"Hearts and Flowers" is the 984th episode of Casualty and the 23rd episode of the 30th series. It was preceded by "Step Right Up" and followed by "Just Do It". The episode was directed by David Innes Edwards and written by Dominique Moloney.
It featured debut guest appearances from Rosie Marcel and Tom Chambers as Jac Naylor and Sam Strachan, respectively. It also featured the return guest appearance of Emily Carey as Grace Beauchamp. Throughout the episode, characters reference Valentine's Day as though it's on that day, heavily indicating that the episode's events take place a day after the airdate, on February 14 2016.
Taking place at the beginning of the night shift, Ethan arrives for work and although Cal attempts to speak to him, he's still clearly angry at him about the previous week's events. Charlie asks Cal where he's going to stay now that he's fallen out with Ethan but he says he hasn't discussed it as it would involve them speaking. Meanwhile Robyn grows concerned about Lofty who is clearly exhausted and was up all night reading about work. Connie and Jacob are just discussing their Valentine's plans when she receives a call from Grace saying she's at a hotel in Holby with her dad Sam's girlfriend, Emma who is suffering from severe stomach pains. Connie tells Robyn to send an ambulance to the hotel whilst remaining on the line to Grace. Elsewhere, Iain attends the scene of an accident where a young woman, Jill, has fallen from a balcony two stories high.
Back at the ED, Emma arrives in the ambulance with Grace and although Connie attempts to greet Grace, she makes it clear that she just wants her to treat Emma. Also, Jill arrives at the ED being treated by Ethan but Cal attempts to intrude causing Ethan to anger. Jill explains to him that she came home and her ex-husband Dion was in her flat and she jumped off the balcony to escape him. She also requests that her fiancée Craig be called into the ED to be with her. At the coffee shop, Max is discussing his Valentine's date with Robyn and realises that Zoe overhears but Robyn sees a striking resemblance between his date and Zoe. In reception, Jack and Noel show Big Mac the newspaper article they had done on his heroic actions, but he insists that he isn't a hero and they're making a big deal out of it. Meanwhile, Connie is treating Emma and she tells her that she has IBS and Connie suspects that could be the cause of the stomach pains, but decides to run a series of tests to rule out anything else. When she asks Grace to leave whilst she speaks to Emma, Grace refuses to leave her side which leaves Connie upset as she shows more affection to Emma. Connie also decides to run a pregnancy test.
Meanwhile, Jill goes in for her CT scan when Craig arrives to calm her down. Whilst she's being scanned, he explains to them that she had been known to be paranoid in the past and that her ex-husband may not have actually been in the apartment. Elsewhere in the ED, Connie decides to run further tests on Emma to determine the cause of her pain and asks what they were doing in Holby to start with and Emma tells her that Sam's giving a talk at a 3 day medical conference. Emma then asks Grace to go and call Sam to let him know they're at the hospital. Robyn also expresses her concerns to Dylan about Lofty overworking himself, and Ethan suspects that Jill's injury could be a possible suicide attempt. Also, Ethan gets angry at Cal for discharging one of his patients.
Connie continues to treat Emma and suspects she may have an abdominal aortic aneurysm, where the artery in her abdomen is swollen and possibly leaking. Just as Connie is about to send her off for a CT scan, Sam walks in and tells her it won't be necessary. Meanwhile Cal treats a man who was trying to treat a girl for Valentine's but she slammed the door on him and his hand went straight through the glass and he ended up with fragments of blue glass embedded in his hand. Zoe walks past Max and notices him carrying a large box of chocolates from Victoria, his fling from weeks ago. He explains that she left them at reception for him along with a pretty terrifying poem. Elsewhere, Sam interferes with Emma's treatment and says he will be having her transferred to a private hospital and won't have her treated on the NHS, something which annoys both her and Jacob. Meanwhile, Ethan continues Jill's treatment and Craig holds back on calling the police as he knows that Jill's mind can play tricks on her. At the same time, Cal realises that the patient he was treating for a hand injury has mysteriously disappeared.
Sam returns to the room where Emma was being treated to find that she's gone, and asks Grace and she tells him they took her for a scan. He angrily tells Connie when she returns with Emma that he's got a private ambulance on its way from The Pennicott Clinic, but Connie tells him he can cancel it as she isn't going anywhere in her condition. Sam tells Emma that they're going to have to operate on her, but Connie seems uncertain about how quick they can get her into surgery. Her and Jacob step outside and she tells him that she wants to keep their relationship secret so Grace doesn't find out due to her difficult time at the moment. Just as they're kissing, Jac Naylor appears and tells them that she came down as she had heard Sam had returned from the US and wanted to say hello. Meanwhile, Cal tries to explain himself to Ethan in the staff room but Ethan is angered and punches him in the stomach. A fight ensues between the two and Ethan ends up pushing Cal onto the floor into the corridor. The two are quickly broken up by a furious Zoe who comes along and tells them both off, but Charlie defends them saying they're going to sort their issues out amicably.
Jac is with Sam and Emma and explains to them that there's only one surgeon working today and that they could be waiting. Sam talks to Connie outside and expresses his dissatisfaction with Emma's treatment. Meanwhile, Ethan tells Jill that there's no permanent damage, only a couple of fractured ribs which will heal naturally. Her and Craig then tell Ethan that she used to work as a primary school teacher but quit as a result of her issues with paranoia. Shortly after, Ethan says he needs to speak to Jill privately and Craig says he'll go and get a coffee. Ethan then tells her that there's evidence of some previously healed injuries including one on her neck which is often a sign of strangulation. She tells him that she thought she'd imagined it but recalled that her ex-husband Dion once told her that the last thing she'd see was his face staring back at her, indicating that he strangled her. Ethan then asked her if she tried to take her own life but she says no and insists that he was there but just when Ethan tells her she has to report it, she struggles to breath and they discover that she has a pneumothorax and they decide to perform the procedure to correct it. Outside the procedure room, Cal's patient with the hand injury from earlier is looking through the glass door at Jill, but Cal discovers him and he runs off again.
Back in reception, Big Mac confronts Jack about a package that he saw Noel receiving from a man outside the ED earlier. Jack tells him that Noel's planning a big surprise for him because of his heroic actions, but Mac still seems unhappy that they went through the effort. Meanwhile, Ethan and Jill persuade Craig to call the police as they suspect that Dion has been stalking her. However, when he goes into the toilets to call the police to report Dion, an unseen person slams his head against the wall, badly injuring his head and face. Elsewhere in the ED, Connie continues treating Emma with her pain worsening with it now in her back as well. Jacob informs her that they're still busy upstairs. Shortly after, Grace asks Connie if she could perform the operation but she tells her that she's a heart surgeon like Sam and the risks would be too big. This annoys Grace and she lashes out at Connie and tells her that she hates her, which deeply upsets Connie.
Whilst recovering in cubicles, Jill has her mouth covered by Dion when he sneaks up on her. Dion is also revealed to be Cal's patient with the hand injury from earlier. Despite Lofty being in the next cubicle, he scared her into staying quiet. He asks her why she ran from him, and explains that he missed her so much and she agrees with him so he doesn't hurt her. He gives her a necklace as a gift and tells her he has a car outside the ED and that if they left now they could be home by morning. She explains to him that the doctors want to keep her overnight and she has a chest drain, but he says they'll just bring it with them. Just as they're about to leave, a tired Lofty drops a container onto the floor which momentarily distracts Dion at the threat of being caught and Jill spots the scissors on the table which could come in handy to fight back with if she needs to. Meanwhile, Jacob find Connie upset in her office after what Grace said to her but he reassures her that Grace confided in her when she was scared in the hotel room. However, Connie says that she only called her because she's a doctor and that's all she cares about.
At the ambulance station, Cal goes to ask Iain if there was blue glass at the scene of Jill's accident, and he says there was all over the glass which confirms Cal's suspicions that the patient with the hand injury from earlier was connected to Jill. In the toilets, Ethan is tending to his facial injury from his punch up with Cal earlier when he hears groans coming from one of the cubicles and finds Craig injured on the floor. He tells Ethan that he thinks it was Dion, and to go and make sure Jill's alright. Back in the ED, Connie returns to Emma and she starts to lose output and Sam tells Connie that she needs surgery now or she'll die. In cubicles, Ethan asks Lofty where Jill is and Lofty says that she was there just a minute ago talking to her partner but Ethan says that's impossible as he was injured in the toilets. At the same time, Cal arrives and tells Ethan that he thinks his patient with hand lacerations was Jill's ex-husband, and the two agree that they have to find Jill. Lofty also tells them that he's missing a pair of scissors.
Meanwhile, Connie realises that the aneurysm must have burst and that she'll need urgent surgery, and Connie says she will have to go upstairs and drag someone out surgery if she needs to. However, Jacob tells her that there's no time, and Sam volunteers to perform the surgery. Outside the ED, Dion is dragging a resistant Jill to his car. He tries to push her in, so she grabs the pair of scissors she took from Lofty's table earlier and stabs Dion in the stomach. At this point, he begins strangling her and this gets Ethan's attention as he goes running over. Cal follows and manages to restrain Dion and they get Jill to safety. Inside the ED, Sam prepares to begin the procedure but realises he can't do it at the last minute and says that Connie will have to. She reluctantly agrees to and asks for Jac Naylor to come down to assist her right away. In the staff room, Dylan finds Lofty and asks him if he's seen Big Mac. Whilst he's there, he tells Lofty about Robyn's concerns about him, but Lofty assures him that he's okay.
Connie and Jac begin the procedure on Emma with Sam overlooking and Jacob assisting. Although her stats initially began to drop and they thought they'd lose her, Connie eventually manages to clamp off the bleed, saving Emma until she can get into surgery. Back in cubicles, Ethan tells Jill that there's no damage to her neck, that Craig only required a few stitches and Dion is stable but will need minor surgery and is with the police. Jill then tells Ethan that she's thinking of going back to teaching. Outside the ED, Sam thanks Jacob for everything he did that night, and asks Jacob how long him and Connie have been together, having picked up on it. Jacob tells Sam that Connie wants to keep it quiet for Grace's sake, and Sam says he won't tell and that he's pleased for him. Meanwhile Max meets his date Zara outside the ED. She catches him looking at Zoe and asks who it is, and Max explains that she's his wife but they're not together anymore. Max and Zara go to meet Zoe and her date Tom. They introduce each other, but Max inadvertently calls Zara Zoe, and she throws the roses in his face and storms off. In cubicles, Jill breaks up with Craig due to the fact he tells her she isn't ready to go back to teaching, and apologises to him and says she doesn't want to hurt him but can't marry him.
Meanwhile, Zoe tends to Max's facial wound caused by the roses but they start kissing. Elsewhere in the ED, Jack accidentally comes upon Big Mac sitting in darkness in a storage cupboard. Jack asks if he's okay, but Big Mac asks him to leave. Jac informs Connie that Emma's out of theatre and is recovering in ICU, and also tells Grace that she should be proud of her mum for saving her. Grace hugs Connie and tells her that she's awesome. In the staff room, Cal attempts to interact with Ethan, but Ethan tells Cal that he's done with him and that he's not his brother anymore.