Episode 5 Junior Doctors: Blood, Sweat and Tears

-Start CPR.

-Shockable rhythm. Charging, everybody stand clear.

In every emergency, we completely assess you.

Can you open your eyes for me?

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

Seven junior doctors...

Can I have a stet, please?

..on the front line of medicine...

-Showtime.

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

Easy, sir, easy.

..with all its blood...

I love a gory, bloody wound.

..sweat and tears.

A little 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's just something wrong with you if you aren't upset by it.

-Have they got...

-What have you taken today?

..what it takes?

-I'll see you tonight.

-OK, drive safe.

I will. Bye!

Wolverhampton in the West Midlands is home to

a quarter of a million people

and is famous for its industrial past.

At New Cross, one of the largest teaching hospitals in the region,

the junior doctors are nearly halfway through their current placements.

-All right. Yep, I will do.

-All right.

-Across town...

-So it's a secret ingredient. It looks a bit dreadful.

..26-year-old first-year Osama

has his own unique way of starting the day.

Every morning, my life starts like this,

but at least it means it can't get any worse.

With his mum away, he's facing the responsibility of being home alone.

So this evening, my mum's working so I have to make my own stuff,

I have to iron my own clothes and do my own breakfast.

I think my mum thinks it's cute that I try and clean up on Friday.

Just doesn't work, it's not good enough.

I think that looks kind of clean.

Don't know. All right.

When the general public probably think of a doctor,

they think of, like, some rich guy chilling out in his Bentley,

but the reality is very far from that.

My day involves so many strange things from putting a finger up

someone's, erm...anus

to doing other, you know, embarrassing things.

Do you want anything to help you open your bowels?

I'm going to say no to that one.

My family are in medicine.

Nothing is awkward, like, you discuss everything.

So, awkwardness has gone down the window in this household.

In the obs and gynae department, Osama is on a mission.

So we seem to have a shortage of scrubs,

so I need to go get scrubs from a different department,

so I don't know what's going on, but let's go.

Oh, like a secret cupboard.

No way.

Thank you. Thank you.

Wow! So, got my premium scrubs, I'm happy.

-How are you?

-Good.

Yeah, man, respect.

Also on a quest to look his best is 24-year-old Emeka.

Dr Emeka is the name, I like to keep on top of the game.

That kind of cut.

When you look the best, you'll be the best.

-Trust.

-Slick style, that's me in a nutshell.

I was eyeing up some of these ties.

Oh, thank you very much.

I definitely like to consider myself a new medical fashion icon.

I'm thinking of going for something a little colourful.

My clothes kind of define my personality,

they kind of say, "It is me, my name is Emeka, nice to meet you.

"How are you doing?"

Ready for the shift now.

On the busy general surgical ward,

first-year Emeka is a few hours into his shift.

The bigger, the better, but some people...

Without warning, a patient collapses in the corridor

and Emeka is the first doctor on the scene.

Are you in pain?

PATIENT GROANS

Can we get him into the assessment room, please, guys?

-What happened?

-You told me I was ready to go at 11

and I was waiting till five, six hours for my paperwork.

Mr Sinclair recently discharged himself from hospital

following treatment for severe stomach pain

and suspected diverticulitis,

a condition affecting the digestive system.

HE GROANS LOUDLY

Today, he's back in agonising pain.

I think I'm going to pass out.

Let's get a drug chart. Can we get some stickers for him?

The pain in his abdomen could be a life-threatening illness,

so the medical team must work quickly to find out what's wrong.

OK, painkillers are coming.

It seems like this man's collapsed, he has some acute abdomen.

He was in here before previously

and, basically, he discharged after his CT came back as OK.

So he's come in now, he's collapsed with a lot of pain.

To help manage the pain,

Emeka must insert a needle into Mr Sinclair's arm

so he can give him morphine.

Yes.

We'll give you some food and medication, all right?

Oh, it's breaking me down.

The more you move, the more it will hurt. Calm down, OK?

Deep breath in, deep breath out.

His colleague, Dr Bhasin, needs to keep the patient calm

so Emeka can carefully guide the needle into the vein.

Slow your breathing down.

Any sudden movements and Emeka could puncture a major blood vessel.

You're going to feel a sharp scratch now.

Slow breathing. Well done.

I'm just so sore.

I know.

PATIENT GROANS AND MUMBLES

It's OK, you're getting a bowl, OK? We're getting a bowl for you.

HE RETCHES

It's OK.

We've got some anti-sickness for you.

Nobody really saw that coming.

I was just doing handover and handover with some of my team

and one of the med school students ran in and told us that...

..somebody had collapsed.

Look at me, look at me.

We've cannulated him, given him some morphine,

which is definitely going to help the pain.

We've given him some fluids and hopefully that will bring down

his heart rate and stop him being so anxious.

And then we'll kind of take it from there.

In obs and gynae,

Baghdad-born Osama is scrubbed up and ready for theatre,

but there is a small problem.

Oh, wow! Are they matching or are they mismatching?

The thing is, they're, like, three sizes too small.

I don't know if you're going to judge me for it. Are you judging me?

They shouldn't be hanging over the edges.

Do you want to change shoes?

-Buy your own.

-Do you think so? This is terrible.

It's a calamity.

I need my own pair.

-What does calamity even mean?

-Calamity is like a disaster.

-Legit.

-Yeah, he does legit as well.

Also, like, a thug as well.

Like these two ladies - big-time thugs.

Let me refer you to a dictionary definition of thug.

You know it's legit when you have to go on Urban Dictionary.

"A thug is someone who is going through struggles,

"has gone through struggles and continues to live day by day

"with nothing for them."

OK, I didn't mean it that way, guys, like,

obviously you guys have a lot going for you.

-INDISTINCT

-OK, bye.

On the surgical ward,

Mr Sinclair is still in agony

and Emeka is desperately trying to find out why.

Is the pain worse?

Not as worse, but still sore as hell.

-Did the morphine help?

-A little bit,

but nothing major.

What kind of pain is it? Is it a sharp pain?

It's right there, a throbbing sensation pain.

What happened?

Was there anything that changed when you went home?

Did you take anything? Did you eat anything?

I used the toilet this morning, that sends me off all the time.

-How was it when you went to the toilet?

-It's hard.

-Hard.

It's hard to go.

Did you have pain when passing a stool?

-Yeah.

-You did?

So much.

And he didn't mention to you anything about diverticulitis

-or diverticulosis?

-Who?

-OK.

-Who did?

Any of the doctors, did any doctors...?

They said I might have that or I might have IBS, I don't know.

This is so bad.

OK, OK, wait right here, we'll get you something.

-You wait with him.

-OK.

Thank you.

Do I get any more morphine?

INDISTINCT

I'm not sure what can cause an acute picture like this.

We don't know exactly what to call it,

we don't know if he's had a breathing perforation or anything.

The next step is a blood test, which will reveal if Mr Sinclair

is suffering from an acute infection.

Just come and ask me about that.

If anything changes or he's complaining of anything,

just come out and call one of them, OK?

He seems quite stable and most things are in place.

We just need to chase his blood results, basically,

and see what we're doing with him from there.

After a challenging nine-hour shift,

Emeka hands the care of Mr Sinclair over to his colleagues.

OK, I'm going to head out. I'm going to head out in a second.

All right, see you in a bit.

He's going to be admitted as a patient in that situation

I was already dealing with a list of my patients,

but the minute I found out he collapsed,

immediately the priority was to get him stable

and get him in a safe environment where he could be fully assessed

and so it just shows that you have responsibility for everyone.

I think that's part of being a doctor,

you just ask any doctor in my position,

they would do the exact same.

Today, Osama is facing his fear of private parts

and assisting with reconstructive surgery

to repair a weakness in the wall of a patient's vagina.

It's vital it's treated

or the patient could continue to experience chronic pain

and be at risk of infections...

..but it's not just Osama's surgical skills coming under the spotlight.

New junior doctor.

You need a new pair of shoes!

They're not mine by the way.

-What size are you?

-11.

Oh, thank you, that's so kind.

Can I have forceps, please?

-Thank you sir.

-Just needed to change my shoes.

Footwear fixed, Osama can get back to the job at hand.

Can you see the difference between this tissue here, yeah?

-Yep.

-This one, this tissue here is going to be fixed so you can see.

Using specialist instruments,

Osama's role is to make sure the surgeon has a clear view

of the vaginal wall.

I think the uterus is reasonably supported,

-so we're not removing the uterus in this case, yeah?

-Oh, great.

OK. We'll try and relax this one.

OK. Basically, he's tightening the suture.

We are coming to an end now.

This is the last stitch.

-No catheter?

-Yeah, we'll probably put a catheter and then remove it.

-Can I have a catheter, please?

-Do you catherise, or...?

-Yep.

-OK, all done.

Surgery complete,

it's Osama's turn at the business end of the operating table.

He needs to fit a catheter to the patient.

A catheter is a tube inserted into the urethra

to allow urine to drain after surgery -

and it's a task all junior doctors have to master.

-Is that the urethral meatus there?

-This is the urethral meatus here.

-Be careful, it's leaking a little bit.

-Oh, yeah.

It's critical Osama gets it in the right place

or he could damage the bladder.

-Push it a little bit further in there.

-Yeah.

You need to see that you are getting urine, are we draining?

Yes, we're draining nice here.

That's fine, thank you very much.

Following a successful catheterisation,

Osama has some more good news to share with his best friend Emeka.

-How you doing, man?

-How are you?

Bro, we were operating on someone's vagina today.

How did you find it?

-Investigation?

-Yeah, it was...it was actually quite straightforward,

it's a nice operation, very quick, surgeon was really good.

I know you and...the lady bits don't really correlate too well.

-In work-wise.

-In work!

No.

-Have you overcome your fear, then?

-Yeah.

Yeah, I've overcome my fear.

Of lady parts down below?

-Yeah.

-That's good, bro, I'm proud of you!

-Thank you.

-Give me some, bro,

-give me some, I'm proud of you.

-Thank you.

Yeah, all right, bro. See you later, bro.

Bye, man.

Smashed it.

Keeping a hospital running is a round-the-clock operation,

and 27-year-old second-year Jo is biking around 16 miles

from Birmingham for the start of a 12-hour night shift.

Tonight, it's her first time covering the ENT surgical ward.

Dealing with sick patients

in an unfamiliar specialty

is a daunting challenge for any young doctor.

Nothing can prepare you for being a junior doctor.

You just have to learn on the job.

I really like looking after people,

I like seeing somebody with a problem,

finding the problem and then just finding a way to fix it.

I want to be a bad-ass surgeon.

OK, sorry, did you say it's stopped bleeding now?

BEEPER

It's 11pm and Jo has an urgent call to see a surgical patient

experiencing severe breathing difficulties up on the ward.

He just had a tracheostomy,

they just cut into his airway from his neck

and he's got, like, a tube in there,

and his breathing is, like, 40 a minute.

The patient's pulse rate is dangerously fast,

and Jo will be the first port of call for treatment.

Can't do my job because I'm constantly getting bleeped.

Hello, there. I'm the SHO, someone called me about Mr Spicer.

-He's using bed five. I'll get you the notes.

-OK.

I've only been with him since eight o'clock.

-And he's deteriorated quite a lot?

-He's scoring a 10 at the moment.

-OK.

-So his respiratory rate is what's concerning me most.

Do you want to have a look at him in bed five?

Jo urgently needs to find out

what is causing 77-year-old Mr Spicer's

dangerously fast heartbeat.

I'm going to just order an X-ray

-and then I'll come back and do some bloods.

-OK.

I'll be back with you shortly, OK?

OK, try not - I know it's easy for me to...

Thank you! I know it's easy for me to say, but try not to panic, OK?

With fewer senior staff on shift during the night,

the patient's life is in the hands of 27-year-old Jo.

The responsibility at night-time feels huge

compared to daytime, because... Especially on my job,

I'm completely on my own,

it's my first time doing ENT

and it's quite complicated, it's quite specialist.

I've never had to deal with a tracheostomy before,

and the potentials for it all, it's serious, it's serious stuff.

Hello there, I'm back.

I need to take some blood from you, if that's OK.

Jo is under pressure to manage Mr Spicer's condition on her own.

I've just ordered a chest X-ray, and I'll run these bloods

and then we'll go from there. Are you feeling any better or...?

A bit better?

OK. Thank you very much.

I am worried, because he's quite sick.

I don't really know what's going on, like, why he's breathing so quickly.

Oh, no, I'm not going to have enough...

This isn't going to work.

Hate not knowing what I'm doing.

Being a terrible doctor.

25-year-old second-year Jess

is a few hours into a 12-hour night shift

and on the other side of the world in Malaysia, her mum is also awake.

Being on call at night brings

different challenges for each junior doctor.

We need to cross this really dark corridor, it's really long.

Everybody's asleep.

-Hello.

-Hello.

People don't really tell ghost stories, like in England.

-Yeah.

-So I was thinking in England, there's no ghosts.

-There is.

-Don't say that.

-There is!

-Don't! OK, don't spook me out!

These doors, they open and shut on their own.

Just open and shut, nothing there.

And Chris, one of the nurses, saw a man standing outside the door,

pressed the button for him and there was no-one there.

-Great.

-You know when people pass?

-Mm.

If there's a side room, we always open the window.

-Really?

-Yeah, we always open the window on the side room

for the soul to go.

You can see from the ward, a cemetery,

which isn't a really good idea, is it, in hospital.

Now that I'm officially freaked out, I'm going to go to the next ward.

-Thanks, Tina.

-OK, no problem, see you, bye. You'll love me. See you.

It's not nice walking around on your own in the night-time in the dark,

anyway, you know what goes on in the hospital and what happens to people

so it's always going to be a worry.

You never know what you're going to see.

In her country, they have ghosts

and in England, they don't, apparently.

I don't know what I'm doing, like...

I cannot call this...

On the ENT surgical ward,

Jo's shift is showing no sign of slowing down.

-Yes, it is.

-Every time she gets bleeped,

someone somewhere in the hospital needs her attention.

Hi, there.

But with Mr Spicer in a critical condition,

Jo has to prioritise him first.

Really, she could wait, couldn't she, and just get...

That's fine, can I take a name?

OK then, that's great, thank you, bye.

How's he doing?

What's his respiratory rate at the moment?

44, it's getting worse.

I've got to speak to the reg about him just...

He looks to me like he's struggling.

I just don't know what to do.

Concerned about her patient,

Jo calls the senior doctor to come and help assess the situation.

I'm just wondering if I could get you to come review a patient for me?

Over the last four hours, five hours now, he's really deteriorated.

He has shallow breathing and he's hyperventilating.

Yes, I will do.

Thank you so much. Bye.

Hi, thank you for coming.

He's going down very quickly.

Can you turn on the lights, please?

INDISTINCT CHATTER

-Ask the anaesthetist to come as well.

-OK.

-Hello, sir.

-He looks like even in the last kind of half hour,

he's looking terrible right now.

-They're on their way.

-OK.

Mr Spicer's heart rate is so high, he's in danger of

going into cardiac arrest. The emergency routine kicks in.

Jo has also requested an urgent X-ray so they can have a look at

Mr Spicer's chest. But at a critical moment, she's made a mistake.

-Me!

-When you fill one in and you don't put a ward on it,

-we don't know where to go.

-Sorry.

-If we haven't had that request

-from earlier, we wouldn't have been able to come and do with this.

-OK.

Sorry, sorry. It was... I was in a rush.

I know, but there would have been nothing we could have done

-short of ringing around every single ward.

-Mm-hm.

The medical team do everything they can.

Eventually, they stabilise the patient.

It was quite scary, just thought he was going to die.

Feels good to have some help.

All right, sir?

-Well done.

-OK.

-Thank you.

-Thank you.

It's eight hours into Jo's shift and in the doctors' mess,

she's taking her first break of the night.

I'm tired now. It's quarter to five and I've literally,

this is the first time we've stopped all night. I've not eaten anything.

I'm feeling a bit zonked.

Um... Yeah, so it was just, touch wood,

going to take half an hour just for a break and then go and see...

Give the wards a call and see if they need anything.

Just going to close my eyes for ten minutes.

Oh, God.

I'm so tired now.

It's 6:30am and with two hours still to go,

Jo has time to check on Mr Spicer.

Good morning, how are you feeling?

Same?

Better, worse?

About the same. I'll just have a listen to your chest, OK?

We'll keep going with the antibiotics,

you got a bit of a temperature now.

And we'll keep going with the water tablets

to try and get some of the fluid off your lungs, OK?

HE MOUTHS

Just use these sponges.

I know. OK, you're doing really well.

I'll see you soon.

He's improved, his spirits are up, I can't believe...

He's really positive, so that will count for a lot of things, I think,

positive attitude will make such a difference.

Just have to wait and see over the next couple of days, really.

Fingers crossed.

After an exhausting-12 hour shift,

Jo can finally head home.

Tough night. I had no idea what I was doing,

I felt really out of my comfort zone, out of my depth.

I'm tired, but nobody died, so that's good.

Cycling is probably the last thing I feel like doing right now,

but give me five miles and I'll be fine.

Today, Osama is putting a recent foot faux pas behind him

and is investing in his own pair of surgical shoes.

-Hello.

-Hey, how are you doing?

And he's got some big decisions to make.

Hm... The fire ones, maybe?

Maybe not.

Oh! Now, this is what I'm talking about.

Leopard-print Crocs.

Excuse me, hello, hi. So I quite like the leopard-print.

-I'm not going to lie.

-Yeah, I'm not going to lie,

-they only come up to size eight UK.

-No, don't say...

-Well...

-What about the camouflage ones?

-Camouflage, we've got that.

-You have?

-What size are you taking?

-Size 11, please.

-11.

-Thank you.

Do you have any, like, new in season ones?

-Like this season?

-These ones have just come in.

Oh, these are new season? OK, let's try them on.

These ones don't have holes in them which is better

because you know how messy surgery is, like blood everywhere and fluid.

No!

-Can I?

-Yeah, sure.

-Thank you.

-Have a seat, please.

-Oh, great, thank you.

No way! Wow!

This is a big decision now!

I need your help! I'll give you a scenario.

Say you're ill, you're in hospital

and a doctor comes to you wearing the red ones

or a doctor comes to you wearing these.

Which doctor would make you feel better?

Probably these ones, I'd say, but again the chilli peppers

-are really awesome as well.

-So you think you're cured from any problem?

I think they will, yes, they will appreciate it.

I don't know, this is tough.

Can I have a moment, please?

Osama seeks advice from best friend

and fashion guru Emeka.

Maybe they're a bit too risky.

-I think let's go for the original ones.

-I think the first ones

-were the best ones, too.

-Yes, yes, yes. That would be perfect.

I might buy these for casual use.

-Thank you. Thank you.

-Thank you very much.

-Have a nice day. Bye.

Nearly halfway through their placements,

it's now time for the junior doctors to take stock of how they're doing.

How's your jobs going, guys?

-Good, I've enjoyed it.

-I've been very fortunate in mine,

I'm literally always in theatre.

-You enjoying it?

-Yeah, I actually like it.

I didn't think I would like it, but, yeah.

When you're a student, like, you don't have responsibilities,

but when you're a doctor scrubbed up in theatre,

-you have responsibilities.

-I've learned a lot, so that's good.

The only thing that I found difficult was ENT.

When they get sick, they get really sick cos it's bleeding or airways.

-Yeah, yeah.

-So that was hard.

Some days you win, some days you lose.

It sounds cheesy but medicine really is a roller-coaster sometimes.

It is, it is, yeah.

I love it. I've been here for two years now and I love it.

Medicine isn't a job, it's a vocation, it's a life

and it's cheesy but it's true so, you know, it's not a case of

I go to work nine to five, I clock in, I clock out.

-It's all-consuming, isn't it?

-It doesn't stop, it's 24 hours a day.

Just because you're not in the hospital

doesn't mean you're not mentally in the hospital.

We should set up our own hospital, guys.

LAUGHTER

Emeka, I think you should be staff nurse.

LAUGHTER

Is it OK if I do a bottom examination for you?

And then I have to put my finger up to see if there are any lumps.

-Got the cyst.

-There's hairs growing through it. I want to touch it.

RETCHING

They have to have surgery, so it's sort of

the worst-case scenario that could happen in this case.