Episode 2 Junior Doctors: Your Life in Their Hands

A typical night in A&E. It's like a battlefield.

Lots of vomit, lots of unconscious bodies lying around.

Full of twenty-somethings after a night of binge drinking, bad behaviour and brawling.

Hey, language!

But not every twenty-something in hospital is a casualty.

I'm Suzi, I'm one of the doctors, I need to ask you some questions.

Ready to take care of these patients are an army of people the same age

who have spent their twenties studying to become doctors.

Their medical training has cost £150,000 each.

They are newly qualified and about to face the harsh realities of life on an NHS ward.

You can pass an exam,

but it doesn't prove you can be a good doctor.

I'm sorry!

It is sort of life and death. HE SIGHS

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

Welcome to the world of junior doctors.

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

Days like today just make me want to quit medicine.

Seven newly qualified doctors are sharing this house in Newcastle.

Second-years Kier, Andy, Jon and Suzi

have been working on the wards for 12 months.

I'm only human, so is every other doctor in the world, you know?

We can't work magic.

First-years Lucy, Katherine and Adam

have been qualified doctors for just two weeks.

I just feel like I'm still out of my depth.

It's more scary than exciting.

They have all spent at least five years at medical school

learning to treat patients and save lives.

Cardiac arrest. I'm in A&E. Can we get...?

Until you actually come and do the job, you don't really realise

that you will have this level of responsibility.

You do know your responsibility is going to be changed.

There is so much to learn. I just feel like I hardly know any of it.

Now as first-time doctors, they're finding out if they've really got what it takes.

Could you give me your hand? This needle's just about to drop out.

Cardiac arrest...turn left or right?

Which way?

And they're learning the toughest lesson of all...

This poor lady we've seen today has been told some of the worst news she's ever going to hear. Ever.

Her life has literally been taken away from her, like that.

..that they can't cure everyone.

Morning in Newcastle. At the house

that our seven newly qualified junior doctors are sharing,

they're getting ready for their next shifts at the city's hospitals.

24-year-old Jon is heading to a new assignment on a new ward.

I've only been doing this job for 12 months,

so I'm not proclaiming to be the best in the world.

As long as I do what's expected of me,

do the basics, you know, and don't make any massive cock-ups,

that's kind of really all that can be expected.

Jon is based at the Royal Victoria Infirmary's Emergency Assessment Unit,

where he's part of the hospital's crash call team.

And it's not long before the crash alarm on his phone goes off.

It means that someone somewhere in the hospital needs urgent attention.

Cardiac arrest.

Jon must drop what he's doing, find the patient and try and save them.

It's a life-or-death situation.

The patient has gone into cardiac arrest. Her heart is failing.

Less than 10% are successfully resuscitated.

Jon is one of the first on the scene.

The patient has no pulse.

Jon starts chest compressions to keep blood flowing around the body.

29...30.

But with no heartbeat, time is running out.

-The team have done everything they can.

-Thanks, guys.

The death of a patient is something Jon and his housemates

will all have to learn how to deal with.

Just need to find a bin.

That's it, really...

It was unsuccessful. Most cardiac arrests you go to are unsuccessful.

If they're not monitored... If they're not on an actual screen...

and people don't see them actually have a heart attack,

there's only about a 10% chance that you get them back.

This lady was pretty ill...

in the first place and then had a cardiac arrest on top of it.

So that was it, really. There was nothing we could do, unfortunately.

So that's that. Back to the ward.

All junior medics must come to terms with the fact

that they can't save every patient.

Junior doctors really are dealing with other people's lives

and that's a huge, huge burden of responsibility.

People feel that and they feel that quite acutely.

It's a level of responsibility that most people

would never have to deal with at any point in their lives,

even when they're quite mature and could perhaps handle it.

Junior doctors are 23, 24...

That's a big deal at that age.

Whether on a crash team or on a ward,

junior doctors have to face life-and-death situations every day.

First-year Lucy is starting her medical career on the specialist gastroenterology ward.

That's a bit strange, our names are on the wall already.

I know. That's scary, isn't it?

No pressure.

The gastro ward deals with all parts of the digestive system, from top to bottom.

They treat patients with life-threatening bowel and liver disease.

So Lucy's first experience of working as a doctor

will be learning to treat some of the most seriously ill patients in the hospital.

When I saw gastro was on here, it was one of the ones I wanted to get some experience on.

It's a hard ward to work on.

A lot of the alcoholic patients are hard to deal with because of their behaviour.

It's either somewhere you love or you hate, there's no sort of in-between.

So I guess with gastro, if you're a bit funny on bowels...

If you don't like bowels and stool samples and things, it's not the place to work.

With six million young people in the UK regularly binge drinking,

the gastro ward is seeing many younger alcoholics.

So 24-year-old Lucy is treating some patients her own age.

There's a new lady in bed 12, she's an alcohol abuser.

She's on the detoxing regime.

She's been referred to the gastro ward to further assess her condition.

Is the pain there all the time or does it come and go?

Living situation, do you live by yourself?

Live in a hostel. OK.

-Do you mind me asking, do you smoke?

-Yeah.

How long have you smoked for?

And do you smoke anything other than cigarettes at all?

-No. Just that.

-Just cigarettes, OK.

And alcohol-wise, I understand you do drink and you're on a detox programme in here, is that right?

What is it that you drink?

How much do you reckon you have on an average day?

-Is that every day?

-Yeah.

So the fact that you're not able to drink is telling you

that you are very poorly, OK.

Did that frighten you?

You're in the right place now to get that sorted. Definitely. OK.

'We are a similar age and that is a strange feeling, that we're in very different situations.

'I hope that in talking to me or whoever manages her in the end,'

it helps her to feel she's being listened to and not judged.

I mean, I certainly wouldn't judge her for any of the decisions she's made

because I don't know what's happened in the past, what's started her off with all of that kind of thing.

It's not for me to say. The most important thing to me

is if we can, we can get her off it and keep her off it.

'Just had a chat with Laura.'

I will go and look at those bloods,

find her notes,

and perhaps speak to Vijay about what to do next

in terms of whether she needs to have that fluid taken off and sent off.

-So I'll go and document all that.

-Lovely. Thanks.

-No problem.

While Lucy is learning to deal with patients with long-term problems,

24-year-old Jon is working at the sharp end of medicine on the Emergency Assessment Unit.

When he's not responding to crash calls he has to deal with emergency cases sent in

from other wards and from local GPs.

It's one of the most demanding wards in the hospital.

Hello, my name's Dr Barclay,

I'm one of the doctors over at the Emergency Admissions Unit at the RVI.

'We are the receiving ward all from GPs and all accident and emergency,'

so it all comes and gets funnelled.

Then some of these patients need to move on to other wards

but there's a backlog in beds there, so basically we have to accept everyone.

Yet there's nowhere to send anyone to.

That's why it's the busiest ward in the hospital.

The ward assesses up to 50 patients per shift.

Jon must learn to separate the mundane from the life-threatening.

A bit of everything, really.

Just try and plough through the patients as much as possible.

He's the ward's first line of defence.

What I'm looking for really in a good junior doctor

is the ability to manage patients.

Not just to make the diagnosis.

What we look for, we look for the transition from being a medical student to becoming a doctor.

Jon's next patient has lost the feeling down one side of his body.

Keep it in the air, don't let me push it down.

Good. This one.

Keep it on it in the air, don't let me push it down.

Jon checks for nerve damage.

It could be a sign of a stroke.

-Ahh, got very tender feet!

-Sorry!

'When you run your pen down someone's foot'

it makes their toes curl downwards, but if you have problems

with the connections in your brain your toes can go upwards instead.

He's passed the pen test.

Next, Jon takes some blood for further investigation.

Have you done this before?

Just a few hundred times. Scratch.

-All done.

-Oh, sh...

-Is that it?

-That's it for needles.

Don't forget me cheque!

The key to Jon's role is prioritising the most serious patients.

So I have a dilemma.

These people came in 20 minutes beforehand,

but this gentleman's slightly sicker.

Swings and roundabouts, really.

Let's see the sick guy, shall we?

Jon's whole life is one big balancing act.

MUSIC: "Song 2" by Blur

Woo-hoo!

I think it's fair to say that doctors have a reputation of work hard, play hard.

'I do lots of stuff in my spare time. I play with drums in a band.'

# You give love a bad name. #

That was great, thank you.

We have a job which is time-intensive so we don't get a lot of time off.

And also it can be quite stressful.

You can be under pressure a lot of the time.

And so, when you do get a chance to let your hair down,

a bit of a release, then you want to make the most of that, really.

'Rugby has a bit of a niche'

for people of my size and with my abilities.

He's definitely a big part of the club both on and off the field.

Size-wise, mainly!

'Jon Barclay's acceleration is one of the finest you'll see'

for a guy who is essentially a whale.

'It can be hard to fit in with my schedule sometimes.

'Today, I finished night shift this morning so I've been awake...'

for 26 hours.

I think it is important to have a life outside of medicine, definitely.

If you just did medicine I would just get massively depressed.

I'd get into a rut and it wouldn't be enjoyable any more.

The time constraints of the job make it hard, but my job's my job.

This is kind of my fun.

ALL SING: # Jon Barclay, you suffer from morbid obesity

# And you're gonna die young Jon Barclay. #

Back at the hospital the Emergency Assessment Unit is getting busier.

Hi, mate, are you still doing jobs from the morning? Have you been able to see anyone yet?

Jon thrives on having lots to do.

But he needs to prove he can stay on top of the workload.

It's just frustrating.

It's pretty busy today. All the beds are taken.

We've still got people in the waiting room. I've got people I need to see

but there aren't any rooms free to see people in.

I don't know why it's such a busy day. It's just a terrible day.

Sort this guy out, I'll see if the one up here is free.

And his day isn't getting any easier.

Another emergency case has arrived.

A man has been admitted suffering a severe seizure.

Jon has to try and diagnose the cause.

You just had another fit.

You bit your tongue which is why your mouth tastes a bit funny.

I need to have a look in your mouth, Fred, to see where you bit your tongue.

He's been admitted to us because he had an alcohol-withdrawal seizure.

It means that when people drink excessively, when they stop drinking,

go sort of teetotal, they go into withdrawal.

Like you would from any other drug.

So we need to give him enough medication to sort of calm him down a bit.

Then we can do some investigations to try to get to the bottom of what's wrong with him.

Jon has stabilised him but there's no let-up.

I was supposed to see this lady about half an hour ago but the rooms were occupied. I just need to...

And there's nothing else I can be doing. This is down time.

I'm literally just waiting.

A patient has been referred from A&E.

She's suffering from a severe asthma attack.

It's years since I've had such a bad attack.

There's just no way to control it at all.

And do you feel like you're struggling to catch your breath or...?

It just seems like there's a blockage. You know?

-Would you say your chest feels a bit tight?

-Uh-huh. Yeah.

Yes. It was like a brick. Uh-huh.

Yeah. And it hasn't even eased off.

-SHE WHEEZES

-Just playing itself.

Do you want to pop up on the couch for me? I'll have a quick examine.

Just have a listen to your heart and your lungs.

Then we'll get you sorted.

Some nice deep breaths in and out through your mouth.

SHE COUGHS AND WHEEZES

She's got a history of lung disease,

so Jon prescribes medication she can inhale

to get to the root of the problem.

We'll give you some nebulisers.

Keep going with that and just try to get on top of that, OK?

I'd love a cup of tea, actually.

SHE LAUGHS

I'll pass that on.

Another patient dealt with.

But there's always another to see on the EAU.

His next job looks like an extreme case of athlete's foot.

What's been going on with you, then?

I was a fireman by profession and I got involved in a lot of different chemical jobs, type of things.

-One doctor put it down to metallic poisoning.

-Right.

-Is it painful?

-No.

Jon prescribes a course of antibiotics.

His ability under pressure hasn't gone unnoticed.

His knowledge base is good,

is sound. He's going to make a very, very safe doctor.

I would be happy to be looked after by him. For a nurse to say that, that's quite good.

As a second-year, Jon's responsibilities are growing.

But on the gastro ward, Lucy's discovering that first-years often have to start at the bottom.

I wonder whether she's passed some stools and they want me to have a look at it.

Right, so if I just have a quick look...

-Doesn't look like there's any blood or anything.

-No, there's no blood in it.

Just greeny, because obviously I've not experienced these things yet.

Sweet smell. Green, very watery, isn't it?

A green and watery stool is a sign of a serious infection.

It could even be the deadly C Difficile bacteria.

But even stool samples can't dent Lucy's passion for medicine.

From a young age she's always known she wanted to be a doctor for a very particular reason.

I've got a little sister, Sophie, she was diagnosed with cystic fibrosis.

That encompasses a lot of care and treatment.

From her coming home, really, from hospital during that time, I got involved in her care.

It really made me want to go further with that kind of thing

and obviously medicine is the perfect way to do that.

On paper, the life expectancy, the prognosis isn't great.

Obviously, that's hard for me and my family when you sit down and actually think about that,

having someone who's so close to you with that kind of condition.

It's good to have helpers. Very handy indeed. Makes it a much nicer process.

Bananas, nuts and I'll add the chocolate chips in a minute.

When Lucy gets stressed, Lucy gets baking.

It might be time, Sophie, to test a bit.

She is the older sister and always wants to look after the younger ones.

Always feeling that maybe that's her role, but she enjoys it so much.

The perfect older sister you could ask for, really.

Lucy's sister is well at the moment but cystic fibrosis is a life-threatening condition.

There are more than 8,500 sufferers in the UK, and they are often in and out of hospital.

At the Royal Victoria, cystic fibrosis patients are treated on the hospital's respiratory ward,

where Lucy's housemate and fellow junior Adam has his first job as a doctor.

Cystic fibrosis affects the lungs and the pancreas. You get lots and lots of lung infections.

Your lungs eventually fibrose,

in that they harden up and shrink down.

You are not able to produce a lot of the enzymes you need to break down

foods and you don't absorb things very well.

So you're malnourished and your lungs are screwed.

Despite advances in treatment, half of today's sufferers won't survive beyond their 38th birthday.

Patient Chris is 20 years old.

What's it like being a young person in and out of hospital so much?

It didn't used to bother us at all...

when I first started coming in every two weeks.

But when you start coming more often...

I was in Christmas, my birthday.

It's like my chest can't cope without IVs.

So as soon as they wear off, I start to develop a cough during the night.

-Then my appetite goes and I just end up back in.

-Mm.

It's like my Sunderland season ticket.

-I can't buy one now cos I don't know when I'm going to be in here.

-Yeah.

Are you in hospital more than you are out of hospital at the moment or what?

It's about 26 out of 52 weeks, yeah.

Really? That's a lot of weeks in hospital.

Cystic fibrosis sufferers are often in and out of hospital and they see a lot of junior doctors come and go.

Next Adam is seeing 28-year-old Laura.

-So how's it going? Shall we see if we can find some blood from you somewhere?

-OK.

Is that blood coming out?

-Oh, yeah, it's blood coming out.

-SHE LAUGHS

Adam seems to be making a good impression.

He's hilarious.

Brightens your day, actually.

You get some that are just not very...

Kind of moody and stroppy teenagers

cos they're all a lot younger these days, aren't they?

Scrubs up well,

as I would say.

'You know, it's got to be hard for them.'

I try and empathise as much as I can but it's limited.

Cystic fibrosis patients bring the junior doctors face to face with the limitations of medicine.

Lucy's finding out if she can cope with this at work,

as she's treating other seriously ill patients on the gastro ward.

It's the start of the shift and she's with consultant Dr Gunn on the ward round.

Consultant runs the consultation with the patient and junior doctor runs around with the pen,

scribbles in the notes and orders blood tests

and writes all the things that need to be done.

Usual notes hunt is going on.

They are allegedly in here but they are not actually in here.

A short history of diarrhoea, sent stools off and she's doing better.

Fine.

Let's go and see.

The ward round is also a chance for juniors like Lucy

to shadow senior doctors as part of their ongoing training.

Dr Gunn is really good. She does teaching on the ward round as well.

Should be a good learning experience.

Dr Gunn's particularly concerned about one patient.

She has been admitted with a swollen tummy.

And you have been unwell on this occasion for how long now?

It's been going on for 12 weeks.

OK. And what is it you have been noticing?

First of all I completely lost my appetite.

I think I've lost at least a stone and a half.

OK. Vomit?

Yesterday.

OK. Your tummy, then, when did that start to swell up?

I'm not sure, but it's got increasingly worse.

How are you with walking around?

A bit wobbly.

See you later, Nora.

The patient has had a number of tests to determine the problem.

Her X-ray is back.

As part of her training, Dr Gunn asks Lucy to assess it.

Bowel-wise, it looks like some gaseous dilation here on the left hand side.

Here there is this sort of central dilated small bowel.

We know she is obstructing radiologically

and it sounds like clinically, because she is acutely distended.

So she's in trouble. She has now got a fairly rapid change in her clinical status

in the last six weeks and now got small bowel obstruction. She has not got a curative disease,

we can't take this out with an operation.

Chemotherapy is not particularly good.

She's not going to be fit enough for it anyway.

I need to assess her clinically but I have to say,

my gut feeling is we should be conservative because I think this is only going to get worse.

There isn't an operation to help with this, be that palliative or otherwise.

Dr Gunn makes the final diagnosis.

It's pancreatic cancer.

In this case an operation won't help and the condition is terminal.

Although she's poorly,

she's got this bright-eyed happiness about her in a funny kind of way.

Like she's here and she's being sorted. I don't know,

I could be misreading it but I get the feeling

she's not going to have any idea of what's about to be said.

Dr Gunn must break the news,

and Lucy accompanies her.

This poor lady that we've seen today has been told some of the worst news,

well, the worst news she's ever going to hear. Ever.

Her life has literally been taken away from her like that,

and she's just been told, "Right, you're going home to die."

So...yeah. Anyway...

Is there anything else you want me to do for her today? Is it all sorted?

-OK.

-Are you all right?

-Yeah.

-You sure?

-LUCY CRIES

I know it's sad, isn't it?

She's, um, she's got good family support, which helps a lot

and we'll get her feeling better, which is the important thing now,

quality of life, which we can definitely improve on.

-I'm fine.

-I know, it's horrible. The difficulty of course...

It's all right. Something just came over me.

I won't be nice because I'll make you worse.

-All right.

-Thank you. That's it for today?

-Brilliant. OK. No problem.

-Thanks, Lucy.

-That's all right.

There's a lot of patients you can't save, if that's the word you use.

You can improve on patients and that's what a lot of the goals are,

not necessarily curing them but making them better.

There are specific challenges, such as the patients who have advanced cancer who come in and die

and that's very hard, I still find that very hard.

After a 13-hour shift, Lucy's finally back at home with the other junior doctors.

Are you OK?

-Just knackered and had a

-BLEEP

-day.

-Why was it a

-BLEEP

-day?

Just this awful case.

A patient has basically been told today that she's got pancreatic cancer.

I don't know, I thought I would be able to keep my cool and I didn't really,

-but luckily I was in the doctor's office at that point.

-That's when it hits you.

-Yeah.

It just left me completely drained. I sat there and I was just like...

Anyway, that was my day.

-Do you need a hug?

-Maybe. Thanks, Kier.

'That was the first time I've been involved in any kind of breaking of bad news.'

To be honest, I don't think it could have been worse bad news to be breaking

'to somebody and their family.

'I'm definitely learning at the moment that there is a limit to what we can do as medics.'

We are only human, and in some ways in medicine, if we could all turn into the superhero,

that would be great, not in the sense of ego,

but in terms of actually being able to save people and cure everybody.

It would be amazing, but that's never going to happen.

Obviously, that's what we'd love to see.

All the junior doctors know that tomorrow, it could be them facing the same situation.

Suzi has been assigned to accident and emergency, where, every shift,

she has to deal with critical cases.

-Are you happy to shock?

-I haven't shocked anyone.

I have been at arrest calls before, but never in an A&E situation.

Can you squeeze my fingers, please? Squeeze them.

It's one of the doctors here. How are you feeling?

Now back in A&E,

she's facing another major trauma incident.

A man has attempted suicide by jumping into the River Tyne.

He was saved from drowning, but after 30 minutes in the river, his core body temperature has dropped

and he's at risk of severe hypothermia.

This gentleman's come in. He was in the River Tyne for about half an hour.

So we have to get him warmed up.

Sharp scratch coming now.

An estimated 30,000 people die from exposure to the cold every year in the UK.

Suzi attempts to bring his temperature back up slowly

by pumping warm fluid into his bloodstream.

-Have you had a drink, then, this evening?

-That's all I've had.

Finally, with his temperature stable, Suzi can check for other injuries.

I was watching the telly this afternoon...

Is that normally sore for you?

-It is sore normally?

-I've been drinking a lot.

Could I ask you to take a big deep breath for me? And out?

HIS CHEST RUMBLES

That doesn't sound clear. Need to get him a chest X-ray. Saturday night.

Everyone else is probably out having a drink. I'm here.

-But I'm helping, so it's fine. What, sorry?

-No drink.

No drink, I know.

He's stable and out of immediate danger. Suzi and the team have done all they can,

but he'll have to be referred on to another department for further treatment.

Also working nights for the first time is Suzi's housemate, 24-year-old Katherine.

She's a first-year, on call and part of a team covering up to 280 surgical patients.

With only a couple of weeks' experience as a fully fledged doctor,

her skills are being severely tested.

When the pain comes on, do you get any other symptoms?

Hello, Joyce.

Can't seem to be able to order any bloods on the computer...

No-one else seems to be having any problems.

In her first few weeks, Cambridge graduate Katherine found the workload tough.

I've just got so much stuff to do.

I've already got a patient that's been waiting for an hour and a half.

Cross this out for now.

I will come back and do that when... I've got quite a lot of jobs to do.

Right. Let's just stop, then.

I don't think I appreciated how difficult it is when you're just

literally being bombarded with jobs to do and everything has to be done in the next ten minutes.

But now Katherine is working nights,

a job which brings its own particular challenges.

It's been pretty busy. Haven't had a break yet.

I'm pretty tired.

But no more tired than I would be on the day shifts

if I'd not had a break until this time anyway, so not too bad.

Been working... I don't know how many hours, since 8.30 yesterday evening.

I'm getting quite tired.

Another patient has arrived and needs a small tube, called a cannula,

inserted into a vein to allow them to get fluid and medication directly into the patient's bloodstream.

But this patient doesn't like the sight of her own blood.

-Let's decide which vein to go for.

-I don't look when you put the needle in me.

I'll let you know when I'm going to put the needle in, so you can look away.

Sharp scratch.

-I just don't like to see the blood go out.

-All right.

Could you give me a hand?

Sorry, this needle's just about to drop out.

Oh, I think it's coming off.

-Have you got it now?

-Nearly done. Gosh, it's now stuck to the pillow.

Sorry. The little bung popped out on the end of the cannula.

We'll just clean it up a bit. The main thing is that it's in and we can give you some fluids.

Finally, the tube is in, minus a bit of blood, and the patient can get the fluids she needs.

(It's hard to concentrate when you're really tired.

(You just have to be careful and be extra cautious

(and recognise your limitations.)

All the juniors are learning just how far they can stretch themselves.

Jon's pushing his limits. He's finished his day job,

but he's just getting started on a night shift of his own.

At the moment, we're setting up for the gig.

We'll do a sound check in a minute when our fourth member finally arrives.

I just hit myself in the face with a cymbal! That was pretty painful.

Jon works hard to fit in a social life,

but even away from the hospital, he can't escape the pressures of being a doctor.

I'm covering urology on nights next week, and I've never done urology.

We had a guy in today, a young kid, 17, who had right-testicle pain, swollen for about a week.

-Did a

-BLEEP

-ultrasound. It's been dead for two weeks.

He must have a high pain threshold.

-What's happened to his testicle?

-It got removed.

Medics tend to talk about medicine outside of work,

which is really boring. I try my hardest not to, because I talk about it for ten hours a day at work.

I try not to talk about it in the evenings.

But I live with medics and I play in a band with medics.

I play rugby with medics.

So you kind of end up reverting to horrible medic chat. But it's all right.

THEY PLAY "Sex On Fire"

All the junior doctors are learning that it's not the kind of job

you can leave behind at the end of the day.

The pressure of work is always on your mind.

After a run of relentless night shifts, Katherine and Suzi are taking time off to hit the shops.

Bit of retail therapy's quite good after a stressful weekend on call.

But even shopping can't keep them off the topic of work for long.

How do you think everything's going anyway, with work and stuff?

When I first started on call, I felt completely thrown in at the deep end. And it was horrible.

I hated my first day on call.

There'll be days when you wish that the ground would swallow you up there and then,

or when something bad happens or when it's stressful.

And you can't get everything done, because you're not Superman.

Every day, Suzi works long shifts and treats critical cases.

The work impacts on all areas of her life.

And even though she's making life-and-death decisions at work,

she still needs a bit of help from Mum and Dad when it comes to tidying her room.

I haven't had time to tidy.

Oh, Suzi! Right, bin liner and skip, Suzi.

I'm wondering why I can't find anywhere to walk.

I was up till 1.00 tidying last night!

What's this here for?

-I was cleaning the surface.

-You keep telling us that normal life is impossible.

Normal life IS impossible!

Last week, I worked five 14-hour shifts and two 12-hour shifts.

I then came home, went to sleep, got up, had a shower, ate some chocolate and went back to work again.

Suzi has made us proud. That little girl, and we've got pictures of her

in all sorts of ridiculous poses, is now responsible and doing things which we can only imagine.

Oops. Can I get back into bed for the rest of the day?

Your room look like you've spent the last week in bed anyway.

It is difficult to see her doing what I know she must be doing,

because she's just our daughter, and...

The mother would like to get into the hospital and just see her working.

I would love to see her working. I have no idea what she looks like.

Yes, I would love to be a fly on the wall when she's in the wards.

I don't want you to overdo it today. Don't get stressed out.

Let's go and crack this egg open.

Right, Suzi, coffee time!

At the hospital, Lucy is back on the gastro ward.

It's her first shift since her patient was diagnosed with terminal pancreatic cancer,

and Lucy's first thought is to find out how she's doing.

On Saturday, she was quite well.

She was managing to drink and keep everything down. She wasn't feeling nausea.

On the Sunday when I came in, she wasn't well at all.

She couldn't get out of bed, and her blood pressure dropped and her sats dropped.

It was all in a two-hour period.

-She passed away. Her family were with her, though.

-Oh, good.

-She didn't suffer for long.

-It wasn't playing on her mind.

-Yeah. That's really sad.

Hello, this is Lucy, F1.

Hi. Yeah.

Thank you. Bye.

That was the bereavement office asking me to come and do the death certificate.

So that's going to be a nice job.

It's another first for Lucy, but one she would rather do without.

I don't think it would matter how much talking about it you do,

no matter how many seminars you have or how many times someone told you about it,

it never prepares you for when it actually comes to it.

It's part of the job, unfortunately, and it's one side of it that isn't a nice side, really.

Lucy's first few weeks on the gastro ward have been a steep learning curve.

Her housemate Katherine also found it tough on her first set of night shifts, but today she's back on days

and is feeling much more confident.

I've been enjoying my job this week, because I don't feel kind of...

Yeah, I'm busy, but not to a degree where I feel I'm doing a rubbish job.

Also, none of the patients seem to be getting sick this week.

Last week, they were all getting sick, which uses up a lot of time.

Her next patient, 29-year-old Malcolm, has had minor surgery on his finger.

But now he's complaining of chest pains.

I've been feeling pain since yesterday morning, but I think it's just to do with work.

-I think it's just muscle pain.

-So it's quite a problem having this pain?

It's just when I do heavy lifting.

Did it come on suddenly or gradually?

-Just gradually.

-Do you smoke?

-Yeah.

-Do you drink?

-Yeah.

How many units would you say a week?

I'm not sure. Probably about 60 pints a week.

-60?

-I don't know what that is.

-Sorry, 16 or 60?

-60.

He drinks about 180 units a week,

which...is way, way, way over what you should be drinking.

Katherine is concerned and decides to investigate further.

From the history, I'm not worried about your heart. The pain's more

around there? On a typical day, how much would you say you drank?

All-day sessions. I was drinking 16, 18 pints.

Do you know if you've ever had any tests done on your liver?

-No, I haven't.

-OK.

Because when I was feeling, I thought maybe your liver was slightly enlarged.

I might ask one of my senior colleagues what they think because it's quite a large amount to drink.

I went to see this guy... This guy, yeah. He's only 29, 30.

I was taking his social history and he drinks 60 pints a week.

And I think he's got a bit of an enlarged liver.

60 pints a week is 120-something units. It's a good spot.

I thought it was the sort of thing

I didn't feel I could go home at the end of the day

having done nothing about.

So it was good to talk to Ian to talk me through what I should do about it

and reassure me that I was right to think that it should be followed up.

If you pop back to the day room...

Katherine sends the patient for further tests on his liver.

A successful diagnosis is a boost to confidence. But a few weeks in,

Katherine is still finding her feet.

I think it'll be a while still before I settle in.

I don't feel massively confident about my organisational skills yet

or my time-management skills. I still need to work on a lot.

I think I'm getting better, slowly.

Fellow junior doctor Adam is also still finding his way.

He's getting to know some of the regular patients on the respiratory ward,

and he's realising the limits to the care he can give them.

Are you comfortable there, sir?

81-year-old John is suffering from an advanced chronic lung disease.

You sure?

You look all skew-whiff.

Just put that cushion up there...

Yeah, there you go.

That'll do.

'He's not really too well. He's on oxygen.'

He's got quite advanced lung disease and he had a heart attack

over the weekend as well, which didn't help matters.

He's a really nice guy, though, so I hope he pulls through.

But the reality is, he's probably only got a short amount

of time to live, and he knows that.

Adam can't cure him. He can just make him feel more comfortable.

I'm going to write you up for that spray that makes the blood vessels wider,

so if you do get any pain, please tell the nurses.

Well, I will take a bit.

Yeah, they call me a vampire.

I can't believe I've got such a bad reputation.

Is that smoking-related?

If you do get any pain in the chest, let one of the nurses know, OK?

Don't just sit on it.

If we can do something about it, we can do something about it.

The blood bank's full now. Until tomorrow! See you in a bit.

Adam has spent five years learning how to save lives, but he can't cure John.

It's difficult when you start to form relations with people on the ward

when you know that realistically, they're relatively terminal.

Really pisses me off that he has to sit there and endure

a quality of life that he doesn't enjoy. It just really pisses me off.

If that was me and my quality of life was like that

and I didn't have any choice in the matter and I had to be kept going,

-I would be really

-BLEEP

-pissed off.

The new doctors are all facing the limits to modern medicine

and of their own abilities to help patients.

I had a patient I sent home last week who came back in via resus.

Obviously when I heard that, I was like, "Crap, could I have done anything earlier?"

But when I saw her, she was fine.

Her tummy was soft, her obs were fine, there was no indication that anything bad was going to happen.

You always think, "Would anyone else have kept her there?

"Should I have done anything else?"

But then I spoke to the consultant and he said, "You aren't able to see into the future.

"There's no way of knowing if someone's fine, that they're going to get sick."

It'd be a really easy job then.

But it's not.

There'll always be good days and bad days and some of the bad days are like the worst days ever.

There is a huge problem, and one that can't be avoided,

of people expecting us to be perfect.

We're only human. We're like everybody else.

The only difference is that we've been to medical school.

We've been trained. That's the only difference.

If you could have one superhero power that wasn't the power of healing

to help you as a doctor, what would it be?

I'd like to be able to see into the future and know who was going to get sick and treat them

right as they got sick, and then they'd be fine again.

But that will never happen, which is why it's hard being a doctor.

I would like the ability to know where anything was just by thinking about it.

Not to summon it to your hand?

It's a very simple thing, knowing where everything is in every IV room or in every crash trolley,

or simply where the gallstone is or the tumour...

Just that ability would cut out an awful lot of wasted time.

I would want something like X-ray vision, with telekinesis.

I can just see the tumour and fix it without opening up the patient.

All yours are really interesting. What I'd have is, I'd have this

unstable DNA that could take all your powers and absorb all of them and put them together,

and then I'd be a super superhero and it would be amazing.

One housemate, Jon, is still at work. He may not have any superpowers,

but in an emergency, he can be a patient's best chance of survival.

It's not long before he has another emergency on his hands.

The crash alarm has gone off again.

Another patient needs urgent assistance.

Level 2 rehabs place. I don't know where that is.

Cardiac arrest.

I've got to find the place first.

I'll have to see what happens when we get there.

The quicker he can get to the patient, the greater the chance of survival.

-I've got to find out where...

-Like the other cardiac arrest he was called to,

it's a life-and-death situation, but the odds are stacked against Jon and the team.

To the left or right?

Which way?

More than 90% of cardiac arrest victims die.

Just going to move you on to the bed. Someone support his head.

Breathe, one, two, three.

The patient's heart rate is crashing.

The team must stabilise his heart's rhythm, or else the man

will go into full heart failure.

Could you roll off a couple of bits of that? Not very long.

Finally, they get his heart rate back to normal.

That was a cardiac arrest call.

This guy didn't actually have a cardiac arrest, he was in what we say is peri-arrest.

His signs were looking bad,

so his heart rate was low and his blood pressure had dropped

and he looked like he might have a cardiac arrest, so we basically pre-empted it.

Turns out by the time we got there, we just did simple things.

Put in some lines in the arms, put up some fluid,

got him on a monitor. He wasn't in too bad a shape.

Back to the ward, and the end of another long shift.

-See you later, guys.

-See you!

When you go to an arrest call, everyone else has different roles,

whether it's sort of...

Oh, crap, there's a lady over there on the floor.

But a junior doctor's work is never done.

Jon, quick!

A patient has collapsed in the corridor.

Hello?

Jon checks for vital signs.

Her heart's still beating and she's breathing.

She's pretty wheezy.

There we are.

What's the matter? Is it shortness of breath?

-What happened?

-Hello, lovely. Ready? One, two, three.

To find out the cause of the collapse, she'll need further tests back on the ward.

Wow! Exciting.

And Jon can finally head home.

Bye-bye!

It's the end of the month.

After four weeks of learning the ropes and facing the limits of their abilities,

juniors across the country have been paid their first ever wage packets.

Except one.

Please be paid, please be paid.

The only one who hasn't received a pay slip.

I think I gave them the wrong... the wrong National Insurance number.

Yes, I got paid! £99 in credit. Sweet!

The basic wage for a junior doctor is about £22,500,

and they're all splashing their new hard-earned cash at the traditional pay-day party.

You've worked for a month without being struck off.

That is an achievement.

It is an achievement!

Every month, that's what I think to myself.

"I have not yet been struck off." Here's to a good job well done.

Next time, is Suzi cut out for the highs and lows of A&E?

I feel...distressed.

Is Kier cut out to be a surgeon?

Patient's looking a bit jaundiced for my liking.

And after all their training, is medicine really the career for them?

Basically, days like today make me want to quit medicine.

Subtitles by Red Bee Media Ltd

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