[arrows whooshing]
[sombre music]
[indistinct hospital PA announcement]
[phone vibrates]
Yeah?
On my way.
[sighs]
[Richard] She'’s tachycardic, up from an hour ago, on Fibral.
Respiration 22 and pressure is down.
That's why we called.
[Elizabeth] Hello, Lisa. Hello.
My name is Elizabeth Taylor.
I'm the consultant surgeon.
This is my registrar, Richard Whitehead.
Lisa, do you know where you are?
Can you hear us all right?
Does it hurt when you breathe?
She's had no increase of pain at McBurney's,
so it doesn't look like appendix.
But she has had ten milligrams of morphine since 9:30
and ten megs of Maxolon.
The history?
[Richard] Um, it was one day of cramping abdominal pain.
Tender abdomen with guarding at the left iliac.
Was given trimethoprim, diclofenac and paracetamol,
and then sent away.
Fuck. They sent her home.
[Richard] She came back three days later in a lot of pain,
elevated pulse.
She was put on IV fluids and then transferred here.
Decreased urine output for two days.
Imaging suggests there's possible bowel involvement,
and notes there is also an IUCD in the situ.
[screaming]
Okay. Sorry, Lisa.
Sorry, Lisa.
[gasping]
Well?
Uh, clearly intra-abdominal catastrophe,
so immediate surgery to assess
for perforated bowel or appendix.
Extensive fluids,
transfer to theatre for laparoscopy, right?
I agree with immediate urgent laparoscopy.
Radiology suggests necrosis of the bowel
and abscess not amenable to percutaneous drainage.
She needs an operation.
Three units packed red blood cells,
cross-matched.
Prep for theatre.
Call Dr. Colton to consent her.
Lisa, we'll see you soon.
[ECG monitor beeps]
All right!
We will go in today using the Hasson technique.
Alex.
[Alex] We are... good to go.
[Elizabeth] Knife.
[Robin] Knife.
[Elizabeth] All right, we make a ten mil incision
just above the umbilicus,
right through the subcutaneous tissue into the fascia.
Kocher.
S-Bends.
[Robin] S-Bends.
[Richard] Thank you, Robin. Holding.
[Elizabeth] Thank you.
Knife.
Now, just a few...
fibres at a time.
And there's the peritoneum.
[Robin] Stitch.
Here you go.
[Elizabeth] Okay.
[Robin] Clip.
- [Elizabeth] Ready? - [Robin] Cut.
[Richard] This one's out.
Thank you, Robin.
[Elizabeth] Thank you. Now, we use traction.
Why?
[Richard] To avoid damaging the underlying structures
when we penetrate the peritoneal sheath into the abdomen.
[Elizabeth] Good, Richard.
- All right. Port, please, Robin. - [Robin] Port.
[Elizabeth] All right, we'll be inserting
three trocars into Lisa today.
Here we go.
[Richard] Uh, reducer. Please, Robin.
[Elizabeth] Give her the gas port there, Richard.
Thank you.
[ECG monitor beeping continues]
[Richard] That's set up.
- [Robin] Gas on. - [Richard] Thank you.
[Elizabeth] All right, maestro.
[Mei-Lynn] Yes?
[Elizabeth] Gas, please.
[Mei-Lynn] Gas is on.
Light is on.
[Elizabeth] There it comes.
[air blowing]
There we are, Richard. You guide it.
There we go.
Marsh?
[foreboding music plays]
Hmm.
[Richard] Well... uh, it's extensive pus.
[Elizabeth] Indeed. Sepsis it is.
All right, I'm inserting the second trocar now.
Yeah, that's good. Thank you, Richard.
Hold it right there, I need direct visualization, please.
Put it back in a little bit.
There...
Okay.
Thank you.
All right, what's going on with the gas?
[Mei-Lynn] How much pressure?
[Elizabeth] I need ten.
We need more flow,
more separation of the organs.
[Mei-Lynn] Flow rate is at six.
But we're not at ten yet.
[Robin] The tank was full.
[Elizabeth] Mei-Lynn, can you increase the flow, please?
[Mei-Lynn] Copy that.
[Elizabeth] Richard, do you want to put in the last trocar?
[Richard] Yeah.
Thank you, Robin.
[Elizabeth] Let's find you a spot.
Here we are.
[Richard] Thank you.
[Elizabeth] Honey, you've got plenty of room Richard,
you've got plenty of room.
You can see?
[Richard] Yeah.
[Elizabeth] All right, Richard. Time's ticking. Let's go.
[ECG monitor beeping increases]
[Elizabeth] Let's go. Give it some welly.
[Richard] Sorry.
[tense music]
[Elizabeth] Fuck! Quick, we need to open.
- We're converting. - [Robin] We're converting.
[Elizabeth] I need the B tray
and arterial instruments, please.
[Robin] B tray, please.
[Elizabeth] Pull the trocars out, Richard.
[Richard] Sorry.
[Elizabeth] Someone call Mei-Lynn back in right now.
- [Robin] Someone call Mei-Lynn! - [Elizabeth] B tray, please!
[Elizabeth] Alex, talk to me.
[Alex] Systolic 90. Pressure is falling now.
[Elizabeth] Of course it's fucking falling.
[Elizabeth] I need the B tray!
[Robin] B, B, quick, quick, quick!
[Elizabeth] Calm, calm.
Please, everybody, quiet.
- [Mei-Lynn] Diathermy?
- [Elizabeth] Uh, no. I don't have time. I'll do it myself.
Richard, hold that.
Alex?
[Alex] Heart rate is 160.
Pushing midribonol now.
[Elizabeth] Hold that, Richard.
Here we go. All right. I'm going in, Alex.
[ECG monitor beeping rapidly]
- Fuck! - Suction.
[Robin] Suction.
Retractors. I'll hold it. Retractors.
- [Richard] Yeah, we need... - [Elizabeth] Nice, Robin.
- [Elizabeth] Good. You got it? - [Robin] I got this.
[Elizabeth] Get the big one.
Pull it, Richard. Pull it.
- [Richard] [indistinct]
- [Robin] Yeah, Richard. - [Elizabeth] I got it. I got it.
- [Elizabeth] Packs. - [Robin] Packs.
[sighs wearily]
- Careful with the ureter. - [Richard] Mm-hmm.
[Elizabeth] Suction-- I can't find it.
Find it.
It's not the IVC,
it's the lumbar artery.
Put your finger on it.
Pressure.
- [Richard] Sorry. - [Elizabeth] Feel it?
[Elizabeth] Right there. It's pumping.
- Feel it? - [Richard] Mm.
[Elizabeth] Keep your finger on it. Clamp.
[Alex] Thank you.
[Elizabeth] Got it? Okay.
One more here. One more here.
Stitches.
Five-0, please.
[Robin] Stitch.
[cutting]
[Elizabeth] Okay.
The torrential bleeding from the vena cava
is controlled with clamps...
[sighs] ...and we move in order of urgency.
Richard has control
of the posterior tear with his finger.
The most urgent is the lumbar vessel
due to the volume of bleeding,
and I am focused on that right now.
There's a rent in the IVC...
which is clamped,
and severe lumbar bleeding in the psoas,
which is posterior...
and deep.
Currently sewing five-0 prolene.
[Alex] Looking much better now.
- [Elizabeth] Okay. - [Alex] Pressure is coming up.
[Elizabeth] Now for the original operation.
Let's wash out this pelvis, pop in a drain,
take out the appendix for good measure.
[Richard] Yeah. Okay.
Uh, I'm-- Elizabeth, I'm sorry.
[Elizabeth] Hey, just close.
- [Robin] Josie. - I need you on this retractor.
[Robin] Yeah.
[Richard] Okay, uh...
Okay, splash me.
- [Robin] Thank you. - I'll take suction. Thank you.
Fuck.
- [Richard] Yeah, well-- - [Robin] Suction.
[Richard] Uh, yes, let me.
Thank you, that's it.
[Robin] Suction.
[sombre music]
[door opening]
[Elizabeth] Unfortunately, I've got to reschedule
my next surgery.
Go tell Lisa's parents it went well.
Uh, don't you want--
[Elizabeth] She's out of the woods.
But surely you could explain--
[Elizabeth] Richard, it went well.
She's in recovery.
They can talk to her in ICU.
You're good with families.
Thank you, Richard.
[breathes shakily]
[Richard] Um, Mr. and Mrs. Williams,
I am Richard Whitehead, the registrar.
I'm with Mrs. Taylor.
Lisa's doing well. She's in recovery now.
I just want to apologize about the delay.
[distant sirens blaring]
[sighs]
[strained breathing]
[machine beeps]
[Jan] Just nice, deep breaths, Lisa.
Just easy breaths. Yeah.
That's it.
How's she doing?
Uh, she's stable.
A bit agitated about the mask.
[Elizabeth] Hi, Lisa.
It went well.
[foreboding music]
[breathing raggedly]
[foreboding music continues]
[register beeps]
[sombre music]
[door creaks shut]
[Elizabeth] Robin, did you get a taxi?
Uh, yeah.
Clear night.
[Robin] Um, yeah. It is.
It's beautiful.
- Want some chicken? - [scoffs]
Got a double shift tomorrow.
- That's shit. - [Robin] Mm.
- I'll talk to Alastair-- - [Robin] Mm-mm.
Please don't.
You can't do things like that.
It might ruin things.
You good?
Yeah.
Yup.
[both giggling]
[seagulls squawking]
[water rushing]
[phone vibrates]
[muted gasp]
Fuck!
[Elizabeth] All good?
Yeah, of course. Uh, five by three.
Walk beside me, Richard.
How are you doing?
[Richard] I'm all right.
Good. How did you hear?
[Richard] Hear what?
[sighs]
Richard, we lost the sepsis this morning.
I was texted on the way in.
She-- What? So she was what, in the ICU?
[Elizabeth] Yes, in ICU.
[Richard] Ah, I didn't know.
Yes, it's a bad outcome.
It's very disappointing.
Okay?
Yeah, of course. Yeah.
The sepsis was too advanced,
and she was likely never going to make it.
The trocar... did that-- Was that--
This was advanced sepsis, wasn't it?
You saw that yourself.
So we'll never know to what degree if any,
the extra time in surgery contributed.
Yeah... I suppose the complication--
The complication may have contributed,
but we'll never know how much.
Right?
So certainly didn't help.
Look, all we can do now is move on.
Get past it. Get better.
Learn.
Morning, Liz.
Good morning, Alastair.
Have you seen the staff photo on the website?
Yes. It looked like a group of prisoners
about to be taken out and shot.
[Alastair] Ah.
Well, maybe it was the black and white.
What can I do for you, Alastair?
Can we have a quick word?
Of course.
I'll catch up.
- Yeah, okay. - [Alastair] Thanks, Richard.
[Richard] No worries.
I'm sorry.
Um, hi, David isn't it?
- [David] Yes. - [Richard] Great, I've got--
Anyway, Alastair?
[Alastair] Liz, the family of Lisa Williams,
who died this morning, are asking to see you.
They're here now.
Oh.
I should warn you, they're very distraught.
They were under the impression that when she was admitted,
yes, it was an emergency,
but an appendix or something like that.
They feel very caught off guard,
and they say they're very unsatisfied
with the explanation from ICU.
Who spoke to them from ICU?
Ben Matthews.
Ben was the intensivist.
[sighs] Andrew.
Elizabeth, how are you?
Well, I'm happy to speak with them.
And what are you going to say?
I'm going to tell them what happened in surgery.
I wasn't there in ICU.
Okay.
What really happened, Liz?
Well, you've obviously read the notes.
Uncontrolled insertion of a trocar
leading to internal damage--
...Which was unrelated to the galloping infection
that led to her fatal deterioration in ICU.
"Unrelated"?
Yes, that's what I said.
Okay...
But you know what you're going to say.
You've got it in hand.
[Elizabeth] I think well in hand.
- Okay. - Thank you, Andrew.
Actually, I just wanted to ask you
if you're coming to the conference,
the Surgical Safety and Measurements Jamboree?
Yes, Andrew. I will take that one for the team.
Actually, I want the whole team to be there. Richard, Robin.
I think it's important.
It's... It's quite interesting.
[Elizabeth] Interesting?
Well... it is about publishing results.
That's our new reality.
Our surgical results are going to be published in the paper.
Mortality, complications.
My results, you mean.
True, your results.
Everything under your watch.
But I don't think it's, uh...
I don't think it's necessarily a bad idea.
It will incentivize us to avoid very sick patients
and it will affect training.
Liz, the family are waiting in the Whanau room.
Thank you.
Andrew.
Elizabeth.
[tense music]
[sad music]
I'm so sorry for your loss.
Well...
This is what happened to Lisa.
Lisa was very sick when she came to hospital.
Some of her reproductive organs had become infected.
We believe this was because of her IUCD.
That stands for "Intrauterine Contraceptive Device."
Uh...
We needed to do what is called a "laparoscopy."
That's a kind of keyhole surgery
where we make a small hole
and... and use a small camera to look inside Lisa
and see... um... what's wrong with her.
And we could see that she was very sick,
that many of her abdominal organs had become infected,
and that she needed a...
a proper operation to help her get better.
And I can give you the details of that if you'd like.
I mean, we just don't know what happened.
We... We want to know more.
[sobbing]
Uh...
There was a complication during the surgery.
We had to make a larger incision than initially planned.
What complication?
[Elizabeth] As I said, her IUCD had become infected.
And, um, we don't know why at this point.
But there are many reasons it could have happened.
Lisa was moved to intensive care after the surgery,
and I was not directly involved in that.
We just thought, "Oh, it's her..."
We just thought her appendix had burst,
which is why it was so bad.
[Elizabeth] I'm sorry.
I know this must be very hard,
but it was not to do with her appendix.
Lisa had trouble breathing in ICU.
The infection was too much for her body,
and this led to her cardiac arrest.
She's in the morgue.
[angrily] Our daughter is in the morgue.
Wh... What's your name?
Elizabeth Taylor is my name.
[camera clicks]
[sighs wearily]
[sombre music]
[siren blaring in distance]
[Andrew] Welcome, everybody,
to this week's M&M.
So we'll start with the Lisa Williams case.
Anaesthesia, nursing, as well as surgery.
Glad to see you.
Uh, excuse me. Where's Dr. Matthews?
Well, Dr. Matthews is an apology.
Dr. Matthews was the intensivist
on Lisa Williams,
- the main case today. - Well...
I'd like to call for this meeting to be adjourned.
[Andrew] Oh... Why, Liz?
Without Dr. Matthews, what's the point?
Well, the point is that
this is a morbidity and mortality meeting,
and in it, we're going to be discussing in particular
surgery and mortality.
The mortality in this case is not related to the surgery.
It's related to her advanced sepsis,
and the nearly 12 hours of intensive care
that failed to save her afterwards.
No, this is just an M&M.
We're not apportioning blame.
Um... Blame?
No--
I want to know what happened.
Family want more information.
What information?
I've spoken to them already.
Well, let's just say their acceptance
of their daughter's death is not yet settled.
Okay, this is so fucking stupid.
Why would that be stupid, Liz?
[Elizabeth] It's stupid, Andrew, because...
We can go through our notes,
you can talk to my team till you're blue in the face.
But we can't possibly know what happened with this girl
without ICU and their nurses here,
because they took over her care
and she died on their watch.
[Andrew] Lisa Williams' parents have questions about errors
made by the surgical staff, not ICU.
They want to know about complications in the surgery,
your surgery, because you told them
there were complications for Liz... apparently.
[chuckles] I mean, for Lisa.
Am I right?
[inhales sharply]
Or...
am I being stupid?
Right. Let me just summarize.
- Anaesthesia started at 1:40. - Yes, it did.
- And the surgery at 1:50. - Correct.
And the gas port was inserted
into the abdomen and, uh, insufflation commenced.
Robin?
Yes. Yes, that is correct.
And you say here in your notes
that Mrs. Taylor verbalized that there was no gas.
Insufficient gas.
I-I said in my notes
that, um, Mrs. Taylor said there was insufficient gas flow.
What did she mean?
What...
She meant there's insufficient pressure of gas in the abdomen
that lifts the peritoneal sac
away from internal structures
that could be damaged by insertion of instruments.
And what was the pressure at that point?
How much gas was in her abdomen?
I mean, frankly speaking,
was it safe to go sticking things in her?
Well, I don't know, Doctor.
Ah! You don't know?
[Alex] She can't know!
The indicator on the insufflator reads "enough" or "not enough."
When the belly is inflated, the gas slows down
as the pressure doesn't let it in there.
The theoretical pressure needed inside the cavity is ten, sure,
but there's no actual gauge that measures that.
It just says the flow rate is or is not high enough
to inflate at that level.
- [Andrew] Okay. - Okay or not.
We had direct visualization of the organ space.
[Andrew] Okay.
And at whatever actual pressure it was,
in my clinical judgment,
there was sufficient pressure--
To insert the last trocar?
Yes, Jason.
Jesus, Jason. There's no definitive timing.
That's what you do.
You use your clinical judgment.
So, who inserted the last trocar, Liz?
Who put it... the trocar in?
Uh...
I did.
[Andrew] You inserted the last trocar
that caused the damage to this girl,
which was a rent in the inferior vena cava,
cut in the posterior abdominal wall,
a tear in the lumbar artery--
Yes, yes, which we repaired, of course.
[Andrew] Okay, good.
Good. Yes.
Okay.
[sighs] Look, it was more complicated than that.
I instructed my registrar, Richard Whitehead,
to make the incision and insert the last trocar,
and he did.
Oh, so Richard inserted the last trocar.
I'm the team leader.
I'm the lead surgeon.
It's my theatre.
Under my instruction,
Richard inserted the last trocar,
which failed to penetrate.
I told him to push harder.
[Andrew] Told Richard...
I said to give it some welly.
"Welly."
That's right.
[sombre music]
Would you look at this gorgeous creature?
[Elizabeth] You're a dog mother.
[Jessica] Have you ever seen anything so photogenic?
- He's like your child. - [Jessica] Mmm.
He's great company.
What's new?
[Jessica clears throat]
You know, it's...
It's complicated.
I met a really smart guy.
[sighs] And your marriage?
[Jessica] It's over.
- Yeah. - [Elizabeth] I'm sorry.
Yeah, I know. It's shit, really.
[sighs] I had a shit week too.
Yeah.
[Elizabeth] Complicated, as you say.
Mm.
Um...
So I really hate to ask, Liz,
but is there any way that Atticus
could stay with you for a little while?
- The dog? - [Jessica] Yeah.
[Jessica] It's just because I'm...
I'm moving into his apartment,
and-and you know, it's no good for a big dog.
There's elevators and stuff.
And Stephen won't take him because he's punishing me, so...
But it would just be for a short term.
Jess, no. I really don't--
I really don't think I can.
Atticus is so old, Liz.
He's totally house trained.
All he does is just lie around in the sun all day and sleep,
and he'll be your best buddy.
I am never home.
Oh, God. Fuck. Don't worry about it.
We're never home either. He's totally used to it.
Robin, where are you?
I want you to come over.
Do you want to?
Um.
Hey, I'm sorry I've been so distracted by everything,
you know, all the shitty fucking shit.
Jessica is making me take her dog.
[laughs]
It's such...
Uh... Okay.
Bye for now.
Call me.
[uneasy music]
[distant crackling]
[sombre music]
[Atticus barks]
[Te] You have been invisible to your patients
and your performance levels have been equally invisible
until now,
because we are going to be publishing
surgical outcomes publicly.
This, of course, raises profound questions,
because once publication starts,
patients and potential patients
will assess your track records and compare you to others.
Of course, they won't know that the surgeon down the road,
who has much better statistics,
only qualified six months ago,
and has operated on a grand total of seven young,
non-smoking white patients,
whilst you have been in the trenches,
operating on the morbidly obese, the diabetic,
elderly brown folk with histories of falls
and gout and respiratory disease.
You will be compared surgeon to surgeon,
and every case of everyone who has ever died
underneath your scalpel
will be on full public display.
Every surgical site, infection, every nicked aorta.
Will some surgeons be forced to retire?
Maybe.
Probably.
Will some surgeons be treated unfairly?
Yes, most likely.
Why, then, should we allow this,
even encourage it?
Transparency and informed consent.
And I'm talking about real consent,
not just a scribble on a piece of paper
moments before operating.
In the broader context, a surgeon--
Sorry. I'm sorry.
Yes?
Liz Taylor.
Yes, Mrs. Taylor?
This will turn surgery upside down.
It is inevitable
that good surgeons will be treated unfairly.
You just said so yourself.
And it sounds like you accept this.
Well, isn't being transparent about your results
what a good surgeon does,
so that your patients are able to give informed consent?
Okay, look, sorry if I'm-- [chuckles]
Maybe I'm coming off like a tendentious bitch...
- [chuckles] - but this is important to us.
Publishing results is a bad idea.
We will avoid very sick patients.
Why risk adding someone who will likely die to my numbers?
Why should I take that risk?
Changes everything.
Which surgeon will give their registrar a go,
if when it all turns to shambles,
it goes on their record?
[Andrew] Liz.
That's... That's a good point.
Lots of good points.
But what we're talking about here is resources.
No! We're talking about numbers.
- Well-- - I'm talking about numbers.
We're talking about ranking people
best to worst in league tables
using data that is insufficient and partial.
And surgeons will be hung out to dry.
[Te] Whoa!
It appears we have entered
the Q&A portion of our session
- slightly ahead of time. - [chuckles]
I just don't think we can be idiots about this,
and do it just because other countries do.
How many cardiac surgeons can we afford to lose?
Do you know how many we've got?
- Twenty-nine! It's not enough. - Liz.
Thank you.
Twenty-nine.
And according to him,
half are going to have to retire soon.
[Andrew] Yeah, okay. That's a good point.
But let's...
Doctor.
[sombre music]
[sombre music continues]
Very gripping stuff.
[Elizabeth] Wasn't it.
Interesting, provocative.
People will be crucified.
[Andrew] Yeah, some surgeons need to reassess.
You're not worried about your data.
The other specialties are nervous.
We're years behind the world on this,
and it's not thought through.
You're not nervous, eh?
'Cause you're brilliant.
You're absolutely brilliant.
But, um...
Elizabeth, unfortunately, it falls to my lot
to tell you that there's been a...
formal complaint.
[Elizabeth] A complaint?
Formal complaint. Lisa's parents.
When were you going to tell me about this?
Well, I'm telling you now.
Piece of shit.
[dramatic music]
Hey.
Hi.
Leave you to it.
I called you last night.
Yeah.
I can feel you disappearing.
Yeah, I just want to get the fuck out of here.
So, what did Andrew want?
Saw he cornered you.
[Elizabeth] Apparently, there's been a complaint
about the surgery.
Like a... Like a formal complaint?
I haven't read it.
Haven't seen it in writing, but yes.
And, um, he wanted to rub it in my face.
Well, that's shit.
Well.
Yeah.
Can't handle you.
[club music playing]
Did you...
Did you know Richard left when you were speaking?
Richard?
Yeah.
No.
He was pretty upset.
Richard is a sensitive type.
He needs to learn to love the hook.
Well, uh...
I don't blame him, Liz.
It was... It was pretty public.
What's public?
The things you say out loud...
Registrars in shambles.
[chuckles]
Oh, Jesus Christ.
What's wrong with people?
[dark music]
[sombre music]
[sighs]
[indistinct conversation]
Andrew.
Seen this?
[gasps]
Fuck!
[bird chirping]
[sharp breath] Unbelievable.
[sighing]
[phone vibrates]
[Richard] Hey.
Uh, sorry to interrupt.
[Elizabeth] Oh, no, you're not interrupting.
What can I do for you, Richard?
[Richard] I, uh... I think it's ridiculous.
That's ridiculous and wrong.
You'll be all right.
Just keep your head down and work.
Don't start looking unlucky.
What does your father say about it?
I haven't told him anything yet.
Isn't that something you'd talk to him about?
You talk about work, don't you?
But the thing is, like, he's just been appointed
to the head of surgery in Dunedin.
Yeah.
I'm just not sure
what position it would put him in if I told him.
- You know? - [Elizabeth] Oh?
Yeah.
Not actually sure what he would say.
He'd probably say you're better than this.
Probably, but...
What if I'm not, though?
[Elizabeth] Come on, Richard.
You don't understand.
Look, I have been having dreams about her.
[Elizabeth] Richard...
We did everything in our power,
inside and outside theatre.
Mistakes may always happen.
They're scary dreams, Liz.
They're just dreams.
Just dreams.
Yeah.
Maybe you'd be interested in some confidential counselling
or something like that.
Can I set that up for you?
I...
I want you to know that,
I know what you've done for me.
I did nothing, Richard.
It was my mistake.
I trusted your judgment, I was wrong.
It's called training.
It has risks.
I took the decision to do it.
[Richard] That was me--
No, I did.
I did.
Me.
Leave it with me.
You can. You can just leave it with me.
Really, I can take it.
[muted groan]
Why don't you get something, hmm?
Get something to eat.
Uh...
Uh, no, no.
Okay, well... [clears throat]
[phone vibrates]
I've got to get going.
So...
To be continued? Yeah.
Well, when are we--
When what?
When will it be continued?
Tomorrow sometime.
I told her parents that she was okay,
that it went well.
You said that.
Yes, I did.
Yes, she was.
Stop telling yourself a different story.
Jesus! Fuck, Richard.
[sombre music]
[Alex] Gonna go fishing this weekend.
You want to come?
- [Elizabeth] Me? - You'd enjoy it.
I don't fish.
[Alex] Well, you could try.
- [phone rings] - You could learn.
Everything is always there.
You go away, take a rest, come back.
Is the patient consented?
Yes.
- It's cancelled. - What, really?
I don't know, they just told me it's cancelled.
[sighs]
Fuck!
[indistinct hospital PA announcement]
[knocking]
Oh...
What happened?
Oh, I'm sorry about that.
He, he ate something in the middle of the night,
forgot about it,
and then remembered all of a sudden during consent.
Oh.
[soft chuckle] You're going through a bit
over there, I gather.
It'll blow over.
[Mary] It's a cracked system, Liz.
Look, how well known is my complaint?
Well, it's about, can't lie.
But as you say, it'll blow over.
[sighs]
Did he really eat something?
So I'm told.
Some spag bowl from the fridge in the middle of the night.
And there's really nothing else...
Nothing else that I can use you for today.
So, um, I'm sorry to waste your time.
[sombre music]
[seagulls squawking]
Excuse me?
Are you Mrs. Taylor?
I am.
I have a registered letter for you.
Oh?
[dramatic music]
What the fuck?
Fuck is this?
[tense music]
[tires screeching]
[voicemail] Hi, this is Robin's phone...
[message beeps]
Robin.
So they've, uh,
"temporarily restricted
my practice of laparoscopy and laparotomy."
Suspended me.
It's fucking...
It's just ass-covering cowardice.
It's unbelievable.
Unbelievable! Anyway.
Call me.
[startled gasp]
[tense music]
[grunts]
[scoffs]
[grunting]
[thudding]
[Atticus grunts]
[Atticus whining]
[thudding continues]
[seagulls squawking]
[phone ringing]
[Elizabeth] Hello again.
Mrs. Taylor...
from the conference.
Please sit down.
You're here to talk about the publishing of data?
I am, yes.
Look... [clears throat]
there's no easy way to say this,
but our priority isn't to shelter
surgeons from criticism.
Our priority is deciding what's good for everybody,
most importantly, the public,
our patients.
I understand that the methodology
may not yet be perfect,
but I believe transparency is a good thing.
And we can improve the methodology over time.
[Elizabeth] The decisions that we have to make
in theatre in fractions of seconds
are boiled down to "they lived" or "they died."
No context, no case histories,
just "they lived" or "they died."
That's not transparency.
It's looking for someone to blame.
I understand what you're saying.
- [Elizabeth] Do you? - Yes.
But once we pass this first storm,
hopefully then we can focus on worthy things,
such as risk adjustment.
Risk adjustment?
[Te] Have you heard of Z51.5?
That's a code for palliative care in the UK system.
A Z51.5 doesn't go on anyone's stats because it says
that the patient was already dying when they came in.
Patients died quietly.
No chemo, no scalpels,
just morphine and flowers.
Would my sepsis have qualified?
Do you understand?
Should I have not intervened?
Maybe, it's better for the patients that way.
Maybe, because at times it's best not to operate.
Let them die with dignity.
And maybe the publishing of data
will mean that more people die with less intervention.
You know what's best for patients, do you?
Sitting here at your keyboard?
I know your reputation, Mrs. Taylor.
You're the best at what you do.
[Elizabeth] One of.
But is what you do always best for the patients?
I'm sorry that sounds tough. I know.
But hospitals hide these things, don't they?
Staff learn to hide things,
and patients never know anything went wrong.
And the ones hurt the most are the families left behind.
We must hold ourselves to a higher standard.
I have a standard.
It's the Hippocratic Oath.
And I'm not trying to hide anything.
[birds chirping]
[door opens]
- [Elizabeth] Hey! - Well, hi.
How are you?
You good?
[chuckles in disbelief]
Did you forget some of your stuff?
No, I, um...
I just... I came to get it.
Well...
Why?
I can't be inside this, Liz.
You'll be Dr A,
Richard will be Dr B,
and the nurses will be there by name,
and one of us will go down.
That's just noise.
[Robin] No, it's not noise.
I need my job, Liz.
[Elizabeth] Robin.
Robin, I can protect you.
[Robin] You can't.
I'm done.
There it is.
- [Elizabeth] I'm sorry. - No, I'm sorry.
Just go.
[melancholic music]
[sighs]
Fuck.
[sad music]
[sighs]
[sighs wearily]
[breathes sharply]
[foreboding music]
[grunting]
[thumping]
- [screaming] - [insects buzzing]
[groans]
[foreboding music continues]
[lock beeps]
[phone vibrates]
[phone notification]
Oh, fuck off, Richard.
[bottles clanking]
[sombre music]
[dog barking on street]
[Elizabeth gasps]
Oh, fuck! Oh, fuck!
[tense music]
Atticus!
Oh fuck! Atticus, here boy!
He's quiet. I didn't see him.
I forgot. I forgot the dog.
- [vet] Right. - I forgot him.
- I forgot he was there. - Okay.
I'm just going to check his heart, okay?
Shhh.
[Atticus whimpers softly]
Yeah.
He's not doing so good.
Um...
I think it's time to say goodbye.
[sighs]
Right now?
- Right now? - [vet] Yeah.
[vet] Okay.
- [Elizabeth] Right. Right. - [Atticus whimpers softly]
- You ready? - [Elizabeth] Mm-mm.
[panting]
You can... You can put your hand on him.
You can help him out.
[Atticus groans softly]
Good dog.
[stifled cries]
Yeah.
I'm going to put the needle in now, okay?
[Elizabeth] Mm.
All right. Here we go.
[stifled sobs]
Check his heart.
He's gone now.
[Elizabeth cries]
Would you like him cremated?
[breathes deeply]
He's not mine.
He's not... my dog.
He's not my dog.
[sobbing]
You killed my dog.
I'm sorry.
[Jessica] What is wrong with you? [sad cello music]
He's gone.
I'm sorry.
I'm so fucking sorry.
[Jessica mumbles]
I'm so fucking sorry.
[crying]
[sad cello music continues]
[Jessica sobs]
[Elizabeth] I'm so, I'm so sorry.
[sad cello music continues]
[birds squawking]
Jesus.
[sighs wearily]
[ringtone rings]
Hello, this is Mrs. Elizabeth Taylor.
I'm trying to reach my registrar,
Richard Whitehead.
Could I get his address, please?
[sombre music]
[knocking at door]
Richard?
Richard, pick up.
[phone ringing close-by]
[gasps] Richard!
Richard!
[tense music]
Jesus.
Fuck! Fuck!
Fucking stupid, stupid.
Fuck. Fuck. Fuck.
Richard? Richard!
Oh, Richard? Richard!
Richard.
Oh, no, no, no.
No, Richard!
[crying]
You didn't.
Please!
Fuck.
Why?
[crying]
[sad music]
[whimpers softly]
[water rushing]
[Andrew] Right.
You were there I'm told, first responder.
- I was, yes. - I'm sorry.
Thank you. Stupid, stupid bugger.
Yeah, sadly so.
But listen, the staff don't know at present,
so do you think you've got this in hand?
I-- Yes, of course.
- I will, of course. - [Andrew] What a business.
For the hospital, for the department,
for everybody.
So, I think you and I should keep a lid on the gossip
and speculation before it even starts.
And, yeah, we've got to keep control of the situation.
Right.
Well, what... What can I do, Andrew?
What can I do?
Well, I think you probably know what this is about.
[Elizabeth] Right.
Yeah, it's not an uncommon phenomenon, burnout.
But I think for the majority of the staff here,
this will be the first time.
So we need to show a united front.
Andrew...
Richard was not "burnt out."
Elizabeth, we need one version of the truth,
for everybody's sake.
How... How does that work, exactly?
Well, did you know my father was a surgeon in Korea?
He was a POW.
And when he dealt with limb trauma,
he would take them to latrines for their examinations,
where there were millions of flies.
You know what that means?
Maggots.
But maggots do their job very well.
They debris dead flesh,
they clean the wounds,
they never sleep, they never take a break.
They're vigilant, consistent, persistent, trustworthy...
Unlike some people.
What's the point?
What are you getting at?
Do you remember you called me "stupid"
at the Mortality and Morbidity meeting?
You really were incredibly rude.
That's what this is about?
No...
[Elizabeth] No?
No, this hospital has invested huge amount in you.
You're a very valuable commodity.
You are brilliant, but you are not easy.
You're emotional.
Yeah, emotional.
I know it's not fashionable to say it,
but I'm not sure women are suited
to a career in medicine,
particularly unmarried women.
But when I have a vested interest in someone,
I act irrespective of the risk.
So it is decided.
What has? What's been decided?
Honestly?
Sometimes, Elizabeth, I could just, you know...
take you or leave you.
I see.
[Andrew] No, I don't think you do see.
You've been given a second chance.
You're going to be back on call after a week's leave.
That's what we've decided.
Then we're going to publish an article
in the New Zealand Journal for Medicine
and you're going to sign up to it.
It'll be about suicide, burnout
and, uh, Richard's effect on your data.
Richard will be shown as what he was...
young, ineffective, out of his depths,
and that he skewed the data.
You know, we took too much care of him.
You took too much care of him.
And it's a tragedy for the hospital,
for the community,
and it led to his suicide.
So, uh...
you know, the staff will get counselling,
there'll be a vigil,
and then business as usual.
And I want you to sign up to it all.
It's called "cleaning the wound," Elizabeth.
Like a maggot.
Those wonderful maggots.
[sad music]
[breathes deeply]
[sniffles]
Liz? Liz.
[sobs]
I'm sorry.
- [Elizabeth cries] - It's okay.
It's all right.
[sad music continues]
[birds chirping]
What?
It's just unfair.
You are good, Liz.
I know that.
I missed his calls.
I could have taken them.
[Robin] Yeah.
And you'll have to live with that.
And I am so sorry.
[sighs] Me, too.
So fucking sorry.
What a mess.
[sighs]
[dramatic music]
[Ben] Jan, I was wondering--
Dr. Matthews?
Yes.
Excuse us a minute.
[Ben] How can I help?
I wanted to speak with you about a patient of ours.
Lisa Williams.
Yes.
Um, if it's okay, I'd like to bring Jan in on this.
She was running the ward.
Jan.
Of course.
[Ben] Okay.
Jan, this is about Lisa Williams,
the sepsis patient from a while ago.
Oh.
Mrs. Taylor was her surgeon
and wants to know about her admission.
- Okay. - Please.
Okay. Well, we had her on the usual lines,
inspected the surgery sites, and they were clean.
There was minimal output in the drains.
Her abdomen was soft.
Well, you tell her, Jan.
I sat with Lisa from about midnight.
She was pretty high maintenance at this point,
and she began to go into decline.
She was deteriorating. The sepsis was advanced.
[Jan] She called out. She was anxious and agitated.
[Ben] She was dropping her stats,
and cyanosis of the lips,
about one breath every second.
[Jan] She was complaining of being cold and tired,
and the catheter was bothering her,
and her breathing was very rapid.
We brought in the on-call anaesthetist to intubate.
Was Lisa able to speak with her parents?
Yeah, briefly.
But then they had to leave the room.
She arrested during induction,
and we began resuscitation.
We worked for... half an hour, I remember.
[Jan] She was 29.
A young, strong woman.
[Elizabeth] Right.
Yeah.
[Ben] Pronounced dead about four... five--
- 4:48. - [Ben] 4:48. Yes.
Wee small hours.
Yeah.
[sighs]
Thank you for caring for my patient.
[Ben] Is that what you...
Is that what you needed?
It is, yes. Some of it.
[Ben] I can get some more notes.
- I can-- - No.
No, it's all right.
Was she lonely at all at the end?
We were all here.
Her family, right up until the intubation.
I was with her during the night.
Thank you both.
This very... was very helpful.
[dramatic music]
[microphone squelches]
[clears throat]
Tena koutou, tena koutou, tena katou katoa.
Good afternoon, ladies and gentlemen.
My name is Andrew McGrath.
As you know, I am head of surgery.
Sad day.
And we are here, unfortunately,
to remember Richard Whitehead,
one of our brightest young talents
whose future has been so cruelly cut short.
And in a few moments,
I would like us to hold a silence while
we remember Richard and the brilliant work he did,
the part he played in the team
of one of our most gifted, accomplished surgeons,
Mrs. Elizabeth Taylor.
But before we do, I would like to say this.
What we now know is that Richard's passing
is the result of the terrible toll of burnout.
This is a tragedy,
but one from which we will all learn,
must learn.
Richard's passing is a timely reminder to us
that all our staff are vulnerable
to these extreme pressures.
And unfortunately,
Richard was, um, one of its victims.
It's not easy having to work
with the responsibility of life and death.
We, the hospital, the administration, the board,
we absolutely recognize this,
and, um, we are responding immediately.
We are, from this moment,
putting in place measures to enhance staff well being
and our collective mental health,
soon as is practicable.
Because we are all in this together,
a team
and a community.
[sighs]
It is indeed a sad day for us all.
A minute's silence, please.
[sighs]
I'd like to say something. I think I should. Don't you?
- [Andrew] Yeah. - I think I should.
[Andrew] Yes. Just a short.
Yeah, as his registrar,
don't you think I should say something?
[clears throat] Sorry.
I'd like to say something, if it's all right.
Thank you.
Hello.
[sighs]
The reason we're all here today is, as Andrew says,
a tragedy.
Richard Whitehead was my registrar.
Many of you knew Richard, and those of you who didn't,
I'm sure you can identify with him.
He was a young man, 26.
And as a registrar, he was still learning,
still training.
He didn't die.
He committed suicide.
And, um, he's dead now because he overdosed.
That's the truth of it.
He took his own life in a filthy garage, alone.
Elizabeth, that's enough.
[Elizabeth] We talk about teamwork.
- Liz-- - We talk about resilience.
Did Richard lack resilience?
This young man for whom I am responsible?
Because if you're telling me he lacks something,
I don't accept it.
I operated on a patient that died after the surgery.
Richard was under my supervision,
and he did as I asked.
I told him to push harder,
and I chose the timing,
and I chose the words I said,
and I chose the way I said them.
And he just...
It's my responsibility.
I am responsible for the risks I take
every time I perform surgery.
And Richard is dead because he blamed himself
for a mistake I made.
I didn't make my responsibility clear enough to him.
He was a student doctor.
And...
And we're hanging
a target around his neck
with this vigil.
[speakers squelch]
And I'm not going to let this boy
be scapegoated publicly
by middle managers and doctors-turned-bureaucrats.
We are in service.
We have a covenant with our patients.
"I will save you with my skills."
But we have a covenant to each other.
We're in service to each other, too.
Both those covenants are being broken here today,
and I will not stand by
and help pretend that's not the case.
That's enough.
[crowd applauding]
Rest in peace, Richard.
Rest in peace.
[melancholic music]
[breathes deeply]
This is what happened.
Lisa was very sick.
She had septicemia.
Although the original operation was marred by an error I made,
without that error,
it's highly likely she would have still died.
The sepsis was advanced.
[sighs weakly]
Ev...
Even though your operation went wrong...
she still could have died?
Yes.
[inhales sharply]
Is there anything
you would have done differently?
That's the hard bit.
No.
I would not.
All the decisions I made were to try to save Lisa.
If the operation were to happen again,
I could make all the same decisions.
But I would endeavour
to be better at explaining it,
be better at taking responsibility.
I allowed doubt to creep in.
Lisa fought.
She fought really, really hard.
You need to know that.
In the end, her body gave up,
des...
despite all our experience and care.
And please know
that your daughter was cared for.
[breathes deeply]
I wanted a good outcome for Lisa.
And I'm so sorry.
Thank you.
[sombre music]
[hopeful music]
[hopeful music continues]
[gentle music]
[gentle dramatic music]
[gentle dramatic music continues]