Episode 1 Junior Doctors: Your Life in Their Hands

# This is an emergency... #

A typical night in A&E.

It's like a battlefield.

Language!

Full of twenty somethings after a big night out.

Lots of vomit, lots of unconscious bodies lying around.

But not everyone is a casualty.

Squeeze my fingers, please!

Taking care of them is an army of doctors, the same age.

They've had five years of training...

-Cardiac arrest in A&E.

-..and a rigorous induction into hospital life.

Take full advantage of being in a bloody good city and a bloody good NHS Trust.

Hello.

-# This is an emergency... #

-Never done this before.

Now they face the reality of life on the wards.

You are the skivvy, the ward bitch.

He was looking at my badge as if to say, "Who are you? What do you know?"

We'll be following seven junior doctors at work...

and at home.

24-year-old Adam is from a family of medics.

There's the massive pedigree within the family that I'll have to live up to.

-Cambridge graduate Katherine.

-I definitely feel I have to work at things.

If I want to achieve something.

Animal lover Lucy, 24.

If I'm feeling stressed, you'll probably see it.

If I'm feeling a bit emotional, I might have to bite my lip.

If I get embarrassed, I blush.

Aspiring surgeon Andy, 25.

-I was

-BLEEP!

-HE LAUGHS

Calm. And I'm cool in the traditional sense of the word.

Wine buff Keir.

I'm a bit of a show-off at times.

Rather lovely!

But sensitive. Very, very useful to me in medicine.

Rugby captain Jon.

As a medical student, you have no responsibility.

Where as a junior doctor, the buck stops with you.

And party girl Suzi.

Someone's life in our hands. I'm 24 and that's like a massive thing.

They'll be working in two of Newcastle's busiest hospitals.

HE GROANS

Cardiac arrest!

Dealing with life and death situations.

She's just been told, "You're going home to die."

And sometimes the bizarre.

I saw a man that had a toilet brush up his bottom!

But are they up to the job?

You're doing well, sir. You're doing well.

I guess if I really messed up I would kill someone.

We're doctors. We've grown up.

But I don't feel as though I've grown up.

I'm still out of my depth and that is more scary than exciting.

Newcastle upon Tyne - the party city of the North East.

Where our seven junior doctors are sharing this house.

-Guys, it's ready!

-Tomorrow they're all starting new jobs.

GLASSES CLINK

And the question on everybody's lips is...

..are they ready?

I just keep telling myself that it's literally tens of thousands of people

who are in exactly my position that are going to be going on the wards. And at least one of those people

are going to make a worse mistake than me!

And that's what's keeping me going!

Look on the bright side, people did it before us.

-There is no reason why we can't do it.

-Exactly.

You will never be ready for it, you just have to deal with it.

It's just that episode of ER when the firemen... Has anyone else seen it?

You're not basing your entire medical fears on what you've seen on TV!

I know, but it was so scary and so horrible!

What do you think it's like? You make mistakes and people can die.

-Isn't that scary?

-Nah!

-It scares me quite a lot.

As Suzi gets ready for bed, her new responsibility starts to weigh on her mind.

Worst case is that someone could be really sick

and could die,

or there could be a sick child or something.

Things that just kind of knock you...

emotionally, I think, are the scariest things

because you don't know how you're going to cope.

-How are you this morning?

-Good.

HE YAWNS

It's day one of their new jobs.

Adam's a first year.

He only graduated a few weeks ago and will be working as a doctor for the first time.

I really don't want to look stupid compared to my peers.

If we start the job and everyone else seems to be coping well,

and I'm coping really badly... you know.

I'm worried that I'm going to try really hard and fail.

I'm not feeling very well. I don't feel ideal.

But hopefully, I'll feel better as the day goes on.

Despite having done a year on the wards,

second year Suzi is still nervous.

I'm scared because I can send patients home from hospital

without speaking to anyone else, and that scares me,

because then you've got the potential to send home

people that are really sick.

On his first day, Adam's keen to dress to impress.

You get a lot more respect when you dress properly, when you're wearing good clothes.

I think it's important to look good on the job.

I've got my new trainers for A&E and everything.

And they're pink! I need pink trainers,

because I've got a pink stethoscope.

So I need to co-ordinate my shoes and my stethoscope.

# I like to wait to see how things turn out

# If you apply some pressure... #

Suzi is working at Newcastle's General Hospital,

in Accident and Emergency.

A&E is demanding and unpredictable, with over 200 cases a day.

These are our new team.

Today, Suzi starts with a full induction.

On your right is the resuscitation room and the monitoring bay.

On your left are three rooms for walk-in type patients.

Shoulder injuries and things, so that's fairly low intensity.

Any questions?

What I'd like to do now is divide you guys up into groups,

of either twos or threes each.

Choose your groups and I'll come back to you.

I think it's quite difficult, especially for a junior doctor,

the first few days, they're under tremendous pressure.

They have to get stuck in, they have to work, right from day one.

One of the things that you often see in junior doctors is what we call

the frozen doctor syndrome.

They come across a critical case, and they just don't know what to do.

ALARM SOUNDS

And Suzi's nerve is about to be put to the test,

as an emergency's coming in.

Suzi, it's all set.

The patient's heart has stopped beating, and it's the team's job

to try and get it started again.

We're waiting for a cardiac arrest call that's come in,

so everyone's just waiting, ready to go.

I'm really excited, but also really scared.

I'm trying to get all my bits and pieces gathered.

Suzi, are you happy to check?

Yeah? OK.

Are you happy to shock?

Can do. I haven't shocked anyone before.

-You haven't?

-No.

OK, fine. We'll show you, then.

This is the first time Suzi has experienced any emergency like this.

I've been at arrest beds before, but never in an A&E situation.

So this is a bit different.

And yeah...the pressure's on, but I want pressure, so that's fine.

SIREN BLARES

The paramedics have got the patient's heart started

in the ambulance.

But the patient arrives in a critical condition.

He was en route with ST elevation MI, when he arrested in an ambulance

with VTAC.

The paramedics shocked him out of VTAC, he's now in sinus with them.

Blood pressure of 114, but he remains unconscious.

'Suzi's first job is to take blood.'

We're in. I haven't got much blood out.

Get some more on the other side as well.

The patient is unconscious, but his body is writhing,

because of the shortage of oxygen to his brain.

If you come round to that side,

the carotid ring is just under the Adam's apple,

and when he starts to go up, we need direct pressure back into the bed.

They need to put a tube into the patient's lungs to help him breathe.

Suzi needs to apply pressure to his throat to stabilise the windpipe.

All right, try and relax for me, sweetheart.

Try and relax for a second.

-All right.

-That's fine.

Well done.

OK.

Finally, the patient's been stabilised,

ready to be transferred to a specialist department.

Probably one of the most difficult I've seen for a long time.

The reason it was so difficult was because he was so combative.

Due to the cardiac arrest, his brain was not getting the oxygen,

the brain was starved of oxygen.

The reaction I saw from Suzi was absolutely brilliant.

She got stuck in. She did a few tasks which are quite difficult.

She was confident in what she did, didn't take long to make decisions, so I think she's very good.

Suzi's made a good first impression,

but she isn't always taken seriously.

Most people age me about 19, 20. I've had 16 before.

-I look 12.

-Did you get your ID, Suzi?

-Yes, I have my ID!

I'm blonde, I like the colour pink, I'm a bit girly, I like wearing dresses, I like getting glammed up.

People are always really surprised when they find out I'm a doctor.

I was shopping out in Leeds once and I was wearing a short skirt and boots

and I could see this man on the ground who was unconscious.

So I went, "I'm a doctor," and everyone went...

And I was like, "I AM a doctor!" And no-one believed me!

I think they think that I haven't got a brain and I don't work hard,

but, you know, I work very hard, this is how I've got here.

I would like people to think that I was a doctor, because it's got that kind of air of respect and things.

And I AM a doctor, so maybe I should get some of that sometimes.

It's only the first day in her new job,

but Suzi's already starting to get the recognition she's been waiting for.

It's a little scary, because it isn't what I pictured today being.

I thought it would be sit and have a chat, this is how everything works.

But it's A&E, and that isn't how A&E goes so... I'm enjoying it, though. It's good.

SIREN WAILS

While Suzi's getting to grips with her new job,

her housemates, Adam, Lucy and Katherine are also starting work.

For all three, this will be their first experience working as doctors.

I'm thinking I just want to prove to everybody that I'm a good doctor.

And how I'm going to go about doing that!

Adam's joining ward 52, respiratory.

He'll have to deal with seriously ill patients who have breathing difficulties and lung disease.

The most important thing today is getting through the day...

I'd say not killing anyone, but I think everyone's quite stable,

but, erm...just making sure that you're good to your patients and that you get everything done.

So I've just got some bloods to do, just kind of routine bloods, just making sure there's no infections.

Adam gets his hands on his first proper patient. Hilda is 81 years old.

Hi, I'm Adam, would it be all right to take some blood from you?

It's got to go to the black pudding factory. You're single-handedly keeping it open.

Sharp scratch.

I'm sorry.

Oh, oh, careful.

You don't need to prick yourself.

Right, can you just hold that for me for a second?

That'll be all right.

A bit of a bruise, I'm sorry.

Hilda has suspected Addison's disease,

but can Adam remember what he's learned when put to the test by a senior doctor?

Do you know what Addison's disease is? Do you know what the original Addison's disease was?

Is the original... Right, I'm trying to think whether it was...

Is the original Addison's disease from pit...

No, it's primary, isn't it?

-Yeah.

-Do you know what I'm thinking of? Anyway, never mind...

So it's primary adrenal failure, and what did Addison describe on postmortem in the adrenal glands?

What was actually causing adrenal destruction?

-Was it an autoimmune...?

-No, it was TB.

TB is the most worldwide... Yeah.

I just got flustered, because it's difficult when you're...

Well, first day as a doctor, and people are trying to assess how much you know,

what level of competency you're at, and you want so badly to make a good first impression.

There's that pressure that I know I could come out with all these things,

but actually coming out with them is a different story.

I could have sounded really smart. I didn't sound smart, I sounded stupid.

With Adam left trying to find his feet, Suzi is back in at the deep end with another emergency.

A woman has been admitted following an overdose.

Can you speak to me? My name is Suzi, I'm one of the doctors.

I need to ask you some questions. ..Can we get some oxygen as well?

And Suzi needs to find out what she's taken and whether the drug cocktail is lethal.

Can I have a quick look in your eyes if that's OK?

Hello! How are you?

A blood sample would provide her with vital clues, but first she needs to calm the patient down.

Trying to give her as much oxygen as we can,

and try and get her to respond.

Relax.

Just leave that on.

It hurts.

I'm just checking your blood pressure.

It's hurting me!

We're just trying to make you feel a little bit better.

-Come and have a lie down.

-Come on.

So that's better, isn't it? There we go.

We just want to get some bloods, but we're not sure it's the best time,

which is a shame, because it would be really useful, wouldn't it?

It might give us a gauge of what she's taken.

We just managed to get a blood pressure off her leg,

because if you put it on her arm, she writhes around a lot.

And she's haemodynamically stable, which means her blood pressure is fine and her pulse is fine.

And the patient is much more settled.

Suzi's shift comes to an end.

It's now down to the night team to try and help the patient.

Back at the house, Suzi catches up with the other junior doctors.

How was your first day?

A learning curve like this.

Back on myself! My first patient was a cardiac arrest in an ambulance who was then taken there.

He was like, "Do you want to help?" I was like, "Yeah, I suppose."

But it was good. But he was really sick.

Yeah, yeah, of course.

But, yeah, I kind of enjoyed it.

-Did you?

-Mmm, I know!

-Stressful but enjoyable.

-Yeah.

I guess I was a little jealous that Suzi was doing A&E,

because it is something that I really want to get to grips with.

You know, do this with a patient, take this, do that, this procedure,

give him this medication, inject this, blah-blah-blah.

Suzi came back with loads of stories from A&E, and that was like awesome.

Adam doesn't see himself as a typical doctor.

# One, two, three, four

# Uno, do, tre... #

If you asked my friends to describe me, they'd probably say that I was cheeky.

Some would say that I borderlined on sleazy, that is not true.

I would say I'm just being myself.

He's got a terrible reputation with nurses.

That's all I'm saying, but there's been a few tears.

My dad's a respected doctor.

Since I was six, I've wanted to follow in his footsteps.

My mum's also a doctor, my brother's a doctor.

My mum's mother was a doctor back in the day.

There's a massive pedigree within the family that I'm going to have to live up to.

I always put too much pressure on myself, and I'm always really hard on myself,

and I never say I've done a good job unless I've done the best job.

I would want to make a difference to as many people as possible

and do something that was absolutely huge.

In essence...I want to save the world.

As he starts another day, it's an opportunity for Adam to make his mark,

but he's hit with a mountain of paperwork.

I'm rubbish at paperwork. Probably because I don't care.

About paperwork, I care about people.

I need to do this, I need to sort this out.

It's just not stimulating at all.

You are the skivvy, the ward bitch, basically.

The part of me that wants to do medicine, I really want some complex task to figure out.

And it's not long before he finds one.

I dropped some stuff in here. Ah...

After five years of medical training, Adam at last has a chance to practise his surgical skills.

I don't even need this pen, I just really want to get it now.

I almost got it!

I need to get it now, because it will be in there forever otherwise.

Sweet!

OK. A lesson to learn, don't drop these in without them being in bags.

While the job's not yet living up to Adam's expectations,

the other housemates are settling into their new jobs.

I have a dilemma. These people came in 20 minutes beforehand.

But this gentleman's slightly sicker.

If there's not an arrow on, we might sew up that ear by mistake, and that would be silly.

Lucy is starting work in gastroenterology.

She'll be treating patients with digestive problems, including liver disease caused by alcohol abuse.

You need to be careful with that.

Alcoholic patients are often quite difficult to treat.

They get agitated and aggressive and start smashing the place up.

For first year Lucy, learning to dealing with addiction is as important as saving lives.

I'm Lucy, I'm one of the junior doctors on this ward.

Just tell me a little bit about what's brought you into hospital.

-There's notes here, but it's easier if you tell me a bit yourself.

-Pain.

-What pain have you been having?

-Me legs.

-Your legs, OK.

-I understand as well that you've been sick with some blood.

-I was, I was.

You see I'm an alcoholic,

and I used to drink 20 cans a day.

-Cans of?

-Lager.

-Lager.

-And then I reduced, reduced, reduced,

now I only take two max.

I don't drink any more. I really, really don't.

If you can come off it completely, that would be the best bet.

-Eventually, because obviously if your liver's damaged already...

-It is.

-Any alcohol's not going to make it any better.

-Oh, I know. I know.

OK. Thanks very much.

It's great to be part of the team. A proper role within a working team

in the middle of a big hospital. It's really quite exciting.

Can you speak to me? My name's Suzi, I'm one of the doctors.

In A&E, Suzi's back at the emergency frontline.

52-year-old Chris is suffering from a serious epileptic fit

and Suzi and the team urgently need to stop it.

We were up here from London.

He's forgot his medication.

Yeah, I know. How long do they normally last for?

I'm not too sure, but the last one that he had when we come up here was about an hour and a half.

A long seizure like this can cause brain damage or can even be fatal.

Suzi checks her drug guide.

She urgently needs to prescribe the right anti-epileptic.

It's quite serious if he's had such a long fit earlier on.

We need to put these anti-epileptic drugs into him.

The drugs are given intravenously.

The patient starts to regain consciousness.

Sorry that we're poking you from all sides, but...

Yes, they're just there to help you.

-It's really important.

-I know you can hear me, Chris, right?

Just try your very, very best, babes.

He hasn't had his anti-epileptic medicine now for coming on to two days, a day-and-a-half,

so we've given him something to stop the fit for the time being. Anything's better than nothing.

He's going to a wedding tomorrow, he's doing the first reading at the wedding, which starts at 2pm.

I don't know if he's going to make it now, just because of all the fits,

which would be a shame, but if he'd had his anti-epileptics, this probably wouldn't have happened.

As Suzi's emergencies continue to roll in,

Adam's day fills up with more run-of-the-mill jobs.

60-70% of the job's probably paperwork, I reckon.

It's something that second year John knows only too well.

Everyone becomes a doctor to see patients and treat patients, not to do paperwork and write letters.

And we've all done that, we've all had those days.

Unfortunately it's got to be done.

And when Adam's not doing paperwork, he's taking blood.

Bloods or paperwork, bloods or paperwork.

Adam still feels like he's not making his mark,

but over in the gastro ward, Lucy's next job is a speciality.

The only thing that's left is for you to go and do a PR examination.

Thanks. Looks like I've drawn the short straw, yes.

The per rectal.

Known in the business as the PR.

The internal bottom examination.

And this is Lucy's first time.

I've never had to perform one as a student.

I mean, we'd done them on models.

There are model bottoms that we can use to practise these things on!

I will be as pain-free as possible.

Second year John has had a year's practice, so he's an old hand at the rectal exam.

OK, so just a small amount of jelly on my finger, all right?

Sticking your finger up someone's bum isn't the most pleasant job!

I'd be lying if I said it was.

So if you just pull your trousers down to your knees for me.

'I obviously didn't reveal the fact that I'd never actually done one before.'

But if you can exude confidence, even if inside you're thinking, "Oh my goodness,"

then at least the patient has confidence in what you're doing.

If you can roll onto your left side.

You put a glove on, it's not really optional...

You explain what's happening...

I'm going to put some lubricant on my finger, OK?

You get them to scrunch their knees up to their chest...

If you just try and relax as much as possible, I'm going to put my finger just into your bottom.

You just have to rise above the embarrassment factor

because the patient is more scared about the experience than you are.

Shouldn't be too painful, it might just feel a little bit strange.

-Perfect.

-All right?

All done. My worst ever experience, I went to put my finger in

and diarrhoea started coming out, and it ran down my hand.

And you kind of saw it, and it gets to the brim of the glove...

and then it went over the brim of the glove and on to my forearm.

I was like, "This is minging, this is minging!"

I'm going to take my finger out now.

So all round, a rather strange experience, I suppose, but something that's very important.

The day shift's coming to an end and Adam's wrapping up for the day.

I'm trying to get jobs for tomorrow sorted,

and hopefully I can come in tomorrow and not be, like,

a clown, like this morning.

I just want to be a bit more prepared tomorrow, so I can kind of hit the ground running.

At home, Adam vents his frustrations.

I haven't used my brain since finals and everyone thinks I'm really thick.

Even those things that don't seem important, they really are.

Even though it seems you haven't really been trained to fill in forms every day.

I get really bored if I'm not stimulated, so I just feel like I'm not really doing anything.

You are though. You will have that day when you have to go and deal with your first really sick patient.

I do have like really big plans for, you know, what I want to get out of medicine.

But there's a lot of paperwork and a lot of routine stuff.

I've just go to take that one on the chin and know that I'm still doing a good thing,

even if it's not as stimulating as I would have hoped.

Adam's not the only one struggling.

Katherine's also starting to feel the pressure of being a junior doctor.

I'm worried that it's just going to be like a never-ending day.

I'm worried that everything's going to take me so long

that I'm just not going to get home until like 10pm.

Because every job's going to take me just that bit longer

because I don't really know what I'm doing.

And because I'm the only one on the ward, the only junior on the ward,

I don't really have anyone to share the jobs with or anything like that.

Katherine's working in the Plastic Surgery Department.

One of her first jobs is to take blood.

But it isn't proving easy to find a vein.

The arm's quite swollen. I think it's going to be quite difficult.

I just can't see or feel the vein at all.

I don't want to take it out of that arm. I could do your foot.

-I can see a little one here.

-Put a tourniquet on.

Yeah, I'll put a tourniquet on.

It's quite small.

I don't know if I can make it bigger though with a tourniquet.

I'll have a go if that's all right.

I'm really not convinced this is going to work.

No, that's not going to go.

Sorry about that, that's quite embarrassing.

I can't get blood.

Thanks.

The patient needs bloods taking and it's really difficult finding a vein.

So I'm going to have to phone someone more senior to ask them what I should do about it.

It's a bit embarrassing.

But once he sees the veins, I don't think he'll mind.

Hi, it's Katherine.

Hi, sorry to phone you. This is really embarrassing.

But I've got a patient and I can't get a vein on her anywhere.

So I've tried her foot, but I couldn't get it.

OK, thanks very much. Cheers, bye.

So, help is on its way.

I'll just go and let the nurse know.

Whilst Adam's managed to take blood from a patient, he's missed the deadline to the lab.

Because I did it after five, it means I have to get it sent in a taxi.

Which means a run-in with Head Nurse Doreen.

Doreen, would it be possible to get a taxi for a sample of blood

to go to the Freeman Microbiology?

It's after five and I didn't realise that, when it's after five, you have to...

Right. We'll have to check with Patient Services, cos we're not using taxis because of the cost.

-Yeah...

-Right. I'll ring and check.

-Thank you. Thanks. Sorry about that.

I should probably check first before I take his blood.

Doreen knows I'm new.

She knows I'm not a twat.

So... And that I will have learned from it.

So, you know, I can imagine Doreen could get angry.

But that was probably her, kind of, nice, "I'm not impressed."

It should have been done long before five o'clock.

The thing is... You're quite right, but because it was at six

and they told me to do it an hour before his gent thingy,

I didn't realise it had to get sent to the Freeman.

I know now. At least I know now.

-You know now. OK.

-Anyway, sorry about that.

-Thanks. Thank you very much.

-You're welcome.

All junior doctors rely on the nurses to help them get to grips with the job.

The nurses are fantastic.

Screwed without them.

If they're new in the hospital,

they don't necessarily know how the system works.

It's our job to try and tell them.

I always make a point of going in and saying, look, I know you're new.

It must be horrible.

If there's anything you're not sure about, ask.

-Did you know you can get medical degrees off iPhones?

-Err...

SHE LAUGHS

We were all students once. We all had to start at the bottom.

You've got to cut them a bit of slack.

Despite support from the nursing staff, first-year Katherine is finding the workload demanding.

-Do you want us to help you?

-I've just got so much stuff to do. MOBILE RINGS

I've already got a patient that's been waiting for an hour-and-a-half now, down in clinic. Hello?

We are busy. We've got a lot of discharges today. We've already got names waiting to go in the beds.

Would you mind if I do these buds? I'm a bit more sorted after I've done these.

I'm trying to help her, but I can't write scripts for her or anything like that.

As a second year, housemate Keir is more experienced.

Cross this out for now. I will come back and do that when I've...

Yeah, I've got quite a lot of jobs to do, still.

Right, let's just stop, then.

The busier you are, the more you need to stop. OK?

Let's just stop.

Go through the list of stuff and write it in order of priority.

Katherine's learning that you have to be tough to make it as a doctor.

I think I like ballet because it looks really girlie and pretty,

but you have to be really quite tough to do it.

My first year at university, I failed two of my exams and I had to spend the entire summer studying.

That was hard. I lost a lot of confidence and I really had

a chip on my shoulder that I wasn't good enough to be there.

I was working just as hard as everyone else, but everybody else had passed and I'd failed.

That was really difficult, to build up my confidence after that.

She knows her own mind and she's very determined.

She's always worked very hard.

So she knows what she wants and everything else just sort of floats by her, really.

I think she comes across as this smiley, bubbly little girl.

But, actually, she is pretty resilient.

I definitely feel I have to work at things

if I want to achieve something.

Only a few days into her job, there's a lot to work at.

-Ward 11's the next priority, that's a child. Children are important to deal with quickly.

-I'll do that.

-OK.

Then we've got loads of discharge scripts that need writing.

We've got drug charts that need copying up.

Now that we're at four o'clock,

there will be people who won't get home tonight

if we don't start getting through discharges, OK?

After a tough first week, Katherine lets off steam to boyfriend Tim.

Hey, how's it going?

I found it really stressful. I felt out of my depth

and I just came home thinking, "What if it doesn't get better?

"What if I actually can't do a good job?"

I don't know if I'm cut out to do this.

Yeah, I think I'm going to have to develop a bit of a thicker skin.

It's the weekend,

and a big night out in Newcastle.

Katherine gets to see Tim for the first time since she moved up here.

# Yeah, yeah We bring the stars out

# We bring the women and the cars and the cards out... #

Adam, Andy, Keir and John are on a boys' night out.

And Suzi's also getting ready for some Friday-night action.

She's about to start her first set of night shifts.

It's a Friday night in Newcastle.

So I think it's going to be pretty busy.

The weekends are the busiest nights for casualty.

In the UK, one million people a year are taken to hospital after drinking.

A & E's a scary job because you don't know

what's coming in through the door.

Is it one casualty, is it ten?

Is it someone that's well, someone that's sick?

From Suzi to Dr Batchelor.

It's going to be really busy.

As the pubs and bars close, it's going to get busier. It's a bit scary.

THEY SHOUT

I've heard they usually have some paramedics on standby here. But right now, it seems...

Where are they tonight?

I've not seen any hint of trouble...

Wey!

Add in a few more drinks in a couple of hours' time and I'll be like, "Good luck, Suzi!"

# ..around here... #

In A & E, the casualties are piling up.

Suzi will find it hard. She will notice,

at night, it's completely different.

It is like a war zone. There are bodies everywhere. She will have to do more.

The pressure on her will be intense.

# They said it changes when the sun goes down... #

Friday and Saturday nights can be ridiculously busy.

Things, as you might expect, can be related to alcohol.

Which can be a bit challenging, at times.

-BLEEP!

-Calm down.

# ..around here... #

Suzi's struggling to find her next patient amongst the mayhem.

No? My God!

It's that guy there, in the corridor with the fluid on.

It's not surprising she's finding it hard to locate him.

He's unconscious on a trolley.

Let's get him into a room, shall we?

The department sees an average of 220 patients over the weekend.

One in five will be treated for alcohol-related problems.

Can you squeeze my fingers, please?

Squeeze them. I think he's had a little bit too much to drink.

So we've got fluids going in to help sober him up.

It's one of the doctors here.

How are you feeling?

HE SNORTS

I have a good time and enjoy a drink when I'm out.

But I have never been to A & E.

Bonus!

Night shifts and irregular hours are part and parcel of a doctor's life,

as the housemates are all discovering.

We have such peculiar shift patterns

and we have such peculiar, kind of, lifestyles

that, ultimately, you end up having to socialise with a lot of people

that you work with as well.

You work long hours and no-one's going to understand that,

apart from other doctors, because they have to do the same thing.

You can never say, "I will definitely be finished at five,"

or definitely be finished at this time.

Something might crop up and you have to stay.

Out of the seven junior doctors living together, Suzi's having the toughest week.

-Suzi's next patient is sober, but in a lot of pain.

-Hello.

Obviously I see what your problem and everything is.

Are you fine with me looking, or would you rather have a guy?

You're fine, yeah?

Tony's stitches have split, following a recent operation to his testicle.

OK, so where is it that's been sore? Round here?

It all the way round there.

It feels like somebody's keeping hold of them, squeezing them.

Probably speak to a urologist about that.

It's generally quite inflamed still, isn't it?

Righty-o. I'll go and have a chat with them and pop back.

-Thanks again.

-Cheers.

Don't mess with it. I would give whoever's on call in urology and say

-you want somebody to have a look.

-Right.

In A & E, I haven't ever seen any testicles before.

As a medical student, I saw them a couple of times,

but not a lot of times.

Pictures are quite a good way of passing on information clearly.

That's why I'm drawing pictures.

If I didn't need to, I wouldn't, because I'm terrible at art.

I think it's awkward, examining a man's testicles who's the same age as me.

And if it was me, I'd be weird if it was a man looking, if I had any problems down there or anything.

It doesn't bother me, being seen by female doctors, you know.

Just as long as it's getting rid of the pain, that's the main thing.

Suzi gives him some painkillers and sends him to theatre to be re-stitched.

The housemates are feeling the impact of their new jobs.

My day was quite hectic. I feel like it's less of a job and more of some sort of

sick initiation ceremony to allow you to be a real doctor.

I don't think being a doctor is all it's cracked up to be. It's just being a ward bitch.

You're saying that you feel experienced enough to be a doctor?

Do you feel ready to give somebody the diagnosis that they've only got three weeks to live?

-Yes.

-Are you sure you could actually

tell somebody they've only got weeks to live?

Because that took me a long time to actually have the courage

to say that to somebody. It's not easy.

There's nothing more I can do without actually being a doctor. So, yeah, I do feel ready.

I need the experience now to hone my skills, and to...

I think it's quite dangerous, in a sense, to have that

understandable confidence that says, "I'm ready to be a doctor."

These are the sorts of things you only get from decades of experience.

That is on fire!

I think that, erm...

-It's the paper, it's the paper.

-It's stopped now.

This week, it seems like Adam can't do anything right.

He needs a chance to prove himself.

You don't realise how much crappy paperwork there is

-and

-BLEEP

-to do until you start doing the job.

I got into medicine for reasons other than my entire day

being taken up doing paperwork.

So I hope that's going to change.

Theoretically, if that didn't change

and I was doing this amount of paperwork for the rest of my days,

I'd quit tomorrow.

But now, Adam could finally get the break he's been waiting for.

He's going on-call.

Covering up to 170 patients over five wards,

he will be the first doctor to see any patients needing medical help.

MOBILE RINGS

Hello. OK, I'm coming, thanks.

A patient is trying to discharge himself against medical advice

and Adam has been asked to try and stop him.

Hi, so you know we just want what's best for you, right?

Please, just look at me, sir. Please, please. Come on. I'm not that bad looking!

You know it's best for you to stay in hospital, don't you?

You do understand that I want to stay for your asthma and to get you better.

-If you go...

-I'm all right.

-..it's against medical advice.

-I understand that.

-Do you understand?

-Yes, I do.

-You do realise that?

-Yes, I do.

You know we just want to take care of you.

I want to go home.

Despite Adams's best efforts, the patient leaves.

He wouldn't stay in hospital, so unfortunately he has absconded

against medical advice. I don't really know what to do about that.

If he wanted to go, he'd probably end up going anyway.

I know. I can't physically force him to stay.

I did as much as I could to persuade him to stay.

Did we come off 30 or 31?

Where were we at before? Oh, crap!

-And then, at last, he finally gets his first real emergency.

-BEEPING

Cardiac, adult, RV.

It's a crash call.

It means a patient somewhere in the hospital needs immediate attention and could be in cardiac arrest.

Hello?

He needs to find the patient as quickly as possible and try to save them.

Less than 10% who suffer a cardiac arrest survive.

He's got a pulse, peripherally.

Adam takes his place in the crash team.

The patient is unconscious, so he checks the patient's pulse.

Fortunately, his heart is still beating.

Then they give him oxygen to bring him round.

You feel the adrenaline just hitting you so hard.

Your heart's pumping so fast and you feel sick.

And, you know, you're sweating and you're like, "OK, what's going on here?"

You see somebody collapsed and you need to assess the situation.

You need to do something quickly and to be decisive.

-BLEEP

-finally hit us.

We're actual doctors now.

On the other side of the hospital, Adam's been called to see

85-year-old Lester with a lung complaint.

Tonight, his condition has deteriorated.

Hi, I'm just going to get you up a bit.

How are you doing?

OK, he's not well. He's not well at all.

Adam decides to investigate further.

He orders a second chest X-ray to compare with the old one.

I could be convinced that the new one is a bit worse actually.

I think it's the heart that's the problem and it's backed up into the lungs.

Yeah, I think the new one is definitely worse. Definitely.

Adam thinks the patient should be on additional medication,

but first he needs to check if he's right with a senior doctor.

Do you think I can give him Frusemide, or is it not really a decision I should be making?

-No, if you're comfortable and you know what you're doing.

-Cool, sweet.

Adam's confident he has got it right.

Yeah, I'm going to give him Frusemide. I'm going to give him Frusemide. I knew it.

This is the first time, as a doctor, he has made a diagnosis.

BEEP!

OK, can we start Furosemide?

40. I'll hand it over and she'll come over.

Thanks very much.

Now, that is different from the day job.

Very different.

That's why you are a doctor.

The first time I'd seen a sick patient on my own

I didn't really know what to do

and I was kind of sat there, thinking,

"What's going on with this guy?"

And the thing is, my gut instinct told me something's going on.

That was pretty much it.

The next day, and Adam is back to check on Lester's progress.

Good evening. How's it going?

The ward nurse has some good news.

His family are chuffed to bits.

It's nice to see something you've put in motion have a good result.

-I'll have a chat with him.

-He'll be delighted to see you.

-I'm so happy about that.

-Seriously, good job.

-Yeah, yeah.

Hello. How are you feeling today?

I feel much better than what I did yesterday.

OK, good. I'm glad to hear it.

And so am I.

'It's my first real taste of doing good.'

It's so nice when you feel you've made a difference in someone's life.

And forever, I'll have that moment.

With the first week under their belt,

some of the junior doctors finally get a chance to let their hair down.

I'm so glad to be finished!

LAUGHTER

Dirty laundry, public.

LAUGHTER

I'm really surprised, actually,

at how I haven't hated it, and I've actually quite enjoyed it. It's been good.

But it's just been so up and down, like really good things and then really bad things.

My life has changed within about a week

from sitting at home, playing PlayStation...

Yeah.

..to running after crash calls and dealing with critically-ill patients.

-It's like you go from nothing to like...

-Welcome to the club.

-Thank you very much.

-It's all right!

'I do question, sometimes, what I'm meant to do in life.'

I still feel, on balance, that being a doctor,

I feel is what I was meant to do.

But I'll just have to wait to see if I fulfil that prophecy or not.

These seven nights have been probably the most challenging seven days I've had in medicine,

but that's what A & E is and that's what life is, so you can't really moan about it or complain.

It's just something that needs doing.

Next time...

Cardiac arrest. Cardiac arrest?

-John's on emergency call.

-You're doing well, sir, you're doing well. Fluid.

And Lucy learns she can't save everyone.

This poor lady has been told the worst news she's ever going to hear.

She's just been told, "Right, you're going to go home to die."

That's... So...

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