This episode marked the departure of paramedic Iain Dean, portrayed by Michael Stevenson. In June 2019, it was announced that Stevenson had filmed his final scenes as the character, but he stated that "Iain's journey [would] continue", and executive producer Simon Harper insisted that "the door [was] wide open for his return". It also marked the end of Jane Hazlegrove's brief guest stint as former regular Kathleen "Dixie" Dixon.
At Mia Bellis' favourite beach, Iain reflects while holding his pebble. Meanwhile, in the ED, after speaking to his father about issues with their boiler, Rash decides to call Gem and leaves her a voicemail telling her that he misses hearing her voice and that he loves her. Mason overhears and sympathises with him, but he is taken aback by his overt drowsiness and recommends buying another bike to help clear his head.
Elsewhere in Holby, at a parcel warehouse, worker Hailey expresses her nervousness about becoming a full member of staff, and her boyfriend and manager Craig jokes that she will get the job as he is her superior. He is concerned when she holds her belly in pain, but she assures him that she is just excited. Craig gathers the other employees and sets them off on their shift. In admin, Dylan informs the team that the department is very busy and instructs them to discharge patients as quickly as possible as they wait for assistance from site services. Mason asks Rash if he should treat his patients in time order, but Rash insists that he is not ready and tells him to run everything by him. Unsatisfied, he asks Ethan if he can take on new patients in minors and keep Rash informed, and he agrees.
Iain arrives at the ambulance station and prepares to speak to Ruby and Jan, but Dixie emerges from the locker room and assumes that he has "told them"; she leaves them alone when she realises that he has not. Confused, Iain asks why Dixie is at the station, and Jan explains that management wants to trial putting critical care paramedics on front-line ambulances before asking him what he was planning on telling her and Ruby. He announces that he wants to apply for a vacancy at HEMS and insists that it is time for a new challenge. Ruby and Jan express their reservations, but he is resolute in his decision, so Jan recommends that he spends the day with Dixie.
Back at the ED, Ethan greets Effie by reception, and she expresses her pessimism about getting onto the cystic fibrosis trial due to her haemoptysis. He tells her not to get "bogged down in the small print" and refer to her patient history and him if asked. He assures her that it will be fine and sends her off upstairs. On the road, Dixie apologises to Iain for her error and tells him that Ruby and Jan were only apprehensive because they will miss him. They arrive at Stan Hawksley's house, and Iain recalls having to treat his dog Rosie. Stan greets and leads them into the kitchen, and Iain is dismayed to discover that Rosie has died.
At the warehouse, Hailey reacts to a sharp pain near her stomach, but her scanner continues to beep, forcing her to continue working. Craig notifies her about her decreasing collection rate, but she becomes agitated and accuses him of slowing her down. She tries to run to her next location, but she is hit by an oncoming vehicle and begins to writhe in pain. In Stan's garden, Iain informs him that he has called the vet, and they will send someone to collect Rosie; Stan initially objects, but he takes solace in knowing she will be reunited with his wife. Dixie explains that his heart is under strain, and Iain suggests that they take him to the hospital. However, by the time they arrive in resus 3, Stan has had an anterior myocardial infarction and has gone into cardiac arrest. Meanwhile, a woman named Anna cries as she desperately tries to hold up a piano that has broken through the floorboards and trapped her foot.
Outside resus, Iain declines a break and a cup of coffee, and he insists on persevering. He suddenly receives a text from Gem asking him to dump Rash for her. Back at the house, Anna's phone starts buzzing, and, with considerable effort, she manages to retrieve it. When she realises that someone named Gabriel is calling her, she declines it and calls for an ambulance. In cubicles, Hailey asks the team to quickly relocate her shoulder, but Rash suggests that they take it one step at a time. Mason examines her and finds that her stomach is slightly distended, but she asserts that it is her back that it is most painful and insists on returning to work as soon as possible to avoid being sanctioned. Mason volunteers to tend to her hand laceration, but Rash instructs Robyn to treat it and leaves to answer a call from Ashok.
At Anna's house, Iain and Dixie move the piano and free her foot, and Iain believes her ankle could definitely be broken. However, to her indignation, Gabriel - Anna's estranged husband - arrives. Outside, as the paramedics load her onto the ambulance, Gabriel prompts Anna to admit that she was sectioned for two months following a psychotic episode caused by severe depression. Back in her cubicle, Hailey calls and assures Craig that she should be able to make her daily quota. As Robyn anaesthetises her hand, Rash returns and informs her that she is showing signs of dehydration. Hailey explains that she does not have time to drink or have toilet breaks during her shifts, and there is not a union at Acquilo. Rash asserts that no job is worth the risk of kidney infection and sepsis, but she reveals her ankle tag and insists that she needs the job. Robyn tries to ask why her boyfriend has not done anything to help her, and Hailey maintains that Craig has already "gone above and beyond" for her. Rash is pulled away to review another patient's blood test results, and Robyn treats Hailey's laceration.
In the ambulance, Anna thanks Iain for his handling of Gabriel and asserts that he does not believe that people with depression can look after themselves. She explains that, while she was sectioned, she evaluated her relationship with her husband and concluded that she needed to get away from everyone. In cubicles, Rash tries to discuss his patients' prescription with Ethan, but Noel interrupts and notifies Ethan of an agitated Effie in reception. Mason presents Rash with Hailey's X-ray and states that it shows that her shoulder is dislocated, and Rash hastily instructs him to get her prepped. He asks Iain if Gem has contacted him recently, and he reluctantly informs him that she is not returning any time soon and does not want him to wait for her. Mason overhears and expresses his condolences before pressing Rash to get on with the relocation.
Outside the ED, Effie tells Ethan that Juliet Chen inquired about her admission in August and fears that she will speak to him about it. Ethan admits that he was "inexact" when writing her medical notes and insists that they will be fine as long as they tell her nothing. Back inside, Iain tells Gabriel that they have to respect Anna's wishes, but he points out that, without him being there, she would have nothing to eat, and he asserts that she was only discharged due to a shortage of beds. Iain argues that she would not have been allowed to leave if the psychiatric staff believed she was a danger to herself, but Gabriel reveals that she attempted suicide during a psychotic episode three months prior. Iain decides to involve Dylan in the situation and asks about Stan's condition, and he is devastated to learn that he went into asystole and could not be resuscitated.
In resus 3, Rash guides Mason through relocating Hailey's shoulder using the Milch technique. Although they are successful, she starts screaming in agony. Dylan enters and reviews her X-ray, and he points out that it shows a fracture at the neck of the humerus. He decides to step up her pain relief as a matter of urgency and sends Rash and Mason to the staff room. In the corridor, Mason reviews the X-ray, and he realises that the one he showed Rash was from November 2018. At the ambulance station, as Iain restocks the ambulance, Dixie encourages him to talk about his feelings around Stan and Rosie's deaths and warns him that he needs to learn to "open up" if he wants to join HEMS. However, he accuses her, Ruby and Jan of "fussing over" him and making him want to leave.
In the staff room, Dylan informs Rash and Mason that, although Hailey's shoulder has been successfully relocated, it has been confirmed that she also has a fracture to the neck of the humerus. He demands to know "what the dickens went on" in resus, and Mason claims that Rash has been distracted by the news about Gem. Rash insists that it was not a factor in what happened and asserts that he did not see a break on the X-ray, but Dylan warns him and Mason that Hailey will likely make a complaint, and he orders them to stay away from her. Mason maintains to Rash that he had to be "honest", but Rash walks away in incredulity. In cubicles, Dylan assesses Anna's ankle and deems it fractured. He tells that Gabriel told him she is on anti-depressants and anti-psychotic medication and asks for the name of her GP. Confused, she asks him what he has told him, and he claims that, given her injury and the state of her house, the medical staff would feel uncomfortable with discharging her somewhere that may be "uninhabitable". She insists that she has everything she needs, but Dylan decides to send off for an X-ray.
Elsewhere, Ethan discusses Effie's recent admission to the ED with trial staff member Gerry Lamb, who suggests he took a "special interest" in her case. However, Ethan asserts that, as he was already aware of the trial, he decided to refer her directly instead of sending her back to the CF clinic. Gerry highlights Effie's lack of clarity regarding the details of her admission and contends that they need to be rigorous about eligible candidates, but Ethan claims that he did not want to overburden her and is aware of the bleak acceptance rates. Outside the X-ray room, Anna tells Iain that she wants to go home, but he argues that he would not want anybody he cares about to live in her home. She asserts that she intended to see her GP, but she has been busy and "it justs takes so long to brush [her] teeth". He empathises and argues that shutting herself off from her family may be "a little too much for now". On their way out, Dixie praises his advice and tacitly suggests that he should follow his own advice.
In cubicles, Will hands Rash Hailey's abdominal X-ray, and Robyn informs him that she has just left. He chases after her and tells her that her X-ray shows a bowel obstruction. He urges her to come back inside, but she fears for her job. Craig states that he cannot allow her to continue working as she would not be covered, so she asks him if he will stay with her; he reluctantly agrees. At reception, Gabriel apprises Iain of Anna's decision to return back home for a few days and apologises for getting frustrated with him. He explains that her mother had died, her boys had left for university, and the school where she taught music forced her into early retirement. Iain tries to tells him that, after what she has been through, she will never really go back to how she was, but she appears, and Gabriel takes her home. Nearby, Effie returns from a meeting and informs Ethan that she has been accepted onto the trial. He congratulates her, and she hugs and thanks him. Will makes a remark, and Ethan insists that she was only overjoyed to have gotten onto the trial, but Will asks him if "that's all there is to it"; Ethan dismisses his suggestion as being "ridiculous".
In admin, Mason tells Rash that he would like to "clear the air", but Rash accuses him throwing him under the bus. Mason argues that he has repeatedly tried to get rid of him, and it is not his fault that he has been dumped. Robyn presents Rash with Hailey's CT results, and he goes to find Dylan. However, Craig calls him over to Hailey's cubicle and, despite Rash insisting that he is not allowed to treat her anymore, asserts that he owes her for his error. Rash informs her that it is likely that she will be admitted to general surgery with oncological input, but Dylan finds him and reprimands him for disobeying his instruction to stay away from her. At the ambulance station, Ruby tells Iain that she and Jan overheard his argument with Dixie and insists that they do not doubt that he is ready to join HEMS. Jan tells him that he is family, and Ruby suggests that the turmoil he has been through will only serve to embolden him. However, he receives a call about a suspected overdose at Anna's address, and he and Dixie decide to take the shout.
In her cubicle, Craig assures Hailey that the medics caught her cancer early and promises to speak to Acquilo's management about allowing her to return to work once she has recovered. He claims that he needs to go back to work and will visit her again the following day, but she begs to differ and suggests that he does not want to burdened by her condition. He insists that she deserves better, and he still cares about her, but she demands him to leave and claims that she realises there are "worse things than getting cancer". Meanwhile, police manage to break down Anna's door, and Iain and Dixie find her sitting in her room; she asserts that she has no intention of taking an overdose and just wants to be left alone. Iain tells her that he knows what it is like to shut everybody out and urges her to show her family how to help. She asks what if she does not go back to how she was, and he claims that "it's moving forward that counts".
In the staff room, Ethan questions Rash about how he missed Hailey's fracture, and Rash tells him that it is not his job to supervise Mason. Rash apologises, but Ethan asserts that, if he continues to make mistakes, he would struggle to write him a reference to move him up to CT1. Once Ethan leaves, Rash tries to call Gem, but he is devastated to be told that her number is not in service. At The Hope & Anchor, Jan tells Iain that she is going to miss him, and he thanks her for everything she has done for him. As Jan and Dixie challenge each other to a game of darts, Ruby apologises to Iain for not being entirely supportive to him and admits that she was just sad about him leaving. Iain assures her that she has nothing to apologises for and thanks her "from the bottom of [his] heart". She asks him if he will keep in touch, and he claims that he "might do". At Mia's beach, Dixie joins Iain as he throws his pebble into the sea.
- Michael Stevenson as Iain Dean
- Maddy Hill as Ruby Spark
- Di Botcher as Jan Jenning
- Neet Mohan as Rashid Masum
- Victor Oshin as Mason Reede
- George Rainsford as Ethan Hardy
- William Beck as Dylan Keogh
- Charles Venn as Jacob Masters
- Amanda Henderson as Robyn Miller
- Gabriella Leon as Jade Lovall
- Jack Nolan as Will Noble
- Tony Marshall as Noel Garcia
- Jane Hazlegrove as Kathleen "Dixie" Dixon
- Abigail Hardingham as Effie Laurence
- Emma Davies as Anna Norman
- Liam Smith as Gabriel Norman
- Hannah Traylen as Hailey Dougan
- Cesare Taurasi as Craig Halten
- Colin Bennett as Stan Hawksley
- James Thorne as Gerry Lamb