"My First Day" is the 591st episode of Casualty and the first episode of the 22nd series. It was preceded by "To Love You So" and followed by "Charlie's Anniversary". It was directed by Andy Hay and written by Mark Catley.
After bumping into a jogger and nearly getting hit by a van, Toby De Silva decides to run to work. At a bus stop, he asks a woman if it is the one for Holby City Hospital, and she tells him that the buses may not be running, but it is located only a few minutes away. As Toby goes inside a shop to buy a bottle of water, Russ Golden tries to flirt with a woman named Fareeda but gets shut down by a witty retort, and Matt Girven argues with his mother Christine about him being late to meet his friends. Outside, as parents Rob and Wendi disagree over the subject of supervised visits, Toby entertains their young daughter Rayne by pulling faces at her; he backs away when her parents notice. Denny stops Toby and points out the bag he has accidentally left behind. Toby thanks him and asks him the name of the dog that is sitting beside him, and Denny explains it is not his and that he is looking after it until its owner returns.
Toby soon arrives at the emergency department and is greeted by Tess in admin who directs him towards the staff room. There, fellow F2 Ruth Winters asserts that the nurses believe that they have "all the power" and try to bully new doctors into submission, and he has to make the right impression; he thanks her for the advice. She tells him that, as F2s, they need to stick together, and Toby claims that she does not look like a junior doctor, given her calmness. By reception, Charlie gives Toby and Ruth a tour of the department and takes them into resus where he introduces them to Jo, a woman who is waiting for a bed on CCU following a myocardial infarction. Toby greets her, and she politely suggests using deodorant.
As Charlie complains about the lack of available staff, Josh leads him to the staff room where his colleagues congratulate him for his 35 years of service in the NHS. Unfazed by their show of goodwill, Charlie introduces them to Toby and Ruth and leaves. As the rest of the nursing staff ponder Charlie's uncharacteristic display of ungratefulness, Maggie and Guppy greet the F2s, and Toby asks Maggie if she has any deodorant to spare. In cubicles, Maggie asks Abs to take Toby to cubicle 3 and get the medical history of Sunny, a man who is refusing to answer why he has taken copious amounts of paracetamol. Toby is uncomfortable with Abs' decision to help Kelsey instead of supervising him, but, when her patient bites her, he allows him to offer his assistance. Toby enters the cubicle and catches Sunny getting ready to leave. Despite his efforts to make him stay, Sunny explains that he took the pills to "punish [himself]" and leaves.
Maggie reprimands Toby for not telling Sunny about the dangers of him refusing treatment and Abs for not supervising him. She suggests that they have been overambitious and takes Toby to treat Nikki - a 21-year-old woman with needle phobia who needs intravenous analgesia. To make her feel more comfortable, he tells her about the effect his childhood fear of the dentist has had on his oral hygiene and suggests that he would not still be alive if he feared vital medical procedures. She reluctantly agrees to have the line inserted, and Charlie pulls Maggie aside for a chat. However, Toby forgets to cap off the tube, causing Nikki's arm to bleed profusely and her to scream in horror. Toby apologises for his error, and Maggie tells him to go outside. By an ambulance, a passerby with a bleeding ear asks him if he is a doctor, and he claims that he is not.
Shortly after, Toby is sent out to observe the paramedics. Believing that the rest of the staff want to get rid of him, he apologises again for his mistake with Nikki, but Maggie assures him that he was just nervous and needs to put in a place where he can do no harm. She hands him over to Dixie who calls him "Dracula". On the road, Toby begins to feel travel-sick and reaches for a bowl. After arriving at an old woman's home, Dixie asks Josh why she has to take Toby, and he explains that the conflict between her and Cyd is not good for patients. When Josh also refers to him as "Dracula", Toby asks if the nickname is "going to stick".
In the rapid response vehicle, Toby asks Dixie if his first patient walking out on him is going to earn him another nickname and suggests that he could end up fired by the end of the day, but she reassures him that her first day was also a "nightmare". They pass the bus stop that Toby visited on his way to work where the people he encountered start loading their luggage onto a coach. Suddenly, it explodes, sending several people flying. As Toby stares in shock, Dixie tells ambulance control to stand by for a major incident and instructs him to stay by her side as they provide first aid. She instructs him to look for survivors in the shop, and he struggles to keep his composure when he recognises some of the fatalities. Nearby, he finds Denny trying to help Russ whose intestines have been eviscerated, and Denny demands him to provide aid. Toby covers his wound and instructs Denny to put pressure on it; Denny objects to him leaving them, but Toby insists that a medical team will arrive soon. Fighting for breath, Russ promises Denny that he is going to "kill [the] bastards" who caused the explosion and begins to weep. Toby finds Fareeda trying to call her father after her leg had been amputated in the explosion. He tries to provide her with reassurance and find something to cover her stump. Despite Dixie's instructions, he insists on using a tourniquet to stop Fareeda haemorrhaging; she trusts him to do what he thinks is right. After Russ is moved by the paramedics, Denny offers Toby his assistance, and they both try to comfort Fareeda; they both recoil in disgust when her scalp sloughs off. Josh and Cyd subsequently take over and inform Toby that he is needed in the Casualty Clearing Station.
On his way out of the shop, he begins to break down, but he quickly composes himself. Outside, Maggie instructs him to retrieve a surgical kit from the CCS. Back inside the building, she tells him that Christine Girven needs to be freed from the rubble as quickly as possible, but they can only save her by amputating Matt's arm. She apprises Matt of the situation, and he agrees to the procedure. Maggie tasks Toby with distracting Matt from the amputation by talking to him, and the two begins talking about classic comedy shows. Matt begins to panic when Christine becomes unresponsive, but Maggie urges him to keep calm as she administers the ketamine. Once he goes under, Maggie informs Toby that the bomb squad has confirmed that the explosion was caused by a device and instructs him to check Christine's pulse. When she begins to have a seizure, he is forced to take over the amputation.
In the CCS, Maggie tells Toby that he did well and orders him to get on the next ambulance. Nearby, Fareeda's father Saeed desperately tries to find his daughter, but he is restrained by police. After Denny finds mehndi tattoos on her hands, Toby warns Saeed that, while Fareeda is stable, he may not recognise her. As he goes to board the ambulance, Wendi continuously mumbles Rayne's name and gives him her hair clip. Ignoring the warnings of the fire service, he runs back into the shop and finds Rayne. He manages to free her as the ceiling begins to collapse, but her father Rob, mistaking him for a predator, wrestles her out his arms and pushes him into the side of the coach.
Toby finds Charlie and insists on finding Rayne, and Charlie reluctantly gives him the keys to his green Morris Traveller. On his search to find Rob and Rayne, Toby spots Sunny walking down the street, but he starts sprinting as soon as he is noticed. Toby pursues him into a small playground, and he warns him that the paracetamol he has taken will destroy his liver and kill him within three weeks if he forgoes treatment. When Toby restrains him by his coat, Sunny explains that he hates being at university, but he feels like he is letting his parents down after they worked hard to get him there. Toby tells him that his parents pushed him into medicine and suggests that Sunny is a coward for opting for suicide rather than confronting his parents. Sunny asks him if he is done, and he punches Toby in the face before running away. Overwhelmed by the day's events, on the floor, he begins to sob and hit the ground in frustration. Once he picks himself up and returns to Charlie's car, he finds it ravaged.
Toby returns to a chaotic ED where Ruth eagerly asks him about the scene of the explosion and delights in a major incident being declared on their first day. However, Tess interrupts them and orders Toby to get cleaned up. In reception, he reports Rob to the police and gives a description of him before Tess summons him back to cubicles. As he sutures a man's head, Toby asks Abs and Kelsey how they manage to stay calm in a crisis, and Kelsey explains that she plays a song in her head. Tess informs Abs that Jo's cannula has tissued, and he suggests that Toby can put a new line in. After Nadia asks for Tess' assistance, Toby successfully replaces the cannula while singing "Bring Me Sunshine" to himself, but he is devastated to learn that Jo died in the process. Tess assures him that her death was not his fault and suggests getting himself a cup of tea. He passes Wendi who repeatedly asks for her "little girl", and he apologises and insists that he did everything he could.
On his way out of the department, Toby leaves his ID at reception. Outside, Sunny apologises to him and offers to be treated, but Toby claims that he needs to be seen by a "real doctor". Under a flyover, he finds a hysterical Rob cradling Rayne and assesses her condition. Rob refuses to hand her over, but Toby asserts that he is putting his child's life in danger and demands him to allow him to treat her. He gives Rayne to him and confirms that she has diabetes. Toby rushes her to Singh Pharmacy & Stores and bangs on its door. The chemist Tajinder Hayer bursts out, wielding a baseball bat, and Toby explains that Rayne is in a hypoglycaemic coma and requires a dextrose solution. Tajinder reminds him that, as he is carrying no ID, he is asking him to break the law, but he allows him to treat her regardless. After reviewing his emergency medicine handbook, he goes to administer the solution; Rayne wakes up. Dixie and Cyd soon arrive and offer to take Toby back to the ED, claiming that "[his] patients are waiting", and he boards the ambulance with a smile.
- Matthew Needham as Toby De Silva
- Derek Thompson as Charlie Fairhead
- Georgia Taylor as Ruth Winters
- Susan Cookson as Maggie Coldwell
- Jane Hazlegrove as Kathleen "Dixie" Dixon
- Suzanne Packer as Tess Bateman
- Ian Bleasdale as Josh Griffiths
- James Redmond as John "Abs" Denham
- Elyes Gabel as Gurpreet "Guppy" Sandhu
- Janine Mellor as Kelsey Phillips
- Ben Price as Nathan Spencer
- Kip Gamblin as Greg Fallon
- Daphne Alexander as Nadia Talianos
- Joanne King as Cynthia "Cyd" Pyke
- Nigel Terry as Denny Davidson
- Emily Corrie as Nell Mendez
- Shane Zaza as Sunny Sagar
- Tehmina Sunny as Fareeda Khan
- Helene Fletcher as Shop Girl
- Samuel James as Russ Golden
- Scarlett Rose Patterson as Nikki Munro
- Llewella Gideon as Christine Girven
- Akemnji Ndifornyen as Matt Girven
- Ryan Pope as Rob Hart
- Leona Walker as Wendi Hart
- Aimee Davies as Rayne Hart
- Kate McNab as Jo Andrew
- Amerjit Deu as Saeed Khan
- Dhirendra as Tajinder Hayer
"My First Day" and "Charlie's Anniversary" were originally two parts of an episode titled "One Extreme to Another".
Early in production, the episodes' plot had to be altered after it was blocked by the BBC's editorial guidelines department as they believed it could have perpetuated stereotypes of young Muslims in Britain. Originally, the episodes depicted a radical Islamist blowing himself up at a bus station and another whose suicide vest had to be carefully removed after it failed to detonate. A spokeswoman for the BBC stated, "Originally I think there was storyline discussion on suicide bombers and they spoke to editorial guidelines. With any storyline process, there are lots of ideas that get put forward which don't make the series. The aim of Casualty is to highlight the work of professionals in these extreme situations." Consequently, the script was revised to have the Muslim characters replaced with animal rights extremists.
Outside of the ED set, the majority of the episode was filmed on Redcliff Street, Bristol and in Clifton. The Hesketh Road scenes were filmed on Redcliff Street; the building used for the shop has since been demolished to make way for the Redcliff Quarter development.
The house Toby leaves at the beginning of the episode is at 50 Granby Hill. The scenes where Toby confronts Sunny, and Charlie's car is vandalised were filmed at Charles Place and Little Caroline Place respectively. Around the corner, on Hotwell Road, the scenes at Singh Pharmacy & Stores were filmed.