Episode 4 Junior Doctors: Your Life in Their Hands

-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'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.

-Never done this before.

-Now they face the reality of life on the wards.

Cardiac arrest.

-And there's no room for error.

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

-These seven are living together...

-To the house.

..as they start out their professional lives as junior doctors.

First years Adam, Lucy and Katherine have been working on the wards for just a few weeks.

One guy was like, "You look about 15.

"This is like helping my teenage daughter with her homework."

And Suzi, Andy,

Keir and Jon have a year's experience under their belts.

We are the new breed, as it were.

We're the new ones, so I think some people could be quite surprised, mostly how young we are.

But when you're only 24, being taken seriously can be tricky.

You're the best freshly 16 months qualified doctor.

And sometimes letting your guard down is as important as keeping it up.

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

It's a tough transition from student to young professional.

Trying to impress your bosses.

I've found his performance has not been consistent.

I'm scared. I'm scared of him.

And your patients.

-Has he ever done this?

-Oh, yeah, he's done it before.

He was looking at my badge as if to say, "Who are you",

you know. "What do you know?"

What does it take to fit the image of doctor?

I think a patient expects a doctor to be always professional.

And can this group of twenty-somethings live up to it?

We are expected to be basically boring now.

It means that everybody's losing their personality.

I have a stethoscope which isn't pink.

Maybe that will change things.

How will they cope with your life in their hands?

# Wake up

# It's a beautiful morning... #

It's early morning at the house and some of the junior doctors

are getting ready for their hospital shifts.

Moving from student to young professional requires a whole new image.

Something 24-year-old Adam's especially aware of as he's only been a doctor for a few weeks.

I'm growing a beard because I wanted to move away from my days as a student and I have grown up.

Although I'm an F1, patients are so receptive to everything I do

and say because to them, I must look

like what a doctor should look like.

You know, tall, not super small, don't look super young.

You know, you can grow some facial hair, wear some decent clothes.

Everything I can do to look more professional is variable.

24-year-old Suzi is a second year and likes to personalise her look.

I have my shoes, which are pink.

And I have my stethoscope, which is pink and it's got my name on it -

Dr Suzi Batchelor, which is me, which is hilarious.

Once at work, Suzi changes into scrubs - the battle uniform for the Accident and Emergency Department.

She's the first point of contact for patients when they come in, so first impressions count.

Suzi has only been in A&E for a few weeks and she's had to learn fast.

Have you had a drink then this evening?

Anything can come through the door and doctors need to react

-professionally, whatever they're faced with.

-Hello.

Tell me a bit about what's been going on then.

-Basically, I went to the bathroom about two-thirty, three o'clock this morning.

-Yep.

I've just moved into the property, so I haven't got carpets throughout.

My bathroom floor was a bit wet. I slid off the toilet seat.

Right next to the toilet seat was a toilet brush and I landed literally on it.

The patient says he's slipped in his bathroom and landed on the toilet brush,

which is now stuck up his bottom.

Have you been able to get any of it out?

Has any of it broken off at all? No.

-Right. And you just tried kind of pulling at it and things?

-I tried easing it in the shower,

but it just seemed it was catching and... Argh!

-Oh!

-Sorry.

I'll put that back up again, all right?

It brings tears to your eyes, I tell you!

-I'm sure it does.

-Argh! Oh! I'm sorry to embarrass you today, ladies.

-Don't be silly. It's fine.

-I'm more embarrassed for myself.

Back in the second, all right? We'll get you some painkillers.

There is a danger the toilet brush has torn a hole in the patient's

bowel and if this is not treated he could die.

Really fast, James. This man, he's had some PR bleeding around it.

I can't see how much more of it there is. Do we get him an X-ray first or...?

Is it...?

Is it in, actually poking out at the end, or...?

-Can you see the...?

-It's like...with the brush on the end of it.

Yeah. I think that needs referring to the surgeons.

That's fine. That's what I thought. We need to pull it out, but if it's been bleeding and stuff then...

-I would just refer it to them and let them take a look.

-That's fine.

A case like this is not unusual in A&E.

They see lots of patients with objects stuck in unusual places.

For Suzi it's a first, but she's managed to keep her composure.

I mean, it's embarrassing for him and he feels bad that

it's embarrassing for us having a toilet brush in his bottom.

But it's the same as anything else.

Yes, it's a bit weird and I'm not used to seeing toilet brushes coming out of people's bottoms, but

I'm a professional. This is what I have to do. Just do it in the way I would deal with anything else.

Hello. I wondered if I could speak to you about one of our patients, please?

Suzi takes advice from the surgical team. They're suggesting that she pulls the toilet brush out.

So if we were to pull it out here and then he bled all over the place, what would we do?

What do we do then? Do you know what I mean? I think his concern

is just we don't know how much is kind of bleeding from the inside

because obviously things can't really get out very easily at the moment because the toilet brush is there.

-We need to get you an X-ray done...

-Right.

..to make sure that there's no hole in the bowel because that can be quite serious.

So if I leave you to get sorted and then I'll come back

and then will get a porter to bring you round to X-ray, OK?

-Champion.

-Is that all right?

Keeping a straight face when confronted with potentially

embarrassing cases is something all junior doctors must learn.

You have to develop that expressionless face where you just

listen to what they say and inside you may be thinking, "Oh, my God!"

but you just don't let that show cos at the end of the

day the patient needs to be treated and you've got to be professional.

It's embarrassing for the patient and you don't want to make it even worse for them.

It's probably taken them a lot of courage to present with whatever's gone wrong.

I'm trying to see if I can see the toilet brush in his bum on this X-ray, but I can't.

But I don't know if it's just cos it's too far down.

The patient's X-ray shows that his bowel is still intact.

But the surgeons decide that an operation under general anaesthetic would be the

best way to remove the brush.

I think in terms of the amount of pain he's in

it's kinder to sort of maybe drift him off.

I think we're going to plan to transfer him to the theatre unit

down at the RVI and maybe he'll go to theatre.

Back at home Suzi and fellow housemates Keir and Andy

discuss the best way to handle patients with more bizarre problems.

I saw a man that had burnt himself with curry yesterday.

I've seen some quite interesting things in A&E, actually.

-Interesting? What's been secreted in what orifice?

-Indeed.

Oh, no! Not one of those.

OK, can you beat spoon, mobile phone, stolen goods, garden gnome?

I've seen a bloody bicycle chain in an X-ray.

Yeah, mm-hm.

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

-Which direction?

-Brush end out.

Right. OK. That makes more sense.

-Really?

-Unless he was trying to have a really good clean up there.

-No.

He said he was in his bathroom and...

He fell over backwards?

..the floor was slippy and he just landed on the toilet brush.

-He had to go to surgery...

-Do you believe him?

-Do I believe him?

It's not my job to question how it got there. It's my job to help him.

It's your job to question how an injury happened.

Yes, and if he tells me something, it's not my job to pry and say well,

"Blah, blah, blah". At the end of the day he has a toilet brush in his bum.

I mean, how much of it was up there if you couldn't get it out?

Well apparently the surgeon said there was a hook on the end of it, so they couldn't just pull it out.

And he went to the surgeons and they pulled it out and

he bled in theatre and then they had to fix him. More beans again for me, for a change.

-I wondered what the smell was.

-Ha-ha(!)

Like Suzi, Andy is also a second year junior doctor.

He's had very little contact with young children...

..but he's now treating them in the Emergency Paediatric Unit.

I am still very green here

so I will need a lot of guidance from

the registrars and consultants, and I'm not afraid to ask.

Andy's the first point of contact in the Paediatric Assessment Unit.

It's up to him to assess and treat children who are sent here.

-Eating and drinking normal?

-Yeah.

He's also part of the crash call team. If his crash phone rings,

it means that a child is in need of urgent attention and he'll have to drop everything and run.

In a cardiac arrest situation this is one of the ones which will go off.

Apparently, if I lose this phone and somebody gets a cardiac arrest

and had no medical attention and died, I could get into a lot of trouble.

Hello.

But junior doctor Andy's finding everyday tasks can be difficult.

As she's only two-years-old Ruby's veins are much smaller

than an adult, making it trickier to take blood.

It's probably the best way to do it.

We'll get this arm around your back

and just cuddle her. So she and you can't see what's going on.

-OK.

-Good girl, Ruby.

Good girl.

RUBY CRIES

-Got it?

-Yep.

All done.

All done. Good girl.

Good girl. Say bye-bye to the man.

'Some doctors find it very hard to have a crying child.'

You're effectively hurting the child by putting a needle in her.

Some people find it very hard,

but I just see it as what I'm doing is helping the child get better.

Practise makes perfect.

Andy's on his way to see his next patient

when his crash phone goes off.

Somewhere in the hospital, a child needs immediate attention.

Andy must get to the child as quickly as possible.

Every second counts.

The patient is a tiny baby. He's just had an operation,

but there have been complications and his heart has stopped beating.

In the last year there have been 27 paediatric cardiac arrests at the hospital.

Fortunately for Andy, some of his seniors are already there.

A senior doctor uses gentle compressions to try and get the baby's heart going.

They also help him breathe.

The team has managed to re-start the baby's heart.

That was the first crash bleep I've had in paediatrics and two things went through my mind.

First, I hope this is only a false alarm and the child is doing well,

and the second thought is "What am I going to do if I'm the first one on the scene?"

But immediately I saw my boss and that was just a great feeling because he will know what to do

and I'll... help and learn at the same time.

The baby has been stabilised and is transferred to intensive care

where the medical team can keep a close eye on him.

On the children's wards, the nurses play a key role in caring for the young patients.

Going to get your bloods done?

If he's going to get on here, Andy must learn to communicate well with the whole team.

'He's quite quiet. I think he's still got'

a bit of fitting in to do.

He needs to talk a bit more and communicate.

We haven't really had a chance to get to know him.

But relationship-building isn't one of Andy's strong points.

I think I'm the kind of person who's difficult to know.

I'm Chinese.

Thank you. Bye-bye.

I came over to this country 12 years ago

and went to a boarding school for five years.

They say I have certain traits of a very traditional, 18th-century Englishman.

That was shit!

We're not having much luck.

We had a speedboat very close to us, probably scaring quite a lot of fish away.

A smile is not cheap.

We don't just give it out, cheaply.

Expression on my face takes up my brain power.

Even my mother's mentioned that I don't smile a lot.

To do well on the paediatric unit Andy will have to learn to

get on with the nurses as well as with the young patients.

Right, have a seat over there.

His next patient is 11-year-old Nikolas.

What were you doing when you hurt your leg?

I was running and I fell on my leg.

-There was a stone and I fell on the stone.

-How big was the bruise?

It was small to start with. Then every day it got bigger and bigger.

Does it hurt around it now?

Not now. Ah!

I'll speak with my boss and we'll get back to you.

I've explained to the child and the family

we will have to do an X-ray to rule out infection on the bone itself.

It could have a really bad consequence if not treated promptly and properly.

Andy's decided on a course of treatment and wants to wait to talk it through with his senior -

but he's leaving the nurses out of the loop.

What's your plan?

My current plan is to get bloods and X-ray.

Have you spoken to Orthopaedics?

Not yet. I'll ask our Reg to have a look at him first and see what he thinks.

Andy's style of doctoring is making the nurses feel shut out.

We work well on here because we work as part of a team.

We expect good communication.

If you're not prepared to communicate and work within the team

then you get pretty short shrift, particuarly if it's busy.

Only a month into their new jobs,

all the junior doctors are still trying to fit in.

Cool, thank you.

Suzi checks her roster for her name. Something's changed.

That's funny.

LAUGHTER

Someone's changed my name on the computer to Barbie.

Good, isn't it? It wasn't me!

And you've made it pink as well!

It's very fancy of you.

You're all so funny.

They really think I have the brain of a Barbie doll, which is very...pleasant.

Do you know how to change your name to Barbie on the system?

-It wasn't me!

-Was it you?

-It wasn't me!

-Who was it?

I'll get to the bottom of it and I'll find out how to do it

and I'll change everyone else's name to something offensive.

Barbie isn't offensive.

Right, do you think Barbie is clever, or really stupid?

I heard people calling me Barbie earlier on and I can understand why.

I've got blonde hair, I've got a pink stethoscope, I've got a pink hair bobble, pink shoes...

Yeah... And it's fine and I know that it's all just banter

but at the end of the day I'm not just a Barbie doll.

I'm not some stupid blonde who just likes the colour pink.

I'm a doctor and I want people to take me seriously.

Suzi puts her concerns to one side and sees her next patient.

At 24, Andrew's the same age as her.

I'm off to see a patient who's been assaulted.

Allegedly.

Tell me a bit about what's been going on?

I had a bit of a fight last night.

-OK.

-A few lads jumped on me.

-OK.

-This is what's happened.

-Andrew was beaten badly outside of a pub.

-Just there.

-On me jaw.

He was kicked in the head, which has caused the left side of his head and face to swell up.

There as well. Ah!

I'm sorry, but I have to have a good feel.

I think we're going to need to get some X-rays done. That looks...

-It's painful.

-Quite a big swelling, isn't it?

-Yeah.

-Yeah, that OK?

Andrew's X-rays are back, but as a junior doctor,

Suzi's not quite sure how to analyse them.

She asks her senior, consultant Jim Connelly, for advice.

He's got a trigonal fracture, I think.

So basically I think he's broken, it's all misshapen, there, there.

I bet he's broken it in three places.

It looks as though, yeah, it's broken maybe in more than one place there.

How do you feel otherwise?

OK. Well we might get a scan of the brain, too. Just cos obviously you blacked out a bit. All right?

-Cheers.

-No problem.

Suzi refers Andrew to the facial team for further tests.

Thanks again for your help. Bye.

# Come on Barbie Let's go party

# I'm a Barbie girl In a Barbie world... #

At the end of her shift, Suzi heads back to the house.

I knew I was going to do that.

You are rubbish!

That's better, isn't it?

But the Barbie incident is still on Suzi's mind, so she talks to fellow doctor Keir.

I've been nicknamed Barbie at work.

-Which is fine...

-Is that not saying that you have an almost perfect figure?

LAUGHS No.

Blonde and have a wide variety of different accessories

and is worth £12.99.

It's fine with staff.

I'm all up for banter, but I do wish that I looked a bit older with patients sometimes.

I do feel like they don't take me seriously, and they never think I'm the doctor. Ever.

As a matter of fact, I say "My name's Suzi, I'm one of the doctors."

-It's my opening line for every patient.

-I wouldn't even do that.

I would say, "My name is Dr Bachelor."

That's not me, though.

I know, but it's a really difficult line to tread

because you don't want to come over as though you think you're an authority figure,

but you do want to inspire trust in people very early on.

'I just associate going by my second name as being kind of older and things,'

and Suzi's quite a fun name and everything, too,

and I guess I just don't want to kind of leave that behind too early cos I mean, I'm only going to get older.

Andy's also worried about how he's coming across on the paediatric ward.

The hard bit about switching to children's medicine

is understanding how things should be done.

Not necessarily medical knowledge related.

It's just understanding how the people are different in the children's department.

That could be quite challenging.

My shoes are leaking, so I've got to fix them.

This is the most technical procedure I've done in my entire life.

Every junior doctors knows that looking the part is part and parcel of the job.

I think it is important to maintain a good smart image when you're working.

If you're looking smart people at least think you're working there,

whether or not they know your role is another thing.

Margaret, where are you going with your table?

24-year-old Lucy is working on the Gastro ward

and she's having to learn the best way to communicate

with the older patients, many of whom have dementia.

78-year-old Margaret's been on the ward since Lucy first day

and is waiting for a bed in a residential home.

-She went for a home assessment visit on Friday.

-Yeah.

If something's quite not right, it gets her really, really down.

Anxious and down. Yeah, I know.

Oh, Margaret. Come on.

At times Margaret's memory loss causes her some distress.

-You don't remember?

-No.

-Where's Marcus? Where's Marcus?

-He's at school, isn't he?

-Yes.

-Yes.

But he hasn't had anything to eat today as far as I know.

I'm sure his mam will have given him something to eat. Come on.

Margaret's chronically confused. She could probably tell you a childhood story with absolute clarity,

but her short-term memory, you know, she probably would struggle

if you asked her to remember a sentence and repeat it back to you.

There are a lot of patients in hospital with dementia

and we have our share of them on the ward.

Some of them are appropriately here

and some of them you think could be housed better in other places.

Lucy's learning that helping patients isn't just about medicine.

It's about having a relationship with them, too.

Aren't they wonderful pictures?

-Who bought these in for you? Did your daughter bring them in for you?

-She brought them in.

-Is this you?

-That's me, yes. When I was 18.

-Look at your hair!

-Loads.

-Amazing, isn't it?

So who's this?

-Thats my husband.

-Your husband. How old were you when you got married?

-21.

-21. Well, thank you for showing me these.

-They're gorgeous.

-They're lovely, aren't they?

-Yeah.

-See you later, OK?

-Right.

The contrast is quite strange and when you sit and talk to someone like Margaret in that capacity

and she says things like, "Suddenly I'm here and all of a sudden I'm old,"

you know, it makes you realise where you are in your life,

and she was once 24 and embarking on, starting a life with her husband or whatever it was,

and all of a sudden now she feels like life's gone by and she's here.

In A&E, 24-year-old Suzi is determined

not to let her age get in the way of being taken seriously.

Her next patient is a 53-year-old man who has come in with chest pain.

Hello. Tell me a bit about what's been going on, then.

The patient has inflammation of the heart.

It isn't a serious condition, but can be very painful.

I'm going to have an examination, if that's all right?

Suzi plans to send the patient home with painkillers,

and checks with her senior.

Can I just run this ECG by you?

-Yeah.

-This gentleman is aged 53.

He's not sweaty, he's not pale.

He says he feels a bit sickly. The pain's worst lying down.

He's not short of breath or anything, but I just wanted to make sure. Thank you.

Suzi goes back to tell the patient he's OK to go home...

..but something's wrong.

God!

I just don't want to talk about it. Seriously.

They're not happy with the explanation Suzi's given them.

But I've just told them what Faith told me to go and tell them.

Let's start again. So they're not...?

They're not happy with him going home in so much pain still

and Suzi's gone and told him that we haven't got anything stronger here,

ie we haven't got tramadol, we haven't got Oramorph.

-They're not happy with him...

-In the sense that those aren't things we're going to give out here

for a pain that could be going on for months and months and months, which it could be.

If he's really saying he can't bear the pain, we can't send him home.

Even if he's completely, you wouldn't even know he was in any pain at all?

Well, then you'd, um...

He's chatting and...

I appreciate that, but if that's what he's saying...

-I know. We can't say "Well, that isn't true."

-We can't say that's not true.

Let me speak to the patient.

The ongoing theme of my whole life is that people don't listen to what I say.

They've asked for my name and they're going to make a complaint against me, because I'm so rubbish.

Maybe I'm just taking it personally, but it feels as if he was looking at my badge as if to say, "Who are you?"

"What do you know?"

"Well actually, I've had five years of training and I've been qualified for over a year."

Junior doctors can find it very difficult when patients look at them

and see a young 23, 24-year-old,

and some young female doctors have been called nurses

and they have been gone through five or six years of highly trained education

and they are very, very skilled. And I think often people don't give them enough credit for that

when they are put in such a foreign environment as A&E.

Don't you worry about it.

Is that all sorted, then, were they fine?

They'll no doubt complain.

Take a chill pill, count to ten.

It's not fair.

I've worked as hard as everyone else has.

It's just like one extra obstacle.

You don't need any extra obstacles here.

I have a stethoscope which isn't pink.

Maybe that would change things.

The complaint against Suzi is dropped but she's left feeling deflated.

All the junior doctors are learning that gaining the trust of their patients

as well as their seniors is a key part of the job.

You look like you've been in a war-zone.

For Adam, a good bedside manner comes naturally.

You've got your arm in a sling, you've got this sticky... Oh, God.

But it's been harder to convince his senior.

With Adam, I found his performance has not been consistent.

His clerking seems to be very good,

but I think when it comes to management, decision making,

it's not necessarily there.

Adam is a confident 24-year-old with high expectations of himself.

In essence...

I want to save the world.

But since becoming a doctor, he's struggled with being a junior.

I've been demoted from ward round to discharges.

60, 70% of the job is probably paperwork.

A few weeks on the job, he knows that the only way to get ahead is to impress his seniors.

Adam is based on the Emergency Admissions Unit,

which treats people sent by their GPs or from Accident and Emergency.

After A&E, it's the ward with the highest turnover of patients.

So what's been going on?

I've just been under the weather.

99-year-old William has been referred by his GP.

His daughter is with him.

Last Friday he started feeling poorly and they put him on antibiotics,

-the doctor put him on antibiotics last Friday.

-OK.

He was on for two-and-a-half days and then he started feeling really sick.

Can you take a big breath in?

William's GP has already done some blood tests

which have shown some abnormalities.

We want your kidneys back to normal

and we want your potassium to come down.

Adam thinks that William's kidneys aren't working properly.

Sharp scratch.

We're going to give you some fluids.

-Whisky?

-Yeah, it'll be a bottle of whisky.

Do you have any preference on which whisky?

-Glenmorangie.

-OK, I'll get you some of that, then.

Adam makes a plan, which includes several further tests

and an ultrasound to confirm his diagnosis.

I think my plan is OK. I really want to run it

by a senior, though, because I think it's a little tricky.

-OK, let's go and see him.

-OK.

Hello, my name's Sophie Rutt, I'm one of the registrars.

There you go.

Sophie Butt!

-Rutt.

-B-U-T-T.

-Very close!

-Are you all right when you're just sitting still or lying down?

-Aye, lying down and sitting still.

So the main problem that we think you've got at the moment is that your kidney function's really not right.

There's something wrong there, maybe, aye?

Anything on examination?

No, no, it looked normal. He's got a trace of pitting edema in his ankles.

-His heart sounds all clear and his chest sounded clean.

-OK.

Before they start Adam's proposed tests,

Dr Rutt asks him to double check the patient's medical history.

So what was his baseline?

Er...

Adam suddenly realises he's made a mistake.

I'm going to look pretty stupid now, but his base keratin number was 232.

I thought because it was looking worse that it's worse!

After checking the records, Adam realises that

the patient's condition hasn't changed for ten years.

-Do you still want a renal ultrasound?

-No.

-THEY LAUGH

-OK.

Adam has to cancel all of the tests he's ordered.

'I basically made a mountain out of a molehill.'

My ethos is I'd rather make a big deal out of nothing

and then somebody go, "No, you don't need to do all that,"

than somebody come in half-dead and me going, "Oh, yeah, they're fine."

Over in the paediatrics unit, Andy's lack of people skills means that he's struggling to fit in.

I don't think I'm anywhere near as approachable as someone like Adam,

or Jon for that matter.

Andy needs to take a blood sample from seven-year-old Briege.

Oh, yeah, he's done it before.

Are you keen to know that he knows what he's doing?

Right, and you're sure you want to watch?

-We're a brave girl.

-What's that?

Just a cleaning cloth. Do you want to smell it? It stinks.

Briege has already had her skin numbed so she won't be able to feel it.

-Smells a bit like your feet, actually!

-Ew!

Andy tries to distract Briege with a joke.

Some guy was coming down the corridor and this other guy

greeting him in the tea room just said to him, "Hey, high five!"

And anybody just walking towards him by nature would respond to it, "Yeah, high five,"

and at that moment a ginormous hand just swings across and smacks the guy off the corridor.

He might have five years of medical training,

but Andy needs to brush up on his jokes.

And you're sure you want to watch?

Why don't we look away?

Silly Billy.

You can have a cuddle with Mammy if you want.

You're going to be very brave, then.

No, I don't want you to do it.

We need to turn away.

I want to look,

-I want to look.

-Tell you what, if you want

to look, that's fine, but you've got to promise me you'll sit uber still.

If you suddenly move then we might miss it and we'd have to do it again.

-I'm going to come over this side.

-You've got to keep still. Is that all right?

I'm going to hold your hand nice and still.

-We don't want to make Andy jump. That's the trick.

-I jump quite easy.

He's a bit of a scaredy cat so he sometimes jumps.

-Nice and still...

-Good girl, you're doing brilliantly

so far.

-You can't feel it because it's been numbed.

-Oh.

-It's that fantastic cream.

-Well done.

-What a brave girl.

Do I have to have another one?

No, providing you stay very still.

-Can't guarantee otherwise.

-Don't have to put it in the other arm.

-Thank you.

-Bye.

There was a joke that he did tell and bless her, the girl was just like...

It went straight over her head, tumbleweed, it was just really grim.

I think Andy's quite a formal sort of guy, and so I think

sometimes some of the younger kids find his manner or his humour kind of quite difficult to understand.

He probably

doesn't understand the ins and outs of the latest Disney movie or perhaps CBeebies or whatever.

But we're educating him slowly and hopefully once he builds his repertoire up,

his communication will probably get a bit better with the kids.

If Andy's going to work well within the team, barriers need to come down.

The nurses have a plan.

We're having a ward night out and we just wondered if you fancy joining us, Andy?

You made it sound a little bit more scary than it should be.

It's not scary! Not just me and you on a night out.

It's going to be an actual ward night out. There's nothing to be scared about.

Yes, I'd love to.

A really nice bonding session so we get to know you, and you can see what we're like when we're out socially.

The ward is very social but he's not actually been out with the ward as yet,

but we're going to take him round the town

and get him into the mood of things.

Unlike Andy, Adam is taking the initiative to win over his nurses

by inviting them to a party at the house.

I at least wanted all you guys to know about it so you could come if you were free.

You legend!

What time?

Any time after work on Friday, pretty much.

Generally, the standard of nurses on AEU, they're very attractive.

I'm quite a flirty person by nature.

On the ward, though, I reckon I've toned it down a lot.

Nurses in particular, they can get away with having a laugh with the patient, being on a level,

joking with them, whereas for some reason it's expected that doctors have got to kind of portray this

conservative image of, "I'm a doctor, blah, blah, blah."

# Riverside

# Let's go. #

It's Saturday night and Andy is getting ready for his night out with the nurses.

# Me and you

# Got a date tonight... #

I don't like doing things that everybody else likes doing.

People drink too much in this country, which I find is

a bit upsetting. I don't see the point of it.

# Let's go, let's go... #

Meanwhile, Suzi is off to start her night-shift on A&E.

I'm suddenly really tired.

I also look terrible.

She's got a long night ahead.

# Let's get this party started... #

I don't get drunk.

Out on the town, Andy's big night out is getting started.

I'll be in a bad state tomorrow, but yeah, what the hell.

In A&E, the casualties are building up.

Josh has just vomited all over himself.

He vomited everywhere yesterday.

I know because you went past him and said well done.

Someone has come in, a fresher, freshers' week, who was in yesterday, intoxicated - he's returned.

It's only like 12.20, intoxicated.

-Getting a hint of kebab in there?

-Yeah, I'm getting a hint of that with a hint of vodka-Red Bull.

# How could it ever come to pass

# She'll be the first... #

For Andy, a couple of drinks are helping him loosen up.

# To describe the way I feel... #

I think I've been more accepted into...their family, I'd say.

Working on a ward is like being a family.

Wild, some people, really.

The nurses' plan has paid off.

Yeah, it's great having Andy out. He's a really good character.

He's having a great laugh and I think we're thoroughly getting to know

the real Andy when he's out and about.

# I said I bet that you look good on the dance floor... #

Andy's dancing is somewhat selective.

Andy obviously has his own style, which we appreciate,

and that's something we'll just have to improve on in the future.

The night has been amazing.

I never knew how much fun the people I work with are outside work.

I'm going to have to love you and leave you.

-Are you?

-I have to, yes.

Don't be daft. You're coming, you're not going home now.

Come on, Andy.

No, you've got to let me go.

Come on. Come out for just five more minutes.

-One drink.

-One drink.

Andy's learning that letting your guard down can be as important as keeping it up.

Hello. How are you?

-In A&E, Suzi is fighting the party revellers a challenge.

-Yes.

-Come one.

Her next patient is Nicholas, a 22-year-old student.

He's been beaten up.

When did this happen?

Probably like four hours ago now. I've been sat here for ages.

That's A&E for you, I'm afraid.

I've literally never had so much fun in a hospital before.

Well, that's good.

Are you a student doctor?

No, fully qualified. If you just look over that door handle, please, I'm going to shine this

into your eyes.

Where is it most sore, if it's sore anywhere? Nose.

Yeah, just nose. Is it broken?

-I think it probably is, yeah.

-Are you going to break it back for me and put it into place?

-No.

-Why?

-What we do here is you get seen at the Freeman after the swelling and everything has gone down.

You give them a call and they'll do it for you. Is that all right?

Do you have any other questions about anything?

Can have your phone number?

You can't have my phone number, no, sorry.

-That's just ruined my A&E experience.

-I'm sorry, I'm sorry.

-Is that your phone number?

-No, this is the number that you call about your nose.

You look lovely tonight.

Suzi, you're the best doctor ever. You're the best trainee doctor ever.

You're not a trainee doctor.

You're the best freshly, 16-month qualified doctor ever.

OK, OK, that's very kind.

Thank you.

Yeah!

-Oh, bless you.

-Thank you.

-Yeah!

-It's unprofessional, so...

Although quite funny, and I'm quite flattered even though he, yeah,

I'm sure it was nothing to do with me. Flattered anyway.

-I'm freezing.

-You're cold?

Can I open up this blanket a bit for you so it's a bit more around you?

On the gastro ward, Lucy is learning to communicate with the elderly patients.

Several suffer from dementia so communication is particularly important,

especially when there's an emergency.

Lucy's called to see her patient Margaret, who has started bleeding.

Where's the stinging coming from, Margaret?

Is it from where you wee from?

That's where the stinging's from?

Because of Margaret's dementia, it's hard to find out what's wrong with her.

Do you think we could get you back to your bed so Lucy can examine you?

That looks like clots, doesn't it?

I want you on your bed. I think it's safer on your bed.

Because Lucy's the junior member of the ward, she looks for her senior.

I'm just going to find our registrar because I need him to help me with Margaret.

BJ, have you seen Samir anywhere?

Is he still here?

Essentially, in any patient who's a post-menopausal women, a PV bleed is considered

malignant until proven otherwise.

Margaret's bleeding could be down to a number of reasons,

but Lucy needs to rule out the worst case scenario, cancer.

It's constant, rather than when she's just passing.

Margaret, I know you're not feeling very well, but do you mind if I take blood from you?

While she's waiting for the senior doctor, Lucy takes some blood samples.

Nearly there. OK, Margaret? I'm really sorry.

Once we've got them, we can send them off.

That's one stage of the process, isn't it?

The senior registrar arrives.

I'll just run those down then I'll come and find you.

Lucy drops off Margaret's blood samples.

They'll have to wait for the results before they know what's wrong with her.

There's not much we can do now until the gynae people have seen her themselves.

It will be a case of waiting for them and going from there.

-I'm just winding you up.

-You're always complaining about having nothing to do on the ward.

Andy's back on the ward.

After his night out with the nurses, he's fitting in much better.

We'll not be complaining to you, certainly.

Yeah, first impressions are very wrong, if last Friday is anything to go by.

I thought he was very shy

and quite reserved, but them dance moves weren't reserved at all.

Nothing reserved about them dance moves!

-He's trying to cheer up a young patient.

-I'm not very good at it.

Are you good at this?

Unsuccessfully.

So the nurses give him a masterclass in children's entertainment.

Just finding bubbles. I have to check your bubble-blowing technique.

-Do I fail the year?

-Yeah.

We won't sign your competencies.

Andy had a lot to learn, communicationwise when he first came.

It's purely not having any experience with children, which he didn't have.

That's pretty impressive.

Getting better.

The staff here have been wonderful.

I know I wasn't going to dislike it but I didn't know I would like it so much.

Yay!

While Andy's won over the nurses, on EAU, Adam's on a mission to impress Dr Jafaar.

What I really look for in a good junior doctor, an F1, is someone who's not only

able to make a diagnosis, but also able to make decisions with regard

to treatment, and that's what's important to the patient, really.

Jafaar looks for you.

He does, doesn't he?

I don't know about him. I'm scared of him.

Adam's next patient collapsed earlier in the day.

-What's going on?

-Last night I was watching EastEnders and I had

a bad stomach. I went to bed and I've never been

-well since.

-Was it not just the drama on EastEnders getting you?

It's not that good!

Have you ever had anything like this before?

I've got bad kidneys.

When you say bad, what do you mean?

I've got, like, double tubes.

-Oh, yeah?

-It's not double kidneys...

-Duplex kidney.

-Yes, I've got that.

Have you got any numbness or tingling down your legs at all?

All the time.

-All the time I get that.

-I just need to find her obs.

Adam thinks his patient has a urine infection and runs his treatment plan past Dr Jafaar.

How many types of renal failure do you know?

-Three broadly, then within each one the different causes.

-Yeah.

So pre-renal, renal, post-renal.

I don't think she's got a stone.

Yes, she's passing urine.

Could that be renal?

I'm asking the questions.

-Sorry!

-You're thinking renal.

-I'm thinking renal.

Dr Jafaar examines the patient to confirm Adam's diagnosis.

I'm going to press on your back.

Tell me if that hurts. Does that hurt?

-Not really, no.

-There?

-No.

-OK. It looks like it's another waterworks infection.

-We'll carry on with the antibiotics through the vein, OK?

-OK.

-Do you have any questions?

-No.

-Fine.

Dr Jafaar, he's a good consultant, he's a strict consultant.

I heard the words "I agree", and that was amazing.

Basically, he agreed with my diagnoses and my management plans, essentially, finer points aside.

So for me that's a great success.

And it's not just his consultant Adam's managed to impress.

Doctors are getting better looking!

Years ago it used to be all oldies, didn't it?

Now they're all shirted up and dress pants and that. Nice.

In A&E, Suzi also wants to be taken seriously.

She's hoping to show that this Barbie has girl power.

Is that meant to look like a Barbie doll? Ridiculous.

A tricky case has come in.

-I've got an interesting lady for you to have a look at.

-OK.

35-year-old Heather has been rushed into A&E with chest pain.

-This is Heather.

-Hello.

-This is Suzi.

Can I ask you about why you've come into hospital today?

I had palpitations this morning soon after I'd woken up.

-OK. Anything else? Did you feel short of breath?

-A bit.

Can I look at your hands first of all?

Is it sore when I press?

-No.

-How does it feel on your chest?

Any pain?

-A little bit.

-Suzi checks Heather's heart.

-Down the left side.

-Thank you, that's great.

What do you think?

The history sounds like...

Palpitations, something going on with the heart.

Do you know any weird and wonderful rare cardiovascular problems

that present with a blue baby, or blue heart disease?

When they're hypoxic.

-Fallot's tetrad

-Yes, that's what she's got.

Oh, really? Oh!

It's a congenital

anomaly, which has four problems with the heart.

-VSD.

-Yes.

Pulmonary stenosis. Overriding aorta.

And right ventricular hypertrophy.

-Brilliant.

-I won't forget that now because I've seen it.

-Absolutely.

-Suzi has correctly diagnosed a rare condition.

Heather has a congenital heart abnormality.

I saw her smiling after she'd got the diagnosis right, especially with such a rare problem.

She got all the clinical signs correct and worked out the diagnosis.

That's a very satisfying point when you get there. I think she was pleased.

I don't think anyone thinks I'm stupid but I bet a lot of people see me and think, "She's blonde.

"Bet she doesn't know anything." But actually I do and it felt nice.

It felt good. It proves I can do it, and I know I can do it, I've just got to have more confidence.

On the gastro ward, Lucy's found out there's some good news for Margaret.

Her blood results have come back negative.

The other day she did become poorly.

It was a bit of a worry because it was out of the blue. She'd been well for ages.

On many levels when we looked at the blood tests and things, actually she was OK. But something was going on.

It was a worry. It was one of the first times

since I've started work, really, that I've felt I've had to doctor in some ways and actually do medicine.

What are you doing with that, honey?

After five weeks of being on the ward, Margaret is finally able to leave.

It looks like Margaret has got a placement at an EMI nursing home locally, which is good,

because it means she's going to be getting a lot more one-on-one care.

We'll miss you. Uh-huh.

I bet you look lovely.

-Have a lovely time.

-Bye, everybody.

You need to look where you're going.

I think we're all going to find it a bit strange over the next couple of weeks

to get used to one of our familiar faces having gone home.

The first time that's really ever happened from my perspective, in terms of a patient who's

been long-standing going home, the change on the ward, the atmosphere.

That bay will be a different place.

People might get some sleep!

It's the weekend and the doctors are throwing a party.

We always have fancy dress at any opportunity.

Medics, for some reason, absolutely love fancy dress.

It's time off from playing the part of a professional,

-and a chance to be whoever they want to be.

-It's Hawaii Five-O. How are you doing?

I like to think that I wouldn't change much.

I'd be pretty much the same.

Even look pretty much exactly the same in 20 years' time.

I'm Chinese, I'm going to look young for a long time.

-I was thinking of opening a bottle of something fizzy.

-Sounds good.

Yeah! Awesome! That's awesome!

Only Keir Shiels would try to teach someone to cha cha to Lady Gaga.

# Just dance... #

We are expected to be boring now, but certainly for me, I'm defying it.

I'm going to

get as much of my personality in as possible.

There's no hurry to grow up and things.

I guess as I get older I'll be happier being called

Dr Bachelor, but at the moment I'm Suzi, you know. That's me.

Next time. Do our junior doctors still think they're up to the job?

-It's just relentless.

-No, you've got a needle sticking out your arm.

Adam's thrown in at the deep end on the night shift.

I've never seen this many patients waiting to be seen ever.

And eight weeks in, can Suzi still cope under the pressure of A&E?

I don't want to look as though I can't do my job.

Do you know how that feels? It makes you feel crap.

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