Episode 8 Junior Doctors: Blood, Sweat and Tears

Seven junior doctors...

Start CPR.

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

Open your eyes for me?

Showtime.

..on the front line of medicine.

Looks busy, man.

All the wards are bleeping me at the same time.

With all its blood,...

We're removing everything.

We'll go in a second with 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...

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

..and death.

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

Have they got what it takes?

At New Cross Hospital in Wolverhampton,

the junior doctors are nearing the end of their placements.

After nine weeks on the wards,

the doctors are going to find out

if they've done enough to pass the year.

It'd be devastating if I found out that, after all that,

I wasn't going to progress.

And they all have big decisions to make about their future careers.

It'd be quite nice to know

what I'm doing, like, where I'm headed.

Get pumped, get psyched.

Get ready for the day.

First-year junior doctor Emeka

is preparing for an end of year assessments

with his clinical supervisor.

Today's the big day. So I need to dress accordingly.

Yeah, yeah, I'm a little bit nervous.

Today, Emeka will find out

if he's done enough to go into the next year.

Having that, mentally, that you've failed,

yeah, it can't happen for me. Not born to fail.

26-year-old Emeka comes from a long line of doctors.

When people knew I wanted to be a doctor, from a really young age,

I think their response was,

"He wants to be like his father, but he doesn't have the ability."

I could see the doubt in people's faces,

I could see the doubt in people's voices

and all it did was push me harder.

He's well-known around the hospital

for taking pride in his appearance.

Do you think there's a good level on top?

-Yeah.

-That's all right. We can keep that.

I think looking good equates to feeling good -

if I look good, I feel good, and if I feel good, I'm great,

like that's fine with me.

But in the surgical department,

Emeka's outfit choices have sometimes been called into question.

Baby blue is just not really my thing, so I...

But if you have to going into theatre to help,

you have to wear these.

I'm hoping I can wear a couple of aprons and dodge all that.

Emeka is putting the finishing touches to today's outfits,

perfecting the right look can be harder than it seems.

Come on, buddy.

Come on, I got you.

You know what...

I've been working out. My neck's getting a little bit thicker.

Getting a little thick for these shirts.

Just as easy as that.

Breathing's overrated, anyway. As long as you look good.

That's what I'm talking about.

27-year-old Jo is nearing the end of her time in trauma and orthopaedics.

Today, she's in theatre assisting one of her favourite surgeons,

Ms Mahroof, with a wrist fracture.

So how old is this injury? Is it...

Just under two weeks.

It's great to be working with Ms Mahroof again.

I would definitely like to impress her.

At this stage of her training,

Joe needs to decide where her career goes next.

I want to go travelling

and there's various things I want to achieve in my career.

I'd be scared of just doing nothing and wasting my life or experiences.

At New Cross, Jo has worked in both the emergency department and surgery.

She's now trying to decide which to specialise in.

I love surgery, but I have really,

really enjoyed my job in A&E,

so I'm a bit torn.

Today's surgery is Jo's most complex so far,

helping to fix Mrs Price's wrist.

The operation starts with cutting open the wrist.

Let's just open this up a bit more.

Ms Mahroof then prepares the fractured area for a metal plate.

Let's get the plate, please.

Once the plate is in, Jo gets the chance to fix in the screws.

I love screwing.

I like it in DIY, as well.

Hold on two secs. Just could go a little bit...

So it's locking into the plate and that's an important element of it.

Can you see that?

There you go. Well done, Jo.

Next, Jo carefully drills holes into the patient's bone.

Any mistakes could cause permanent damage to the patient's arm.

-I can't feel anything so I don't want to go.

-No, don't.

Having successfully fixed the fracture,

Jo has one last chance to impress Ms Mahroof

with her suturing skills.

That's it, well done.

The skin's a lot, kind of, looser isn't it?

Use your assistants and don't pinch.

-That's it.

-I want it to be perfect.

That will come with time.

Jo did very well, she improved from her first suturing that she did.

You could see she was getting more confident as she went along,

which was pleasing. She does what she's told.

That's important.

I think Ms Mahroof did kind of notice I was a little more relaxed.

I was really pleased with the end result. So...

Just getting the computer ready for the ward rounds.

On the surgical ward, Emeka has a plan to impress Mr Curran.

Yeah, I'm trying to be that, you know that student at school

who does everything extra and the whole class looks at him, like,

"You're such a suck-up." I want to be that suck-up.

He's determined to make a good impression because today,

Mr Curran will decide whether Emeka passes into his second year.

These are her bloods, those are her vitals.

I'm about making Mr Curran's life easier,

so he'll make my meeting easier.

I was actually holding the door for just Mr Curran,

but everyone seemed to walk through!

So I was like, "OK, all right, you guys are good as well."

Mr Curran, are we still good for three o'clock?

I hope so, I'll let you know if there's a problem.

All right, cheers.

Emeka is getting on with his jobs for the day

when he's interrupted by a consultant.

It's not acceptable.

-Take it off?

-It's an infection control, take it off.

The consultant has asked Emeka to remove his tie.

I feel confused.

Because I've had this tie for a while now

and she hasn't said anything about it.

Although he's been wearing a tie clip,

it's not been in the right position to meet the hospital's rules.

Sorry? Yeah, but why? Why now?

It's not part of the uniform policy...

What's the uniform policy?

Because in case of emergency, right, cardiac event,

if you go and, say, you are doing CPR and your tie there,

it's just going to pull you down.

-It can't, if it's clipped.

-And then if you've got a massive wound,

you're tie's going to go in.

But it's clipped, that's the point,

and I worked on two wards, prior to this.

I've been on the job for nine months.

Yeah, but she doesn't care, it doesn't matter.

-Why?

-This is surgery.

Feels a bit unnecessary.

Just like that.

Seven weeks in the job, in the middle of the day,

in the middle of the ward,

it's a bit...

It is what it is. It is what it is.

Whatever.

With the day's surgery over,

Jo gets a chance to share her plans for the future with Ms Mahroof.

You said you might not want to do orthopaedics, or A&E.

Have you decided?

The problem was I really enjoyed A&E, so I was getting a bit kind of

like, oh, God, now what do I... What do I want to do?

And I realised that it was always surgery,

I've missed being in theatre. It's just such an...

You kind of feel like you're home when you walk in, don't you?

What are you doing now, what's your plans?

So, I'm moving to Australia.

I've never worked in medicine, outside of the NHS,

so it will be really interesting to see how they do it there.

You might find things are no better anywhere else than they are here,

but I think it's important that you go and find out for yourself, really.

-Whether the grass is actually greener, or not?

-Yeah.

And it may not be greener, but...

-Different.

-But, saying that you gain so much by going abroad.

You actually bring stuff back to the NHS, as well, which is fantastic.

So I wouldn't ever discourage anybody

-from going abroad but, you know, come back.

-Come back to New Cross.

-Fabulous.

-You're never going to get rid of me.

Absolutely. We don't want to.

I'm just really pleased that Jo has decided, as a woman,

she would like to do trauma and orthopaedics

cos a lot of young ladies ARE put off by the fact

they think there's going to be

a terrible lifestyle, that they can't manage

drills and screws and it's too onerous,

but it's nothing like that and where there's a will, there's a way.

I'm coming to the end of something. This was my foundation training

and I'm not the baby any more and you've got responsibilities

and you're supposed to like know what you're doing, be good.

So it's a strange feeling.

I think I'm ready for it.

Anna is coming to the end of her first year

as a junior doctor.

Today, she will be in charge of a medical student.

I'll have my own minion.

I don't think I'll be bossy, though.

I can't believe it's been a year since I was in this position

and really scared of starting in hospital

and now I'm actually here teaching a medical student.

At the start of her placement, Anna struggled to find her feet.

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

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

Even straightforward procedures were a challenge.

I'm going to see if one of my senior doctors can try.

Now, a more confident Anna is on the respiratory ward

with medical student Unat.

Do you want to get his scan?

Do you want to prescribe this?

-I'll have a go.

-OK.

I don't think you realise, kind of, day-to-day,

until you see someone that is where you were a year ago

and realise, "OK, maybe I have learned something."

Anna's next job is to show Unat how to do an arterial blood gas,

a delicate procedure which isn't easy.

I actually didn't do one as a medical student,

cos I was too scared to do one.

This is Unat. I'm just going to be teaching him how to do it.

Just have to make sure that you expel all the air, first of all.

Just a sharp scratch.

Anna has to take blood straight from the patient's artery

to check her oxygen and carbon dioxide levels.

Let me know if you want me to stop at all.

To minimise the pain to the patient,

Anna needs to act quickly and with precision.

Sometimes just try and draw back, as well.

Even if you haven't got a flashback, sometimes, it...

-Yeah.

-..can get something.

Yes. There we go. Done it.

-I knew we'd get there in the end.

-Yeah.

Thanks for that. I think ABGs are quite difficult

when you first start.

It's really easy just to, kind of, get discouraged

and give up, but just keep trying.

That was so me this time last year,

nervous and slow and, kind of, not sure what to do.

Just made me realise I think how much I've come on in the last year.

Thanks for today, anyway. It's good to have some extra help!

-Thanks, guys.

-See you.

During their lunchtime break,

Emeka has arranged to meet his best friend Osama.

-Hey! What's up? How are you doing?

-Yeah. Good, man.

-How are you doing?

-Not too bad.

What's up? Oh, how was your meeting?

I haven't had it yet.

But what happened to the tie?

-Bro...

-What?

-Bro...

As soon as I got news of your tie situation I was, like,

"Oh, man I need to go counsel you."

I know it's a big deal for you, man.

I think I need to be there for you.

I appreciate that.

I was literally just on the ward.

And Miss E spotted me and she was just, like, "No ties."

-That's terrible.

-Right in the middle of the ward,

I just had to rip the bad boy off.

Oh, man, I'm really sorry to hear. That's terrible news for you, man.

I know, feel a bit naked, a little empty.

I can't remember the last time I wore a shirt at work without a tie.

-The tie was you.

-I know, and I was the tie.

Bro, how do you feel about your meeting, then?

I'm hoping it's still, still goes down.

Has Mr Curran got wind of your tie news?

I'm sure somebody's told him what happened.

Oh, do you think you'll go down in his eyes after the tie situation?

I don't know. I have no idea what's going to happen.

After lunch, Emeka manages to track down Mr Curran in surgery.

Hi, Mr Curran. How's it going?

Afternoon. Apologies.

I've a patient on the operating table,

it's going to be a couple of hours.

-OK.

-So I think your final assessment will have to wait.

OK, all right. Well, thanks for letting me know.

-See you next week.

-All right, thank you.

Meeting postponed,

Emeka will have to wait to find out if he's passed his year.

I guess it gives me the weekend to, you know, get my head together,

find out what I'm going to wear, cos obviously I was thrown off by today.

Junior doctor Jess is on her way to a night shift at New Cross hospital.

Night shift work definitely carries more responsibility,

as compared to day-to-day routine work.

People say I make medicine look quite easy.

I'm like, "It's not easy, medicine's not easy at all."

25-year-old Jess is nearing the end of her second year.

I wouldn't describe myself as bossy, so to be the boss,

it's almost like stepping out from my comfort zone.

During her time in haematology,

Jess has had to manage some serious medical emergencies.

OK, how bad is the pain?

This is very difficult,

especially when you just walk in.

I feel like, when you're in that situation, you just handle it.

Does get easier with time, but to some extent, I now realise

how much more can go wrong.

As Jess's shift starts, she receives an urgent bleep.

So I need to go to the ward urgently,

because there is a lady with a really fast heart rate.

At the same time, other wards are bleeping me, as well.

Hello. Hi, sister.

-Where is she?

-Yeah. She's inside room two.

OK, cool. Good evening, my name's Jess, I'm the doctor here.

-How are you feeling?

-Not too good.

Not too good. OK. Do you mind if I listen to your chest?

Thank you.

Lillian has come in complaining of heart palpitations

and pain in her chest.

Sorry, Lillian, I'm just going to step outside.

Jess is concerned that the patient's heart rate is still very high.

She calls her medical registrar for some urgent advice.

Her heart rate's 160.

We've tried some vagal manoeuvres, tried blowing into a syringe.

That has not seemed to settle it down.

What shall we do next, in terms of direct treatment?

OK. I've read about it, I've not given it before, no.

The consultant has recommended a drug called Adenosine

to regulate the patient's heart rate.

So I've never administered Adenosine before and, basically,

it blocks the conduction of, like, the electrical waves in the heart.

So, essentially, you kind of stop the heart for a few seconds.

Dr Mirayala has arrived to help Jess administer the drug.

Feel a strange feeling, but it will pass on soon.

OK.

Jess injects the drug into Lillian's vein.

It's a tense moment as they wait for the heart to restart.

You're all right.

-OK.

-Oh! Mmm.

OK. You should start feeling a little bit better in a minute.

Lillian's heart has started again and is now beating at a normal rate.

Has that feeling gone a bit?

-It's gone.

-It's a horrible feeling, that Adenosine.

On a positive note, it has done what it should do.

It has slowed you down.

Thank you ever so much, thank you.

No, no, no.

It was definitely quite scary.

It was a good experience to do it.

Yeah. And make my patient get better very quickly, as well.

So, I think the outcome was...

Yeah, it was...

Everything turned out well, which is like, phew.

Thank you.

Bye.

I think, being in an emergency situation,

being the only doctor on the ward,

you do feel that sort of pressure and you do feel that responsibility,

as well. But, you know, you do grow into that role.

Finally, Emeka meets Mr Curran for his end-of-year assessment.

Because the meeting has been postponed,

it's kind of made the anticipation even greater.

It's a bit like more hyped up.

Hyped up now. This is making me a little bit more nervous.

-Come in.

-I've been praying that it all goes well.

So, you've been here on this firm for about two months now.

How have you got on?

I've enjoyed it, I really enjoyed surgery.

I enjoyed the team.

What mistakes have you made?

Mistakes...

I don't have any glaringly obvious mistakes I've made.

We all make mistakes, be honest.

I think...

What happened on the ward on Friday?

I hear one of the consultants had a word with you.

Miss Algoda had a word with me about wearing my tie, but, yes...

Not sticking to the dress code is a mistake.

Yes. So I assumed I was following the policy of the dress code.

You're allowed to wear a tie, but it needs to be tucked in.

-Especially because I don't...

-And how did you react when she discussed

-your tie with you?

-When she, obviously, told me to take it off,

I was a little bit surprised.

To my knowledge, I thought she'd seen it with me on

throughout my placement.

Our impression is that you know your book work very well, yes.

-Thank you, yeah.

-What you haven't got is experience.

You can't have experience at this stage of your career.

And you need to listen to people who give you advice, more senior people.

-Yeah.

-OK?

Not always receptive to getting advice, I'm told.

I guess... I guess that's personal opinion.

I'd like to think I'm receptive in getting advice.

It's not a personal opinion, it's a general opinion.

Personally, I don't think I have any issue,

in terms of taking advice from others.

Have you got what it takes to get on in surgery?

Have you got the commitment and the drive?

I believe I have what it takes to go forward.

If that was definitely the career...

You've certainly improved during your time here.

We felt you were a little bit laid-back when you started.

So, our overall assessment.

I have to decide whether we have no concerns about you,

some concerns about you, or major concerns about you.

As far as I'm concerned,

I'm happy for you to proceed on to the next stage of your training.

OK, perfect. That's great.

So enjoy your remaining weeks.

Into theatre, into clinic.

Yeah. I'll make sure I get into theatre and clinic.

-And careful how you talk to people on the ward.

-Yeah. I'll...

-..watch my mouth.

-Thank you very much, Mr Curran.

It wasn't quite as smooth as silk as I wanted, but it was like...

It was like peanut butter,

but crunchy peanut butter with the bits in it.

Smooth, but a little bit rocky. The main thing is he signed me off.

If he didn't, I probably wouldn't be joking about it.

So, it was good.

Emeka is back on night shift in the surgical ward.

One of his patients, 84-year-old Dennis,

has severe infection in his gall bladder.

Are you in any pain at all?

-No pain.

-No, just feeling a bit...

Feeling a bit exhausted?

Emeka is concerned because Dennis's BP is dropping.

I'm just going to keep a close eye on you, OK?

-Yeah.

-All right?

This could be a sign he's in septic shock, a life-threatening condition.

I am worried about Dennis.

He's quite a frail old man.

You do feel for these patients and what they're going through.

The best thing is to be as caring as you can

because you think, if this was my grandfather,

I'd want people there caring for him.

Emeka decides to give Dennis some fluids to help stabilise him.

One, two, three.

Is that a bit better? Much better.

But, even after the fluids, Dennis's BP is still too low.

Emeka decides it's time to call for some help from the registrar,

Dr Mumtaz.

-Where is he, is he there?

-Yes.

My name is Dr Mumtaz. I'm the registrar on call tonight.

-Yeah.

-How are you doing?

-I'm shattered.

-Do you mind if I listen to your chest?

Go ahead.

Thank you. Sorry, sir, sorry.

Just breathe in and out.

-I've got you.

-OK.

Breathe in.

Lie back.

Dennis, can I be honest with you?

I'm a bit worried about you.

Mm-hm.

You've got an infection in your gall bladder,

for which you are on antibiotics.

They can't do anything with the gall bladder because of your weak heart.

We're trying to get on top of the infection,

but things seem to be quite tricky at the minute.

Anything happens, press it, OK?

It's the heart which is giving way for him, unfortunately.

Do I call ITU, see if like, level two type...?

-The way he's talking, he doesn't want to be touched with tubes.

-Yeah.

We've discussed it with him.

He said he wouldn't want CPR, or to be intubated.

I think he, kind of... He's tired and he just...wants to go.

If he gets worse, that will probably be it for him.

We need to tell the family this is what's happening.

Dennis will now remain on the ward and be kept comfortable.

When I first came into this career,

I thought I'd be able to save everyone.

It was a bit of naivete, really, but...

You kind of get hit hard with the fact that you won't and you can't.

I think Emeka did really well.

He was faced with a difficult situation.

When things were getting out of control, he called me appropriately.

So I think he did really well.

I think he's going to be a really good doctor.

Tonight is a special occasion for the junior doctors.

They're all getting together to celebrate their successes.

Oh, wow. This looks great.

Wow!

Oh!

-Oh.

-Oh, my God, it's so hot in here!

Wow! We thought it was hot enough with the candles.

You do scrub up well.

Cheers.

Yeah. Yeah. I get it. Yeah.

-Cheers.

-Cheers.

Cheers!

-We never get to do stuff like this. It's lovely.

-It's great.

Yeah, yeah, I'm going to miss you guys.

Oh, don't say that!

We could have our own hospital, guys. Come on.

I would love you to be my doctor.

-Thank you.

-So where are you going to be a GP?

-I'll move there.

-Yeah, GP.

Well, I would definitely have Jo working on my bones.

Thanks.

-Gosh, yes.

-Guys, I'm not doing gynaecology.

If I could choose the first face my baby saw

when it entered this world,

you have fabulous eyebrows.

I would want my baby to see that.

I feel like my baby should know what real eyebrows look like!

Oh, thank you. Guys!

So, who's learned something this rotation?

I learned about, like, decorum in the workplace

and, like, how to behave with and around the seniors.

I think I've seen a change, so that's good.

-How about you?

-I think there were two types of constructive criticism.

One was like when they're gentle about it

and they break it to you in a nice, soft way,

but then other consultants are a bit more direct.

At that moment, you don't like that person,

but afterwards, you're thankful, because you're like,

"Actually, yeah, I've learnt the most from you."

What's painful is that those are the experiences where you learn the most

and that is engraved in your head.

Tell us about Life.

Life is the best.

Yeah. Little babies are just so cute.

So much effort goes into bringing a child into the world.

I thought it was easy. I didn't know before this.

Excuse me.

I'm very glad you have learned this before you have become a father.

-Yes.

-I thought childbirth, right...

-Yes, come on, it just falls out.

We just sneeze and we've just given birth.

Well, congratulations, guys.

Everybody survived.

We've learned lots, we've made friends and here's to the future.

-Cheers!

-To the future.

-Cheers!

The junior doctors round off the night

with some serious moves on the dance floor in Birmingham.