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"Before a Fall" is the 614th episode of Casualty and the 24th episode of the 22nd series.

Synopsis

Abs once again decides to call another nurse meeting and says that the work-to-rule is being called off, Tess makes an inspirational speech to the nurses praising them as the reason the department operates as smoothly as it does. Marilyn blames Tess that the department should not have been closed where Tess tells her that if Charlie was still here then they would not have had to close the department. Ruth is tasked to deal with a 6 year old girl who fell while playing in a play area. Adam and Jessica treat an autistic child and Jessica contradicts all of Adam's decisions. Ruth is then given a drunk patient to deal with and she tells him that he needs to sleep it off. Adam is about to sedate the boy in order to suture his head injury when Jessica calls him out on his plan and tells him that she doesn't agree with it. It then transpires that the patient Ruth said was a drunk suffered a major brain bleed and his blood is not clotting. He dies in resus, Harry tries to ensure her that she is not to blame herself for what has happened. She then proceeds to tell the autistic child that Adam and Jess treated that his dad has died when they find a picture of the boy in the fathers wallet. Tess' emotions finally come to light after she exposes her true feelings to Harry about the stress on the department. Ruth apologies to the department for her mistake and Adam replies by telling her that it was okay as Toby kills patients everyday. She goes home to write in her diary. Abs and Toby decide to surprise her in order to cheer her up when they find Ruth hanging by her neck from the ceiling. She is rushed into resus where the team try desperately to save her.

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