ALWAYS
AND
EVERYONE

Episode Eleven

Episode Summary:-

Things are a little more hectic after the somewhat slack spell we saw in last week's episode. In fact, organised chaos probably describes it quite well!
       This week's cases: Lou arrives at work to find the team fighting to stabilise the victim of a stabbing to the heart - not helped by either Mr Roxborough (the cardiothoracic SpR with an attitude problem) or the girl's panicking father. Despite Roxborough's disparagement of Rob's treatment ("veterinary medicine") the team do manage to stabilise the woman preparatory for surgery, at which point she's handed over to Roxborough (accompanied by Rob's great parting comment - "Now it's your turn. Don't cock it up.")
       Andrew, who appears to be having another bad day, upsets the mother of a charming little tyke who has fallen down the stairs but is essentially uninjured: she later makes a complaint about his attitude (not that anyone seems to take it terribly seriously. Mind you, under the circumstances that's not surprising...)
       Stuart treats Ginny Butler, in A&E with a nasty but apparently innocent laceration on the palm of her right hand - but her account of how she got it keeps changing...
       James is rushed in by ambulance, suffering from a bowel obstruction: Rob hands him over to David for treatment (initially somewhat to the younger doctor's dismay!)
       A badly burned homeless man who had been lying, ignored by passers-by, at the station for hours.
       A ruptured appendix, and Kate's 'fitting' diabetic, are also mentioned but not seen.
       And amongst all the rush, a group of students are visiting to see what goes on in an A&E department...

Last episode saw the department qui... (oops - nearly said the Q-word!) slack enough for David to sit and chat with Billy Duncan after suturing his hand. In this episode everyone is rushed off their feet. It's another of those carefully structured elements that make the series so realistic - that combination of unrelenting pressure when the department is at its busiest contrasting with the less fraught periods (although even these can be stressful, since we can never know what's going to happen next.)

It was good to see Alan and Freddie again - I do like the interplay between the pair! So Alan's going to try for the supervisor job that Freddie has just talked himself out of? That won't go down too well!

I was happy to see the Mike/Stella problem resolved in such a mature way - even if it did take Ritchie locking himself in the toilet to make it happen! I found myself staggered by Stella's amazing lack of awareness (calling Mike a part-time father? And whose fault was that, pray?) and her obvious belief that she would be awarded custody. Mind you, it could have gone that way. There were obvious pros and cons on both sides: Stella can offer the boys a full-time parent, and the fact that she's overcome whatever it was that affected her for so long bodes well for the future stability of her family. And she's right - the A&E department is not an ideal environment for children. But Mike has looked after them amazingly well - "We're a unit. We're close." - under very difficult circumstances. But I think the clincher was that the boys feel very little resentment towards their mother - which could only have been due to Mike refusing to give in to what must have been the almost overwhelming temptation to disparage Stella. To agree to their going camping in France with Stella is big-hearted of Mike (although after hearing Stella's "We both love you and we both wanna be with you and it's hard." I think he had a better idea of how she felt than previously). I hope Stella isn't going to try to take advantage of that. Gentle persuasion works far better with Mike than threats.
       But I do wish he hadn't shaved off that incipient beard and moustache. They really did suit him...

Cathy still looks rough. Is there something seriously wrong, there? (Other than general disillusionment, I mean.)

So David is rapidly becoming Rob's blue-eyed boy. You've got to admit he was great though - especially with the students. The boy will go far! (But is Kate developing a 'thing' for him?)

Andrew remains a puzzle to me. He has a little boy quality that's very appealing - and a very nasty, hurtful streak to offset it. Were his words to Chris motivated by spite? Whatever the reason, it's a fine piece of acting - I'm fascinated by the way the character is developing.

Stuart's role was interesting and complicated. What seems at first a fairly straightforward injury gradually assumes far more profound implications as Ginny moves from chatty 'normality' to uncontrolled panic: it's obvious she's very disturbed (and I fully understand why she feels that way), but Stuart insists on keeping his word to her (I've said before he's an honourable man - even when, as Lou points out, it results in his putting the A&E staff at risk). He admits he's not qualified to deal with Ginny's mental problems - but then tries to talk her husband out of having her sectioned. You can take respect for patient's rights a little too far... But it's his words to her - "It's a disease like any other. It's curable, but you have to meet us half way." - that finally persuade her to go with the psych voluntarily. And there's real hope for her, too - "I might be down, but I'm not out." I just hope she can find it in herself to forgive her husband. He's only trying to help...
       While I thought Rob's summing up of Stuart was a bit blunt - "did well: might make an OK registrar one day" - I can see what he means. Stuart is a lovely character, but he doesn't have the drive to go very far. But then again, heaven help the medical profession (and the patients) if everyone wanted to be a consultant!

And then there's Lou... Poor Lou. Exactly what happened in her past to make her the woman she is? As Rob points out when checking her wrist, "You really don't like relying on anyone, do you?" She's always so keen to go 'by the book' whenever there's a danger to herself or her colleagues - to have the police or security involved. I'm going to hazard a guess it has a lot to do with her words when the burns victim is brought in - "Why didn't someone report an assault?" Was she assaulted? And by whom? And when?

Chris really is faced with a dilemma. Not only does she now have to contend with the gossip about her and Rob (which I would assume is actually gentle and amiable rather than otherwise, as they are both well-respected and fairly popular), but she also has to think ahead. If she does become a consultant at St Vic's after her exit exams, would others see it as because of Rob? Because she wants to be near him? Because he 'pulled strings'? (I don't know whether that happens in the medical profession - but since it happens everywhere else I wouldn't be at all surprised!) And as Andrew pointed out, she doesn't sleep with workmates on principle (hmmm... so presumably the times they've spent together were all quite innocent...) But she's a good and valued member of the team at St Vic's. I can't imagine her really wanting to leave. In the meantime, she's attempting a bit of damage limitation - and puzzling Rob in the process. The fact that he doesn't seem too bothered by it does suggest their relationship is comfortable and easy rather than passionate!

And Rob? Rob is his normal competent, confident, inspiring self.

Notes

SpR - Specialist Registrar. A training post.
       "Four. In a night." [Rob] I assume he was joking? Though given his Army Medical Corps background... Back

Surely if she was suicidally depressed Mike would have noticed? Or did she try to hide it? We already know Mike isn't the most perceptive of men (actually that goes for most of the men in the series - I'm not going to mention men 'in general'..!) so maybe he really wasn't aware of what was happening, especially if, as Stella says, he was intent on advancing his career. I liked that telling little exchange -

              [Mike] "So it's my fault now?"
              [Stella] "No - but it's not all mine, either."

       At least Stella recognises the fact. Back

From Dr Irvine - "When Stuart was talking about 'sectioning' Ginny, he said it was for 28 days. There are sections for that length of time, but they aren't normally instituted in an emergency.
       The Mental Welfare Commission exists to look after patient's rights. The commission members include psychiatrists, nurses, social workers, lawyers and lay people. Doctors can't section someone for say, just being drunk or under the influence of drugs - despite what that person might be threatening to do to either themselves or others. The whole process is very complicated: there are legal papers to be signed, these have to be properly registered and followed up.
       But if a person is deemed to be suffering from a mental disorder, they refuse to be admitted to hospital, and are thought to be a danger to themselves or others then they can be detained or sectioned. Generally as it was shown, it is much better to try and get the patient to be a 'voluntary' patient as opposed to being sectioned but sometimes it has to be done - and there are very strict rules regarding this.
       An emergency order lasts for 72 hours, a doctor plus nearest relative or mental health officer (social worker) are required to sign the form. This is so a patient can be assessed. Often once they have been admitted and treatment has started, if there is an improvement, the section is allowed to lapse if the patient agrees to stay for treatment. (If further time is required then other parts of the Mental Health Act will be used.)
       There is an assessment order which does last for 28 days. This needs two doctors (one of whom needs to be qualified psychiatrist, the other can be the patient's GP), an MHO or relative to sign. There are also orders which last for much longer, but which have to be applied for through the courts. In those cases the patient would have legal representation." Back

Wonderful acting, great direction, and a wholly believable script, all working together to take clichés and make them really mean something. Back

I'm told that if a doctor suspects that there is a fracture of the scaphoid bone (a 'clinical scaphoid fracture'), it's normally treated by being put in a cast for two weeks. This particular bone of the wrist doesn't always show up as being fractured when X-rayed, and if it's not treated properly and immobilised in a cast it can lead to long term wrist problems. If it was sufficiently painful for Rob to suspect a fracture, having an X-ray should have made no difference to the way it was treated - it should still have been put in a cast. However, with a cast on Lou couldn't work or drive, so her refusal to have it treated properly, as well as emphasising the dogged, self-willed, self-reliant aspect of her character, also means that she can continue working. After all, we all want to know what she decides about the baby, and we can't do that if she has to take two weeks off while her wrist heals (well, OK, we can since the nature of the programme means the next episode could be set two weeks later - but you know what I mean!) Back

Dr Irvine tells me that this episode confirms that Chris is an SpR. The training lasts for five years, at the end of which are the exit exams - examinations for each individual speciality. These, along with an interview, have to be passed before the individual can be considered for a consultancy - which isn't necessarily as straightforward as was made out here, since it depends to some extent on the competition! Back