
— | wasn't aware that | was messing up.
— Just keep your mind on the job.
That's something you can manage.
Being on the job.
OK. We're just moving you to another cubicle
so that the doctor can see you, Mr Crichton.
— Brigadier.
— Oh, excuse me.
A lot of fuss and nonsense about nothing.
A twinge of indigestion after a difficult session
at the magistrate's court.
— Could happen to anyone.
— Oh, dear.
Am | safe here, Nurse?
Well, we do our best, Brigadier.
The first bit of illness in my life
and those private insurance blighters say
I'm not covered because the premium was late.
— How annoying for you.
— | do hope
this is not some sort of ramshackle setup.
— His, erm, STs are up in two, three and AVF.
— What's all this gobbledygook?
The heart tracing suggests that
you may well have had a heart attack, sir.
Well, I'll not be wanting
any black magic remedy.
(Laughs)
James Parker was suffering from
hypertrophic obstructive cardiomyopathy.
An abnormality of the heart muscle
often affecting otherwise fit, young people,
but nonetheless leaving them
at risk of sudden death.
And the puncture marks on his arm
were because the second on-call
sent off some routine bloods.
This doesn't get anyone off the hook
for Mrs Mansfield.
"Off the hook." Now, Look...
| said... You heard me, Graham.
| said no witch—hunts.
| have a list here of seven factors
highlighting staff negligence in this case.
Factor one, poor communication
between staff nurses and doctors.
— Factor two...
— Winnie Mansfield was murdered
by people who cut our costs to the bone,
forcing us to employ too few staff
with too little training.
Factor two, nursing staff's over—indulgence
in sick leave...
Gone private all my life.
The National Health,
well, it might serve Joe Public,
but you lot are too busy
running around like headless chickens
to provide a fellow
with the attention he requires.
What's this contraption here, young lady?
The indications are
that you've had a heart attack.
The drip is to dissolve the clot
in your coronary artery.
Yes, well, I'd prefer a more private room.
And | want to see the consultant forthwith.
What you want right now is bread—and—butter
National Health medicine.
Factor six, duty rotas being altered
without consultation.
Factor seven, note—keeping incomplete
and uncontemporaneous.
Claire, anyone | should see before | go?
No, we're ticking over like a Swiss watch,
Dr Turner.
Good show. Bye.
Dr Maitland. | consider it unprofessional of you
to take beverages while dealing with patients.
Well, I'm too busy with my job
to take a tea break.
| know your schedule is hectic, Doctor,
but you wouldn't want your patients
to consider that your deportment
detracts in any way from
your usual high professional standards.
Would anybody like to register their offence?
You took a pint of milk from the doctor's mess.
If the account is not settled by the end
of the week, further action will be taken.
District managers have expense accounts
that run into thousands of pounds.
The region's just blown ten million quid
on a computer system
that can't add two plus two,
I'm sure Claire's great milk robbery
is gonna undermine the entire NHS budget.
I'm not here.
This is the half-day that keeps my hours
in the limits you keep bragging about.
| must have gone home and not realised it.
Dr Collin, | shall speak to you shortly about your
objections to covering Ear, Nose and Throat.
You will settle your account with hotel services.
Good night.
Alf.
| just came to say goodbye.
Thanks, son, thanks for everything.
Bad luck about Winnie Mansfield, wasn't it?
Yeah. Did you get to know her?
Well, no, not really.
Some nights | used to have a chat
with her niece when she came in to tuck her up.
You know, the one that's the night nurse
on the other ward.
She'd do a few things to make her aunt
more comfortable, wouldn't she?
Save bothering the staff.
Oh, aye. She's a good girl.
Like if Winnie was feeling short of breath,
she'd turn up her oxygen?
Oh, aye. Yeah.
Good luck, Alf.
Don't let me see you back here in a hurry.
Caroline.
Her niece. Her niece.
— You and DeVries?
— Yeah.
Can't believe it.
It's even harder to believe than you and me.
You've got a face on you tonight
like a slapped arse.
| just wonder what it would be like
to have a normal life.
— Not to be tired all the time.
— (Pager beeps)
— Oh, God.
— (Pager) Please contact Coronary Care.
I've got to go.
Thank you.
This potato, barely cooked.
— I'd have been better off at home.
— You can take your own discharge if you like.
But you've had a heart attack.
Part of your heart's dead.
Anything might happen.
You might go into pump failure.
Your lungs will fill up with fluid
and you'll drown.
Or one of the muscle strands in your heart
might snap.
And one of the valves
will just flap open uselessly.
Or part of the heart wall might give way.
You'll have a hole from one chamber to another.
Or the sac around your heart might fill up,
it will squeeze your heart so hard
that it won't be able to work any more.
Of course, there's always the chance
that you might get a blood clot as well.
Could shoot off anywhere, give you a stroke,
make you go blind, lose a leg.
Or the electrical conductivity in your heart
might play up,
give you bizarre heart rhythms.
Then, of course, there's always
the risk of a sudden cardiac arrest.
Just like that.
Yes, I'l... I'll stay.
Good.
Bye.
Er, thank...thank you.
— Oi!
— Sorry.
— Aren't you Sister Periera’s son?
— Yeah.
I'm waiting for her for a lift home.
— What's your name?
— Steven.
— What's yours?
— Mr...
Adrian.
Like your car.
Yeah, she's a beauty, isn't she?
| got her up to 120 last week.
You should get home,
your wife must see nothing of you.
Maybe that's just as well.
Things at home are, er...
Not long after we were married, Alison had her
mentally handicapped sister move in with us.
— She's a lovely girl, but...
— Things are hardly better with me and Mick.
But | shouldn't bore you with my troubles.
Do you want to go for a drink?
OK.
OK, well, if you send her up to Casualty,
I'll have a look at her for you. Bye-bye.
Julie, I've just accepted a query meningitis.
— The details are in the book.
— OK.
The young asthmatic PCO2 5.0, PO2 7.6.
I've just sent off for repeats.
Start aminophylline low with 250mg in 100ml
of normal saline over 20 minutes.
If PCO2 rises, she's going to ITU.
Thank you. Dr Maitland, RMO,
Sorry, can you hold for one second?
Your diabetic's just arrived,
not looking at all well.
Do a BM and dip their urine,
I'll be there as soon as | can.
Yes, Doctor, carry on. Thank you.
Right. OK.
Well, send them up to Casualty immediately.
Thanks, bye-bye.
— That's a possible MI on its way, Julie.
— OK. Claire.
Claire, is Andrew the only RMO
who does ENT as well?
This on-call swapped with Andrew.
It's for you, then, I'm afraid.
Nasal epistaxis in 7.
| don't know bugger all ENT. Besides,
I'm busy enough with my patients.
See if there's an ENT registrar on call.
The results are just in,
she's going to ITU now.
Claire, | know you're rushed off your feet,
but | am concerned about this nosebleed.
— Where's the ENT registrar?
— In transit between here and the General.
Patrick says he's not answering his aircall.
Please?
I'm really sorry to keep you waiting,
it's like a madhouse in here tonight.
I'm Dr Maitland.
Let me take a wild guess, nosebleed?
Mummy, is Daddy ever going to stop bleeding?
Yes, your Daddy's going to stop bleeding
very soon.
I'm a haemophiliac.
Right. Well, let's get you into the resus room
just in case.
Julie, can you get on to the blood bank
for some Factor 8, please.
— Your husband's a haemophiliac?
— Yeah.
We'll try and get hold of some Factor 8,
the blood clotting factor that he lacks,
to help stop the bleeding.
Sorry to bother you,
you must be rushed off your feet.
Blood bank, Factor 8, Mr Cullen, resus.
lll G&S him. Just in case,
there's nothing to worry about.
He should be packed.
I've never packed a nose in my life.
Has the ENT registrar still not answered?
Switchboard say he's at the General,
the General say he left half an hour ago.
| think it's getting worse.
Oh. Erm, let me have a Look.
Oh, dear.
I'm sorry.
Blood bank have just called. No stocks of
Factor 8, they're having to send out for some.
Erm...
Mr Cullen, let's get you down now, sir.
Keep him still! Tricia!
A syringe, please. Now!
We need a Foley cath and a syringe, please.
Mr Cullen, you must try and keep calm.
We're going to try and get
a small balloon into your nose
— to stop the haemorrhage.
— (Coughing and choking)
Hold him still. | can't see to get this in,
we need some suction going, please. Now!
And fluids. Can | also have some O neg
as soon as possible, Tricia, please!
It's coming, it's on. It's on, it's on.
— OK. We're in.
— (Choking)
OK, he's losing consciousness.
Let's intubate him.
(Claire) | can't see this.
Can you try and move his neck a bit?
He's losing output.
You do chest compressions, I'll sort the airway.
Where the hell's that O neg?
Let's get him monitored up now, please.
Quick as you can.
Adrenalin 1mg, atropine 3mg, please.
(Monitor flatlines)
As quick as you can, please,
Still asystole,
| want a large spinal needle
and 5mg of adrenalin.
He's not got enough blood circulating
to get the drugs to where he needs it.
You take over the ambu bag.
(Pager beeps)
Erm, Dr Maitland, RMO.
Erm, send him up immediately.
(Graham) An appatling tragedy.
| shall make a representation
in the strongest possible terms
at the committee meeting tonight.
(Chatter)
(Laughter)
(Laughter)