Pulse (2017) s01e07 Episode Script
Episode 7
1 You've gotta toughen up.
Can't save them all.
Why this hospital, Frankie? Why my department? Because you're the best, and I want to learn from you.
I just want happy.
ELI: Wish I could give you happy.
CUTTER: How did this girl die? I mean, how is that even possible? MITRI: Nothing went wrong.
The surgery was fine.
This is a SAC 1.
It's gonna be investigated.
How are you going with the RCA? So, I've been thinking I can assure you, the RCA is progressing well and I am committed to seeing it through.
- There's a loose stitch.
- Check it.
Uh What's your call, resident? Um I must have been mistaken.
Right.
You told Mitri in the operation and he did he did what? Frankie, I told you this in confidence.
You can't tell anyone.
Tell anyone what? Just let it just let it all play out, please.
BERGER: The tumour's still in the temporal front lobe.
Speech centre is clear.
Seems clear.
You're mixing words more.
My statement for the RCA.
CHAN: With chemo and radio, two years plus.
BERGER: And will I still be able to talk? CHAN: 15 to 20% chance you'll lose some speech and/or cognition.
Jesus! Berger! Berger! Berger! Help! Someone asked me yesterday Tell me about your dad The love, the happy memories Deep down and dusty, that you had I took some time to say something Then I had all the words But he and I ran out of time I was seen and never heard I'd leave home before the sun And I'd come home in the dark I'd fill my day with other things Oh, I thought he had no love But I'm older now And I know He was always watching me I just wish my old father time Would take us sailing on the sea.
(FLATLINE BEEPS) BERGER: I've got you, Frankie.
Open my lungs Move your hands inside my chest Cut me deep beneath my skin I'm ready to fall out My body's caving in Hold me down so that I can feel the heat Cut me with the sharpest knife I'm ready for the pain Oh, oh, oh, oh-oh, oh, oh, oh, oh.
(SIREN WAILS) - Mm.
So, how was it? - What? - Eli! - It was good.
It was great.
So much for your sage advice about not having sex with colleagues.
- Did you tell him? - I didn't need to.
He knows the scar when he sees it.
And what did he say? - Nothing.
- Nothing? - Well, he kissed it.
- Aww! That's kind of gross.
But sweet.
Um so we're serious? Oh I don't know, Lou, but I definitely took a risk.
- I'll see you later.
- Hey.
Where are you going? Well, I've got a meeting.
The RCA findings are handed down tomorrow.
You put everything in your report? I thought you said we couldn't discuss it.
I'm just checking.
Yep.
(ELEVATOR DINGS) Hey.
Good news.
Damien Walsh has got a kidney.
- Well, that is good news.
- Yeah.
Sounds like a cracker.
Zero mismatch, no DSAs.
- Will he and his family know that? - Yeah.
Just trying to keep their hopes under wraps.
Speaking of hope, how are you? Fine.
Noticed you were a bit unsteady on your feet.
- Ah, here she is.
- Team's coming together.
What have we got on the donor? We have a 16-year-old male who, uh died in a car accident just near Canberra.
I'll be doing the retrieval myself.
Brilliant.
And, uh let me know the condition as soon as you can, yeah? Will do.
I'm just prepping him.
Do you want to come in? Damien, exciting news! - Do you like my socks? - Uh, yes.
They are nice and bright.
- He calls them his lucky socks.
- Won 100 bucks wearing these.
I'm not sure why he's so convinced it's the socks.
I wasn't wearing anything else.
- It's a joke.
- (LAUGHS) Yeah.
Well, early signs are very good.
When will we know for sure? Well, like I said, this is an anxious time now because we're waiting, but the retrieval is under way, and as long as the kidney's in good condition, you should be having your operation in a matter of hours.
So, I'll be in touch, okay? Thanks.
- Fingers crossed.
- Yeah, he needs this kidney.
Uh, it says here 60ml of Aricept.
- No, it doesn't.
It's Aranesp.
- Well, that's not what it says here.
- It does say Aricept.
- Oh.
- Thank you.
- Frankie.
Weren't you on night shift? Shouldn't you be sleeping? - I am, only I'm vertical and moving.
- Oh.
Impressive.
Do you want to grab a bite later, before I go on shift? - Yeah? - Yeah.
It's just food.
Well, you like Turkish? I've been known to devour the odd gozleme.
Great, well, a mate of mine opened a Turkish place round the block.
- You want to join me there? - Sure.
- Hi, Sam.
- Hi.
Thanks for joining me, mate.
Um I've been appointed family liaison.
- You right? - Yeah.
Any news on the RCA yet? Surely you've got some answers by now.
Yeah not yet, mate.
I'm sorry.
- I just want the truth.
- I know.
That's what the root cause analysis is for.
A senior cardiac surgeon who's not involved in either operation goes in and looks at the autopsy results, the statements, interviews, and tries to figure out the cause.
I know what I saw that day.
I know what I felt, something wasn't being said.
How is Zac? He misses her.
He still wakes up every morning, thinking she's alive.
We both do.
Mate, it's it's gonna be it's gonna be tough, all right? You need each other to get through this.
- Yeah.
- Yes.
Go on, just head in, grab a coffee, and I'll be in a minute.
- Okay? - Okay.
I don't know how I would explain the loss of a parent to a child.
Yeah.
Well, the good news is you don't have to.
You don't have kids.
- Well not yet, but I will.
- Really? (CHUCKLES) Yeah.
People do.
Yeah, but I mean a medical specialist with a compromised immune system, wouldn't that be impressive enough? I mean, adding kids to the mix, that's, uh superhuman territory, right? Well, call me Wonder Woman.
(LAUGHS) Yeah, right.
Anyway, um south side of Glover Street Park around midday.
I'll text you.
Is that everyone for the initial transplant op? Yes.
Where's the resident surgeon's interview? CAROL: Here.
- Let's check it again.
- Ooh, talk about pedantic.
- Just kidding.
- Nothing wrong with being thorough.
No, no.
I like thorough.
Surgeon Dr Mitri, anaesthetist Dr Lee, physiologist Dr Ho.
- Scrub nurse - Chanteau Paul.
- Fetcher scout nurse.
- Belinda Tang.
Wasn't there a female resident? Uh, yeah.
Louise Tannis.
Is there a problem, Dr Bell? You interviewed Louise Tannis, right? Yep.
- How thorough was the interview? - Thorough enough.
I think we can wrap this up pretty quickly for tomorrow.
(PHONE BUZZES) Hello.
I was just trying to call you.
Oh, sorry.
I got a call from Cutter.
I'm on the retrieval team I just read your interview for the RCA.
There's nothing in it about a loose stitch or you calling a stop check.
Is there anything in anybody else's? - No.
- So, what's the truth? What you told me after Zoe died or what you said in your RCA interview? - I confided in you.
- I didn't ask you to, Lou.
If it happened, it happened, and pretending that it didn't It's easy for you to say.
It's not your career on the line.
You didn't do anything wrong.
You just followed protocol.
It's not as simple as that.
Mitri didn't refuse to check it, he was so confident he was right, he asked me to do it.
He got you to check his work.
Everyone was waiting.
I couldn't see.
I wasn't sure, so I let it go.
- This is my fault.
- No.
This isn't on you.
The lead surgeon has to check.
As if that matters.
Look, if I speak up, it's gonna be my word alone.
Dr Cutter, sorry Yeah, you better make this quick.
Um there are a few unanswered questions for tomorrow about Zoe's first operation.
You mean like, "Was it a botched job?" Well, whether all the checks and procedures were followed, - if there were any factors - Well, I wasn't there, as you know.
But I was wondering if there was any indication in the second operation or just anything that you may have heard.
It's a dangerous job, questioning the efficacy of the divine.
So, what do you need? - Someone to speak up.
- You have nothing? Looks like the key person is being intimidated into silence and the rest are closing ranks.
What about the anaesthetist, Dr Lee? Says she didn't hear a thing.
Well, several years ago, Dr Lee claimed to have been a victim of bullying herself.
She lodged a complaint, but then withdrew it before the case was heard.
I'd have another chat with her.
(PHONE BUZZES) Look who managed to get themselves a double-page spread.
Oh, that's about the heart graft transplant you guys did a couple of months back.
Yeah.
You'd think, from this, Astro Boy had pulled it off single-handedly.
Taught him everything he knows.
But you watch who gets head of surgery.
Hope you're planning to speak up tomorrow.
Oh, I don't think I should.
Well, it's your chance to knock this dick swinger off his pedestal.
But what if it jeopardises my chances of getting on the surgical team? Well, you did that when you slept with him.
- Hey, how are you with helicopters? - I've been once.
I threw up.
Oh, great! Don't do that on our way to Canberra.
Okay.
- (CLASSICAL VIOLIN MUSIC PLAYS) - Looks like raised JVP on the right.
MAN: Listen! Listen to that violin.
Just gonna have a listen to your lungs.
This part here.
(MELANCHOLY VIOLIN MUSIC PLAYS) - Ah, beautiful.
- Shh, shh, shh! I can hear some crackles.
You've got fluid on your lungs.
Let me see your legs, okay? I used to play this.
Oh.
You play? My dad is a doctor, but he was very close to becoming a violinist.
Ah.
Well, life is full of these choices, huh? My son I thought my son was going to be a musician, but he studied law instead.
He was quite the advocate until he had his accident.
- Your legs are very swollen.
- Should be here by now.
A severe pitting oedema to the knee as well.
Look, I'm finishing my shift soon, but, um I'll let the night shift team know, okay? He must be proud of you.
Your father.
Doctor.
My dad is a very hard man to please.
I'll see you soon, okay? Oi? Hey, didn't we have a date or something? I didn't think it was a date.
Two people, place, time, that kind of date.
I got caught up with RCA stuff.
I'm sorry.
What's with the cold snap? Okay, what have I done? Eli, we slept together once.
That's all.
(SIGHS) 'Compromised immune system', that's probably three words you don't want to hear, right? Your assumptions about what I can and can't do, my health and my future, none of your business! I gave you my account.
Just checking that there's nothing that you would like to elaborate on.
Haven't we done this before? We need to do it again because a resident is blaming herself for something that is not her fault.
A patient died, we need to investigate what happened and why.
Do you seriously think that bringing Mitri down - is gonna change the system? - I'm not trying to bring anybody down.
I'm just trying to get to the truth of what happened, and right now, what is in the way of that is fear.
Monica, you once made a complaint about a surgeon yourself, so surely you can understand how hard it is to Okay.
I That complaint cost me my place in the surgical training program.
Yeah? Which is why I'm now an anaesthetist.
She won't speak up without support.
Well, it's not coming from me.
(SIGHS) WOMAN ON P.
A.
: Paging Dr Bell.
Dr Bell.
TANYA: Where's Dr Bell? TABB: I think she had to submit statements for the RCA.
Keep going.
We need to get through handover.
He's a 49-year-old male with fever of unknown origin, mild productive cough.
We need to exclude underlying HIV.
I'm sorry.
You just missed the two sickest patients.
We'll have to bring you up to speed afterwards.
But back to the priority cases, Tabb.
Okay, next is Gamal Aswany, a diabetic male in his mid-70s with a background of CCF.
He's actually a brilliant violinist.
Oh, thanks, Tabb.
Can we stick to the medicine, please? Sorry.
Uh presents with shortness of breath.
- (PAGER BEEPS) - Bibasal crackles, JVP is elevated by two centimetres.
Guys, I gotta go.
I got a code blue.
He's definitely gonna need more furosemide through the night.
- Okay? Thank you.
- I've got it.
- Night shift is fun.
- (CHUCKLES) Whoo-hoo.
See you.
(VIOLIN MUSIC PLAYS) Mr Aswany, I'm Dr Bell.
I'm just checking in on you this evening.
I hear you're a bit short of breath.
Could you lean forward for me, please? Did this come on suddenly or slowly? Fairly quickly.
This is lovely music, but do you mind if I turn it down? Sorry.
My son insisted I bring it along.
It soothes me.
I can hear a heart murmur and you have water on the lungs.
But your ECG looks okay.
Um I'm gonna give you some medication to help with your breathing.
He's been a long time.
Doctor, radiologist needs to speak to you urgently.
Excuse me a moment.
Patient Debbie Campbell from Neuro in bed 43.
Had a chest X-ray.
Could be an aortic tear.
What's your experience level? I'm PGY2.
I'm a year and a half out.
Organise a CT aortogram and get the patient to ICU.
Chances of survival are very low.
I hope you've got a light load, because I think this'll take most of your night.
Can you, um? 40 of furosemide, and I'll be there as soon as I can.
Of course.
Debbie Campbell? I'm Dr Bell.
- Are you in any pain? - Uh my back.
Could you lean forward for me? And what sort of pain? Is it dull, sharp? - Uh, it's like a tearing.
- CAROL: BP's over.
Gotta get it down.
Uh, my husband, he sent me to Emergency, and then the doctors they sent me to Neurology, and now they've sent me up here.
The doctors in Emergency thought you might have had a mini-seizure, so they sent you to Neuro.
Nothing showed up on the brain scans, but something did show up on the chest X-ray.
Debbie, we think this problem is connected to your aorta, which is the main artery pumping blood from the heart to the rest of the body.
We need another test, but this might require urgent surgery.
We'll call your husband and get him to come back in.
Oh, when you say urgent, what do you? It's just that we've come back It's for my sister's wedding.
If this is what we think, surgery would be immediate, so I'm sorry, you won't be going to your sister's wedding.
I'm supposed to be the maid of honour.
I know, it's a terrible disappointment, but your health's the priority here.
I'm sure she'd understand.
Could you organise a bed in ICU, and I'll get on to the aortogram? Mm-hm.
I'll be back in a few minutes to check on you.
Okay.
Thank you.
- Great.
Thank you.
- Husband's on his way.
Are we talking about an aortic dissection? Almost definitely.
The aortogram is done.
- Did you call ICU? - Yep.
No beds.
- Are you serious? - Very.
Um, where's Tanya? Dealing with an arrest in Psych.
That's two blocks away.
- Where are you going? - Well, I need Debbie's report.
Patient in bed 5 is still in serious pain, despite analgesia and bed 13 had a fall trying to get out of bed, hit his head.
- Well, any sign of a concussion? - Not so far.
But you need to review.
Well, I'm sorry.
This takes priority.
Bed 14, new IVC.
Bed 2, rechart meds.
Bed 62, new IVC.
And Bed 19, patient in pain.
- Thank you.
- (SIREN WAILS) (SIGHS) Oh, shit.
(PHONE BUZZES) Now, this had better be good 'cause I'm halfway through a particularly fine pinot.
I have a patient with a confirmed aortic dissection.
One kidney is already dead, the bowel is on its way out.
Well, get her into ICU.
Yeah, there's no beds.
Who's the vascular surgeon? Um, Leach, but he's in theatre already.
And Cutter's already on retrieval, right? Sounds like you've struck gold.
Yeah.
What do I do? Well, where's Tanya? Uh, she's busy.
It's just me.
Look, get her onto IV beta-blockers and then get her out of there and into the jungle.
I'm sorry.
What did you say? Get her into surgery, whatever way you can.
Okay, I will try.
Thank you.
Uh, Carol, can you page the reg on general surgery and get that for me? Pharmacist on call won't come in for this.
Says you can't give IV beta-blockers on ward, only in ICU.
Well, that's where she would be, if there was a bed.
Fine.
I'll call him.
Lazy bastard might want to come in and save a life.
MAN: Look, when I left, they thought she'd had a small seizure.
Now you're telling me it's her heart and she's lost her kidney, she could lose her bowel? A tear like this means that blood escapes into layers of the aorta and it restricts blood flow to the organs, and they just stop functioning.
- Can you fix it? - We need to get her into surgery.
But, Mr Campbell, you need to understand that this is life-threatening.
Try not to move.
Stay, stay, stay, stay, stay.
The pharmacist did come in and there are no IV beta-blockers in store.
- What?! How does that happen? - Oh, I don't know, it just does.
Zilch.
Okay, we need GTN patches.
We don't have a choice.
And did you page the reg on general surgery? Yes, I did.
There was no answer.
Well, I'll hunt him down myself.
Look, he's finishing up now, but he's completely unqualified to do an aortic dissection.
It'd be like asking you to go in and fix it.
- We need to operate now.
- Yeah, well, who's on call? - Duvenbeck, but he's not answering.
- Well, where's Cutter? - She's on retrieval.
- Mitri? Oh, right.
A resident waking up a surgeon who's not on call.
Hmm! Yeah, well, good luck with that.
(OWL HOOTS) CUTTER: Why did we have to land in the middle of nowhere? LOU: Mechanical problems.
They didn't tell me anything else.
Then why'd they take off in the first place? I guess they didn't know they had any.
Great.
We're stuck in the middle of BF nowhere.
Hey, did you call the team in Canberra? - (PHONE RINGS) - No, they're waiting, but they can't wait forever.
Shit! Cutter speaking.
Dr Cutter, it's Frankie Bell here.
I'm sorry to have to call you, but I have a patient with an aortic tear.
There's no beds in ICU and no surgeon to do the job.
Then transfer the patient to another hospital.
Their chances of survival are low as it is.
You can't afford to waste any more time.
Look, call Pickering at Carlton.
He'll operate on anything with a pulse.
- Okay, should I? - (PHONE BEEPS) WOMAN: Doctor? The antibiotics for Debbie Campbell, her cannula's tissued.
Well, give her them orally.
Shit.
Such a headache.
Have you got anything? Oh.
Um Tampon? Not this week.
Nah, I don't have any.
Should I ask those guys? Well, they don't need a tampon.
(SIGHS) They're gonna have to start the operation without us.
Which kidney are we getting? Well, Berger wanted the left, but they've got first dibs.
You know, we should be in there now, because I can see that team, they're gonna be circling in there like vultures.
Well, maybe they could Skype us in while they're examining the organs, and then someone else can do the transporting if the kidney's viable.
Good idea.
- Let's try that.
- Mm-hm.
(SIREN WAILS) Dr Cutter suggested that you might be able to help.
My sister should be here.
Uh, no, he's in theatre already, which is why I'm calling you.
You can't always fix things when they're broken.
I have no idea, I'm I'm sorry, but the patient is about to die.
- I need to get her into surgery.
- Sorry.
I'm on the telephone.
I shouldn't have to wait.
You know, I've been on anti-discrimination boards.
- I know quite a lot about it.
- Look, I'm sorry, sir.
Did you say you're looking for your sister? The patient in bed 26, he's increasingly short of breath, Coda, it's a musical term, meaning 'the end'.
Saturating on two litres of nasal.
Okay, four more litres of oxygen by mask.
I've got too many other patients to deal with.
I'll be there when I can.
- I'm broken from the accident.
- Okay.
Um, could you please look after this young man? Dr Kalchuri says she needs your help upstairs.
- Yeah, I can't.
I think maybe Neuro.
- My sister should be here.
- I'm not European.
- No, Vascular.
Sorry, Vascular.
- I need the Vascular Reg.
- Sir, this is the Cardio Unit.
Are you sure you need to be here? What about we take you up to Neuro? How can I be European? I was born in Auburn.
Oh, come on, come on, come on, come on.
So, I - and then they bundled me in.
- Mm-hmm.
Just bundled me in.
Dr Kalchuri wants you to call her, ASAP.
She needs assistance.
Oh, well, so do I.
Sorry.
Yes, hi.
Is that Vascular? Yes, hi.
Um Oh, is this is this the surgeon? Yeah, I've spoken with Dr Pickering in cardio.
He's given his approval.
It's midnight.
Why are you calling me now about this? Well, he told me that I need to get approval from you for the transfer.
The initial CT scan was two hours ago.
No, I I understand that.
But I can't get her into surgery here, so I'm just trying Call in the morning, if you haven't managed to get her into surgery, we'll consider taking her.
She's lost the blood flow to her left kidney.
Well, it's gone, then.
We can't save it.
But if we don't get her into surgery, she'll lose her bowel.
Right now, the patient's stable.
No all signs are saying that she won't last the night.
No, we're not accepting her.
Call in the morning.
(HANGS UP) DEBBIE: (WHISPERS) Kenny if anything if anything happens to me Deb, don't.
Don't, Deb.
- If I don't come back - Hey.
I want you to tell.
.
You're having this operation, then you're coming home.
You're my angel, okay? You're not going anywhere.
Got it? I'm sorry.
Excuse me.
Debbie, I'm afraid that we have to transfer you to another hospital.
Wait.
You said that this was serious.
We don't have a surgeon here, right now, to do the operation, so you'll have to bear with me while I get it organised.
(DEBBIE BREATHES RAPIDLY) Hey Hey, hey, stay still.
I'm sorry.
Hey.
Don't be sorry.
Okay? This is Everything will work out.
I love you so much, Kenny.
- I love you.
- Just hang in there.
Keep calm and just stay relaxed.
(DEBBIE BREATHES RAPIDLY) SURGEON: Left kidney's a little enlarged, by the look of it.
No.
Wait I think what we have here is a horseshoe kidney, that is usable.
Of course it is.
We'll have it.
MAN: Well, technically, you'd have to say this is the left kidney.
Why? Before we descend into complete anarchy here, I should point out that there's a high risk of trauma with this kind of injury.
Let's see what we have here.
That's one damaged kidney.
I'm afraid both teams have drawn the short straw.
(SIGHS) Shit.
Nothing like coming home empty-handed.
LOU: I can't believe it.
It looked fine on the surface.
Yeah, they often do.
- (PHONE RINGS) - I'll call the team.
That poor kid there, waiting in pre-op.
Oh, it's your mate again.
- How'd you go? - Uh, they won't take her.
Cardio said yes, but the vascular refused.
Well, we'll have to make them take her.
- Okay.
- Look, leave it with me.
Uh, we didn't get to Canberra.
It's a long story.
We're driving back to Sydney now.
But it's a no-go with the kidney for Damien, I'm afraid.
Thank you.
I'm so sorry.
The kidney was damaged.
It wasn't good enough for you.
We can do better.
It's disappointing, I know.
It sucks.
Look, there is a program.
It's called the Paired Kidney Exchange.
You're not compatible with Damien, but you would be paired with someone who is a match.
You would donate a kidney, Damien would get a kidney, just not to and from each other.
If you're interested, I can look into it for you.
(PAGER BEEPS) Okay.
For now, just go home and rest and we can talk about it another time.
I'm so sorry.
We'll get through this.
Doctor the patient in bed 26 is struggling to breathe.
Descending to, um, 82% and he also complained about chest pains.
- How bad is the pain? - 3 out of 10.
Give him some GTN, another 80 of furosemide and increase oxygen to six litres.
I will be there as soon as I can.
- BP's still over 200.
- (PHONE BUZZES) Dr Cutter - Carlton Hospital is accepting care.
- Really? I've organised an Intensive Care ambulance.
Tell Carol.
Yes, I will.
Absolutely.
Thank you so much! Thank you very much! Where have you been? I've had five MET calls going, all of them unstable.
I have a patient here with aortic dissection.
Well, then, she needs to be in surgery right now.
There is no surgeon available here.
I've organised a transfer to Carlton.
But I can't get her BP down.
When I arrived, it was 220/110.
- What is it now? - 200/95.
Mr and Mrs Campbell, this is Dr Tanya Kalchuri.
What's the story with those patches? There's no IV beta-blockers.
She's got rebound tachycardia.
You know that the treatment for that is - Excuse me, Doctor? - IV beta-blockers.
We don't have any, so I'm trying to get her BP - Don't use patches.
- If there's no IV? Use oral, oral and more oral.
Nurse, can we get some oral beta-blockers? - Doctor, what's going on? - Just one moment, please.
Excuse me, Doctor?! Not me, Joe.
You see, they're all racing this way, that way, and this way and that way Ah, Patient Care here to transfer to Carlton.
And there's trouble.
The apple pie No, no, no.
We organised Intensive Care paramedics.
We're just your run-of-the-mill variety.
Dr Bell? Yeah, that's right.
This It took me two hours to sort out this transfer.
- Bloody morons.
- That's because of my brain.
- It's broken from the accident.
- Not you, mate.
Not you.
Doctor, what's going on? Why aren't they taking her? They're the wrong paramedics, but don't worry I'm sorting this out.
The apple pie is in the bed.
You know, my sister - Who is this guy? - I don't know! I thought he was from Neuro.
He's not from Neuro.
You said you'd sort it! Sir, we really do need to know your name.
- Not me, Joe.
My sister.
- What about your sister? - What's her name? - Where is your sister? Rookwood Cemetery.
(BEEPING) - 200ml, please.
- Yeah, sure.
- There's not enough time.
- What about Mitri? Not on call.
What's worse, waking up a surgeon who's not on call or sitting at a coroner's court because a patient died and it's on your head? (PHONE BUZZES) (SIGHS) Yep.
Um, this is Dr Bell.
I'm sorry to wake you.
But I'm afraid that I have no choice.
- I'm not on duty.
- I know.
But I have a patient with an aortic dissection and no surgeon.
Okay, so, who's on call? Duvenbeck.
He's not answering.
Cutter's on retrieval, and I've tried to get her transfer to Carlton, but they sent the wrong paramedics.
(LAUGHS) Hang on, hang on.
You want me to come in there and save your arse? No, not mine.
The patient's.
I'm I don't think she'll last the night.
She's lost one kidney.
She's about to lose another.
I know how serious an aortic dissection is, Dr Bell.
It's a high-risk operation as was the other.
If I come in there, you need to accept that the outcome is what it is.
Got it? Yes.
Is he coming? Well done.
LOU: Oh, God.
I'm so tired.
CUTTER: Oh! You There is literally nowhere else in the world I'd rather be right now than with my pillow.
I don't think mine would recognise me.
Where are you going? It's the middle of the night.
I've got a date with my pillow.
No, you have a date with me in an aortic dissection.
What? I thought the patient had been transferred! I need you in theatre.
Mitri, I am seriously struggling to stay vertical right now.
Then do it lying down.
Please.
We need a team.
Well, are you happy with Dr Tannis assisting? - Sure.
I'll see you in there.
- All right, then.
Tighten your lower sphincter and refocus.
KENNY: Just hang in there.
Mrs Campbell? I'm the surgeon who's gonna operate on you.
We've assembled the best possible surgical team for this, okay? So, you can be assured, you're in excellent hands.
Bless you, Doctor.
Thank you.
Dr Bell will do her best to keep you informed.
In the meantime, try and get some rest.
You make sure you come back.
And tell those angels you belong here, with me.
I'll have to.
I couldn't stand looking down and seeing you with someone else.
The apple pie is on the bed! That's a coda.
- I'm sorry.
- It means 'the end'.
I think his name is Adam Aswany.
Coda's a musical term, it means 'the end'.
- Aswa Oh, Aswany! Yes, Gamal Aswany.
- It's the end.
(QUIETLY) His end His end You're his son.
- His end.
- "Hizend"? His end! His end! Room 26! He's gone.
The apple pie's on the bed.
Coda.
The end.
There will be too many flowers.
People crying.
All those wet tissues.
(MEDICAL EQUIPMENT BEEPS) MITRI: Can't see.
Suction.
- (SUCTION GURGLES) - (YAWNS) (YAWNS) Am I boring you two? Mm.
Clamp on.
Hand me the suture.
Whoops.
Damn.
Steady now.
We'll start again.
Come on, you.
Behave.
Got it.
That's it.
Good result.
Yeah.
And another notch in your surgical belt.
It's not every day a surgical resident gets a shot in an aortic dissection.
(WATER RUNS) - You did well.
- (P.
A.
BEEPS) Thanks.
WOMAN ON P.
A.
: Please report to Dr Ford in his office.
Urgently, please.
Nurse Bonbridge, Dr Ford's office.
(BEEPING) You told me he was short of breath! I said he needed to be reviewed and that he would need more furosemide.
That is a long way from bi-ventricular heart failure.
He has a history of CCF.
It was in the notes, Frankie.
I am not a mind-reader.
He should have been listed as high-priority.
He had a heart murmur that you didn't pick up.
That is the point of handover, Tabb.
- It is your job to keep me informed! - Uh, you were distracted.
Your head was in the bloody RCA.
Do you remember? Were you even listening to me? How the fuck am I meant to listen to something that's not being said?! Aaagh! It's lovely music, but do you mind if I turn it down? Did this come on suddenly or slowly? Fairly quickly.
(SIGHS) Coda.
That's a musical term.
The apple pie is in the bed.
The apple pie is on the bed.
That's a coda.
Aah! Ohhh! (WEEPS) Ohh! Mr Campbell? Yes.
Your wife is now stable.
The torn section of the aortic valve has been repaired using a Dacron graft.
Bless you, Doctor.
Bless you.
Unfortunately, decreased blood supply to the organs meant she lost one of her kidneys.
But I'm fairly certain she'll make a full recovery, as long as we keep her blood pressure under control.
Thank you, D Thank you, Doctor.
I can't thank you enough.
Maybe if I I kiss your feet? That might be a little unhygienic and, uh, possibly not in the best interests of the patient, huh? (CHUCKLES) - Thank you, Doctor.
- Oh Thank you so much.
Thank you again.
(SIGHS) LOU: Hey.
Hear the good news, right? About the aortic tear? She's gonna be okay.
Yeah.
I heard.
But, um I lost someone else.
I spent all night trying to get a surgeon to operate on that tear and there was all these MET calls and there were no other doctors around.
Well, then, the tear takes priority.
I knew he had breathing difficulties.
And I think that his son was trying to tell me that he was in trouble, but he's brain-injured and I didn't know he was and I couldn't I didn't get there in time and he died.
And he had a history of CCF.
I missed it.
But even even if you'd picked it, you But his son has lost his carer.
He's got no one.
You know, and I've been pushing you to speak out at the RCA over Zoe's death, so the truth will come out, and here, I have lost a patient myself.
So, who am I to judge? Your patient died because you couldn't be in two places at once.
You couldn't.
But it's possible Zoe died because (SIGHS) a surgeon took offence at his work being questioned by a junior surgeon.
That's arrogance.
And you're right.
It's dangerous.
You did everything you could.
You always do.
The social worker's seen him and organised care.
Don't worry.
He'll be right.
No wet tissues.
No flowers.
What was his favourite song? ('CELLO CONCERTO IN A MINOR' BY VIVALDI PLAYS) (ADAM CRIES SOFTLY) ('CELLO CONCERTO IN A MINOR' BY VIVALDI CONTINUES) MACK: The autopsy has revealed the bleed was most likely the result of a missing stitch, the possible causes of which have been outlined.
A sudden spike in blood pressure, causing the existing stitch to burst.
Friable hard tissue, incapable of holding the stitch.
Or a problem with the initial stitching itself.
The committee is satisfied that hospital protocol was followed and no single cause can be identified.
This in no way diminishes the the trauma suffered by the family, and the staff involved.
A formal apology has been made to the patient's husband, and counselling made available to all Sorry, Dr Mack.
I want to suggest that while there may be protocol in place, it's not always adhered to, and that that may have been the cause.
Well, there's nothing in your report about it.
At what point? Before we took the patient off the cardiopulmonary machine, uh Dr Mitri was about to declamp.
I thought I saw a loose stitch.
And? And I said, "Stop.
Do not unclamp.
" Dr Mitri, do you recall this? Uh she may have said something, but I'd been working for 14 hours straight and I was focused on the operation.
But, no.
No, no.
I I don't recall it.
Did anyone hear Dr Tannis raise a concern? Sir, can I just say that the culture of bullying in this hospital means that people are afraid to speak up.
Well, you can say whatever you like, but without any evidence to substantiate such a claim I don't have any evidence.
But the fear amongst staff is so strong that they won't say anything for fear of personal repercussions.
Now, Louise Tannis is telling you the truth.
But she's been cornered and bullied.
That's that's enough.
Dr Bell, would you please let me chair this meeting as I see fit.
Dr Tannis, you mentioned nothing about this in your interview and, yet, you have just now alleged you thought you saw a slipped stitch.
How certain were you? - Certain enough to call it.
- Did you call it a second time? No.
Dr Mitri heard me.
He told me to check it.
And did you? Yes.
She should never have been asked to check it in the first place.
But I I couldn't see anything.
I was under pressure.
How did you proceed, Dr Tannis? I let it go.
And I shouldn't have.
Dr Tannis? You did the right thing.
You're very brave.
(TRAIN RATTLES) It was a whitewash.
Lou was crucified.
She's been made to do a graded assertiveness training course.
Nothing for Mitri, who's "an exemplary surgeon "and valuable member of the surgical team.
" I'm sure they're very reluctant to shatter the confidence of someone like Mitri.
He's a top-rate surgeon and saves lots of lives.
It doesn't make it right.
It just makes it complex.
You're fighting the good fight, Frankie.
We just lost.
You lost the battle but not the war.
That debated incident is now on record and serves as a deterrent to any surgeon who's tempted to ignore the advice of a team member.
Well, too late for Zoe Mendosa and her family.
The two things birds need to survive Context and perspective.
But they need to leave the ground in order to get it.
It's a teaching hospital, so why don't you teach me? No, look.
You're jumping the gun, Frankie.
No, look, don't patronise me! Right? Now, this is how it's gonna play.
And I'm sorry I don't have testicles.
- CAROL: Your boss is not okay.
- Has something happened? I don't know what's going on, but we were about to do this kidney biopsy and he just froze.
BERGER: I'm not having the operation.
Not until I've seen the Paired Kidney Exchange through.
Well done, Sherlock.
What can we do to stop this whole thing from falling over? His judgement is impaired and if something happens, you're both done for.
Can't save them all.
Why this hospital, Frankie? Why my department? Because you're the best, and I want to learn from you.
I just want happy.
ELI: Wish I could give you happy.
CUTTER: How did this girl die? I mean, how is that even possible? MITRI: Nothing went wrong.
The surgery was fine.
This is a SAC 1.
It's gonna be investigated.
How are you going with the RCA? So, I've been thinking I can assure you, the RCA is progressing well and I am committed to seeing it through.
- There's a loose stitch.
- Check it.
Uh What's your call, resident? Um I must have been mistaken.
Right.
You told Mitri in the operation and he did he did what? Frankie, I told you this in confidence.
You can't tell anyone.
Tell anyone what? Just let it just let it all play out, please.
BERGER: The tumour's still in the temporal front lobe.
Speech centre is clear.
Seems clear.
You're mixing words more.
My statement for the RCA.
CHAN: With chemo and radio, two years plus.
BERGER: And will I still be able to talk? CHAN: 15 to 20% chance you'll lose some speech and/or cognition.
Jesus! Berger! Berger! Berger! Help! Someone asked me yesterday Tell me about your dad The love, the happy memories Deep down and dusty, that you had I took some time to say something Then I had all the words But he and I ran out of time I was seen and never heard I'd leave home before the sun And I'd come home in the dark I'd fill my day with other things Oh, I thought he had no love But I'm older now And I know He was always watching me I just wish my old father time Would take us sailing on the sea.
(FLATLINE BEEPS) BERGER: I've got you, Frankie.
Open my lungs Move your hands inside my chest Cut me deep beneath my skin I'm ready to fall out My body's caving in Hold me down so that I can feel the heat Cut me with the sharpest knife I'm ready for the pain Oh, oh, oh, oh-oh, oh, oh, oh, oh.
(SIREN WAILS) - Mm.
So, how was it? - What? - Eli! - It was good.
It was great.
So much for your sage advice about not having sex with colleagues.
- Did you tell him? - I didn't need to.
He knows the scar when he sees it.
And what did he say? - Nothing.
- Nothing? - Well, he kissed it.
- Aww! That's kind of gross.
But sweet.
Um so we're serious? Oh I don't know, Lou, but I definitely took a risk.
- I'll see you later.
- Hey.
Where are you going? Well, I've got a meeting.
The RCA findings are handed down tomorrow.
You put everything in your report? I thought you said we couldn't discuss it.
I'm just checking.
Yep.
(ELEVATOR DINGS) Hey.
Good news.
Damien Walsh has got a kidney.
- Well, that is good news.
- Yeah.
Sounds like a cracker.
Zero mismatch, no DSAs.
- Will he and his family know that? - Yeah.
Just trying to keep their hopes under wraps.
Speaking of hope, how are you? Fine.
Noticed you were a bit unsteady on your feet.
- Ah, here she is.
- Team's coming together.
What have we got on the donor? We have a 16-year-old male who, uh died in a car accident just near Canberra.
I'll be doing the retrieval myself.
Brilliant.
And, uh let me know the condition as soon as you can, yeah? Will do.
I'm just prepping him.
Do you want to come in? Damien, exciting news! - Do you like my socks? - Uh, yes.
They are nice and bright.
- He calls them his lucky socks.
- Won 100 bucks wearing these.
I'm not sure why he's so convinced it's the socks.
I wasn't wearing anything else.
- It's a joke.
- (LAUGHS) Yeah.
Well, early signs are very good.
When will we know for sure? Well, like I said, this is an anxious time now because we're waiting, but the retrieval is under way, and as long as the kidney's in good condition, you should be having your operation in a matter of hours.
So, I'll be in touch, okay? Thanks.
- Fingers crossed.
- Yeah, he needs this kidney.
Uh, it says here 60ml of Aricept.
- No, it doesn't.
It's Aranesp.
- Well, that's not what it says here.
- It does say Aricept.
- Oh.
- Thank you.
- Frankie.
Weren't you on night shift? Shouldn't you be sleeping? - I am, only I'm vertical and moving.
- Oh.
Impressive.
Do you want to grab a bite later, before I go on shift? - Yeah? - Yeah.
It's just food.
Well, you like Turkish? I've been known to devour the odd gozleme.
Great, well, a mate of mine opened a Turkish place round the block.
- You want to join me there? - Sure.
- Hi, Sam.
- Hi.
Thanks for joining me, mate.
Um I've been appointed family liaison.
- You right? - Yeah.
Any news on the RCA yet? Surely you've got some answers by now.
Yeah not yet, mate.
I'm sorry.
- I just want the truth.
- I know.
That's what the root cause analysis is for.
A senior cardiac surgeon who's not involved in either operation goes in and looks at the autopsy results, the statements, interviews, and tries to figure out the cause.
I know what I saw that day.
I know what I felt, something wasn't being said.
How is Zac? He misses her.
He still wakes up every morning, thinking she's alive.
We both do.
Mate, it's it's gonna be it's gonna be tough, all right? You need each other to get through this.
- Yeah.
- Yes.
Go on, just head in, grab a coffee, and I'll be in a minute.
- Okay? - Okay.
I don't know how I would explain the loss of a parent to a child.
Yeah.
Well, the good news is you don't have to.
You don't have kids.
- Well not yet, but I will.
- Really? (CHUCKLES) Yeah.
People do.
Yeah, but I mean a medical specialist with a compromised immune system, wouldn't that be impressive enough? I mean, adding kids to the mix, that's, uh superhuman territory, right? Well, call me Wonder Woman.
(LAUGHS) Yeah, right.
Anyway, um south side of Glover Street Park around midday.
I'll text you.
Is that everyone for the initial transplant op? Yes.
Where's the resident surgeon's interview? CAROL: Here.
- Let's check it again.
- Ooh, talk about pedantic.
- Just kidding.
- Nothing wrong with being thorough.
No, no.
I like thorough.
Surgeon Dr Mitri, anaesthetist Dr Lee, physiologist Dr Ho.
- Scrub nurse - Chanteau Paul.
- Fetcher scout nurse.
- Belinda Tang.
Wasn't there a female resident? Uh, yeah.
Louise Tannis.
Is there a problem, Dr Bell? You interviewed Louise Tannis, right? Yep.
- How thorough was the interview? - Thorough enough.
I think we can wrap this up pretty quickly for tomorrow.
(PHONE BUZZES) Hello.
I was just trying to call you.
Oh, sorry.
I got a call from Cutter.
I'm on the retrieval team I just read your interview for the RCA.
There's nothing in it about a loose stitch or you calling a stop check.
Is there anything in anybody else's? - No.
- So, what's the truth? What you told me after Zoe died or what you said in your RCA interview? - I confided in you.
- I didn't ask you to, Lou.
If it happened, it happened, and pretending that it didn't It's easy for you to say.
It's not your career on the line.
You didn't do anything wrong.
You just followed protocol.
It's not as simple as that.
Mitri didn't refuse to check it, he was so confident he was right, he asked me to do it.
He got you to check his work.
Everyone was waiting.
I couldn't see.
I wasn't sure, so I let it go.
- This is my fault.
- No.
This isn't on you.
The lead surgeon has to check.
As if that matters.
Look, if I speak up, it's gonna be my word alone.
Dr Cutter, sorry Yeah, you better make this quick.
Um there are a few unanswered questions for tomorrow about Zoe's first operation.
You mean like, "Was it a botched job?" Well, whether all the checks and procedures were followed, - if there were any factors - Well, I wasn't there, as you know.
But I was wondering if there was any indication in the second operation or just anything that you may have heard.
It's a dangerous job, questioning the efficacy of the divine.
So, what do you need? - Someone to speak up.
- You have nothing? Looks like the key person is being intimidated into silence and the rest are closing ranks.
What about the anaesthetist, Dr Lee? Says she didn't hear a thing.
Well, several years ago, Dr Lee claimed to have been a victim of bullying herself.
She lodged a complaint, but then withdrew it before the case was heard.
I'd have another chat with her.
(PHONE BUZZES) Look who managed to get themselves a double-page spread.
Oh, that's about the heart graft transplant you guys did a couple of months back.
Yeah.
You'd think, from this, Astro Boy had pulled it off single-handedly.
Taught him everything he knows.
But you watch who gets head of surgery.
Hope you're planning to speak up tomorrow.
Oh, I don't think I should.
Well, it's your chance to knock this dick swinger off his pedestal.
But what if it jeopardises my chances of getting on the surgical team? Well, you did that when you slept with him.
- Hey, how are you with helicopters? - I've been once.
I threw up.
Oh, great! Don't do that on our way to Canberra.
Okay.
- (CLASSICAL VIOLIN MUSIC PLAYS) - Looks like raised JVP on the right.
MAN: Listen! Listen to that violin.
Just gonna have a listen to your lungs.
This part here.
(MELANCHOLY VIOLIN MUSIC PLAYS) - Ah, beautiful.
- Shh, shh, shh! I can hear some crackles.
You've got fluid on your lungs.
Let me see your legs, okay? I used to play this.
Oh.
You play? My dad is a doctor, but he was very close to becoming a violinist.
Ah.
Well, life is full of these choices, huh? My son I thought my son was going to be a musician, but he studied law instead.
He was quite the advocate until he had his accident.
- Your legs are very swollen.
- Should be here by now.
A severe pitting oedema to the knee as well.
Look, I'm finishing my shift soon, but, um I'll let the night shift team know, okay? He must be proud of you.
Your father.
Doctor.
My dad is a very hard man to please.
I'll see you soon, okay? Oi? Hey, didn't we have a date or something? I didn't think it was a date.
Two people, place, time, that kind of date.
I got caught up with RCA stuff.
I'm sorry.
What's with the cold snap? Okay, what have I done? Eli, we slept together once.
That's all.
(SIGHS) 'Compromised immune system', that's probably three words you don't want to hear, right? Your assumptions about what I can and can't do, my health and my future, none of your business! I gave you my account.
Just checking that there's nothing that you would like to elaborate on.
Haven't we done this before? We need to do it again because a resident is blaming herself for something that is not her fault.
A patient died, we need to investigate what happened and why.
Do you seriously think that bringing Mitri down - is gonna change the system? - I'm not trying to bring anybody down.
I'm just trying to get to the truth of what happened, and right now, what is in the way of that is fear.
Monica, you once made a complaint about a surgeon yourself, so surely you can understand how hard it is to Okay.
I That complaint cost me my place in the surgical training program.
Yeah? Which is why I'm now an anaesthetist.
She won't speak up without support.
Well, it's not coming from me.
(SIGHS) WOMAN ON P.
A.
: Paging Dr Bell.
Dr Bell.
TANYA: Where's Dr Bell? TABB: I think she had to submit statements for the RCA.
Keep going.
We need to get through handover.
He's a 49-year-old male with fever of unknown origin, mild productive cough.
We need to exclude underlying HIV.
I'm sorry.
You just missed the two sickest patients.
We'll have to bring you up to speed afterwards.
But back to the priority cases, Tabb.
Okay, next is Gamal Aswany, a diabetic male in his mid-70s with a background of CCF.
He's actually a brilliant violinist.
Oh, thanks, Tabb.
Can we stick to the medicine, please? Sorry.
Uh presents with shortness of breath.
- (PAGER BEEPS) - Bibasal crackles, JVP is elevated by two centimetres.
Guys, I gotta go.
I got a code blue.
He's definitely gonna need more furosemide through the night.
- Okay? Thank you.
- I've got it.
- Night shift is fun.
- (CHUCKLES) Whoo-hoo.
See you.
(VIOLIN MUSIC PLAYS) Mr Aswany, I'm Dr Bell.
I'm just checking in on you this evening.
I hear you're a bit short of breath.
Could you lean forward for me, please? Did this come on suddenly or slowly? Fairly quickly.
This is lovely music, but do you mind if I turn it down? Sorry.
My son insisted I bring it along.
It soothes me.
I can hear a heart murmur and you have water on the lungs.
But your ECG looks okay.
Um I'm gonna give you some medication to help with your breathing.
He's been a long time.
Doctor, radiologist needs to speak to you urgently.
Excuse me a moment.
Patient Debbie Campbell from Neuro in bed 43.
Had a chest X-ray.
Could be an aortic tear.
What's your experience level? I'm PGY2.
I'm a year and a half out.
Organise a CT aortogram and get the patient to ICU.
Chances of survival are very low.
I hope you've got a light load, because I think this'll take most of your night.
Can you, um? 40 of furosemide, and I'll be there as soon as I can.
Of course.
Debbie Campbell? I'm Dr Bell.
- Are you in any pain? - Uh my back.
Could you lean forward for me? And what sort of pain? Is it dull, sharp? - Uh, it's like a tearing.
- CAROL: BP's over.
Gotta get it down.
Uh, my husband, he sent me to Emergency, and then the doctors they sent me to Neurology, and now they've sent me up here.
The doctors in Emergency thought you might have had a mini-seizure, so they sent you to Neuro.
Nothing showed up on the brain scans, but something did show up on the chest X-ray.
Debbie, we think this problem is connected to your aorta, which is the main artery pumping blood from the heart to the rest of the body.
We need another test, but this might require urgent surgery.
We'll call your husband and get him to come back in.
Oh, when you say urgent, what do you? It's just that we've come back It's for my sister's wedding.
If this is what we think, surgery would be immediate, so I'm sorry, you won't be going to your sister's wedding.
I'm supposed to be the maid of honour.
I know, it's a terrible disappointment, but your health's the priority here.
I'm sure she'd understand.
Could you organise a bed in ICU, and I'll get on to the aortogram? Mm-hm.
I'll be back in a few minutes to check on you.
Okay.
Thank you.
- Great.
Thank you.
- Husband's on his way.
Are we talking about an aortic dissection? Almost definitely.
The aortogram is done.
- Did you call ICU? - Yep.
No beds.
- Are you serious? - Very.
Um, where's Tanya? Dealing with an arrest in Psych.
That's two blocks away.
- Where are you going? - Well, I need Debbie's report.
Patient in bed 5 is still in serious pain, despite analgesia and bed 13 had a fall trying to get out of bed, hit his head.
- Well, any sign of a concussion? - Not so far.
But you need to review.
Well, I'm sorry.
This takes priority.
Bed 14, new IVC.
Bed 2, rechart meds.
Bed 62, new IVC.
And Bed 19, patient in pain.
- Thank you.
- (SIREN WAILS) (SIGHS) Oh, shit.
(PHONE BUZZES) Now, this had better be good 'cause I'm halfway through a particularly fine pinot.
I have a patient with a confirmed aortic dissection.
One kidney is already dead, the bowel is on its way out.
Well, get her into ICU.
Yeah, there's no beds.
Who's the vascular surgeon? Um, Leach, but he's in theatre already.
And Cutter's already on retrieval, right? Sounds like you've struck gold.
Yeah.
What do I do? Well, where's Tanya? Uh, she's busy.
It's just me.
Look, get her onto IV beta-blockers and then get her out of there and into the jungle.
I'm sorry.
What did you say? Get her into surgery, whatever way you can.
Okay, I will try.
Thank you.
Uh, Carol, can you page the reg on general surgery and get that for me? Pharmacist on call won't come in for this.
Says you can't give IV beta-blockers on ward, only in ICU.
Well, that's where she would be, if there was a bed.
Fine.
I'll call him.
Lazy bastard might want to come in and save a life.
MAN: Look, when I left, they thought she'd had a small seizure.
Now you're telling me it's her heart and she's lost her kidney, she could lose her bowel? A tear like this means that blood escapes into layers of the aorta and it restricts blood flow to the organs, and they just stop functioning.
- Can you fix it? - We need to get her into surgery.
But, Mr Campbell, you need to understand that this is life-threatening.
Try not to move.
Stay, stay, stay, stay, stay.
The pharmacist did come in and there are no IV beta-blockers in store.
- What?! How does that happen? - Oh, I don't know, it just does.
Zilch.
Okay, we need GTN patches.
We don't have a choice.
And did you page the reg on general surgery? Yes, I did.
There was no answer.
Well, I'll hunt him down myself.
Look, he's finishing up now, but he's completely unqualified to do an aortic dissection.
It'd be like asking you to go in and fix it.
- We need to operate now.
- Yeah, well, who's on call? - Duvenbeck, but he's not answering.
- Well, where's Cutter? - She's on retrieval.
- Mitri? Oh, right.
A resident waking up a surgeon who's not on call.
Hmm! Yeah, well, good luck with that.
(OWL HOOTS) CUTTER: Why did we have to land in the middle of nowhere? LOU: Mechanical problems.
They didn't tell me anything else.
Then why'd they take off in the first place? I guess they didn't know they had any.
Great.
We're stuck in the middle of BF nowhere.
Hey, did you call the team in Canberra? - (PHONE RINGS) - No, they're waiting, but they can't wait forever.
Shit! Cutter speaking.
Dr Cutter, it's Frankie Bell here.
I'm sorry to have to call you, but I have a patient with an aortic tear.
There's no beds in ICU and no surgeon to do the job.
Then transfer the patient to another hospital.
Their chances of survival are low as it is.
You can't afford to waste any more time.
Look, call Pickering at Carlton.
He'll operate on anything with a pulse.
- Okay, should I? - (PHONE BEEPS) WOMAN: Doctor? The antibiotics for Debbie Campbell, her cannula's tissued.
Well, give her them orally.
Shit.
Such a headache.
Have you got anything? Oh.
Um Tampon? Not this week.
Nah, I don't have any.
Should I ask those guys? Well, they don't need a tampon.
(SIGHS) They're gonna have to start the operation without us.
Which kidney are we getting? Well, Berger wanted the left, but they've got first dibs.
You know, we should be in there now, because I can see that team, they're gonna be circling in there like vultures.
Well, maybe they could Skype us in while they're examining the organs, and then someone else can do the transporting if the kidney's viable.
Good idea.
- Let's try that.
- Mm-hm.
(SIREN WAILS) Dr Cutter suggested that you might be able to help.
My sister should be here.
Uh, no, he's in theatre already, which is why I'm calling you.
You can't always fix things when they're broken.
I have no idea, I'm I'm sorry, but the patient is about to die.
- I need to get her into surgery.
- Sorry.
I'm on the telephone.
I shouldn't have to wait.
You know, I've been on anti-discrimination boards.
- I know quite a lot about it.
- Look, I'm sorry, sir.
Did you say you're looking for your sister? The patient in bed 26, he's increasingly short of breath, Coda, it's a musical term, meaning 'the end'.
Saturating on two litres of nasal.
Okay, four more litres of oxygen by mask.
I've got too many other patients to deal with.
I'll be there when I can.
- I'm broken from the accident.
- Okay.
Um, could you please look after this young man? Dr Kalchuri says she needs your help upstairs.
- Yeah, I can't.
I think maybe Neuro.
- My sister should be here.
- I'm not European.
- No, Vascular.
Sorry, Vascular.
- I need the Vascular Reg.
- Sir, this is the Cardio Unit.
Are you sure you need to be here? What about we take you up to Neuro? How can I be European? I was born in Auburn.
Oh, come on, come on, come on, come on.
So, I - and then they bundled me in.
- Mm-hmm.
Just bundled me in.
Dr Kalchuri wants you to call her, ASAP.
She needs assistance.
Oh, well, so do I.
Sorry.
Yes, hi.
Is that Vascular? Yes, hi.
Um Oh, is this is this the surgeon? Yeah, I've spoken with Dr Pickering in cardio.
He's given his approval.
It's midnight.
Why are you calling me now about this? Well, he told me that I need to get approval from you for the transfer.
The initial CT scan was two hours ago.
No, I I understand that.
But I can't get her into surgery here, so I'm just trying Call in the morning, if you haven't managed to get her into surgery, we'll consider taking her.
She's lost the blood flow to her left kidney.
Well, it's gone, then.
We can't save it.
But if we don't get her into surgery, she'll lose her bowel.
Right now, the patient's stable.
No all signs are saying that she won't last the night.
No, we're not accepting her.
Call in the morning.
(HANGS UP) DEBBIE: (WHISPERS) Kenny if anything if anything happens to me Deb, don't.
Don't, Deb.
- If I don't come back - Hey.
I want you to tell.
.
You're having this operation, then you're coming home.
You're my angel, okay? You're not going anywhere.
Got it? I'm sorry.
Excuse me.
Debbie, I'm afraid that we have to transfer you to another hospital.
Wait.
You said that this was serious.
We don't have a surgeon here, right now, to do the operation, so you'll have to bear with me while I get it organised.
(DEBBIE BREATHES RAPIDLY) Hey Hey, hey, stay still.
I'm sorry.
Hey.
Don't be sorry.
Okay? This is Everything will work out.
I love you so much, Kenny.
- I love you.
- Just hang in there.
Keep calm and just stay relaxed.
(DEBBIE BREATHES RAPIDLY) SURGEON: Left kidney's a little enlarged, by the look of it.
No.
Wait I think what we have here is a horseshoe kidney, that is usable.
Of course it is.
We'll have it.
MAN: Well, technically, you'd have to say this is the left kidney.
Why? Before we descend into complete anarchy here, I should point out that there's a high risk of trauma with this kind of injury.
Let's see what we have here.
That's one damaged kidney.
I'm afraid both teams have drawn the short straw.
(SIGHS) Shit.
Nothing like coming home empty-handed.
LOU: I can't believe it.
It looked fine on the surface.
Yeah, they often do.
- (PHONE RINGS) - I'll call the team.
That poor kid there, waiting in pre-op.
Oh, it's your mate again.
- How'd you go? - Uh, they won't take her.
Cardio said yes, but the vascular refused.
Well, we'll have to make them take her.
- Okay.
- Look, leave it with me.
Uh, we didn't get to Canberra.
It's a long story.
We're driving back to Sydney now.
But it's a no-go with the kidney for Damien, I'm afraid.
Thank you.
I'm so sorry.
The kidney was damaged.
It wasn't good enough for you.
We can do better.
It's disappointing, I know.
It sucks.
Look, there is a program.
It's called the Paired Kidney Exchange.
You're not compatible with Damien, but you would be paired with someone who is a match.
You would donate a kidney, Damien would get a kidney, just not to and from each other.
If you're interested, I can look into it for you.
(PAGER BEEPS) Okay.
For now, just go home and rest and we can talk about it another time.
I'm so sorry.
We'll get through this.
Doctor the patient in bed 26 is struggling to breathe.
Descending to, um, 82% and he also complained about chest pains.
- How bad is the pain? - 3 out of 10.
Give him some GTN, another 80 of furosemide and increase oxygen to six litres.
I will be there as soon as I can.
- BP's still over 200.
- (PHONE BUZZES) Dr Cutter - Carlton Hospital is accepting care.
- Really? I've organised an Intensive Care ambulance.
Tell Carol.
Yes, I will.
Absolutely.
Thank you so much! Thank you very much! Where have you been? I've had five MET calls going, all of them unstable.
I have a patient here with aortic dissection.
Well, then, she needs to be in surgery right now.
There is no surgeon available here.
I've organised a transfer to Carlton.
But I can't get her BP down.
When I arrived, it was 220/110.
- What is it now? - 200/95.
Mr and Mrs Campbell, this is Dr Tanya Kalchuri.
What's the story with those patches? There's no IV beta-blockers.
She's got rebound tachycardia.
You know that the treatment for that is - Excuse me, Doctor? - IV beta-blockers.
We don't have any, so I'm trying to get her BP - Don't use patches.
- If there's no IV? Use oral, oral and more oral.
Nurse, can we get some oral beta-blockers? - Doctor, what's going on? - Just one moment, please.
Excuse me, Doctor?! Not me, Joe.
You see, they're all racing this way, that way, and this way and that way Ah, Patient Care here to transfer to Carlton.
And there's trouble.
The apple pie No, no, no.
We organised Intensive Care paramedics.
We're just your run-of-the-mill variety.
Dr Bell? Yeah, that's right.
This It took me two hours to sort out this transfer.
- Bloody morons.
- That's because of my brain.
- It's broken from the accident.
- Not you, mate.
Not you.
Doctor, what's going on? Why aren't they taking her? They're the wrong paramedics, but don't worry I'm sorting this out.
The apple pie is in the bed.
You know, my sister - Who is this guy? - I don't know! I thought he was from Neuro.
He's not from Neuro.
You said you'd sort it! Sir, we really do need to know your name.
- Not me, Joe.
My sister.
- What about your sister? - What's her name? - Where is your sister? Rookwood Cemetery.
(BEEPING) - 200ml, please.
- Yeah, sure.
- There's not enough time.
- What about Mitri? Not on call.
What's worse, waking up a surgeon who's not on call or sitting at a coroner's court because a patient died and it's on your head? (PHONE BUZZES) (SIGHS) Yep.
Um, this is Dr Bell.
I'm sorry to wake you.
But I'm afraid that I have no choice.
- I'm not on duty.
- I know.
But I have a patient with an aortic dissection and no surgeon.
Okay, so, who's on call? Duvenbeck.
He's not answering.
Cutter's on retrieval, and I've tried to get her transfer to Carlton, but they sent the wrong paramedics.
(LAUGHS) Hang on, hang on.
You want me to come in there and save your arse? No, not mine.
The patient's.
I'm I don't think she'll last the night.
She's lost one kidney.
She's about to lose another.
I know how serious an aortic dissection is, Dr Bell.
It's a high-risk operation as was the other.
If I come in there, you need to accept that the outcome is what it is.
Got it? Yes.
Is he coming? Well done.
LOU: Oh, God.
I'm so tired.
CUTTER: Oh! You There is literally nowhere else in the world I'd rather be right now than with my pillow.
I don't think mine would recognise me.
Where are you going? It's the middle of the night.
I've got a date with my pillow.
No, you have a date with me in an aortic dissection.
What? I thought the patient had been transferred! I need you in theatre.
Mitri, I am seriously struggling to stay vertical right now.
Then do it lying down.
Please.
We need a team.
Well, are you happy with Dr Tannis assisting? - Sure.
I'll see you in there.
- All right, then.
Tighten your lower sphincter and refocus.
KENNY: Just hang in there.
Mrs Campbell? I'm the surgeon who's gonna operate on you.
We've assembled the best possible surgical team for this, okay? So, you can be assured, you're in excellent hands.
Bless you, Doctor.
Thank you.
Dr Bell will do her best to keep you informed.
In the meantime, try and get some rest.
You make sure you come back.
And tell those angels you belong here, with me.
I'll have to.
I couldn't stand looking down and seeing you with someone else.
The apple pie is on the bed! That's a coda.
- I'm sorry.
- It means 'the end'.
I think his name is Adam Aswany.
Coda's a musical term, it means 'the end'.
- Aswa Oh, Aswany! Yes, Gamal Aswany.
- It's the end.
(QUIETLY) His end His end You're his son.
- His end.
- "Hizend"? His end! His end! Room 26! He's gone.
The apple pie's on the bed.
Coda.
The end.
There will be too many flowers.
People crying.
All those wet tissues.
(MEDICAL EQUIPMENT BEEPS) MITRI: Can't see.
Suction.
- (SUCTION GURGLES) - (YAWNS) (YAWNS) Am I boring you two? Mm.
Clamp on.
Hand me the suture.
Whoops.
Damn.
Steady now.
We'll start again.
Come on, you.
Behave.
Got it.
That's it.
Good result.
Yeah.
And another notch in your surgical belt.
It's not every day a surgical resident gets a shot in an aortic dissection.
(WATER RUNS) - You did well.
- (P.
A.
BEEPS) Thanks.
WOMAN ON P.
A.
: Please report to Dr Ford in his office.
Urgently, please.
Nurse Bonbridge, Dr Ford's office.
(BEEPING) You told me he was short of breath! I said he needed to be reviewed and that he would need more furosemide.
That is a long way from bi-ventricular heart failure.
He has a history of CCF.
It was in the notes, Frankie.
I am not a mind-reader.
He should have been listed as high-priority.
He had a heart murmur that you didn't pick up.
That is the point of handover, Tabb.
- It is your job to keep me informed! - Uh, you were distracted.
Your head was in the bloody RCA.
Do you remember? Were you even listening to me? How the fuck am I meant to listen to something that's not being said?! Aaagh! It's lovely music, but do you mind if I turn it down? Did this come on suddenly or slowly? Fairly quickly.
(SIGHS) Coda.
That's a musical term.
The apple pie is in the bed.
The apple pie is on the bed.
That's a coda.
Aah! Ohhh! (WEEPS) Ohh! Mr Campbell? Yes.
Your wife is now stable.
The torn section of the aortic valve has been repaired using a Dacron graft.
Bless you, Doctor.
Bless you.
Unfortunately, decreased blood supply to the organs meant she lost one of her kidneys.
But I'm fairly certain she'll make a full recovery, as long as we keep her blood pressure under control.
Thank you, D Thank you, Doctor.
I can't thank you enough.
Maybe if I I kiss your feet? That might be a little unhygienic and, uh, possibly not in the best interests of the patient, huh? (CHUCKLES) - Thank you, Doctor.
- Oh Thank you so much.
Thank you again.
(SIGHS) LOU: Hey.
Hear the good news, right? About the aortic tear? She's gonna be okay.
Yeah.
I heard.
But, um I lost someone else.
I spent all night trying to get a surgeon to operate on that tear and there was all these MET calls and there were no other doctors around.
Well, then, the tear takes priority.
I knew he had breathing difficulties.
And I think that his son was trying to tell me that he was in trouble, but he's brain-injured and I didn't know he was and I couldn't I didn't get there in time and he died.
And he had a history of CCF.
I missed it.
But even even if you'd picked it, you But his son has lost his carer.
He's got no one.
You know, and I've been pushing you to speak out at the RCA over Zoe's death, so the truth will come out, and here, I have lost a patient myself.
So, who am I to judge? Your patient died because you couldn't be in two places at once.
You couldn't.
But it's possible Zoe died because (SIGHS) a surgeon took offence at his work being questioned by a junior surgeon.
That's arrogance.
And you're right.
It's dangerous.
You did everything you could.
You always do.
The social worker's seen him and organised care.
Don't worry.
He'll be right.
No wet tissues.
No flowers.
What was his favourite song? ('CELLO CONCERTO IN A MINOR' BY VIVALDI PLAYS) (ADAM CRIES SOFTLY) ('CELLO CONCERTO IN A MINOR' BY VIVALDI CONTINUES) MACK: The autopsy has revealed the bleed was most likely the result of a missing stitch, the possible causes of which have been outlined.
A sudden spike in blood pressure, causing the existing stitch to burst.
Friable hard tissue, incapable of holding the stitch.
Or a problem with the initial stitching itself.
The committee is satisfied that hospital protocol was followed and no single cause can be identified.
This in no way diminishes the the trauma suffered by the family, and the staff involved.
A formal apology has been made to the patient's husband, and counselling made available to all Sorry, Dr Mack.
I want to suggest that while there may be protocol in place, it's not always adhered to, and that that may have been the cause.
Well, there's nothing in your report about it.
At what point? Before we took the patient off the cardiopulmonary machine, uh Dr Mitri was about to declamp.
I thought I saw a loose stitch.
And? And I said, "Stop.
Do not unclamp.
" Dr Mitri, do you recall this? Uh she may have said something, but I'd been working for 14 hours straight and I was focused on the operation.
But, no.
No, no.
I I don't recall it.
Did anyone hear Dr Tannis raise a concern? Sir, can I just say that the culture of bullying in this hospital means that people are afraid to speak up.
Well, you can say whatever you like, but without any evidence to substantiate such a claim I don't have any evidence.
But the fear amongst staff is so strong that they won't say anything for fear of personal repercussions.
Now, Louise Tannis is telling you the truth.
But she's been cornered and bullied.
That's that's enough.
Dr Bell, would you please let me chair this meeting as I see fit.
Dr Tannis, you mentioned nothing about this in your interview and, yet, you have just now alleged you thought you saw a slipped stitch.
How certain were you? - Certain enough to call it.
- Did you call it a second time? No.
Dr Mitri heard me.
He told me to check it.
And did you? Yes.
She should never have been asked to check it in the first place.
But I I couldn't see anything.
I was under pressure.
How did you proceed, Dr Tannis? I let it go.
And I shouldn't have.
Dr Tannis? You did the right thing.
You're very brave.
(TRAIN RATTLES) It was a whitewash.
Lou was crucified.
She's been made to do a graded assertiveness training course.
Nothing for Mitri, who's "an exemplary surgeon "and valuable member of the surgical team.
" I'm sure they're very reluctant to shatter the confidence of someone like Mitri.
He's a top-rate surgeon and saves lots of lives.
It doesn't make it right.
It just makes it complex.
You're fighting the good fight, Frankie.
We just lost.
You lost the battle but not the war.
That debated incident is now on record and serves as a deterrent to any surgeon who's tempted to ignore the advice of a team member.
Well, too late for Zoe Mendosa and her family.
The two things birds need to survive Context and perspective.
But they need to leave the ground in order to get it.
It's a teaching hospital, so why don't you teach me? No, look.
You're jumping the gun, Frankie.
No, look, don't patronise me! Right? Now, this is how it's gonna play.
And I'm sorry I don't have testicles.
- CAROL: Your boss is not okay.
- Has something happened? I don't know what's going on, but we were about to do this kidney biopsy and he just froze.
BERGER: I'm not having the operation.
Not until I've seen the Paired Kidney Exchange through.
Well done, Sherlock.
What can we do to stop this whole thing from falling over? His judgement is impaired and if something happens, you're both done for.