Episode 7 Junior Doctors: Blood, Sweat and Tears

Seven junior doctors...

-Start CPR.

-Stop doing the drugs, please, and help here.

Open your eyes for me.

-Showtime.

-..on the front line of medicine.

It looks busy, man.

All the wards are bleeping me at the same time.

..with all its blood...

-We're removing everything.

-Second adrenaline.

I love screwing.

-..sweat...

-I think lots of doctors are competitive.

..and tears.

You're not going to die.

The doctors of your future...

I want to be the best junior doctor.

..facing life...

-Lion King moment.

-..and death.

He's tired. I think he just wants to go.

Have they got what it takes?

-Cheers.

-Cheers.

25-year-old Jin is about to start a nine-hour shift in the emergency

department at Wolverhampton's New Cross hospital.

I have to remark on the fabulous weather that is

far and in between and rare in the British culture, isn't it?

So we have to enjoy this bright weather, but unfortunately,

I am working. I hope it's a sunny A&E,

in the sense that everything will be smooth and chilled,

so let's go for it.

Jin is a second-year junior doctor.

However, he didn't always have that ambition.

I wanted to be an accountant, I wanted to do business.

At one point, I even wanted to be a Hollywood actor, believe it or not.

Obviously, I'm not good looking enough, but...

But all those things crossed my mind, but obviously,

you can tell that none of them was suited to me.

I won't be able to survive without coffee.

Why not?

Addiction, habit.

Compulsive behaviour.

-There you go.

-Thank you.

-No worries.

It looks busy, man.

I think that expression said it all.

On an average shift, Jin will see around ten patients.

How can I help you today?

One of those today is football fan Mr Fowler.

He's come in with a suspected abscess.

Is the abscess in the belly button, or...?

They don't know. They just said it was an abscess that burst.

Yeah, I can't see any abscess.

-No.

-What's coming out of the belly button?

Pus and blood is coming out of it.

I'm getting pain right across my stomach.

So, now, right now, would you say it's gone better?

No, it smells worse.

-How bad's the pain?

-It gets to about seven.

Is it sharp or dull?

-Sharp.

-No fever, no shakes?

-Yeah, I've been getting shakes.

-If you wait here, I'll be back,

-all right, so...

-OK, no problem.

As a junior member of the team,

Jin must check in with senior

colleagues to ensure he's making the right decisions.

The only thing that makes any difference in terms of morbidity

and mortality in somebody who is

septic is the speed at which they get antibiotics.

I couldn't see any visible abscess on the outside.

Neither can I. But that I don't find reassuring, that I find worrying.

But wouldn't he be really unwell?

But he's getting there.

The consultant is concerned Mr Fowler is at risk of sepsis,

a potentially fatal infection.

Jin urgently needs to give

medication and take a blood sample to rule this out.

We'll keep you updated. We'll give

you the antibiotic and we'll put you on a drip, sir.

We'll see what the blood test shows.

You might have to come into hospital.

But, let's take it a step at a time.

At the moment, we're treating him

like he's going to get really unwell.

You know, we're putting a line in,

we're giving him fluids, IV antibiotics.

I'm doing a whole range of bloods, we're going to call the surgeons.

You know, we're treating him like he's going to get really unwell.

But we will see how unwell he gets.

Junior doctor Osama is on his way to start his shift in obs and gynae.

# Look back and watch me smack that

# All on the floor

# Smack that Give me some more... #

Junior doctors have three placements a year.

This is Osama's last.

So, this afternoon there's about 15 operations going on.

I guess I want to be operating

all the time and I guess these kinds of lists

are perfect me to get my experience up.

26-year-old Osama was born in Iraq and moved to Britain in 2001.

Unfortunately, a big world event happened,

9/11, and my name was Osama.

I used to walk around school and everyone was chanting my name.

I thought, "Wow, gosh, I'm so popular in school."

I quite like my name, although it's quite unpopular name at the moment.

It's like being called Adolf during World War II.

Osama is over halfway into his placement on obs and gynae.

Although still only a first year junior doctor,

today he has the big responsibility of looking after a medical student,

23-year-old Simon.

It's the job I'm going to be starting, hopefully, in August,

so it's really good to get a good

insight and sort of following him

and his day-to-day jobs is really useful

to give me an insight into what

I'm hopefully going to be doing in the summer.

So, she's having a cystoscopy done.

Just a camera test, looking at the bladder.

Osama's first job is to meet patients having operations today.

He's asked Simon to lead a

consultation with a patient due to have a bladder procedure.

And do you know what you're having done today?

I've got problems with my bladder

from radiation damage after I had a lot

of radiation when I had cancer.

-OK.

-So they're going to try and sort it out today.

And do you take any regular medications at all?

-Omeprazole.

-And nothing else to thin the blood?

-No.

-Nothing for blood pressure?

-No.

-Or heart disease or anything like that?

-I've got a pacemaker.

-You've got a pacemaker.

And do you have any things you need to take that?

-No.

-What's the pacemaker for?

Sometimes, my heart will stop when I was asleep, but start again.

But not quickly enough, so if I got up...

-I've got you, yeah.

-..I just pass out.

-OK. Perfect.

I mean, not so perfect for you, but, yeah, I guess.

-Thank you.

-Thank you very much.

-OK, thanks.

-Bye.

-Smashed it.

-Pretty much.

Yeah, no, no, you actually asked all the questions.

You did everything correct. And your patient manners were really good,

which I really like. Like, I love admiring patient manner.

I'm learning a few things from you, you know?

As well as medical supervision,

Osama is also expanding Simon's vocabulary.

Simon, you've smashed it so far.

-Yeah.

-So far, so good.

-No flopping.

-So I like "smashed it."

He was like, "nailed it," as well.

I like how he calls everyone bro.

Including the nurses.

I think that, you know... Really good.

In the emergency department,

Jin is still ruling out

life-threatening sepsis for Mr Fowler,

who has a suspected abscess.

I wish I could make the core decision myself, but I don't have...

Unfortunately I'm too junior for that.

I don't have the relevant experience or knowledge to do that.

I want to be the best, though, the best.

I want to be the best junior doctor.

His condition hasn't deteriorated,

so Jin now needs to consult the on-call surgeon about the next step.

Discharge is coming out of the belly button.

Yellow and foul-smelling discharge.

He's not unwell in himself, is he?

He is uncomfortable. Just sharp umbilical pain.

Seven out of ten severity.

If it's not a proper abscess, there is nothing we can offer,

because it is not a surgical problem.

Just a course of antibiotics will be more than enough.

The patient's blood tests are back and it's good news.

Let's see. That's fine, that's fine, that's fine, that's fine.

He looks... OK.

I've spoken to the surgeon and he doesn't need to be admitted.

Hi, sir. I've spoken to the surgeon,

and they feel that you don't need to be admitted.

We've measured your blood, blood culture, you know,

we've looked at your observations.

I've had a word with the general surgeon and they feel that you don't

-need to be in hospital.

-OK, so what is it, do they know?

It could just be, you know, a superficial infection,

not necessarily an internal abscess.

If it's an internal abscess, you would be very, very unwell,

so we're happy to discharge you.

On the respiratory ward, Anna is starting her shift.

I was a very squeamish child and would cry at the sight of vomit and

sometimes vomit myself.

I remember being on a bus once and the person in front of me

was feeling sick and I remember I came out in these shivers.

It has kind of been such an extreme change now to being a doctor where

I'm sometimes vomited on.

I don't know what's happened.

I've kind of become desensitised to it over the years.

With ten applicants for every place at medical school,

she's come a long way to be a doctor.

I feel really nervous.

But she didn't have an easy start on her placement

nearly two months ago.

Oh, gosh. It's got a cover on it, so we're fine.

I feel a bit like a spare part at the moment.

-Ow.

-I'm not really sure what I'm meant to be doing.

-Whoa.

-I did have a moment today

where it felt like everyone was dying.

In my head, I'm just panicking

and not actually thinking about the answer.

I don't think I've made the right decision here, and hate it.

It's an important day for Anna.

She's having her final assessment.

If she doesn't pass, she'll have to repeat the whole year.

Being a doctor is competitive and I think medicine,

kind of the competitive personality fits medicine very well.

I think lots of doctors are competitive.

I'm not competitive at all.

You know, I just like to get along with everyone and have a nice time.

Not passing F1, I don't know.

I think I probably would have a moment of despair

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

But, fingers crossed, I pass.

Jin has been working long hours for several weeks in the emergency department.

It's now seven hours into his shift and a patient has been

brought in who's overdosed on antidepressants and painkillers.

28 mirtazapine.

Approximately 20 co-codamol.

How many Naproxen? What's his GCS?

Examining motor, verbal and eye response,

Jin needs to rate the patient's

level of consciousness on what's known as

the Glasgow Coma Scale.

Jin must be accurate with his GCS score

so the team can monitor whether

the patient is deteriorating.

So next time I'll do that if I can't wake up a patient?

Dr Qureshi has some questions about his assessment.

How did you rate?

So, motor, verbal and pain.

Motor, verbal and pain?

-Is it pain?

-Which medical school did you go to?

No, motor, verbal, and what was the last one?

-Sorry, I'm just really tired.

-Do you want me to leave you alone now?

-Kind of.

-Have you had enough?

-Kind of, yeah.

-OK.

When are you in next?

-Tomorrow.

-OK.

Well, on Monday... Are you here on Monday?

-No.

-Are you in on Tuesday?

-Yeah.

-OK, on Tuesday, I want...

I will ask you the Glasgow Coma Scale,

the competence and how you measure it.

And if you don't know it by then, I'll tell your supervisor.

OK.

Not very happy, obviously.

I know she's just joking,

but she's just embarrassed me in front of everyone.

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

How would you feel?

How would you feel if you were embarrassed like that in front of everyone?

They're not kids. They are doctors.

We're all adults, we're all

professionals and it was not really a telling off, but it was

trying to make Jin realise the importance of basic principles of

assessment in an acutely unwell patient, and essentially that is the

essence of his job in emergency medicine.

And if he's not able to do that,

then I think it's a failure on our part,

as well, as consultants,

that we are not giving him that proper teaching and training.

You cannot work in an emergency department and not know what

a Glasgow Coma Scale is and its components are.

Just had a long day and I just, for some reason,

my mind just switched off.

I guess it was the pressure.

Everyone was watching me and it's just...

My mind went blank.

With an hour until they're due in surgery,

Osama and Simon are focused on fuelling up for the job.

But, first, Osama must smuggle Simon into a secret part of the hospital.

So, you can't tell anyone about this.

So, this is for junior doctors.

I guess Simon's going to be a junior doctor very soon,

so I guess he is kind of, but don't tell anyone.

So, you go by the name of Barry and you're a senior registrar.

Oh, Emeka's here.

How are you doing?

So, bananas, potassium.

And then obviously some vitamins. And tuna.

This is the secret for any surgeon.

They need a lot of protein.

I lived off this stuff for six years in med school.

It just reminds me of med school.

So, hopefully, I'll be able to recapture the knowledge from med school,

as well, when I'm in theatre.

This is why I can eat this. You fancy playing some football?

Let's go for it, man.

The competitive world of junior doctors

even extends to table football.

How do you win this game?

I think you have to score more goals than your opponent.

You think so?

I think that's a goal to me, bro.

Is it? Oh.

The thing is, every time I get a goal,

you automatically get two participation points.

-OK.

-Two more participation points.

Two more participation points.

I remember you telling me like today is a big day in theatre.

Yeah. I'm taking my student, Simon, with me.

-OK.

-He wants to be a surgeon. He's really good.

-Oh, really?

So he's really keen to be in theatre, so I'm taking him with me.

So I guess I want to show him what it's like.

To be fair, it sounds like you're a pretty dope mentor.

Oh, thank you, bro.

-If I were Simon, I'd feel lucky to have you.

-Aw.

Bro, I'm blushing.

Oh, there you go, bro. I need to go.

I smashed it.

Jin's confidence has taken a knock this week.

So, off shift, he's meeting up with senior colleague

and friend, Raul, to get some advice.

-Oh, man.

-So, how's it going?

Yeah, I had a run-in with Dr Qureshi.

-Oh, yeah.

-She's grilled me about the Glasgow Coma Scale.

-Oh, yeah?

-And...

Oh, yeah. I heard about this.

You heard about it? A little bird told you, yeah?

A little bird being the whole of the A&E.

It's a little fishbowl, man.

Whatever you do, everyone knows about it the next day, man.

-Yeah.

-No, that's all right.

It was the end of a nine, ten-hour shift.

-Yeah.

-I was wrecked. My mind went blank.

-Yeah, yeah, yeah.

-The pressure of everyone looking at me and...

I think, with that kind of stuff, you know it.

If I were to ask you about it now, you'd be able to tell me.

Yeah, definitely, definitely.

But, when you're so tired, you can barely think.

I was quite similar.

There would have been days where I did everything right and I'm

like... Your level of confidence grows. And then, because of that,

you come across more stuff and you think you can do it yourself.

Yeah, I've had that.

Exactly. Some are like, "Yeah, I'm on this one."

I'm one of the most confident F2s in A&E, right?

-Yeah.

-And on another day, it comes crashing.

Exactly. And you miss something huge.

And you're like, "Oh, I can't believe I missed that."

-That's true.

-And then, all of a sudden,

"Yeah, it was a good thing." I know it's not the nicest thing,

being criticised in front of staff.

-I find it difficult...

-Why's that?

-I'm a bit of a perfectionist.

You're going to make mistakes.

Sometimes, I'm like, "Yeah, I can boss this."

But, when I'm feeling out of depth,

I'm not afraid to ask for help.

Anna's on her way to meet her supervisor, Dr Bateman,

for her final assessment.

He decides whether she's done enough

to become a second year junior doctor.

When we see young doctors just finished medical school,

and they come onto the wards and it's a completely different field.

They don't have feedback in the same

way that they do in medical school

in terms of how they're performing and, you know,

you do see students sink or swim.

Hello.

So just to catch up with you again

and this is the final validation from your foundation programme,

so it's really nice to see in the last two months in

respiratory you've had very positive feedback from your clinician,

Dr Carter.

And running through your checklist,

you've basically completed all the requirements.

You've had positive comments from your practical procedures,

your clinical work, and from the rest of the team in respiratory,

which is really helpful.

Any comments about... Obviously, you're two months into respiratory.

Any comments, anything else you'd like to raise?

I think I can be quite shy, sometimes.

I think I do need to push myself to,

I don't know, kind of get stuck in.

Yeah, I think so. And I think one of the most important things is,

essentially, there's a huge range of evidence,

we've been saying with the other trainees,

and you've shown good engagement with all these things,

so we're quite happy that you've done all the things that you were

-required to do.

-Oh, good.

It's been a pleasure. I think you've done really well.

I've seen a change in Anna in the

-sense that I think Anna is probably more confident now.

-Thank you.

A lot of the doctors have fed back on her compassion and her

professionalism. I think she's recognising herself

she's doing a good job and that she's good at what she's doing.

Being competitive doesn't

necessarily mean you're the best doctor for your patient.

What patients need is, you know,

a doctor who cares and a doctor that's going to work hard for them.

Have you already seen the patients in DCU?

In obs and gynae,

Osama and Simon are about to assist Mr Saeed on a major procedure.

A full hysterectomy.

Literally, we're inducing this lady into menopause.

We're removing everything.

We're removing the uterus, removing the ovaries,

removing the fallopian tubes.

We're removing everything.

So, yeah, this is the biggest operation in gynae.

Osama has back-to-back operations,

but on general surgery, Emeka is having a slow day.

I'm looking all right today, you know.

Oh, wait, who's this?

I don't understand how he's got enough time to do this stuff.

I guess, sometimes, you have days where there's not much going on.

So I'll probably send a reply to him at the end of the day,

after the big operations.

There are three applicants for every surgical traineeship.

As a junior, you're always trying to

compete with other juniors to try and get into theatre.

So, for example, the registrar will try to get into theatre.

The senior house officer will try to get into theatre.

The F1s will try to get into theatre,

so you're always trying to compete to try to get into theatre.

Mr Saeed is giving Osama more surgical responsibility,

which will help him stand out from his peers for a traineeship.

Mr Saeed is kindly going to step out of this one and let the registrar

do most of the operation

and therefore I'll be stepping up to do what the registrar's role is.

And then the medical student,

who is becoming a doctor soon, will be doing my role.

Getting experience like this is

literally like a once-in-a-lifetime kind

of thing, to become a surgeon,

so you need this kind of experience.

The team will remove the womb, uterus,

fallopian tubes and part of the cervix.

You'll be helping soon.

So this is the womb here, look.

This is the bladder here in front.

-OK.

-The cervix was here, so we push this all the way down.

This is the top of the vagina.

Oh, my word, it's such a long cervix.

Osama has the responsibility of suturing the wound.

It's was a really good experience.

You can just see the anatomy really well.

Did you see, like, the ovaries, uterus, fallopian tubes...?

Yeah, it all came out.

It was good.

Osama smashed it. So, all good.

It went well. Yeah, there were some really nice anatomy in there so

it's a really good learning experience, as well, for me.

If you want to be a good surgeon, you need to get as much theatre

experience as possible, so you have to sacrifice some time.

Simon, he's only a medical student, but he's already sacrificing, like,

coming in extra to do this.

Like, other medical students are literally at home right now.

All your colleagues are, like, chilling at home.

Yeah. Exactly, they are at home.

That's what you have to do to become a good surgeon.

Now Osama's finished his shift,

he can finally get to the important business of replying to Emeka's

earlier text.

He's taken about 20 selfies,

which is kind of the usual number for him per day.

But, wow.

Oh, this is cute, look.

Wish you were here.

I'm only just starting the selfie game, so, I don't know,

I don't think I'll be able to hack it, but I'll try and challenge him.

Emeka has smashed this.

I need to learn from him. I'm like his apprentice, essentially.

Hopefully, one day, I'll be at his level.

Successful day over,

Anna heads home to celebrate her

huge achievement with boyfriend Fraser.

Look, we've got a tiny prosecco to celebrate.

Yay! Tiny prosecco.

-Well, it is a weeknight.

-Yeah.

-How did the meeting go?

-He was really nice, my supervisor.

He said that he could see I'd got

-more confident and that he thought I was a good doctor.

-Wow.

Yeah, it was really nice.

And he said I was in the top third.

-Top third?

-Yeah. Bossed it, man.

Bossed it. Well done.

Whoo.

Jin is coming to the end of working a week of late shifts.

Do you want to know the reason why I love tuna so much?

It's because I'm really good on the drums and I can play a TUNE-a.

He's been called to assess a patient with a persistent nosebleed.

How can I help you today?

-Nosebleed.

-Nosebleed, yes.

Both nose, or one nostril?

-One nose.

-Continuous?

-Continuous.

-No other symptoms?

No.

With the help of ENT doctor Oommen, Jin cauterises the septum,

the cartilage that divides the nose.

Cheers, mate, thanks.

He did the cauterising very well.

Achieved the right result.

So we're just going to use the cream

and send the patient home.

-All right?

-Yeah, thank you.

-No worries.

This is exactly what they mean when you say junior doctors learn on the job.

Now that I've seen one, I should be able to do it by myself.

There's different ways of learning on the job.

You can be grilled by a consultant, which isn't particularly nice.

Handsome henchman, dealing with a patient.

There's learning from patients themselves.

Yeah, it's all sort of collaborative.

They come together to give you an experience, really.

After struggling to recall

the Glasgow Coma Scale on a previous shift with Dr Qureshi,

Jin has done some important revision.

Hello, Jin, how are you?

Hi, Doctor Qureshi.

I'm very well, thank you.

-Are you OK?

-Yes.

-What did we learn, then?

So, in terms of...

It's E4, M6 and V5.

-OK.

-E4 would be opening eyes simultaneously,

or opening eyes to voice or opening eyes to pain or not opening eyes at all.

-OK.

-Motor would be obeys commands or localises the pain,

or withdraws from the pain,

flexes to the pain, extends to the pain, or doesn't respond at all.

-OK.

-And voice would be fully alert, or disorientated or confused,

or uttering inappropriate words,

or uttering complete incomprehensive sounds.

So why do you think it is so important?

So, it's important to assess GCS because you need to see the level of

impairment consciously,

which would guide future management neurologically.

I hope you didn't feel I was very harsh?

At the time I did, but... I sort of knew I had to do it,

but I didn't know it inside out, bang, bang, bang.

But now I do, so it's definitely

been beneficial to me in the long-term.

-Right.

-I feel like a real doctor.

-You feel like a real doctor?

No, I'm not saying that I didn't before, but, like...

Oh, God. You know what I'm saying.

I didn't mean it in that way.

Retrospectively, it has actually improved me as a doctor.

Because you've had this viral pleurisy for three weeks,

it's going to put a lot of strain on your muscle.

Particularly the muscle lining of

your rib cage and the lungs because it's

getting irritated by all the cough.

Before, I was OK, but it's

definitely developed me in that regard.

And it has been a painful learning experience, but one, no doubt,

that's made me a better doctor.

It's nearing the end of Jin's shift

when Dr Qureshi comes to say goodbye.

She's leaving the department.

See you, Dr Qureshi.

In the short time we've known each other.

The short time we have known each other.

Yes. It's been a pleasure.

Yeah, if I end up going to Preston, is it?

I have friends in Preston, so...

-You come and see me, yeah.

-They might be working there, actually.

You might bump into them.

What are you going to tell them, not to see this doctor?

-Stay away from her?

-I'll warn them about you.

I will give them a heads up on the WhatsApp.

Best of luck. I'm sure you'll be fine.

-Yeah, thank you, thank you.

-All right.

-Genuinely, thank you.

-Best of luck with everything.

-Thank you very much.

-OK.

I quite like having a student with me.

It's kind of a sense of power.

What mistakes have you made?

As soon as I got news of it, I was like, "Oh, man,

"I need to go, like, counsel you."

I feel a bit naked.

I love screwing.

Here's to the future.

-Cheers.

-Cheers.