Episode 4 Junior Doctors: Blood, Sweat and Tears

-Start CPR.

-Shockable rhythm!

Charging, everybody stand clear!

I have an airway emergency.

Can you open your eyes for me?

Can you stop doing the drugs, please, and help here?

30 second adrenaline.

Seven junior doctors.

Can I have a stet, please?

On the front line of medicine.

Showtime.

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

Easy sir, easy.

With all its blood...

I love a gory, bloody wound.

..sweat, and tears.

This programme contains some scenes which some viewers may find upsetting

A bit nervous.

You're not going to die.

The doctors of your future...

What the...

I actually slipped on my wedding dress.

Everybody stand clear.

..facing life...

I'm part of the family now. Lion King moment.

..and death.

I think there'd be something wrong with you

if you weren't upset by it.

Have they got...

What have you taken today?

..what it takes?

Just 12 miles north of Birmingham

is New Cross Hospital in Wolverhampton.

The hospital is home to one of the busiest emergency departments

in the West Midlands, treating over 130,000 patients a year.

30-year-old junior doctor Omar

has just arrived for a ten hour night shift

in the emergency department.

It's his second night shift this week

and he's still getting used to his new sleeping routine.

Did you oversleep much?

Yeah, I literally woke up at one, then woke up at two,

then woke up at three, then woke up at five,

then thought I'll get up now.

Newlywed Omar has one other passion in life besides medicine.

I love cars, I love driving fast, I love driving on tracks.

And it's something I really enjoy.

My wife doesn't understand my love for cars and thinks I need help.

That one's nice.

Even at his wedding to wife Samira, he couldn't resist

hiring a white sports car for the day.

Omar likes these pictures.

When you thought you were James Bond.

This is the second time

that Omar has worked in the emergency department

and he's considering making it his full-time job.

The biggest thing for me riding on this rotation is if I enjoy it,

it would strongly push me to apply for a career in emergency medicine.

With a full waiting room,

Omar checks to see who his next patient is.

It's a 40-year-old lady with a injury to her neck.

My name is Omar, I'm one of the doctors.

Can I ask what's brought you in today?

I actually slipped on my wedding dress.

I hit my head first, my feet went up in the air.

Mr and Mrs Fisher have arrived by ambulance

straight from their wedding reception

leaving their 70 guests behind.

You weren't dizzy, light-headed or anything,

it was just a simple trip over your dress, or...

-It was, I slipped straight on my dress, no, I wasn't dizzy at all or anything, no.

-So it's not... OK.

The childhood sweethearts have only been married for a matter of hours.

What's hurting at the moment?

My head, where I hit it, of course, and my neck.

If you have a traumatic fall,

there's a risk that you may have broken a bone

or fractured a bone, and if you don't diagnose and treat it

and manage it appropriately, it can have serious complications.

What I need to do, I need to get some of the staff members

and we need to do something called a log roll.

It's a procedure where we sort of roll you to one side

whilst keeping your neck completely straight.

I need to log roll a patient in three.

Can't find your legs.

To prevent any further injury,

Ms Fisher's neck must be kept perfectly straight.

One, two, three.

If there's a problem, Omar needs to find it quickly,

otherwise she could be at risk of paralysis.

I'm tapping you on the back of your head, is that painful?

No, that's fine.

Yeah? Normally, we may need to cut your clothes off,

-but I think...

-No, no, don't.

OK, we're going to roll you back, one, two, three.

The neck's fine, which is the thing we were concerned about.

We'll pop the bed up, light-headed, a bit dizzy.

So we will give you some pain killers,

and we'll let you go in a short while, OK?

Any questions, anything you want to ask?

-No, that's fine, thank you.

-All right, excellent.

Thank you.

Oh! Now I'm so tired.

Because I've got a long train, I don't know what happened.

I just slipped on it

and my feet just went from underneath me

and my head just hit the ground first.

So I was just walking.

Long day.

-Eventful.

-Yeah, very eventful.

This morning, 24-year-old Anna is working on the respiratory ward.

She's one of the youngest junior doctors at New Cross.

Have we got 1-2's dru chart?

Yes.

Away from the hospital, Anna has a favourite way to unwind.

I actually have one quite unusual hobby and that is ballroom dancing.

I absolutely love it.

And rock back out.

It's a bit of glam time in the week.

I think it's important to have interests and other things to do

outside of work, because you completely switch off from medicine.

Anna is working with consultant doctor Ejiofor.

Think her obs have been stable.

They're going to see Mrs David

whose CT scan results have shown some abnormalities.

Despite her six years' medical training,

there's one thing that Anna still has to learn...

-Morning.

-Morning.

..how to break bad news.

My name is Dr Stan Ejiofor, this is Dr Anna Burns.

Such a hard task, breaking bad news.

We are lucky as juniors that it's usually the consultants

and registrars that take it on.

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

You had a more detailed CT scan, you went through the tunnel.

-Yeah.

-OK, and that scan was to do a scan of the head?

-Yeah?

-Not like there's nothing there!

Well, we know there's something there now,

cos the scan suggested there was something there,

so you're OK with that part.

We also did the scan of your chest and your tummy.

-Yeah.

-And looking at it from the CT scan,

there's been spread of cancer to the liver.

Is there any treatment for that?

Well, the difficulty is trying to find out what sort of cancer it is.

-Yeah?

-Yeah.

And there are ways to try and find out, that out.

OK?

I'd like to talk to my family first.

-Yeah.

-And see what they've got to say about the matter.

Yeah.

All right?

I can come back a bit later on to have a chat with you.

And we can take things from there.

-yes, OK, Dr.

-If you've got any questions at all in the meantime,

-just let us know.

-OK.

It was awful to watch cos she's a really cheerful lady

and I could just tell, you know, what was going on under the surface.

It was really heartbreaking to see.

Breaking bad news to someone is something that all junior doctors

have to learn via the training that you've done,

and also by seeing it being done on various ward rounds.

But trying to do it and do it properly is sometimes quite hard.

I'm going to try and come back just after clinic to have another chat...

It's really kind of shown me the time pressures that the NHS have

because Dr Ejiofor is actually in clinic this morning

and he's already an hour late,

so it's like how do you rush something like that

and telling someone they have cancer?

There's just absolutely no time to kind of do it properly

and take her outside and it's really difficult, I think.

Thank you.

Junior doctor Jo is preparing for a big day.

I think that's normal, to have a coffee machine in your room.

She is going to be assisting in surgery for the first time in a year.

So today I'm going to theatre, yay!

I'm really excited.

27-year-old Jo is currently working

in the trauma and orthopaedics department.

As part of her placement,

she's spending a day working with a surgeon.

It's going to be an intense day.

Got to have my game face with me today.

After coffee, this will be my game face.

I'm really easy to look after, I'm basically like a dog. Just feed me,

run me, and then every now and again tell me I'm a good girl

and I'm sorted.

Like all junior doctors,

Jo needs to choose what type of medicine she wants to specialise in

but she's still undecided.

I love surgery, and it's, you know, here's a problem, let's fix it.

But I have really, really enjoyed my job in A&E so I'm a bit torn.

Second-year junior doctor Jin is starting his shift

in the emergency department.

Really don't want to be working, I'm shattered right now.

Struggled to get up this morning.

For my first weekend,

I'm hoping it will be really quiet, cos I'm tired, man.

It's his sixth shift this week and it's taking its toll on his body.

Oh man, I've got tummy pain.

Oh, man.

My bowels are just, I think it's just impacted, you know?

I'm sure you've been constipated before, you know, not nice.

Takes ages to open... Let's just stop, man.

South Korean born Jin has always had very high standards.

When I make mistakes, I think I take it harder on myself

than other people do.

I try my best not to make mistakes because emotionally it upsets me,

it makes me feel rubbish about myself.

I would be a doctor even if the pay wasn't as good.

The core of being a doctor is about who you are,

it's about the profession, it's about treating patients,

caring for people. That's what I believe.

Even though Jin isn't feeling at his best,

his first patient of the day is waiting.

80-year-old Kenneth has come into the emergency department

for the second time after a series of falls.

OK, sir, how can I help you, what's happened?

In my last week, I've had three falls.

The fall that brought you in today, you didn't hit your head or anything?

No, I just slid. I just slid down onto the carpet.

-OK, sir.

-I'm quite heavy and I can't get up.

-Why couldn't you get up?

-Too much weight.

-Too much weight.

-Too fat.

-So that sort of...

Oh, come on sir. That's, that's usual for you though,

-I mean as in like...

-Usual?!

Oh, God, oh, God, Oh, God.

I don't mean it in that way, sir, I don't mean it in that way, sir.

OK, sir, sorry, I've just got a stomach....

Rumbling stomach, rumbling stomach.

Do you want me to get a doctor?

Hey-hey!

With a medical complaint of his own,

Jin needs to quickly finish seeing the patient.

I'll discuss with the consultant whether we need to do another CT

of your head because we've already done one in the last couple of days

and this sounds like a mechanical fall.

It's just because you're on warfarin,

it could increase the risk of bleed in your brain with falls.

-I'll see you again sir.

-Yes.

When the blood test results are back. I'll come back in again.

All right, Yep, I will do.

-All right.

-All right.

-Take care, sir.

-Thank you very much.

OK, no worries.

I need to go toilet.

Even the busiest junior doctor can't ignore the call of nature.

In surgery, Jo is preparing to help orthopaedic surgeon Ms Mahroof

to remove a ten-year-old growth the size of a tennis ball

from a patient's elbow.

I'm excited.

I'm a bit nervous as well, yeah, cos I haven't...

I haven't done surgery in so long, I'm a bit like...

The patient has been given a local anaesthetic in her arm

and will be awake during the whole operation.

This is really cool.

Jo is one of the six people in theatre and has been given

the important job of spreading the patient's skin as Ms Mahroof

makes careful incisions.

The skin around the growth needs to be fully removed

before it can be safely taken out.

This is definitely a two-man job, isn't it?

Or a two woman job.

Don't need no man.

-Excellent.

-It's nearly there, isn't it?

See? Clean's coming nicely.

Yeah.

-Look at that.

-It's a girl!

With the growth removed,

gore-loving Jo gets to have a closer look

before it's sent off to the lab to confirm what it is.

-Look at that.

-It's like a chocolate cyst.

-Yeah!

-That's so satisfying.

For the last stage of the procedure,

Ms Mahroof gives Jo the opportunity

to help suture the elbow incision.

Do I want it coming out deep down here as well?

No, just similar to where you are, that's it, yep.

It's crucial that Jo gets the stitches exactly right

so that the elbow heals properly

and the patient is left with a tidy scar.

That's not quite big enough, is it?

No, and go closer to where you've entered the skin on that side.

So see, the clenching is starting.

Yeah, is that all right? Yeah, is that too much?

No, no. Well done.

Oh, Ms Mahroof is just fantastic.

She's so inspirational and so encouraging,

she's definitely a role model.

I want to be like her!

She actually sutured better than I do!

No, she sutured extremely well.

I was really pleased with it, actually.

I just found myself completely zoned into it.

And I don't really get that feeling with anything else that I've found.

Do you know if you want to do trauma orthopaedics then?

I'm 99.999% sure, yes.

I'm not going to apply for a job if I don't love it.

Yes, I think that's the right thing, cos working within

the health service is not easy with everything else

that's going on at the moment.

You need to be able to find a core of peace within your job

and if you don't enjoy that job at hand

as well as all the other rubbish, it's unbearable.

Yeah. I'll go home and think about it all now.

Yeah, exactly.

In the emergency department, Jin is back from an unscheduled break.

I was on the toilet. I'm just relieved, you don't need to know.

I just went toilet and had a big...motion myself.

-Oh, lovely!

-Not that you needed to know.

-TMI?

But, yeah spent 20 minutes in there, man.

I was in the toilet for 20 minutes, it was slowing you down.

Him or you? He was in toilet?

I was in toilet 20 minutes.

Impacted.

-Anyway, anyway.

-All right.

So I'm not being deliberately slow.

I'm telling everyone!

Junior doctors struggle when they start.

Number one is a longer shift, number two is a changing shift pattern.

You start with the morning, come lunchtime, then evening, nights.

Their digestive system is upset and their sleep.

I'm just, like, letting people know where I was for the last 20 minutes.

Last year, the government brought in a controversial new contract

for junior doctors in England,

that they believed would be fairer for doctors and safer for patients

and would help provide better NHS services.

For many doctors at New Cross,

today is the first payday since the new contract came into effect.

I woke up, the first thing I did today

was look at my bank statement.

I can eat for another month!

The junior doctors are getting together for a payday tradition

of pizza in the doctors' mess

and the new contract is on everyone's mind.

I don't think anyone really wins with a junior doctors contract.

People just lose slightly less.

Yeah.

Is what I'd say. It's a grade of how... How much you're losing, yeah.

Anyone with any job that has a contentious topic

such as your contract and your work, your hours and your pay,

everyone's going to have an opinion, aren't they?

It's been such a hot topic, recently.

I'm 25, and compared to my peers who did a normal degree in a normal job,

at 25, in my life I am nowhere near where they are.

They are closer to getting a mortgage,

they are closer to getting married,

having a life, settling down, having kids.

-I am nowhere there.

-I do feel, I agree,

I feel like I'm about three or four years behind my peers

of the same age from medical school.

You look at every corner of the NHS and everything, you know,

there is problems that the pay is not as glorious

as maybe some people think.

Everyone moans about their job and it's more just frustrations

that, you know, oh, I want to be able to do more and help more people.

At the end of the day, I... I love my job and think I'm really lucky.

Away from the respiratory ward,

Anna is enjoying some well-deserved time off

with pilot boyfriend Fraser.

How are we doing, then?

For her birthday, Fraser has bought Anna her first ever skiing lessons.

-It looks horrendous!

-No, you'll be all right.

Oh, God!

Really hard.

With Anna working more evening and weekend shifts at the hospital

and Fraser doing long hours as a pilot, their schedules often clash.

I've been on nights and Anna has been working long days

so as I'm going out to work, she's been getting in,

so having some time together is really, really nice, actually.

Yeah!

Was it harder than you expected?

I think so, yeah.

I think it's just made me really want to go on a skiing holiday.

We'll have to do some saving.

With the new contract, it means I can't afford anything.

-I know.

-You'd think now, I'm working so many more hours, weekends,

doing 14-hour days, and it's, like,

I should really see a big boost in my pay from what I had before.

-But it isn't there.

-It's not there.

26-year-old junior doctor Jin is halfway through his shift.

ED.

You go in half an hour and you fix it.

I'm going here because it's busy there.

The emergency department at New Cross Hospital

treats over 350 people a day.

I need to just do these treatment charts.

Like all the doctors in the department,

Jin is under pressure to see his patients

within the hospital's target time-limit.

90% of patients either have to be sent from the ED Department

up to the ward or sent out, discharged, within four hours,

so if the patient is still here and it's four hours,

then that means that we've gone over the limit.

Jin, Jo needs a plan on that man with the arm.

Oh, is he back from the X-ray?

-OK.

-She just wants a plan.

OK, no worries. It's going to breeze, isn't it?

Could you give me just five minutes?

I'll be back.

I just need a quick...

A quick discharge. Yep.

We're trying our best to keep to that four hours,

which is chaotic and hard because how can you expect us to do that

when it's understaffed, there's a lack of junior doctors,

lack of staff resources?

Behind it all, we're always stressed out.

We're all working hard for our patients.

We're trying our best and it's not falling apart, it's still going,

but a lot can be done to change the system, I think.

Having avoided breaching the four-hour time limit with one patient,

Jin returns to Mrs Choo, who's suffering from severe dizziness.

Sorry, sorry, just had to quickly discharge a patient.

Can you give us a water sample?

-Mm-hm.

-If you can provide us with a water sample,

get one of the nurses to do a line and standing blood pressure.

If that's all normal, then we can discharge you.

-OK.

-We'll try to get you out as soon as possible.

-Thank you.

-No worries.

Jin wants to measure her blood pressure when she's standing

and sitting to see if it's causing her dizziness.

If the blood pressure is dropping from when you're lying

and then standing up, you're going to get dizzy and faint

because your blood pressure is dropping.

That's her sitting and that her standing blood pressure,

only she's going to leave.

Whoa, whoa, that's quite high, here, isn't it?

There's a greater than 20 difference as well, isn't there?

There's a bit of a possible drop in blood pressure.

Jin is concerned about his patient's blood pressure results

and checks with senior consultant Dr Galani.

Standing is a bit high.

It's 198. It's a greater than 20 drop.

-But she basically...

-No, sorry, standing goes up.

Yeah, it goes up.

-So that...

-Oh, it's not a drop, is it?

Oh, God. I'm not thinking straight right now.

I'm not thinking straight. Sorry, sorry.

-Oh, God.

-That's fine.

Sorry about that.

Clearly I'm tired.

I can't do simple maths.

It's not a drop, it's actually increased. Just...

Can I go on a quick break?

-Go on a...?

-Quick break.

-Break?

-Yes. Break.

-What's break, guys? You know anything called break?

He's, like, "A quick break? What's a quick break?"

Break? Why haven't you gone earlier?

We asked the EU and the working time directive...

Off you go. You should have gone earlier, man.

Jin finally gets to eat his lunch seven hours into his shift.

I'm going to get a little political.

When I say this, I mean no offence to the politicians

at the top, right?

Unless you work on the front line as a junior doctor and as a nurse

and as all the staff, you don't know what it's like.

Unless you experience it.

So they're only counting statistics and numbers

and looking at the budget and determining, and it's all good,

that's what you need as well,

but I think we need more doctors,

more senior doctors and more junior doctors who represent us

to sit on the table to advise the politicians.

To keep the NHS alive, they need to keep us alive.

They need to keep us moralised. They need to keep the staffing levels

alive and at the moment I don't see it happening.

Away from the hospital,

newlywed Omar is catching up with two other junior doctors,

Anthony and Raul.

How long have you been married?

Just trying to figure it out!

That's not a good sign!

You should have your first anniversary present

planned out already, man.

Yeah, it's fine, it's all in here.

Everything's up here, everything's in here.

Have you got anything big planned out?

-Taking her anywhere?

-Going abroad.

It's just a case of planning it now.

Time's flown by.

How is actually, like, balancing married life and...?

I think just now, with this A&E rota, everything is a bit manic.

Our rota changes every week.

I think you need to look ahead and sort of see, you know,

what big gaps I've got.

It just takes more planning.

It's been fine so far, thankfully.

We'll see how it goes.

But I think that's the one thing about A&E,

it's a lot of shift patterns.

Yeah, that's true.

It's nearing the end of Jin's shift.

Tired, man.

And the emergency department is reaching its busiest time of day.

Does it always get this busy at night?

-Of course.

-Is it because there's less doctors on at night?

-Is that why, or...?

-Yeah.

-Oh. And more patients.

Is it your left side?

-Your left hip?

-My right.

On your right hip?

ALARM SOUNDS Suddenly, the emergency alarm goes off.

-What's going on?

-I don't know.

A patient has gone into cardiac arrest.

Jin needs to get to them, and fast.

Every second counts

and he must quickly assess what needs to be done.

Oxygen...

The ambulance crew are pumping the chest

to keep the blood flowing around the body whilst the heart has stopped.

Can I grab a stent, please?

Jin carefully monitors the patient's pulse for two minutes...

Has that been the time, two minutes?

..to check for a sign that they can try and restart the heart

by shocking it with an electric current.

-Shockable rhythm.

-Carry on.

-Press charge, yeah?

-Wait.

Charging. Everybody stand clear.

Check pulses, please.

Shockable rhythm? Will I press charge?

Charge, please.

Stand back, stand back.

Shocking.

Continue.

Rhythm's back, rhythm's back.

Check for pulse.

At last, a pulse has been detected in the patient

and she has come round, disorientated but alive.

It's 11pm and Jin has finally finished his shift,

12 hours after it started.

I've worked long hours every day.

I feel shattered, I feel tired.

When you experience things like this, it keeps you going

and it reminds you that you are making a difference

and you feel gratified in the sense that the patient survived

and you were there, doing your little part, and that's...

..that's a rewarding feeling.

It makes everything else worthwhile,

all the other emotions and the crap and all the politics

about the NHS and the demoralisation and, you know,

all the staff shortage, all that becomes secondary, in a sense,

after events like this.

I feel a little emotional now.

Cardiac arrest is the ultimate life-and-death situation in medicine.

It doesn't get any more life and death than this.

I think that's part of being a doctor.

You just act. You have responsibility for everyone.

You can try it.

Have you ever...

parts down below?

Yeah.

It's quite scary. For a second, I thought he was going to die.