Documentary series following the lives of seven newly qualified junior doctors. Anna experiences how to deliver bad news on the respiratory ward.
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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.
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...
I actually slipped on my wedding dress.
Everybody stand clear.
I'm part of the family now. Lion King moment.
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.
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.
-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?
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...
..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.
-OK, and that scan was to do a scan of the head?
-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.
-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.
And there are ways to try and find out, that out.
I'd like to talk to my family first.
-And see what they've got to say about the matter.
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.
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.
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.
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.
-I'm quite heavy and I can't get up.
-Why couldn't you get up?
-Too much weight.
-Too much weight.
-So that sort of...
Oh, come on sir. That's, that's usual for you though,
-I mean as in like...
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?
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.
When the blood test results are back. I'll come back in again.
All right, Yep, I will do.
-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 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.
-It's nearly there, isn't it?
See? Clean's coming nicely.
-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.
-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.
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.
-Not that you needed to know.
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.
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.
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.
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.
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.
-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.
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?
-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?
-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.
-We'll try to get you out as soon as possible.
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.
-Oh, it's not a drop, is it?
Oh, God. I'm not thinking straight right now.
I'm not thinking straight. Sorry, sorry.
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...?
-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?
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.
And the emergency department is reaching its busiest time of day.
Does it always get this busy at night?
-Is it because there's less doctors on at night?
-Is that why, or...?
-Oh. And more patients.
Is it your left side?
-Your left hip?
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.
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.
-Press charge, yeah?
Charging. Everybody stand clear.
Check pulses, please.
Shockable rhythm? Will I press charge?
Stand back, stand back.
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?
It's quite scary. For a second, I thought he was going to die.
It is pay day - the first since the government changed junior doctors' wages and working hours, and the pressures of working as junior doctors in the NHS are starting to show. In the ED, newlywed Omar treats a bride who has had a fall on her big day.
Nervous first-year Anna experiences how to deliver bad news on the respiratory ward. Jin struggles through some medical problems of his own during a busy ED shift and helps with a cardiac arrest. Jo spends an exciting day in surgery, helping to remove a tennis ball-sized growth from a patient's elbow.