Pennod 5 Doctoriaid Yfory

-*

-Our cameras have followed students

-from Cardiff University.

-You see things you wouldn't normally

-see. You have to grow up quickly.

-15 individuals on an unique course.

-We get the creme de la creme.

-I'm the most competitive.

-I'm itching for the responsibility.

-From the classroom

-to hospitals across Wales.

-It's going to be more challenging

-than anything they've done before.

-Entering the medical world

-for the first time.

-Young student doctors

-are like little chicks.

-Do you remember that?

-It was hilarious.

-Facing the greatest challenge

-of their young lives.

-This year was the first time

-I saw someone die.

-It really hit me

-because she's not going to recover.

-I feel like I'm drowning,

-that I'm not doing enough work.

-Medicine is hard.

-The course is going to be hard.

-As we chronicle every step

-to become tomorrow's doctors.

-We'll be the doctor on the scene.

-We'll be in charge.

-This is superb.

-What made me choose this path?

-This is not about elitism.

-You have been given a gift.

-You must use that gift to do good.

-For young students, there is

-an unique challenge in Year 3...

-..the oncology project.

-For three months, the students

-are assigned to a cancer patient.

-They chronicle

-every clinical step...

-..and see how the disease

-affects patients and their families.

-It's the experience of being

-the other side of the desk.

-This term we've been doing

-the oncology project.

-Basically, we're assigned to

-patients with some form of cancer.

-It can be treatable

-or they're palliative.

-We follow them for three months

-and write up our project.

-My patient is Nina.

-She used to work as a nurse.

-She has cancer -

-she previously had breast cancer.

-It's returned

-and spread to her lungs.

-She's palliative.

-This is Catrin's first experience

-of dealing with a cancer patient.

-When I first met her,

-she was receiving chemotherapy.

-The chemo stopped working

-so the cancer was growing back.

-I'm here to meet

-my oncology patient.

-She's meeting

-a thrombosis specialist.

-She has secondary breast cancer.

-She had a scan a few weeks ago which

-showed her treatment wasn't working.

-You have a medical student following

-you around. Is she behaving?

-She's not bad.

-If she weren't full up,

-I'd have her as a daughter.

-That's not bad.

-They found clots on her lung.

-And also fluid.

-They're now deciding on the

-best course of treatment for her.

-If there's a small clot there...

-..we want to treat that,

-but I also want to make sure...

-..that any other clots

-are being treated as well.

-She deteriorated quickly

-in next to no time.

-She became more breathless

-and she'd cough a lot more.

-Just the fluid

-building up on her lungs.

-You can't cure me

-but you can keep me going.

-I think you're doing great.

-It's very unfair.

-It is, it is absolutely crap.

-And it always seems to hit

-the nice people.

-The oncology project is important...

-..because the students

-get to know the patients...

-..at a very vulnerable time

-in their lives.

-In numerous examples,

-the student and the patient...

-..have become very close.

-It's odd seeing the other side

-and dealing with their families...

-..and the social, psychological

-and physical aspects.

-I think it's a privilege

-for them to be part...

-..of such an unique time...

-..and painful time

-in a patient's life.

-While Catrin experiences

-the long term effects of cancer...

-..Sioned meets a patient who's

-been diagnosed for the first time.

-My patient is Neil.

-He's coming to Velindre

-with his partner Linda.

-He's been diagnosed

-with cancer of the tonsils.

-I've never really dealt

-with cancer patients before.

-I didn't know how to talk

-about cancer.

-People are frightened

-of the word cancer.

-I felt awkward initially,

-I didn't know what I should say.

-I'm in Velindre this morning

-meeting Neil.

-He comes in every day

-for radiotherapy.

-He started a fortnight ago.

-He's facing 40 sessions

-of radiotherapy.

-Neil's treatment is intense -

-every day without fail.

-He has a mask fitted

-before he starts, to hold him still.

-The radiotherapy beams must target

-the same place on the tumour.

-Cancer is a terrifying disease

-for the whole family.

-Linda is never far from Neil's side.

-She's suffered from breast cancer.

-Because he's had

-such a positive prognosis...

-..then I suppose the initial shock

-is "Oh, it's cancer."

-And then, you know, coming down

-to a place like Velindre...

-..and see what work they're doing...

-..and you think,

-"Oh, yeah, he's gonna be fine."

-We reassure each other.

-He's been doing really well.

-They initially thought

-he might lose his oesophagus...

-..and he'd have to be fed by tubes.

-I didn't know what to expect

-before starting the project.

-I hope he'll be OK after the

-treatment. It's a positive story.

-Some students

-have very different patients...

-..who respond to treatment

-differently.

-Back in Newport, Nina has

-an impossible decision to make.

-It was the most difficult

-appointment I had with Nina.

-She'd had a lung biopsy

-to determine...

-..the next course of treatment.

-Nina's cancer is spreading

-despite her chemotherapy treatment.

-It's interesting

-to see the difference...

-..when you're the other side

-of the door.

-I'm sitting there

-waiting for the doctor.

-When you're following a doctor,

-you have so much to do.

-It reminds you when that patient

-comes through the door...

-..they've been patiently waiting

-for the results for hours.

-They only want to hear good news

-but that's not always the case.

-You're hoping for good news.

-The emotions are so real by the time

-you reach the doctor's room.

-The patient listens intently

-to every word the doctor says.

-You should reconsider the options.

-Up to now, we've given chemotherapy.

-And that's stopped working.

-It makes you realise the enormity of

-the experience of seeing the doctor.

-Wow.

-Tougher every week.

-I remember the options.

-One was a clinical trial, the other

-was a treatment with side effects.

-It was awful.

-I can go on to a clinical trial...

-..which involves injections

-once a month.

-..or I can keep coming here

-and have hormone treatment...

-..with something else alongside it.

-That might not work as well.

-I knew the enormity

-of that decision for them.

-I couldn't make that decision,

-just like...

-They had such a huge decision

-in front of them.

-I've been feeling so well this

-last six weeks off of the chemo.

-I don't know

-if I really want to go back on it...

-..to be quite honest.

-But I've got to

-if I want to be here.

-'Tween the devil

-and the deep blue sea really.

-Back to square one.

-It's all back to square one.

-I think he finds it very difficult.

-He knows she doesn't want chemo.

-I think that's hard

-for him to accept.

-It's her decision

-at the end of the day.

-He has no control.

-I understand if she's had enough.

-You don't want...

-You want to enjoy life.

-I was told I had two years and

-I've done ten months of that now.

-So...

-..yeah.

-You know there's no cure,

-it's just the best we can do.

-The best we can do.

-You're looking now to see is the

-treatment worse than the disease?

-Is the treatment

-worse than the disease?

-Because the last lot really was,

-wasn't it?

-It was horrendous.

-I don't want to do that again.

-Just want to see the kids grow up,

-that's the worst bit.

-The little ones.

-That was quite overwhelming.

-She said she wouldn't see

-her grandchildren growing up.

-That really hit me, actually.

-I was just like...

-That's quite like...

-Sorry.

-I think now,

-she said it hit her today.

-It's a reminder

-that there's no cure.

-It hit me too because when I speak

-to them, and we're having a chat...

-..you do forget that...

-Now that I've got to know them and

-I know what's going to happen...

-..when she said that,

-it really hit me.

-I felt I had to hold back a little.

-It's just such a huge thing.

-Sorry.

-.

-Subtitles

-Subtitles

-

-Subtitles

-With one term remaining

-until graduation...

-..expectations are high

-for final year students.

-Without warning, Guto and Swyn's

-skills will be tested to the fore.

-Today, we've set up a cardiac arrest

-scenario with the students.

-They don't know

-we're going to bleep them.

-They haven't dealt with this

-on their own before.

-Blood pressure is around 119.

-We're quite happy with that.

-BLEEPS

-He still needs to do

-the end of block reports thing.

-BLEEPS

-Guto?

-Uh?

-Oh, OK.

-See you soon.

-Hiya.

-OK, what's happened here?

-Mr Jones...

-..he's become unresponsive.

-There's no pulse.

-Carry on with the CPR.

-I'll get the defib ready.

-The first time they do it, the

-adrenaline has built up on the way.

-They're out of breath

-and they're not sure what to expect.

-It could be a child,

-it could be anything.

-Just putting the defibs on.

-I'm switching it on, OK.

-We're going to shock. OK?

-I'll turn it up to 150.

-Charging. OK?

-When Guto was using the defib,

-it's important to realise...

-..that these are real defibs,

-they're not toys.

-Off.

-Carry on.

-OK, is there IV access?

-No, we tried earlier.

-We couldn't get it in.

-Are we going IO?

-IO?

-Can you get an IO kit out?

-Can you get an IO kit out?

-

-There's one to your side.

-As a rule, there's a team of six.

-There's enough for one to make

-decisions, one to do the defib...

-..one to get access,

-one to administer drugs...

-..someone to swap

-for the chest compressions.

-The ECG looks alright,

-check the pulse.

-There's no pulse.

-We can't shock. Adrenaline.

-Adrenaline, one milligramme.

-One in ten thousand.

-Adrenaline going in.

-Hello. Check the pulse.

-Can we do an ABCDE, please?

-OK. What's his name?

-OK. What's his name?

-

-Robert Jones.

-Hello, Robert?

-Can you confirm your date of birth?

-OK, we can stop there.

-OK, well done.

-Right, so, how did you feel

-when your bleeper went off?

-I just panicked.

-I just panicked.

-

-Calmed down now.

-It was the adrenaline first

-when it went off.

-You don't know what's ahead.

-You were the team leader.

-What do you think

-you should have been doing?

-Did you feel like a spare part?

-It felt odd standing there

-doing nothing...

-..but I think it's important

-to have someone...

-..whose role is to keep an eye

-on what everyone else is doing.

-It could have been more slick.

-It's the first time we've done it...

-It's the first time we've done it...

-

-Practise, yeah.

-If I was in that situation

-next time...

-..at least I'd have an idea

-about what to do.

-For a first time,

-that was very good.

-There we go.

-It was good to have the experience

-of practising something like that.

-A month into the oncology project...

-..Sioned returns

-to Velindre Cancer Centre...

-..to catch up with Neil after

-a difficult chemotherapy session.

-After the last chemotherapy,

-Neil wasn't keen on another course.

-We'll discuss in the review

-whether he takes the final course.

-He felt very ill

-after the previous one.

-They'll discuss

-if it's worth another go.

-So I would like you to have...

-So I would like you to have...

-

-No, you wouldn't.

-You said the wrong thing

-with your tinnitus.

-I would like, if you will have it...

-..there is a benefit to you

-having your final chemotherapy.

-The best treatment is for you

-to have all three chemotherapies.

-Some people come to this stage in

-their treatment and they're unwell.

-Not able to eat or drink,

-very severe side effects.

-We wouldn't give them

-the third chemotherapy.

-You're in good shape

-for where you are in your treatment.

-No, I'm not.

-On that basis...

-..I would like to offer you

-the full course of your treatment.

-That gives us the best chance.

-You just want to torture me,

-don't you?

-I'm not going to force you

-to have it.

-I'll have it then. If you think it's

-best, that's what we'll go with.

-We discussed whether he'd have

-the final chemotherapy.

-That's booked in for next week.

-I didn't think he'd take it but

-the consultant talked him round.

-He's having his chemotherapy

-next week.

-That finishes your treatment,

-we've done all the treatment we can.

-We've given it our best shot.

-It's the final week

-of Neil's treatment.

-He's here

-for the final chemotherapy.

-Hiya.

-Last week you said

-your pain was quite bad.

-They told you to double

-your painkillers.

-That's because

-you are actually taking it.

-Linda found out that Neil was

-refusing to take his painkillers.

-That's why he was in so much pain.

-The pain was stopping him eating.

-How's it been over the weekend?

-Bad, really bad.

-And he've stopped eating.

-Have you?

-The dietician weighed him and he's

-lost more weight since the weekend.

-She was worried about his weight.

-She considered inserting a tube.

-The tube goes up through the nose

-and down to the stomach.

-That provides him with nutrition.

-So I can see

-a PEG feed coming on here.

-Can you?

-Do you think

-you can force yourself to eat?

-They discussed one at the start

-of the treatment.

-He said right from the start that

-it was the one thing he opposed.

-He's had a shock today to hear that.

-He's been focused

-on completing the treatment.

-To hear that,

-it was a setback for him.

-The oncology project

-is about understanding...

-..from the diagnosis,

-all the way through the treatment...

-..and hopefully,

-a good resolution...

-..in some cases,

-not a good resolution.

-In many cases,

-the resolution is not good...

-..but every patient,

-irrespective of where they get to...

-..deserves the same standard

-of care.

-It's an eye opener

-about what's ahead for us.

-You're not human,

-you're not in the right job...

-..if you turn up for work

-every day...

-..thinking that person's

-just had that diagnosis.

-I wouldn't want

-to be like that either.

-How are you?

-Better than I was

-but I'm still breathless.

-Over the weekend,

-I was in a bit of a state.

-I had it drained yesterday...

-..and they said

-they got a litre of fluid off.

-It's rapidly accumulating.

-We've got no choice but

-to recommend you go to chemotherapy.

-OK.

-We need to get on top of it.

-I think that's the way

-we need to go.

-OK.

-Alright?

-It's good for you, innit?

-Yeah.

-Nina was hoping to avoid

-more chemotherapy.

-It's just what I didn't want to do.

-Just what you didn't want to do.

-There's no option, is there?

-Doesn't sound like it, does it?

-Doesn't sound like it.

-Tubes in, tubes out.

-Makes you feel like

-you're shuffling off now.

-It's for the best at the moment.

-It's the best of what we've got.

-Yeah.

-It's important that we see this...

-..so we understand the impact

-it has on patients in the future.

-One traumatic experience for me...

-..was having a patient who had

-no symptoms before the treatment.

-What hit her more than anything

-was the treatment itself.

-She had terrible side effects,

-it was excruciating watching her.

-She deteriorated every week.

-I could see the deterioration

-and that was difficult.

-The pain wasn't coming

-from the cancer itself...

-..but from the treatment

-that was meant to heal her.

-If it's like the other lot when I

-had the first one, I'm not doing it.

-I'm not that brave.

-Being a patient

-is immensely challenging...

-..both for the patient themselves

-and for everybody around them.

-It sounds glib

-but it does change your life.

-It changes your whole life.

-You need to understand that dynamic

-if you're going to be a doctor.

-It's helped me because no-one in

-my family has had that diagnosis.

-It also scares you.

-You read in the paper,

-"one in two of you."

-It scares you.

-I think it's important

-for us to have this.

-I feel as if I've grown up -

-it's made me think more...

-..about how patients feel

-and the fears they have.

-I think a lot of people think,

-"Why me?"

-The risk factors

-are smoking and drinking.

-My patient had never smoked,

-didn't drink much. Why me?

-You're sitting in a room and you

-have no idea what to tell them.

-If you're a good doctor...

-..you have feelings...

-..and you can feel the loss

-for the family.

-You need to show

-some kind of humanity...

-..because it's difficult.

-If you can't,

-if you have no emotions...

-..I don't think

-you're in the right job.

-Neil agreed to a tube

-to help feed him...

-..but since then, he's completed his

-treatment and made a full recovery.

-Nina's chemotherapy

-treatment continues...

-..in the hope that she will be able

-to spend more time with her family.

-S4C Subtitles by Adnod Cyf.

-.