RFDS (2021) s02e05 Episode Script


PETE: I think we need
to readjust the tube.
CHAYA: I thought the
locum said not to touch it.
He's hypoxic. Do we have a
choice? We need to do a cric.
WAYNE: The cognitive test did
reveal some issues with his speech.
- From the cut?
- Yeah.
But they've attempted to repair it.
We'll know more in the coming weeks.
Eliza and I got a call from
Clinical Governance yesterday
about the incident
review into White Cliffs.
They've asked for Eliza to run it.
You do know that this
is about an incident,
not about a single clinician?
- How much you drinking lately?
- Zero. Give it up.
- For real?
- Take my pills and insulin.
Wayne's not available.
Try Eliza and Graeme?
- Beautiful Eliza?
- Hey? Yeah.
Are you two shacked up yet or what?
Oh, I should have told
you. It's a one-time thing.
Is this why her running the
review has been such a problem?
It isn't.
There's a good heartbeat. And
I reckon you're nearly 12 weeks.
It might be time to tell Graeme.
That's bloody fantastic.
Hey, bro. It's Timmy. Yeah,
I just got your message.
I'm out bush with the
boys, so reception's shit.
Oh, and a heads up,
I left my prayer boots in
the washing machine again.
Oh, can you take 'em out before
Mira sees 'em and goes ballistic?
Oh, and if you can chuck a
couple of dollars in my account
for being such a good brother, I'd
really appreciate that, bro, hey.
- Oh.
- What's this?
Chilli scrambled eggs,
but Oi, get out.
Oh, my God.
I know, right? He's
the Masterchef of Dubbo.
Who are you, and what
have you done to my son?
I took a couple weekend cooking
classes. It's not a big deal.
Hey, Daz, could you
call my phone, please?
- Yep. Hang on.
- Wayne.
Sorry, Timmy's boots. He
forgets he's living with women.
Wait, can you call it
again? I can't hear it.
Hang on, what does being
a woman have to do with
not putting muddy boots
in a washing machine?
They're prayer boots so
What are prayer boots?
Boots you pray in.
OK. Are we all ready or?
Hey, Darren, could you put mine
in a takeaway container, please?
I thought I thought we were
going to have this here today.
Oh, well, now I'm beyond
late. Oh, my God, this phone.
There's the ciggies in the laundry tin.
He does smoke outside, Mirs.
OK, but when the baby comes,
that one's got to stop.
- Sorry. Can I please
- Disgusting.
Can we all just stop, please?
Sorry, I just
I did all of this because I wanted
to have a nice family brekkie
because I've got some news and, sorry,
I wasn't sure who to tell first,
so I thought I'd tell you
all at once, but, um
I'm I've decided
I'm going to move to Dubbo.
Like, full time.
Wait a sec.
Oh, yes. Yes.
I'm so sorry, but I have to go.
- Alright. I'll, um I'll talk to you later.
- Yep.
Hello? Yeah, I'm fine. Yeah.
ELIZA: Any Critical Incident Review
looks systematically
across all processes:
rostering, fatigue, policies,
procedures and equipment,
safety mechanisms, environment,
patient practice and
knowledge and skills.
The sat phone reception was
patchy, the roster was in chaos,
the environment was mud and
dirt, the SMO was exhausted,
and the patients were drunk.
So yeah, I guess that
leaves knowledge and skills.
This isn't a witch hunt.
I just I really
want you to know that.
Are you ready to start?
Yeah, fire away.
So you were short a doctor because
the backup hadn't been confirmed?
That's right. I'd had some personal
news which caught me off guard.
And as a result, I
Well, I dropped the ball.
When did you first notice
something was wrong?
On the plane?
So the patient desaturated
below 90, but FO2 was 100,
and circuit, total volume P-pressure
everything was fine.
I was the backup, I assumed
the message to Wayne had sent.
Regrettably, it hadn't.
So I checked breath sounds and saw
that the tube was 28cm at the teeth.
So I listened to the chest and
realised that the tube was only
in the right lung and that's when
I decided that we had to adjust.
But the locum said
not to touch the tube.
He also said that the tube was at 26cm.
It's really hot in here, isn't
it? The air con must be off.
And then turbulence hit and
it just kind of came out.
You tried with direct
laryngoscopy and blind bougie.
But the airway was a mess,
couldn't see anything,
so both attempts ended up oesophageal.
What happened then?
Oh, well, then we two-person
bagged and masked. That was no good.
We went blind bougie and then LMA.
Did you try a Guedel?
And that's when you hit the vortex?
Yeah, well, we decided that
I I decided he needed
a surgical airway. Yeah.
And what technique did you use?
Finger scalpel.
And when was the last time
you had a simulation with that?
I don't know. Maybe two
months. Three months?
Did you consider the scalpel bougie
technique with the turbulence,
given the risk of losing the
hole or slicing your finger?
Why, is that what you would have done?
It's not about what I
Do you think it would have
made a difference to his voice?
It's not about blaming,
it's about trying to figure out
how we can all do better for the future.
Oh. Morning, Daddy.
Alright, two things:
never call me that again,
and that would be my desk.
- What's that face?
- What face?
That "I'm worried but still in control
kind of not in control" look you got.
It's nothing.
You sleep here?
Me? Yeah. Oh, uh, yeah.
Had the late shift last night,
and the review thing was really
early this morning, it's crazy.
What's with the suitcase?
Oh, that suitcase.
Freya and I kind of had
a big fight last night.
I said some mean things,
she said some things.
Wasn't good.
Uh, sorry, Matty. Are you OK?
Yeah, yeah, I'm fine. Just
But also kind of not.
(VOICE BREAKS) Pretty sure it's done.
I mean, are you, though?
Sometimes a bit of space can help?
You know, if I'm honest,
it's been coming for a while.
It's just hard.
OK, We'll just You let me know
if there's anything I can do, OK?
33-year-old male ex-army just
did a stint in Papua New Guinea.
Asthma as a child, but
no known lung conditions.
His GP suspects we're dealing with
a multidrug-resistant tuberculosis,
so it's airborne PPE for all of us.
Yeah. Yeah, no, I heard you.
Ex-Army, childhood asthma,
drug resistant TB and PPE.
Well, I'm in a conundrum.
I either drink a whole lot of water now
and avoid the debilitating
dehydration of full PPE on a hot plane,
but then I'll be needing to pee
all day in a suit I can't remove,
on a plane with no toilet.
- That's a conundrum. Gloves.
- Thanks.
So what's your strategy?
Either pack an incontinence pad
or go easy on the sports drinks.
- Goggles.
- Hey, are we alright?
Yeah, of course.
- Full PPE in 40 degrees. Love a sauna.
So, do you want broad-spectrum
anties anyway, or
Yeah. Worth a shot.
(CLATTER) Oh. What is this doing here?
- Are you right?
- I'm fine. I'm fine.
Why is there a suitcase
in the middle of the floor?
- Sorry.
- Sorry. That's mine. I had to bring some gear in.
How many times do I have to go
through the safety guidelines?
Yeah. OK. It's my fault. Sorry.
You all roll your eyes
and complain about them.
But people still leave their
crap everywhere to trip over.
No, I'm sorry. It's my bag.
It was a mistake. I'm sorry.
We don't have time for mistakes.
We're in the middle of a
Critical Incident Review.
Industrial agreements
are still outstanding
and timesheets haven't been filled in.
I'm the base manager.
I'm not a babysitter
for a group of adults
who need to get their shit together
and leave their personal
lives outside that door.
Do you understand? I
said, "Do you understand?"
- Lee, point's been made.
- Clearly it hasn't.
I'm sorry. It won't happen again.
He and Freya just broke up.
Well, how am I supposed to know that?
You know, this is because
you came back too soon, right?
I mean, Jesus, you just
been through major surgery.
Have I? Have I, Graeme?
Thank you for reminding me.
I'm not reminding.
I'm telling you, you're taking it
out on people. It's not like you.
Jesus, you can be so onerous.
Just give me some space, OK?
Just for once, give me a break.
We did. You didn't take
it. Stop being a martyr.
You're so desperate to
come back and manage things
when you're struggling
to manage yourself.
What the hell?
- PETE: Yeah, on Comms.
- Bugger.
- You right?
- Yeah. Yeah. Just lost something.
Prepare cabin for landing.
He couldn't even sleep last
night he was coughing so bad.
Hi, Seb. We're from the RFDS.
We're here to take care of you.
Hey, Seb.
Just going to get you to pop one
of these masks on for us, mate.
- What?
- Popping Popping on a mask.
- Claudine. There you go.
- Thanks.
OK, Seb. Take some deep
breaths for me, please.
Seb, does it hurt to breathe?
- Yeah?
- Alright, SATs are 90, RESPs are around 30.
No wheeze but some bibasal crackles.
It does look like tuberculosis.
Let's start him on a non-rebreather
at ten litres per minute
and get him on board.
We need to get him to a
hospital as soon as possible.
- It's alright.
Hey, Darren.
- Hey.
- Hey.
- How ya doin?
- Yeah. Yeah, good.
Just checking in.
You reckon I'm being selfish?
Maybe. But what's wrong with that?
Your dad wouldn't be where he is today
if he hadn't put himself first.
And we wouldn't have met and
this baby wouldn't be on the way.
And I certainly wouldn't be having it
if it wasn't something
that I wanted for myself.
I know Dad thinks I'm leaving
because of the baby, but it's not.
Honestly, it's Back
in Dubbo, it's like
You can be your own person
and not just Dr. Wayne's son.
I just don't want to hurt anyone.
Well, it's better than
resenting other people
because you did something
that you didn't want to do.
You know?
- Well, I better get back to it but
- I'll see you tonight.
Yeah. See ya.
GRAEME: Taxi craft and station.
Cockpit closed for take off.
(SEB GROANS) So hot.
Sorry, mate. Air-con doesn't
work 'til we're in the air.
- Oh, bugger.
We right, Grae?
Sorry, team. A bit of a problem.
What is it?
- We're bogged.
- Bogged?
- Bogged.
- Dry bogged. Happens sometimes when we turn.
We're not moving 'til
I get us out of here.
And no air conditioning.
It's 50 degrees in here.
Nothing I can do about that.
OK, we can't move him, so we need
to keep him as cool as possible.
We need to get his trousers off,
and one of us needs to
go back and get some ice.
Hey, Claudine's still
here. Why don't you go?
Are you going to be alright with him?
Yeah, I'm fine. I'm fine.
I'll radio if he deteriorates.
- Alright.
Well, I'll be as quick
as I can, I promise.
Alright. Alright. Sorry, Seb, I've
gotta take your pants off, mate.
I'll need you to come back for a
tow as soon as possible, please.
Hey. Everything OK?
Not particularly. We're dry
bogged at Grafton Station.
Oh, no. Is the patient OK?
He's hot. Everyone's hot.
Hopefully we'll be back
online in a half hour or so
but can we have engineering on standby
in case I snap this front wheel?
- Yeah, of course, and
- I'm running low on hours.
So even if I get this online, can
we have an alternate closer by?
OK, sure. We'll have to have
a negatively pressured room.
- I'll call Mildura and
- Gotta go.
Eliza, are you in there yet?
Yep. How's he doing?
Uh, not great. His SATs are down to 86.
Temperatures's 40, his resp's around 30.
So I've bumped up the O2 to 15l.
OK, if that doesn't work,
try him on the high-flow
nasal prongs at 60l a minute
and perhaps some propofol and
rock in case we need to intubate.
I'm on my way.
Roger that.
Thank you.
- How are we looking?
- Wheels up in 20. Unless I snap one.
What are the chances of that?
Not insignificant.
- What?
- Ugh.
Is this dinner?
That's the best I could find.
Any changes?
Yeah, his SATs are up a bit to 88,
but his temperature is still 40.
OK, let's get this meat and
veg under his arms and groin.
Hey, we good for oxygen?
How much have we got left?
Uh, 6000l.
If we keep him high
flow at 60l a minute,
we got a bit over an hour and a half.
I think we should intubate
now before we move.
Intubate, really?
It'll preserve oxygen supply,
saves us doing it mid-flight
if in case he tires,
plus it'll have the added benefit
of bringing his temperature down.
Sorry. Goggles keep fogging up.
- Are you going to be OK to intubate?
- Yes.
- Trachs, equipment. Ready to go when you are.
- OK.
Right, thank you.
Teenage girl, 18.
Possible seizure at the IGA and
then again on arrival at the clinic.
She's sleeping, but not postictal.
No tongue biting or
loss of bladder control.
What do you reckon? Pseudo seizures?
Not sure. Could still be epileptic.
Or stroke, infection, drug
and alcohol withdrawal.
Let's triple check the
meds she's on too, please.
It goes without saying,
but you can always
stay with us, you know?
Yeah, there's still another 20 weeks
before there's a screaming
baby in the house.
Oh, you guys.
Wait, but isn't Timmy
staying in the baby's room?
Well, it looks like Darren's
making the move to Dubbo full time,
so there's his room.
Thought that might happen.
Because of the baby?
No, because
He's being his own dog.
You know, going out into
the world like you did.
And I'm in, by the way,
with the living arrangements.
Prepare the cabin for landing.
- G'day, I'm Wayne.
- Hey.
- Hey, Matty.
- Raelene.
- Adrian not on?
- No, he's on leave, unfortunately.
I worked here years ago,
so I'm just filling in.
- She had any more seizures?
- Yeah. Two now.
- Any mention of drugs or alcohol?
- Not that she's admitted to.
Any obvious triggers or
changes to medication?
No, no, she was talking fine.
And then I did all her obs
and then bam, off she went.
Briony, darlin',
we got the big doc here from the
RFDs come to take a look at you.
Can you turn around
for us, please, sweetie?
The poor thing.
She come in here with milk
and pasta sauce all over her.
I had to clean her all up.
Hey, Briony. I'm Wayne.
Mind if I ask you a few quick questions?
You have a history of seizures?
Can I check your tongue quickly?
You on any prescribed
medications for anything at all?
OK. Alright. Let's just keep her safe.
OK. ETG through, bougie out.
Inflate the cuff.
Inflating the cuff.
Are you OK?
Don't worry about me.
- Fogging, good CO2 trace.
- Equal chest rise.
He's bagging easily.
Secured, 24cm at the teeth.
Equal breath sounds.
I'll connect the ventilator.
You take a PPE break.
I'm good.
I'll take over.
Alright. Easy does it.
That'll do ya.
OK, we're out.
Let's get to a flash
motel in Mildura, shall we?
So are we're even going
to talk about Dubbo or
What's there to talk about.
You said you were going. It
was a statement, not a question.
Right, well, there was a question,
but you just walked out
before I could ask it.
OK. Go on, then.
Come with me. Come to Dubbo.
That's it?
No, seriously. I mean,
think about it. We could
We can both work at the base there.
We could rent a little place in town.
Don't you want to just start afresh
somewhere? Get out of this place.
Hey. Sorry.
- G'day, mate, sorry, I'll just
- No, you're fine.
Just finished a session with
Chaya. Thought I'd say hello.
I'll be back in five.
Righto. Hey, see ya, brother.
Yeah. See ya.
Was he calling you this morning?
He's a client. I'm helping with
Chaya. Is there an issue with that?
You can't see how into you he is.
This is my job, Darren. It's
what I do in Broken Hill.
OK, just Will you just
think about Dubbo? Please.
Matty, let's get some IV access, please.
Briony, could you lift your leg for me?
There you go.
Uh, what was that?
Uh, he came in drunk this morning,
covered in urine and vomit.
He wouldn't let me near him,
so I put him down the back
to let him sleep it off.
Do you want me have a look at him?
No, it's fine. Don't
want to waste your time.
We get them here a lot. It's better
just to let them sleep it off.
Briony, show us your tongue again.
What do you think?
Well, it's hard to know
if it's PNES or epileptic.
What, so you reckon
might be pseudo seizures?
What's that supposed to
mean? You think I'm faking it?
No, that's not what we're saying.
It can just be really
hard to tell between
PNES, non-epileptic, or
epileptic seizures, OK.
Matty, you stay with Briony.
Can we see this other patient, please?
Yeah. Suit yourself.
But if you ask me, he's
just putting on a show.
Mm-mm, mm-mm.
All right, let's get that window open.
Mm-mm, mm-mm.
I gave him a blanket,
but I couldn't get near
him to help him get changed.
He was He was
incomprehensible and agitated.
You know, I'm here on
my own, so I was wary.
Hey, Timmy. Timmy, can you hear me?
Hey, hey, hey, hey.
I need water for him, towels and wipes.
Hey, brother. Hey. Hey,
Timmy. Timmy, can you hear me?
Hey. Hey. You're alright,
brother? I'm here now.
I'm here now, I'm here.
- It's the best I could do.
- Here, drink up.
I did give him water,
but he wouldn't take it.
Every time I tried to do anything
to help him, he got aggressive.
- Can you give me his chart, please?
- Yeah.
You know, I shouldn't even be working.
I put in for worker's comp a month ago
on account of my knee that
got smashed lifting a patient.
You think that they approved that, no.
You sure these numbers are accurate?
Yeah, well, they were this morning.
You didn't see how high
his blood sugar was?
Yeah, that's normal for out here.
That's not normal for him.
His diabetes has been under control
on insulin for the past 12 months now.
And how was I supposed to know
that? What is he, a patient of yours?
You've got his respiratory rate as 18.
- Did you actually count them?
- What do you mean?
Did you count each breath,
Raelene, or did you just guess?
I looked. It looked normal.
I didn't have time to stand
there for a whole minute
and count every breath.
Did you do an ECG, a blood gas?
I couldn't get a needle near him.
Was he this confused on presentation?
As I said, he was aggressive
and he reeked of alcohol.
- He would not let me do anything.
- Raelene, which was it?
Was it agitated or was it aggressive?
It was both, I guess.
Matty, get in here with my kit.
So you have really never noticed
the alcohol smells of ketones
on a diabetic's breath before?
Or just not on guys that look like him?
Grab that end of the bed.
We need to do a blood gas to
see how acidotic he's gotten.
- Jimmy.
- So you guys deal with this guy a lot?
He's Wayne's brother, and he's
been doing well for a while now.
Alright, let's package Briony up
for transfer for CT and further tests
and let Mira know
we've got two patients.
Do I tell her it's Timmy?
She's going to find out sooner
or later. Come on, let's move.
Wow. Like stepping
back in time, isn't it?
As long as it's got a firm bed
and a mini bar with a cold beer.
I feel like I've sweated
out about six kilos.
It's the bogged-plane diet.
Right. This is me.
Have a lovely evening.
- You too.
- You too. Thanks, Grae.
- Thank you for today.
- You too.
- Night.
- Night.
Clearly it was a mistake me
doing the review, wasn't it?
You don't disagree?
I already said I don't mind.
Well, your demeanour suggests otherwise.
- What demeanour?
- This.
Eliza, I don't have a problem
with the review or with you.
Clearly you do. I feel every time
We both know I have no
control over how you feel.
Look who's dating a therapist.
What's that?
Nothing. Have a good evening.
I've got a 50-year-old male
with diabetic ketoacidosis.
PH 6.9, ketones 9.5,
initial blood sugar of 52 with, um
Sorry, with insulin,
dextrose and potassium
going through a central line, thanks.
How is he?
His blood pressure is OK.
Hopefully his potassium stabilises.
I meant how's your brother?
His nails are too long.
He needs a shave.
His hair could do with
a wash, but he's OK.
Looks like Dad.
I'm heaps better looking
than you. (LAUGHS)
How are you feeling?
Ah. Oh, shit. Uh.
No, no, no, don't try and get up.
Don't try and get up. You got
all these lines here, look.
They're going through your
neck. They're keeping you stable.
Where the hell Where the hell am I?
You're racking up some more
frequent flyer points with the RFDS.
Oh, shut up, Wayne. I am not.
Yeah, we're halfway to Adelaide.
You got really crook in
Menindee with your diabetes.
When's the last time
you took your insulin?
Oh. I forgot it when I went
out hunting with the boys.
I just suddenly got real crook, eh.
What's wrong with you?
Eh, you look like you've been crying.
You scared me.
I'm sorry, Kaku.
I haven't heard that name in years.
I need you for this kid.
You don't need me. You'll be right.
Except with the footy. You
can't teach him how to kick.
- Teach her, actually.
- (LAUGHS) Fair dinkum?
We're gonna have a girl?
Oh, well, I guess girls
can play footy too now, hey?
- Oh.
- Hello.
- Didn't think you'd answer.
Didn't think you'd want to talk to me.
I was way too harsh.
But fair.
Didn't have to stick the boot in.
No, I think you did.
I have no idea what
I'm doing at the moment.
I can't remember anything,
my eyes are drier than the Nullabor,
and I have this overwhelming
anger about the smallest things.
This sounds really tough. I'm sorry.
Anyway You checked in?
Yeah, ta. Got my beer,
got the crossword.
OK, hit me.
Alright, uh, Japanese practice of
fixing broken ceramics with gold.
Eight letters.
Wow. She's on fire tonight.
If you call tracky-dacks,
a dirty bottle of shiraz,
and a small tub of ice-cream "on
fire", then, yeah, I'm scorching.
Smoking hot. Wish I was
right there with you.
Um, seven letters, beginning with O.
Difficult and unpleasant to deal with.
Oh, God. I'm sorry.
No, don't be.
I was confused, mostly.
I had to look it up.
Anyhow, uh, I'd better let you go, hey.
Oh, OK.
Unless you want to keep talking.
Well, I've got wine and you got beer.
Alright, what season of
RuPaul's Drag Race are you up to?
Oh, good. We're going highbrow.
Well, I do find it rather educational.
I really like the British
seasons. They're my favourite.
Ow, ow, ow, ow, ow, ow.
Ow, ow!
No, no, no, no, no,
no, no, no, no, no, no!
Ow! Ow, Ow!
Knock, knock.
It's open. Come in.
Oh. You alright?
I'm just an idiot. I can't
believe I let this happen again.
I get kidney stones when I'm dehydrated.
Yeah. Um
Well, I got your painkillers,
Hydralyte, and Maltesers.
(LAUGHS) You remembered.
Well, only because it's
insane to pick these over M&Ms.
Hey, can I ask you something?
Yeah, sure.
Why did you cancel that holiday?
Uh, yeah.
Everything was complicated.
You know, work and life,
and, I don't know
I guess I was scared.
- If things between us went
- Badly?
We'd be stuck in London
together for two weeks.
Or if things went well
and we were together in
London, and at the end of two weeks,
I was stuck - again - wondering
what the hell I should do.
Ow, ow. Ow, ow. Ow, ow, ow, ow!
What can I do?
Oh, nothing. Just
Just please, just
Oh, no. Just This is
mortifying enough. Just
Just, just stay there, and
I'm just going to die quietly
in the bathroom from the pain or
the shame, whichever comes first.
Ow! Ow, ow, ow!
You OK?
Thank you for everything
you did for me, brother.
Oh, it's here.
Something's not right.
Oh, shit. He's tombstoning.
Grab the G10 and the aspirin.
- You're alright, brother.
- Are we gonna make it to the hospital in time?
No, no. I'm drawing up a
full dose of thrombolytic.
Oh, hey, listen to me, listen to
me. I've gotta tell you something.
I want you to hear me, OK? Look at me.
You're having a heart attack.
But I'm giving you this medicine here,
and I expect it to help you out, OK?
- Here, mate
- You're going to be OK.
take this aspirin.
Yeah. There you go. There you
go. You're right. There you go.
- Shh.
Wayne, have you seen his
Advanced Care Directive?
No CPR, no intubation, no ICU.
- Yeah, I've seen it.
And have you seen his wishes?
What wishes?
Gotta get the pads on. Here we go.
Hey, listen. There's
a blockage somewhere.
That medicine I gave you, it's not
working as fast as I hoped it would.
Hey, so we've got to find
something else. Hey, look at me.
I'll find something else.
And this form you got here?
Listen, this form you got here,
it says if your heart stops,
you don't want me to
press on your chest,
put the tubes in your lungs, OK.
- Are you sure about that?
- Timmy.
Hey. Are you sure? It's your
choice, Kaku. Hey, listen to me.
- It's your choice.
- No.
I need you to be clear, OK?
You want me to resuscitate you?
I don't want to leave you,
but I don't want none of this.
I don't want none of this.
Oh, but, brother, you know
how black my heart is, brother.
You take me home. You take me home.
Ha. Oh.
Can you hear him, brother?
No, no, no, no. You stay with me.
Kaku. Hey, brother. Hey, Timmy. Timmy.
- Mira, we need to shock.
- Yep. Copy.
Um, oxygen away.
- Shock again.
One more.
Oh, God, no.
No, no.
I love you.
I love you, brother.
I love you.
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