[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...
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. 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]
[呼嘯的箭]
[陰沉的音樂]
[不詳醫院公共廣播公告]
[手機震動]
是的？
我在途中。
[嘆氣]
[理查德]她心跳過速， 從一小時前開始，在 Fibral。
呼吸廿二和壓力下降了。
這就是我們打電話的原因。
[伊莉莎白]你好，麗莎。你好。
我的名字是伊莉莎白泰勒。
我是顧問外科醫生。
這是我的註冊員 理查懷特海德.
麗莎，你知道你在哪裡嗎？
你聽得到我們說話嗎？
呼吸的時候會痛嗎？
她沒有增加 麥克伯尼的痛苦，
所以看起來不像 就像附錄一樣。
但她已經喝了十毫克 從九點卅分開始服用嗎啡
和十兆Maxolon。
歷史？
[理查] 嗯，那是有一天 腹部絞痛。
腹部觸痛 守衛在左髂骨。
給予甲氧芐啶， 雙氯芬酸和撲熱息痛，
然後送走。
他們送她回家。
[理查]她回來了三 幾天后，在巨大的痛苦中，
脈搏昇高。
她接受了靜脈輸液 然後轉移到這裡。
尿量減少 兩天的產出。
影像顯示有 可能的腸道受累，
並註意到還有 現場放置 IUCD。
[尖叫]
好的。對不起，麗莎。
對不起，麗莎。
[喘氣]
然後？
呃，很明顯 腹內災難，
所以立即手術評估
用於穿孔 腸或闌尾。
大量液體，
轉移到劇院 腹腔鏡檢查，對嗎？
我同意立即 緊急腹腔鏡檢查。
放射學建議 腸壞死
和膿腫不順從 至經皮引流。
她需要接受手術。
三個單位 濃縮紅血球，
交叉匹配。
為戲劇做準備。
打電話給科爾頓醫生徵求她的同意。
麗莎，我們很快就會見到你。
[心電圖監視器蜂鳴聲]
好的！
我們今天將使用 哈森技術。
亞歷克斯.
[亞歷克斯]我們...很高興出發。
[伊麗莎白]刀。
[羅賓]刀。
[伊莉莎白]好吧， 我們做了一千萬個切口
就在肚臍上方，
直接穿過皮下 組織進入筋膜。
科赫。
S 型彎頭。
[羅賓] S 形彎。
[理查]謝謝你，羅賓。 保持。
[伊麗莎白]謝謝你。
刀。
現在，衹需幾個...
一次纖維。
還有腹膜。
[羅賓]史迪奇。
幹得好。
[伊麗莎白]好的。
[羅賓]剪輯。
-[伊莉莎白]準備好了嗎？ -[羅賓]切。
[理查]這個已經出來了。
謝謝你，羅賓。
[伊麗莎白]謝謝你。 現在，我們使用牽引力。
為什麼？
[理查德]為了避免損壞 底層結構
當我們穿透腹膜時 鞘入腹。
[伊莉莎白]很好，理查德。
-好的。波特，拜託，羅賓。 -[羅賓] 港口。
[伊莉莎白]好吧， 我們將插入
今天將三個套管針插入麗莎。
開始了。
[理查德]呃，減速機。 拜託，羅賓。
[伊莉莎白]給她 那裡的加油站，理查。
謝謝。
[心電圖監視器繼續發出蜂鳴聲]
[理查]就這麼定了。
-[羅賓] 加油。 -[理查]謝謝你。
[伊莉莎白] 好的，大師。
[梅琳] 是嗎？
[伊莉莎白]請加油。
[Mei-Lynn] 瓦斯已打開。
燈亮了。
[伊莉莎白]它來了。
[吹氣]
我們到了，理查德。 你引導它。
我們開始吧。
沼澤？
[不祥的音樂響起]
唔。
[理查] 嗯... 嗯，是大面積的膿。
[伊麗莎白]確實如此。 是膿毒癥。
好的，我正在插入 現在是第二個套管針。
是的，那很好。 謝謝你，理查。
就在那裡，我需要 請直接可視化。
把它放回去一點。
那裡...
好的。
謝謝。
好吧，發生什麼事了 用瓦斯嗎？
[梅琳] 壓力有多大？
[伊莉莎白] 我需要十個。
我們需要更多的流量，
更多的器官分離。
[梅琳] 流量為六。
但我們還沒到十點。
[羅賓] 坦克車已經滿了。
[伊莉莎白]梅琳，你可以嗎 增加流量可以嗎？
[Mei-Lynn] 複製那個。
[伊莉莎白]理查德，你想要嗎 放入最後一個套管針？
[理查德]是的。
謝謝你，羅賓。
[伊莉莎白] 我們幫你找個地方吧。
我們到了。
[理查德] 謝謝。
[伊莉莎白] 親愛的，你有 理查德有足夠的空間，
你有足夠的空間。
你能看到嗎？
[理查德] 是的。
[伊莉莎白]好吧，理查德。 時間在流逝。我們走吧。
[心電圖監視器蜂鳴聲增加]
[伊莉莎白]我們走吧。 給它一些好處。
[理查德] 對不起。
[緊張的音樂]
[伊莉莎白]操！ 快點，我們需要打開。
-我們正在轉換。 -[羅賓]我們正在轉變。
[伊莉莎白] 我需要 B 托盤
和動脈 樂器，拜託。
[羅賓] B 盤，拜託。
[伊莉莎白] 拉 理查德，把套管針拿出來。
[理查德] 對不起。
[伊莉莎白] 有人打電話來 梅琳現在回來了。
-[羅賓]有人打電話給美琳！ -[伊莉莎白]B盤，拜託！
[伊莉莎白] 亞歷克斯，跟我說話。
[Alex] 収縮壓九十。 現在壓力正在下降。
[伊莉莎白]當然 它掉下來了。
[伊莉莎白]我需要B盤！
[羅賓] 乙，乙，快，快，快！
[伊莉莎白] 冷靜，冷靜。
請大家安靜。
-[梅琳] 透熱療法？
-[伊莉莎白]呃，不。我不 有時間。我自己來做。
理查德，堅持住。
亞歷克斯？
[亞歷克斯] 心率為一百六十。
現在推中核糖醇。
[伊莉莎白] 堅持住，理查德。
開始了。好的。 我要進去了，亞歷克斯。
[心電監視器快速發出蜂鳴聲]
-糟糕！ -吸。
[羅賓] 吸。
牽開器。 我會握住它。牽開器。
-[理查德]是的，我們需要... -[伊莉莎白]很好，羅賓。
-[伊麗莎白] 好。你明白了嗎？ -[羅賓]我明白了。
[伊莉莎白]買個大的。
拉它，理查德。拉它。
-[理查德] （模糊）
-[羅賓]是的，理查。 -[伊麗莎白]我明白了。我得到了它。
-[伊莉莎白] 包。 -[羅賓] 包。
[疲倦地嘆氣]
- 小心輸尿管。 -[理查德] 嗯嗯。
[伊莉莎白] 吸力—— 我找不到它。
找到它。
這不是下腔靜脈，
這是腰動脈。
將手指放在上面。
壓力。
-[理查]抱歉。 -[伊莉莎白]感覺到了嗎？
[伊麗莎白]就在那裡。 它正在抽水。
-感覺到了嗎？ -[理查德]嗯。
[伊莉莎白] 保留你的 手指放在上面。夾鉗。
[亞歷克斯]謝謝你。
[伊莉莎白] 知道了？好的。
這裡還有一個。 這裡還有一個。
縫針。
拜託五點零。
[羅賓]史迪奇。
[切割]
[伊莉莎白] 好的。
洶湧的流血 從腔靜脈
由夾具控制...
[嘆氣] ...然後我們搬家 依緊急程度排序。
理查德擁有控制權
後部的 用手指撕開。
最緊急的是 是腰椎血管
由於出血量大，
我很專註 就現在而言。
IVC裡有租金...
被夾住的，
還有嚴重的腰椎病 腰肌出血，
哪個是後...
和深。
目前正在縫製 五比零。
[亞歷克斯] 現在看起來好多了。
-[伊麗莎白]好的。 -[亞歷克斯]壓力來了。
[伊麗莎白]現在 對於原始操作。
我們來洗一下這個骨盆吧 彈出排水溝，
取出闌尾 為了更好的衡量。
[理查德] 是的。好的。
呃，我是──伊莉莎白，對不起。
[伊莉莎白] 嘿，就在附近。
-[羅賓]喬西。 -我需要你使用這個牽開器。
[羅賓] 是的。
[理查德] 好吧，呃...
好吧，潑我吧。
-[羅賓]謝謝你。 -我會吸力。謝謝。
糟糕。
-[理查]是的，好吧-- -[羅賓]吸力。
[理查德] 呃，是的，讓我來。
謝謝，就這樣了。
[羅賓] 吸。
[陰沉的音樂]
[開門]
[伊莉莎白]不幸的是， 我得重新安排
我的下一次手術。
去告訴麗莎的 父母一切順利。
呃，你不想——
[伊莉莎白] 她已經走出困境了。
但你肯定可以解釋——
[伊莉莎白]理查德， 一切順利。
她正在康復中。
他們可以在重癥監護室與她交談。
你和家人相處得很好。
謝謝你，理查。
[呼吸顫抖]
[理查德]嗯， 威廉斯先生和夫人，
我是理查德•懷特海德， 登記員。
我和泰勒夫人在一起。
麗莎過得很好。 她現在正在康復中。
我衹是想道歉 關於延遲。
[遠處警報聲響起]
[嘆氣]
[呼吸困難]
[機器蜂鳴聲]
[簡] 很好， 深呼吸，麗莎。
衹是輕鬆的呼吸。 是的。
就是這樣。
她怎麼樣？
呃，她很穩定。
對於面膜有點激動。
[伊莉莎白] 嗨，麗莎。
進展順利。
[不祥的音樂]
[呼吸急促]
[不祥的音樂繼續]
[註冊蜂鳴聲]
[陰沉的音樂]
[門嘎吱一聲關上]
[伊莉莎白]羅賓， 你打到計程車了嗎？
呃，是的。
夜色晴朗。
[羅賓] 嗯，是的。這是。
很美麗。
-想要一些雞肉嗎？ -[嘲笑]
明天雙班。
-那是狗屎。 -[羅賓] 嗯。
-我會和阿拉斯泰爾談談-- -[羅賓] 嗯嗯。
請嫑。
你不能做那樣的事情。
它可能會毀了事情。
你好嗎？
是的。
[兩人都咯咯笑]
[海鷗的叫聲]
[水流洶湧]
[手機震動]
[低聲喘息]
糟糕！
[伊莉莎白] 一切都好嗎？
是的，當然。 呃，五乘三。
走在我身邊，理查。
你好嗎？
[理查德] 我沒事。
好的。你怎麼聽到的？
[理查德] 聽到什麼？
[嘆氣]
理查德，我們輸了 今天早上敗血癥。
我在進去的路上就収到簡訊了。
她——什麼？ 那麼她在加護病房裡是什麼？
[伊莉莎白] 是的，在重癥監護室。
[理查德] 啊，我不知道。
是的，這是一個糟糕的結果。
非常令人失望。
好的？
是的，當然。是的。
敗血癥太嚴重了
她很可能 永遠不會成功。
套管針……做到了—— 那是——
這是晚期膿毒癥， 不是嗎？
你自己也看到了。
所以我們永遠不會知道 如果有的話，達到什麼程度，
額外的時間 在手術中做出了貢獻。
是的...我想 併發癥——
併發癥 可能做出了貢獻，
但我們永遠不會知道有多少。
是嗎？
所以肯定沒有幫助。
看吧，我們能做的就是 現在繼續前進。
過去吧。變得更好。
學習。
早安，莉茲。
早安，阿拉斯泰爾。
你有看過工作人員嗎 網站上的照片？
是的。看起來像 一群囚犯
即將被帶出去射擊。
[阿拉斯泰爾]啊。
嗯，也許 這是黑白的。
阿拉斯泰爾，我能為你做些什麼？
我們可以快速說幾句嗎？
當然。
我會趕上的。
-是的，好吧。 -[阿拉斯泰爾]謝謝，理查德。
[理查德] 不用擔心。
對不起。
嗯，嗨，大衛，不是嗎？
-[大衛]是的。 -[理查]太好了，我有--
無論如何，阿拉斯泰爾？
[阿拉斯泰爾]莉茲， 麗莎威廉斯的家人，
今天早上去世的人 正在要求見你。
他們現在就在這裡。
哦。
我應該警告你， 他們非常心煩意亂。
他們的印像是 當她被錄取時，
是的，這是一個緊急情況，
但有一個附錄 或類似的東西。
他們感覺很措手不及，
他們說 他們非常不滿意
ICU的解釋。
誰在 ICU 與他們交談？
本•馬修斯.
本是重癥監護醫生。
[嘆氣] 安德魯.
伊莉莎白，你好嗎？
嗯，我很高興 與他們交談。
你要說什麼？
我要告訴他們 手術中發生了什麼事。
我當時不在 ICU。
好的。
到底發生了什麼，麗茲？
嗯，你顯然已經 閱讀註釋。
不受控制 插入套管針
導致內部損壞——
……這是不相關的 奔騰的感染
這導致了她的致命 ICU 病情惡化。
「無關」？
是的，我就是這麼說的。
好的...
但你知道什麼 你會說。
你已經拿到手了。
[伊莉莎白]我認為 很好在手。
-好的。 -謝謝你，安德魯。
其實我衹是 想問你
如果你來的話 參加會議，
手術安全 和測量大露營？
是的，安德魯。我會採取 為團隊提供的那個。
其實我想要整個團隊 在那裡。理查、羅賓.
我認為這很重要。
這……還挺有趣的。
[伊莉莎白] 有趣的？
嗯……是關於 發佈結果。
這就是我們的新現實。
我們的手術結果正在 將發表在報紙上。
死亡率、併發癥。
你是說我的結果。
確實，你的結果。
一切都在你的監視之下。
但我不認為這是，呃......
我不認為 這肯定是個壞主意。
它將激勵我們 避免重癥患者
並且會影響訓練。
LZ，家人都在等呢 在華瑙的房間裡。
謝謝。
安德魯.
伊麗莎白.
[緊張的音樂]
[悲傷的音樂]
我對你的損失感到非常抱歉。
然後...
這就是麗莎的遭遇。
麗莎病得很重 當她來到醫院時。
她的一些生殖能力 器官已被感染。
我們相信這是 因為她的子宮內避孕器。
這代表「宮內 避孕器具。
呃...
我們需要做什麼 稱為“腹腔鏡檢查”。
這是一種鎖孔手術
我們在那裡打一個小洞
並且...並使用一個小的 攝影機觀察麗莎的內心
看到...
然後看...嗯... 她怎麼了。
我們可以看到 她病得很重，
她的腹部有那麼多 器官已感染，
並且她需要一個...
正確的操作 幫助她好起來。
我可以給你詳細信息 如果你願意的話。
我的意思是，我們衹是不 知道發生了什麼事。
我們...我們想了解更多。
[抽泣]
呃...
出現了一個併發癥 手術期間。
我們必須做一個更大的 切口比最初計劃的要大。
什麼併發癥？
[伊莉莎白]正如我所說， 她的子宮內避孕器已被感染。
而且，嗯，我們不 此時就知道為什麼了。
但也有很多 它可能發生的原因。
麗莎被轉移到重癥監護室 手術後的護理，
我並沒有直接 參與其中。
我們衹是想， “哦，是她……”
我們衹是想 她的闌尾破裂了
這就是為什麼它如此糟糕。
[伊莉莎白] 對不起。
我知道這一定很難，
但這不是要做的 和她的闌尾。
麗莎遇到麻煩了 在 ICU 裡呼吸。
感染是 對她的身體來說太多了
這導致 她的心臟驟停。
她在停屍房裡。
[憤怒]我們的女兒 在停屍房裡。
什...你叫什麼名字？
伊莉莎白•泰勒是我的名字。
[相機點擊]
[疲倦地嘆氣]
[陰沉的音樂]
[遠處響起警笛聲]
[安德魯] 歡迎大家
本週的 MandM。
所以我們將從開始 麗莎威廉斯案。
麻醉、護理、 以及手術。
很高興見到你。
呃，對不起。 馬修斯博士在哪裡？
好吧，馬修斯博士 是一個道歉。
馬修斯博士 是重癥監護醫生
關於麗莎威廉斯，
——今天的主要案例。 -然後...
我想打電話詢問這個 會議休會。
[安德魯] 喔...為什麼，莉茲？
沒有馬修斯博士， 有什麼意義呢？
嗯，重點是
這是一種病態 和死亡會議，
在其中，我們將 特別討論
手術和死亡率。
本例的死亡率為 與手術無關。
與她有關 晚期敗血癥，
以及近十二小時 重癥監護室
未能保存的 之後的她。
不，這衹是一個 MandM。
我們不會推卸責任。
嗯……責備？
不 -
我想知道發生了什麼事。
家人想要更多資訊。
什麼訊息？
我已經和他們談過了。
好吧，我們就說一下 他們的接受
他們女兒的死 尚未解決。
好吧，這實在是太愚蠢了。
為什麼這會是愚蠢的呢，莉茲？
[伊莉莎白]這很愚蠢， 安德魯，因為…
我們可以翻閱我們的筆記，
你可以和我的團隊談談 直到你臉色發青。
但我們不可能知道 這個女孩發生了什麼事
無重癥監護室 還有他們這裡的護士，
因為他們接手了她的照顧
她在他們的註視下死了。
[安德魯]麗莎威廉斯的父母 對錯誤有疑問
由手術人員製作， 不是加護病房。
他們想了解 手術中的併發癥，
你的手術， 因為你告訴他們
出現了併發癥 對莉茲來說……顯然。
[笑聲] 我是說，為了麗莎。
我說得對嗎？
[猛吸一口氣]
或者...
我是不是很儍？
正確。 我簡單總結一下。
- 一點卌分開始麻醉。 -是的，確實如此。
- 手術時間是一點五十分。 -正確。
且氣口已插入
進入腹部，並且， 呃，開始充氣了。
羅賓？
是的。是的，這是正確的。
你在筆記中說
泰勒夫人用言語表達了 沒有瓦斯。
氣量不足。
我-我在筆記裡說過
嗯，泰勒夫人說 氣體流量不足。
她是什麼意思？
什麼...
她的意思是還不夠 腹部氣體壓力
提起腹膜囊
遠離內部結構
可能會被損壞 透過插入儀器。
壓力有多大 那時？
她的腹部有多少氣體？
我的意思是，坦白說，
走得安全嗎 把東西塞進她體內？
嗯，我不知道，醫生。
啊!你不知道嗎？
[亞歷克斯] 她不可能知道！
氣腹機上的指示器 讀作“足夠”或“不夠”。
當肚子鼓起來的時候， 氣體減慢
作為壓力 不讓它進去。
所需理論壓力 空腔內有十個，當然，
但沒有實際的 衡量這一點的儀表。
衹是說的是流量 足夠高或不夠高
膨脹到那個水平。
-[安德魯]好的。 - 好吧還是不行。
我們有直接的可視化 器官空間。
[安德魯]好的。
並且無論如何 實際壓力是
根據我的臨床判斷，
有足夠的壓力——
插入最後一個套管針？
是的，傑森。
天哪，傑森。 沒有確定的時間。
這就是你所做的。
您使用您的臨床判斷。
那麼，是誰插入的 最後一個套管針，莉茲？
套管針是誰放進去的？
呃...
我做到了。
[安德魯]你插入 最後一個套管針
導致 對這個女孩的傷害，
這是在的租金 下腔靜脈，
在後部切開 腹壁,
腰動脈撕裂——
是的，是的，我們修復了， 當然。
[安德魯] 好的，很好。
好的。是的。
好的。
[嘆氣]看，更多 比那複雜。
我指示我的登記員， 理查懷特海德,
做切口 並插入最後一個套管針，
他做到了。
哦，所以理查德插入了 最後一個套管針。
我是隊長。
我是首席外科醫生。
這是我的劇場。
在我的指導下，
理查德插入 最後一個套管針，
未能滲透。
我告訴他要更加努力。
[安德魯] 告訴理查德...
我說給它一些好處。
“威利。”
這是正確的。
[陰沉的音樂]
你會看一下嗎 這個華麗的生物？
[伊莉莎白] 你是狗媽媽。
[潔西卡] 你看過嗎 有這麼上鏡的嗎？
-他就像你的孩子。 -[傑西卡] 嗯。
他是一個很棒的公司。
什麼是新的？
[潔西卡清了喉嚨]
你知道，這是...
情況很複雜。
我遇到了一個非常聰明的人。
[嘆氣]你的婚姻呢？
[傑西卡] 結束了。
-是的。 -[伊麗莎白] 對不起。
是的，我知道。 這眞是狗屎，眞的。
[嘆氣]我也度過了糟糕的一週。
是的。
[伊莉莎白] 正如你所說，複雜。
嗯。
嗯...
所以我眞的不想問，莉茲，
但有沒有什麼 那樣阿迪克斯
可以和你在一起 一會兒？
-狗？ -[傑西卡]是的。
[傑西卡] 衹是 因為我...
我要搬進他的公寓
而且-而且你知道， 這對一隻大狗來說沒有好處。
有電梯什麼的。
史蒂芬不會接受他 因為他在懲罰我，所以...
但它衹會 是短期的。
傑西，不。我眞的不——
我眞的不認為我可以。
阿迪克斯這麼老了，莉茲。
他完全是受過家庭訓練的。
他所做的衹是躺著 整天在陽光下睡覺，
他會成為你最好的朋友。
我從來不在家。
哦，上帝。 別擔心。
我們也從來不在家。 他已經完全習慣了。
羅賓，你在哪裡？
我想讓你過來。
你想要_____嗎？
嗯。
嘿，對不起，我已經 如此被一切所分散註意力，
你知道， 所有這些該死的狗屎。
傑西卡正在製作 我帶她的狗。
[笑]
就是這樣...
呃……好吧。
暫時再見。
打電話給我。
[不安的音樂]
[遠處的爆裂聲]
[陰沉的音樂]
[阿迪克斯咆哮]
[Te] 你曾經 對您的患者來說是看不見的
以及你的表現水平 同樣是看不見的
到目前為止，
因為我們是 即將出版
手術結果公開。
這當然會引發 深刻的問題，
因為一旦出版開始，
患者和潛在患者
將評估您的記錄 並將你與其他人進行比較。
他們當然不會知道 路上的外科醫生，
誰有更好的統計數據，
六個月前才獲得資格，
並已手術 總共有七名年輕人，
和白人患者，
當你有 曾在戰壕里，
對病態肥胖者進行手術， 糖尿病患者，
棕色老人 有跌倒史
和痛風 和呼吸道疾病。
你會被比較 外科醫生到外科醫生，
以及每個人的每一個案例 誰曾死過
在你的手術刀下面
將全面公開展示。
每個手術部位， 感染，每個有缺口的主動脈。
一些外科醫生會 被迫退休？
或許。
大概。
一些外科醫生會 受到不公平對待？
是的，很有可能。
那為什麼， 我們是否應該允許這種情況發生
甚至鼓勵嗎？
透明度 並知情同意。
我正在談論 眞正的同意，
不衹是塗鴉 在一張紙上
操作前一刻。
在更廣泛的背景下， 一名外科醫生—
對不起。對不起。
是的？
莉茲泰勒.
是嗎，泰勒夫人？
這會轉 手術顛倒。
這是不可避免的
那些好的外科醫生 會受到不公平的對待。
剛才你自己也這麼說的。
聽起來像 你接受這個。
嗯，不是被 對您的結果透明化
好的外科醫生會做什麼，
讓您的患者 能夠給予知情同意嗎？
好吧，看， 抱歉，如果我是—[輕笑]
也許我要下車了 就像一隻有傾向性的母狗一樣…
-[輕笑] -但這對我們很重要。
發佈結果 這是一個壞主意。
我們會避免 病得很重的病人。
為什麼要冒險添加某人 可能會死於我的數字嗎？
我為什麼要冒這個險？
改變一切。
哪位外科醫師會 試試他們的註冊商，
如果當這一切 變成一片廢墟，
這會記錄在他們的記錄中嗎？
[安德魯]莉茲.
那是……這是一個好點。
有很多優點。
但我們正在談論的 關於這裡是資源。
不！我們正在談論數字。
-然後 - -我說的是數字。
我們正在談論 對人進行排名
排行榜上從最好到最差
使用的數據是 不充份和片面。
外科醫生將 被掛起來晾乾。
[特] 哇！
看來我們已經進入了
我們會議的 QandA 部份
- 時間稍微提早了一些。 -[輕笑]
我衹是不認為 在這件事上我們可能是儍瓜，
這樣做衹是因為 其他國家也是如此。
有多少心臟外科醫生 我們輸得起嗎？
你知道我們有多少人嗎？
-廿九！這還不夠。 -莉茲。
謝謝。
廿九。
據他說，
一半會去 必須盡快退休。
[安德魯] 是的，好的。 這是一個很好的觀點。
但讓我們...
醫生。
[陰沉的音樂]
[陰沉的音樂繼續]
非常扣人心弦的東西。
[伊麗莎白]不是嗎。
有趣，有挑釁性。
人們將被釘死在十字架上。
[安德魯] 是的，有些外科醫生 需要重新評估。
你不擔心 關於您的數據。
其他專業 很緊張。
我們落後了很多年 世界對此，
而且還沒有經過深思熟慮。
你不緊張吧？
因為你很聰明。
你眞是太棒了。
但是，嗯...
不幸的是，伊莉莎白 這是我的命運
告訴你 有一個...
正式投訴。
[伊莉莎白] 投訴？
正式投訴。 麗莎的父母。
你什麼時候去 告訴我這件事嗎？
嗯，我現在告訴你。
一坨狗屎。
[戲劇音樂]
嘿。
你好。
讓你去吧。
我昨晚打電話給你了。
是的。
我能感覺到你正在消失。
是的，我衹是想離開這裡。
那麼，安德魯想要什麼？
看到他把你逼到牆角了。
[伊莉莎白]顯然， 有投訴
關於手術。
就像一個... 比如正式投訴？
我還沒讀過。
沒見過 書面形式，但是是的。
而且，嗯，他想要 把它擦在我臉上。
好吧，那是狗屎。
然後。
是的。
管不了你。
[俱樂部音樂播放]
你有沒有...
你知道理查德離開了嗎 你什麼時候說話的？
理查德？
是的。
不。
他很沮喪。
理查德是一個敏感的類型。
他需要學習愛鉤。
嗯，呃...
我不怪他，莉茲。
這是……這是相當公開的。
什麼是公開的？
你大聲說的話...
註冊商陷入混亂。
[笑聲]
噢，耶穌基督。
人們怎麼了？
[黑闇音樂]
[陰沉的音樂]
[嘆氣]
[含糊不清的對話]
安德魯.
看到這個了嗎？
[喘氣]
糟糕！
[鳥鳴聲]
[急促的呼吸]難以置信。
[嘆氣]
[手機震動]
[理查德]嘿。
呃，抱歉打擾了。
[伊莉莎白]哦，不， 你沒有打擾。
我能為你做什麼，理查？
[理查]我，呃... 我認為這很荒謬。
這是荒謬和錯誤的。
你會沒事的。
衹要保持頭腦清醒 下來工作。
嫑開始顯得不走運。
你父親做什麼 說說吧？
我還沒告訴他任何事。
那不是嗎 你會和他談談嗎？
你談工作，不是嗎？
但事情是這樣的， 他剛被任命
到外科主任 在但尼丁。
是的。
我衹是不確定
它會處於什麼位置 如果我告訴他的話把他放進去。
-你知道？ -[伊莉莎白]哦？
是的。
實際上不確定 他會說什麼。
他可能會說 你比這個更好。
或許吧，但是…
但如果我不是呢？
[伊莉莎白] 來吧，理查德。
你不明白。
你看，我曾經 夢見她。
[伊莉莎白] 理查德...
我們竭盡全力，
劇院內外。
錯誤可能總是會發生。
這些都是可怕的夢，莉茲。
它們衹是夢想。
衹是夢想。
是的。
也許你會感興趣 一些保密的諮詢
或類似的東西。
我可以為你安排嗎？
我...
我想讓你知道，
我知道你為我做了什麼。
我什麼也沒做，理查德。
這是我的錯。
我相信你的判斷， 我錯了。
這就是所謂的訓練。
它有風險。
我決定這麼做。
[理查] 那是我——
不，我做到了。
我做到了。
我。
留給我吧。
你可以。你可以衹 交給我吧。
眞的，我能接受。
[低聲呻吟]
你為什麼不得到 有什麼，嗯？
吃點東西。
呃...
呃，不，不。
好吧，好吧...[清喉嚨]
[手機震動]
我得走了。
所以...
待續？是的。
好吧，我們什麼時候——
什麼時候什麼？
什麼時候會繼續？
明天某個時候。
我告訴她父母 她沒事，
一切順利。
你這麼說。
是的，我做到了。
是的，她是。
別再告訴自己了 一個不同的故事。
耶穌！理查德。
[陰沉的音樂]
[亞歷克斯]要去釣魚 這個週末。
你想來嗎？
-[伊麗莎白]我？ -你會喜歡的。
我不釣魚。
[亞歷克斯]嗯，你可以嘗試一下。
-[電話鈴聲] -你可以學習。
一切都一直在那裡。
你走開，休息一下 回來。
患者是否同意？
是的。
- 取消了。 -什麼，眞的嗎？
我不知道，他們衹是告訴 我的已經取消了
[嘆氣]
糟糕！
【不詳醫院 公共廣播公告]
[敲門聲]
哦...
發生了什麼事？
哦，對此我很抱歉。
他他吃了東西 半夜，
忘記了，
然後想起 在同意期間突然發生。
哦。
[輕笑]你走了 透過一點
在那裡，我聚集。
會吹過去的
[瑪莉]這是一個裂縫 系統，莉茲。
看看，多麼出名 是我的抱怨嗎？
好吧，這是關於，不能撒謊。
但正如你所說， 它會吹過去的。
[嘆氣]
他眞的吃東西了嗎？
有人告訴我。
從冰箱拿出一些spa碗 在半夜。
而且眞的有 沒有別的…
沒有別的事我 今天可以用你。
所以，嗯， 很抱歉浪費你的時間。
[陰沉的音樂]
[海鷗的叫聲]
打擾一下？
您是泰勒夫人嗎？
我是。
我有一個註冊的 給你的信。
哦？
[戲劇音樂]
搞什麼鬼？
是這個？
[緊張的音樂]
[輪胎的尖叫聲]
[語音信箱] 嗨，這是羅賓的電話...
[訊息提示音]
羅賓.
所以他們，呃，
「暫時限制
我的腹腔鏡檢查實踐 和剖腹手術。
把我停職了。
眞糟糕...
這衹是 遮屁股的怯懦。
眞是難以置信。
難以置信！反正。
打電話給我。
[驚呼]
[緊張的音樂]
[咕噥]
[嘲笑]
[咕嚕聲]
[重擊]
[阿蒂克斯咕噥]
[阿蒂克斯抱怨]
[轟鳴聲繼續]
[海鷗的叫聲]
[電話鈴聲]
[伊莉莎白]你好。
泰勒夫人…
來自會議。
請坐。
你來這裡是為了談論 數據的發佈？
我是，是的。
看...[清喉嚨]
沒有容易的事 這麼說，
但我們的首要任務 不是為了庇護
外科醫生免受批評。
我們的首要任務是決定 什麼對每個人都有好處
最重要的是，公眾，
我們的病人。
我明白 方法論
可能還不夠完美，
但我相信透明度 是一件好事。
我們可以改進 隨著時間的推移，方法論。
[伊莉莎白] 決定 我們必須做的
在劇院裡 秒的分數
歸結為 “他們活著”或“他們死了”。
沒有背景，沒有案例，
衹是“他們活著” 或“他們死了。”
這不是透明度。
它正在尋找 有人應該責怪。
我明白你在說什麼。
-[伊莉莎白]你呢？ -是的。
但一旦我們通過了 這第一場風暴，
希望我們可以 專註於有價値的事情，
如風險調整。
風險調整？
[Te]你聽過Z五十一點五嗎？
這是安寧療護的代碼 英國的護理體系。
五十一點五 無法繼續 任何人的統計數據，因為它說
病人已經 當他們進來的時候就快死了。
病人安靜地死去。
不用化療，不用手術刀，
衹是嗎啡和鮮花。
我的敗血癥符合條件嗎？
你明白嗎？
我不應該干預嗎？
或許，這樣更適合 病人就是這樣。
也許吧，因為有時 最好嫑操作。
讓他們有尊嚴地死去。
也許還有數據的發佈
將意味著更多的人 在較少的干預下死亡。
你知道什麼是最好的 對病人來說，你呢？
坐在鍵盤前？
我知道你的名譽， 泰勒夫人。
你在你所做的事情上是最棒的。
[伊莉莎白] 之一。
但這是你一直在做的事 對病人最好？
抱歉，這聽起來很難。 我知道。
但醫院卻藏起來 這些東西，不是嗎？
員工學會隱藏東西，
病人永遠不知道 出了什麼問題。
而那些傷害最深的 是留下來的家人。
我們必須堅守自己 達到更高的標準。
我有一個標準。
這就是希波克拉底誓言。
我並沒有嘗試 隱藏任何東西。
[鳥鳴聲]
[門打開]
-[伊莉莎白]嘿！ -嗯，嗨。
你好嗎？
[難以置信地笑]
你忘記了嗎 你的一些東西？
不，我，嗯...
我衹是……我是來拿它的。
然後...
為什麼？
我不能在裡面，莉茲。
你將成為A博士，
理查將成為B博士，
和護士們 將會以名字出現在那裡，
我們中的一個人將會倒下。
那隻是噪音。
[羅賓]不，這不是噪音。
我需要我的工作，莉茲。
[伊莉莎白]羅賓.
羅賓，我可以保護你。
[羅賓]你不能。
我受夠了。
就在那裡。
-[伊麗莎白] 對不起。 -不，對不起。
走吧。
[憂鬱的音樂]
[嘆氣]
糟糕。
[悲傷的音樂]
[嘆氣]
[疲倦地嘆氣]
[呼吸急促]
[不祥的音樂]
[咕嚕聲]
[怦]
-[尖叫] -[昆蟲嗡嗡聲]
[呻吟]
[不祥的音樂繼續]
[鎖定蜂鳴聲]
[手機震動]
【電話通知】
哦，滾蛋，理查德。
[瓶子叮噹作響]
[陰沉的音樂]
[街上狗叫]
[伊麗莎白喘息]
哦，操！哦，操！
[緊張的音樂]
阿蒂克斯！
喔操！阿蒂克斯，在這裡，孩子！
他很安靜。我沒有看到他。
我忘了。我忘了那隻狗。
-[獸醫] 是的。 -我忘了他。
-我忘了他在那裡。 -好的。
我衹是要去 檢查一下他的心，好嗎？
噓。
[阿蒂克斯輕聲嗚咽]
是的。
他做得不太好。
嗯...
我想是時候了 說再見。
[嘆氣]
現在？
-現在？ -[獸醫] 是的。
[獸醫] 好的。
-[伊麗莎白] 是的。正確。 -[阿蒂克斯輕聲嗚咽]
-你準備好了嗎？ -[伊莉莎白] 嗯嗯。
[氣喘吁籲]
你可以... 你可以把手放在他身上。
你可以幫助他。
[阿迪克斯輕聲呻吟]
好狗。
[壓抑的哭聲]
是的。
我要放 現在就打針，可以嗎？
[伊麗莎白] 嗯。
好的。開始了。
[壓抑的抽泣]
檢查他的心。
他現在已經走了。
[伊莉莎白哭泣]
你願意把他火化嗎？
[深呼吸]
他不是我的。
他不是……我的狗。
他不是我的狗。
[抽泣]
你殺了我的狗。
對不起。
[傑西卡] 有什麼問題嗎 你？ [悲傷的大提琴音樂]
他走了。
對不起。
我道歉。
[潔西卡咕噥]
我道歉。
[哭泣]
[悲傷的大提琴音樂繼續]
[潔西卡抽泣]
[伊莉莎白]我如此， 我很抱歉。
[悲傷的大提琴音樂繼續]
[鳥兒的叫聲]
耶穌。
[疲倦地嘆氣]
[鈴聲響起]
你好，這是 伊麗莎白•泰勒夫人。
我正在努力 聯絡我的註冊商，
理查懷特海德.
請問我可以得到他的地址嗎？
[陰沉的音樂]
[敲門]
理查德？
理查德，接電話。
[附近電話鈴聲響起]
[喘氣]理查！
理查德！
[緊張的音樂]
耶穌。
糟糕！
眞儍。
糟糕。
理查德？理查德！
哦，理查德？理查德！
理查德.
哦，不，不，不。
不，理查德！
[哭泣]
你沒有。
拜託！
糟糕。
為什麼？
[哭泣]
[悲傷的音樂]
[輕聲嗚咽]
[水流洶湧]
[安德魯]對。
我聽說你在那裡， 第一響應者。
-我是，是的。 -對不起。
謝謝。 愚蠢的，愚蠢的混蛋。
是啊，可悲的是。
但是聽著，工作人員 目前不知道，
你也這麼認為 你手上有這個嗎？
我——是的，當然。
-我會的，當然。 -[安德魯]眞是一樁生意。
對醫院來說， 對部門來說，
對於每個人。
所以，我認為你和我應該 封住八卦
和猜測 在它開始之前。
是的，我們必須 保持對局勢的控制。
正確。
嗯，什麼... 我能做什麼，安德魯？
我能做些什麼？
嗯，我想你可能 知道這是關於什麼的。
[伊莉莎白] 是的。
是的，這並不罕見 現像，倦怠。
但我認為對大多數人來說 這裡的工作人員，
這將是第一次。
所以我們需要 展現統一戰線。
安德魯...
理查德並沒有「精疲力盡」。
伊莉莎白，我們需要 眞相的一個版本，
為了大家的利益。
怎麼……怎麼辦 那行得通嗎？
嗯，你認識我父親嗎？ 在韓國當外科醫生嗎？
他是一名戰俘。
當他發牌時 伴有肢體外傷，
他會帶他們去 考試用的廁所，
哪裡有 數以百萬計的蒼蠅。
你知道這意味著什麼嗎？
蛆。
但蛆蟲卻會 他們的工作做得很好。
他們肢解死肉，
他們清理傷口，
他們從不睡覺， 他們從不休息。
他們警惕，始終如一， 執著、値得信賴...
與某些人不同。
有什麼意義？
你到底想說什麼？
你是否記得 你叫我“儍瓜”
在死亡時 和發病率會議？
你眞的太粗魯了。
這就是這個的事嗎？
不...
[伊莉莎白] 沒有？
不，這家醫院已經投資了 你身上有大量的東西。
你是一個非常 有價値的商品。
你很聰明， 但你並不容易。
你很情緒化。
是的，情緒化。
我知道這不是 時髦地說，
但我不確定 女性適合
從事醫學事業，
尤其是未婚女性。
但當我有了既得利益 對某人感興趣，
我不顧風險地採取行動。
就這樣決定了。
有什麼？ 決定了什麼？
坦白說
有時，伊麗莎白， 我可以，你知道...
帶走你或離開你。
我懂了。
[安德魯]不， 我認為你沒有看到。
你已被賜予 第二次機會。
你會回來的 請假一週後隨傳隨到。
這就是我們的決定。
然後我們就去 發表文章
在新西蘭 醫學雜誌
你要去 註冊它。
這將是關於自殺、倦怠
還有，呃，理查的 對您的數據的影響。
理查德將被展示 正如他本來...
年輕、無能、 從他的深處，
並且他歪曲了數據。
你知道，我們採取了 太關心他了。
你太照顧他了。
這是一個悲劇 對醫院來說，
為社會，
這導致了他的自殺。
所以，呃...
你知道，工作人員 會得到諮詢，
會有守夜活動，
然後一切如常。
我想要你 註冊這一切。
它被稱為 「清理傷口，」伊莉莎白。
像蛆一樣。
那些美妙的蛆蟲。
[悲傷的音樂]
[深呼吸]
[抽鼻子]
麗茲？莉茲。
[抽泣]
對不起。
-[伊麗莎白哭了] -沒關係。
沒關係。
[悲傷的音樂繼續]
[鳥鳴聲]
什麼？
這太不公平了。
你很好，莉茲。
我知道。
我錯過了他的電話。
我本來可以帶走它們。
[羅賓]是的。
你將會有 忍受這一點。
我很抱歉。
[嘆氣]我也是。
太抱歉了。
眞是一團糟。
[嘆氣]
[戲劇音樂]
[本]簡，我想知道—
馬修斯博士？
是的。
請原諒我們一分鐘。
[本] 我能幫忙嗎？
我想和你談談 關於我們的一個病人。
麗莎威廉斯。
是的。
嗯，如果可以的話，我願意 讓簡也參與進來。
她負責管理病房。
簡。
當然。
[本] 好的。
簡，這是關於 麗莎威廉斯，
敗血癥患者 從不久前開始。
哦。
泰勒夫人是她的外科醫生
並想知道 關於她的入學。
-好的。 -拜託。
好的。好吧，我們有 她按照平常的路線，
檢查手術部位， 他們很乾淨。
有最小的 排水管中的輸出。
她的腹部很軟。
好吧，你告訴她，簡。
我和麗莎坐在一起 大約午夜時分。
她本來就很高 此時維護，
她開始 走向衰落。
她的病情每況愈下。 膿毒癥已進展。
[Jan] 她大聲喊道。 她很著急，也很激動。
[本]她是 放棄她的統計數據，
以及嘴唇發紺，
大約每秒一次呼吸。
[Jan] 她在抱怨 在又冷又累的情況下，
和導管 打擾了她，
和她的呼吸 速度非常快。
我們帶來了待命的 麻醉醫師進行插管。
麗莎能夠 和她的父母說話？
是的，簡單地說。
但後來他們有 離開房間。
她在入職期間被捕，
我們開始搶救。
我們工作過... 半小時吧，我記得。
[簡] 她廿九歲。
一個年輕、堅強的女人。
[伊莉莎白] 正確。
是的。
[本]宣告死亡 大約四...五——
-四點卌八分。 -[本]四點卌八分。是的。
差不多一小時。
是的。
[嘆氣]
謝謝你 照顧我的病人。
[本]那是你...
那是你所需要的嗎？
是的，是的。其中一些。
[本]我可以得到更多的筆記。
-我可以 - -不。
不，沒關係。
她孤獨嗎 最後呢？
我們都在這裡。
她的家人，就在上面 直到插管。
晚上我和她在一起。
謝謝你們倆。
這非常...非常有幫助。
[戲劇音樂]
[麥克風靜噪]
[清喉嚨]
特納庫圖，特納庫圖， 特納•加圖•卡托亞。
午安, 女士們，先生們。
我叫安德魯麥格拉思。
如你所知， 我是外科主任。
悲傷的一天。
不幸的是，我們在這裡
紀念理查懷特海德，
我們最聰明的人之一 青年才俊
誰的未來 就這麼殘忍地縮短了。
就在幾分鐘之內，
我希望我們 保持沉默
我們記得理查德 以及他所做的出色工作，
他在球隊中扮演的角色
我們最有天賦的人之一， 有成就的外科醫生，
伊麗莎白•泰勒夫人。
但在我們這樣做之前， 我想說這個。
我們現在知道的是 理查德去世了
是可怕的結果 倦怠的代價。
這是一個悲劇，
但其中之一 我們都會學習，
必須學習。
理查德的去世是 及時提醒我們
我們所有的員工 是脆弱的
面對這些極端的壓力。
不幸的是，
理查德是，嗯， 其受害者之一。
工作並不容易
帶著責任 生與死。
我們，醫院， 行政部門、董事會、
我們絕對認識到這一點，
而且，嗯，我們是 立即回應。
我們，從這一刻起，
採取措施 提高員工福祉
和我們集體 心理健康，
在可行的情況下盡快。
因為我們都在這之中 一起，
一個團隊
和一個社區。
[嘆氣]
確實是 對我們所有人來說都是悲傷的一天。
請默哀一分鐘。
[嘆氣]
我想說些什麼。 我想我應該。不是嗎？
-[安德魯]是的。 -我想我應該。
[安德魯]是的。 衹是一個簡短的。
是的，作為他的登記員，
你不覺得嗎 我該說點什麼嗎？
[清嗓子]抱歉。
我想說一句話， 如果沒問題的話。
謝謝。
大家好。
[嘆氣]
我們都在這裡的原因 今天，正如安德魯所說，
一場悲劇。
理查德•懷特黑德 是我的註冊員。
你們很多人都認識理查德， 以及那些沒有這麼做的人
我相信你可以 認同他。
他是個年輕人，廿六歲。
作為註冊商， 他還在學習，
仍在訓練。
他沒有死。
他自殺了。
而且，嗯，他現在死了 因為他服藥過量。
這就是事實。
他結束了自己的生命 一個骯髒的車庫，獨自一人。
伊麗莎白，夠了。
[伊莉莎白]我們說話 關於團隊合作。
-莉茲-- -我們談論韌性。
理查德缺乏韌性嗎？
這個年輕人為了誰 我有責任嗎？
因為如果你告訴我 他缺少一些東西，
我不接受。
我為一個病人做過手術 手術後死亡。
理查德在 我的監督，
他照我的要求做了。
我告訴他要加倍努力，
我選擇了時機，
我選擇了我所說的話，
我選擇了說話的方式。
而他衹是...
這是我的責任。
我有責任 為了我所承擔的風險
每次我做手術時。
理查德死了 因為他責怪自己
因為我犯了一個錯誤。
我沒有盡到自己的責任 對他來說夠清楚了。
他是一名實習醫生。
然而...
我們卻掛著
他脖子上的目標
隨著這個守夜。
[揚聲器靜噪]
我不會去 讓這個男孩
被公開當替罪羔羊
由中階管理人員 以及醫生出身的官僚。
我們正在服務中。
我們有一個約定 與我們的患者。
「我會救你 以我的技能。
但我們有一個約定 彼此。
我們正在服務中 對彼此也是如此。
這兩個盟約都是 今天這裡被破壞了，
我不會袖手旁觀
並幫助假裝 事實並非如此。
這就夠了。
[人群鼓掌]
安息吧，理查。
安息。
[憂鬱的音樂]
[深呼吸]
這就是發生的事情。
麗莎病得很重。
她患有敗血癥。
雖然原來的操作 因我所犯的錯誤而受損，
沒有那個錯誤，
很有可能 她還是會死。
膿毒癥已進展。
[無力地嘆氣]
埃夫...
雖然 你的操作出錯了...
她還有可能死嗎？
是的。
[猛吸一口氣]
有什麼嗎
你會的 做得不同嗎？
這就是難點。
不。
我不會。
我所做的所有決定 我們要盡力拯救麗莎。
如果操作 如果再次發生，
我可以讓一切 相同的決定。
但我會努力
為了更好地解釋它，
更好地採取 責任。
我允許懷疑悄悄潛入。
麗莎戰鬥了。
她眞的非常非常努力地戰鬥。
你需要知道這一點。
最終，她的身體放棄了，
儘管...
儘管我們所有 經驗和關懷。
並且請知道
你的女兒受到照顧。
[深呼吸]
我想要一個好的麗莎結果。
我很抱歉。
謝謝。
[陰沉的音樂]
[充滿希望的音樂]
【充滿希望的音樂繼續】
[輕柔的音樂]
[輕柔的戲劇音樂]