Episode 6 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,

after five years of training...

Cardiac arrest in A&E.

..and a rigorous induction into hospital life.

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

-Never done this before.

-They face the reality of life on the wards.

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

"What do you know?"

-Cardiac arrest.

-And there's no room for error.

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

For the last three months, the junior doctors have been

working in two of Newcastle's busiest hospitals...

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

..where they're dealing with life-and-death situations every day.

This guy's really, really poorly.

I don't want him to arrest.

It's been a steep learning curve.

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

But now they're finishing their first placements and moving on to new departments.

Having become comfortable over four months in something,

-I'm back to square one at the bottom of the learning curve.

-As they prepare to move on,

do they still think they've got what it takes to be good doctors?

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

I've still got that feeling of,

"God, I can't believe I'm actually a doctor."

And how will they cope with your life in their hands?

Early morning in Newcastle.

At the house, the junior doctors are getting ready

for the last few shifts of their current four-month placements.

First up is 28-year-old Keir.

The world is a better place when it has coffee in it.

Next is first-year doctor, 24-year-old Katherine.

If you want to, we could share a cab. It'll only be two quid each.

Yeah, let's do that. I hope it's not another day like yesterday.

Yesterday I didn't leave until 6:45pm.

As Keir and Katherine head to hospital,

25-year-old Andy is just getting up.

Always have to check if the milk is off or not - a certain someone has

a habit of leaving the milk outside the fridge.

Next up is 24-year-old Lucy.

-How long does it take to dry your hair?

-I would say about 20 mins.

Finally, 24-year-old Adam is running late.

Overslept a little bit.

Not getting back into...the daytime pattern very easily

from night shifts.

If I don't bring something to eat, then I don't get time to eat.

All the junior doctors are coming to the end of their current jobs.

They've each got just a few shifts left before, as part of their ongoing training,

they move onto new wards and departments.

I guess you take the cap off to flush it.

Moving from job to job as a junior is a difficult issue.

As a doctor, at some point to have to start taking responsibility for what you do yourself.

If we don't gradually loosen the reins, so to speak,

and loosen the closeness of the supervision,

then a doctor never learns to take responsibility for themselves.

Second-year Keir has been working in plastic surgery for the last three months.

His experience on plastics has helped him decide he wants to work with children long-term.

'I love dealing with Paeds cases,'

children are just the best patients.

'It's a great challenge, but it's very fulfilling.'

Before he finishes here, he gets the chance to assist on his first ever operation on a child.

Can I check that you are definitely Kai Norman? Is that you?

Three-year-old Kai was born without a fully developed thumb.

Today it's going to be removed by the surgical team.

I have never been in paediatric theatre before today.

The obvious difference is that what you're dealing with is a lot smaller.

So a scar that you create won't just heal with rubbing,

it's also going to stretch as the hand grows.

Keir is shadowing top paediatric surgeon Mr Rannan-Eliya

who will be removing Kai's thumb.

The only reason to keep it would be to able to save...

As a reconstructive surgeon, you try not to throw anything away.

The skin, even though it's a small amount,

it could potentially be useful.

What we're doing today with Kai is unfortunately some children are born

without the structures on the thumb side of their arm forming properly.

In his case, his thumb was sort of half formed

and it was only attached to the palm of his hand by a very thin stalk.

It's twisting and catching and therefore of no use to him functionally.

At the end of the day, if we remove it, we can avoid it getting damaged.

Does Kai suffer from any eczema, any asthma, heart conditions...?

He has got a heart condition where he has a murmur on his heart.

-No other medical problems other than that?

-He has bad kidneys.

He's only got one kidney working.

Kai's complicated medical history

means it isn't going to be a straightforward operation.

Because of his cardiac problems, we can do it under sedation,

-but we're quite happy to give a general anaesthetic.

-Right.

Any operation on a small child is potentially dangerous,

mainly because of the anaesthetic issues.

Anaesthesia at a young age, in Kai's case here,

the operation itself is technically not that challenging.

But it will be... There is a potential risk to him

in terms of his lungs and his heart

which we have to bear in mind.

We're here for different sort of things - his kidneys and his arm.

He's had bits of bladder problems.

We're here quite often, aren't we?

The last time was about seven months ago.

We're doing well, really. Hopefully we're not staying in.

I can't believe they put us in this room because we're supposed to be in and out today.

We'll probably be staying, won't we?

I hope not, cos Kai wants to go to the toy shop after here.

Don't you?

Get a new toy for being so brave.

Before the operation starts,

Keir and Mr Rannan-Eliya explain the procedure to Kai and his mum.

Hello, Kai. Hi, are you all right?

How are you? Are you OK?

Can I have a look at your hand?

So we're going to take that...away

because it is becoming a bit of a nuisance, isn't it?

-You keep getting it caught, don't you?

-Does it hurt when it gets caught?

Oh, dear.

Hello, can we have Kai Norman brought along to theatre, please?

While Keir scrubs up, Kai is put to sleep under anaesthetic.

Surgeons need years of experience to perform a delicate operation like this,

so Keir can only assist.

On-the-job learning is all part of the junior doctor's training.

The thumb has no bone, but there are tiny blood vessels and nerves

that must be cut precisely to avoid leaving Kai with long-term problems.

Is there chance of him getting a neuroma or scar there later?

Absolutely. That's why... Not on the scar per se,

but at the end of where that nerve regenerates, hopefully,

instead of being on the scar.

There is that risk, absolutely.

If the nerve isn't cut correctly,

it could cause a growth or tumour in Kai's hand.

They've cut the nerve, and the thumb is removed successfully.

Despite having spent three months on the plastics ward,

Keir knows he's still learning.

'It was a nice little...

'operation to see. I thought that they would literally tie it'

or get a pair of scissors and cut it straight.

But actually, for a simple procedure,

it was a little more complicated than I thought it was going to be.

It would've been nice to have had a go at it, but I think that when

you're dealing with children, you need to be ultra-cautious.

Having a go with an adult and leaving a scar

that's not quite perfect,

is very different from having a go with a child

and leaving a scar that's not quite perfect.

And I'm not the person to give Kai a perfect result.

Knock, knock. Hello!

How are you doing?

Mr Rannan-Eliya is impressed by Keir's progress as a junior doctor.

Keir has moved from being fresh through to now his second year

and he's shown quite a lot of qualities

into making sensible decisions, making good plans

and being safe, which is ultimately what it's all about.

He's got a bit of an anaesthetic hangover.

'Even though he's now in his second year following Medical School,'

he's got a very long way to go

to becoming a fully independent hospital practitioner.

Because there's an awful lot to learn,

an awful lot of skills to practise and develop,

and at the end of the day, there's nothing to beat experience

-in terms of learning.

-See you later, young man.

-Are you going to say bye?

-Are you going to say goodbye to me?

He's turning into a teenager already!

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

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

Also coming the end of her current assignment is Keir's housemate, Suzi.

She has spent the last three months in A&E

where a new emergency case has just been admitted -

a three-week-old baby has been brought in by her worried parents.

She's been crying for the last couple of hours, from the morning.

She's not normally crying that much.

BABY CRIES

Continuous crying can be a sign

something is seriously wrong in a newborn baby.

Is that her normal cry, or is that a bit...?

-It's not her normal cry.

-No.

-Is it normally more like a proper scream?

-Yeah.

Suzi examines her tiny patient.

With a baby, it's hard to know what's going on,

but her experience on A&E is telling her that something is wrong.

We'll do some more observations on her

and we'll do her temperature and I'll chat to one of my colleagues here.

I'll get them to come and see her as well. OK?

Parents are a bit concerned and with babies,

it is quite hard because you don't get any clues.

They don't say what's going on.

Babies that are well will cry with all of their lungs.

With her, I don't know.

Maybe it'll all be absolutely fine,

but I'm just going to err on the side of caution

and speak to Paediatrics. It's their specialist area.

Can you speak to me?

My name's Suzi, I need to ask you a few questions.

Suzi spent the last three months working on A&E,

the sharp end of acute medicine.

I'm waiting for a cardiac arrest call to come in.

-I'm really excited, but also really scared!

-Since her first day,

she has had to deal with everything from heart failures...

MAN GROANS

..to heart throbs.

Suzi, you are the best trainee doctor ever.

She's proved herself a capable doctor on the A&E ward.

The reaction I saw from Suzi, was absolutely brilliant.

And she's learned that in this job, a social life comes second.

It's 1am on a Saturday night

and everyone else is out having a drink.

I'm here and helping so it's fine.

Coming to the end of her assignment on A&E,

her three months' experience means she isn't fazed

by a difficult case like baby Adla.

She consults her boss on what to do next.

Three weeks old, just a bit unsettled since this morning.

I was going to speak to Paeds about them.

Anything more apart from being unsettled?

Normally doesn't cry, but has quite a whingey cry.

Settled if she's still, but if you try and move her and things,

she gets very irritable.

Temp was 37.5 earlier, just going to get them to do it a second time

and see if anything has changed.

Repeat the obs, stick a pad in and try and get urine.

Speak to Paeds. Good.

To find out exactly what's wrong, baby Adla is referred

to a specialist children's doctor for further investigation.

This case has been good training for Suzi's next job -

working with newborn babies.

I think any practice with babies and children is always good.

Obviously, my next job is going to be on special care

and doing baby checks and things.

It is good to get practice handling babies, although sometimes I feel a bit...

awkward as I've never had a baby and don't know how to hold them properly.

But I'm sure it will come to me,

otherwise I'm going to struggle!

Around the hospital, all the junior doctors are on their last few shifts

in their current jobs.

Jon has been learning that there's never a dull moment on the emergency assessment unit.

I need to draw on your leg, unfortunately.

And for Andy on paediatrics, it's been getting to grips with treating kids and teenagers.

Deep breath in.

Back in plastics, Keir is working in their specialist children's trauma clinic.

Right, hello.

His experience on this placement

has helped him learn a lot about treating children.

Children don't like you when you poke their burns or examine their heads.

You've got to have little tactics to try and distract them.

BABY CRIES, HE MAKES WHINING SOUND

I don't know why that noise works, but it works every single time!

OK, it all seems to...have closed really nicely.

No need for an operation with this one.

The good paediatric doctors can occupy the child really well

or can deal with the parents really well.

The great ones are the ones

who are able to become a four year-old briefly.

That is a beauty.

Over the last three months, it's not just his patients that Keir's entertained.

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

I was thinking of opening a bottle of something fizzy.

THEY LAUGH

His work with children on the plastics ward has helped him

make a big decision about his future.

Shake my hand, excellent.

I think medicine, particularly medicine involving children,

is great fun and dynamic.

Are you a bit frightened?

There's no need to be frightened.

In a few days, Keir will be starting his next assignment

on the paediatrics ward, so he's making the most of his experience of treating kids on the trauma clinic.

Hello! Are you Gabby?

It sees a lot of children with minor gashes and wounds.

Keir and the team have to decide if they need stitches.

You're certainly the cutest patient I have had all day.

He says that to all the girls!

His next patient is two-year-old Gabby, who has a deep gash in her forehead.

She's fell against an iron chimney.

Initially as soon as it was done, quite a pool of blood,

but it stopped as soon as the pressure was applied.

You're not a forensic pathologist, are you?

These are exactly like the photographs you get from forensic pathologists!

OK, let's pop you on here, shall we?

Well done.

Keir needs to asses if Gabby's wound needs stitches,

or if it can just be closed with sterile surgical strips.

Once kids injure themselves,

they will have scars whatever we do to them.

Our job is to make the scars as neat as possible

and that is why operating on children and giving them neat scars

is of paramount importance for us.

The wrong decision could leave Gabby with an ugly scar.

Silly noise!

It doesn't look infected, it looks very clean indeed.

I'm not sure whether we would even stitch that up

because I think it has actually closed really nicely.

You're VERY brave!

You're very brave indeed, aren't you, Chuckles?

I'll just go and speak to the boss about it and see whether we would need to close it.

I don't think we would need to do anything with it, to be honest,

but I'll just go and chat to the big man.

But with only a few months of experience on plastics,

it's not a decision Keir can make alone.

He calls in his senior registrar for advice.

Hi, I'm one of the other doctors, just come to have a look.

This is Gabby and she has fallen over playing yesterday

and struck her head on an iron chimney

that is in the garden.

I wasn't convinced that it definitely needed stitches.

-50/50, isn't it?

-It is.

I just thought if we steried it, it might...close naturally.

Yes, that is certainly an option.

How old is she?

Two, just gone two.

-I think we ought to operate on this.

-Oh, right.

She is a two year-old and as she grows, that gap will grow.

Keir had thought Gabby's wound didn't need stitches.

It's assessments like this that only come with experience.

'It is very difficult for somebody'

who has limited experience in plastic surgery

to come in as a junior doctor in plastic surgery

and make difficult decisions like that,

especially when they've not seen many of these wounds.

It was a thing of lack of experience rather than lack of judgment.

The stitches will be dissolvable, although you'll be able to see them.

They'll dissolve in a week's time.

I'll organise all of that.

OK, tinker. She is the most gorgeous patient

that I think I have ever had.

First-year Lucy is coming to the end of her assignment

on the gastro ward.

-Knowing his history, I'm not sure if we'll improve it that much.

-That's fine.

-I was having problems.

-Thanks for letting me know.

They treat diseases of the digestive system and deal with some of the sickest patients in the hospital.

Lucy's had to learn to cope with patients dying, which the team on the ward know can be difficult.

'For some reason you may have a spate of them,'

sometimes two or three deaths in a row and then go several weeks without having anybody.

Obviously, it's better for us, the relatives and the patients

if we manage to get them better and back home,

even if it is for a short period of time.

Many patients here are in hospital for a long time.

Lucy has become attached to one in particular -

she's been on the ward since Lucy's first day.

Her motions are worse again.

Oh, no. Really?

Her elderly patient is suffering a severe bowel infection.

Lucy has only got a few shifts left on the ward

and before she finishes, she wants to see her patient well enough to be moved to a nursing home.

They described it like...baby poo.

But she is still eating.

We need to keep her going on that,

because the problem is if she doesn't eat, she's not going to get better.

In her first few months, Lucy's been learning that the job can be emotionally challenging.

It's probably the worst news that she is ever going to hear, ever.

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

She's had to learn that, even as a doctor,

she can't save everyone.

'I am definitely learning that there is a limit to what we can do as medics.'

We are only human and in some ways, if we could turn

into the super hero, that would be great in terms of actually having to save people and cure everybody.

In reality, that's never going to happen.

But back on the ward, Lucy is very concerned about her patient's condition.

She's really, really confused and really dehydrated,

and although we're not treating her infection actively,

if she's dehydrated, we should give her fluids to make her more comfortable.

Basically, the decision was made last week by Dr Gunn with her family

that she wasn't going to be actively managed any more

and that she was for TLC -

just giving her a bit of love, really.

If she gets ill again, like she has,

we're not going to give her antibiotics because what's been

going on with her is she has come in, she's getting recurrent infections,

treating one infection and precipitating another illness.

We've tried for a long time.

The decision that's been made is the right one.

That doesn't make it easy because she is still someone's grandma, still someone's mum.

Because the patient isn't responding to medication,

all the team can do is make her as comfortable as possible.

She's just gone downhill so much.

-It's really sad.

-In a funny way as well, her knowing she not going home

hasn't helped because she's probably lost the will a little bit.

Oh, dear. Never mind.

I might be a while longer, I'm afraid.

Also coming to the end of her first job is Katherine, who is working on plastics

where she's responsible for processing pre- and post-surgery patients from several clinics.

You remember all the important things

because you just spend all day looking at your lists,

you remember everything important there is to be done.

But it's a nice security thing.

It's quite satisfying to tick things off once you have done them as well.

But with patients waiting for her in clinic and a full surgical ward, she has a growing list of things to do.

The time pressure is stressful rather than the actual job.

You just feel like you're not doing a good job because you're so rushed all the time.

Everyone wants you to do their job first and you've got lots of people from different wards and different

members of the team, doctors and nurses all wanting different things and having different priorities.

You can't end up pleasing everyone,

and I think that's the most stressful aspect of the job.

I'm so sorry it has taken so long.

Over the last few months, 24-year-old Cambridge graduate, Katherine,

has sometimes found herself swamped by the workload of a first-year junior doctor.

I'll come back and do that when I've...

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

Let's just stop then. The busier you are, the more you need to stop.

She has finally proved her potential as a doctor.

Have you ever had any tests done on your liver?

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

-Good spot.

I think I'm getting better.

Slowly.

I think it's going to be a while before I settle in.

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

Now after three months, she needs to prove she's learnt to handle the time pressures of the job.

Hello, Mr Punton.

You're getting a bit of a tight chest.

Can you tell me a bit more about it?

Mr Punton has come in for an operation,

but is now suffering breathing problems.

When you say it's tight...

do you mean you wheezy?

Have you had any problems with asthma before?

You have problems with asthma normally?

I just need to find a nurse.

I can't find any anywhere!

Hi, I'm really sorry. Could someone do some obs on Mr Punton?

I can't find the nurses looking after him and he's getting a tight chest.

I think it's his asthma, because he's got asthma.

Katherine's housemate, Keir, is a second year on the ward

and she asks him for a second opinion.

Keir... Mr Punton is feeling tight chested.

He's asthmatic.

-Getting nebulisers...

-Has he had his inhaler?

No, he hasn't got one. He just has nebulisers.

-He's never had an inhaler?

-I don't know.

Check what medications he usually has.

-He's not written up.

-I know he's not written up for them, but check...

He said he's normally on nebulisers. He hasn't had it today.

Has it been crossed off?

Keir decides to speak to the patient himself.

Hello, sir.

How are you doing?

Have you got any heart problems, any lung problems?

Just asthma.

No-one has ever said anything about your heart RATE before?

I was told that you were feeling very wheezy and chesty.

Phlegm? So you feel like there is something you want to cough up.

We'll give you some water in a nebuliser

to try and clear anything

that might be in your chest that you feel that you want to bring up.

-I don't think there's any need for any Salbutamol.

-OK.

And what about an ECG?

Yes, I'm going to talk about that.

-There you go.

-Cheers.

-So an ECG...

-Yes, let's get an ECG, let's do...some bloods.

I just need to do something. I'm going to be a while.

Can I order the ECG for you?

-Yes, please.

-Are you OK? You're looking a little stressed.

No, it's just that I have a long list of things to do.

While Kier writes up the notes, Katherine just needs to arrange

an ECG to check the patient's heart rate.

But today isn't a good day for ordering ECGs.

I'm supposed to be seeing a patient in clinic, but I need to go and do this ECG first.

The ECG department are understaffed,

so they can't come up and do the ECG, so I'm doing it myself.

I'm back, Mr Punton.

I'm just counting down the ribs to make sure

I'm putting the stickies in the right place.

You just need to keep very still when the machine starts recording.

OK, let's switch it on.

ECG MACHINE BEEPS

The results need further investigation,

but it means Katherine's other patients will be kept waiting.

I'm not entirely sure what's going on, but I'm not stressed about it,

because I can look it up on the internet, I can ask about it.

I'm more stressed about the fact I've got a patient waiting down in clinic

whilst I'm trying to sort this out,

and no-one's answering the phone in clinic,

so I've no way of letting them know, so they just think

I'm not bothering to turn up when it's cos I'm sorting out something more important.

Yeah, it's just on his notes.

The tests have revealed a faster than normal heart rate.

It could be a sign of further problems.

I mean, this bit is completely regular.

What I might do is I might just walk down to EAU

and show this to a medic and see what they say.

With a bit of help from Kier,

Katherine can now get on and see her waiting patients.

I've still got all this to get through, and it's 4pm

and I have patients to see so...

I was hoping to make a gym class that starts at six, but there's no way that's going to happen now.

She may still be running late, but her three months' experience

have taught Katherine essential lessons about being a junior doctor.

I think I've definitely learnt to grow a thicker skin in my first few months as an F1.

I think I'm not getting as stressed about the little things any more.

I have my moments when it gets busy,

but I think I'm a bit more chilled out,

and maybe a bit more confident.

She's learnt a lot in the four months, and I'm sure

she'll take that onto her next ward that she has to work on.

We will miss her and, you know, it is sad.

I suppose because you're following her journey, you've followed her journey

from the beginning, really, and just watched her grow, I suppose.

I'm getting emotional! Eeh,

she's just so lovely, she's really canny when you think about it.

It's difficult. You get me on a good day and I'm like,

"Yay, I love my job, I can't believe they pay me to do this,

"I'm doing a really good job,"

and then I go home at the end of the day feeling really satisfied, like I've done my best.

And the next day it can just be horrendous,

and you go home feeling completely and utterly demoralised

and hating your job and thinking, "I can't believe they pay me so little!"

On the gastro ward, Lucy is dedicating her remaining time

to helping her long-stay elderly patient.

I'm going to see if I can get some fluids in her quickly,

get her hydrated, because if she's got diarrhoea again,

she'll get dehydrated because she's not drinking enough.

Her condition hasn't improved, so Lucy and the team decide

to give her intravenous fluids to replace the liquids she's losing.

How are you this morning?

Are you feeling a little bit confused?

Tired, yeah.

Yeah, that's tight, isn't it?

I'm going to pop my head in and see you again a bit later, all right?

She's just really poorly.

Completely confused.

She's just a lovely old lady and...

she's just getting poorly.

And...

..I just don't really... It's just hard.

You kind of know there's nothing more we can really do for her any more.

Lucy has become emotionally attached to her patient,

who has been on the ward throughout Lucy's placement here.

Fine. That was your temperature.

She was just being sweet, and I was, "I've got to get out of here. I'm just going to cry."

I just went in just now, and she was just so sweet to me.

You look at someone.

She didn't have a clue what was going on, you just think, "Oh..."

I'm just a soppy idiot like that, that's all.

The emotional side of doctoring is all part of the juniors' learning curve.

Right, anyway...I'll be fine.

I need to write her notes and move on to the next person, and it'll all be better.

-Here you are, I brought some for all of yous.

-Thanks!

-There you go.

-That's amazing.

-Pauline made it.

-Caramel shortbread... Mmm!

Wow!

That's bloody amazing.

You can't help anybody...

..or tell anybody how to work their emotions. You've got to...

-It's life experience, it's...

-It'll come with it.

She will learn in time

and learn by the experience that she's had, how she's coped with it

and how she, in herself, will learn to cope with it, really.

'Doors closing.'

Back at the house, after another long shift,

Lucy has a special recipe for stress relief.

Today, I've had a really long day, I've had a busy day

in terms of things going on with patients

and horrible situations with patients, so actually, coming home

and doing this is very therapeutic for me,

because it means I can get lost in it a little bit,

enjoy something a bit different.

I find it so relaxing,

and I really enjoy making things for people, you know.

Even if I haven't got a purpose for it,

I really enjoy that side of it and just...

I don't know, looking after people, I guess,

that comes into it a little bit as well.

If medicine goes to pot, I'm going to do a professional cookery course, I think, open a tea room!

While Lucy's baking, housemate Suzi is heading to choir practice

after a demanding day at the hospital.

I don't want to be late, I hate being late for things!

The long hours of a junior doctor can make having a life outside work hard.

CHOIR SINGS

'It's nice to do something else challenging apart from my job.'

Just being able to sing and not think about my patients.

It's quite calming as well,

like the things that we're singing are quite kind of pleasant and nice,

which is good. Yeah, it's really fun!

All the junior doctors are coming to the end of their current placements.

At the hospital, Adam's arriving for one of his last shifts,

while housemates Jon...

Lucy...

and Andy are already hard at work on their wards.

That leaves Katherine and Keir at home together.

I woke up feeling very sleepy and grumpy,

and then I came down to the kitchen, and the cake fairy had been.

She always knows when you need cake,

and it just magically appears.

I make no apologies for this at all.

Suzi is coming to the end of her four months on A&E,

but tonight's shift is going to be another first.

This is the new A&E at the RVI,

so the other one is closing

tonight at midnight officially.

And this is the new one, and it's all very nice and shiny,

and it smells all new. And there's no patients!

What more could you ask for in an A&E department?!

But it won't be quiet for long. Tonight, Newcastle's state-of-the-art £10m

accident and emergency department will open for the first time.

It's so different and so big.

We're in reception, which I'm sure very soon will be quite busy

when all the patients arrive.

The place is so weird, it's so quiet.

A&E is not normally a quiet place.

At midnight, the old A&E closes, and all of Newcastle's ambulances

will be sent to this new department instead.

Suzi and the team will have to get used to the new surroundings

and treat up to 200 emergency patients.

It's a huge night for all our staff, anxiety levels are through the roof.

The department we're moving to is about three times

the size of our previous department,

and I think the new doctors

are going to find it hard

because they don't know where things are yet.

No-one really knows what's going to happen, and obviously

we're doing the same job, but it's a totally new building.

Apparently it's different to use the phones here.

Pretty basic things, but half of what we do is based on speed,

and if you don't know what you're doing, then it's much harder to go faster.

Suzi will be the first junior doctor to try out the new department.

I've only got to know the old A&E,

and then it's, like, let's change everything to the new A&E.

I know how everything works over there, but not here,

I don't even know where everything is here!

Suzi and the team have just a couple of hours to get to know their new department

before the first emergency patients will start to arrive.

We don't quite know what's going to happen tonight.

It is a waiting game, and we hope things go smoothly.

Upstairs, on the wards, Suzi's housemate Adam is also on nights.

He's part of a team covering several different wards.

I'm kind of getting used to the whole night-shift rhythm a little bit.

I don't enjoy it, but I'm getting used to it.

His first job is a simple procedure - taking blood.

Hello, sir.

I think it's the other chappie I'm looking for.

I think it's the other chappie I'm looking for.

I'll let you get back to sleep.

Sorry to wake you, sir, my name's Adam, I'm one of the doctors.

I do have to take some blood from you some time in the next hour or so.

'It started out busy tonight and I've got a lot of things to do.'

To be honest, all nights start out busy.

I don't know how it'll pan out.

24-year-old first-year Adam started his career as a doctor with high expectations.

Ideally, I would want to make a difference to as many people

as possible and do something that was absolutely huge.

In essence...

I want to save the world!

Assigned to the respiratory ward, he soon discovered some of the job

wasn't that glamorous.

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

It's just not stimulating at all.

But when he's had the chance to treat seriously ill patients...

How are you doing?

He's not well, not well at all.

..he's proven he's got the medical knowledge.

Do you think I can give him furosemide? Is it a decision I should make?

-If you're comfortable and know what you're doing...

-Sweet.

I knew it, I knew it!

And he's shown he has the makings of a good doctor.

How are you feeling today?

Much better than what I did yesterday.

Good. I'm glad to hear it.

Seriously, good job.

Adam is coming to the end of his first job as a doctor

on the respiratory ward.

He's made good progress but, like all the juniors,

still has a long way to go.

He's doing well. He's a good member of the team.

He can stand on his own two feet,

but the question is what you're asking of him.

He's receptive to learning and hearing some new ideas and thoughts.

That's the most important thing -

that you're receptive to the process of getting better,

day on day, week on week, year on year.

That's the most important thing.

For me, confidence is a bit of an issue.

I think I come across as someone who's confident

and thinks they know what they're doing - ish.

But in reality, I'm very much questioning myself

every step of the way and always feel like I need to ask a senior.

Even though I know something might be right, I just can't take the decision on my own. I need to check it first.

That's good practice at my stage, anyway.

We're just going to open the doors now because people have arrived

before we were quite ready.

They're so keen!

In accident and emergency, the new department is officially open.

It's not long before Suzi has a patient.

It will be one of her last as an accident and emergency doctor.

How are you feeling, then?

-Not too good.

-Tell me about what's been going on.

Catherine has been brought in with severe shortness of breath,

but that's not the only problem -

she has a history of chest problems and lung disease.

I've been on antibiotics, I've been on steroids,

-and I'm still the same, put it that way.

-OK.

It's something Suzi has seen several times on A&E

so she knows exactly what tests she needs to do.

I need to take a blood test from here which I'm sure you've had done in the past.

I hope you're good, because I go mad with them

when they take it from there.

Sharp scratch coming now, OK?

You OK there still?

How was that?

-I'll give you 8 out of 10.

-Oh, that's all right!

Fine with that.

The chest X-ray is back.

Suzi refers the case to her senior, Jim, for a second opinion.

She feels she's been trying to keep herself out of hospital,

but this morning, it just got...too bad.

-It sounds like it's infected.

-Yeah.

Get the rest of the bloods and I'll cast an eye over it.

It's serious enough to mean a stay in hospital.

Suzi orders some more blood tests and refers Catherine to another ward for further treatment.

She can then move on to her next patient.

Do you feel wheezy at the moment?

You sound a bit wheezy.

By the end of the shift, it's business as usual for Newcastle's accident and emergency team.

I'm finding where everything is which slows things down a bit, but...

thankfully it wasn't too crazy so there was time to be slowed a bit.

By the time it gets to Friday night and everybody's going out

and getting drunk, I'm sure it'll be a very different story.

It's gone really well. The staff have done brilliantly.

There's been a lot of support staff in the background to help them

as a safety net in case anything did go wrong.

Fortunately, I haven't needed to use them and they've coped really well.

The patients are coming and being seen, being treated and leaving, so that's great.

Couldn't have asked for anything more.

It's the end of an era, as the old department closes for good,

and Suzi is coming to the end of her placement.

'I've decided to leave A&E.

'Even though, at times I found it really stressful,'

I've had more kind of responsibility than I've ever had in the past,

which is obviously quite scary.

But it's gone well, I think.

Over the last three months, Suzi has matured well.

It's a short time for a junior doctor,

but I would class her as an above-average trainee.

She has a quick grasp of knowledge

and she gets stuck into things very quickly.

What I've seen so far of her, she will make a sound physician.

Lucy's on her final shifts on the gastro ward, but before she leaves,

there's some good news about her long-term patient.

What is the actual plan for her?

-Well, they're coming to assess her today.

-Right.

-She can go tomorrow.

-Brilliant.

Thanks to the efforts of Lucy and the team,

the patient's condition has improved and she is now well enough to be moved to a nursing home.

They've got a bed, she's diarrhoea free, so she can get out of here.

-Yeah.

-I'm so pleased.

She'll never get home home, but at least we're getting her out of hospital, which is a massive step.

I didn't think we would get that.

I'm just coming to say ta-ra,

because you're off in the morning, aren't you?

I'm not here tomorrow.

So I just wanted to come and say...

all the best and I hope it all goes well settling in.

Don't you try and get up, missy!

Don't want you falling over!

Take care of yourself, won't you?

Make sure you get that bacon sandwich first thing tomorrow morning!

'It's weird that we're both leaving at the same time.

'It's a strange closure, but quite nice.'

We were expecting the worst last week, but she's picked up completely.

She's a lot happier, eating well and everything.

However long she's at the nursing home, she's a stronger lady

than she was and we finally got her out of here diarrhoea-free and everything.

This has taught me a lot. It's taught me about social care for patients, making sure patients are happy.

That's just as important in their recovery

as making sure their medication is OK, which is another thing I've learned.

Hopefully it's prepared me on some level for my next stage.

Lucy's more than ready to move on.

She's just so interested in what she does.

She likes what she does.

She's got feelings so she can look at things from different angles.

The fact that she's a people person,

I think she'll go very far.

After four months, all the junior doctors

have finished their first placements.

They've faced serious emergencies...

MOBILE BEEPS Cardiac arrest.

..dealt with challenging cases...

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

I don't want to take it out of that arm.

-..as well as the more unusual.

-Are you able to get any of it out?

Has any broken off?

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

They've learned that bedside manner is key.

Lift this leg straight up in the air, keep it there.

I can tickle you here and there.

They've had to come to terms with the fact they can't save everyone.

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

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

They've had good times...

Yes, I got paid!

-..and bad.

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

And had some fun along the way.

And they're still only at the start of their careers as doctors.

Today, all the junior doctors

are beginning work in their new departments.

As they start back at the bottom, do they still think they're up to the job?

The more I do, the more I realise

how far I've got to go and how much work it's going to be.

There's just so much stuff that I don't even know.

I don't know if I'll ever be sat there thinking, "Yes, I'm a good doctor, doing a good job

"and I'm happy with the way things are going."

I think I'm always going to think there's more I can be doing,

or something I can improve on.

Junior doctors spend the first two years in a hospital

moving around different departments.

It's the best way for them to build up the experience they need.

Jon is starting on the orthopaedic ward.

I feel like I've got a lot more knowledge

in terms of the medicine that I knew.

But in some respects, I'm right back at the bottom again

learning about orthopaedics.

It's swings and roundabouts.

Keir will be tested on paediatrics, the children's ward.

I've been looking forward to Paeds

since I first got confirmation that I was doing it.

So, yeah, I kind of feel like...

I'm in the place I want to be.

I'm now in a situation where having become comfortable

over four months and something,

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

Look at the screen. You'll see the microscope pass through...

Adam's challenge will be looking after critically-ill patients in intensive care.

I'm not going back to square one.

I've come here with experience and knowledge from my first job

and I'm a lot more comfortable about being a doctor

and a lot more together as a person. I'm less fluffy,

less flapping around.

I'm fairly excited by the next four months ahead.

Something like this is what I needed.

I want to get stuck in.

Lucy is going into a completely different environment -

researching genetics in a laboratory.

You're learning every single day.

Although I've been working four months, I still feel like...

there's such a way to go.

I certainly feel like I've come quite a long way since that first day

when I stepped onto the gastro ward

and just felt like a rabbit in headlights.

Andy will be learning how to pass on his medical knowledge -

he'll be teaching anatomy to future junior doctors at the university.

A right femur or left femur?

'It is a little bit nerve-racking'

in the first teaching session.

I keep having to feed them more information.

They are asking questions, which is a good sign and means they are interested in learning.

I think I'm enjoying it so far.

And from life and death on A&E,

Suzi is looking after newborn babies.

I think at first you're kind of finding your feet and things,

hoping that you're going to be OK. But as you get into your second year,

hopefully you get a bit older and think, "I can do this."

Even if I have a bad day, I think, "It's a bad day,

"but I can do it the following day

"and the day after that and a hundred more days after that."

That's the way it goes. BABY CRIES

I've still got that feeling of,

"I can't believe I'm actually a doctor!"

Like, a doctor!

That's quite...cool, I suppose.

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