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This article covers a real-world subject which should not be taken as part of the Holby universe.

Episode 1142 of Casualty is the fourth episode of the show's 34th series. It was directed by Fiona Walton and written by Johanne McAndrew and Elliot Hope.

This episode marked the return of Jane Hazlegrove as paramedic Kathleen "Dixie" Dixon for a two-episode guest stint to facilitate Michael Stevenson's departure from his role as Iain Dean. After over nine years on the show, Dixie made her last appearance on the show in January 2016 during the 30th series. Her return was announced in August 2019.


As Iain recounts his disastrous date the night prior to Ruby, he is taken aback when he receives an envelope containing an invitation from Sam to a charity skydive. Elsewhere in Holby, brothers Fred and Alfie Gatlin use wooden planks, pallets and concrete blocks to create a bicycle obstacle course. At the ED, Archie confronts Dylan about him "fobbing [her] off with sprained ankles and dislocated shoulders" after she is relegated to minors, and he allows her to treat patients in resus when she assures him that she is ready; Will is unamused when Dylan tasks him with keeping an eye on her. On the dirt track, as the brothers test out their course, Alfie brakes sharply, causing him to fall off his bike and land on a metal rod. Fred initially believes that he is feigning being injured, but he is mortified to discover the rod embedded in his chest.

At the ambulance station, Iain explains that Sam completed the skydive the previous year. Ruby asks him if he plans on accepting the challenge, and he says no. He then receives a shout from control pertaining to Alfie's incident. Meanwhile, a hooded man carrying a bag containing a bottle of clear liquid approaches a vintage car, but he is confronted by its owner Vincent Millbank. The man asks if he knows who he is, but Vincent is not interested and tries to call the police. The man attempts to wrestle the phone out of his hand and accidentally splashes Vincent's eyes with the liquid, causing him to shout in agony; he gives him his garden hose to rinse his eyes and quickly makes his escape. However, as he calls for an ambulance, he is hit by an oncoming car.

Iain and Ruby arrive at the scene of Alfie's accident, and they discover that Fred has removed the rod from his chest. Ruby assesses him as being peri-arrest and suggests calling for HEMS; Iain concurs. Outside the ED, Rash wheels his bike in as he discusses bin collection with his father over the phone. Mason compliments his bike and claims that he has been considering buying one to help "save the planet"; Rash asserts that he "wouldn't have had that up high on [his] list of priorities". Nearby, a whimpering Vincent drives into the hospital grounds and is found by Jade. He is reluctant to leave his car unattended, but Jade assures him that it will be moved and guides him into the department.

As the air ambulance lands, Alfie goes into PEA, and Iain attempts to resuscitate him. Chris Albright - a HEMS doctor - assesses his condition and is forced to resort to a clamshell thoracotomy. Iain is surprised to be greeted by Dixie - now a HEMS paramedic - who aids Chris in preparing Alfie for the procedure. Jade takes Vincent into resus 2, and Archie informs her that she could have put another patient at risk by bringing him through reception. Archie examines his condition and tests his eyes' pH level. Outside, Will suggests that Vincent may be the victim of an acid attack; she wryly asserts that he should be a doctor. Back at the scene of Alfie's accident, Chris attempts to suture, but his view is obscured by a haemorrhage. He advises that they compress the aorta, and Dixie recommends that Iain do it, given his military service in Afghanistan. Iain agrees and follows Chris' lead, and Alfie's heart starts to beat.

Mason encourages Rash to bet on Sharmella's condition.

In cubicles, Rash assesses social butterfly Sharmella Wilson, a young woman who claims to be suffering from intermittent head pain and neck ache, as well as nausea. Mason bets £10 that she merely has a hangover; when Rash refuses to join in, he suggests that he bets his bike against his car. However, Rash insists that he does not gamble when it comes to his patients' health. In resus, as Vincent's eyes are irrigated, Archie asks him why someone would single him out as a target, but he is clueless. When he tries to swear vengeance against his attacker, she encourages him to remain calm and explains that he requires irrigation until both of his eyes have a neutral pH. Will enters and asks Archie if she has ordered an ophthalmology review and a tetanus, and she assures him that she has. In reception, Dixie and Chris transport Alfie to the lift for surgery. Meanwhile, Vincent's attacker - Seb Sanderson - is taken into resus and is horrified to see Vincent next door. Will decides to have him sent for an X-ray of his ankle; once he leaves, Seb scratches a burn he sustained to his wrist.

By reception, a shaken Fred insists on visiting his brother, and Iain promises to get an update on Alfie for him. Nearby, he shares a hug with Dixie, and she explains that she is temporarily seconded to Wyvern Air Ambulance Service until a replacement partner for Chris is found. Fred and Alfie's mother Tilly bursts into the department and castigates Fred for not taking proper care of his brother. Once Iain takes Fred to triage, Dixie apprises Tilly of Alfie's situation. In cubicles, Mason informs Rash that Sharmella's tests only show mild dehydration and hypotension. Outside, Mason suggests that he give her "an egg butty, some painkillers and call her a cab", but Rash opposes his "cavalier" attitude and posits that her symptoms could point to a potential thunderclap occipital headache - a red flag for a subarachnoid haemorrhage. Mason disagrees and, given Rash's unwavering stance, proposes that he reconsider their wager. Rash brands him as "unprofessional", but, with Mason and Jacob's encouragement, he acquiesces and agrees to the bet.

In resus, Archie notices the burn on Seb's arm, and he claims that it is a friction burn from when he landed on the road. Regardless, she applies litmus paper to it, and it confirms that it is acidic. Will confronts her about her treating his patient, and Archie criticises him for not spotting the burn and goes to call the police. At the ambulance station, Dixie tells Iain about her life in Cornwall with Jess and Olivia, and points out that he has not been in touch. Iain apologises and explains that "things got a bit on top of [him] this last year", and she assures him that she knows what he is going through. He argues that she managed to get past it, but she explains that it has been nearly five years since Jeff's death, and, although she has since moved on, she has never forgotten him. Iain tries to ask her how she managed to overcome her grief, but Chris alerts Dixie that they have a shout and praises Iain for his work in the field before leaving.

Archie learns of Vincent's history of child abuse.

A limping Seb tries to leave the hospital grounds, but Archie finds him and warns him that he will be caught by the authorities. However, she is left shocked when Seb details Vincent's history of child abuse which had resulted in his best friend Michael's recent suicide; he insists that he only wanted to damage his car. Feeling sympathetic, Archie gently leads him back inside the department for an X-ray. By the entrance, Fred asks Iain if Alfie is going to die, and Iain assures him that the theatre team are doing everything to prevent that outcome. After a frantic Tilly tells Iain to sit with Fred as she tries to find someone to cover her shift, Fred regrets removing the rod and not taking proper care of Alfie, and he expresses his wish that Tilly would spend more time at home with them. Tilly returns and asks if there is any news, and Iain tells her that Alfie is still in theatre. She apologises to Fred for losing her temper with him and holds him as he sobs.

As Archie returns to resus, Vincent berates Jade for accidentally spilling his cup of water. She informs him that his eyes' pH is increasing, and they can stop the irrigation once they get a neutral reading. Vincent warns Archie that he has friends on the local council and the hospital board, and he tells her that if "[she gives him her] best", he will "spare [her] from [his]". Outside his office, Dylan reprimands Rash and Mason for wasting hospital resources on diagnosing Sharmella, and Mason claims that he tried to point out to Rash several times that her symptoms were alcohol-related. Rash asserts that he could only rule out a subarachnoid haemorrhage with a CT scan, and Dylan instructs him to discharge her. They return to Sharmella's cubicle, and Rash points out that this is the sixth time she has been admitted to the ED in six months and tells her that she cannot use the ED every time she has a bad hangover. She confirms that her headache is subsiding, and Rash orders her to clear the bay. She angrily asserts that, as her father pays his taxes, she is entitled to whatever she wants from the department, regardless of its severity. Rash accuses her of wasting NHS resource, but Mason argues that he is projecting. Sharmella asks what the NHS is for if it is not for making people feel better and takes a photograph of him. Mason asks Rash for the keys to his bike lock, but Rash instead instructs Jacob to discharge Sharmella and walks away.

In another cubicle, Archie informs Seb that, now that he is medically cleared, he will need to speak to the police, and she asks him if he was the person who gave Vincent water at the scene; he says yes. Seb recounts to her how Vincent hated Michael the most and bullied him for years, resulting in him having a nervous breakdown at university. Archie asks him if he has ever written to Vincent to make him see how much harm he has inflicted, but Seb insists that he only cares about his car. In the peace garden, Tilly calls her boss and states that there is no one available to cover for her. Iain tells her that Fred is worried about her, and she explains that she works the sex chat lines and regrets not being at home in the morning; he tells her that she cannot torture herself over "ifs and buts". She explains that she is aware that she is relying too much on Fred and claims to be working additional shifts so she can afford to take him and Alfie away at Christmas. Believing that she needs to focus on her children, she decides to resign, but she receives a text informing her that Alfie is out of theatre, and she and Fred run back inside.

Seb visits Vincent in resus and explains that he was a student at Abbeyhurst School who now works with children with psychological trauma - "the kind of children [Vincent] helped create". Seb asks him if he remembers a boy named Michael Penrose and informs that his name features heavily in her suicide note. Vincent realises that Seb is his attacker and insists that he "moulded boys into men", but Seb angrily accuses him of killing his friend; Will forces him out of the room. On PICU, Tilly thanks Iain for saving Alfie and wishes that she could tell her son how much she loves him. Iain assures her that, although he is in an induced coma, he can still hear her. In resus, as Archie examines his eyes, Vincent claims that he made sure that his "boys" knew how to toe the line. He mentions that Seb is rumoured to have been hit by a car, and he vows to make him wish he was never born. Meanwhile, Dixie finds Iain on PICU and tells him that she was going to call him after learning of Sam's death, but she recalled how annoyed she got when people threw sympathy at her after Jeff's death and decided to rely on him calling her once he was ready. He shows her the skydiving challenge he received and tells her that the ED reminds him of Sam every day; he asks her if she has been happy since moving to Cornwall. She claims that she is "happier" and suggests that he could start feeling the same way with the skydive. She points out that her shift will end soon and invites him for a drink at The Hope & Anchor.

Will looks suspiciously at Archie.

Outside the ED, empathising with his situation, Archie tries to help Seb escape by calling him a taxi, but Will points him out to the police, and he is arrested. At the bar, Dixie reminisces about Jeff's "stupid" habits, including him leaving sweet wrappers and half-eaten food all over the ambulance, and Iain tells her about Sam forcing him to urinate whilst sitting down at her place, resulting in him habitually doing the same at home. Nearby, Mason confronts Rash in full biking gear, and Rash tries to get out of giving him his bike; Mason is unwavering, and Rash reluctantly hands him the keys to the bike lock. Dixie recalls her first shift with HEMS where she nearly vomited during her first flight because of the choppy weather, and she asserts that she now feels the "buzz" of her first shout every day. She strongly encourages Iain to join HEMS and points out that her post is still open. By reception, Will asks Archie if she heard about Seb trying to "go AWOL" and ponders how he managed to elude security, but Archie suggests that "weirder things" have happened in the ED. As Will leaves, she catches Dylan and asks him if he instructed him to keep an eye on her, but he denies it and claims that he asked him to keep an eye out for [her]". Outside, Jacob directs Will towards Vincent's car which has been damaged with acid, and Will looks at Archie suspiciously as she passes by.



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