INTERVIEW | Niamh Algar speaks about her role as a battle-hardened doctor in ITV’s new series Malpractice

Dr Lucinda Edwards (Niamh Algar) is a smart, battle-hardened doctor, but we meet her on a nightmare shift that ends in the death of an opioid overdose victim, Edith Owusu. Despite the support of her medical supervisor, Dr Leo Harris (James Purefoy), Edith’s grieving father (Brian Bovell), demands an inquiry into Lucinda’s actions on the fateful night.

Leading the medical investigation are Dr Norma Callahan (Helen Behan) and Lucinda’s former colleague, Dr George Adjei (Jordan Kouamé). While George feels this was an unavoidable tragedy, Norma is suspicious of Lucinda’s behaviour and decisions in the lead up to the patient’s death.

As the pressure of the investigation intensifies, Lucinda’s relationship with husband Tom (Lorne MacFadyen) starts to fracture, and her confident professional exterior begins to crack. Is Lucinda hiding something?

What were your initial thoughts about Malpractice?

My first reaction was, ‘Oh my God.’ Because it’s relentless and this character is thrown into something completely out of her depth. You feel as if she is just trying to keep her head above water throughout the entire story. So, I thought, ‘This is going to be quite the marathon of a shoot.’

The script was so compelling. Written by Grace Ofori-Attah, who worked as a doctor. And then you’ve got the director Philip Barantini. So in my head, as I was reading it, I was thinking of those two people. Along with World Productions who are renowned for these high-paced, cliffhanger, adrenaline-filled series. I knew it would be incredibly exciting to explore and be a part of. Then thinking, ‘OK. Now I’ve got to try and pull off being a doctor.’

The fact that someone like Grace has written this is really important. Exploring the medical profession and the misuse of drugs. I’m fascinated by human behaviour. That’s why I became an actor. So, the idea of addiction and drug abuse has always been something I look at with very empathetic eyes.

What else did you learn from that experience?

What I learned from it is there is a huge mental health crisis that’s happening. A lot of these staff are being left to deal with people who are mentally ill with nowhere else to go. So they find themselves in A&E at two in the morning.

The pandemic has impacted on a lot of people’s mental health. I think many people were selfmedicating at the time because they couldn’t see their doctor or were too scared to go near a medical facility. With an increase in anxiety and depression due to the pandemic. People have become a lot more open and able to talk about it.

Addiction comes in all different forms. Not just substance abuse. It was fascinating as part of my research to speak to recovering addicts and how they came to be dependent on drugs. And it’s not as difficult as you think. Mostly everyone knows someone who is an addict in some form. Or people who don’t realise they have an addiction.

Who is Dr Lucinda Edwards?

Lucinda is a registrar at the West Yorkshire Royal Hospital working in the A&E department. Having been on the frontline during the pandemic. She finds herself at the centre of a malpractice case after a young lady is brought into A&E after a drugs overdose and subsequently dies.

As the story develops, we learn more about Lucinda and her life. Working in a very hectic environment that she normally thrives on. And she has to deal with the repercussions of what happened that night.

We also learn a little about what she went through at the hospital during the pandemic. Including dealing with patients who believed Covid was a hoax and refused to wear masks. I can only imagine how stressful and infuriating that was for a medical professional who is trying to save people’s lives. Also seeing so many dying from Covid.

Then you have people coming in seeking medical attention who aren’t taking it seriously. Claiming it’s their basic human right not to wear a mask. But yet the person sat next to them has the basic human right of being able to feel safe. I can’t imagine just how much patience and strength hospital staff would need in that situation.

The drama shows the enormous pressure hospital doctors and nurses are under?

It’s constant problem solving. When a patient comes in, before you’ve even thought about how you can treat them you have to think about where you can put them.

My mum was a nurse in Ireland for 40 years and my sister-in-law is an A&E nurse. I grew up listening to stories about how difficult it has always been. I’m just so impressed and in awe of people who can work in an environment where there are already so many obstacles thrown at you before you’ve even started your shift. It’s down to the fact that you care. That’s it. They care about people and want to look after them. You just wish everyone thought the same way.

Lucinda works in a very sensible, pragmatic way, thinking, ‘OK. I’m at the centre of this. What’s the problem and how do I fix it?’ And you are trying to do that in the least amount of time. But Lucinda never has enough time to do anything and is always running out of time. Facing life and death situations every single day, multiple times a day.

We see the trauma that Lucinda has to deal with. Of seeing things go wrong that a lot of the time weren’t her fault. And how – and if – you can park that and move on. How can you switch off from spending an entire day in what feels like being on a battlefield? Then to walk into your home with your three-year-old daughter who just wants to spend time with her mummy and play games. As a person, how do you make that switch?

There is an impact on Lucinda’s home life with her partner Tom and three-year-old daughter Abi. I interviewed A&E doctors and asked them how they switched off. One of them replied, ‘I don’t switch off. I just try and get as much sleep so that I can do the job the next day.’

They don’t really have time to think about what they have done that day. Because they are already thinking about what is going to happen – or what could happen – tomorrow. It’s that idea of always thinking ahead. That for me was the route into the character. Lucinda doesn’t stop and she doesn’t want to stop. She is terrified of stopping because then she has to think about everything that has happened. Then what could that do to her? It’s like a pressure cooker that Lucinda has been put into and you are just waiting for her to explode.

What was it like filming on the hospital set?

The hospital set was very authentic and realistic. It felt very real. It was like the most immersive theatre.

We had so much space on the hospital set because we built everything from the ground up at the old Shipley Tax Office. We had these large, long corridors. While when I was in an actual A&E I couldn’t get over how many times we actually had to hug the wall as a trolley goes by. It’s a tight, compact area. I thought, ‘If only we could give this set to a hospital.’ It had to work as an A&E but also as a practical working set.

How did you approach depicting some of the medical procedures?

We did these amazing medical procedures where our production designer and prosthetics had actually built torsos. There’s one scene where Lucinda is carrying out an emergency thoracotomy which means you open up someone’s chest and then she is massaging the heart mechanically in order to get it going again. So we had this chest prosthetic – three of them – which we would be cutting into. They were incredibly realistic. We had a team of medical advisors who were on set the whole time and they were saying, ‘We wish we had this for our medical students to learn on.’

But with most of the prosthetics we just had one or two so you only had one or two chances to get it right as you are cutting in to them. So you needed to know exactly what you were doing. As an actor you’re making sure you’re staying in character and also that you are going to get the procedure right. Because this could be the only version we get filmed. So I definitely had that natural pressure that would be on the character. But, of course, it wasn’t life or death for me as it would be for a real doctor.

In another scene Lucinda has to suture – sew stitches – in an eyelid. I was completely fine with it all because you are just focusing on the task in hand. But for that one I was more stressed. Before we started filming I had two weeks to prep. To get as much practical hands on experience as I could – not practical in the sense of actually working on patients but I needed to physically look like I knew what I was doing.

My sister is a vet so I went home to Ireland and spent a couple of days with her. She taught me how to suture using oranges. There wasn’t a safe orange in the house. My mum came in and said, ‘I was planning on making fruit salad with that.’ So we had all of these half stitched up oranges.

That scene was later on in the shoot so I also bought a suturing kit online and had it in my flat in Leeds. So whenever I was learning lines in the evening or watching telly I would just be practicing suturing.

You also filmed inquest scenes at a coroner’s court?

We shot that in a proper court house before we filmed anything in the hospital. It was terrifying to be there as an actor and be cross examined. It felt very real.

What was it like working with the rest of the cast?

I had worked with Helen Behan before on The Virtues. That was my first television series. With Helen playing my sister-in-law. There’s a very different dynamic in Malpractice with her playing Dr Norma Callahan, this very serious woman who is investigating the drugs overdose death at the hospital. There’s this head-to-head battle between the two of them. They were fun scenes to shoot. It’s like a chess game with Lucinda constantly trying to keep her head above water. You could feel the tension building throughout.

Priyanka Patel, who plays junior doctor Ramya Morgan, is an incredible actor to work with. She brought so much to that character. This huge heart. Ramya is almost Lucinda 10 years previously. Lucinda is terrified of Ramya making mistakes because the minute you do that it’s on your record for the rest of your life. Lucinda is someone who is constantly trying to keep going and fix things. Trying not to look back on the mistakes she has made. Being on the frontline during Covid with so many patients dying has been this huge trauma in Lucinda’s life. That was something completely avoidable. But at the time she couldn’t see it for what it was. So there’s almost like that big sister quality that comes out with Lucinda and Ramya. In the sense she warns Ramya while at the same time she is educating her. It’s this tough love relationship.

I also really enjoyed working with Lorne MacFadyen. In the script, I was really drawn to his character Tom, Lucinda’s husband. Tom is a man who feels at times helpless in understanding the stress his wife faces on a daily basis working in A&E. He knows her better than anyone and believes that she is a good person. But as the story progresses, you get to see someone who’s beginning to find it difficult to remain strong when Lucinda retracts further into herself and lies more about the extent of what’s happening. Their relationship in the story of Malpractice showcases the challenges families face when one partner is dealing with serious trauma, anxiety and how that can break down a marriage. It was so refreshing to read a male character in a series with so much heart and vulnerability.

What did the director Philip Barantini bring to Malpractice?

The term ‘go rogue’ was this constant phrase you could hear from Phil down the other end of the set. It meant he was happy with what we had already filmed in a scene so the last take was to maybe find something new and different. It’s really interesting what you find in those takes when the pressure is off because you know we have the material for the day. When you are given freedom that’s when creativity is born. It allowed for incredible moments of improvisation and spontaneity within the drama. It was one of the best experiences I’ve had as an actor.

If you are lucky in terms of work, actors get to inhabit so many different people over the course of their career?

It is such a huge privilege as an actor that you get to learn about people you would never otherwise have thought about on a regular basis. To live in someone else’s shoes for three or four months is a privilege.

People and their behaviour fascinate me. I’ve always been fascinated by doctors because it’s a very selfless profession and a lot of the time a thankless one. For me, it’s about understanding what drives a person to put themselves in that situation where you are dealing with people’s lives.

How do you reflect back on working on Malpractice?

I worked with a fantastic team on this. The kindest and most welcoming set I’ve had the joy of working on. Everyone in every department really went above and beyond and cared so much about the drama. There is so much happening all of the time in this story. There were a lot of things to keep track of with many layers.

It was definitely a character I found hard to shake off after I finished filming. Lucinda really got under my skin. I think that’s a good sign. Of knowing you cared about it and it meant a lot to you. Coming from a household where there are so many people within the medical profession there is that extra pressure of wanting to make sure you are representing it in the most truthful way. The character, for me, lived and she existed. So when they called ‘cut’ in your final scene you are saying goodbye to the character. This has been the hardest role to shake off, definitely.

What I completely underestimated was the physical residual feelings your body holds on to. Even in a traumatic and dramatic scene you know you are acting. Your brain has said, ‘We’re acting. This is all scripted and it’s fake.’ But your body still produces that adrenaline you would have. I think that is something that sometimes can be overlooked in parts of this profession. Actors really do put themselves through it in an emotional state. And it’s the understanding that you as an actor are responsible for your aftercare when you go home. Being aware of how that might have some sort of effect on you and taking care of yourself.

You are coming home trying not to think about the scenes you’ve done that day. And then you have to learn lines for the next day. It was a huge challenge. But I love challenges. The greater the challenge the greater that reward. That feeling of looking back on it and going, ‘Wow, we actually did that.’ You just hope people respond to it. I’m so proud of the work we did. It was a tough shoot but everyone gave 110 percent every day. I was very fortunate to have an amazing team around me.

Malpractice starts on ITV tonight (23/04) at 9:00pm.