Episode 3 Junior Doctors: Your Life in Their Hands

A typical night in A&E.

-It's like a battlefield.

-Language!

Full of 20-somethings after a big night out.

Lots of vomit, lots of unconscious bodies lying around.

But not everyone's 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 in a bloody good NHS Trust.

-I've never done this before.

-Now they face the reality of life

on the wards, and there's no room for error.

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.

For the last month, seven of these rookie doctors have been working

and living together as they embark on their careers in medicine.

Ultimately, one of the most important traits in any doctor is maturity.

Take that off!

First-year doctors Adam and Katherine are just starting out on the wards.

It's been a tough first few weeks for aspiring surgeon Katherine.

I still kind of feel like I'm finding my feet

and I'm finding ways of doing things.

Second-year Suzi,

Andy, Jon

and Keir have just 12 months' experience under their belts.

At 28, Keir's come to medicine late.

There's a great satisfaction in putting people back together.

And rugby fanatic Jon has a packed social calendar.

I think the reputation that doctors maybe have as work hard and play hard, I think that is kind of true.

All of these young doctors are newly qualified.

A lot of them just look as though they have come out of school.

But the big decision they will have to make next is what kind of doctors do they want to be?

Surgeon or medic?

You want to do surgery.

I don't even have a direction at the moment.

And are they even cut out for medicine at all?

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

There are many paths a young medic can follow.

But the big decision is whether to wield the surgeon's knife, performing operations,

or be a doctor and treat with medicine.

Hello. It's Keir, on-call Plastics.

28-year-old Keir is on a four-month placement in plastic surgery.

That's a beauty, isn't it?

As a second year junior doctor, he's got to decide which of the many specialities to follow.

I was at work helping a joiner put some glass in a window, and it just slipped through my hand.

-So it was glass that cut...?

-Yeah.

-OK.

Can you lift your thumb up towards your nose?

Good. Obviously, I don't want to cause your pain.

And I want to make sure that you haven't torn through any of the tendons that attach into your thumb.

Can you turn it over?

-Are you a joiner yourself?

-No, I'm a painter and decorator.

Painter and decorator, hence the graffiti around your wound. OK.

We really need to get in there and clean it out, just to make sure that there's nothing in there.

If we just left it,

it would scar up quite nastily in there and it would really restrict the movement of your thumb.

-And for your job, you need a good grip.

-Yeah.

What I will do is I'll put you on the list for theatre,

but I'll get one of the registrars or consultants

to come and have a look, just to see how it's best to do it. Have you got any questions?

-No.

-No? Bonzer! Great. I'll be back in a minute.

In 10 weeks' time, I have to have decided

finally what direction the rest of my medical career is going to take.

With a deadline for a decision, Keir has to make up his mind to be a surgeon or a medic.

I don't know whether to do neurosurgery

or whether to do paediatrics

in order to end up specialising in children's brain problems.

So I really need to try and work out whether I want to do a surgical

or a medical career. And I don't know.

I spent the majority of my childhood not really knowing what I wanted to do.

I used to be on the university ballroom and Latin dance team for a while.

I used to do wine-tasting professionally.

Kind of quite plummy and pruny.

Rather lovely.

Play the piano...

quite badly. I should have practised before you came in.

But I found that my biggest love, which I do regularly, is dramatics, theatre, acting.

# Sit down, you're rocking Sit down, sit down, sit down

# You're rocking the boat... #

I would say that I've been using acting skills every day that I've been on the ward.

I'd rather camp it up and ballroom dance with a nurse

than tone things down for the sake of keeping things calm.

I can follow you and do the Viennese if you want.

'I've found that medicine is the career that kind of draws together'

all of my principal interests into one job.

For Keir to work out if surgery is for him, he needs to get as much practical experience as possible.

Do you want to jump up?

-Ooh. Wheee, you're flying.

-His next patient is two-year-old Devon, who's had a nasty burn.

Do you want to shake my hand?

-Excellent.

-Young patients will always require a little more entertaining.

-I hear that you've got a poorly hand, is that right?

-Yeah.

-Knocked your hand on the hot grill? Is that right?

-Yeah.

-And is it the back of your hand or the front?

-Yeah.

It is the back of your hand or the front of your hand?

That's good. What exactly happened? He reached in for some toast, did he?

He just reached in, caught the top of it.

Oh, wow!

Keir needs to check if the wound is infected.

These are magic scissors.

Swabbing it will be painful, so he employs a little sleight of hand.

Ah, there it is.

This is a special tickling stick, OK?

I can tickle you like that, I can tickle you up here,

I can tickle you here. And I can tickle you there.

-Swabbed.

-Thank you.

I'm going to give you some medicine to make you better, OK?

-Yeah.

-You've got to promise me that you'll take it.

That's the first time you haven't said "yeah".

You're starting to get wise to this.

So we'll put a dressing on and then we'll review it in two days.

So you need to hold onto that or give it to Mummy.

-Say thank you.

-There we go.

-Good boy.

-Well done.

-I've just come to give you your appointment.

-Bye!

-Thank you.

Back at the doctors' house, fellow second-year Jon suffers none of Keir's indecision.

Jon is pursuing his lifelong ambition to be a surgeon.

I'm studying at the moment for my first part of my surgical exams.

When I booked this exam, I didn't know what my rota was going to be.

Unfortunately, it happens it falls in the middle of a week of nights for me.

Obviously, I've got a pretty thick book

to revise from. And I've got two of these to get through.

So, yeah, it's obviously not...

going to be easy,

but...who said anything in life was easy, eh?

But Jon doesn't have a strong track record for great time management.

I don't really take life too seriously. I like having a laugh.

Lack of focus on the job nearly saw Jon fail his first year as a doctor.

There's a lot of red here.

I've just put it off till the last minute, really,

which is kind of stuff that I do. That's kind of how I work.

-Jon's problem is squeezing all his hobbies into a busy doctor's schedule...

-Squeeze!

..and leaving enough time to do his exam revision justice.

I think if I had a magic wand, I woke up in the morning,

and they said, "You could be the front man

"for the biggest band in the world or you could be the best surgeon

"in your particular field," I think I'd take the superstar surgeon.

If Jon even wants to make it as a regular surgeon,

he's going to need to strike a perfect balance between work and play.

Knock-knock. I'm one of the doctors.

Tonight is the start of a week of night shifts.

Tell me a little bit about what went on today that's brought you into hospital.

Fine, OK. Righty-ho.

Well, you're not doing too bad.

What, 86, does that make you?

My maths isn't too bad, then.

I'm going to examine you now, if that's all right. Deep breath in for me.

Jon has chosen to sit his surgery exams early.

I am quite young to be doing these exams.

I think it's just a good way to show my kind of dedication

that I want to become a surgeon, and hopefully, if I pass,

it's another sort of accolade under the belt, really.

Knock-knock. We'll give you some antibiotics and we'll keep you

in with us until you're feeling a bit more better on your feet.

All right?

-Yes.

-I'm just going to take this phone call. I'll be back in a second.

The on-call phone's summoning him to another patient.

-Yeah.

-Jon's got his work cut out to fit everything in this week.

I couldn't foresee that I would be on nights when I was doing my exam when I booked my exam.

I have to go to rugby training cos I'm the captain.

I have to come to work, obviously, cos they pay my wages.

So, yeah, it's all a bit...

of a mess, really. But it'll be all right in the end. Just nothing could be helped, really.

Clean the end of that so that we can get a good look.

Can you feel it?

Back in Plastics, Keir is seeing another patient with a hand injury.

This here is bone.

This is the finger pulp, and this is bone.

So I can see what I'm dealing with now.

The tip of this patient's middle finger was chopped off in a gate.

He needs surgery, and Keir is part of the operating team.

-Hello.

-Are you OK?

-Yes.

-My main problem with this is the nail.

So we need to remove

the nail and then flap the skin over the top? Is it?

-Yep.

-I've never done this before. I'm quite excited and a little trepidatious at the same time.

The big question for Keir - is surgery the direction he wants to take?

I think it's very difficult when the young doctors of today

are trying to make their choices.

They have to make it so much earlier in their careers than I did.

I got to try a whole load of different things.

Keir's in a problem, because he knows where he wants to finish up,

but he doesn't know what to do along the way.

And it's just difficult for him.

Keir has only been working in surgery for a few weeks.

This procedure will give him real hands-on experience, especially as this patient is called Mr Hands.

Have a go.

Clasp the bone.

I'm just literally nibbling?

Yeah.

-What I'm hoping to do is preserve a little bit of the joint.

-Mm-hm.

The operation is performed on a conscious patient so Mr Hands can go home the same day.

The bone in his finger is shortened with a tool called a bone nibbler.

We're down to about there.

-Oh, fantastic.

-Wow, look at that.

-That's not a bone nibbler - THIS is a bone nibbler.

-Right.

-You don't mind us talking, do you?

-No.

-That's all right.

At the end of the operation, Keir stitches up the tip of Mr Hands' finger.

Lovely.

Well done. Grand.

See you a bit later, all right?

Keir may be capable, but does he want to pursue surgery as a lifelong career?

People say that decision's the easiest one.

I find it the hardest one.

Major choice - surgeon or medic.

And you can't tell, can you, cos you like both?

I know that I would not be unhappy in either.

In fact, I'd probably be happy in either or both.

The boy did good.

Just what I expect. He has... natural ability.

It would be a shame to lose him from surgery.

While Keir's getting his head around surgery, first-year Adam

is starting a new placement on the Emergency Assessment Unit.

I'm Adam, by the way. I'm one of the F1s on today.

-Hi, I'm Angeline.

-Hi, nice to meet you.

It's the same ward where Jon's working nights.

It's fast paced and high volume, with a constant stream of acutely sick patients.

Patients do not want to be sat around for hours and hours and hours

waiting for doctors to make decisions about them.

So if we're slow, it backs up in the A&E, and that's a major problem.

It's the sort of work Adam's hoping to make a career of.

-Scratch, scratch.

-This is the chance he's been waiting for.

More jobs, more jobs, more jobs.

The pace is certainly faster on the EAU.

And you can tell that you need to get things done quickly.

Right, focus. That's one person.

So it's core CT.

I need to...

Right, core CT. OK, I've printed off the stickers...

It does require focus, and I think it's very easy on here

to get distracted and pulled away in lots of different directions.

And so it's important to be focused.

Yeah, I do want to make a good impression on this ward.

I want them to think that I'm competent and I can get on with my jobs

and...that I can basically take care of myself.

-Over the past month, ambitious 24-year-old Adam...

-One down, a hundred to go.

..hasn't found his job living up to his high expectations.

Would it be all right to take some blood from you? ..Do you want any help?

You are the skivvy, the ward bitch.

-At first, he found it difficult getting up to speed on the wards.

-At least I know now.

-You know.

-Yeah.

His biggest frustration has been too much paperwork and not enough patients.

How can I kind of like base this on what I want to do as a career,

because I'm having very little exposure to the actual job?

Adam's new placement on EAU should give him the patient contact he's been waiting for.

But it's a tough ward for a first-year junior doctor.

I'm just going to go ahead of you.

-It's probably easier to get the beds moved.

-OK.

In terms of the experience they get here,

they see lots of patients. It's quite a busy unit.

-And they all just go the normal way - I don't need to fax anything?

-The usual.

-OK.

I think the onus is on us to get as many

jobs done as possible, cos there's a lot of new patients to see. I think 30.

So...quite high.

She had a fall. I queried a fractured left shoulder, but Orthopaedics have ruled that out.

That'll be your first job when we finish seeing the other ones. One thing that I would say is that

he's taken quite a while to do jobs I've given him this morning.

I don't know how he's got on. I need to check on that now.

But one of the things he'll need to learn is to speed up a bit and see more patients.

We were told as a general rule of thumb that we shouldn't take longer than an hour to clerk a patient.

So as long as you do the history and the examination in around 40, 45 minutes, and spend maybe

15 minutes writing it up and doing a management plan, that should be OK.

Clerking, or checking in a patient, means making a full examination,

reviewing symptoms and taking a medical history to come up with a diagnosis.

So do you work at all?

-Not now.

-Not now. Did you before?

-Yeah.

What did you do?

-Chef.

-Oh, really?

Adam has to complete all this within an hour, which means there's no time for small talk.

Yeah, yeah. You know the best one I had was in Middlesbrough - Akbar's.

I think I liked Akbar's.

But in Newcastle... where did we go the other day?

Adam should be taking the patient's medical history, but he's going off topic.

Guess where I come from.

Where do you think?

Yeah. Lebanese.

It's a good guess.

Half an hour's gone by, and Adam has only just started examining the patient.

No swelling, that's fine.

-OK.

-This clerking has gone 30 minutes over the deadline, but Adam's not concerned.

That's fine. I'm doing it at my own pace

and I'm probably keeping to that time, so I'm quite happy with that.

As some of the junior doctors finish their shifts, Suzi's only just starting.

She faces a busy night in the Accident and Emergency Department.

I expect drunken injuries, people that have been in fights,

people that have fallen over and hit their head,

people with suicidal ideas cos they've had a drink.

Everything, really.

Everything that A&E can offer.

Which is everything.

Over the last four weeks, Suzi has had a baptism of fire, having never worked in A&E before.

Have you had a drink this evening?

She's had to face a constant stream of serious emergency cases.

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

-We're here to help you.

-It's really important.

A few hours into the shift and an emergency case arrives.

A 76-year-old woman comes in with breathing difficulties.

-I'll go.

-Come on, then.

I'm waiting for a patient with COPD to come in. COPD is an airway problem.

It's a bit like asthma, but people get it when they get older.

COPD, or Chronic Obstructive Pulmonary Disease,

is a narrowing of the airways, and can be caused by smoking.

My name's Suzi. I'm one of the doctors here. Tell me a bit about what's been going on? Pain?

-Have you been coughing anything up at all?

-A little bit yellow.

But the pain, this time it's going up my neck.

And I feel distressed.

Very short of breath?

The patient is panicking, so Suzi stabilises her breathing.

She is quite short of breath at the moment.

She's come in with worsening pain over the past day. I just want to get her chest X-ray organised.

Her heart's going fast because her chest is bad.

One can kind of trigger off the other one.

-How is your breathing normally?

-Not great, but better than this.

-Have you been feeling feverish and warm at all?

-Yes.

-You have been?

And this chest pain all came on suddenly? Yesterday, was it?

Terrible. It's got worse and worse.

PATIENT COUGHS

Are you OK?

Yeah.

Ohh.

-SHE COUGHS

-What a day.

-What a day, indeed.

Inhaling the drugs quickly calms the patient's breathing.

Tests reveal a chest infection which could be life threatening without treatment.

-How do you feel now?

-A lot better.

-A lot better? Good.

Any other questions at the moment?

-I could do with a drink of tea.

-A drink of tea?

I haven't had anything from 2 o'clock to drink. I feel as though I'm parched.

Relating to people of all ages is an important skill for all junior doctors to have.

I've only had two biscuits all day.

-I haven't eaten anything.

-You must be starving as well.

I'm not really, no. Just thirsty.

I've eaten more than that and I'm starved.

I'm always hungry.

I really like seeing patients that are quite old and challenging.

They've got lots of life experience and they're just interesting patients.

Mary! >

Do you want your cup of tea?

You can only have sips of it, OK?

-And if you feel sick, or anything, stop. OK?

-OK.

-We don't want you feeling sick, or anything.

-Right.

-Lovely, ta.

-There you go. ..You've got one as well.

Small sips.

I haven't had a drink since 2 o'clock.

Not sure a cup of tea quite cures everything.

If it helps patients calm a bit and feel a bit more relaxed

and breathe a bit more easily, maybe it's a good thing.

We'll have a food fight after eating.

-You missed.

-Backfired!

-Yeah, but it went nowhere near me.

While Suzi's grafting on nights, the junior doctors on dayshift

discuss their future careers and the sacrifices they're prepared to make.

You look at girls and you know who's going to put career first for the rest of their life.

-And Katherine's actually too nice, like a home-maker girl, to...

-Seriously?

-No, no.

-My mum's already given up on having grandchildren any time soon.

No, no, you're not going to have them soon.

But I think things will change with you later. And I think you'll really want them.

< Katherine, why do you want to be a surgeon?

I want to do surgery because I like surgery.

-We, as men, have a slightly unfair advantage in surgery, being we have less to worry about.

-It's easier.

-It's easier.

-No, I completely agree with that.

-I think nothing worth doing's easy.

-No, that's true.

-I will not let anything stop me from having children.

-No, same.

-That's easy for you to say.

You might not have to give up as much for a chance of having a child as, say, a woman might.

-Unfortunately, that is just the way it's going to be. It is unfair.

-It is a slight disadvantage.

I don't know.

I've worked hard to get into medical school, I've worked hard in medical school, and I'm working hard now.

I'm not going to base my future career choice, that I've worked really hard for,

on something that might or might not happen.

Success has never come easily for first-year Katherine.

Would you mind if I just do these bloods?

I'm a bit more sorted after I've done these.

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

That was hard.

Hi, sorry to phone you. This is really embarrassing, but I've got a patient.

I can't get a vein on her anywhere.

Katherine is aiming for a career in the competitive field of surgery.

I definitely feel I have to work at things if I want to achieve something.

After last night's chat, Katherine's decided to find out for herself if it really is harder as a woman.

And who better to ask than a female surgeon.

I'm hoping she's not going to put me off and tell me that you can't have a life outside of surgery,

and that you can sort of have it all, as it were.

Anna O'Riordan is one of only three females out of 74 surgeons in her hospital.

A lot of people, when I tell them I want to do surgery,

-they say, "You'll end up wanting a family and you won't be able to do it."

-That's rubbish.

There are plenty of women surgeons

who have families and very good careers.

-Have you had the chance to have a family?

-Yes, I have a baby girl now. It's been the highlight of my life.

My colleagues, who are all male and I'm the only woman, they were extremely supportive.

I couldn't have asked for a better bunch of people to help me.

So you can only try and guess and plan for the future

and be willing to compromise and change path as life goes on.

So you think just go for what you want to do?

-Go for what you want now.

-But be aware you might change your mind?

-Yeah.

-We're entitled to change our minds.

-Yes.

-We're women, after all.

Anna's invited Katherine to see her at work.

It's important that every opportunity you get to go to theatre

to see an operation, to be involved in an operation,

that you grab those opportunities to be sure that's really what you want to spend your life doing.

There are some people who are naturally gifted, so won't have to put in a lot of effort

and everything will come easy to them.

For the rest of us, the more time you put into something, the more reward you get from it.

The patient has a tumour in her kidney.

The keyhole surgery Anna's performing is highly specialised,

so first-years like Katherine can't assist. Just watch and learn.

So the kidney's supposed to lie up here.

So I'm getting my instruments in. A small incision here.

'I think it is really difficult, but if I can stick at it, I don't see any reason why I can't do the same.'

We have to clean the camera.

'It's just nice to see people that have got that, and there's the light at the end of the tunnel.'

I am just going to have to work my socks off, just work incredibly hard.

The three-and-a-half-year-old girl, she's had a week or so history of chicken pox.

-Around the hospital the other junior doctors...

-I'll see this person.

..are getting on with their day-to-day jobs.

Keir's back in theatre, but he's still making up his mind if he wants to become a surgeon.

Whether I want to do surgery long term, I don't know.

But it's by coming to theatre and experiencing it a lot that I'll get a taste for it,

or decide that I want to go down a more medical rather than surgical route.

There's lots of medical problems, OK, which you can treat...different ways.

And surgery is one of them.

Us, we surgeons, we treat things by removing them.

This patient has a tumour in her arm.

What I'm hoping to get out of it is actual surgical experience of

cutting round tumours, removing them, sewing back up.

Keir scrubs up.

As a second year, he's allowed to assist with the removal of the tumour.

In order to be a good surgeon, you need the eyes of a hawk,

the tenacity of a lion,

and the hands of a lady.

I'm still at the stage where I do it carefully, concentrating on everything.

He's a bit slow, but, you know, that's a learning curve.

He'll just need to practise it more and more.

And as I was saying, it doesn't necessarily have to be in theatre,

-but he can take sutures home.

-So, we've just got to dress that now.

Jon and Suzi are back on the nightshift...

-I am going.

-..leaving Keir to confide in first-years Katherine and Adam.

Since you qualified as a doctor, and maybe even before, you have wanted to do surgery.

-Yeah.

-You have defined yourself as a surgeon.

When I was doing my GCSEs at 14, I didn't want to be a surgeon.

But I don't even have a direction at the moment.

I'm five years older than most people who are in my job, anyway.

I don't want to be making a mistake.

You don't want to piss around any more, you've done that past,

you want to get on with things, get your training under your belt and just keep going.

I think if you're going to fluster about any decision, I think it will be this one.

-And I think justifiably, as well.

-It's really worrying, because you look at people like Jon,

and Jon is already sitting exams for what he wants to do.

He's sitting his surgical exams.

Like most first-year junior doctors, Adam needs to speed up to make sure that patients are seen to quickly.

So he's decided to put himself on a clock.

For this next one, I'm going to time myself. So, I want to get it all done within an hour.

That will mean that I won't be able to say or do anything for an hour.

Because that will push me over the edge of the hour.

So I'll put a stop watch on my iPhone, and hopefully that will be enough.

So, time will now go...

In the past, Adam's been taking over 90 minutes to clerk patients, so he needs to really focus on the job.

And do you drink much alcohol?

OK. Um, do you have any funny heart rhythms?

Adam is slow, but I think, often,

people need to be trained to prioritise their work.

So, just look at something in the distance, yeah?

And I'll just have a look into your eyes. ALARM BEEPS

All right, yeah. I know, I know. Over time.

Another patient that's taken too long to assess.

It's been an hour-and-a-half - half an hour over time.

There's loads of patients to be seen.

Adam's next patient has been transferred from a hospital in Scarborough

suffering from chronic hip pain.

I understand you had a fall - was it yesterday or the day before?

-No, it was last week.

-Last week!

Don't laugh when I tell you what I fell off. I was on the carousel!

You fell off...was it the horse? Doing something fun, right?

Adam is trying to achieve a balance of good patient care with time-keeping.

-I'm waiting for a new knee replacement.

-Right.

Every time I'm having a fall, it's making the pain in my knee worse.

What were you hoping we could do?

-Cut it off.

-Cut your knee off?

I'll just go and get a chainsaw, hang on.

THEY BOTH LAUGH

I know I can laugh now, but it's no joke.

Do you have anyone to help you round the house?

-No.

-No.

I can't cope at home... with things.

-I just want to get shot of this pain.

-OK.

So as I can have some sort of normal life,

so I don't have to rely on people to do things for me.

I want to be able to do them myself.

She's pretty down, pretty depressed, and maybe I did take a little bit longer because of that.

Maybe I have to curb that and clerk more patients, I don't know.

But, you know, I'm new, and I kind of felt a bit bad for her, so...

EAU is a challenge for any new doctor, and Adam's still proving too slow.

Have you got much you need to do at the moment?

-I've got quite a few jobs, yeah.

-I'll see the next one by myself.

-OK.

-We need to get the beds moving. The most important thing is to get this lady discharged.

-OK.

-So I'll grab Neil to see the patients with me.

-OK.

-We need to get patients out of here.

-OK.

Because Adam's taking too long to clerk patients, he's now being asked to discharge them instead.

I've been demoted from ward rounds to discharges whilst ward round's going on. Yeah...

So many things, so little time. No-one's going to care about what you think or say, anyway,

because you're an F1.

As long as you get the jobs done, that's what matters.

So I just have to do it.

And there's just hundreds of pieces of paper, which are...useless.

In short, I thought that EAU would be what I was looking for, kind of that fast pace, you know,

getting to clerk patients, getting to see patients all the time,

and just a bit of paperwork with discharges and that would be it.

But in reality,

so far,

I don't really like it!

But I'm all about the acute medicine, so if I don't do this,

then I've got no career options!

No, I do, I like...

Well, I've got no career options right now.

If all my career options involve this much paperwork...

Katherine is still working on her career options.

She's keen to get into theatre and assist the surgeon.

This patient has cut through the tendons of his little finger.

It will be very interesting for you, because you've probably seen flexor tendon injuries in clinic,

but you probably don't appreciate what it takes to repair them.

The surgeon must find the ends of the severed tendon by opening up the hand.

So, we found our two distal ends, which are there...

The next job is to stitch the two ends of the tendon back together.

It's really scary operating with such tiny structures.

So what's the rate of rupture after a repair?

-Any guesses?

-Straightaway?

Yeah, you'd think that, wouldn't you, but it's not.

It's day 10 to day 14 where it's the weakest.

Katherine gets her chance to try out some simple stitching.

What I want you to do, I want you to match this crease to that crease. Take your time, there's no rush.

Bring your needle out completely.

Don't go too deep. Let go of the needle-holder. Good.

Keep your elbows close to your body. It's not easy,

but if you learn it the right way, it will become easy.

Brilliant, well done. That's finished.

I think like with most aspects of medicine, you do have to get a balance, with a personal life.

My head's saying that surgery is a lot of work,

maybe I'll burn out, or just give up and get fed up with all the work,

but my heart's saying that that's what I really want to do, so I should go for it.

While Jon and Suzi start the night shift, some of the others head for the boozer.

Ah, it's good to get out of the house.

First-year Adam confides in the second-years that the day job is getting him down.

-I'm doing

-BLEEP

-all clinical work at the moment, I'm just sat there doing paperwork.

I did like 20 discharges this morning.

I was locked away in a room. When I did come to clerk a patient, my brain is just not there.

The headline of the Times today

-was about 23% of junior doctors quitting the NHS.

-I know.

It does raise an issue that a lot of junior doctors ARE upset with their jobs as they stand,

and how they're paperwork monkeys, and getting very little clinical experience.

I've never felt lacklustre before, like now.

-Like, I've never felt like, do you know what, this is a

-BLEEP

-job, I want to quit.

I want to do something else, because this is a waste of time.

Everybody has thought about that as an F1. And that's brave, just to say, "I don't enjoy this."

But what we can tell you is, it will get better.

Days like today make me want to quit medicine.

Jon's only at the start of a 13-hour shift.

Dancer Natasha's arrived with chronic chest pain.

How would you describe the pain?

-Sharp.

-Sharp.

-It's when I breathe in, it'll...

-So, it catches when you breathe in?

-Yeah.

When you were moving and stuff, like dancing, obviously, it's a very active job - no pain?

No, when I'm dancing, I have no problems whatsoever.

A few tingly fingers, but that's it.

OK, fine. Do you want to pop up onto the bed and I'll examine you quickly.

All right, I'll just take your pulse.

So where do you teach dance?

All over, Newcastle, Northumberland.

What's your speciality?

Zumba.

-Oh, the fitness thing?

-Yeah.

Lift this leg straight up in the air.

Keep it there.

Very good. And the same with the other one.

Very good. All right, fine.

We'll take some blood as well, just to look at markers

of infection and inflation, and we'll take it from there, OK?

All right? Just stay there and I'll be back with some stuff for blood in a second.

It's nice to see young doctors on the ward.

I mean, they're normally quite old and got no personality, but...

It's nice to see someone come in and have a chat with you,

rather than just treat me as a patient, and that's it.

But, yeah, he's quite nice.

Nice and straight for me...

After investigations, Jon's able to rule out anything serious, and Natasha's discharged.

'We just did a blood test, and that's normal, so she's been able to go home.'

It was just a muscular pain, due to the strenuous job that she does, she's a dancer and stuff.

Jon's not the only one working into the night solving medical cases.

In A&E, Suzi's able to experience a huge variety of medical conditions.

-Old lady.

-Old lady. Just baby-sit, if that's all right?

It's helping her work out what she wants to specialise in.

Hello, how are you?

It's a busy place. But I'm glad I'm in here with you.

Rose is 76 years old.

She's come to A&E this evening with chest pain.

-Are we done?

-We are done.

-Eeh, there, that wasn't too bad.

I could just eat something nice.

-That makes two of us.

-Like what?

-Chips.

-Chips and beans.

Oh!

I love chips!

-Do you think by any chance that she'll be OK to go home tonight?

-I don't think she'll be going home.

There are some changes in her ECG, which look as though it could be the heart.

So we're going to give you some tablets for that, OK?

'I do like old patients, I think they're challenging to treat.'

I did a care-of-the-elderly job last year, and it was really interesting,

and challenging.

So I wouldn't be surprised if I ended up doing that.

But I know it's medicine something, I'm just... It could be lots of things, we shall see.

With Rose stabilised, Suzi can transfer her to another ward in the hospital.

-I hope that everything gets sorted and you get out soon. All right?

-Yes, thank you.

Thanks again for putting a smile on my face, OK?

-Yes, thank you.

-Thank you again.

-Bye, darling.

-See you later.

Oh, I think she's lovely.

A lot of them just look as though they've come out of school.

I just think old people are really cute.

He needs bloods, he needs bloods...

Oh, God!

It's the middle of the night at the hospital.

In EAU, Jon is running on empty.

The time is now quarter to four in the morning...

He's now worked a week of night shifts, and his surgical exam is on his mind.

I booked my exam before I knew what my rota was, that's the...

That is the...erm...

risk you take, and it came back to bite me in the ass a bit, really.

I didn't really get much sleep today, so I've been...

I got up about 10 o'clock this morning, so I guess I've been up

for...whatever it is, 16 hours or something.

Which isn't ideal, but I had some stuff I needed to do today, like revision for my exam.

Right, I'd better see this lady. Where is she?

Left...

Hello, my name's Jon. I'm one of the doctors...

After a 13-hour night shift, Jon finally goes home to sleep.

He's been awake for over 24 hours.

This has been the busiest three days I've had as a doctor, I think.

I've been up for pretty much 27-hours straight now.

With his surgery exam now only a day away, revision is the last thing on Jon's mind.

In three hours' time I've got rugby training and then...

And then I've got my last night, so...

Erm, I'm pretty tired, I might just go and fall asleep.

While Jon gets some sleep, downstairs, Keir's practising his surgery skills.

Blades please. Thank you!

That's hilarious.

Practising stitching on a banana is a very good substitute for human skin.

The patient's looking a little jaundiced for my liking!

Have you noticed you've got a medical student standing behind you?

That's fine, don't worry, SISTER.

The thing about practising is, you don't necessarily practise

the way that you would do things in real life.

It's like when you practise the piano,

you don't go into a concert and play scales and arpeggios.

But you need to play scales and arpeggios in order to play properly.

Cut, please.

-Can we send for the next one?

-Yeah.

I think we've got two strawberries and a fig waiting.

We'll do the fig next.

We'll need the tourniquet and the juicer.

When I'm at work, it's just inside for 12 hours and I don't see the sunshine.

After sleeping off the night shift, Suzi spends the afternoon at the beach with some friends.

-I reckon a lot of people retire here. I'd definitely retire here.

-I would.

I'm a little way off the old pension, though, just yet.

Suzi's been trying to decide where her future lies

and it seems that her perfect career path has been staring her in the face.

Did you decide what your speciality is going to be?

Care of the elderly. Or respiratory, because it's got lots of old people there, too.

I love talking, obviously.

And it's great... I know!

Definitely medicine. I'm more of a chatter than a chopper-upper, so medicine, I think!

After a few hours' sleep, Jon is also making the most of his time off work.

As captain of his rugby club, and with a big match looming, Jon didn't want to miss today's training.

Rugby's really important. Obviously, it's not ideal

that training's tonight, but I want to make sure that we train well and progress as a club.

It's a bit of obligation but it's also what I enjoy doing as well.

Sacrifice is a sacrifice, but if you want to do something, you'll find a way to do it.

The only problem is, he's also got an exam tomorrow.

I want to just get the exam done and then I can put that to one side, and concentrate on other stuff.

The big day's arrived. Jon's driven all the way to Edinburgh to sit his exam.

I don't really get nervous about exams, so I'm fine.

And with a jam-packed work and social life, there's been little time for revision.

The book's about this thick, and I've read about this much. So we'll have to see, we'll have to wing it.

Sleep and me, we're good friends, but we don't see each other as much as I would like.

Yeah, it's been a pretty manic last 24 hours, but, um...

you know, after I finish my exam, then it's over, isn't it?

So, just go back to normal life. So it's not too much of a faff, really.

I'm young, I can still do it, it's not going to kill me,

a bit of lack of sleep. You can sleep when you're dead, can't you?

Jon's got six hours of exam papers ahead of him.

Disenchanted first-year Adam hasn't been enjoying work.

Now he's meeting his boss to talk about it.

All junior doctors have regular meetings with their supervisors to discuss their career.

How's it going? What are the problems?

-You know, what do you need?

-Erm...

Everything going all right, or...?

No, I mean, like, I'm not... It's not like I'm...

I'm not hugely enjoying the job, as it stands. I don't dislike it,

I just feel like I'm only doing very mundane things, and I wasn't using my brain at all,

if I'm being honest.

You have felt like you are literally nothing but a ward clerk

-and a form-filler.

-Yeah, pretty much.

It's a very honest response, and it's very truthful, and I know it is

-because absolutely everybody feels like that when they start.

-Yeah.

Don't worry about it, you will have more than ample opportunity

-to take responsibility, make a few decisions...

-Yeah.

-That will happen, just give it time.

-I shouldn't complain.

-No, don't go chasing it, it'll come and find you.

-I'm sure it will.

It'll find you, don't worry.

'Some of them get to the point of slightly resenting'

that they're just admin bodies.

But at the same time, there will be occasions within the same week,

perhaps on-call, perhaps just when they're covering the ward,

there isn't senior cover at hand,

when they've got some real medical emergency to deal with.

And then suddenly, the admin stuff seems a lot more attractive.

He was very supportive, and quite understanding of, you know,

how things are as a new F1, and I didn't really expect that.

Really nice guy, and I think he kind of gave me a couple of useful tips as well, as I go along the way,

and tried to get me thinking a little bit about things.

Adam may be more positive, but has Jon's lack of revision hindered his exam performance?

Yeah, that was pretty hard!

Erm, the first paper was just epic,

it was just so hard, like, I knew nothing!

Jon's now got to wait six weeks to see if he's scraped through.

With a renewed enthusiasm, first year, Adam, returns to EAU

on a mission to prove himself to the head of the department.

I hope that I do good clerking,

versus some of the not-so-good clerkings I've done in the past.

He's been trying to hit the ward targets all week.

I really want to make a good impression,

just because I want to be a good doctor,

and also because this potentially is a part of a career option for me.

And the pressure's on, because this time the boss is going to time him.

You need to see this patient, sort them out, do all their bloods, get their whole investigation done,

make a management plan, write up their drip card, the whole lot,

in an hour. Do you think you can do that?

-I'll do my best.

-OK.

-All right, cheers.

It's 4 o'clock now, and the timer is running.

So, we've set Adam this task, to see the patient within an hour,

and we need to see whether he can get quicker here.

-Why are you stressed?

-Because I...

-But you're working with Ashley.

-Yeah, I know, but...

-He's the nicest doctor in the world.

He should be seeing the patient now, definitely.

-Hello. What's been going on with you?

-Chest infection.

-OK.

-Yeah, last couple of weeks, it just won't clear up.

-OK.

I had to have a cancer operation,

which left my stomach up here now.

-Right.

-I might have had a reflux or something during the night.

-Yeah. You're normally well with the breathing?

-Yeah.

He's doing all right, he wants to make a good impression.

Just look up for me, sir.

20 minutes in, Adam's moved on to examining the patient.

Fantastic, OK.

He's halfway through, and he should be getting on to thinking about taking bloods and things.

There's 30 minutes to go, and Adam's on-track.

But there's no time for small talk.

-What are you doing here?

-What do you mean, lad?

Do you know what, I thought you were Sarah from the back.

Then I looked at you, and it was, "Ah, it's Charlotte," I was like,

"Do I just make up that I meant to say that?"

Sorry, sorry.

16 minutes left - Adam needs to get his skates on.

Hello.

-Are you ready?

-I've finished.

Well done, that was within an hour.

Adam's finally done it.

He's hit the target - checking in this patient in under an hour.

It's good to feel like I'm actually improving, because...

-so far in F1 I haven't really felt like I've improved in anything until I started in EAU.

-You are, yeah.

This is the first time I've felt like I'm becoming an actual doctor.

Adam did really well.

He came on, and he was,

as often is the case when you're first on emergency admissions,

it's a bit bewildering, overwhelming,

and he coped with that very well.

Yeah, I have improved a lot, but by God, have I got a LONG way to go.

And I'll make it in the end, even if it kills me.

-How old are you?

-Six.

-Six.

Are you a bit frightened?

Yeah. There's no need to be frightened, OK?

We see little brave girls like you...

Second-year Keir is back in the plastic surgery clinic,

treating some of Newcastle's junior outpatients.

Is it hurting all the time?

-It is.

-When I move it.

It's hurting most when you move, OK. That's cool.

What we do need to do is clean it, OK?

Are you feeling a bit dizzy and queasy and rotten?

-No? Excellent.

-Just really hungry.

You're really hungry.

After weeks of soul-searching, and careers advice from the hospital,

Keir has finally reached the conclusion that medicine, rather than surgery, is for him.

I think medicine, particularly medicine involving children, is just,

you know, is great fun, and really dynamic.

Making people feel better.

That's it, that's what it is, it's making people feel better.

And it's not just by giving them penicillin, it's also by cheering them up.

And that's what I like doing.

I like making people feel better.

Good. All right?

It's been nice to meet you, all right?

And we'll get your wrist back together.

Keir's big decision made, and a tough week behind them,

Keir, Adam and Andy get to let off some steam...

Who's ready to get their arses handed to them on a plate?

..and for once forget about being doctors - on the race track.

Are we going to have a winner's and loser's prize?

You're going to win, aren't you? You're going to make me wear a dress.

He's looking faster!

Everything we do, we do hard, yeah? We run hard, we tackle hard, we give them nothing for free.

And with the exam behind him, Jon can focus on his rugby team's first match of the season.

And the team secure the result they were after.

Being on a week of nights, I've had a crazy week, I was tired.

So to come out here, blow the cobwebs away, and get a win, there's no better feeling, it's great.

So that's a false victory for you, there you go.

Andy's the winner, and Keir is the loser.

There you go, Keir!

Spray you!

Jon toasts his team's success, too - in time-honoured fashion.

# Jon is a horse's arse

# He is a horse's arse. #

CHEERING

Keir has left the building.

And as race loser,

all that's left for Keir to do is complete a forfeit.

Morning. Morning!

I lost a bet.

I'm not embarrassed. I'm not embarrassed at all.

I should have driven quicker. If I bump into one of my patients today...

..hopefully they won't recognise me.

Morning.

Next week...

-Has he ever done it?

-Oh, he's done it before.

..the balance between being young and professional can be tricky.

But sometimes letting your guard down

is as important as keeping it up.

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

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