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The 43rd episode of series 33 is the 1135th episode of Casualty overall. It was directed by Piotr Szkopiak and written by Dana Fainaru.

Plot

Connie wakes up in her office and leaves for home. However, when an aggressive man is forcing taken into the department, and she narrowly misses getting hit by a paramedic on a motorcycle, she feels intimidated and hides in her office.

Elsewhere in Holby, prison officer Liz Gage searches her kitchen for an important brown envelope and asks her husband Stephen if he has seen it, but he is preoccupied with feeding their infant daughter. He asks her if she has paid the car tax, but she snaps at him and questions why he is "hassling" her. She subsequently finds her eldest daughter Immy drawing on the envelope and harshly reprimands her, but Stephen interferes and tells her that he wishes she never took the promotion.

In her office, after applying her makeup, Connie spots Ciaran laughing with Will and Archie. Perturbed, she prepares to take a tablet of diazepam, but she receives an email from Hanssen about Ciaran, imploring her to respect the board's decision to hire him and work cordially with him; she dismisses it and takes the medication. On the first floor of the department, Archie presses Ciaran on her complaint about Connie's scapegoating and suggests that he does not believe her, but he tells her that, since she was the only witness to the incident with Kat Hollis, "[his] hands are tied". However, he assures her that they are "on the same team" and states that they need to keep watching her; unbeknownst to them, Connie is watching their conversation from the staircase.

At HMP Stonehurst, Liz informs her colleagues that, due to understaffing, they are all on the late shift, and she instructs Matt Davies to follow her into the cell block. There, she asks him what is going on, and he reluctantly recommends watching her back. In his cell, Carl conducts a drug deal over the phone, and his cellmate Stan Villiers reprimands him for stepping on his bed sheet while wearing trainers. When Carl turns a young drug addict away, Stan tells him that he is vulnerable and criticises the way he treats him. Liz and Matt enter their cell and order Carl to leave. Matt hands Stan a letter that was delivered to him, but he tells him to "send it back". Carl sarcastically asks if there is "nothing for [him]", and both officers tell him to get out. After she asks Matt to check the door, Liz contemplatively looks at the brown envelope.

3343ConnieLosesFocus

Connie begins to lose focus in resus.

In resus, as Connie and the team attempt to control an antecubital fossa bleed, Ciaran enters and waits for them to finish. When the patient's blood pressure continues to drop, Connie begins to lose her concentration, prompting Archie to press for a plan of action. Ciaran asks Connie to see him in her office once the patient is sent to theatre. Back at the prison, Carl thoroughly searches his cell for something, but Stan suggests that he is "wasting [his] time". He shouts in frustration and angrily confronts Liz, and she claims that she is "not doing it anymore" because "they are onto [her]". He begins to threaten her and demands her to hand over the drugs, but she orders him to return to his cell. Suddenly, Carl puts Liz in a headlock and holds her hostage with a shiv. She calls for Matt who arrives with a baton, but Carl commands two other prisoners to hold him down and orders Liz to capitulate or he will release all of the prisoners. She refuses, and he stabs her and takes her keys, promising that he will burn the building down. However, Stan throws Carl onto the fence, and he and Matt take Liz in his cell for protection.

In her office, Ciaran confronts Connie about the backlog of X-ray reviews, calling them a "total mess", but she dismisses his concerns and claims that she will "add it to [her] list". Meanwhile, smoke begins to enter the cell Liz, Matt and Stan are taking cover in, and Matt asks Liz why Carl attacked her. In the main block, officers in riot gear try to control the rioting inmates. Outside resus, Ciaran suggests to Connie that her doctor training programme could do with some improvements and offers to make changes himself if she is too stretched, but she insists on coming and finding him. At the prison, Iain and Jan are escorted to Stan's cell to treat Liz.

In admin, Ciaran asks Will and Archie for their opinions on the doctor training programme and posits that it needs trauma simulations rather than PowerPoint presentations, but Connie derisively agrees on the stipulation that he can arrange cover for the entire department. Nearby, Charlie finishes a call with HMP Stonehurst and tells Connie that she "needs to hear this". In the cell, while Iain assesses Liz's stab wound, Stan tells Jan that he has asthma, and, to his disapproval, she organises for someone to take him to the hospital. Once he is taken to the ED, Ciaran loudly orders the staff to quickly move the prisoners into cubicles. Liz is taken into resus, and Connie allows her husband to see her. To Connie's exasperation, Ciaran leads Jan into the room with Carl who has sustained a suspected right ankle fracture and lacerations. She insists that his injuries do not warrant him being in resus, but Ciaran asserts that, given that he instigated the riot, he does not want him to cause any trouble with the other prisoners. She tries to argue with him, but Ciaran declares that his decision is final. An indignant Connie instructs Will to perform a formal primary survey on Carl and returns to Liz who has fluid in the base of her left lung. Stephen subsequently arrives in resus, and Connie leaves Archie to fill him in.

Outside, Connie confronts Ciaran as he organises the hospital's security guards and asserts that, as Clinical Lead, she makes the clinical decisions, but he reminds her that, despite her complaints to Hanssen, she should know that she has no choice but to work with him. In cubicles, after assessing Stan, Dylan decides to test him for pneumonitis, but he insists that they do not need to bother treating him and recommends treating more "decent people". Matt visits Stan and thanks him for helping him and Liz in the riot, but he does not like the idea of receiving a commendation for his actions, and he claims that he does not want help and just wants to return to his cell; Duffy suggests that "they'd better hurry up".

3343JacobAsksConnieIfSheIsOkay

"You okay?"

Struggling to keep her composure, Connie takes more diazepam. However, Jacob knocks on her door and enters, prompting her to snap at him. She apologises, and he asks her what is wrong; she does not respond. He informs her that Archie needs her assistance as Liz's sats had suddenly dropped while she was setting up for a chest drain. In cubicles, Matt tells Duffy that, without Stan, he and Liz would have been seriously hurt in the riot. He apprises her of his repeated refusal to accept letters, visits and privileges, and his fruitless efforts to convince him to see the prison doctor, and Duffy contends that she "won't take no for an answer". Back in resus, Connie assesses Liz and explains to Stephen believes that she is developing a tension pneumothorax. Archie proposes performing a thoracostomy, but an overwhelmed Connie tells her to "give [her] a second". With Liz struggling to breathe, Stephen demands Connie to help her, and she instructs Archie to remove one of the wound's dressings to relieve the pressure. Carl returns from his X-ray, and Will approaches Connie with the results. As Marty moves Carl back into his bed, he shouts in pain, causing the symptoms of Connie's PTSD to begin to manifest; Jacob asks her if she is okay. Frustrated, she tells Will and Marty to give Carl morphine, and she goes to confront the prison officers guarding the room. Stephen asks Liz who was responsible for her injuries, but she claims that she does not know. When he suggests that the cause of the attack is why she has "been in a state all the time", Archie and Jacob ask him to wait outside. While Archie checks her over, Carl smiles at her from across the room.

By reception, an irritated Charlie informs Connie that they are officially out of cubicles. When she points out that the path to resus is blocked by beds carrying prisoners, he tells her that it is Ciaran's idea to have "reinforcement". Nearby, Iain gives Ruby a cup of coffee, and she claims that she is sure she owes him one. He suggests going out for a drink, but she tells him that she is attending the paramedic support group and asks him to come. However, he receives a shout about an incident back at the prison and leaves to attend it. In resus, Carl asserts that he has deep vein thrombosis, but Will points out that it has not been mentioned in his notes and tacitly suggests that he is lying. Vexed, Carl loudly proclaims that the riot happened because the inmates were not being supplied with drugs, and he claims that they can report them at any time. He tries to convince Connie to give him more analgesia before he is taken back to prison, but she orders for a D-dimer test and a post-cast X-ray, instead. In another bay, Liz asks for her husband.

In cubicles, Duffy apologises to Stan for the long wait for his X-ray and assures him that they will get the results back soon, but he claims that he does not know what the point is. When he leans over to vomit, she notices his clubbed fingers and goes to consult Dylan. Back in resus, Liz begs Stephen to put the brown envelope behind the cistern in the disabled toilets. He realises that she has been dealing drugs and demands to know why, and she explains that they were going to be repossessed and urges him to it or she will end up going to prison herself. As Carl is taken for an X-ray, Stephen begrudgingly agrees to hand over the drugs. Elsewhere, Duffy notifies Dylan of Stan's condition and mentions his finger clubbing, and he decides to chase his chest X-ray. In the disabled toilets, Stephen opens the envelope and finds bags filled with drugs.

Matt offers Stan a sandwich, insisting that he should eat something, but Duffy informs that he cannot eat until his test results come back. When she asks him if he has been losing weight, Matt claims that he has, but Stan denies it and asserts that he has not been experiencing any other symptoms. Duffy explains to him that the collection of his symptoms suggest that they need to look further into his condition, but he wants to be left alone. Dylan returns with the results of Stan's chest X-ray, and Stan admits that he already knows that his lung cancer has reemerged. As Connie tries to unblock the path to resus, Carl tells Marty that he desperately needs the toilet, and he hesitantly allows him to use it. Back in his cubicle, Stan explains to Dylan that his scar was from the biopsy he underwent privately and that he was declared cancer-free after a course of chemo- and radiotherapy. Dylan suggests taking him for a scan, but he is not interested as he faces spending the rest of his life in prison. Matt urges him to think about his family and assures him that he is a good person, but Stan reminds him of the severity of his crimes and calls him a "joke".

3343IainJanFindHangingPrisoner

Iain and Jan find the hanging prisoner.

Back at the prison, Iain and Jan rush to the prisoner that they have been called in to treat, but they are shocked to discover that he has hanged himself. In cubicles, Duffy apprises Matt of Liz's improving condition and suggests that he will soon receive a commendation for his actions. Noticing that he looks forlorn, she assures him that Stan probably did not mean what he said, but Matt explains that he wanted to join the army, but he was turned down for being "too soft". He tells her about Stan's defence of him and the other prisoners' fear on him, and, while he recognises the crimes he has committed, Matt posits that nobody deserves to die alone.

In resus, while Connie and the team treat a woman, Liz swears to Stephen that she will not deal drugs again and thanks him for delivering the final batch. However, when she notices Carl's infuriated face, Stephen asserts to her that he is "nobody's courier" and that, despite his unemployment, he is "man enough to stand up to scum like him". The two start fighting, and Will and Jacob are forced to hold them back. In the corner, Connie suffers a panic attack. Outside resus 3, Duffy asks Matt if Stan has seen photographs of his family, and Matt insists that he has always refused them; she tells him to come with her. In her office, Ciaran reprimands Connie for causing the incident in resus after trying to undermine him. Once he leaves, she desperately opens her handbag and takes a tablet of diazepam. Duffy and Matt return to Stan's cubicle and show him photographs of his daughters' families, including one of his grandson. Duffy suggests reconsidering his decision to refuse treatment for their sakes, but he insists that he is of no use to anyone and that they are better off without him. She apprises him of her dementia diagnosis and tells him that the only thing that will get him through his struggles is the love and support of his family. However, she is interrupted when Stan begins to cough up blood.

As the prisoner's body is taken away, Iain reflects on his numerous suicide attempts and fruitless battle with addiction. Jan suggests attending the paramedic support group that evening, but he refuses. Connie returns to resus and asks Archie to help out in minors. While she fills a syringe with a local anaesthetic, Archie asks her if she is alright, but Liz begins to shout in pain. Archie discovers that her cannula is kinked, and Connie proposes flushing it with saline. When Duffy arrives with Stan, Connie asks her to flush the cannula. She reminds her that she is not even supposed to be in resus, she reluctantly agrees. Connie tells her that the saline syringe is the one nearest to her, and Duffy administers the solution. Archie elects to perform a bronchoscopy on Stan, but he refuses. Duffy urges him to think of his family, and he ultimately agrees to it. As Connie injects Carl with what is supposed to be a local anaesthetic, Jacob tells Liz that he will try to ask Stephen to allow her children to visit her. Charlie asks Connie when Carl will be ready to be sent back to prison, and she tells Archie to start suturing his hand. As Liz tries to explain herself to Connie, her speech begins to slur, and she complains of her vision worsening. Across the room, Carl shouts in pain as Archie attempts to suture his wound, and she suggests that the anaesthetic should have started working by now. Liz subsequently has a seizure, and Connie realises the error she has made. After she orders Marty to retrieve a lipid emulsion, Liz goes into cardiac arrest.

3343IainAtSupportGroup

"Even though you got there just in time, that is something that will stick with you forever."

At the Coach and Horses, Ruby introduces herself to the group and announces that she is chairing the meeting. When she asks if somebody would like to get them started, Iain appears and volunteers. He explains that witnessing the suicide victim hanging in their prison cell deeply affected him, and it made him remember what it was like seeing it for the first time and realise what it must feel like when the victim is somebody close to him. Back at the hospital, Connie watches Liz from outside ITU and struggles to come to terms with her mistake.

Cast

Trivia

  • The episode was originally meant to air on 13 July, but it was postponed due to coverage of the 2019 Wimbledon Championships overrunning the previous week and pushing the previous episode back a week.

External links

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