Episode 2 Junior Doctors: Blood, Sweat and Tears

PHONE PINGS

SIREN WAILS

-Start CPR.

-30 seconds adrenaline.

-Look at that.

-Easy, sir, easy.

-When did this become this bad?

-One hospital...

-Can I have a step, please?

-..seven junior doctors...

-Showtime.

-I've got an emergency, so I need the crash team here.

-I'm excited!

-Little bit nervous.

-VOMITING

..working on the front line of medicine...

-Do you want to have a chat?

-MOANING

-..with all its blood...

-I love a gory, bloody wound.

-LAUGHTER ..sweat...

-Try not to worry.

-..And tears.

-Just feels like I'm surrounded by death at the moment.

-The doctors of your future...

-Can I ask what's brought you in today?

-I slipped on my wedding dress.

-..facing life...

-BABY CRIES

-Then I got to hold the baby as well.

-Lion King moment.

-..and death.

-ALARM RINGS Have they got...

-Stand back!

-..what it takes?

ENERGETIC DANCE MUSIC PLAYS

Wolverhampton - home to one of the largest teaching hospitals in the

Black Country - New Cross Hospital.

Across town, it's first-year junior doctor Anna's birthday.

And today, her pilot boyfriend Frazer is treating her

-to breakfast in bed.

-Wow.

# Happy birthday to you, happy birthday to you... #

Yay!

# Happy birthday, dear Anna, happy birthday to you. #

-Look at that!

-Happy birthday.

-LAUGHTER

Do you think I can use my birthday as an excuse to not do very much

-work today?

-No, I don't think so.

-LAUGHTER

I'm the only doctor in my family.

My mum's a schoolteacher and my dad works in a market.

I was always a bit of a science geek in school,

so it kind of seemed like a natural career path.

I remember doing cardiology and dissecting a frog's heart and thinking,

"Yeah, this is amazing!" And I love it!

Have a good day.

Being a doctor is important to me.

It's not just a kind of 9-5 job that you come home and forget about.

I am a doctor, and that's a 24/7 thing, really.

Anna is one of the youngest doctors at the hospital, and today,

she'll be working on the respiratory ward.

It is difficult, I suppose,

cos being so young and at the start of my career,

and then, you know, you're dealing very closely with patients who are

old and dying and very ill.

It can be really difficult.

Happy birthday, Anna!

It's my birthday.

-Is it?

-Yeah.

-Oh, happy birthday, I didn't know.

-Thank you.

Over the past couple of weeks,

24-year-old Anna has been part of the medical team responsible for the

treatment of 95-year-old Gladys.

I can't breathe, even when I'm eating, I can't breathe very well.

-So, you've had infection on the lung.

-Have I?

-Yeah, it's going to affect your breathing.

But it's going to take about six or seven weeks to recover from this.

It's the beginning of her shift,

and Anna gets an update on Gladys's condition.

I've just been told that the nurses are a bit worried about 4/3,

Gladys. Apparently they said they can't put their finger on it,

-she just seems a bit off.

-She didn't look great yesterday.

She was saying she found it difficult to breathe.

Her temperature was just a bit low, but otherwise...

just don't know what's going on.

Hi, Gladys, how are you?

The nurses see the patient a lot longer than we do.

They see them overnight, they see them all the time.

We see patients for brief encounters throughout the day,

and we make our judgment from that,

but I think the judgment of the nurses is as important.

For a junior doctor, it's really difficult to make that judgment,

and I don't expect them to make that judgment,

especially at Anna's level.

I think it really is an important lesson that you learn after a few

years, is that when a nurse tells you they're worried,

you do get worried.

Second-year junior doctor Jin is starting his first week in the

emergency department.

-COUGHING

-That's quite a cough you've got there, haven't you?

26-year-old Jin was born in South Korea.

He left for London with his mum and dad when he was five years old.

We moved to England because my dad had a calling to become a reverend

here, to set up a Korean church for,

you know, Korean people living in England.

-I am always praying for you.

-In his second year,

Jin has already completed stints on clinical oncology and psychiatry.

As a second-year doctor, it's more about the level of responsibility.

So people, so the nurses and staff around you, will expect more from you.

-Have you had a blood test since you've come in today?

-No.

-No blood tests at all?

So when you get called to see an unwell patient,

you're expected to know more things,

you're expected to manage it in a more professional, more senior manner.

So I've read through your information, so we don't need to repeat what's happened.

You went to see the... I am repeating myself, aren't I?

Not only does Jin hold a degree in medicine,

but he also considers himself a master of comedy.

So, I think I'm funny.

I'm seeing a lot of young, female patients.

-It's good!

-HE CHUCKLES AND COUGHS

LAUGHTER

It's a joke, man. I'm not sure my friends might agree.

With having a wry, sarcastic sense of humour,

it's very good if used rightly for relieving tension and bringing

that smile to people's faces every day in what can be at times a

stressful NHS environment.

So, one of the consultants just randomly grabbed me and said,

"Have you done a nasogastric tube before?" I said, "No, I haven't had the opportunity.

"I have seen them being done." So he said, "Come and do one and I'll supervise you."

So I agreed to it, cos it's a great learning experience.

Even in their second year,

junior doctors will still encounter new procedures.

Keep your head still, follow my finger with your eyes.

This might unnerve some people, but not Jin.

Good communication skill helps.

Putting them at ease, acting confident when inside you,

you're...you're panicking and you're not feeling good.

But it's all about how you appear outside.

With everything in life, isn't it, it's all about how you appear outside.

You know.

Huh?

The patient's there.

But I am confident.

I am confident, very confident that...

Trust in me as a doctor.

And as a human being.

Today, Jin will be assisting consultant Mr Manakatu.

He's a bit like flying Superman.

He jumps from one place to another and you can't find him.

Mr Manakatu, is he around?

He going to fly back here any time, or...?

I've got other patients to see and stuff, I can't hang around forever.

But don't, like...

don't, you know, don't say anything to him, just, like, just casually...

"Oh, hi, Mr Manakatu."

Ooh!

-Thank you, thank you.

-Jesus!

-LAUGHTER

-Are we ready?

-Yeah, yes, man. Well, not... Well...

-Hi.

-Hello..

On respiratory, there's no slowing down for birthday girl Anna.

-How busy are you?

-I'm very busy today.

Yeah, lots going on. Lots of scans to be done.

Discharges that I haven't had a chance to look at yet.

Yeah, still got lots to do.

But we'll get there.

-Hello, Gladys, how are you?

-I'm just not very well.

-OK.

-And on top of all of this, I'm really worried about Gladys.

So it's just a bit of a mental day so far.

-Are you cold? It seems...

-I am cold.

Concerned with her rapidly deteriorating condition, Anna,

along with the senior consultant,

analyse Gladys' X-ray results.

It's not looking good for her, to be honest.

We've kind of been waiting for the next infection to take hold,

because she's quite weak at the moment.

She's got lots of oedema, so fluid build-up in her legs and arms.

I think she's really struggling.

She's usually so cheery and so lovely, and...

it's a real shame.

-Hello, there. Are you ready?

-The emergency department.

With the help and guidance of senior consultant, Mr Manakatu,

junior doctor Jin is about to perform his first ever nasogastric

-tube insert.

-What you might want to do is flex his neck

when you...as you push through.

And you can actually ask him to swallow it himself.

And sometimes they can just do that.

So let's take it out. Do you want to help him out?

Suddenly, Mr Manakatu is called away,

leaving the young doctor with nurse Amajit to complete the procedure.

So am I doing it and you're supervising me

or is he coming back to supervise me?

-What's the plan?

-I think he's going now.

OK, we can just do it. Are you all right, sir?

We don't want to make you too uncomfortable, sir.

Is that all right, sir?

Whatever you can manage.

Down, down a bit.

-That's good.

-When you feel it, try swallowing it,

it will go down more easily.

-Good.

-Don't worry, sir.

The key is to relax and not panic.

Just swallow as much as you can, OK?

-You ready?

-Yeah.

All right, sir.

So, I can feel the blockage.

-So we need a bit more pressure.

-Bit more pressure.

Do I tilt at an angle?

No, just put pressure on.

It doesn't seem to be going in.

You all right, sir?

That's not going to go.

No.

Oh.

What did you do that I didn't do?

-Just put extra...

-I did.

It's cool.

It's a lady's touch, sir.

It's a lady's touch. Keep swallowing.

It's important that Jin inserts the tube correctly,

otherwise it could get stuck in the patient's windpipe.

Swallow, swallow, swallow, don't worry.

Swallow, swallow, swallow.

Can you get a bowl, please?

Jin is struggling, but Mr Manakatu is on hand.

So, how are we doing?

I've managed to get it in up to here.

OK, sometimes what happens is it tends to curl in the mouth.

First thing is, bring it down so you can access.

Going to gently lower this down, sir.

So what we're going to do is work this together, OK?

When I push it, it's already in, you just have to gently swallow it, OK,

that way, you're not fighting it, OK, sir?

Swallow for me, sir.

That's it. That's gone in. That's fine.

-See?

-Ah, now you're getting the stomach contents.

Swallow it a bit, sir.

That was...easy.

-Yeah.

-Thank you, sir, all done.

Thank you, sir, you'll feel better now.

How did you find that procedure?

It went in definitely in the right place,

I could tell it wasn't in the trachea or bronchi,

I could tell it was in the oesophagus, the way he was,

the reflex with the swallowing.

-Yeah.

-But it was just reassuring the patient and going at the right pace.

As long as you get the patient

to be confident about you, then half the battle is won.

-Thank you very much, Mr Manakatu.

-No problem.

Yeah, he's saying, "Good job, Jin," in two ways,

one to encourage me, and two because maybe I didn't completely flop.

So.. It's good, it's like you learn a new skill as a doctor and feel

a bit more...

A bit more competent!

26-year-old Osama,

originally from Baghdad but now living in Wolverhampton,

is a first-year junior doctor

working in obstetrics and gynaecology.

Essentially, being the oldest in a Middle Eastern family,

I didn't really have much choice in terms of what career path I could

choose. My father's a doctor and my mum's a doctor.

My cousin's a doctor.

Everyone's got initials after their name.

My biggest fear in obs and gynae and medicine in general is just dealing

with people's private parts, essentially.

Yeah, I don't want to mess in that area!

Ahead of an important surgery,

Osama is getting advice from some fellow junior doctors.

So, guys, I'm assisting a C-section tomorrow, do you guys have any tips?

-Have you done it before?

-No.

-Well, in this one,

you're the second pair of hands for the surgeon.

-Really?

-There's only one assistant.

-One assistant?

-Which is you.

How stinky is the whole thing?

-No.

-It's not, OK.

When do they name the baby?

Is it, like, right there? "What do you call this guy?"

Depends on the family.

And then the baby goes in, like, a baby bed, or something like that?

-Wave it at the parents.

-The baby goes away pretty swiftly.

And how slippery is the baby?

You don't really get to tell that.

The midwife usually takes the baby away.

How bad would it be if I dropped the baby?

-You shouldn't!

-Would it be bad?

-I don't think that will happen.

-Would that be a disaster?!

Maybe don't touch the baby!

OK, I won't touch the baby.

Does the baby poop, as well?

-I guess it could do.

-You need to be careful if you hold the baby, and,

like...

That'd be a disaster. Basically, the take-home message is,

-don't wear designer clothes tomorrow.

-Yeah, don't.

BABY CRIES

Cor!

What a long day!

I don't know if it's been that long, it's just felt like it's been,

I don't know, epic and busy and horrible.

But now the celebrations start!

After a long shift...

..Anna is finally finished.

And the celebrations can begin

as she heads home to Wales with boyfriend Frazer.

Right then, off we go.

Do you want me to text your mum to say that we're leaving in a minute?

Yep.

You're off for your birthday now!

Yay!

Time to drive for four hours!

Do you think this Chinese will be open at 11.30?

Yeah, it will be.

-Go in.

-At last. Happy birthday!

Oh, it's so nice to see you.

I've waited all day for this!

# Happy birthday to you

# Happy birthday to you

BOTH: # Happy birthday, dear Anna Happy birthday to you. #

-Ah!

-Yay!

-Thank you.

-So what sort of birthday have you had?

-It's been a long day.

-Has it?

-Yeah, we had a really ill patient, as well.

There are times where I think

I don't think I've made the right decision here,

and I hate it, it's a really hard job, you know. I think

other people my age don't kind of take on these things like,

you know, dying patients.

But still, this is, you know, what you've worked for, isn't it?

-Yes.

-All those years.

SHE LAUGHS

Lucky me!

It's a new day in Wolverhampton.

While most junior doctors are still in bed,

Osama has arrived early to prep for his big day.

I'm assisting my first C-section,

which I'm buzzing about, that's why I'm here so early.

-There's no-one here.

-It's 7.30,

and before he enters surgery,

Osama is taking a moment

for some last-minute revision.

Good baby names.

Maybe my name will come up under this.

So, top five baby names.

Aidan, Jackson, Ethan,

Liam, and Osama.

No, I'm joking, not Osama.

I have a feeling it got really popular

up until 2001, for some reason,

and then...it decreased in popularity.

I'm a junior doctor, my day-to-day

life involves death and suffering and this is the first time

I'm actually involved with bringing a life into the world.

I guess that's why I'm excited, but also nervous,

because nothing can go wrong.

Are you all set for today?

Yeah, yeah.

Before the procedure,

Osama and Dr Goyal visit the patient, Victoria,

and partner Ken to brief them on what to expect from the surgery.

Hello! Are you OK?

-Fine, thank you.

-My name is Dr Goyal and this is...

-Osama Hinds.

-..one of the doctors.

-Osama.

-And you know why you're having the operation?

-Yes.

-Just tell me, what's the reason for it?

Because we've got twins that we had a caesarean with before,

so we elected for one this time.

And this time it's a single baby, right?

-Yes.

-OK, that's fine then.

Right. So you have had the experience of the caesarean section,

you must have been told what to expect in a caesarean section.

And so most of the things are exactly the same, as it goes.

Most of the time it works out absolutely fine and you can expect

to go home in a couple of days' time.

People generally think that C-section is just a minor procedure,

but actually there's anaesthetic involved, there's a blade involved,

there's a lot of cutting involved and suturing involved

and there's also a baby involved,

so like, there's two patients to deal with.

So yeah, it's quite a serious operation,

it's not something to take light-hearted.

Across town, Jin has another urgent procedure to deal with -

the weekly shop.

My Korean food for the next shift.

In A&E, I'm finding it harder to eat regularly.

You only get a half-hour break for the entire shift.

It's not 100% healthy,

but I try my best, like I won't eat unhealthily every day.

Hot dogs, yay!

OK, I think I'm done,

just a few more snacks and that's it.

Snacks are the most important thing. Well, not the most,

but it's really important, cos I have a sweet tooth.

I need it. I'm addicted.

For the ward.

At New Cross Hospital,

back from her trip home to Wales...

..Anna is on the respiratory award.

During the morning meeting,

Anna gets an update regarding Gladys's condition.

Sadly, it's not good news.

So, Gladys has actually passed away,

she died in her sleep.

Which is sad, but I think it's a relief really,

for us and for her family,

cos they've been in and out so many times and had so many ups and downs

that I'm relieved for them it's finally happened

and she's comfortable. So...

It's still sad.

Being the junior doctor on duty, it's 24-year-old Anna's job

to fill out the documents to verify

Gladys's death and record the official cause.

OK.

I think maybe I was glad it was me that did the verification.

I think it just holds a bit more gravity

when it's someone that you know

and you know what's happened to them and why they died.

It was more poignant verifying Gladys's death, you know,

just that first moment when I saw her

and thought, "Oh, it is actually Gladys."

Yeah, it's sad.

As a doctor, you see people dying all the time

and although you have huge empathy

and that's how you deal with

patients and with families,

you forget that junior doctors

have only been seeing this for a very short period.

Dealing with death is a daily occurrence

for junior doctors - however, this particular case has hit Anna hard.

Her family always reminded me of my own,

cos she's always visited by her daughter and granddaughter

and it reminded me of my mum and my own grandmother

cos we were all really close before my grandmother died.

They do remind me a bit of my family.

On obs and gynae,

Osama is getting ready to assist on his first ever C-section surgery.

Thank you, goodbye! Thanks for the tips yesterday.

Osama will have to get over his fear of private parts

if he's going to successfully bring new life into the world today.

I wonder if it's going to have a full head of hair,

cos I saw a baby just then with a full head of hair.

I was like, wow!

My bet's on that I think he'll have a full head of hair.

Maybe I should have brought gel with me,

we should gel the baby's hair.

Fashionable short, back and sides.

Showtime.

Getting hands on in surgery

is how junior doctors better understand anatomy

and learn new procedures.

You're coming to a layer, what's that one called?

-That one?

-Maybe the...

..external oblique?

Make another guess.

-The fascia.

-The rectus sheath.

-Oh, right, OK. Sure.

So, this step is to create as much space as possible.

Yeah. He wants to come out!

Scissors, please.

-Is this the bladder?

-Yeah. That's right.

Move it towards your side.

-My side? Got it.

-That's right.

Come in the middle and apply the pressure.

-Yep.

-Thank you.

OK, so there's the baby...

..and the baby is crying!

OK, there's the baby.

-Ah!

-Show it to the mum.

-Wow!

-BABY CRIES

Hello!

-He wants to hug you.

-Wow!

Mum and Dad are given their bouncing baby boy.

Words can't describe that, to be honest, that was really good.

The baby was just so cool!

Um...

I literally can't think of the word to describe that.

I think, like, how precious life was,

I don't know if people realise it.

I advise everyone to see childbirth because it's just incredible,

the way the baby came out and it's so fragile...

Everyone should see it, for sure.

I think if people saw it,

we probably wouldn't have wars or homicide or genocide,

stuff like that, because it's just so...

It's just, wow!

I'm so happy that I got to experience that.

On the respiratory ward, Anna has received a message.

So sweet, it's a thank-you card from Gladys's family

to say thanks for the care we've given them,

which says, "A special thanks to Sharon, Cath and Anna

"for all your kindness and thoughts." That's so sweet.

It's kind of bittersweet, cos you kind of have a thank-you card

even though she's died.

It's just really nice - it's times like this I think

when it makes the job worthwhile.

It's really nice to actually feel like, yeah,

I'm appreciated as a junior doctor.

It will probably be painful,

it's not the most pleasant thing to have,

but it will be very quick, I promise.

It doesn't matter how old the patient is,

it's what they mean to you, really.

I think it just makes me think when I see patients now,

it makes you just think a bit more

about making sure the patient's comfortable,

cos that's what we all want for our families.

Thank you very much.

Having successfully assisted on his first C-section delivery,

Osama is being guided through the suturing procedure by Dr Goyal.

My job was to cut the right places and also to hold the instruments...

..and I also got to apply some fundal pressure

at the top, so the baby could come out easier, so that was so cool,

and then I got to hold the baby as well, which was a Lion King moment.

It felt so good!

I got to hold the baby

before the parents even got to hold the baby, so...

..I'm basically part of the family, now!

Pleased with his performance today,

Osama calls his mum...

-Hello?

-Hello, hello, Mama.

-Hello, Osama - how are you?

-Good, thank you.

..also a gynaecologist.

Mum, I just finished a C-section list.

Oh, well done.

-It went really well, actually.

-Well done, Osama, well done.

You will be a very good surgeon, well done.

-Oh, thank you, Mum.

-I'm very proud of you.

Oh, thank you.

With the seal of approval from Mum...

It's cos I had no warm-up.

..Osama meets with fellow junior doctor Emeka to shoot the breeze...

..and some hoops.

It feels so good leaving the hospital.

It's like the smell of hospitals, you know, that chloride smell.

Oh, gosh, just the fresh air here.

How are you getting on with obs and gynae and whatnot?

Yeah, bro, it's actually been really good. I'm learning a lot as well,

I'm getting a lot of surgery experience.

Exactly, you get loads of theatre time.

-Which is sick.

-Which is good.

-One more quick game?

-All right, let's do it, bro.

-All right, let's go.

-Yay!

-Killed it.

Oh, that IS broken, dearie me.

-It's going to be the painful bit now.

-Ow!

Bones!

So you drink, yeah?

And then you feel unsteady and you fall, is that right?

No.

INDISTINCT

Worst case scenario is the patient arrests in front of me.

I love a gory, bloody wound.

Yes! It's the best.