Episode 5 Junior Doctors: Your Life in Their Hands

A typical night in A&E.

It's like a battlefield.

Language.

Full of twentysomethings 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.

HE GROANS

Cardiac arrest.

-And there's no room for error.

-You're doing well, sir.

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

Seven newly-qualified doctors are sharing this house in Newcastle.

Second years Keir, Suzi, Jon and Andy, already have some experience.

First years Lucy,

Adam and Katherine are newly qualified.

They've all chosen one of the toughest careers on the planet.

But have they got what it takes?

Most people have jobs that are busy some days and not busy other days, and it's swings and roundabouts.

It's just relentless.

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

Adam has struggled with the reality of life as a doctor

so how will he cope on his first night shift?

Never seen this many patients waiting to be seen on EAU, ever.

Can Suzi continue to cope with the relentless pressure of accident and emergency?

I don't want to look as though I can't do my job. You know, how that feels? It makes you feel crap.

Eight weeks into their new placements, do they still think they're up to the job?

I don't want to be known as a doctor that does the bare minimum.

I want to be known as the guy who goes the extra mile.

You feel like you're at the bottom of a very, very tall ladder, looking up,

and, like, it's a huge climb.

It's 8pm and while most people have already done a day's work,

three of the junior doctors are about to start a 12-hour night shift.

Second years Suzi and Jon have now clocked up a fair few night shifts.

But it's the first time for Adam.

Yes, it's scary, the night shifts.

You've got a lot less support at night.

No matter what happens during out-of-hours, it's always more scary

because you'll always have more responsibility.

That's why it's so scary...

..because more than at any other time,

it's all about how you put your clinical skills

into assessment and you make your decisions.

It's kind of you and a few other, like, doctors,

looking after the whole hospital.

Tonight is going to be a particular challenge for Adam,

who's struggled in his first few weeks as a doctor.

He was frustrated by the amount of admin and lack of patient contact.

You are the skivvy.

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.

But when he finally saw patients, he was criticised for being too slow.

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

-Are you serious?

-Yeah.

He felt like he was never getting anything right.

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

As he gets ready for his first night shift, how will he cope?

Fellow first-year Katherine did her first night a few weeks ago

and gives him some tips.

I'm a little apprehensive, to be honest.

Do you have any suggestions on, you know, things I should do,

or not do?

Take some chocolate

because at four o'clock in the morning,

you'll be, like,

feeling really rubbish but you won't really know why,

-and it's because you haven't eaten.

-Right, right.

-You won't feel like pasta, you won't feel like something savoury.

-Right, right.

24-year-old Suzi knows exactly what Adam's about to face.

I will be honest.

My first night shift, which was on surgery,

was my worst day at work of all time.

On surgery?

And I came home and cried in the morning,

and then I couldn't get back to sleep because I was so worried about having to go back in that day.

I'm sure you'll be fine.

Adam only left medical school eight weeks ago.

This is a chance for him to prove he can really do the job.

But before his shift has even begun,

Adam has another worry to contend with.

I'm just going to check that's all right.

I've totally just broken my...

I've done the same thing again!

It's so low that it hits kerbs. The front hits kerbs.

Urgh!

-BLEEP

-sake.

He's based on the emergency assessment unit as part of a team

where he may be called to any number of 170 patients.

It's really hard here.

You've got to be quick and get things done,

you've got to have a good knowledge. It's really, really busy.

So, tonight he could be stretched to the limit as he covers five wards.

Although it's eerily quiet,

it's actually more busy than it is during the day.

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

Ever.

Like Adam, Jon's also based on EAU tonight.

He's primarily ward cover,

so he goes and sees all the patients on the wards that the nurses think are sick,

and he sorts them out,

and I'm solely based on EAU side of leave here.

Adam's first patient is 70-year-old Paul,

admitted with breathing difficulties.

HE COUGHS

Are you bringing anything up with that cough, sir?

HE COUGHS

-Sometimes.

-Any blood in there?

No, no.

I've tried to put a little bit in there.

Is it normally just like that, or is there any colour to it?

-It's been coloured, it's been grey, green.

-Any other problems?

Any strokes? I know you've had a heart attack.

A doctor did mention that I had

-a stroke of some form, or, you know, I get a flutter in this eye.

-Yeah.

So although it's never bothered me, I feel embarrassed -

all the boys think I'm winking at them.

We'll try to find out what's going on, but it's good to have you in,

give you a bit of an MOT, and check you over, yeah?

HE COUGHS

You keep on getting harassed by the wards,

which is just standard when you're on F1 on nights.

They just phone you up all the time.

PHONE RINGS

-Hello, F1 Claremont.

-Still more to see.

Hiya.

Yes, you are now literally my next person now.

All right, bye.

OK, when I say next, I was lying.

# Sometimes I go out by myself... #

While first-year Adam's finding his feet,

second-year Jon is taking everything in his stride.

Stress is like a rocking chair.

It gives you something to do, but doesn't get you anywhere.

Just get on with it, just deal with it.

Jon's cool exterior's about to be tested.

He's called to see a woman who's attempted suicide by overdosing on prescription drugs.

She's got some ECG changes

so that means it might be affecting her heart,

so I just need to see her and see if there's anything else I can do for her.

The ECG or heart monitor,

shows the drugs had she's taken have sent her heart rate rocketing,

which could trigger a cardiac arrest at any moment.

How are you feeling?

I can imagine.

Have you got any palpitations or heart racings? No?

Just feel a bit drowsy?

OK, we'll just have to wait and see how it goes, all right?

I need to do another blood test at the wrist, I'm afraid, is that OK?

I need to give another blood test at the wrist, all right?

We have to.

I'm afraid we have to do it because we need to monitor how...

how much acid's in your blood cos that could cause you to have problems with your heart,

and your ECG's already showing your heart's going a little bit faster than we would like,

and we need to try and find a reason for why that is.

So I'm really sorry but we have to do it.

If it's any consolation, I'm quite good.

I do them quite a lot.

All right, sharp scratch.

Sorry, you're doing really well.

I know you're sore, you're doing really well.

That's it, done now.

All right?

The majority of overdoses we get in here don't have any sort of lasting damage,

and are more, sort of, cries for help,

and just people who sort of really regret it after they've done it

and really don't do themselves any lasting damage.

We'll just have to see. It'll take days, weeks.

So, you know, it's a bit of a waiting game now.

The team have stabilised her,

but her heart rate will have to be closely monitored over the next few days.

Whilst Jon's coping under pressure, Adam's being pulled in every direction

and trying to juggle all the demands thrown at him.

Hello.

It's not you.

My name's Adam Beaini, I'm one of the doctors.

Can you hear me?

OK, can we pop a needle in your arm?

I think the night's always going to be tricky.

You know, it's a cross between patients needing stuff on the wards,

and people needing to kept on the EAU.

It's just a matter of what needs prioritising.

Adam is called to see another patient.

Can we pop a needle in your arm?

-Just so that we can give you your medications?

-No.

But even the simplest jobs can be difficult when a patient's half-asleep.

OK, sharp scratch.

-Ooh, you're hurting me!

-All right, all right.

-Ow!

-No, no, no, you've got a needle sticking out of your arm!

I put the needle in her arm, and she just goes, takes her hand away,

and then blood starts pouring out everywhere because the thing started coming off.

Right, let's do the other one quickly and then get out of here

because otherwise, like, someone's...someone's going to have my arse for lunch.

Adam is trying to keep up with his jobs but his patients are beginning to back up.

PHONE RINGS

Hello, F1 Claremont.

I'm just seeing someone with chest pain at the moment in EAU.

Could you call me back in a bit

and just let me know how she's doing?

All right, thanks, bye.

Most people have jobs that are busy some days and not busy other days,

and it's swings and roundabouts, and peaks and troughs.

EAU's just not.

It's just relentless.

Like, you never win.

You're never on top.

Pulled in every direction,

Adam constantly has to decide which patient takes priority.

I have a bit of a dilemma -

should I go and see somebody with a spiked temperature,

or this lady who had a stroke in A&E,

and she doesn't look very well.

Let's have a look at her notes.

There's more pressure on the junior doctors.

They've got requirement, they need to be here with us,

but they also need to be on the wards seeing patients.

I think sometimes the doctors get quite pressured by us.

They'll have to get used to it!

The nurse has just given me stick for being too slow.

PHONE RINGS

PHONE RINGS

Hello, F1 Claremont.

Adam's called away again,

as another patient needs a doctor.

Housemate Suzi is working her night shift in A&E.

Even with experience, nights are challenging.

Her confidence was recently knocked when a patient threatened to make a formal complaint about her.

The family are just basically not happy with my figuring out of things.

-Where's Camilla?

-Let me speak to him.

Feels like he was looking at my badge as if to say, who are you?

You know. What do you know?

I just don't want to talk about it, seriously.

Back on the ward, Suzi must put this episode behind her.

She's called to see an elderly patient, an ex-smoker, admitted with dangerously low oxygen levels.

Jean... Jean. So, she had a stroke last year, she's been in with her chest quite a bit.

-She was in four weeks ago with a chest infection.

-It's always been chest related in hospital.

Is this how she is normally when her chest gets bad, or is this different?

No, the last couple of times, she hasn't been as bad as this.

Suzi must assess whether 86-year-old Jean is unconscious, or asleep.

Jean?

Jean? Jean? JEAN SNORES

How are you feeling?

Uh-huh.

-Do you have any pain anywhere?

-Ahh.

No.

James?

Suzi asks her senior doctor for advice.

James, this is this lady here, she's 80 something.

-The daughter saw her yesterday and she had a bit of a cough.

-Mm.

She's come in this evening more lethargic and quite drowsy and things.

She could be drowsy because she's got a UTI, or she's got a chest infection.

-She mobilises herself, does she, or does she need help with that?

-I don't know. I need to find out.

I think we just need to try to find a bit more collateral out about her,

what she's normally like, does she feed herself, that sort of thing.

-Yeah.

-Is that all right?

-Yes.

-OK.

Brilliant. Thank you.

Suzi's sent back to ask more questions to make an accurate diagnosis.

So she's normally in bed, or...?

No, she normally sits in her wheelchair in the lounge, you know.

-She's quite sociable?

-Yes.

-And does she...feed herself?

-Does she get help with that?

-No, she's got...

-Well, she can feed herself.

-She can feed herself, but she's got a very, very shaky hand.

-Right.

-So she does need help, but she does feed herself.

-I'll just go and put this

through the machine, I'll be back in a second.

I asked some of it, I just didn't ask all of it.

I'm not bloody perfect.

Suzi's ordered a chest X-ray to get to the bottom of Jean's breathing difficulties.

She's got some changes in her chest X-ray. She's got a bit of an infection there.

She diagnoses a chest infection and decides on a course of antibiotics.

Jean?

-Haaa.

-How are you feeling?

-Uh-huh.

-We're giving you some antibiotics for your chest, because you've got a bit of an infection there. OK?

-Aaah.

OK.

Suzi asks James to double check Jean's X-ray.

It's looking serious, and he asks Suzi to order stronger antibiotics.

Can we give Cefuroxime instead of...?

-Am I just in time?

-Yeah.

Good. How can I change it on the order?

Jean needs to be transferred to a specialist unit in another hospital.

Hello, I'm calling from A&E at the General, I wondered if I could just...

let you know that one of our patients is coming over later on this evening.

But Suzi can't wake Jean up, and it's too risky to transfer an unconscious patient.

Right then, OK. Thanks, bye.

I need to speak to James about it.

James, the Med Reg says that she can't go in the back of an ambulance.

She's in Resus 4.

Jean? Hiya! Can you open your eyes for me?

Hi, Jean? How are you feeling?

You're all right. All right. All right.

Sorry. I'm sorry. How are you feeling, Jean?

I'm sorry to wake you up like that. That's horrible, isn't it?

Sometimes with people that are quite drowsy, you've got to be

a bit firmer to try and wake them up

and actually elicit how drowsy they are.

She's a bit more alert than I think Suzi thought.

I don't want to call the Med Reg back, she's going to laugh at me!

Jean was just asleep. Suzi needs to phone the other hospital to explain her mistake.

Fully conscious, the patient can be transferred after all.

My registrar has since been in to see her, and he's been able to rouse her and, after that,

she was fine, and able to speak and do things, move around.

Thanks again. Bye.

I was crying earlier, because I was just really stressed.

I feel like that all the time, actually!

It gets worse. It's worse when you're on nights, I think. You feel a lot more...

-It is. You're more sensitive.

-Yeah. You feel there's not as much staff around and things.

I think you feel more like you're making decisions on your own, don't you?

You feel more like a burden on the registrars, too,

because they have to answer all of your silly questions!

'Junior doctors working in a new department, it's really tricky.'

They come in with what we think is very little experience.

They've done House Officer jobs where they're really quite led

by the more senior doctors.

When they come to us, we expect them really to be making decisions

on the hoof, admitting and discharging patients off their own back and off their own knowledge.

And it seems that they're asking more and more questions of the more senior doctors, the registrars.

Which is a good thing to start with, but then they need to progress on.

Sometimes it seems like that's not happening as quickly as it used to.

-Don't worry about that.

-I know, but I just feel kind of like...

-Yeah, well...

-But it's so basic.

-You didn't do anything wrong.

Oh, I know, I know. I think I was just feeling down earlier.

-The senior doctors on A&E know how hard it can be.

-'I think a junior doctor's confidence'

can be knocked by the whole situation in A&E.

It's a very fast-paced environment.

Some patients can be very demanding.

'Other patients can present with very complicated problems and often

'a young F2 has got the problem of dealing with that.

'I think you must have a very sensible head on your shoulders'

and a good way of dealing with that when you struggle.

MOBILE RINGS

-Hello.

-Back in EAU, Adam and Jon are coming to the end of their 12 hour night shift.

It's 5:40 in the morning on...

..Saturday 3rd October now.

Or is it the 4th? It's the 3rd.

I have no idea.

Sunday the...

Oh, God. Anyway, I'm up-to-date on my jobs, and that's a good thing.

Yeah, I'm quite tired tonight.

Tomorrow night I'll be more sprightly after I go home and sleep.

Adam has nearly made it through, but there are still patients to be seen.

Hiya, pet.

My name's Adam Beaini, I'm one of the doctors.

All right, pet. Try and keep some oxygen back on, OK?

I'll take your pulse and listen to your heart first. Then I'll listen to your back.

-Sure.

-And I'll have a quick feel of the tummy.

And then we'll have a chat about what I think's going on, OK?

So, do you want to just rest back on to the pillow for me?

Righto.

I hope you're not going to poke, poke, poke, like they were doing the other day.

Let's hope not, eh?

You've maybe got more experience than some of these young lads.

Right. D'you reckon you'll be able to keep that in?

-Yeah.

-All right, pet. I'll see you later.

-In my eighties now.

-Well, you don't look it.

-SHE GIGGLES

-Thank you!

See you.

Is he married?!

It may have been tiring, but working nights has given Adam the patient experience he was desperate for.

It is nice, learning to do things myself

and I am becoming a bit more independent,

without feeling like I'm putting patients at risk

or being, you know, a rubbish doctor.

I feel like I'm being OK, so I don't feel too bad about anything.

'I feel like I'm doing an OK job. I think it's really important that I've had to experience nights.'

I think it's kind of encompassed what it is to be a junior doctor, being on nights and doing like,

-you know, the

-BLEEP

-jobs, the good jobs, and everything in-between.

I think it's just been a really crazy experience.

As Adam heads home, housemate Keir is starting his shift on the Plastics Ward.

Hello. How are you doing, Sir?

-I really like it here.

-It is, it's great. You know,

you are buzzing! Two weeks ago, you would have walked down this corridor going, "I hate my job!"

Now, you're walking down this corridor, just jumping and buzzing and being happy.

You're constantly doing something, you feel like you're part of something that's working towards...

But you will find that medical consultants and registrars on the ward

will start involving you a lot more in treatment plans and will start asking you to assess patients

and just going with your findings. And you will be trusted a lot more.

So you might not just be as much of a paperwork monkey as you were.

OK, dude. Well, I'll see you back at the house.

Cool. I'll catch you later.

Bye-bye.

While Adam's buzzing from his first night shift, at home, Suzi's confidence is low.

'I hate it when I do anything wrong or I think, "Oh, I could have done that better." You know?'

And if we do anything wrong in our job, the worst thing that can happen is that someone dies.

And that's like a massive thing.

Like, someone's life in our hands.

Like, I'm 24, and that's such a kind of burden and stress and things.

Despite coping well on the wards, Jon's also thinking about his performance as a doctor.

I kind of scraped through this last year,

just doing the kind of bare minimum.

And I guess, you know, I don't want to be known as a doctor or whatever that does the bare minimum.

I want to be known as the guy who goes that extra mile and, you know,

would do anything to make sure that patients are OK and stuff like that.

So I guess I've got a few challenges this year.

In fact, he's got a lot to prove.

He just scraped through his first year after failing to keep up with his assessments.

There's a lot of red here.

I just put it off till the last minute, really. It's the kind of stuff I do, that's how I work.

He wants to be a surgeon, and has just taken an exam to get into that field.

But it was squashed into a hectic week of night shifts and rugby training.

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.

While he's waiting for his exam results, Jon goes home to Oxfordshire, to see Mum and Dad.

Hey, Dad, how's it going?

Hello, sunshine, how are you? Nice to see you.

'We are quite a close family. We like spending time with each other.

'I try and get home when I can,'

even if it's just for a couple of days, just to see Mum and Dad.

I think Jonathan expressed an interest in being a doctor

when he was about six or seven. I mean,

like all boys, "I want to be a fireman,"

"I want to be a policeman," "I want to be a truck-driver."

But when he got his A-level results, he gave me a big hug and he said, "Mum, I'm going to be a doctor."

And I mean, I was in tears, and I think he was almost in tears as well.

His mum knows that he can be very laid-back, and is anxious to find out how the exam went.

The first paper was really hard, the second paper was pretty easy.

Well, not easy, but nicer questions.

-I think I've probably passed the second paper.

-But you've got to have...

But you have to pass both, it's not like a cumulative thing. So...

'He does try hard,'

but he doesn't give you the impression that he has tried hard.

He'd always, you know, if he had homework to do, he would be

the one that would stay up all night the day before it was due in.

You know, I might have been brilliant and passed it.

Yeah. Pigs might fly!

-It's happened in the past!

-Well, it has, yes.

'He nearly failed a couple of his exams'

in his first year, and I think that really brought him up short.

And he thought, "Yeah, I do need to maybe put a little bit more effort in."

Back in Newcastle, Jon's housemates, first year Katherine

and second year Keir are working on the Plastics Ward.

Over the past few weeks, Keir has been learning the importance of a good bedside manner.

'I think medicine'

is just...is, you know, great fun and really dynamic.

If you want some time off, you know, just...just make it an excuse!

I would say that I've been using acting skills,

'every day that I've been on the wards.'

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

'Making people feel better,

'that's what it is. And it's not just by giving them penicillin,'

it's also by cheering them up.

And that's what I like doing.

Many of the patients in the Plastic Department need major reconstructive surgery.

And it's the job of the juniors to give them emotional support.

-Hey. How are you doing?

-All right.

-Good, good. Um, blood tests are back...

Keir is looking after 20-year-old Dean,

a builder with serious injuries after a motorbike crash.

'Dean is an example of the sort of patient we see quite a lot in plastic surgery.'

He's very young, very fit, very healthy.

But came off his motorbike at quite a high, but LEGAL, speed.

'And you know, it has pretty much destroyed the left-hand side of his body.

'He's dislocated, ruptured, and broken his shoulder. He's broken his forearm in two places.'

He's stripped the skin off his legs, you know,

he's got very little function down the left-hand side of his body now.

How's the graft doing?

It was sore last night, I must admit, on the leg.

Mm-hm. The orthopaedic surgeons put the shoulder back together and we're trying to put the skin back together

'in his leg.'

Keir and the team need to assess if Dean's first muscle transfer and skin graft has worked,

or if he needs another operation.

All of the nerve fibres that have been cut are all knitting back together

and the ones that knit back together first are, helpfully, the ones that feel pain.

I'll have a look at your painkillers

and make sure that you're on the right stuff.

With a complicated case, it's important Keir communicates everything clearly.

He's been fantastic. Very good at describing and...

you know, getting the picture in your head...

Not all of us understand everything but he's very good at getting it over,

so he's the best one that I've probably met, to be honest.

After Keir and the senior team review Dean's progress,

there's bad news. His arm is doing well but he needs further surgery on his leg.

I've been notified that I'm going to have to have another operation now, for another muscle to get moved into

my leg because it's such a big hole, a big gash in my leg that it literally needs filled up.

So I'm not going to say I'm not worried about the operation, because it's something that's pretty major,

but it's something that's got to be done.

As a second year, Keir now has to face up to answering difficult questions.

'Dean's injuries will... will take months to sort out.'

If I'm asked by him, I can't say, "Oh, I'll get one of my seniors."

'I am now in a position where I can answer his questions, and should.'

It's Katherine's job to take some blood before his big operation.

-It's pretty serious on Thursday, mind, isn't it?

-Hm?

On Thursday, it's pretty serious - what's going to happen.

-The operation?

-Yeah.

-Yeah.

-I kind of thought I'd be going home today.

Mm. You've had some of your skin moved around, haven't you? To cover up where your skin's been taken off

by the motorbike accident. Not all of it's taken

so he needs some skin or muscle taken from somewhere else.

The surgery to repair the hole in Dean's leg could take many hours and there's no guarantee of success.

The blood vessels in the flap that have been attached to the blood vessels at the site of the injury,

he's worried that they'll clot off or go into spasm

'and the flap won't get enough blood supply and will basically just die off.'

If the operation fails, Dean could lose his leg below the knee.

Back at the house, it's an important day for second-year Jon.

I get my results of my surgery exam today.

Exam results...

Exam results. That might do it.

Ah, right. Yeah.

I didn't pass.

Obviously, I'm disappointed. Nobody likes to take stuff and fail.

I probably didn't dedicate enough time to it as I should have done.

I didn't revise as much as I should have done.

A lot of people, when they qualify, are very swept up in the job and the career and stuff.

I think me personally, I want to still have a life and,

yes, I want a career, but not to the detriment of everything else.

Suzi's also feeling low.

So with a few days off, she's heading home to Ireland to get some support from Mum and Dad.

They know me better than anyone else. So their feedback and things is always very useful.

Her parents are keen to find out how she's coping with work.

I think confidence is an issue, personally. If you're having

a bad day, sometimes you don't feel as confident and things.

You know, say if you kind of think, "Oh, I always ask that question, and the registrar has asked me,

you know, 'What did the patient say to that question?'"

I didn't ask it on that one time. I think, "Oh, I should have done it."

And I think I've got high expectations of myself.

You're not, by nature, somebody who goes around blowing her own trumpet all the time.

-Yeah, I know. I'm not.

-So to speak.

-Yeah.

So I think maybe that, and yet I would like you to feel that...

-I know what I'm doing.

-Yes, exactly. I think you know what you do at work.

-I think that's coming, yeah.

Her parents know that Suzi is her own worst critic.

I suppose as a child she probably lacked confidence.

"So and so is better at sport and so and so is thinner than I am..."

She's always been...

I don't know, very hard on herself, in some respects, but then I suppose, at the end of the day, it's what's

-made her work very, very hard, because she's always wanted to be the best she possibly can.

-Yeah.

Suzi's brother, who's just qualified as a pilot, is also home.

-How are you?

-Good to see you, Suzi.

-I'm very well.

-Well.

When I started my first week or two, actually flying passengers, doing my line training,

it was just... Everything was so fast

and I thought I'd never get my head around it in the end but then after a while you get the confidence.

-Yeah.

-Something just clicks

and it all just comes together.

I've always known that I can do things but I don't come across very confident sometimes.

-Like in loads of things.

-When it comes together and you get good results it must be rewarding.

Oh, yeah, yeah, yeah. Like...

It's, like, satisfying, being able to, like, not fix people that are sick but, you know, think that

they've got a cannula in because I did that, or they're feeling better because I've been in here

managing them in resus on my own, and they're alive, still!

Yeah. I didn't think you'd be a doctor, you know.

10 or 15 years ago, I didn't.

-Once you'd decided to do it, I didn't really have too much doubt that you'd achieve it.

-Thank you.

Argh! Don't tickle me!

SUZI SQUEALS

-Be good, be good, be good.

-Take care, then.

-Bye! Thank you for having me home.

-Oh, don't mention it.

- Take care, Suzi. - See you soon.

Take care.

After a few days at home, Suzi's spirits are back up.

'I do feel as though I'm up to the job in A and E, even though sometimes it's really hard

'and challenging and I have bad days and I think, "I could have done that better"'

or blah, blah, blah... But in any job, even if you're great at that job,

you're going to have bad days, because we're only, like, human after all.

Back in Newcastle, Adam's just finishing nights.

Keir and Katherine are starting their day on the Plastics Ward,

where Dean is recovering from his operation.

-You all right?

-How are you doing? You all right?

Yeah, good. Feeling better at all?

I do feel rough, yeah. I was bad last night, but...

-I don't know whether you've heard it off the nurses, my stories and that, but...

-No! What happened?

Well, it was very hot in here. Let's just say it was hot in here and...

-Oh, and you'd just had a bit too much morphine, and...?

-I had a lot of morphine in us

and I kind of thought all the nurses were walking around in their underwear, like.

And I did ask her, "Have you been walking around in your underwear?"

-She went, "No, no - you'll make us go red."

-Aw.

-Were you in the theatre?

-No.

We did actually pop down but they'd finished by the time we got there.

It was quite quick, wasn't it?

Mm, it was quite quick.

-Well, I think they're pretty pleased with it.

-Good.

Everyone that's come in has said that it looks good, like.

I deserve a bit of good luck now.

Definitely, yeah.

I think it's especially important to have good relationships

with the patients on Plastics because whilst a lot of patients

are in and out in two or three days,

we have a lot of patients on who are quite long-term.

Even though the operation went well, Dean's future is uncertain.

If the graft doesn't take, he could face losing his leg.

SIREN WAILS

Do you want me to call X-ray in a bit, then?

-Yeah.

-Right.

-Yeah.

Suzi's back on A and E. The unit's very busy.

The senior doctor is already dealing with

two critically ill patients and there's another on his way in.

-You're going to take this for me, then?

-Yeah. Is that all right?

-I'll be here, yeah.

-Yeah, so just like...

An elderly man has been rushed in with breathing difficulties.

It's a chance for Suzi to prove she can handle a critical case by herself.

Albert?

How are you feeling?

His blood pressure is extremely low.

What does he sound like?

Rattling everywhere.

-Kind of coarse...

-OK.

-..crackles. But I'm going to listen to his back in a second.

-OK.

He's not looking very well.

No, I'm worried about him.

I'm just putting some fluid up because the patient's blood pressure's very low. Dangerously low.

After listening to his chest, Suzi suspects a serious chest infection.

I think it could be septic.

It means that he's ill from an infection.

Very sick. That's the long and short of it, really.

I'm just going to take some bloods.

She orders a chest X-ray, to confirm her suspicions.

Yes, he's had a chest X-ray and James has seen it and thinks it's more...

infection, rather than heart failure, so now we're just working on bringing his...

blood pressure up a bit and his pulse down a bit.

Suzi's diagnosis is right.

She resuscitates the patient with fluids and administers antibiotics.

Do you need anything else for him, James?

Are you feeling any better?

-Uh-huh.

-That's good, and you're able to speak now. Brilliant.

He looks a little bit better now than he did when he first came in.

He's a bit more alert. He's looking around.

His blood pressure stabilises.

Wow! 90 over 52.

We're winning.

Suzi's patient has gone from being critically ill to stable and it's a massive boost for her confidence.

I feel quite, like, alive.

I like helping people. That's why I'm here.

And I felt more, like, clear and concise, which isn't a forte of mine,

but I'm working on it.

It's a work in progress, my self-confidence.

On the Plastics Ward, Katherine's patient, Dean, is hoping to be discharged.

Things are looking good. Everything's fantastic on the leg. It's healing well.

Basically, just waiting to go home. I'm ready to go home now.

The plastic surgeon, Mr Alrawi, wants to see if the graft has taken.

So you dangle it twice every day.

They're doing it twice. Morning and afternoon.

Righto.

Has it always been like this?

-Yeah.

-Yeah.

WINCES

Does it look really good though?

-Yeah, looks good.

-Yeah?

I think you're doing well, at this stage but there's still some raw area.

It potentially can become infected.

-Stay over the weekend.

-Stay over the weekend, yeah.

-Yeah, you reckon?

-That all right?

-If it's got to be done, it's got to be... I'd like to go home, like.

I know you want to go home but this is a big-time

-operation so you don't want things to go wrong after all this time.

-No.

'The recovery from this operation,'

or from this type of injury, takes around 8 to 12 weeks.

'Things can go wrong. More of those young people are passionate and are keen to go back on their feet.'

If they overdo things,

and they don't comply with what we told them to do, so...

So hopefully he'll be all right.

He sounds a sensible chap, so he should be all right.

Dean's clearly disappointed but Katherine's job now is to help keep him positive.

-Are you getting a bit fed up of this place?

-I just want to go home. Just let us go home.

You don't like to see patients being stuck in hospital for any length of time but it's always nice

when they're so positive and cheerful and it makes your job a lot easier, I think.

Ah, cheers. THEY CHUCKLE

While Katherine comforts Dean, Keir has been called to

the Children's Clinic on plastics.

-He's seeing six-year-old, Aleysha.

-Can you feel me tickling your foot?

OK. OK, and can you feel me tickling the top of your foot?

Can you feel me tickling the side of your leg?

Can you feel me tickling the other side of your leg?

I really enjoy the challenge of working with children.

They are great fun and you've got to use a lot of lateral thinking

in order to distract them from the thing that you want to do.

-How old are you, Aleysha?

-Six.

-Six. Excellent. Good. I liked being six.

I was six a very long time ago.

A good age to be, six. OK.

Do you have any questions at all?

No.

No, OK.

We're going to need to put some stitches in just to close it up

because it's quite a deep wound and it's also in an awkward place.

Every time she bends her ankle, it'll pull so we need to keep it together.

OK. Erm, I'll see if we can get it sewn up today.

OK.

If we can't, it will be tomorrow.

But I'm working on trying to get everybody seen today. OK?

Working out on what level you can talk to people from child to adult,

child to adult, and not come over as immature

but, at the same time,

not come over as unable to communicate with a child.

So it's a real kind of acting challenge in many ways,

which is probably why I enjoy it.

You have to change character a lot.

Adam has finished his night shifts on emergency admissions

and is going back to work on the respiratory ward,

where he first started as a doctor.

I learnt a lot in EAU, definitely a lot more than

I learnt in respiratory, just because of the nature of the job.

The EAU is so varied

and it's just really good for being a well-rounded doctor.

Whereas on respiratory, I haven't made any executive decisions.

I think it's probably going to be a bit like being a ward monkey again.

I don't know. There's pluses and minuses with it, really.

But when he gets there,

he's straight into working with patients, helping Dr Burns.

They're seeing 86-year-old Elsie,

admitted with breathing difficulties.

-Right, I'll be honest with you, we haven't got all the answers yet.

-No.

I think we need a repeat chest X-ray

and we need some repeat bloods today.

-We'll get you there, we'll sort you out.

-Are you sure?

Oh, yes, we'll sort you out.

-We're not there yet, I'll be honest with you.

-No.

It's been nice to see you and we'll see you again.

-Thank you very much.

-Thanks.

-It's a pulmonary oedema?

-It could be, couldn't it?

This is not a normal X-ray at all.

The thing is with Dr Burns, he's really

good at teaching as he goes along.

That's really, really helpful.

He's always asking me what I think of chest X-rays and it's fantastic

because I feel like I'm actually learning something as I'm

going along, as opposed to being a mindless drone.

It's easy in F1 to actually become deskilled,

compared to as a medical student.

If you just go along doing all the admin jobs and don't do any thinking.

Adam's given an opportunity to assess a patient himself.

So how are you doing, sir? How's the breathing?

-It's getting back to normal. I still have the shortness of breath.

-OK.

Are you managing to walk a bit further than you were before?

-Oh, yeah, I've been up, I've walked to the coffee shop.

-Oh, yeah.

-Twice yesterday.

-Oh, yeah.

-And twice on Saturday.

-Can I have a listen to your chest?

-Certainly, yes.

It's nice to review patients myself.

I feel like I'm actually doing something useful.

Just doing jobs on their own and not reviewing anyone,

not making any executive decisions, sucks.

Actually reviewing one or two patients is really good.

I think it's really important for my own kind of self-confidence

and to keep me going.

I've actually had quite a pleasant day, to be honest with you.

I've just realised that.

It does get easier.

I think the hardest time is shortly after qualification.

They're finding it extraordinarily difficult,

they've suddenly lost a lot of confidence

because they think they know nothing.

They are normal, healthy individuals going through unusual

periods of stress and they just need a little bit of nurturing.

I've got to have matured so much since the first day.

I care less about money and about materialistic things,

about superficial things and about pointless things.

I feel like I've got a purpose in life now.

Suzi's also been given a break on A&E.

A patient has come in with a serious gash on her arm.

-How did you do this?

-I was slightly inebriated last night, shall we say.

I went to the toilet and forgot there was a bath mat

and I was wearing my high heels and I fell right over the bath mat,

right through the bathroom window.

Suzi's senior is trusting her to perform the stitches.

-It's the first time Suzi's done this.

-I don't sew anything.

I don't know how easy the sutures are going to be.

I've only done it on mannequins before. It'll be interesting.

She won't be on her own.

Richard will guide her through, but it's still nerve-racking.

-Do you have any models I can have a quick play on?

-No.

-I'll talk you through it.

-Yes.

-Suzi must decide what kit she will need.

-One per cent.

She'll need a steady hand.

-Comfortable there?

-Yeah, yeah.

-It's gonna be a little bit stingy.

-All right?

-That's fine.

-Try and keep nice and still. All right?

That's fine. I've got three tattoos, I've got 17 piercings.

This is a walk in the park.

Richard demonstrates with the first stitch.

You're going in perpendicular to the skin.

Follow the curve of the needle round.

And pick it up with the forceps.

That's the no touch technique, which helps keep the wound nice and clean.

-That's one.

-Yeah.

-Two times round.

-Mm-hm.

-Grasp it just at the end.

-Then pull and give it a little twist to lock the knot.

-Okey-doke.

-Now, it's Suzi's turn.

-Good luck.

-Righty-ho.

With her senior supervising her first attempts, the pressure's on.

So perpendicular, like that. Then, in like that.

-And a flick of the wrist. OK.

-Mm-hm.

-With this hand, holding it like that.

-Yeah.

Like a pair of chopsticks.

-Like that?

-Yeah.

Good. Excellent there. Pick it up before you lose it. OK.

Pull it through.

-One, two and the end.

-OK.

-And the twist locks the knot.

-Right, yeah.

If you lose the tension at this point, you have to start again.

-Yeah.

-Are you OK with that?

Right through.

Just twist. Good.

Yeah!

Well done, you.

Thank you for being so good and just sitting there.

You're welcome.

I'm really impressed. They look really neat. It didn't hurt.

Thank you for being so good and patient with me. It was very useful.

-Yeah!

-Thank you!

No bother.

I've just done my first stitches!

-What, what, what?

-I've just done my first suturing, yeah.

I put in some stitches!

That was a good job for a first go.

I was really nervous, in case you couldn't tell.

I was like, "I can't grip anything. My hands aren't working!"

My hands also are red, with all the sweat I've been perspiring under those gloves. Thank you.

That was really, actually, kind of fun.

She did a good job.

Slow and steady wins the race, as they say.

It's another boost for Suzi.

A&E's very different

to any of the jobs that Suzi or any of

the other junior doctors will have done beforehand.

You get patients off the street, if you like, and you're the first one

to deal with them and that's quite a daunting thing to do to start with.

But you can really see that Suzi's confidence

and ability to deal with these sorts of problems has really improved.

While Suzi's on a high, John's back on EAU, mulling over his surgery exams.

I got my, like, mark breakdown and I only missed out on passing by seven marks,

which kind of makes it a bit worse, but, you know, whether you miss by a mile or an inch, you still miss,

so I wasn't good enough on the day, which is fine. I can accept that.

That's all part of the learning process.

I think, when I go back into it the next time, I'll definitely do more revision.

In the plastics department, there's good news for Dean.

-After nearly a month in hospital, he's finally going home.

-Hello.

I shouldn't even be saying hello.

I should be saying goodbye! Finally.

-It's been a long time.

-I know.

And how is the foot bearing up?

Healing good, to be fair.

You're going to be walking before you know it.

I'd be surprised if you didn't run back in here.

I might just skip. I don't know. I'll see what takes my fancy!

Patients can stay with you, in your mind, for different reasons.

Sometimes they're patients who've had horrid complications.

Sometimes they're patients who have recovered despite the odds.

But Dean is just going to kind of be there as somebody who, despite really

disabling, debilitating injuries, had a positive face all the time.

His injuries have severely limited his mobility,

and he will pull through because he wants to.

-It's been a pleasure.

-Thank you very much.

-No problem. Brilliant.

-Cheers, mate.

-Bye-bye.

-Thank you very much.

I'm getting to go home. 27th day here.

I'm happy it's eventually come round and the operation went really well and it's really healing fast.

I'll be coming back here.

When I can walk, I will walk into this ward and I'll give them all

a hug because they've been so good to us.

Keir and Katherine can reap the rewards of time well invested and a positive outcome.

Tonight, Keir's cooking for his house mates. It's a chance for them

to get together at the end of a long week.

This is just really simple.

It's just salmon with

kind of pork and apple stuffing.

Well, cheers. Here's to...

Here's to civilisation!

Civilisation and plastic cups.

Kier, did you get a specific recipe for this, or...

-No.

-Did you not?

-No.

-You just made it up?

-That's incredible.

This is just all made up.

Shall we just...get married or something?

Would that work for you? Because this is really pleasant.

-OK.

-Sorted.

-OK.

-Brilliant.

-Yesss!

Takes all the stress out of my life.

Are you finding things as hard as you thought you would?

I haven't found it harder than I thought it would in terms of the work itself.

What I've found hard is to actually take care

of myself and work at the same time because so far,

all I've done is neglect myself for four weeks.

Even on a night off, work is never far from their mind.

I suppose when you talk to a lot of people who

aren't doctors, they kind of ask you what sort of doctor you want to be,

where you want to be a consultant.

Consultant is not even in my brain.

You know?

I don't have this image of me as a consultant in my head at all.

-I don't.

-I don't.

I wish I could. But it just seems like a far-off dream.

I think I'll always question whether I'm up to the job, and I think it's an important part

of good medical practice to question yourself.

Obviously, I have bad days.

That's fine. But I feel as though, yeah, I can do this.

And even if I have a bad day, I think, it's been a bad day but I can

go back and do it the following day and the day after that.

CHILD CRIES

-Next time...

The more I do, the more I realise how far I've got to go.

They're coming to the end of their first placement.

Having become comfortable over four months in something,

I'm suddenly back to square one, at the bottom of a learning curve.

Have they got what it takes to stand on their own two feet?

I can't find anywhere!

Are you all right? You're looking a little stressed.

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