Ciaran Coulson is an executive troubleshooter who worked in Holby City Hospital's emergency department for two months in 2019. An experienced emergency physician who worked across the United States, he was brought into the department by the hospital trust after it failed to meet its targets.
Appointment to the emergency department
In May 2019, hospital CEO Henrik Hanssen confronted Clinical Lead Connie Beauchamp about the department's poor performance. She offered to provide him with a proposal, but the hospital trust decided to appoint a troubleshooter instead. (CAS: Episode 1128)
On 1 June, Ciaran started his first shift in the department and expressed his intent to establish a Rapid Assessment and Treatment system so patients could be treated more efficiently. However, Connie was sceptical and defied him to consult the team before enacting his plan. With a large queue of ambulances waiting outside the building, Ciaran deemed that Connie's patient's injuries were not life-threatening and instructed her to start prioritising the patients outside.
Connie subsequently announced to the team that the RAT system would be implemented, but she quickly abandoned her post to treat patients in cubicles and in resus. Ciaran reprimanded her for ignoring their "agreement", but she claimed that, due to a lack of planning and consultation, his plan was unfeasible. Later, when it transpired that Connie's patient was suffering from a pneumothorax, Ciaran disagreed with her decision to perform a chest drain. Connie snapped at him and insisted that she had clinical authority, but, when she called Hanssen to back her up, he told her otherwise. Once Connie left, Ciaran guided registrar Archie Hudson through using a thoracic decompression catheter, and she successfully stabilised the patient; she thanked him for his help.
That evening, as Connie was leaving, Ciaran assured her that they were both just doing their jobs and maintained that they could work together. She agreed, and he jokingly accused her of "stealing [his] best lines", prompting Connie to retort that she was not known for stealing or surrendering but was rather "renowned for being indefatigable". (CAS: Episode 1129)
The following week, Connie left Ciaran in charge of the department whilst she attended a discussion panel at the National Conference of Acute Trauma. In admin, he announced that he was initiating a time and motion study where each member of staff had to keep a log of their activities. Archie took issue with his idea and suggested that he was "checking up on [them]", but he averred that he was gathering data to identify areas for improvement. Several hours later, Ciaran approached her and pointed out that she had not initiated her study, but she claimed that she was busy saving lives.
After working together in resus, Archie asserted that the study was flawed as it could not measure the value of certain activities such as speaking to grieving relatives. After she informed him that she completed her study to deny him the satisfaction of calling her out, whilst maintaining that the data was still useful, he revealed that he was using the study to find out which members of staff would struggle to cooperate with him and argued that she "came into line pretty quick". In Connie's office, Ciaran tried to view the data from the study, but the software had become corrupted. He asked consultant Will Noble and Archie if they knew anything about it, and they denied having any knowledge. Will asked him if the loss of the data would result in the study being repeated, and Ciaran opted to trust the staff to do their jobs properly. (CAS: Episode 1130)
Taking down Connie
Connie returned from the conference the next day and was dismayed to discover that Ciaran had established a rapport with the other members of staff and moved into her office. She asked him if it was a "permanent arrangement", and he explained that it made sense for him to "be on the front line". However, she later had enough of his occupancy of her office and moved his belongings into the staff room. Irritated, he promised to report her behaviour to Hanssen. Later that day, following an intubation incident, Ciaran confronted Connie and Archie. Archie attempted to talk through the sequence of events, but Connie interrupted her and claimed that Archie caused a bleed during intubation. Ciaran probed for more information, but Connie continued to speak over Archie and ushered her out of the staff room. (CAS: Episode 1131)
On 22 June, Ciaran took issue with sister Lisa "Duffy" Duffin's decision to intervene when a young diabetic girl named Carrie ran into the bus she was riding and urged her to consider precautions and liability on account of her dementia. However, when the girl's foster mother Emma claimed that Duffy saved her life, he allowed her to continue working on the case. In cubicles, Carrie experienced a seizure and was taken back into resus. Ciaran instructed clinical nurse manager Charlie Fairhead and consultant Ethan Hardy to take over her treatment and asserted that they could not afford any more mistakes. Duffy maintained that she gave Carrie the correct concentration of glucose, but Ciaran ignored her rebuttal and ordered her to remain nearby as to ward off any suspicion. Once Carrie was stabilised, he recommended spending the rest of the day coming to a rational decision about her future in the department, and Duffy refused to be "bullied into resigning".
Later that day, after Duffy managed to convince Carrie to accept help with her diabetes, Ciaran apologised to her for jumping to conclusions and praised her "tenacity and patient care". Nevertheless, he claimed that the hospital was no place for sentimentality and reminded her that she was "suffering from" dementia, but Duffy corrected him by stating that she was "living with" the condition. She subsequently decided to quit her job as a sister to assume a non-clinical role in the department. Connie, who was in a meeting for the day, caught wind of the news and confronted Ciaran for his hand in Duffy's resignation, but he assured her that Duffy had his full respect and asserted that he did her a favour. (CAS: Episode 1132)
On 29 June, after a man was stabbed in the neck by his estranged wife with a key, Will instructed Archie to fetch Connie to help out in resus. However, feeling that Connie was not fit to practise, she decided to get Ciaran instead. Later that day, Archie expressed her concerns to Ciaran about Connie's competency and her scapegoating her. Ciaran asked her to produce a written account of the incident involving Kat Hollis and expressed his appreciation of her speaking out. (CAS: Episode 1133)
On 13 July, Archie pressed Ciaran to take her complaint about Connie's scapegoating seriously and suggested that he did not believe her, but he told her that since she was the only witness to the incident with Kat Hollis, "[his] hands [were tied]". Nevertheless, he assured her that they were "on the same team" and claimed that they needed to keep watching her; unbeknownst to them, Connie was watching their conversation from the department's main staircase.
Later, Ciaran confronted Connie about the backlog of X-ray reviews and suggested improving the doctor training programme by incorporating trauma simulations; she derisively agreed on the condition that he could find cover for the entire department. After a riot broke out at HMP Stonehurst, Connie vehemently disagreed with Ciaran's decision to keep the instigator Carl Jenkins in resus to prevent him from interacting from the other inmates, but he declared that his decision was final. She also confronted him when he brought in a surplus of security guards, but he reminded her that, despite her complaints to Hanssen, she had no choice but to work with him. To keep resus secure, Ciaran decided to block the path to resus with beds and guards. Furious, Connie cleared the way, but a fight occurred soon after between Carl and injured prison officer Liz Gage's husband Stephen, leaving Will and Jacob Masters to physically restrain the two. In her office, Ciaran reprimanded Connie for undermining him and causing the incident. (CAS: Episode 1135)
The next day, following an incident in resus where Liz went into cardiac arrest after accidentally having her cannula flushed with lidocaine instead of saline, Archie tried to prove Connie's guilt to him with deductive reasoning, but he required a sworn testimony before he could involve Hanssen. However, when Archie could not remember if the syringes were labelled, Ciaran went to check the sharps box in resus; unbeknownst to him, Connie had already replaced it and binned the unlabelled syringes. By reception, she maintained that she would neither confirm nor deny that there was a mix-up with the drugs until she had read the notes; Ciaran warned her that he intended to report her involvement in the incident with Hanssen. She suggested that he would have already spoken to him if he had proof, but he claimed that he wanted to give her the chance to "save face" before she became "utterly unemployable".
Later, Archie insisted that she saw Duffy flushing Liz's cannula with the syringe Connie indicated, but, when Ciaran told her that she would need to stand before a disciplinary panel, she was hesitant due to her history of whistleblowing. Nonetheless, Ciaran posited that, if both she and Duffy voiced their concerns about Connie's competency, it could have sealed her fate. He decided to talk to Duffy, but she claimed that she did not trust herself and acknowledged that she could have picked up the wrong syringe. He warned her that, if she admitted to making the mistake and blamed it on her mental deterioration, it would have been "a sad end to an impressive career", but she insisted that Connie could not have made the error. At the end of the day, Duffy resigned, and Ciaran accused Connie of "[throwing her] under the bus in cold blood". (CAS: Episode 1136)
Following Duffy's resignation, Ciaran told Archie that they had to "watch and wait" for Connie to make another mistake, but, when Will accidentally nicked one of the blood vessels in Fiona Nyeman's hand, he decided to use it as an example to bait Connie and forced Will to apologise to the patient. However, after he cited "recent mistakes in the department" and claimed that Will was "an example to others less diligent", Charlie believed that he was referring to Duffy and confronted him.
Later that day, after receiving a tip-off from Will, Archie discovered a box of diazepam in Connie's drawer, and she reported his finding to Ciaran. As she was preparing to leave the hospital, Ciaran entered her office and ordered her to open the drawer. She objected, and he offered to take the case higher, such as to Hanssen or the police. For the "sake of expediency", she handed him the key to the drawer. Upon opening it, he discovered that the drugs were missing; unbeknownst to him, she was hiding them in her handbag. Ciaran promised to pursue the matter until she "[got what was] coming to [her]", but she ordered him to get out of her office. (CAS: Episode 1137)
On 27 July, after it was announced that there would be an inquiry into the department over-prescribing benzodiazepines, Ciaran vowed to lead it and make sure that there were witnesses when Connie finally caved under the pressure. In her office, when the ED was put on major incident standby after a fire broke out in a warehouse, Ciaran maintained to Hanssen that, if "everyone [was] on their game", they could take all of the casualties; Connie reluctantly agreed. He also volunteered to lead the inquiry, but, to his indignation, Hanssen allowed her to take charge.
In resus, Connie lost her confidence and got Archie to lead an escharotomy on a patient with full-thickness burns to his torso. Unfortunately, they soon lost all output, and he was pronounced dead after 20 minutes of CPR. Archie apprised Ciaran of the situation, and he claimed that the most important thing was that she would be "rattled". However, Archie disagreed and reminded him that a man had lost his life; she was staggered when he immediately started calling Hanssen to discuss the benzodiazepine inquiry. Ciaran and Hanssen subsequently visited Connie in her office, and she claimed that she had been too busy to follow up on the inquiry. Ciaran offered to take it off her hands, but she insisted that she could manage. Asserting that they could not be seen to be "dragging [their] heels", Hanssen asked Connie to email him the paperwork, and she obliged.
When the department reached full capacity, staff nurse David Hide confronted Ciaran about his decision to not divert patients. When he overheard porters Gem Dean and Rosa Cadenas discussing where they should take their patient who had been evicted from their cubicle, Ciaran admonished them for not using their initiative, prompting nurse Robyn to sarcastically suggest moving them into a broom cupboard. He admitted defeat and instructed them to move the patient in cubicle seven to Orthopaedics. Outside, paramedics Iain Dean and Ruby Spark arrived with a patient named Stuart, but Ciaran told them to keep him in the ambulance as he was not a priority. Iain challenged him, but Ciaran told him to "suck it up". However, Stuart soon started to deteriorate, and Iain defied Ciaran's orders and took him into resus. He reprimanded him and accused him of overdosing Stuart on Diazemuls, but Ruby defended Iain and asserted that the patient would have suffered brain damage. Ciaran told operational duty manager Jan Jenning that her paramedics had jeopardised the "smooth running" of the department, but she argued that his system had not "looked smooth all day" and encouraged him to write her a complaint so she could return the favour; he backed down.
Later that afternoon, Hanssen called Ciaran to Connie's office and demanded an explanation for him prescribing three times as many benzodiazepines as any of his colleagues. Ciaran denied the allegation and blamed Connie; nevertheless, Hanssen notified him that the hospital would not renew his contract. Ciaran confronted Connie and claimed that she framed him, but she feigned ignorance and closed her door in his face. In the staff room, he insisted that Connie had framed him, but Archie pointed out that he had become too fixated on her. He acknowledged his mistake and apologised, but he maintained that he was not the one who should have been leaving and urged her to not let go of what happened. After telling her that it was "on [her] now", he groaned and left the ED. (CAS: Episode 1138)