Episode 3 Junior Doctors: Blood, Sweat and Tears

-'Start CPR.'

-Can I have a second adrenaline?

-Look at that.

-Easy sir, easy.

-When did this become this bad?

One hospital.

Can I have a stet please?

Seven junior doctors...

-Show time.

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

-I'm excited.

-Little bit nervous.

PATIENT VOMITS

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

Do you want to have a chat?

..with all its blood...

I love a gory, bloody wound.

..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...

I got to hold the baby as well, Lion King moment.

..and death.

-Have they got...

-Stand back!

-..what it takes?

Wolverhampton in the West Midlands is home to over 250,000 people.

Its biggest hospital, New Cross,

treats over 4,000 patients every single day.

Junior doctor Jo is arriving

for a 12-hour shift.

It's my first day on call today.

I don't really know what I'm doing. Feeling a bit...

Oh, backwards.

Feeling a bit apprehensive, bit nervous, but I think hopefully I'm just going to wing it all day.

27-year-old Jo is from Greater Manchester and she's the first

female doctor in her family.

My father's a GP and both my parents' fathers,

and their brothers and fathers, are GPs.

Medicine is a really competitive career.

Everyone's competing and you've got to be the best

and you've got to be good, and if you've done something, someone else has done it, and better.

I think I've got what it takes to be a doctor. I hope I've got what it takes.

I'm single at the moment because nobody wants to date me...

No, I'm joking. I don't know.

It's Jo's first week working in the trauma and orthopaedics department.

-Got a handover.

-Have you?

-Yeah.

And senior doctor Rahul needs her to assist with a patient.

-Are you sure?

-Check the X-ray.

-Have you had a consultant check?

-Don't need one.

-Are you sure?

-Yeah.

OK. Who's the patient, where are they?

Ooh, that is broken.

-You're right.

-You think?! It's got a few pieces there as well.

Just a few, yeah. Ooh, dearie me.

-OK.

-Yeah?

-OK, I'll have that.

-Do you accept that?

-I accept.

-Is that all right, in your orthopaedic opinion?

-I accept.

-In my expert orthopaedic opinion, I accept it.

-OK.

Jo's patient is 56-year-old Polish born Mr Ledvan.

He broke his leg while stepping off a train.

Hello there. My name's Jo...

The team need to realign his broken bones before setting them in plaster.

Do you have any medical conditions?

Blood, high blood pressure?

Sometimes it's very high cos I'm...

HE WHISTLES

Sometimes after drink is high.

-Yeah, it goes high.

-You understand, yeah?

Yes. Do you drink every day, or just sometimes?

Are you crazy?! Every day, I'm working.

Yeah, some people... I'm just asking.

Just, just weekend.

-OK, just weekend.

-Friday, Saturday, that's it.

-OK, that's great.

-Cos my condition's right, you know?

What we're going to do...

-Yeah.

-Give you some gas and air to breathe on

and we're going to pull the leg

and put it in a plaster to make it stick.

-No problem. I don't need gas.

-Yeah?

-Just put it, please.

-You don't need gas?

-No.

-Are you sure?

-Yeah, I'm...

-Listen.

-You can have gas.

-No, no, no, no.

-I've heard it's good!

I'm very strong man, you know.

His ankle just moving in my hand.

Yeah, it's just... You can feel the bones just moving and crunching.

Look how happy he is.

This is Jo's first ever leg fracture pulling procedure.

-I'm going to start pulling again in a minute.

-Yeah, yeah. No worries.

Once the broken leg is set,

they have to do an X-ray to check that it's straight.

-Cool. You have it?

-Mmm-hmm.

-Yeah? OK?

-Mmm-hmm, mmm-hmm.

-Right.

Can you still feel that?

Wiggle your toes for me.

-That's great.

-That was all right.

Yeah. I'm all right, can do it again.

We go for a beer now? Yeah?

-Listen... No!

-No.

No, first I'm going pee-pee, and...

I could literally feel his ankles, like, wobbling.

It was, like, going...

You could feel the fragments like grinding against each other.

I love stuff like that.

It's so cool, isn't it?

Love it. Love it!

Bones!

She didn't put any egg in this, you know?

How disrespectful.

24-year-old junior doctor Emeka...

It's not like I asked for an omelette.

..is currently working in the general surgery department.

Today, Emeka has been asked to assist with a laparoscopy on a

patient with stomach cancer.

I'm getting pumped for surgery.

Getting pumped to get in the theatre.

Bit scared, little bit nervous

but slightly buzzed at the same time, so it...

..should be fun.

I've always known that, being a black person in a white society,

things would be harder for me

and it has spurred me on and pushed me on to succeed.

I think, in that situation, it can break you or make you.

Being a doctor's really important to me, because it's what

I've always wanted to achieve and I feel like if I hadn't achieved it,

I kind of would have failed in life.

A laparoscopy involves inserting a small camera into the abdomen.

So right now I'm just

refreshing my basic anatomy!

The nerves are definitely kicking in.

This is a skill Emeka will have to master

if he's to make it as a surgeon.

Today, he will be assisting senior consultant Mr Curran.

There's certain skills involved in holding the camera, or the

laparoscope, when you're doing these procedures, but we find that junior

doctors pick it up very quickly because they're brought up on video

games and the like, which we never had in my day.

The worst that can happen is he asks me something and I know nothing

about what he's doing and the patient and he just thinks,

"This F1 is totally clueless."

Some consultants can be like that. I kind of like getting nervous,

especially cos a lot of the time

I'm quite cool, quite calm, quite collected.

HE EXHALES LOUDLY

Yep.

If no more cancer is found,

then the planned operation to remove the patient's tumour will go ahead.

-Yeah.

-But it's not coming... You can just see a little bit of...

That's what I thought.

Mr Curran is giving Emeka the opportunity

to use the camera for the first time.

This is a big responsibility for a junior doctor.

OK. It's a relatively quick procedure if everything is OK.

They have found no sign of the cancer spreading.

That was awesome.

Holding the camera, you know, manoeuvring in a real-life patient

and watching the whole thing unfold,

it was quite a quick procedure so it was...

It was really good, I really enjoyed it.

I thought that was awesome.

I'll definitely try and get in more theatre time

and do a bit more of the complex stuff, a few complex cases.

When you actually get in the theatre, it humbles you

and you get to learn something new,

learn new skills and develop yourself, and that's the only way

you can really grow as a doctor.

Junior doctor Jin lives on the hospital campus in halls.

He's getting ready for his shift.

Essentially it means I'll be at the front line of the battlefield

treating patients, being their first point of contact when they're brought in by

the ambulance, or they come in via their GP or themselves.

26-year-old Jin has dreamt of being a doctor since he was 16.

I'm a nice person.

But I like to win and I like to, you know, give my best

shot at everything that I do.

Medicine is his first love.

But he has another.

There's nothing better than smashing the drums at

the end of the day. I wouldn't go as far as saying I'm a rock god.

What, a doctor by day and a rock god by night? No!

Jin's placement is in the emergency department -

the busiest place in the hospital,

seeing up to 450 patients a day.

This is a 49-year-old male gentleman who has a...

highly unpronounceable name.

He has attended A&E more than eight times in the last two,

three weeks, all with a similar problem...

..alcoholic intoxication.

He's had all sorts of problems. He's had fractures,

he's had head injuries, he's had fits.

Surprisingly, his liver's quite stable, though.

Jin's patient is Mr Alvedas Romas -

a homeless man from Lithuania,

and a known regular to staff in the emergency department.

-You know when you fell?

-Yeah.

Did you lose consciousness?

-No.

-No?

-No.

Why did you fall?

Because you are unsteady?

-Yes.

-Because you drink too much?

Is that why you fell and hurt your face?

-Yes, yeah.

-Because you drink and...

So you drink, yeah?

And then you feel unsteady and you fall. Is that right?

OK...

Jin needs to carry out a medical assessment

to check for other injuries.

Can you hear?

-Yes.

-Hear?

-Yes.

And see? How many?

Two.

Three. Four.

Two.

OK, keep your head still, follow my finger, follow my finger.

Mr Alvedas Romas was previously admitted to hospital with a

fractured wrist and finger, but he left without treatment,

and his finger has now become infected.

-Painful.

-Yes.

-Painful?

You see the injury?

-Yeah.

-We will bandage...

-Yeah.

-Clean.

And then we'll send you home, OK?

-Good?

-Yeah.

Do you understand what I'm saying?

-Oh, you want to eat? You want food!

-Yes.

I'll see what we can do, OK? I'll ask the nurses, OK?

But we'll bandage the wound,

-the clean, and then eat, and then you go, OK?

-OK.

-Good?

-Yeah.

-Good man.

Satisfied that he is well enough to be discharged, Jin leaves him

with the nurses to have his wounds treated.

We're going to give that finger a bit of a clean, is that OK?

Obviously there's, like, two sides to a coin.

These patients, they come in almost every day, you know?

Some patients, like, come in, like, ten plus times a day and they often come in...

They hang around, they either self discharge or come in for just food or whatnot.

And really, they are sort of, you know, using up bed space, you know,

wasting resources, in a way, but then on the other side of the coin,

sometimes they come in and there is actually something wrong with them.

Like the case that I had last week where there was a patient,

he was very similar to this guy, homeless, living in the streets,

multiple attendances, and he came in and he was severely septic and

unwell with a massive infection in the eye,

threatening to spread to his brain.

So...

It's like, you know, it could become a case of the boy who cried wolf.

You still have to do the full examination.

You all right?

Miss Greenman?

He'll probably laugh in my face, won't he?

I think we made it worse.

The X-ray results are back for Mr Ledvan's leg fracture.

We're not happy, we're not happy with...

-We're not happy with the manipulation.

-We're not happy with the reduction films.

-Yeah.

So we're going to redo it...

and make it straighter.

The bones are not straight,

so Jo and senior doctor Rahul will need to do it all over again.

We're going to ask you again, sir - do you want any pain relief,

-or are you OK?

-Yeah, I'm all right.

-You're OK?

-Yeah.

-OK.

-Maybe tomorrow.

-Maybe tomorrow, OK.

-LAUGHTER

It's vital that they get it right this time,

otherwise nerves, vessels and blood supply could get damaged.

Sorry, mate. It's going to be the painful bit now.

Once again, Mr Ledvan refuses pain relief.

-Ow.

-I know, I know.

-Ow. Ow.

-Ow.

-You're doing really well.

Mr Ledvan is facing a lengthy recovery.

His painting and decorating job

will have to go on hold for at least four weeks.

-Does that feel better in the ankle that time?

-Yeah, yeah, it did.

I put loads of pressure on myself to be perfect and to get it

right the first time, and I feel, you know, like, I've not...

I didn't do my job properly because I got it wrong the first time,

but it just happens, you know.

You're doing it blind.

You know, the more you do, the better you get, so it's a kind of case of practice makes perfect.

-Much better.

-Is it?

It is, but it's still slightly laterally displaced.

Why, why, why? Hold on, let's have a look.

This time, Jo and her colleague Rahul are confident the leg is set in the correct position.

-Oh, come on...

-Slight...

-I'll take that, I'll take that.

-Yeah, I'll take that.

-Score. Score, smashed it.

-Teamwork.

-Cool.

Jin, Jo and Emeka are meeting up with some of their fellow

junior doctors for some time away from the hospital.

-Come on, man.

-What you saying, bruv?

What's good, bro?

But instead of giving their brains a rest, they're taking on Escape Live.

OK, are you all ready to go?

-Yes.

-Perfect. If you'd like to all follow me, please.

-Great.

It's a group challenge where you have to get out of a locked room by

collecting clues and solving puzzles.

Oh, look, bro, these are coordinates for this, I think.

Oh, wait! No, look - the constitutions.

What month is the missing sign? It's August, but how do I...

-Come on, it's August, man.

-Is it definitely August?

-Wait, no, no, no, no, no, no, wait.

-No, wait, look.

-It's not August, it's July.

-It's July.

LAUGHTER CHATTER

-Love pirates!

-Our time will be up in eight minutes!

-Oh!

-All right.

Red, red, red, red.

Yellow, blue, red, red.

BELLS RING

Yellow, green, blue!

BELLS RING

-Something's gotta happen.

-Yes!

-Yes!

-That was a good song though, guys.

-Jo, good work.

-You didn't sing it well, but...

I'm not singing it!

-Yeah!

-I feel like I want to stay here for a while.

-Just in time...

Did you ever think as a child that that you'd ever be an actual doctor?

-True, yes.

-I never thought I'd actually be a doctor.

True. I thought I could be a pretend doctor.

-And now you are!

-Even little things felt big - prescribing paracetamol,

everyone has paracetamol at home.

-Terrifying!

-And I was like, "Oh, my God."

-Terrifying.

Every single thing I had to, like, triple check.

Yeah, the first time I ever prescribed paracetamol I looked in

the BNF online, and then I went for the BNF book as well,

just to double-check that the BNF was the same.

And it's just paracetamol, like...

With the patient, I went through their weight and their allergies ten times.

I then went and examined the patient

before prescribing the paracetamol, just cos I was like...

There's so much that you can't learn in medical school.

But that's the good thing about it. That's what I like.

Every day I go in and I learn something new.

Whilst a lot of twentysomethings might be out partying,

25-year-old Jess is on her way to a 12-hour night shift.

Hopefully I'll do well, my patients feel well cared for

and I do the right thing, and do them justice, basically.

As part of the night team, she will be on call

with the responsibility of looking after six wards

with over 100 patients.

Night shifts are unpredictable,

so some people really enjoy them, but for me...

..I think I'm the kind of person that prefers, like,

more controlled environments, so...

Having, having... Going into a night shift always gives me,

like, a little bit of nerves, yeah.

Junior doctor Jess is from Malaysia.

As a top student,

she was hand-picked to come to medical school in Britain.

My perception of the NHS is that the people who benefit from it most are

the people who need it the most.

My parents and my family have been very supportive,

and they've always encouraged me to pursue my opportunities.

You will achieve what you want to

achieve, and you'll make all of us proud.

We're very, very proud of you.

I am really proud of what I've achieved so far.

There's actually nothing that you can't do

if you really, really, really work hard at it.

Nights can be the quietest time at the hospital,

with fewer staff on shift.

Right, OK, where's the patient?

She's in two six.

Two six, OK. I'm just going to see her.

This gives junior doctors more responsibility,

as they are often the only ones on call.

Tonight, Jess is treating 90-year-old Nellie.

Are you having any chest pain?

Nellie suffers from lung disease.

She's struggling to breathe,

and her heart rate has increased dramatically.

-Yeah.

-OK, how bad is the pain?

Where is the pain?

OK, let me get you some...

Let me get you something, OK?

This is very difficult, especially when you just walk in,

and you feel like you need to do something

but you're not really sure what to do, sort of, like,

just jumping in straight away without sort of, like,

taking a step back to think...

..that's not the best thing to do.

I am worried about her.

OK, nice deep breaths.

Nice deep breaths.

NELLIE COUGHS

-Oh.

-OK.

-Please.

-Right, OK.

So I'm just going to call the med reg.

Unsure what to do, Jess calls for backup.

Hello? Hi, Tosh. Hi, this is Jess.

I need some help. I've got this 90-year-old lady

who is having a heart rate of 154 at the moment.

ECG's been done.

We can see that her T waves are really raised in the old ECG,

but now it's even more raised.

I'm just wondering, what do I do now?

OK, cool. Thanks, bye.

Right, so the med reg is coming.

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

and I think when the heart stops,

the possibility of getting it restarted

is very, very, very low, so I think that's what we're trying to prevent.

Prevent an untimely death, essentially, yeah.

MACHINES BLEEPING

The registrar on call has arrived to help Jess.

Hi.

Kind of...

No, no, I'm not OK.

Hello.

He assesses Nellie.

Her heart rate has increased.

Hello...

The registrar helps Nellie

by giving her a drug to slow down her heart rate.

I definitely felt worried,

and I think the next time that I do encounter it, you know,

it's not something that's going to be as stressful

as the first time I did it.

When you see a patient's getting better,

there's no feeling like it in the world.

So I think that's why I still do what I do regardless of the fact

that I do feel a huge amount of responsibility.

-When?

-Tonight.

-Yeah, I'll still be there.

Yeah, yeah, it is good.

Busy. Right, I'll go and see if I can find my pen,

and I'll give this one back.

Jo has been called to see a patient with a severely lacerated finger.

I love a gory, bloody wound.

It just makes me really happy.

I get excited.

What was it that you were using, sorry?

-An electric plane.

-Electric blade?

-Plane.

Clint owns a horticulture shop

and was in the middle of refurbishing it

when the accident happened.

It will grow back. It won't be exactly the same as it was.

-No, yeah.

-But it might just be a bit rough and,

you know, flat, that sort of thing.

-So...

-So, you want to... If you look at the last little divot in between.

Jo needs to administer anaesthetic into the finger

in order to clean it properly and prevent infection.

I'll give you the easier side to do.

It's the first time she's done this,

so Dr Mannakatu is showing her how.

Let me do that one for you. It's going to sting a bit, sir.

Sorry about that.

It's going nice and easy, sir - that's important.

At about 10 degrees, in that divot, OK? Yeah.

Be careful not to prick yourself.

Don't put your finger under it, OK?

-Yeah.

-Cos you don't want to prick yourself.

-This divot is there.

-That's the one, yeah. So, aspirate.

Just make sure you don't hit an artery and you're not pushing in on

the artery. Always aspirate and then inject.

That's it. And take it out.

Be careful about your sharps.

That's it.

OK.

-Good bit of practice for you.

-Yeah!

Will you give me another...

Will you give me a...

We could try that, I suppose.

With the finger fully numb,

Jo can now clean the flesh and apply a compression bandage.

A lot of my job, I'm just doing everything for the first time

with an actual patient, which is pretty terrifying,

and you feel so much pressure to get it completely perfect,

and it makes you feel like a bad doctor if you don't.

But, at the end of the day, it is the first time you're doing it,

so, you know, no matter how many times I've read how to do it or I've

seen people do it, or I've YouTubed a video of how to do it,

actually doing it on a patient is a completely different ball game.

It's really hard.

Away from the hospital,

Jo is catching up with her friends who are also medics.

-I love...

-It's a love-hate relationship.

As with most junior doctors,

there's one topic of conversation never far from their lips.

Yeah, I like a good gory, bloody wound...

Something that's going to explode unless I do something!

That's disgusting!

Your dream job is like my worst nightmare.

Yeah, same - I was just thinking that that's absolutely the last

thing I want to do is, like, surgeries, emergencies.

Yeah, I know.

But I know I'm not... I know I'm not a surgeon, and that's fine with me.

So what do you want to do? Go on.

Yeah, love it. Sexual health, love it.

Claire loves manky vaginas.

Yeah, like, sit me down

with some, like, horrible...

-A retained tampon?

-Yeah! I got called to A&E the other day to

remove a tampon, and I was like... I got bleeped by A&E.

I answered the phone. I was like, "I've been waiting two months for this."

Like, "Absolutely," like, "I'll be down straightaway."

-I was so... I was like a child.

-Christmas morning!

-Yeah!

I was like a child on Christmas Eve.

I was like, whipped out my forceps, like...

-out it popped, it was great.

-Yeah!

It was great, like, I love stuff like that.

I love, like, women, periods, all that stuff, and that's like, yeah,

that's what I love.

That's the thing that's so great, isn't it?

Like, there's a lid for every pot.

Yeah, exactly. Exactly.

I think you need to be passionate about it to do it...

-Yeah.

-I think that's the one thing I've realised, that you...

-You just need to enjoy what you do.

-It's so intense, you have to...

you do have to sacrifice quite a lot of things for the specialty that

you do, and unless you really want to do it there's no point,

-because you're just going to be unhappy.

-I definitely could not do a job that I didn't love.

-Yeah.

-No way.

I'd just do a half-arsed...

Oh, man.

-Rumbling stomach, rumbling stomach.

-Do you want me to get a doctor?

-JIN LAUGHS

-Ah-ha, hey!

You've had some tests whilst you've been in hospital.

It's such a hard task, breaking bad news.

-What's brought you in today?

-I slipped on my wedding dress.

I really want to just squeeze it and see if it'll...

-Look at that.

-It's a girl!

-Look at that.

-Yeah.

-It's like a chocolate cyst.

Oh, the... Yeah!

-ALARM SOUNDS

-What's going on?

Cardiac arrest is the ultimate life and death situation. It doesn't get more life and death than this.