Pennod 2 Ward Plant

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-Ysbyty Gwynedd

-serves the largest area in Wales.

-Some children have to travel

-over an hour to get here.

-Take out the inhaler,

-shake it and put it back in.

-You never know

-who will come through the door.

-I've had a call to see a 7-year-old

-with a rash and neck pain.

-Could be meningitis. We'll see.

-This makes it a fantastic training

-hospital for nurses and doctors.

-It's important to encourage interest

-in medicine amongst young people.

-They need to be encouraged

-to go for it.

-They will be responsible for giving

-treatment here in the future.

-Do you like that bike?

-Let me have a listen.

-Don't worry. You're not watching

-the wrong programme.

-Tomos Owens, who used to be

-a member of Y Bandana...

-..is now Dr Tomos Owens.

-# Tonight in the Anglesey #

-Here he is, on his way to work...

-..on the children's ward

-at Ysbyty Gwynedd.

-Tomos is one of six doctors

-training to be GPs in Gwynedd.

-As part of his training...

-..he's spending six months

-studying paediatrics.

-I'd never done paediatrics

-before this placement.

-I did it for about six weeks

-at medical school in Manchester.

-But this is my first job

-as a doctor.

-I was worried at first

-but I wanted to make sure...

-..I'd had experience

-of working on a children's ward.

-Usually we start at 8.30am

-but I'm a little later today...

-..because I'm going to the teaching.

-There's more traffic and parking

-is difficult at this time.

-I remember deciding

-I wouldn't mind being a doctor...

-..if I did alright in my exams

-at school in Year 7, 8 and 9.

-I was going through an emo phase

-at the time.

-I liked the idea

-of being a forensic pathologist.

-I knew you had to study medicine

-to do that.

-So that's why I decided

-to give it a go.

-Since university

-and starting work...

-..I've realized I'd rather work

-with people who are alive...

-..rather than carry out autopsies

-on dead people!

-But that's the weird reason

-I chose to do medicine!

-I remember realizing it was

-difficult once I got to university.

-I went to Ysgol Syr Hugh Owen

-and had a great time there.

-I went to university and everyone

-there had A grades in everything.

-Everyone had done

-Grade 8 piano or trumpet.

-Everyone had been

-head boy or head girl.

-I thought, "OK." I did Grade 8

-trumpet and Grade 5 piano.

-I happened to be in a new band

-called Y Bandana!

-That was a cool, quirky thing

-to put on my application form.

-I remember getting there and

-thinking everyone was so clever.

-It was a struggle to cope with

-the workload in the first two years.

-It was hard and it was a lot of work

-but you have to persevere.

-The learning continues.

-Anywhere here, please.

-What I know is if you're suspecting

-glandular fever...

-..amoxycillin is not

-the best antibiotic to choose.

-That's why I'm asking.

-Tomos is with us for six months and

-we're nearing the end of that time.

-He's well used to dealing

-with children by now.

-Around 20% of the population

-are children.

-Between 20% and 25%

-depending on where you live.

-Children are high users

-of health services and GPs.

-So we feel it's important

-that every GP...

-..spends six months on a children's

-ward looking after sick children.

-But today, Dr Tomos isn't

-the only one receiving training.

-Half the ward staff

-are on an emergency care course.

-This means there aren't enough

-doctors on the ward.

-So I'll do the ward around here

-and cover on PAU, yeah?

-We'll sort out upstairs then, yeah.

-We'll sort out upstairs then, yeah.

-

-Fine.

-There aren't enough doctors today.

-It's just me covering downstairs

-with the registrar.

-There's one other

-junior doctor upstairs.

-Normally there are at least four.

-I'm a bit concerned it's going to be

-busy but I hope it'll be OK.

-PHONE RINGS

-Hello. Paeds SHO.

-Hiya.

-I've just had a call

-for a seven-year-old boy...

-..with a rash and neck pain.

-Could be meningitis. We'll see.

-38.8 temperature.

-OK. We'll see him on Dewi Ward.

-Thank you very much. Take care.

-When a doctor suspects meningitis,

-there's no time to lose.

-Within fifteen minutes,

-Stephen has arrived.

-I'm concerned about the neck pain.

-He doesn't want to look up.

-Sometimes when children

-have a sore throat...

-..they complain of pain in

-the back of their throat and neck.

-It doesn't look like

-a meningitis rash.

-It looks more like an allergy rash.

-But he has no history of allergies.

-Often, when children

-present with an allergy...

-..they have a history

-of other allergies.

-It looks like an allergy rash so I'm

-going to prescribe an antihistamine.

-Something like Piriton

-that you can buy over the counter.

-We'll see if that settles the rash.

-He also seems quite well.

-He was jumping around.

-If he was more drowsy,

-I might have taken some bloods.

-For now, I'm just going to

-keep an eye on him.

-We'll give him the antihistamine

-and see how he goes.

-One of the seniors will look at him

-once we've monitored him.

-This is all part

-of Dr Tomos' training.

-But in reality, for the doctors

-and nurses of Ysbyty Gwynedd...

-..the training never ends.

-This is Jake.

-Jake has been close to death

-several times...

-..so that staff know what to do when

-real babies are rushed to hospital.

-The nurses haven't wasted a second.

-They've called for a doctor...

-..and Jake's condition

-deteriorates quickly.

-What's the temperature?

-What's the temperature?

-

-36.9.

-This is an eight-month-old baby...

-..who's not been very well

-for the last week or so.

-A bit irritable, not feeding,

-has been vomiting.

-Been to the GP who has sent the baby

-in an ambulance to us.

-OK.

-OK.

-

-Mum is on her way.

-We hold sessions like this so that

-teams can practise what they do...

-..with sick children or adults.

-It doesn't happen that often.

-This isn't Holby City!

-It's good for teams to come here...

-..to practise the most challenging

-scenarios that could come up.

-Is he making excessive sound from

-the airways or is it a clear cry?

-Just a clear cry.

-A referral comes through

-telling us exactly what's wrong...

-..with the child or baby.

-We then have to act

-exactly as we would on the ward.

-The temperature was 36, wasn't it?

-The temperature was 36, wasn't it?

-

-Yeah.

-OK. I'm not comfortable

-with that heart rate.

-Would you mind getting the register

-to see who's on call?

-I can see the SATS are coming up.

-Back in the real world,

-Sophie has arrived.

-She fainted when her mother was

-trying to put an earring in her ear.

-I've just seen Sophie,

-a six-year-old...

-..referred here

-from the emergency department.

-She said she felt hot

-and she collapsed.

-They tried to rouse her

-but she wouldn't wake.

-She woke up quite quickly when her

-mother gave her a few gentle slaps.

-We'd be more worried

-if she was groggy or confused.

-I discovered what I thought

-sounded like a heart murmur...

-..when I examined her.

-It's an additional sound

-when you listen to the heart.

-Usually you just hear the heart

-but there was an additional sound.

-Some children have them -

-they're called innocent murmurs...

-BLEEP

-BLEEP

-

-..and cause no problems.

-But murmurs can cause some

-to collapse and so on.

-I've done an ECG just to investigate

-further. It looks OK.

-It might just be

-a coincidental finding.

-That's where we are at the moment.

-In the training room, Jake's heart

-rate has gone through the roof.

-The medical term for this

-is supraventricular tachycardia.

-One way of slowing down the heart...

-..is to put the baby's face

-in ice cold water for 10 seconds.

-Three, four, five, six...

-..seven, eight, nine, ten.

-In this little drama,

-the technique has worked.

-Jake's heart rate has slowed down.

-Do you forget they're mannequins?

-Do you forget they're mannequins?

-

-After a while, yes.

-You get so absorbed.

-It's a really good way of learning.

-Jake has survived

-another training session.

-Until next time. Thank you, Jake.

-But now there's a real baby

-to see to.

-Jack is about a month old.

-He came in over the weekend.

-He's just not feeding

-and isn't himself.

-He usually feeds well.

-Blood tests have come back normal

-but he's had antibiotics.

-Things are OK.

-He's also been given ranitidine

-for reflux.

-He does seem to have improved

-with that.

-But we'll just keep an eye on him

-for a while longer.

-I've just heard that the other

-patient referred by the GP is here.

-Hiya, Liam. Are you OK?

-Who's this with you?

-Nain.

-Nain.

-

-Nain. Hello, Nain.

-I'm Tomos,

-one of the paediatric doctors.

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-This young man is Liam. His stomach

-has been hurting for three days.

-Your GP phoned me earlier and told

-me a little about what's going on.

-I know he also spoke to

-the surgical team...

-..because you've had a stomach ache.

-Is that right?

-It's pain here.

-I've had stomach ache as well

-but mostly it's just normal pain.

-Where exactly is the pain?

-There.

-On the right hand side. OK.

-How long does the pain last?

-It doesn't stop.

-OK. So it's there all the time.

-When did it start?

-When did it start?

-

-Sunday night.

-Sunday night. OK.

-There are a few of us here

-doing the GP training at the moment.

-There's a good group

-of Welsh speakers.

-There's a big demand

-for Welsh speakers...

-..especially on a children's ward

-so paediatrics...

-..and in mental health.

-It's important to encourage interest

-in medicine amongst young people.

-They need to be encouraged

-to go for it.

-There's nothing worse

-than not trying...

-..because you think

-you're not good enough.

-If I asked to give me a number...

-..where 1 is very little pain and

-10 is the worst pain imaginable...

-..which number would you say?

-I'd say six now.

-I'd say six now.

-

-Has it been worse than six?

-Yes.

-When was it at its worst?

-On Sunday night and at night

-as well.

-At night? OK.

-Which number would you say then?

-Which number would you say then?

-

-Eight.

-So it goes as high as eight.

-It's so nice to be able

-to work in Welsh.

-People appreciate

-Welsh-speaking doctors.

-It's nice to be able to work

-in the area where I grew up.

-I lived in Manchester

-for a few years.

-But I feel there's a demand

-for doctors in this area...

-..and I want to come back

-so why not?

-OK. OK. Can you lie down for me?

-We've done an urine test

-and that's OK.

-We'll probably do some blood tests.

-We'll check infection markers

-and make sure your kidneys are OK.

-Your liver is up here

-and your kidneys are there as well.

-If it's going to the back

-it could be in your kidneys.

-Sometimes a kidney infection

-can cause pain.

-It can sometimes burn

-when you urinate.

-At out of hours,

-they mentioned it could be stones.

-It is a possibility but I'd expect

-to see blood in the urine.

-That is the other thing.

-It could be a kidney stone

-or a kidney infection.

-I'll do blood tests to check kidney

-function, liver function and so on.

-When we have the results back, I'll

-also ask the surgeons to see you.

-Is that OK? Cool.

-The registrar has seen him and he

-thinks it could be constipation.

-Although his bowels open every day,

-sometimes that isn't enough.

-From what he's described,

-he has quite hard poos.

-We're going to give him some

-laxatives to see if he feels better.

-We'll go back to him later

-to see if they've had an effect.

-He's going to stay in a little bit

-longer just to keep an eye on him.

-This is Leia.

-She was sent in by her GP because

-she was having trouble breathing.

-The doctor has decided to try

-the blue inhaler.

-There are two reasons for this.

-It opens the pipes in her lungs

-and works immediately.

-You need to cover her mouth

-and push this in.

-You need to hear the valve clicking

-five times.

-You take out the inhaler,

-shake it and put it back in.

-Another puff

-and another five clicks.

-She needs ten of those

-while she's here.

-Can Dad give you this?

-So you need ten of these. OK?

-One. It needs to cover

-the nose and mouth.

-You need to leave that in.

-Right, Dad.

-Let Nurse Angharad show you again!

-Slowly. That's it.

-Just breathe normally.

-Pull it out, shake it.

-We're on the second now.

-OK?

-We need to count to ten.

-That was three. Can you count?

-Well done.

-Last one.

-We'll just assess her oxygen levels

-and her heart rate.

-If the oxygen levels fall, the

-doctor will come to listen to her.

-She might need the inhaler sooner.

-So she'll be OK for two hours now?

-Can she go to play?

-Yes, just not too much

-running around!

-It's hard to tell a six-year-old

-girl not to run around!

-In a brand-new play area.

-Sophie, the girl with a hear murmur,

-is going home.

-No, that's fine.

-Any problems in the meantime,

-you know where we are.

-One of the seniors

-listened to Sophie's heart...

-..and he agreed

-there is a heart murmur.

-He was happy we'd done the ECG

-and everything was OK.

-She's fine in herself.

-We don't need to keep her in.

-But we're going to arrange

-an echocardiogram.

-It's like an ultrasound

-on the heart.

-Similar to an ultrasound scan

-on pregnant women.

-We just want to see if there are

-any abnormalities or problems...

-..causing the murmur.

-We probably won't find anything...

-..but we'll investigate

-because we've discovered it.

-That will take place

-as an outpatient appointment.

-Hopefully she'll be fine

-in the meantime...

-..and that the echocardiogram

-doesn't highlight any problems.

-She's going home in a minute.

-Just keeping you updated.

-See you later.

-Is Leia out there?

-Is Leia out there?

-

-Erm...

-Yes.

-Leia came in because

-she couldn't catch her breath.

-It sounds like she's had a virus

-which has caused her to be wheezy.

-As you can see,

-she's feeling a bit better now.

-She's on an inhaler

-every two hours...

-..and I'm checking

-she doesn't need anything extra.

-You could think it's asthma

-but it's hard to tell with children.

-You don't want to put a label on it.

-Asthma can come and go.

-With a virus, it happens

-and then it gets better.

-I'll go and see how she is.

-Hiya, Leia. Are you OK?

-Can I have a listen to your chest?

-Do you like the bike?

-Do you? OK. Let's have a listen.

-Did you have the mask earlier?

-Let's listen.

-Do you like going on the bike?

-OK. If you turn around,

-I'll listen to your back.

-Thank you, Leia.

-Thank you very much.

-You can carry on playing.

-Well done. See you later.

-Her chest doesn't sound too bad.

-Someone else will listen

-in about an hour...

-..just to check

-if she needs something.

-If not,

-we'll stretch to another hour.

-We like to stretch them four hours

-between inhalers...

-..before they go home.

-That will be for the night shift

-to decide.

-If she needs it more regularly

-or if the oxygen levels rise...

-..she might have to stay in.

-I won't know that until tomorrow!

-Hopefully she'll get to go home.

-We'll see.

-Someone else

-who hopes to go home is Liam.

-Hiya, are you OK?

-So it's worked, has it?

-Has the pain gone?

-Great.

-We'll carry on with those sachets

-once you go home...

-..to keep you regular.

-I'm glad to see you're much better.

-Has the pain gone completely?

-Yes.

-Yes.

-

-Success!

-Patient of the day. Well done you.

-Happy?

-Nice to meet you both. Take care.

-I've just had a call from the GP

-in Llanfair.

-A 30-week-old baby's not well.

-She may have a chest infection...

-..but he's more concerned that

-she's not keeping down any fluids.

-They're giving her water

-and paracetamol...

-..and it's coming straight back up.

-We'll wait for her to arrive

-and then I'll assess her.

-I'm just going to do

-some paperwork now.

-Tomos' day is over.

-No-one was terribly ill.

-But plenty of variety and experience

-for the aspiring GP.

-It's handover time at the minute.

-I'll pass on the message. Nice one.

-..doing something.

-I enjoy the work

-and that's the most important thing.

-I wasn't very sure what to expect

-when I was 15 or 16...

-..and deciding to do medicine.

-The variety is amazing.

-There's a job for everyone,

-no matter what their interests.

-I'd encourage young people

-to go for it.

-If you're interested and think

-it's something you'd like to do...

-..go for it.

-Ellie's come in from the GP with

-what sounded like a chest infection.

-The GP was more concerned

-about the fact...

-..she wasn't tolerating oral fluids

-for 24 hours.

-We may need to have a look and see

-whether she needs IV fluids...

-..if she's not drinking at all

-and what are they planning to do.

-That's it. The handover's done

-and my day is over.

-My colleague, Owen Wilson,

-will carry on.

-He'll see the patients who've been

-referred that I didn't reach.

-It's been quite busy. A few

-admissions. Some bloods to do.

-It's another Monday.

-We'll have more fun tomorrow.

-I'm going home now.

-I'll see you tomorrow.

-OK? Ta-ra.

-But one little girl is still here.

-She's much better. What we'll do

-is give the inhaler this time.

-I can only predict but I think

-she'll be able to sustain...

-..four-hourly without inhalers.

-Then we'll be able to send you home.

-Much improved.

-Much improved.

-

-Much improved.

-We have to do the pump again.

-Once more.

-Leia wasn't seriously ill...

-..but she was poorly enough

-to stay in hospital.

-All I did was prescribe some

-inhalers and sort out some steroids.

-I hope to see her again when she's

-running around and completely well.

-Stephen's rash disappeared a few

-days after coming to hospital.

-The specialist decided Sophie

-had no serious heart problems.

-Liam hasn't had any stomach problems

-for months.

-Leia now has an asthma pump

-to use when needed.

-Dr Tomos is currently in Holyhead

-training to be a GP.

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