Original subtitles

What happened?

Got short of breath during the night.

— Why didn't you come in, for heaven's sake? — Thought | could wait till my dialysis.

We're gonna have to dialyse you straight away, David.

— I'm in pulmonary oedema again, aren't |? — You have congestive cardiac failure

due to fluid overload.

Shortness of breath is due to pulmonary oedema,

possibly with intercurrent pneumonia.

The kidneys'll be as grotty as ever. My guess is urea 30, creatinine TIOO.

Urea 25, creatinine 1000.

It's a bet.

Assume the position. I'll be back.

Thanks. That's fine.

No joy. Let's try flushing with saline.

It's blocked, isn't it?

Yep. It's either a clot or a stenosis.

No, no. We can't use the other side.

That blocked six months ago.

(Sighs)

We go for the femoral vein.

Hey!

Ruby Taylor, date of birth 14/12/17.

Patient number G67451.

(Whistles) Query small bowel obstruction.

— Can you go and help with the tendon repair? — Fine.

— Thanks, Kirsty. — Get her into the ward.

— No probs. — I'll book her in theatre.

— It's done. — Cheers. Can you lend me a tenner for today?

It'd be a great help if you could see the next one before you go.

— Sure. — Thanks.

— (Kissing noises) — (High voice) | love you, Julie.

Julie, | really love you. James, | really love Julie.

David's renal failure was caused by IgA glomerulonephritis when he was eight.

He now has haemodialysis three times a week.

— Are you waiting for transplant? — Kidneys are like the buses.

Better off mixing it with steak and putting it in a pie than wasting it on this tosser.

If you wanted to get into my underpants, slapper, you only had to say so.

Right. You find the femoral pulse and work out the relations from there.

— Nerve, artery, vein... — NAVY. Nerve, artery, vein, Y—fronts.

Sodium 130, potassium 5.6.

Bicarb 25, urea 28.3, creatinine 1175.

Damn.

| do get bored being right all the time.

Right, OK. Let's get this going and start dialysis so we can get those numbers down.

— Kirsty, | didn't realise you were in here. — Can | help?

— Yeah, please. — Can | have some diamorph?

OK, but you'll have to draw it up, Doctor.

Aren't there any proper nurses about?

We'll be fine, thanks, Kirsty. Can we have the 12 leader, please?

— No problem. — We'll give you something for the pain, sir.

Where is it, in the middle of your chest? Does it go to your arm, neck, jaw, teeth, back?

— Back. — Ever had this pain before?

Thanks. Can you see if any of the medical team are about, please?

These should make you more comfortable.

Rate 110. Rhythm...

Sinus tachy. No signs of ischemia infarction.

Your heart tracing is normal but it still doesn't rule out some kind of heart attack.

Chest pain unresponsive to opiates. Normal ECG.

What's your differential diagnosis?

Try an aortic dissection for starters.

Al murmur, no rub. Organise urgent CT thorax.

Measure blood pressure in both arms. Let's start an labetalol infusion.

Isn't blood pressure a nurse's job?

| suspect the cause of your pain is a tear in the big artery coming out of your heart.

We're going to lower your blood pressure and scan your chest.

You may require surgery. If the aorta continues to tear, you may die of it.

Any questions, queries, comments or worries?

My kind of patient.

We're just CT'ing him now but | expect he'll need urgent cardiothoracic assessment.

Um... | think you should look at this first.

That's a false alarm. Yeah, sorry.

This isn't your heart. You have a fractured vertebrae in your upper back.

ls that serious?

No. Turf to orthopaedics.

Liz?

When | ask you to do a blood pressure, you do it, OK?

Not smarting because of your misdiagnosis, by any chance?

I'm sorry, Harry, but the doctor's not here yet.

As soon as she arrives, I'll ask her about your results.

— Thank you, Sister. — All right?

— Sorry. — Liz.

Did you forget Andrew's not here today?

Oh, yeah. Sorry. | was really busy down in Casualty.

Course you were. Bloods.

Phlebotomist couldn't do the INR on Mrs Kaur and the U and E on Harry Gates.

Venflons, that's Harry again, plus the chap with the CVA.

These need writing up for analgesia.

There's a couple of rewrites and a review antibiotics.

And Harry's really anxious to know if they've got his pleural cytology yet.

It never rains but it pours, eh?

(Sighs)

Rob? You couldn't be a real sweetie and phone for some results for me, could you?

I'm not really used to taking test results.

OK.

— But | suppose | could. — You're a life—saver.

— Everything all right, Kirsty? — Yes, thanks, Julie.

Actually, um... Has Mr Smedley mentioned anything about Mr Tennant?

No.

Why?

Microscopic appearance of oat cells.

Thank you.

Oh, Liz. I've got that report on Mr Gates.

— Did they find any malignant cells? — Malignant cells?

Um... No, no.

Dr Reid, yeah. You were bleeping me.

(James) So the chief says to this bloke, "Death or Um Bongo?"

The bloke chooses Um Bongo so they tie him to this tree in the blazing heat

and all the warriors in the village take it in turns to shaft him up the dirt box.

So then the chief says to the second shipwrecked bloke...

— Shit? — Shipwrecked.

He says, "Death or Um Bongo?" And the bloke chooses death.

And the villagers, they all cheer and they chant, "Death by Um Bongo, death by Um Bongo!"

So, Raj. Why don't you ask Julie to put in a word for you with Kirsty?

That Kirsty, right? She's just, um... She's just too good for me.

— Get away. — No, mate. I'm just a loser.

Sounds like the Oedipus effect in action.

What's that?

— Boring, that's what. Wanna game of pool? — Yeah.

A prediction may actually increase the likelihood of an event that it was actually meant to avert.

Or the fact that Oedipus was warned by the oracle actually made the tragedy happen.

Let's just say that a man predicts that a woman won't fall for him.

Word gets back to her, and then she might be attracted to his modesty.

(Both shout) Losers!

(Both giggle)

Is, um...that a normal feature of your social life?

They're just having a laugh.

When you said come for a drink, | didn't realise you meant with your mates.

| suppose you've told them that Paul Tennant is trying to accuse you of negligence?

I'LL just get another drink while you squirm.

Just cut it out, will you? Just put on a bit of a better show for Julie, please.

— Where's the tenner you owe me? — We thought you wanted to be alone with her.

Anyway, we're not the ones who brought our girlfriend down.

Hey, what's this? Not another chick? Don't you ever rest?

Hello, boys.

— Hello, Mr DeVries. — Hello, Mr DeVries.

Mr DeVries.

No wonder they're standoffish. There's not one of them you haven't been gitty with.

| thought you said you were gonna give up smoking.

I've put worse in my mouth,

— I've a meeting. — of?

The Consultants Committee.

Hm. A whole evening of screwing junior doctors.

Have you thought any more about my moving in with you?

In with me or on top of me, Adrian?

| have a son.

Oh.

— | have a clean slate with someone. — What are you gonna do?

Be his father.

Adrian, you can stay and talk if you want. I'm sorry.

| have to go.

Doctor?

— Do you know about the fluid off my Lung? — Yes. We got the report this morning.

No malignant cells.

— No cancer, then. — Not cancer.

— How are you feeling today, David? — Better, thank you, Dr Hudson.

— Thanks to Claire. — Sh. Her head will swell.

— So, what are my scores for today? — 20 and 950.

(Hudson) Well, your heart failure is improving.

— | can't carry on like this, though, can I? — No.

We need to achieve permanent access to your circulation in order to continue regular dialysis.

Soon, right? Before this thing breaks down.

Yes. | think we should confer with the surgeons about creating venous access.

You're running out of options with me, aren't you?

— David, | think you... — Let's just hear what the surgeons have to say.

— Could you deal with that, Claire? — Yes, Dr Hudson.

— Goodbye, David. — Bye.

As you know, we've been testing some fluid which has been collecting around your Lung.

— Ah. — Thanks.

Indulgent of you to join my ward round, Dr Reid.

It's all clear, isn't it?

— Oat cells. — | see. I'll talk to Mr Gates alone.

— Debbie, would you stay? — Of course, Dr Hudson.

I'm afraid there is some bad news, sir.

We've discovered something called oat cells in the fluid.

Oat... Oat cells?

Yes. This is suggestive of a growth.

— It's not cancer, though? — Listen to Dr Hudson, Harry.

It is cancer. | am sorry.

But...

The other one... She said it wasn't.

I'm afraid there's been a misunderstanding for which | can only apologise.

| am very sorry.

But... She... She said it wasn't.

She... She told me.

Oat cell cancer eats people alive. Have you not heard of it?

Yes. It was Rob.

What, is there something going on between you two?

Of course not. He's boring.

All right. Just leave this to me, will you please, Claire? Go on.

Yes, Dr Hudson.

Now. | do not like hearing you blame other members of staff

when it was a doctor's duty which you failed to discharge properly.

We have lost our patient's trust.

Now how are we expected to guide him through his illness?

| hope you realise how much trouble you've got me into.

| was trying to help.

David, I've brought one of the surgeons to see you.

Hi, I'm Mr Smedley. Excuse me.

| remember you.

You don't make it very easy, do you, mate?

— Had a Gortex graft? — Broke down.

He's had two radiocephalic fistulas, a brachiocephalic and a Gortex graft.

His central veins are stenosed.

Unfailed CAPD.

Femoral line's only access we've got?

— Yeah. — Hmm...

We need to go over your notes, David.

Don't go and talk it through behind my back.

Let me hear what's happening. Please.

OK.

We've reached the end of the road.

| don't think it's possible for us to continue your dialysis once this femoral Line fails.

— What can you do? — A transplant.

— Anything else? — No.

You know how long I've waited without one coming up?

We can request an increase in your priority for the waiting List.

If one doesn't come up?

Your renal failure will go uncorrected and you'll die.

Thank you.

Uohn Kettley on TV) A good deal of cloud feeding in, but clearer skies to the north west

means colder conditions, and there will be a general frost, maybe down to minus three

over in north-western parts of Scotland, but down here in the south, it will be pretty windy.

That's the Lot. Ta.

Look. I'm sorry about this afternoon.

| suppose it was partly my fault.

It's just that sometimes | think you just need someone to look after you.

Oh, Christ...

— Oxygen running. — (Sobbing)

The pulse is thready.

She's shutting down, James. | can't find a vein anywhere.

Diane Lucas, 31-year-old primigravida.

Eight weeks pregnant. Pedestrian involved in an RTA.

Diane, I'm gonna examine you. I'm sorry if you feel any discomfort.

But it's not safe to give you painkillers in this condition.

Raj, get an IVI going. Colloids.

Chest exposed. Collar fixed.

Chest well intact. No paradoxical movement.

Can you take over the airway, Julie?

All right, there.

Probable haemothorax.

| can't get a vein anywhere. I'm gonna do a central line.

Raj, get a chest drain kit ready, please.

She's having contractions.

Aborting.

Come on, Raj. Help James with the central line, please.

Try and hold still. Sharp pain. Won't last long. Got the subclavian in?

Diane, I'm gonna make a small incision on your side

and insert a chest drain kit to release pressure round your Lungs.

Nearly over.

— Good. OK, here we go. — (Shouts)

Well done. That's the worst of it.

(Groaning and sobbing)

I'm in. Clamp the tube and connect, please.

(Scissors) Raj, get bloods off. FBC, U and E, cross—match 12.

See about some O neg and get the radiographer to do a skeletal survey.

— Obs and Gynae? — At eight weeks, we look after the mum first.

— (Julie) De—clamping. — (James) She's not pregnant any more.

Her belly's distending. Something's ruptured in here.

Mr DeVries. RTA, she's lost her baby. She's got a haemothorax and she's in deep shock.

Probable internal abdominal bleeding.

BP 80 over 50.

The other one in the accident's not looking very well.

She's losing consciousness. Did anyone mention head injuries?

Scissors, see to the other one. I'LL handle this.

(DeVries) Someone phone theatre and tell them we're on our way.

Start transfusion as soon as we're cross—matched.

Is there some O negative on the way?

Right. It's the driver, he's in a lot of pain. Obs are pulse 140...

Doctor? It's my wife.

Mr Lucas?

I'm afraid her condition is serious. She's being taken to theatre immediately by the consultant.

How's the baby?

I'm sorry. Your wife lost her baby.

Look, | am sorry, mate, but | have the other accident victim to see now.

Come on, Mr Lucas. Come on. Come on. We'll get a cup of tea.

I'm the Casualty surgical registrar. Any pain, sir?

What do you think?

— Where? — My shoulder.

— Right or left? — Right.

Bit early to be this merry, isn't it, sir?

Yeah, | had a bit of a knees—up after work.

Made a big deal today, made a lot of money.

Shoulder seems fine. Might be a referred pain from your abdomen.

— What about here? — Oi, ya bastard!

Mr Smedley, there's a policeman here to breathalyse this gentleman.

What?

While I'm here injured, you want to breathalyse me?

Why don’t you just smack me in the face? Bugger off.

— Go on, bugger off! — Perhaps now wouldn't be such a good time.

OK.

Nothing serious, is it?

No.

Nothing serious at all.

Oj!

Where do | get a piss around here?

A drink or something!

— Would you like anything for the driver? — I've repeated his obs. Thank you.

How often do you want me to do his pulse and blood pressure?

He'll be fine. Just leave him to sleep it off, eh?

Scissors! Theatre.

Bleeder. Clamp it. Come on, clamp it.

Got it.

There's bleeders popping up everywhere. We'll have to tie them up. | can't see a bloody thing.

The blood pressure is rising.

Pulse is dropping.

Was there a head injury?

— Not as far as anyone could tell. — There's something going on inside her skull.

She's blown both pupils. BP’s still rising.

She's combed.

Two more minutes.

Mannitol

— Raj, | know you're really busy... — Yeah.

But it's the driver from the RTA. Mr Smedley did his obs and they were normal.

— | checked them and they're different. — No offence, but you're a student nurse.

Scissors is a surgical registrar. | think he can manage a pressure and pulse, don't you?

— Yeah, | know, but... — Raj, query MI in four. Not looking good.

— Yeah, I'm on my way. — OK.

— OK. I'll see this one, then I'll see your chap. — OK, thanks.

No sign of recovery.

We should maintain her on the ventilator, check for brain death.

Yes.

Thank you, all. This was no one's fault.

Would you speak to ITU and the transplant team?

Sure.

I'LL go and ask her husband.

Let me take your cup, Mr Lucas.

(Raj) Mike, Mr DeVries and Mr Smedley are here to speak to you.

How is she?

We did everything we could, Mr Lucas, but I'm afraid her injuries were too severe.

— She didn't suffer, did she? — No, she didn't suffer, sir.

I'm really sorry to interrupt.

Would you take a seat, please?

There's something | have to ask you.

| know it's difficult at this time.

But I'd like to ask you to consider

giving consent for your wife's organs to be taken for transplant.

| know how hard this is, Mike.

My own wife was killed ten years ago by a drunk driver.

| was asked to make this decision too.

| said yes and I've never regretted it.

Pulse 140, blood pressure 90 over 50.

— I'll cross—match him. — (Groans)

— Thanks. — What's happened?

| think this guy's ruptured a liver. Much longer and he'd be a dead man.

Well done for spotting him.

Oxygen, please.

Mr DeVries, | think there's a ruptured liver in here.

Yes, Mr DeVries.

I'm sorry about your wife. | didn't know.

I'm glad you're only playing up.

Might have been sober two hours ago.

I'm really sorry.

| just wanna know what was going through your mind.

| mean, to try a thing like that.

| was here. You could have talked to me.

It's like Paul wanting you out. This would have been playing straight into his hands.

You wouldn't have confided that to me either, would you?

Well, | mean, if we can't even talk to one another...

| don't know what kind of relationship we've got, really.

(Raj) | can't work out why you were always giving me the cold shoulder.

Well if she's found out, she wouldn't be so pleased.

What's all this about Mr Floppy?

| don't think that's gonna be a problem tonight.

— (Voices on TV) — Lying in bed watching telly.

You patients have it easy.

So what are you doing tonight, then, David?

Dunno. Thought we'd go out on the town.

— In your dreams. Think again. — I give in.

You're going to the general.

Yeah?

Yeah. They've got a kidney for you.

Best get over there before it gets smelly.

Claire?

| know.

This is a photograph of my wife.

And, er...

These are all the patients that were helped after her death.

You made the right decision.