Maternal (2023) s01e06 Episode Script

It's my husband,
I think he's overdosed.
- OK.
- I'm a doctor. He's got a weak pulse,
and I think he's going
into respiratory arrest.
- Guy.
- Pinpoint pupils.
Can we try naloxone?
He's coming round.
Guy?
Guy, can you hear me?
Guy. Guy, can you hear me?
- What've we got?
- Overdose. Naloxone administered.
He'll be coming round
and ready for you on the acute ward.
- Bad news for City last night.
- Nah, it's a test of faith.
We'll pull through, you'll see.
Just got to make the most of
Forty-year-old male.
Presumed opiate overdose.
One shot of naloxone.
Still low-level consciousness,
and I'm concerned
about his resp rate.
On my count. Three, two, one, slide.
Guedel airway, resps are low.
Saturation's 93%.
I'm not happy about this
level of consciousness.
Resp rate's dropping.
- He needs another shot of naloxone.
- Get me another shot of naloxone.
Guy?
Get a naloxone infusion set up.
Go and get your consultant. Guy?
- What?
- Get Marco.
Resp rate recovering.
Oxygen saturation's improving.
Catherine.
- Have I got my dates muddled, or?
- Er, yeah.
I came with a heart. Been in
a transplant operation all night.
Oh, wow. How did
And I was just filling Lars in
on the new hierarchy.
Great.
Oh, well, elective
backlog calls, so
Catherine, would you swing by
my office?
- I've got the investigation panel today.
- When you have a moment.
Sure
- I was going to tell you.
- I'm sorry.
- Yeah.
- Yeah.
It's not
Actually, are you free for a minute?
- Yeah.
- Thanks.
Hello, Sami's sister.
We met when you were born.
You probably don't remember.
I don't know what to do.
I'm scared of what will happen
to you if
we don't take you.
I'm scared of what will
happen to me if we do.
And none of this is your fault.
I can't keep this up, Lars.
It was supposed to be
a tough few months
until I got the consultant job.
I'm paying as much as I earn
in childcare,
and I'm barely seeing her.
Well, you know,
there is another solution.
Get another consultant's job, yes,
but that's gonna take some time.
Elis could come live with us.
I Look
I'm not judging your parenting.
But this is pragmatic.
But you think she'd be best-off
with you.
Well, you can't do
General and Trauma
and raise a child on your own,
you said so yourself.
I could retrain
and change specialties.
You'd be happy just throwing away
a decade of education?
- There are ways I could build on it.
- Do you wanna give it up?
Why should I have to?
I mean, you didn't have
to give up your career.
Cos I have Brigitta.
It's a wonderful
amazing place to raise children.
And you'd still be part of her life.
Just a different balance. Right?
And you're right,
why should you have to give up
on the job that you love?
The job you're good at
so good at.
Just think about it.
Mae, I can't talk right now.
Sorry, I know you've got
the investigation today,
but Jakub Wozniak is back
with another chest infection.
They're asking for you.
Wh-What shall I?
I-I'm on my way.
It's not appropriate
for you to be here.
We agreed restricted duties
for your own sake.
I mean, it is visiting hours,
so I could just wander in there.
He's not responded
to three rounds of antibiotics.
- A line for the fourth has just gone.
- Can I go in?
I mean, where do we
stand legally if I treat him?
Maryam
I don't think there's
very much clinically
that you can still do for him.
Even if we trialled a fifth round,
he's got no veins left.
- We're not winning.
- Well, let me try, at least.
Come in with me, and
then we can say you did it.
Dobroho ronku. Zoya, Kateryna.
- Hi.
- Hello.
Pryvit, Jakub.
That is a tiny vein.
Well done.
Dyakuyu.
Helen, where have you been?
Didn't you get my messages?
Lars has just
Helen?
Catherine, it's not time yet, is it?
Hi.
Have you seen him
since they brought him in?
No. I'm the last person
he wants to see.
Why wouldn't he want to see you?
- You saved his life.
- He didn't want saving.
If Maggie had remembered his
Fuck! I haven't dropped off
Maggie's swimming costume!
Fuck
I don't understand
how things got so bad.
He got suspended, er, a couple
of days ago for drinking on call.
Oh, God.
Well, how'd that happen?
How'd they?
I reported him.
You know, this isn't your fault.
He found out that I
slept with someone
else.
Hiya. We can't get him onto HDU,
he's on the Acute Ward.
- He can't be on his own ward!
- There's no space anywhere.
He'll be with his
patients, for God's sake.
No, it it's fine. It's OK.
Is he there now, or?
- Yeah.
- OK.
- I'll come with you, OK?
- Yeah.
Settling in, then?
I officially start as
Consultant yesterday.
As promised, new rota.
The trust waived my
notice period so I can
- pitch in clearing the waiting lists.
- Jack, I
I'll be taking on
an extra elective list
on a Saturday, where possible.
I'm either on call, on nights
or on weekends the whole
Three out of four
weeks, I'm on call!
Yeah, well, with
my promotion, it's
It's what the department needs.
You're gonna have to
look at this again. I can't
You telling me you can't do
the job that's required?
What?
I can't do any favours, Catherine.
Take some time with it.
Let me know tomorrow.
Did you hear about Guy
Cavendish? Helen's husband.
He tried to take his
own life this morning.
Have you seen her?
Can you give me something to do?
Is he gonna be OK?
I'm so sorry.
Thank you.
I'm in love with him.
This is not your fault.
Whatever happened
between the two of you
whatever he said
or he didn't say to you
what he did this morning
is not your fault.
Do you hear what I'm saying?
You should go home.
No. No, I wanna
I'd rather keep busy
like you.
Can I sit with him?
When he's well enough for visitors,
it will be his parents
and his children.
Fuck! Fuck!
Helen.
Hey, stop!
Hey, hey. Come on.
Hey! It's OK. Oh, it's OK.
It's OK.
I keep thinking,
this time yesterday
If I could just go back and
And, what, stop him?
This didn't start
yesterday, though, did it?
I knew he'd been struggling.
I mean,
we'd we'd tried counselling
after he told me about Louise.
Fucking Louise!
- Not that I'm any better.
- Don't.
Your judgement was so loud,
it was practically a speech
bubble above your head.
I'm sorry.
- You know, right?
- Yeah.
Did you tell him?
Yeah.
- What did he say?
- Helen, go back and be with Guy.
I'm so angry with him.
I feel like I could kill him myself.
You'd have to use your left hand.
And how could he do this to me?
How could he do it
to the kids?
I mean, what the fuck
am I supposed to tell them?
Life's never gonna be
the same again, is it?
You'd tell your patients
to take it one day at a time.
How did I let this happen? Ow, fuck!
- Sorry.
- My hand's really sore.
I'm gonna be late
for Maryam's meeting.
Oh, "Help." OK I'll be back.
Catherine
just look out for her.
Go back and sit with Guy.
Our recommendation for actions
may include changes
to processes or systems,
or further training and support
for individuals.
We can
Excuse me.
We can offer stronger action
against individuals
where there is a case
for culpability.
So, shall we make a start?
Dr Afridi, as the lead physician
treating Edward Williams,
what prevented you from
administering antibiotics
within the recommended timeframe?
I gave what I believed to be
a direct instruction to Dr Segman
to call Microbiology,
so that they could find
an antibiotic
that Edward could tolerate.
But that call wasn't made.
The instruction to call Microbiology
wasn't in Edward's notes
at the time of his death.
Er, that was an oversight
on my part.
- It was an extremely busy shift.
- And your first full shift back
after, what,
28 months of maternity leave.
In an acute setting,
which was in breach of Dr
Afridi's return-to-work plan.
Did you raise concerns
about being given pagers
or being placed in CAU?
I definitely tried to say
something to Dr Fisher.
- We were by the hand-dryers.
- And you felt fit to practise?
Yes.
Let's make an exception
and give him more time.
All right.
Matt?
- Was that Psychiatry?
- Yeah, erm
I Basically, I told them
he's not fit to be assessed.
Do you think they'll section him?
If it's what he
needs, then, yeah.
I keep
thinking back over our
conversations, trying to find the
the language, or the tells.
I think I knew he was struggling.
He left a a note.
Do you think I
I should read it,
or give it to Psychiatry, or?
Shit, Helen, I don't
I don't know. I'm so sorry.
Thank God you found him.
What was the return-to-work plan
you put in place with
the training director?
We agreed we'd spend my first week
in a non-acute setting,
and then assess my readiness
to return to full duties.
But you were pulled out
of an IT induction by Dr Fisher
on day one to carry
the labour ward pager?
I'm struggling to find staff
to meet the MINIMUM requirements
across our services,
never mind meet guidelines.
Was Dr Afridi given the opportunity
to come off the
acute and on-call rotas
that she shouldn't have been on
in the first place,
immediately following
Edward's death?
No, she
No.
What support was
she offered, Dr Fisher?
Perhaps, and I regret
this assumption now,
I saw Dr Afridi
as a fresh pair of legs.
- My team are exhausted.
- I understand that Dr Afridi
has recently been placed
on restricted duties.
We both agreed that she should be
away from acute settings
until the conclusion
of this investigation, yes.
Do you think, in
hindsight, Dr Afridi,
that you might have come back
too early from maternity leave?
My instruction to
Simon wasn't clear.
This is to call Microbiology?
But I assumed he'd hear
it was for him, because
when I was an F1, I wrote down
every syllable my reg said.
I checked, I double checked,
I asked if I wasn't sure.
That was my training. You show up,
you arrive early, you leave late.
No matter how
insurmountable the challenge,
you always find a way
to make it work.
You don't make mistakes,
but if you do,
you take
responsibility for them.
That's the standard I've held
myself to my whole career.
Well, we appreciate
your candour, Dr Afridi.
Were there other instructions
Dr Afridi gave you during the day
that you understood WERE for you?
- Yeah, sure.
- Like?
Edward's urine dip?
Yeah.
But you didn't carry
out that instruction.
I thought she meant that I
could ask a nurse to do it.
Can I ask, Dr Afridi,
what did you think
coming back after maternity leave
was going to be like?
I knew we were short-staffed.
I'd heard a lot about burnout.
I knew we were struggling
to meet the challenges
children were facing
in their health and development.
And in yourself?
You said you felt fit to practise,
but did you feel
confident coming back?
No.
I felt tired.
I felt scared about being tired.
I felt rusty.
I hadn't cannulated a
patient in over two years.
I felt
I couldn't remember the doctor
I was before I had children.
- I feel changed.
- Changed how?
I feel like all the pieces
of who I was
have been thrown up in the air,
and
some of them still haven't landed.
Rather than asking someone
to judge themselves in hindsight
on their readiness to return
to front-line medicine
after maternity leave,
perhaps it would be more useful
to consider
why they weren't given
the support they needed
to ensure they were ready.
Why Dr Afridi wasn't
offered the support
to process the trauma
of Edward's death.
I'd like to bring us back
to the question
of why the sepsis guidelines
were not followed.
My clinical understanding
of Edward's condition
is that it was against the odds
that Microbiology
would have found
an antibiotic within the hour
that didn't send him
into anaphylactic shock.
And even if they had, we don't
know if he would have lived.
- I think Edward was let down.
- Yes, I agree.
Edward was let down
by the same systems
that let Dr Afridi down.
I understand the urge to pin
that failure on an individual.
Oh, it's so much easier
than fighting for real change
in a system.
Besides, Dr Afridi's right.
We keep finding ways in the NHS,
don't we?
Somehow, we make it work.
We try and hold it all
on our shoulders
because we're the ones
who have to look patients
and their families in the eye
and let them down.
It costs us something
to hold ourselves
to those incredibly high standards.
And when we're pushed
to maintain those standards
in impossible circumstances,
it costs us everything.
Hello. Hi! How are you? Are you OK?
I wore Ariana's
spare swimming costume!
Did you? Aw.
Er, she's not staying
for after-school club today.
OK.
- Mummy, it had Nemo on it.
- Did it?
Oh, can I have a cuddle?
Good afternoon, Dr Cavendish.
You're on AMU. Naloxone infusion.
No intubation.
- Here.
- Oh
Don't look too cogent,
Psychiatry have been round.
- Don't.
- Don't what, mate?
We didn't look after them properly.
We should've done better.
I expected to feel
this wave of relief.
I feel like I got away with it.
I've thought about him
every day since he died.
I know I could have done better.
That doesn't sound like
getting away with it to me.
I don't know what to do with myself.
I didn't expect
to still be a doctor.
I think the question is, do
you still want to be a doctor?
Are you on call?
No, but I think
- I have to scrub in anyway.
- Hm.
Holding yourself
to impossible standards.
Catherine.
Thank you.
Call you later.
Did the line hold?
No.
I know them best.
I'm OK, honestly.
Swab.
He's just fucking hosing.
I can't see anything.
Can someone sort the fucking lights?
Blood pressure still dropping.
- Mind if I assist?
- What are you doing here?
Fourteen year old hit
by a car, ruptured spleen.
Have you divided
the retroperitoneal attachments?
I can't get to them.
Blood pressure still dropping.
We need some more blood.
Jack.
Jack?
Yeah.
Can you get to them?
I can't see the splenophrenic
or the splenorenal.
No, still can't see them.
When it's bleeding like this
you need to feel for them instead.
Scissors, please.
Run your scissors along your fingers
like this.
OK. Roberts, please.
Second Roberts.
Blood pressure stabilising.
Hold the tray up a bit higher
for me. Thank you.
Spleen out.
- Ligate or transfix?
- Always transfix. Stitch, please.
Some scissors, please.
Yes?
Thank you.
Clamp off slowly.
OK, let's tidy him up.
- More warm wash, please.
- No. No. That's enough.
Catherine, can you close him up?
Great work, everyone.
And, er, don't forget the drains.
I think this might be the time
to consider
that he may not survive this.
Sometimes, our job as doctors
is to accept there are things
that we can't fix.
So I think the best
thing for Jakub,
for you,
is to give him a death
with some dignity.
I can't.
- I can't tell her.
- You can.
I just saved
that boy's life in there,
not to mention your arse.
- Don't speak to me like I'm
- What? My junior?
Whatever's going on
between you and Helen,
you need to stop it.
What's coming next for her is
gonna be long and hard and messy,
and you're not
really up for that.
- I care about Helen.
- Then leave her alone.
I'm not your boyfriend any more,
Catherine, I'm your boss.
Then fire me.
But you might want to consider
having at least one
decent surgeon around.
His blood pressure is very low.
Things are slowing down.
Matt said that
you've been talking.
Maybe you don't want to look at me.
I wouldn't blame you.
Hello.
I'm here.
I love you.
Whatever you need to say,
I'm here to listen.
I'm sorry.
Me, too.
Do you need me for something?
I couldn't do what you just did.
Everyone thinks it's about
the heroics and the saves, but
this is what it means
to be a doctor.
For me.
You'll find out
what it means for you.
I don't think
I'm cut out for paediatrics.
What you got next?
Orthopaedics.
People don't die of bad knees
very often, do they?
Are you on today?
Yep. Come in!
Have you been here all night?
I can't do this any more.
- Catherine, is it?
- Yes.
Great.
Myofascial release therapy
is a massage technique
that breaks down the scar tissue
on your perineum
caused by birth trauma,
releasing the tension
in the web of muscles
that holds your vagina
and other pelvic organs.
This picture
I know where everything is,
I'm a surgeon.
I just want to be able
to have sex again.
OK. Why don't you just take
everything on your lower half off
and hop up so I can take a look?
I'll just warm the jelly up for you.
Now, it can be quite
an intense sensation,
so if you do need
a break at any point,
- just tell me to stop.
- I'll be fine, thank you.
OK. Here we go, then.
- Are you OK?
- Erm, fine. Never better.
Well done. When you're ready,
swing your legs round
and stand up for me.
I will step outside
so you can get yourself
back together.
You OK?
Sorry, I
It just feels good
I feel like I'm in my body again.
Good. You're OK.
Do you want a glass of water?
I can't let you take her.
I appreciate
what a generous offer it is.
You and Brigitta are great parents,
and Sweden sounds like
a wonderful place to grow up,
but I can't do it.
My body won't let me.
So are you gonna change jobs?
I don't know.
I'm gonna take it one day at a time
for a little while longer,
I suppose.
Yeah. Not sure that's good enough.
It's going to have to be.
I'll come by the flat later
and see her?
Maybe we can talk some more.
I'm sure Elis would love to see you.
There's not much
more to say, is there?
This This, erm
This arrangement that we have,
it's not sustainable.
- It's post-natal depression.
- Is it?
Cos whatever it is,
I need to find a way
to work through it.
Have you thought it might be PTSD?
Would it make you feel better
to give it a label?
You're a doctor,
I'm just trying to
I'm so tired of people telling me
how I must be feeling.
- What do you want me to do?
- Listen to me.
I'm listening.
I'm in no fit state
to take on another baby.
Don't. Please don't
say it, Maz, please.
This is the hardest thing
I have ever done.
If I don't put myself first,
I'm going to end up like Guy.
I mean, could they
give us more time?
There's another family.
That's why they're pushing us
so hard for a decision.
I'm sorry.
- Hi.
- Hi.
How is he? Sorry, how are you?
How are you both?
He, er
He's fit to assess,
according to Psychiatry.
I just wanted to say, er,
thank you for yesterday morning
for stepping up and
taking such good care of him.
It was really impressive.
I should go and be with him.
Oh, you know, they
were saying yesterday,
they're gonna need a locum
or someone to act up as consultant.
Yeah. Yeah. He's gonna be off
indefinitely, so
Did they mention any names or?
Right, I think they assumed
the most qualified person
wouldn't be up for it, so
you have to let them know
if you were.
Thanks, Tessa.
Mummy, catch the bubbles.
Fast asleep.
Are you sure?
Yes.
I need to check dates.
I don't know when I can
get back over here again.
I don't wanna leave her.
There has to be a
better way to work this.
- Can you move to Sweden?
- No, I can't.
Well
there has to be some way
to help you to
- I don't know.
- Me neither.
There must be a better solution.
When do you start?
I will be acting up
as consultant
as soon as I'm ready to come back.
So, I don't know, maybe next week.
A junior doctor no more.
You've made it.
Congratulations. Well deserved.
Slightly dark circumstances,
but thanks.
When are you coming back?
- I dunno.
- Give it a while. I might have to wait
till Professor Thomas dies,
and I don't want to be the last.
I'll keep an eye on the obituaries.
And all thoughts on alternative
surgical specialties welcome.
- Boobs.
- Very mature.
No, breast surgery.
They have these fellowships.
Because women do women's bits?
No, because it's all elective,
so the hours are decent.
Take as much time as
you need, though, Maryam.
It's really important.
- Oh how was the fanny witch?
- Oh, yeah.
Well, her power is real,
so, regrettably,
we'll have to burn her.
Does this mean
you can have sex again?
Yeah. Hypothetically.
- Oh
- Make good choices.
Do boobs pay well enough
to cover childcare?
You just paid someone
like 50 quid to get fingered.
And she said I still need
three more sessions, so
What?
Oh, wow.
You and vaginas, honestly.