Cubicle three, PFO - pissed, fell over.
Four, PGT - pissed, got thumped.
Five, PDE - pissed, denies everything.
Where are you from? Leicester.
No, where are you from?
Sweden(!)
India, I reckon.
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. Nagging(?)
Raj, in 12. Tib and fib.
This is nothing to worry about.
Take paracetamol and see your GP if it's no better in the morning. (Silly cow!)
Ow! What appears to be the problem?
Claire!
Oh, I'm sorry. I'm RMO today.
You wouldn't hold the bleep for a couple of hours, would you? Sure. Ta.
Oh, Rajie! I saw this out shopping and I knew it'd be right for you. Let's put it on your tie.
Right.
When was it that you and she...?
During my house job. Bloody hell! A year ago!
When was the last time you had a bit of how's your father? A year ago.
Yes! Yes!
Now, SHE gains a full-scale deflection on Raj's babe-ometer.
Babe alert! Casualty. Babe alert!
Hello. Sprained wrist?
Let me have a look at that for you.
Mm-hm. What's a joint like this doing in a nice girl like you?
Claire, 17-year-old lad fell off a bridge into a lake. ..Clear.
His mates took 20 minutes to fish
him out. There's no output.
Pillock!
Find a low-reading thermometer.
Clear.
Rectal temperature's only 25 degrees.
Put the defib away.
OK, Phil. I want blood gases, full blood count, U and Es, glucose, amylase, clotting,
a chest X-ray and a 12-lead ECG.
James, where's the nearest place with access to ECC? Nowhere within 30 miles. OK. He stays with us.
Wrap him up. I'll pass a central line and run in warm fluids. Warm, humidified oxygen. Ventilate after.
It's a different doctor every time I come here. Dr Turner thinks I'm a medical mystery.
I had this problem in London in '77.
I've noticed this ache.
I'm pleased with your progress, Miss Climie. Thank you. ..Discharge back to GP, staff.
You wanted to see me? Yes, Andrew.
You're taking too long with consultations.
It's difficult to see people in ten minutes.
The managers tell us we can see people in ten minutes, so we see them in ten minutes.
Acquainting oneself with the patient's background - one minute.
Calling the patient in - as long as a minute, if they need help.
Patient going to the examination
room to undress - as long
as two minutes, if they're infirm.
Examining the patient - two minutes. Patient dressing - two minutes.
Phoning the lab for an important result which hasn't been filed - one minute. ..Thank you, staff.
Completion of audit form so management can see how we're doing - 30 seconds.
Booking new appointment and ushering out - 30 seconds. How many minutes is that?
Ten.
The system doesn't allow for the most important thing - talking to people.
I don't make the rules, Andrew.
Thank you, Dr Turner.
Hey!
Time for some more adrenaline.
Right, that's a quarter of a milligram.
Won't his lungs be full of water if he spent 20 minutes drowning? The X-ray showed no sign of it.
A lot of victims don't due to laryngeal spasm. This lad is a dry drowner.
Forgive the delay. Outpatients is overbooked. Thanks for coming.
We've got a 17-year-old - dry drowning.
Core temperature on arrival of 25.
He's been in ventricular
fibrillation for two hours.
I don't anticipate
successful cardioversion until
the core temperature is 30 degrees.
Quite.
I suggest we accelerate re-warming.
I try to feed the line into one of the paracolic gutters. Yes.
The principle is that we bathe the abdominal cavity in the warmed saline
so that the heat is transferred to the circulation.
Thank you, sister.
I advise that you change the fluids
at intervals of 30 minutes.
Yes, Dr Turner. You do the next one.
What did you say
was his last temperature, staff?
27.
Good. I'll be in Outpatients.
I think he's changed, you know.
< Who?
Mick.
< What's changed about him?
He thinks it's time to settle down.
We've set a date in the spring.
O-oh!
We can practise
you catching the bouquet.
Hardly!
It's time you had a fella.
There's no better contraceptive
than a child.
As you know, in A and E, we have actively been seeking a locum consultant
until a permanent appointment is made.
While efforts continue, the present arrangement will obtain
in that the consultant surgeon on take will cover A and E.
Surgeons shoulder enough responsibility.
The second item pertains to the changes to the surgical specialties 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 cross covers.
Physicians doing surgery! It's been a long time since I heard owt so daft!
< The vacancy coincides with your on-call days, Dr Yates and Dr Turner.
Barry's SHO is Claire Maitland, a second-year SHO with full MRCP.
If asked to cover ENT, no doubt she could obtain a post elsewhere. < And your SHO?
Andrew Collin. New to the rotation.
Lucky to gain a place considering his mediocre academic background.
I see.
< Gentlemen.
This proposition is lunacy. To have our junior doctors undertraining 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. I need to take it off to make your breathing easier.
DISCREET COUGH
See one, do one, teach one. That's what they tell you. There isn't the time for proper supervision.
That's not how it should be. I've heard of junior doctors asking patients to talk them through.
The patient's had it before. No, no. If you're not sure, get help.
And 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 I do with my wrist is my business.
Hmm!
RATTLING >
Mrs Trimble! >
BELL TINKLES
I don't believe it!
Look, Mrs Trimble! One hand!
< KNOCKING I was hoping to speak to Mr Docherty.
He's just popped out for a few moments.
He's advising on an urgent case at the General.
Mrs Trimble, look! No hands! >
In your three theatre lists per week, er, two general, one urology,
you perform fewer operations than any other of our consultants.
I can't help feeling that it might be a more efficient use of resources
to restrict you to two lists per week, freeing a list for another surgeon.
I find medicine abounds with lists.
Divisions of the facial nerve, er, temporal...
..zygomatic, er, TZ, er...
Twelve Zulus buggered my cat.
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. It'll be a clinic.
Shortly thereafter, early retirement beckons.
Oh, Mr Docherty, I AM sorry.
Don't be, Mrs Trimble. They haven't got my list yet.
Thanks.
Some bloke in the canteen reckoned he'd have had an operation if this were a trust hospital. Are we?
Buggered if I know.
I think we are. No. I don't know.
There's an easy way to tell.
If you're not, patients wait for ages, the nurses are short-staffed and doctors work long hours.
In a trust, patients wait for ages, nurses are short-staffed and doctors work long hours.
Seems I've dumped on you, Claire. Yeah. I've accepted three patients for you.
The only one who's here is the query temporal arteritis. You got the bleep? Yeah.
Three-and-a-half hours you've been going.
Continue CPR, please.
You're occupying the resus room while we're open to critically-ill patients.
You know that victims of
hypothermia are capable of survival
after prolonged resuscitation.
Let's hope that no-one else's survival is jeopardised.
Also, this is taking one of my nurses out of circulation.
All right, then. I'll take over.
< OK, we could do with an extra pair
of hands in the plaster room.
Could you cover your eye, please?
How many fingers do you see?
I didn't realise it was so blurred.
OK.
FB right eye. Cubicle seven. Thanks.
Julie, 200 milligrams of i.v. hydrocortisone stat, please. OK.
OK, Mr Gillespie, if you'd just like to hop on the bed. Mr Docherty, consultant.
Me John Thomas is playing up. You know, er, 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? His catheter's stuck. We can't get the balloon to deflate.
If the catheter is cut above the valve, the balloon will deflate spontaneously.
SNIPPING
OW!
Ah! Oh, dear me!
What are you going to do now?
Don't panic, my boy.
We'll wheel you to ultrasound, wherein we drive a long needle through your abdomen
and, er, pop the balloon inside you.
A-ah!
"Ellie-May could not believe that those hands, which had guided a fighter plane in Vietnam,
"now were caressing her yielding body so sensuously."
"'Oh, Chuck,' she breathed."
It's like an oven in here. Carry on.
It makes me wanna chuck!
A worker's fallen off scaffolding.
Multiple injuries.
I'd like to continue this resus.
We're gonna need a room this size for X-rays.
We'll want an anaesthetist. We'll move to a cubicle. ..Join me later.
Do you need a hand? Thank you.
Trolley coming through the corridor!
Mind out.
OK, first left. OK. OK. G-g-gently! All right? OK.
Straight in.
Frank. Mrs Johnstone. Room two.
Transfer her.
Want a coffee?
No, I'm gonna have a word.
SIGHS
Excuse me.
I've had Dr Shaver on the phone. Do you know who that is? No.
She's chairperson of the local medical committee.
She's also the GP of the patient you told to go home.
She's back in today with temporal arteritis. What are you playing at, boy?
Dr Shaver also phoned me, Adrian, in my capacity as consultant in charge of A and E at the time.
Raj, my understanding is that you were only given a vague history
when you had a number of pressing clinical duties.
I suggest that you and I meet in private to discuss the lessons that can be learned. Yes.
Thanks, Mr Docherty.
I hope that's not him off the hook.
Ruth Shaver has warned...
She's 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, constitutes a breach of confidence.
If I hear of any further discussion the matter will be referred to the General Medical Council.
Trolley coming through!
My patient.
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, I agree, Sir Maurice. It's probably nothing to worry about.
Perhaps it would be reassuring for
all if I were to see Her Ladyship
at my rooms. ..My pleasure.
Do we have the chest X-ray?
Yes, Dr Turner.
His sodium is 123.
Hyponatraemia might be due to inappropriate ADH secretion. It might be due to... Mitotic lesion.
Let's see what's thrown up in the pleural aspirate. We should check plasma and urine osmoloties.
Was that you having a knock
in the nets at the medical school?
Could have been. Use your feet more.
I should talk. I was more of a bowler, really. Medium pace over the wicket.
Now, it's more snail's pace over the hill.
If we get the weather again, the consultants could take on the juniors. Marvellous idea!
Do you play the beautiful game? No, I never really... Never mind.
Do you smoke, sir? Oh, no, no! I gave up this morning.
But you've been losing weight? I think I have.
Don't forget to culture for
tubercle. The most likely pathology
is neoplastic. 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? Actually, Andrew, I want a word.
I've been asked to inform you that, when you're on call, you've to cover ENT.
On top of the fact that as RMO I'm busy enough, I've never done any ENT.
Reluctance to accept responsibility does not dispose one's seniors towards providing a reference.
But I am NOT trained for it!
No-one wants to have the reputation
as a troublemaker.
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."
BLEEPER
This is Dr Collin. ..Oh, hi, Alison.
No, I'm on take tonight.
Well, I think I DID tell you.
It's not gonna make any difference. Just hang on. Can you do a form for this MSU? Is that your wife? Yeah.
She's concerned I'm not showing commitment to church activities. Fascinating(!)
"His hand unbuttoned her blouse which clung to her ripe breasts.
"'I don't care about your flashbacks,' she husked. 'Take me now.'"
Dr Maitland? Yes. Are you aware Dr Yates's clinic started an hour ago?
Hand this case to another doctor and attend. I think doctors on call for emergencies should be excused.
I can't be in two places. Without you, 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.
30.2.
Yes!
Clear.
Nothing.
We'll cook him. Continue re-warming and shock every half-an-hour?
Yeah, sounds sensible to me.
I'm afraid I've arranged to see one of my private patients. I'm on my mobile.
I'm told the family have been tracked down. I've just enough time to speak to them.
Now, you can hand over to the on-call team.
Thanks, Dr Turner. Do you hand over to first or second on? We're staying. Of course we are.
At low temperatures, the heart is unresponsive to drugs or electrical stimulation.
We give supportive treatment first.
After being like this, isn't there a risk of brain damage?
Hypothermia results in a low metabolic demand. The likelihood of lasting damage is reduced.
We can't say how things will go.
It's too early.
We understand. Thank you SO much
for everything you're doing.
That's what we're here for.
How are your eyes now? No problem at all. Good.
Alf, I thought I might have a quick word. Fire away, doc.
Sorry we didn't get a chance to talk earlier. Never do.
Someone reminds you that every minute you spend with one patient keeps another waiting. Don't worry.
I know. Just as I knew that first doctor put the needle in the wrong side.
Well, he'd been up all night. He seemed a decent enough fella and I didn't want to cause trouble.
I just wanted to confirm what you suspect. The most likely cause of your problems is lung cancer.
I thought so. But there's a chance it could be something else. There's some tests need to be done. OK, son.
OK, I'll see you, Alf. I'll see you, doc.
Ah, just the, er...
My secretary passed on your letter regarding your application for the, er...
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?
If my SHO can find something to do when she should be at home, I'm sure I can.
I'll bet Turner won't mind the old buffer looking in. What's his temperature?
Er, 33, wasn't it?
200. OK. Clear. ..Clear.
When are the interviews for that registrar's post at the General? I didn't apply for it.
Graham Turner seemed convinced you'd dance it. More long hours,
some poxy research project of no importance whatsoever. There's no climbing out of this cesspit.
Aye, you'll find that as you climb the ladder all that changes is the droppings from above get warmer.
BLEEPER
Excuse me.
He's been dead for ten hours. His temperature's normal. Can we move on?
If that's what YOU think, call off the resuscitation. Sign your name. It's not my responsibility. Exactly.
It's easy to make decisions when you don't have to carry the can. I do!
Maybe we should think about it. We carry on!
Hold it! Sinus brady.
Good output on that.
Time for the old buffer
to fade away.
Our lad's trying to breathe on his own now.
Best see if there's an ITU bed anyway, just in case. You must be joking. It's full of Bosnians!
We've been working hard for hours...
I'm meeting the lads for a drink. You're welcome to come. Maybe next time.
< He's gonna be all right?
Yes, he'll pull through. >
Oh, thank you!
It's part of the job.
Actually, James, maybe I will.
Subtitles by Linda Singh BBC Scotland 1995