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







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If you are a UK resident with a TV licence, you can watch this episode on BBC iPlayer.

Episode 1182 is the first episode of series 35 of Casualty. It was directed by Steve Hughes and written by Kevin Rundle.

This episode was the first to be filmed after production of Casualty was suspended due to the COVID-19 pandemic in March 2020. It explores the impact of the pandemic on Holby City Hospital's emergency department and the personal lives of its staff.

This episode marks the final regular appearance of receptionist Noel Garcia, portrayed by Tony Marshall.

Plot

90 days into lockdown, Charlie enters the area of the emergency department encompassing cubicles and admin, which is now the COVID-19 area, and asks for Connie. None of the team know, and Rash asks if there is any news. After removing his PPE, Charlie continues searching for Connie and finds her sobbing in the conference room. She tells Charlie that she "can't do this". She explains that everything she has tried has failed, and she does not know what to tell the team anymore. Charlie assures her that she has been doing an incredible job and that the situation is not her fault. Connie claims that she always knew that it was only a matter of time before members of staff got sick, but she did not realise how many of them would end up contracting the virus. The ICU doctors have told her to speak to "the family", but she does not know what to say and claims that she is not ready for them to withdraw treatment. Charlie suggests that she take a step back and try to think objectively, but she does not want the patient's life support to be turned off.

11 days before lockdown, Ethan watches news coverage of the COVID-19 pandemic in Italy where there have been 15,000 confirmed cases and is concerned by the impact the virus has had on their admissions. Connie assures him and Rash that the hospital will be having a meeting with the estate team in the afternoon to prepare for their first cases of COVID-19. She suggests to Jacob that they set up a "hot zone" in the department for anyone with a respiratory illness or fever, have separates teams and entrances, and isolate the department from the rest of the hospital. Charlie urges her to contact procurement about daily deliveries of PPE as the ED does not have enough for a pandemic; Connie promises to bring the issue up at the meeting.

Will, after overhearing Connie, asks Dylan and David if they are exposed to the virus; Dylan assures him that they should be fine as long as they practise proper hygiene. However, David does not want to take any chances and reveals a respirator that he bought online. Will laughs it off, but Dylan is interested and asks for a purchase link. As David tries to calm himself down, Rosa, who is now a healthcare assistant, quietly asks him if he is coping with the change in routine. David assures her that he is fine and tells her that her new roles suits her. Noel jokes that she has chosen a "simple" time to change roles.

Marty asks Robyn if she reckons that his holiday to Ibiza will happen, but Noel suggests that he write it off. Marty is shocked when Rosa arrives with a large pile of newly-delivered body bags, and Rosa claims that hospital management fears that the hospital is not going to have enough.

Connie finishes a call with St James' Hospital who have converted their testing pods to hot assessment areas. Nearby, pregnant woman Zosia fears that she will be infected and refuses to leave the ambulance. Fenisha concedes that there is a risk, but she argues that she needs treatment and offers to step back while she disembarks. Connie overhears and insists on having the hot zone set up as soon as possible. She opines that the hospital may fare better if the government institutes a nationwide lockdown, but Jacob reminds her that they would not be able to visit each other. She jokes that he might not have the energy to see her if the country is hit by COVID as hard as Italy and invites him over for dinner.

One day before lockdown, Noel complains that protective screens have not been installed at reception and jokes that he may need to start sending more Christmas card to curry favour. Connie assures him that screens will arrive by the end of the week.

Fenisha is shocked by Lev's decision to move out of his and Faith's home during lockdown. Faith explains that they cannot risk Luka catching the virus and leave to speak to Connie about Faith staying at home. Fearing for her baby's health, Fenisha approaches Jan about self-isolating and lies about being asthmatic. Jan is surprised by the revelation but nonetheless instructs her to inform control.

Jade expresses her concerns to Robyn about struggling to communicate with people constantly wearing masks, and Robyn agrees to learn basic medical sign to help her.

Ethan informs Connie that his patient, who was admitted with breathing difficulties and a fever, visited the races the weekend prior and that his chest X-ray shows shadowing consistent with the COVID-19 patients in Italy. Connie instructs Ethan to isolate the patient immediately and tells Noel to call domestics about a suspected COVID-19 patient in the department.

In the present day, Connie reflects on "Patient Zero" and regrets the "buzz" around them and claims that she was already planning the speech she was going to make.

Connie makes her speech.

Back on the day of the first case, Connie apprises the team of the news and assures them that the patient is stable and under observation. However, Connie decides to be honest and states that they will be facing a once-in-a-lifetime event. She warns them that some members of staff will get sick, but there are protocols in place to protect them and the patients. She assures them that she has faith in all of them.

In hindsight, Connie is unsure if she even believed what she said in her speech and feels like she is making it up as she goes along. Charlie does not want her to blame herself, but Connie asserts that someone has to take responsibility for the in.adequate planning and management of the pandemic. Charlie argues that the department has always managed to come through difficult situations as a unit.

10 days into lockdown, Rash treats Anthony O'Reiley — the son of a patient treated in December 2019 — for symptoms of COVID-19. Anthony claims that he has had several false alarms on account of his hay fever and explains that the cycling event he planned to attend in the summer has most likely been cancelled. Rash hopes to have him back on his bike as soon as possible as his oxygen saturation is normal and suggests that he self-isolate, but Anthony's father is shielding because of his COPD. As Anthony tries to leave to use the toilet, he collapses and is taken to resus. There, Connie reviews Anthony's X-ray and comments that, even as a cardiothoracic surgeon, she has never seen comparable amounts of lung damage and is staggered that Anthony managed to walk to the ED by himself. Rash explains that silent hypoxia is emerging as a common feature of COVID-19 and suggests that they cannot rely on oxygen saturation anymore to rule out the disease; Connie recommends that he do a blood gas every time as a fail-safe. Connie asks Rash if he is OK with speaking to Anthony's father, but Rash does not know what to say. Connie tells him to be honest.

Outside resus, Robyn sees Anthony and tells Connie that the department has already sent similar cases home. However, Connie tells her that they should just hope that they made a good assessment at the time.

13 days later, Rash is left devastated when Anthony dies.

In the conference room, Charlie empathises with Connie and assures her that her response to the situation is natural.

Five days into lockdown, Doris Parry — a care home resident — is readmitted to the ED after falling off her chair. Doris expresses her dislike of not being able to use the normal entrance to the ED and asks Noel to restore it, but Charlie claims that Noel would be a very rich man if he had that power. She does not recognise Charlie, but, when reminded, she flirtatiously promises him that she is infection-free.

85 days later, Charlie uses Doris as an example of an asymptomatic COVID-19 patient and explains that he still would have sent her back to the care home even if he had the directive to swab every patient for COVID.

The team loses Doris.

After Doris' condition deteriorates due to COVID-19, Dylan deems her not well enough for non-invasive ventilation and suggests that the team "let her go". However, Jade cannot hear Dylan's reasoning and tries to help Doris. Dylan and Charlie try to explain that Doris will not recover and that they need to make responsible decisions, but Jade still cannot hear. Robyn signs "I'm sorry, it's hard" which convinces Jade to reluctantly let go of Doris and allow her to die. As Jade leaves devastated, Dylan suggests to Charlie that her role may need to be re-evaluated if her hearing is compromised.

Over the next few days, the resus team continues to lose more and more patients to COVID. By the 18th day into lockdown, Dylan has started showing symptoms. Jade is frustrated that she is unable to treat COVID patients and vows to find a way to do more.

In the conference room, Connie asks Charlie what stopped him from walking away. Charlie recalls a quiet night shift where the local pizza house donated food to the staff, and the internet.

19 days into lockdown, Noel films Robyn, Ethan and Rash dancing in their PPE for the internet. However, Noel accidentally deletes the video and films them again.

The next day, Will is frustrated and storms out when another COVID patient dies. He complains to Connie about some of the PPE being two years out of date and asserts that the government's guidance has left the staff unprotected for weeks. Connie contends that she is under as much pressure as him and claims that she has not had a day off in weeks. After calming down, she explains that her father died alone in a hospital corridor, and she came to the ED to make sure that never happened again. She vents her frustrations at not having enough equipment and high-dependency cubicles to save patients and blames the situation on the NHS already being crippled. Connie gives Will permission to take time off, but Will refuses to leave the team short-staffed.

In the present day, Charlie reminds Connie that they have spent three months making difficult decisions and suggests that she is just delaying the inevitable.

49 days into lockdown, Dylan is taken into HDC.

Charlie tells Connie that ICU are waiting for her to contact the family, but Connie argues that there could be new treatments and trials in the future that may save the patient. Charlie recalls the day when Duffy died and him refusing to accept that it was over, and he contends that any further delay will be about her, not the patient. Connie finally agrees to contact the family. As Charlie leaves the room, David passes by and asks if he is alright; Charlie explains that Connie is making a difficult phone call.

Ethan calls the patient's family.

On the 47th day of lockdown, Ethan calls a dying, male COVID patient's family and informs them that he has requested not to be resuscitated. Ethan tells them that the patient will likely die soon and tells the family that relatives cannot visit the ED under any circumstances, but he reassures them that Jade has volunteered to sit with him until the end. He weeps once he finishes the call, but David visits to give him the detail of more families to contact.

Outside the conference room, David remembers there almost being a script for speaking to the families of older patients but not those of healthy patients in their prime like key workers and children.

42 days into lockdown, Zosia, who has contracted COVID-19, is readmitted to the ED after going into labour. She asks if her baby will have the virus, but Jacob does not know. Ethan manages to deliver a baby boy and manages to resuscitate him. Zosia wants to hold her son, but Ethan is reluctant to allow her to on account of her diagnosis. After much deliberation, he allows Zosia to hold the baby which helps to stabilise her. Ethan warns Jacob that his mask has dropped, but Jacob claims that it is the "least of [his] worries". However, Jacob later takes his own temperature and discovers that he has a fever.

In the present day, David points out that front line workers are vulnerable as they do not stop working even if their protective equipment fails them.

71 days into lockdown, Karla Capelle video-calls her husband Derek from the ED after being diagnosed with COVID-19. She informs him that she is going to be put on a ventilator due to her lack of improvement and fears that she will die, but Derek assures her that she will be OK. Rosa hands Marty a heart a volunteer had made for the COVID patients and their families to keep them connected. Derek brings their daughter Ava onto the call, and Karla tells her to look after Daddy for her. Once the call ends, Marty presents Karla with the heart, and Karla claims that she was making them for the care home residents and did not anticipate needing one herself. She asks Marty if sedation is the end-point of her treatment and asks who administers it; Marty volunteers to stay with her throughout.

59 days into lockdown, Zosia's infant son is put on a ventilator. Meanwhile, downstairs, Noel is booked into the ED with COVID symptoms.

After finishing the call, Connie informs Charlie that the family trusts the experts and that they did not even know that their relative was sick in the first place.

On the 60th day of lockdown, Jacob returns to the ED having recovered from COVID-19, but he notices an alarming number of people from ethnic minorities, including Noel, contracting the disease. He wakes Connie in her office and insists on discussing the trend. Connie disputes Jacob's observations, but Jacob argues that people from ethnic minorities disproportionately fill vulnerable roles and urges her to "shout" with him. Connie rebukes him when he asks her if she thinks that ethnic minority lives matter and argues that she does not have time to risk-assess every patient, but Jacob demands that she make the time and have his back. Connie admits that she was scared and could not sleep when he caught the virus, and she agrees to formulate a plan with him at the end of the shift.

When Connie visits Noel in his cubicle, he tells her that she and Jacob are great together and suggests that she "go for it". Connie tells him that he will be put onto a ventilator if his condition gets serious. Noel fears that he is going to die and contemplates not being able to meet his grandchild, but Connie assures him that he has as good a chance as anyone else. She apologises for not congratulating him on becoming a grandfather and offers to take him out for dinner to celebrate once the pandemic is over.

In the conference room, Connie realises what she needs to do, but she is not ready; Charlie claims that, as people have different reactions to the virus, there is always "a tiny sliver of hope".

Downstairs, the team claps for Zosia as she leaves the department with her baby.

"I'm so sorry. Sleep well, my friend."

In ICU, Connie sits with Noel after his life support is turned off and tells her friend to "sleep well".

Back in the ED, Connie decides to give the team one last moment of happiness before informing them that Noel has died. She remarks that Noel was the first in and last out every shift, and she cannot imagine the department without him. She explains that the ED has been given the option to divert to St James', but the team unanimously agrees to continue working to honour Noel's memory. After answering a call, Jacob informs the team that there has been a multi-vehicle RTC and tells them to be kind to each other and show Noel what a great team they are.

Outside, while the resus team waits outside to complete the handover, Karla leaves the department and reunites with her family.

The episode ends with the following text:

90 days after the first lockdown, the UK had suffered 42,589 deaths. We continue to fight this battle together.

Cast

References

External links


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