Episode 6 Junior Doctors: Blood, Sweat and Tears

-Start CPR.

-Shockable rhythm.

-Charging. Everybody stand clear.

I have an airway emergency, we need to assess 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.

-I'm 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?

-Are you all right?

-Yes, good, thank you.

-Right, I have got...

At New Cross Hospital in Wolverhampton,

junior doctor Jo has been called to the children's emergency department

to take a look at a one-month-old baby.

Mum's woke her up this morning, took her out of her baby grow and noticed

-the right foot, the second, third and fourth toes swollen.

-Right.

There's indentation there, where there's potentially been

either cotton or a piece of hair.

The fourth one is grossly swollen with broken skin underneath

and it's quite offensive smell.

-Right, OK.

-Over to you, please, lovey!

-Cool, I'll go have a look.

-Right, she's in one?

-She's in number one, yeah.

-Okey dokey.

-Mum was quite tearful, but she's all right now.

-Aww, OK.

It's hard work becoming a doctor.

There's definitely a really strong desire to have a life

outside of work, so I'm currently training for a triathlon,

which is a 400-metre swim, a 20k bike and a 5k run.

Terrified because I've never done it before and also,

although it's not that far, it's going to be fast.

If I wasn't a doctor, I think, actually, I'd just like to...

be a professional dog walker or something

cos that would just be great!

Hello, there.

Hi, my name's Jo, I'm one of the orthopaedic doctors.

-This is Marnie?

-Yeah.

-And you're Marnie's mum. What's your name?

-Amy.

Amy, hi.

So, I've just had a bit of a handover from my colleagues,

but do you want to tell me about what's been going on?

Basically, I thought she had trapped wind,

-cos she goes blue in the mouth, do you know what I mean?

-Yeah.

She's been unsettled all night and when I woke up this morning,

I've undressed her to change her nappy

and when her socks fell off I just noticed her toes.

OK. So when was the last time you saw the foot looking normal?

-It would have been in the morning, like.

-So yesterday morning?

-Yeah.

OK.

-Yes, it looks like something's got wrapped around it, doesn't it?

-Yeah.

Let's have a look.

Aww.

The others have had a look and they can't see anything.

That's right, but...

BABY GURGLES

OK.

So, it looks like it's probably a piece of hair or a piece of cotton

that's got wrapped around, and are you aware of any

-allergies that she's got so far?

-Nothing at all so far.

-OK, then.

You are gorgeous, aren't you?

Look at you. OK, what I'm going to do is have a chat with

one of my seniors to come and have a look as well, but, obviously,

-we want to make sure there's nothing wrapped around there.

-Yeah.

And get that off as soon as possible, OK?

I know it's easy for me to say, but try not to worry.

I know. The first thing I did was start worrying.

Yeah, you would do, though, if it's your baby, wouldn't you?

So I'll go and have a chat with my boss

-and I'll be back with you shortly, OK?

-OK, thank you.

-No worries.

If there is something wrapped around baby Marnie's toe,

it needs to be removed as a lack of blood supply could result

in the toe being amputated.

I've just seen a one-month-old baby.

The mum took her, undressed her this morning,

and it looks like a piece of hair

has wrapped around her second, third and fourth toes of her right foot.

The fourth toe is really quite red, swollen,

a little bit of discharge coming out on the bottom.

I just would like you to have a look at it.

OK, then.

So if I just say admit to PAU and then we'll just review on the ward?

OK, that's great.

No, that's all right.

Thank you. Bye.

Hello. So, I've just had a chat with my registrar

and what we're going to do is send you over to the paediatric unit

and they're going to come and have a look, but it's going to be in a couple of hours, I'm afraid,

-cos they're just in clinic at the moment.

-Yeah, that's fine.

So we'll just have a look and we just need to keep an eye on it.

You know, if there was a hair round it, cos we can't see anything,

if it's gone, it should improve over the next couple of hours,

but we just need to keep an eye on it anyway, so if it's no better

-or if it gets worse, then we need to do something about it as well.

-Yeah.

-OK?

-OK, thanks very much.

-No worries.

-Thank you.

-Pleasure.

Jo's diagnosis was correct.

Baby Marnie had minor surgery to remove the hair.

She's now made a full recovery.

It does feel nice when you're right,

but it's more that it gives you confidence in that

your clinical judgment is correct

and sometimes you just get a feeling about patients, so it's

really reassuring to know that

that's right and that you did the best for them,

cos the worst thing is to think, "Oh, God, I missed something"

or, "I sent them home and something really bad's happened to them."

Jess came to the UK from Malaysia to train as a doctor.

She relies on her family for emotional support.

What we see on a daily basis can be quite scary to a lot of people.

Sometimes I'll come home from work and I will tell my sister,

"Oh, you know, I had this giant bleed today."

And then she'll go, like,

"You mean you saw someone die in front of you?" And I'll go,

"Yeah, yeah, yeah. I saw someone die in front of me today."

It can have a toll on you. It can have a psychological effect on you.

Today, Jess is on shift in the haematology department.

One of her first patients is Andrew, who's come in for chemotherapy.

He's suffering from lymphoma, a type of blood cancer.

I've upped your painkillers yesterday.

How are you feeling today?

All right, just wearing off a little bit.

Are you opening your bowels? Cos they can be quite constipating.

Yeah, it's... Yeah, it's, erm...

-like, watery.

-Still watery?

-Yeah, it's nothing solid.

-How long has that been going on for?

A few days.

That's why I stopped the Senokot a little bit,

cos that often comes with having too much.

-Do you know what haemorrhoids are?

-Hmm.

-They're soft blood vessels that dangle out from your bottom.

-Yeah.

And sometimes you have to push them back in. Do you have that?

When I was on chemo last time.

OK, do you mind if I come back later to examine your bottom? Is that OK?

-Yeah, that's fine.

-That's fine?

-OK.

-I'll see you later.

-OK.

-Bye, Andrew.

I think I'm a bit concerned about the fact that he's

saying that he's got blood on the tissue when he wipes

and also blood on the pan when he passes.

It can be due to something very benign,

so something that's not dangerous, so, for example, haemorrhoids,

but it can be due to something more serious as well, so, for example...

..things like colon cancer can give you bleeding from the bottom.

He's now in a potentially very serious place

in terms of his medical condition.

In an attempt to cure his cancer,

Andrew is having chemo to prepare for a donor.

If Jess finds a problem,

his life-saving treatment may be delayed.

This is the third time I've had a relapse in the lymphoma.

Thought I'd got over it and then it's like going six steps forward

and nine steps back.

When it comes back again, it's...

it's life-changing.

Everything has to change.

The kids were only young when I was first diagnosed,

they were only seven and 11.

Meanwhile, well, we just try and...

..laugh things off.

Jess needs to examine Andrew to find out why he's bleeding.

Hello, hi. Sorry to wake you. I'm back.

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

I need you to lie on your side

and I need you to expose your bottom area as well.

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

bumps or any cuts or bruises, OK?

I'm just going to put some gel on the area, OK?

-That's feeling quite cold. And can you feel me touching you here?

-Yeah.

-And here?

-Yeah.

-OK.

OK. And all done.

OK, I'm very happy about that. Thank you so much.

-OK. Thank you.

-See you later. Bye.

That is good. No, that's really, really good.

If I did find blood when I examined him,

I would probably have to investigate him more.

If I found a haemorrhoid, then I wouldn't have to investigate him

because that's a benign condition.

But because of my examination findings,

I don't think it's as serious as I initially thought it was.

It's good news for Andrew.

Jess needs to wait for the test results to come back,

but it looks like he'll be able to begin chemotherapy.

I think my main worry was that he wouldn't be able to

have his chemotherapy, but as long as he's well in himself,

that will be able to go ahead.

If anything, I'm less worried now.

-Bye, Raj. See you!

-Bye!

Today, 27-year-old Jo is working on the trauma and orthopaedics ward.

-It's getting bigger.

-It's her lunch break...

-I've lost it.

-..and she has a personal matter to deal with.

A cyst on her head.

There it is. If I squeeze it...

No, because it might pop out and that'll be disgusting.

Don't think we've got suture packs here.

But we're going to need some swabs.

Take some water for injection. Needles and syringes.

There's suture...

Oh, hello. I was just looking for your book. It's all right.

-You all right?

-I was just grabbing a suture pack.

-That's fine. I'll put it in the book.

-Thank you.

Adrenaline's running.

I'm sure it would have been fine, but it just looks a bit dodgy

if I'm just stealing stuff.

But I got what I need.

It's not going to go wrong. There's nothing really that can go wrong.

There's nothing there to go wrong.

Today, have-a-go Jo is letting someone else have a go.

Fellow doctor, Kingsley.

I love having injections at the dentist.

I don't know why.

I used to, like, be terrified of the thought of a needle in my mouth

-and one day I went and the dentist just went, "OK, a sharp scratch" and did it.

-OK, Jo, sharp scratch.

So whenever you inject, you have to draw back a little bit

to make sure that you haven't gone into a blood vessel.

-I think we're done there.

-Sweet!

So we'll give it a few seconds for it to actually do its biz.

-I literally couldn't feel a thing.

-Good, good.

-Da-da-da!

-That's when the magic happens.

I love this sort of thing. I think it's great.

I get really excited if someone's got to do a minor procedure.

I'm like, "Yes!"

Some people find it really scary, but I love it.

-I've got the cyst.

-I want to see what comes out.

Just about forking it out now.

That might be, like, an animal in there. Imagine a spider crawled out.

That would be upsetting, wouldn't it?

Can't feel anything. It's so weird.

Yeah, that's a sac. I want to touch it. Is that really bad?

Just touch it...

Eww, there's hairs growing through it. That's gross.

It's really, like, weird.

-That's it. Done.

-Thank you!

It shouldn't really bleed, Jo.

No, it shouldn't, should it? Should be all right.

In terms of minor procedures, it doesn't happen very often,

but every now and again we do it for each other. Like today.

And, to be fair, it's a fairly safe procedure

within a very nice confined environment.

And so if anything had gone wrong,

there was scope for us to escalate it very quickly.

But it was only a small cyst on the scalp, so yeah, it's fine.

-Looks really good.

-It's good, isn't it?

-Well anaesthetised as well.

-Yup, didn't feel a thing.

-HE LAUGHS

Away from the hospital, Jo and Jess are meeting up.

They're nearly halfway through their placements

and there's a lot to catch up on.

The thing is, I never really think about it.

Everyone always says there's so much responsibility in your job,

you kind of don't think about it, do you?

Um, yeah, I don't sit down and mull over how much responsibility I have.

I think if I did, I would probably go, like, a bit insane.

Do you like having the responsibility, though?

I think I like responsibility that I know is within my capability.

I was just, like, randomly on the ward, in the doctors' office, just typing away,

and then there was a guy having a transfusion reaction

in one of the side rooms.

-And he was having, like, signs of anaphylaxis.

-God.

And I was like, "Oh, my gosh."

I was like, "OK, guys, get a trolley and a crash... You know, do ABCDE."

And then, for that few minutes

that you're the only doctor on the ward, you're like, "Oh!"

And then when my reg comes, I'm like, "Phew!"

That feeling of when you, like, realise someone's really sick

and your heart just kind of skips a beat. You're like, "Oh, God."

Because then you know that you're the only doctor there.

-That is terrifying. What happened in the end?

-Um...

So, we managed to stabilise him, but he crashed again

and this time he passed away.

It was very, like... I felt very let down afterwards.

It's very strange because I know he's not related to me...

But when they're your patient, you have a bit of a relationship, it's always really sad.

Yeah, I didn't cry or anything.

-I just felt a bit down.

-I think that's normal.

26-year-old Jin is at home,

getting ready for his first night shift in the emergency department.

I'm good, man. I'm good.

Should be similar to a day shift, except that it's night-time

so I'm going to be tired and all that. Let's see how it is.

I've never done it before.

As long as it's not crazy busy, then I'm cool.

I am a perfectionist.

When I was younger, it was more sort of disadvantageous to me

because I would take longer to do things.

I used to always be the last one out of the classroom

because I'd be packing my bags.

I was a bit of an idiot when I was growing up - in my eyes, anyway.

-I thought you finished last week.

-Where?

-Here.

-When?

-How was that going to happen?

-I thought you were finishing up.

I'm a part of the furniture, man.

One of Jin's first patients of the night is Mr Khan.

He's suffering from a shortness of breath.

Two weeks ago, 65-year-old Mr Khan suffered a heart attack

on a trip to Pakistan.

-What?

-Blue's your colour. Really suits you.

Oh, does it? Thank you. Thank you.

He's being held in infection control,

as he's recently returned from foreign travel.

We've done a heart trace, which hasn't shown evidence of heart attack,

but in the blood tests we do, it's worthwhile to do the troponin,

which measures whether there's been heart damage.

The second thing - and the most important thing, I think - is

whether he's got an infection

and whether the infection might be something that

he contacted from Pakistan, which is why we're being a bit cautious.

So we need to put a needle in him and give him some...

He's obviously dry, so give him some fluids

and stat dose of IV antibiotics. Do you have any questions for me?

-No, that's fine.

-No worries.

-Just want him back...

-Back to normal.

-Back to normal.

Well, leave it with me, we'll sort it out, OK? OK.

All right, sir? You understand or...? OK, good stuff.

To find out what's wrong with Mr Khan,

Jin needs to take some blood.

Not quite. I'll have another go.

Don't worry, I'll get it in.

-Is it just cannula you're doing?

-Hmm?

-Is it cannula?

Yeah.

HE SIGHS

-No?

-No.

I shall get someone else to have a go.

Jin has been unable to find a vein.

-Get one of the seniors?

-Yeah.

-Hey, man, you any good at cannulas?

-I'm very good, yeah.

Yeah, yeah, make me feel like crap, make me feel like crap, yeah.

Senior doctor Raul steps in to help Jin cannulate Mr Khan.

ECG shows tachycardia.

Yeah, that was smooth, man.

-OK, so, do you want that?

-Yeah.

Thanks, man. I can take care of the rest.

Do the bloods before they clot first.

-Yeah. Thanks, man. Appreciated.

-It's all right.

All good.

I don't feel great. Low self-esteem at the moment. But...

Can't be 100% perfect. He had difficult veins, though. So...

Since arriving in Wolverhampton as junior doctors, Jo, Jess

and Anna have become good friends.

Anna has invited the girls round for her signature dish, fish pie.

-I am very competitive, I have a problem.

-Are you?

-Yeah.

-Are you?

-Yes.

-Wow. I found one.

-LAUGHTER

-Are you not competitive?

-I don't think I'm competitive,

in the sense that I go around saying I'm competitive.

-I'm not that competitive.

-No, I say that I'm not, but actually I am.

It's terrible. I need to, like, chill out a bit.

-I'm not competitive.

-Really?

-Yeah.

-Not in anything?

-Not even, like, with yourself?

-Um... No.

LAUGHTER

That's why we are friends!

THEY LAUGH

I'm terrible. I'm so bad.

LAUGHTER

Jess.

On ENT, they used to decide if it was the Hunger Games,

we decided we'd win!

LAUGHTER

Oh, I would so win the Hunger Games. Oh, my God.

I would win the Hunger Games. Definitely, hands down.

I'd kill you all.

THEY LAUGH

Sorry, I wouldn't take any prisoners. I'd just be like, "No..."

I'll pick off the weakest of the crowd first.

You can find some people being competitive even on the ward,

like, "Well, I've cannulated five patients."

-"I only cannulate at the first attempt," you know?

-Yeah.

-Yeah.

Sorry.

-It's hard balancing everything, isn't it?

-Really hard.

Being a doctor and then having a social life.

PHONE BEEPS

Such a kind of emotionally gruelling job sometimes, isn't it?

Cos you get told off, we get shouted at.

You have patients die on you. You make mistakes.

And I'm always telling myself, "I don't need you to tell me I'm not good enough.

-"I tell myself that enough already."

-Yeah.

-Yeah.

It's 4:30am, and Jin is seven hours into his night shift.

He's called to treat 29-year-old Mr Martin,

who's been suffering with a severe headache for the past 12 hours.

Did it come on suddenly or gradually?

-Gradually.

-Gradually. It got worse. And is it in the front of your head?

-Both sides?

-MR MARTIN HICCUPS

I'm going to be sick.

-You feel sick, do you? Have you actually vomited at all?

-Yeah.

He had these, um...

HE RETCHES AND COUGHS

OK.

As a child, Mr Martin suffered from hydrocephalus -

a build-up of water on the brain.

To treat this, a shunt was inserted into his head to drain

the fluid down a tube and into his chest.

Is it getting worse?

MR MARTIN BURPS

Unsure what to do next, Jin asks senior doctor Jason for help.

He's got no visual disturbance, but he has got nausea

and he's just vomited quite a fair bit, like, purple foodie contents.

-He does have headaches occasionally.

-He's got a VP shunt.

-Yeah.

-OK.

He's going to need a CT scan then.

He's got a shunt.

OK, check the shunt series. What painkillers has he had? None?

He's had codeine, paracetamol, ibuprofen, co-codamol,

none of them's worked, according to them.

-What's his pain score?

-10.

-10.

-He's shivering in pain.

He can't lift his head.

-Put a cannula in, give him something a bit stronger.

-Yeah.

-Let me sort the CT out.

-So, bloods, cannula and...

-Bring him down this end as well.

-Yeah, yeah, sure. Major, yeah?

-Yeah.

I'm going to put a needle in your arm, and we're going to

give you some IV painkillers, and it will take the pain away, OK?

Before continuing the assessment,

Jin needs to give Mr Martin intravenous pain relief.

Sharp scratch.

Yet again, this involves cannulating.

-You OK?

-Yeah.

Think I may have hit a valve, actually.

Yeah.

Damn.

Sorry, sir. Try again. I think I hit a valve.

HE LAUGHS

Don't worry, I'm sure this is nothing compared to the

headache you're having.

Mr Martin hasn't suffered from hydrocephalus since he was a child.

Oh, dear.

I'm not having a very good day today.

If the shunt in his head has become disconnected,

the hydrocephalus could have returned.

MR MARTIN WINCES

Ah!

Sorry, sir. You OK?

Finally.

On the fourth attempt at cannulating, Jin is successful.

Mr Martin can now receive morphine to relieve his pain.

OK, sir, all done, all done.

I think they're just waiting for you.

If you hop onto that chair, sir.

A CT scan will determine if the shunt has become disconnected.

Don't think it's my day today for getting it!

It's like they don't want to go in.

I never have to have that many attempts usually.

I don't know what's going on.

With this guy, like, the other guy that I failed, er...

..I didn't feel as confident.

This guy I felt that I can get it, you know.

I don't know why I wasn't getting it the first time, cos I should have got that in,

but, hey, that's life, you know, you miss some, you get some.

HE LAUGHS

The results of the CT scan are back.

Skull X-ray. Obviously this tube is the shunt.

-And there's a disconnect here.

-That's quite obvious, yeah.

So, there. Probably there as well.

Other one's not quite as clear.

So, you need to get a Norse referral on the system to the QE.

Presumed new hydrocephalus,

and splitting of the shunt on the skull view.

So, there, there's the shunt again.

-You see the ventricles are significantly dilated.

-Significantly big, yeah.

Which is why he's got a headache and why he's vomiting.

He needs more painkillers as well, so give him some more morphine.

-All right?

-That's fine, yeah. Thank you.

Hydrocephalus.

It's hydrocephalus, so they have to have surgery or some

interventions to reconnect the shunt so that it's draining properly.

So, sort of the worst case scenario that could happen in this case.

The condition Mr Martin suffered from as a child has returned.

He'll now be transferred to a hospital 20 miles away

in Birmingham for surgery to repair the shunt.

I'm still a little pissed off about that cannula failure, to be honest.

Not the second patient, the first patient.

I'm not happy with Raul, just the way he walked in like a boss

and did it like it's a matter of fact thing, and I tried so hard.

Made me feel very small, that did.

Brilliant. Thank you, thank you.

It's the day of Joe's first ever triathlon.

I am so nervous.

It's just a horrible, like, waiting feeling, and I just...

I just want to get it done now.

Well, no, actually I don't want to do it. But, no, I do.

I think I just need to start and get it done.

Three, two, one.

HE BLOWS WHISTLE

It's very nice to be out here and not at work on a Sunday morning,

just exercising, happy people, outdoorsy people, it's good fun.

After 400 metres of swimming, Jo completes 20K on the bike...

Well done, guys. Well done.

..and finishes with a 5K run.

-MEGAPHONE:

-And we have another finisher coming in.

Really good job.

APPLAUSE

Well done, Jo Rooney.

Great effort.

Oh!

That was really good.

I've got the bug. I'm definitely going to do more now.

First one done. It hurt, but it was really fun.

I think I've earnt a pint, actually. Don't you?

Category position. 5 out of 23.

-Well done.

-Oh!

Oh, I came fifth, I was fifth lady?

-Yeah.

-Fifth lady!

Oh! I'm really happy!

-Well done.

-Thank you.

Oh, my God. I'm really happy.

Not very happy obviously.

He's just embarrassed me in front of everyone.

Sometimes, you know, you can take it too far, I think.

This is the biggest operation in gynae.

We're removing everything.

Not passing F1, I think I probably would have a moment of despair

where I would think, "Shall I just give up?"