Cardiac Arrest is a British medical drama series produced by World Productions for BBC One. It aired from April 1994 to June 1996. The show focused on the lives and challenges of junior doctors working in a hospital setting and was known for its realistic and sometimes dark portrayal of the medical profession. The series was controversial owing to its cynical depiction of doctors, nurses and the National Health Service (NHS), although it has often topped polls of the UK medical profession as the best medical drama of all time.[1]
Cardiac Arrest was created by Jed Mercurio, who wrote under the pseudonym John MacUre. Mercurio is a British writer and television producer and, before pursuing a career in writing, he worked as a doctor in a hospital in Wolverhampton. His experiences as a doctor in the medical field influenced the realistic and often gritty portrayal of the medical profession in the series. Mercurio's perspective provided a visceral, albeit wryly humorous, look at the NHS in the 1990s. At the time of airing, Mercurio was still a doctor.[2] He later went on to create another controversial medical drama for the BBC in 2004, Bodies.
Series 1 had run for six episodes, which was broadcast between 21 April and 2 June 1994.
Dr Andrew Collin (Andrew Lancel), a junior doctor, starts his first day at work as house officer, and meets his new colleague, SHO Dr Claire Maitland (Helen Baxendale). He deals with multiple situations over the months, and is increasingly dillusioned due to the expectations junior doctors. He is also required to do a three-day and night shift on call, while Claire tries to shield him from his worst abuses in order to preserve his sanity.
Series 2 had run for eight episodes, which was broadcast between 19 April and 7 June 1995.
Andrew returns to the hospital and is now an SHO. To his chagrin, the consultant physician Dr Graham Turner (Michael MacKenzie) has a far better relationship the new house officer Dr Phil Kirkby (Andrew Clover) whose father went to school with Graham.
At the organisational level, a new hospital administrator, Paul Tennant (Nicholas Palliser) demands even more efficiency from the medical staff, which places Andrew in the ENT (Ear nose and throat) duties even though he has no training for those skills, he instructs Claire to abandon resuscitation of a hypothermia patient in order to fulfil her clinic duties.
While Claire is covering for Andrew one night in casualty, a haemophiliac man is brought in with a nosebleed, since Clair is not trained in ENT, she is unable to stop the bleeding, which leads the man to bleed to death. Clair exposes the systemic failures to the media, but she is fired on an unrelated technicality.
The hospital soon attracts additional adverse publicity when the anaesthetist Dr James Mortimer (Jo Dow) is diagnosed with HIV, following a discovery that he has a Kaposi's sarcoma, but he is still permitted to work. The diagnosis is leaked to the media and a scandal ensues, and manager Paul Tennant (Nicholas Palliser) pressures James to take leave of absence.
Meanwhile, Phil is attempting to draw up chemotherapy doses for a patient during Christmas Day despite having no experience, he rings a drunken Dr Turner, who is the only one available, he advises Phil to draw up the treatment, but he gets the dose wrong and the patient dies of anaphylactic shock. He takes the full blame and denies that he sought Turner's opinion, but the inquest returns a finding of unlawful killing.
Series 3 had run for thirteen episodes, which was broadcast between 2 April 1996 and 25 June 1996.
The hospital has another new house officer, Dr Liz Reid (Caroline Trowbridge), who is constant trouble and Claire (who is now rehired as a registrar) shows little respect for her. Their new boss, medical consultant Dr Sarah Hudson (Selina Cadell), reprimands Clair for frightening Liz, but Hudson also confronts her over the latter's habit of blaming her own mistakes on colleagus. Claire describes Liz as "mad" and breaks her pager in a fit of rage.
Meanwhile, Turner's position becomes less secure. Dr Hudson assures Claire that Turner's neglect of his duties has not gone unnoticed. Soon an audit into consultants' attendance begins, but the junior doctors quickly realised Turner was forewarned. When he advises Andrew to attempt the insertion a temporary pacemaker, Andrew calls Claire in, who is off duty and slightly drunk due to Turner negligence, Tennant cautions Turner about his approach to his duties.
Phil, now a surgical house officer, faces continual taunting from his new boss Mr Adrian DeVries (Jack Fortune), begins to aggressively suggest to Turner that he should be the one facing manslaughter charges of the chemotherapy death. Phil confesses the Docherty and he breaks a deal in which records of the accident are lost so Phil cannot be charged, in return for Turner being removed as head of the committee.
Public scandals continue at the hospital, which puts pressure on James to resign. Sister Jackie Landers (Ellen Thomas) speaks on television about bad patient and is severely reprimanded by Tennant, but Sister Julie Novac (Jacquetta May), makes similar comments to other reporters, which leads Tennant to become suspended over her remarks.
After Tennant become reinstated, he attempts to have Julie's new partner, Scissors Smedley, fired over procedural errors he committed when asking a student nurse to administer medication to a critically ill child. When Julie finds out that Scissors had not told her about Tennant's manipulations, she breaks up with him.
James's HIV infection affects Andrew, who had begun an affair with staff nurse Caroline Richards (Jayne MacKenzie), her ex-lover Luke (Terry Sue-Patt) was also partner James's and Luke had been tested positive for HIV, putting Caroline at risk. She eventually reveals to him that she is pregnant.
Adrian DeVries's son, Steven (Christopher Woodger), the result of a past relationship with Sister Debbie Pereira (Gabrielle Cowburn), is brought in seriously injured after being hit by a car. Devries and his team attempt to save Steven's life, but fails to do so, leaving Devries in tears.
In the season finale, Liz is in a psychiatric ward following a breakdown, along with another patient murdering patients with drug overdose. He forces his way into Liz's room when Andrew visits her, and stabs Andrew with a needle containing insulin. Andrew is rescued by the casualty team, along with newly reunited Claire and Scissors towards the resuscitation room, ending the season.
Although billed as a comedy, and darkly humorous in many respects, Cardiac Arrest explores several disturbing themes. It demolishes many cherished concepts of healthcare one after the other, and did not attempt to be politically correct. It attracted complaints from many quarters during its airing, although enjoyed huge support amongst junior doctors[citation needed].
Cardiac Arrest is stark in its portrayal of racist attitudes, which are depicted as endemic throughout the health service. In one episode, an Indian locum who is clearly incompetent is assumed to be so, not because of his deeds, but because he is Indian. In Series 3, Raj is not chosen for a GP training scheme to Docherty's surprise: DeVries calmly reveals that doctors with "foreign" names are never chosen.
Raj is often shown arguing with his mother on the telephone about her desire for him to get married.
Female patients and staff are portrayed as subject to continual sexual harassment. Raj and James – who is actually a bisexual man with many male partners – have a "babe alert" system whereby they page other male doctors to come and ogle attractive female patients admitted to casualty. When Claire suggests to a female nurse that she would support a sexual harassment case that the nurse could make against James, the nurse replies that she would lose her job over it.
When the media reveals that James is HIV positive, Raj is sympathetic and unsurprised by the revelation of James' sexuality, saying merely that he assumes James acquired HIV via "unprotected sex with an infected woman... or man." He then goes on to explain that he has known for some time and knows that James had to be secretive given the pervasive homophobia of the medical system and community. James is later falsely accused of child abuse after a man who recognised him from media coverage of his infection sees him feeling for a pulse in his son's leg. The father is openly and aggressively homophobic.
In an early scene, we see several junior doctors smoking in the doctors' office, and Claire commenting that soon someone will say it gives you cancer. This is just one scene where doctors are depicted as acting very far from their cherished public persona.
Andrew is rapidly seen as being the most put-upon person in the hospital. Nurses will not flush venous lines: Andrew must do it. Porters will not transport blood specimens: Andrew must do it. Every menial job seems to default to him, and he rapidly runs out of patience. After three days of continuous duty, Andrew is speaking to a patient's family, breaking bad news. One male relative stands up to Andrew in a threatening manner and says "What sort of doctor are you? You couldn't even be bothered to shave before you came to work today!"
Consultants are mostly portrayed as callous and uncaring towards matters of patients and their own staff such as junior doctors, nurses and house officers.
Andrew's consultant, Dr Turner, at first seems friendly and approachable. However, he never appears on the ward, leaving the treatment of patients to Claire. We see him chatting on the telephone about his golf fixtures. Later he attempts to persuade an exhausted and desperate Andrew to forgo his holiday, bribing him with a good reference for his next job. Finally, he attempts to have Phil take the blame for a medical error that kills a patient.
Both of the younger surgical consultants, Betancourt and DeVries, are portrayed as aggressive bullies.
The more positive portrayals of consultants are with the portrayals of Dr Yates, Dr Hudson and Mr Docherty, the last being the most notable example of all. Early in the first series Mr Docherty is portrayed as pleasant and cheerful, but also bumbling and incompetent, frequently requiring to be rescued by Monica. He often loses his way in the middle of a sentence. His characterisation changes slowly as the series progresses, to the point of Mr Docherty's becoming the most notable senior doctor of the programme. Dr Yates is portrayed as a sympathetic character who, in stark contrast to Turner, genuinely supports his juniors and stays behind to assist them, and more than once is vocal in his opposition to management's tendency to look for a scapegoat for patient deaths caused by systemic flaws. Dr Hudson is portrayed as a no-nonsense yet scrupulously fair character.
Managers are portrayed with considerable venom. The Series 1 hospital manager is uncaring and dismissive, even of Andrew's most desperate complaints of abuse:
In Series 2 and 3, Tennant is primarily interested in protecting his own job, and that of his ally Dr Turner, and in improving hospital metrics such as outpatient waiting times, rather than improving working conditions for staff, or care for patients.
In Series 1, nurses attract perhaps the cruellest depiction of all. They are frequently shown as gossiping, conniving women, chatting at the nurses' station while ill patients languish without attention, or Andrew fumbles around, hopelessly busy and in great need of assistance.
In Series 2 and 3 senior nurses become participants in storylines and are treated with less caricature and portrayed more positively. One of these is Charge Nurse Patrick "Hanging" Garden (Peter Biddle), although he has his moments of being portrayed negatively, especially during the second series, where he is one of the most unsympathetic towards James and opines that the latter should be sacked.
Many nurses have suggestive nicknames, such as "Nurse White-Coat" (Joyce Falconer), so called because she would apparently sleep with "anyone in a white coat".
In common with other medical dramas, (such as The House of God or even M*A*S*H), Cardiac Arrest portrays junior hospital medicine as an unending parade of sexual adventure for the staff, partly because longer-term relationships are placed under enormous stress by their working hours. Few characters are in stable relationships. In the first series, among the junior doctors, only Monica is married. Later, even this relationship breaks down, and Monica eventually takes her own life. By the second series, Andrew is married but shortly begins an affair with his old girlfriend Caroline. Claire has relationships with several of the surgeons: Simon Betancourt, and Adrian DeVries who were both married.
The series is extremely critical of medical training. Claire and Mr Docherty, both sympathetic characters, repeatedly discuss in detail that medical training is unduly demanding of junior doctors and that both the knowledge and training needed are increasing without recognition or appropriate supervision. At the end of the first series Docherty directly addresses the question of hazing practices in medical training when Betancourt tries to defend his treatment of Monica by saying that he went through a similar process.
Junior medicine is portrayed as a school of hard knocks, where junior doctors achieve success and skill over the corpses of their mistakes. They achieve promotions and status by underhand means. No-one is supportive to anyone else's problems.
Cardiac Arrest was produced by Island World. It had envisaged creating a sitcom set in a hospital, but when Jed Mecurio responded to its advertisement for a writer the show became a portrait of the NHS from the perspective of junior doctors.[3] Series 1 and 2 were filmed on location at both Ruchill Hospital and Stobhill Hospital in Glasgow.
Mercurio appears briefly in a cameo role in series 2 as a man who does not know who he is, and in series 3 as a ringer brought in to supplement the junior doctors in a cricket match. Mercurio is also visible in the final episode, celebrating Mr Docherty's marriage. Mercurio served as technical medical adviser on the second series (and then 'production consultant' for the final series), which gave him much more access to the hands-on process of production, and which he cites as his apprenticeship in producing/directing.[4][5]
The critical response to the series was generally positive; it was twice nominated for Best Original TV Drama Series/Serial by the Writers' Guild of Great Britain and twice in the same category by BAFTA Scotland.[6]
Doctors were reported as finding the series to be representative of life in an NHS hospital.[7] In a 1999 survey of British doctors' attitude to television depiction of their profession, 15% of doctors voted for Claire Maitland as the fictional doctor they would most like to be compared with.[8] When the series had not yet been released on DVD, an online forum for doctors ran a campaign for its release. The Royal College of Nursing however complained that it portrayed nurses as witless and callous. Virginia Bottomley, the Health Secretary at the time of airing, described it as closer to a Carry On film than a drama.[7] During the height of the controversy Jed Mercurio wrote a letter to the newsletter accompanying the British Medical Journal claiming that most of his criticism came from "retired old consultants", but says he has since decided that much of the controversy was a media creation.[9]
Notably, the series originated the medical term "killing season" for the supposed association between newly qualified doctors starting hospital practice and an increase in medical errors and mortality, which data do not support. In 1994, the British Medical Journal concluded that, "newly qualified house officers have been falsely accused of increasing the number of deaths in hospital and that the idea of the killing season is very much fiction."[10] A 2009 Imperial College London study of records for 300,000 patients at 170 hospitals in the years between 2000 and 2008 found that death rates were 6% higher on Black Wednesday than the previous Wednesday.[11]
The complete series was released as a five-disc DVD set, Cardiac Arrest: The Complete Collection, on 16 April 2007. The DVD contains all three series, but no extras such as commentary.[12]In September 2023, the complete series was repeated over three weeks on BBC Four and made available on BBC iPlayer,[13] together with an interview with Mercurio about the series.[14]