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"Meltdown" is the 593rd episode of Casualty and the third episode of the 22nd series. It was directed by Richard Signy and written by Sasha Hails.

This episode marks the first appearance of Tristan Gemmill as consultant Adam Trueman and Joanne King's final scenes as paramedic Cynthia "Cyd" Pyke. It also features the return of Matt Bardock as Jeff Collier; he last appeared on the show four months prior in the series 21 episode "The Apostate".


Charlie visits Nathan on NICU and offers him a drink. Nathan informs him that his daughter has been off the ventilator for 24 hours, and the brain haemorrhage she had at nine days had affected her breathing centre. He tells Charlie that he decided to call her Angel. Elsewhere in Holby, a young woman named Lauren frantically runs around a small neighbourhood, and she becomes distressed when she hears her baby crying in a nearby house. Back at the hospital, Angel stops breathing, and paediatrician Andy Fishman gently nudges her back into a steady rhythm and explains that she merely forgot to breathe. To help keep her "committed to the new effort she has to make", he decides to give her oral caffeine.

Meanwhile, Lauren uses a street sign to climb onto the house's roof and enter her son's bedroom through a window. However, the baby's grandmother Maureen orders Lauren to leave before she calls the police, but she pushes her into a light fixture and runs out of the house; Ian pursues her to talk sense into her. On their way into the emergency department, Alice doubts her abilities as a healthcare assistant, and Guppy assures her that, after the incident the week before, she can "get through anything". As he leaves to mentor Ruth and Toby De Silva, Patricia Crampley approaches Guppy about the death of her father Artur who died in his care, but he claims that he is busy. She insists on speaking to him and leaves Alice to organise a conversation.

At the ambulance station, Cyd circles an advertisement by Selbridge Ambulance Service looking for qualified paramedics and technicians, and Josh offers to put a word in for her. As Dixie tries to call her, she explains that, as much as she is desperate for a change, the situation is "delicate"; Josh understands but warns her that the job could go quickly. On a hospital ward, Dixie leaves Cyd a voicemail informing her that she will be discharged later and expressing her eagerness to start working with her again.

Lauren runs to a construction site and attempts to hide from Ian, but her baby continues to cry. She desperately covers its mouth with her hand and waits for Ian to leave the area. Once she stops hearing his calls, she panics when her baby stops breathing and becomes more disorientated. In cubicles, Alice pulls Guppy aside and tells him that Patricia insists on talking to him, but he asserts that he cannot bring her father back and instructs her to get Nathan to speak to her. At the building site, Lauren confronts Ian and asserts that he cannot have his child back. She grabs a large metal pole, and Ian attempts to wrestle it out of her hands, but she knocks him to the ground and kicks him down when he tries to get back up, causing him to fall unconscious.

Adam talks Lauren out of suicide.

As Adam Trueman goes for a jog, he spots Lauren preparing to jump off the top story of a carpark and quickly rushes up the stairs to stop her. He urges her not to kill herself and asks her to consider the possibility that she may immediately regret it. A passerby - Tanya Healy - interrupts, but Lauren orders her to stay away. Adam assures her that she will be fine and sits on the ledge with her. Back at the ED, Alice enters Nathan's office and finds Charlie retrieving a folder from under his desk. She explains that Guppy wants Nathan to speak to Patricia Crampley, but Charlie apprises her of Nathan's whereabouts and tells her to send Guppy up so he can have a word with him. Meanwhile, Adam suggests to Lauren that they both jump, but he points out that they may not be killed instantly and painlessly. Lauren begins to break down, and Adam holds her in his arms.

At the ambulance station, Josh and Cyd receive a call about the incident with Lauren, and Josh tasks Cyd with driving. She claims that she is rarely allowed to drive, as Dixie likes to be in control, and Greg "believes he's being a gentleman"; Josh jokingly suggests that "maybe it is time for a transfer". On the construction site, Ian calls Maureen and tries to tell her his location, but he struggles to speak in his condition. At the carpark, Josh and Cyd assess Lauren's hand and decide to take her in. Adam agrees to stay with Lauren, and Tanya offers him her phone number in case the police require a testimony. Once he leaves with Lauren and the paramedics, Tanya notices that he has dropped a USB stick.

On NICU, Angel goes into asystole, and Andy commences heart massage. Guppy enters and asks for Charlie, but he sternly tells him that it is not the right time. Angel's heart rate and colour begin to return, and Andy decides to put her back onto the ventilator. Nathan asks why she is in such a poor condition, and Andy explains that she has likely contracted an infection, and the team will give her a "huge blast" of antibiotics and then wait. Downstairs, Dixie leaves a card and a cardigan for Angel in Nathan's office. In admin, Patricia confronts Alice about Guppy's whereabouts as he hides on the mezzanine. Alice recommends addressing her issues with the patient liaison officer, but Patricia begins to lose her temper and demands to talk to "the doctor who was with [her] father when he died"; Kelsey interjects and promises to have someone see her.

On the construction site, Greg immobilises Ian, and Maureen explains that Lauren was sectioned following a drug-induced psychotic episode. She insists on calling the police as Lauren's behaviour is unpredictable under the influence of drugs, and finding her grandson. In resus, Guppy retrieves a box of morphine ampoules from the drugs cabinet, but Alice unexpectedly appears through a nearby door, causing him to drop several of them on the floor. She informs him of Patricia's presence at reception and assures him that he tried his hardest to save her father, but Guppy is more concerned about the loss of the morphine. Once she leaves, he holds an ampoule contemplatively.

In cubicles, a bored Dixie visits her colleagues as Josh, Cyd and Adam escort a distressed Lauren to a bay. Tess recognises Adam from a previous occasion, and he introduces himself to the rest of the team as the department's new consultant. Tess welcomes and informs him that he will need to start working immediately, and he promises Lauren that he will return to her as soon as possible. He mentions the bombings, and Tess claims she is still "seething" at the lack of a Clinical Lead and an updated majax procedure. Meanwhile, Ian is taken into resus, and Adam decides to take the lead, much to Maggie's annoyance.

Jeff makes his return.

On the wards, Dixie finds the job advertisement in Cyd's pocket, and she claims that she is "just checking out other possible situations"; Dixie misinterprets her intentions as her "[worrying] about [her] too much". To her shock, Dixie notices that someone is in her hospital bed and goes to investigate, but she and Cyd are pleasantly surprised to find Jeff who announces his return to the team. Back in the ED, Guppy agrees to assist Toby and Ruth with a boy named Peter who has a displaced distal tibia with intermittent circulation. Guppy decides that his issues are merely positional and elevates his foot, but Ruth argues that an intermittent pulse is indicative of vascular compromise and suggests manipulating the tibia under anaesthesia. Regardless, Guppy asserts that he has encountered many similar cases in the past and instructs Ruth to let the orthopods do the MUA in theatre.

In another cubicle, as Alice attempts to debride a maggot-infested wound, the patient gropes her breast, causing her to recoil in horror; Adam overhears and reprimands them. She thanks him and claims that she is "not really coping very well" as a new HCA, and he advises her to remember that she is the one in charge, not the patient. Nearby, Peter begins shouting in agony, and Adam feels no pedal pulse in his foot. After reviewing Peter's X-ray, he recommends Ruth's proposed course of treatment and asks Guppy what happened. On NICU, Nathan informs Charlie that Angel has been diagnosed with a severe E. coli infection, and her kidneys are shutting down, but he maintains that there is still hope.

On their way out of the department, Cyd asks Josh to put a word in for her at Selbridge, and Tanya asks of Adam's whereabouts. Upon finding him, she returns his USB stick, and he explains that it contains the contents of a book he is writing. However, they are interrupted by Lauren loudly refusing to have her coat taken. She begs Abs to tell "them" that "they" made her attack Ian, and she becomes distressed when Maureen recognises her voice and angrily confronts her. Lauren accuses Maureen of taking her baby and trying to kill her, and she violently attacks her. The medics manage to restrain and sedate her.

On NICU, Charlie explains to Nathan that Angel will never be able to maintain her bodily function due to the infection, and Andy claims that nothing else can be done for her. Nathan refuses to believe that his daughter will die and insists on keeping her on the ventilator, but Charlie maintains that she has no chance of recovery. Andy suggests that they take her off the ventilator and allow Nathan to hold her; Nathan begins to accept her fate. Back in cubicles, Abs leaves Guppy to watch Lauren as he consults with the police and the Riverbank staff, but Patricia approaches him. He takes her to one side and tries to explain that her father's death was an accident, but she praises his honesty and humility, and thanks him for taking care of him during his final moments. Abs returns to Lauren's cubicle and discovers that she has gone missing; he scolds Guppy for becoming distracted and asks him what his problem is.

Back on NICU, Andy assures Nathan that he feels Angel is "ready to go", and she is gently wheeled into the room. Nathan asks to have some CDs retrieved from his office, as he has heard that hearing is the last sense a person loses, and Andy obliges. Once the medics leave, Nathan holds Angel and tells her that he loves her. Meanwhile, Maureen leads Lauren out the back of the hospital and asks her what she has done with her grandson. She takes her back to the building site, and Maureen rushes towards the cries of the baby coming from a cement mixer, but she is knocked unconscious by the bucket of an excavator. Lauren retrieves her child from the mixer and is delighted to find that he is still alive. On NICU, Nathan indicates to Charlie that Angel has died, and he goes to console him.

Nathan publicly vents his frustration.

Maureen is taken into resus, and her condition begins to rapidly deteriorate. Once Ian's condition begins to worsen, Adam leaves Guppy to resuscitate Maureen, but he believes it would be futile. Adam assesses Ian and finds a displaced clavicle. He promptly relocates it, and Ian's blood flow is restored. Nearby, Maureen becomes asystolic, but Guppy loses his nerve and leaves the room. Maggie takes over and suggests that Maureen is gone. Nathan returns from NICU and insists on working, and he starts berating the other members of staff for failing to run the department "smoothly", suggesting that, following the bombing, they would have "learnt [their] lesson". Guppy apologises for letting his colleagues down and hands in his badge, asserting that he is "not a doctor". As Nathan leaves, Charlie apprises the team of Angel's death.

On the ward, the paramedic team celebrate Dixie's return to work with champagne, but they are shocked to learn from Josh that Cyd has been given the job at Selbridge. She assures them that it is only "a silly transfer" and asserts that she needs a "different" experience. Outside resus, Alice overhears Tanya discussing the possibility of her landing "a real scoop" and having a lead on Adam. Alice tries to prevent her from following Adam in the lift, but she fails. She manages to catch them on the first floor, but Adam selects another floor. He offers to take Tanya out for dinner, and the two share a passionate kiss. On the ward, Cyd asserts to Dixie that they are not making each other happy anymore, and she cannot give her what she wants. Cyd hugs her, and Dixie eventually reciprocates. A frustrated Nathan returns to his office and prepared to review a selection of documents, but he finds the cardigan and card Dixie left for Angel and weeps.




The episode was produced by Chris Lovett.


The scenes at the construction site were filmed at Bamfield Lodge Care Home in Whitchurch, Bristol which was being built at the time. The scene where Adam Trueman talks Lauren Riggs out of suicide was filmed at Broadmead Car Park.


  • In the advertisement above the Selbridge Ambulance Service's job offer, the deadline for applications is stated as "Friday October 14th 2007" when that date was on a Sunday.

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