Episode 1 Junior Doctors: Your Life in Their Hands

Emergencies...

Have we got paddles on?

..bad behaviour...

..bedside battles...

Alfie, Alfie, Alfie...

..and buckets of blood.

It's a tough job being a doctor.

It's even tougher when they're young...

Am I right or not?

I feel like a child, really, cos in their eyes I think you probably are.

..untried...

I said to her, "I want the nurse, please don't touch it."

The first time any of us do anything,

we're going to be ...

..and inexperienced.

Everyone's in the same boat.

Push it through...

No-one knows what they're doing.

But after years of studying...

Oh! Oh dear.

..it's time to put theory into practice on medicine's frontline.

Facing the biggest challenge of their lives are eight junior doctors.

Clear!

CHEERING

The youngest - 22-year-old Andy.

The first day I start I will be terrified, honestly, I will be.

Self-confessed princess, Priya.

-Your tea.

-Thank you, good morning.

I get pampered, bless my parents, they do everything for me.

Outgoing Aki.

Some people describe me as Kensington meets rock 'n' roll.

Chelsea girl Milla.

This is by the Queen's hatmaker, isn't it?

I love going to balls, I get invited to many of them.

From a family of doctors, Sameer.

I don't feel like a real doctor yet.

At the moment I feel like a fake doctor.

Rugby player Ben.

Rugby's something you have to put 100% into.

I always expect 100% of myself.

Laid-back Amieth.

I quite enjoy watching life unfolding in front of me.

Lucy, the perfectionist.

I don't feel like a doctor, and now it's come round I think,

"Just go away and leave me for another year, I'm not ready!"

After a rigorous induction...

Bit more help, the patient is responding.

They'll be starting in one of London's busiest hospitals.

BABY CRYING

I'm sorry.

Dealing with life...

and death...

Any pulse?

..highs...

I'm so happy.

..lows...

It's just complete ..., basically.

..and the unexpected.

You know how you have those receipt spikes?

She's impaled her hand on that.

But have they got what it takes to be doctors?

The patient I saw earlier has fainted.

If you made a bad mistake, worst case scenario

someone could die, simple as that, really.

This house in south-west London is home to our eight junior doctors.

Can we get six large pizzas, please?

They're all about to start new jobs.

Do we know what these are, or are we just guessing?

I would like us to toast to an amazing year, actually,

and hopefully an incredible start to our careers - cheers.

Six are first years and have never been doctors before.

If they work out you're useless in the first few days,

it's not a good place to be, probably.

I've got an awful memory, and I really have to work around that.

Just make sure you write everything down.

I do, but then I lose my paper.

Second years Amieth and Ben have only 12 months experience

and are facing new challenges in a new hospital.

How did you guys feel on your first day, in your first week?

Petrified.

It's terrifying, and the first set of nights are horrible.

Oh, no!

OK, I'm not going to ask you any more questions!

Is anyone up for a revision session tonight?

No.

I need to go through my finals notes.

Even after six years at medical school,

apprehensive Aki is getting in some last-minute revision.

I'm going to be a little bit nervous on the first day.

Especially when you're looking after some pretty sick patients,

they could deteriorate quite quickly, so I want to make sure I'm prepared.

ALARM BEEPING

Everything our junior doctors have trained for starts today.

I'm not going to lie, I am quite nervous about it.

It's exactly the same feeling as starting a different job.

I've done other drops before, and that's the same,

or starting school, but I guess you've got that added pressure

that it's people's lives, rather than, erm...schoolwork.

-See you later, man.

-Enjoy.

-See you this evening.

Across Britain, it's the same story...

See you later.

Thousands of junior doctors are facing their first shifts on the wards.

For ours, it's an early start - except for one.

I've just woken up,

but it's good because my shift actually starts at 11 o'clock,

so I have a nice bit of a lie in on my first day,

I can have a leisurely breakfast.

That's my bus!

You're listing to Radio Chelsea and Westminster,

broadcasting live from the hospital here on the Fulham Road.

If you spot one of our new recruits, be sure to give them a cheery

welcome and please be patient as they settle in and learn the ropes.

Hi, it's my first day, I'm Andy.

We're your new doctors, my name's Lucy.

It is historically known as Black Wednesday,

because it is the day that junior doctors arrive on the ward.

We're the new doctors, we thought we'd introduce ourselves early.

It is renowned within nursing

that the changeover period on that day in August can be very fraught,

so most of the time if you're sensible you don't roster yourself to work.

Hello, Mr Straw.

How are you feeling today?

Andy's first job is in trauma and orthopaedics,

dealing with bone and joint problems.

OK, so I'm going to have a go at doing, erm,

a cannula, if that's all right?

He's fitting a device called a cannula to Mr Straw.

It's a difficult job, but one every junior doctor has to master.

All right.

OK, so, sharp scratch coming up.

He must find a vein and insert a hollow needle for medicine to be injected through.

Right, that's not in.

So, let's have a look at this hand, shall we?

-You all right there?

-Yeah, fine.

-Good.

After several attempts, and worried about hurting the patient,

Andy stops.

On second thoughts, I think you need a bit of a half an hour break,

because obviously it's quite painful.

-All right? Is that OK?

-It's fine.

I'm sorry I didn't manage to get that in there, OK?

I couldn't get it in, I think it's four times,

so I'm going to come back later, give him a bit of a break,

cos it's not that nice

having someone repeatedly stab you with a needle.

It is frustrating, not being able to do something first-time,

but sometimes you've got to be determined and not give up, I guess.

Cannulating is a real skill.

If they come to me or any of my staff and say, "I'm struggling,"

good on them.

What I don't want is a patient sitting there

like a pincushion having had six or seven attempts.

If you haven't got it in two attempts, it's not your day,

let's get somebody else in to do it.

These look like my size.

That looks about right.

Amieth is out of bed and ready for his first shift in accident and emergency.

Trousers, top - we're sorted.

As a second year, Amieth only has a year's experience

and is new to this hospital and department.

This is the first task, to find the main desk

so I can see the next patient.

I think A&E potentially could make or break a doctor.

Every day we see life and death situations, and we have to make

very quick decisions as to how to turn that around.

I think it's very nerve-racking for junior doctors at first

and it's interesting to see how they cope with it.

His first patient has blood in his urine and Amieth starts with some standard tests.

That's pretty good, so I'd like to examine the prostate.

Do you know how that's examined?

It's through the back passage, OK?

SHE LAUGHS

He said, "I don't enjoy that."

I don't enjoy it either.

So, for this job you need a finger,

some gloves and some lubricating jelly.

He may be starting his new job at the bottom,

but Amieth doesn't let things get him down.

I'm a serious guy.

Haven't you noticed yet?

I'm very serious, all the time.

I can't even say that with a straight face!

I think I'm very funny, but most people don't tend to laugh at my jokes,

and I don't know if it's because they don't know I'm telling a joke

or just cos it's not funny.

I'm just very laid-back and I let things happen.

I've got a very laissez-faire attitude, as Del Boy would say.

I'm not particularly ambitious, I'm not particularly driven,

I like to just float along through life and let things happen.

I'm not really looking for glory or riches.

I figure I'll just turn up to work,

try and make as many people better as are plonked in front of me

and then go home at the end of the day.

PHONE RINGS

Back in A&E, Amieth's relaxed attitude is about to be tested.

Hello, Chelsea and Westminster?

It's an emergency call.

An ambulance is on its way with a patient in critical condition.

Senior doctor Barbara Cleaver and her staff get ready.

This is Amieth's first resuscitation with the A&E team.

SIREN

The patient's heart has stopped beating

and has been in cardiac arrest for more than 20 minutes.

The chances of survival are falling.

The emergency routine kicks in, and Amieth must move fast to keep up.

Two people either side need to be getting a line in now, please.

Amieth, pop a line in, please.

He must get a needle into a vein.

With that, they can inject adrenaline to help restart the heart.

BUSILY CONFERRING VOICES

OK, can we stop and see what this rhythm is?

MACHINES BEEPING

Is it shockable?

Yeah, have we got paddles on?

Compressions, please.

Carry on compressions, please.

Pumping the chest keeps blood and oxygen flowing round the body,

and makes it possible for Amieth to find a vein.

OK, charging.

OK, everybody, stand back.

Oxygen off, delivering shock.

Shock delivered.

They try a shock to the heart, but it doesn't work.

There are still no veins he can use in the hand.

Shut down.

I'm going to see if I can get a line in for you.

Do we have any access yet?

Time's running out, so he tries the foot.

-Has anyone got any access?

-No, not yet.

Are you in? Lovely, OK, we've got a line in the foot.

OK, well done, that's a good line.

A milligram of adrenaline ready, please.

And, Amieth, you should be wearing gloves, as well.

-Adrenaline in.

-One milligram of adrenaline has been given...

Adrenaline flowing, the team has a better chance of saving the patient.

Stop for a rhythm check, please.

Have we got any output with that at all?

Continue CPR.

I'll do it.

Bit faster, Amieth.

Amieth pumps the chest...

and more adrenaline goes in.

Amieth, stop CPR.

Any pulse?

No pulse.

Carry on CPR.

But the team is losing the patient.

Charging.

Shock it, yeah, let go.

Everybody, stand back. Shock delivered.

In the hope of kick-starting the heart, they give one last shock.

Any output from anybody?

OK, Amieth can you continue CPR, please?

Despite the team's best efforts, there's no response.

OK, Amieth, I think what we've done what we can for this lady,

so I'm going to get you to pop back and carry on seeing your patient, if that's OK?

Sure.

Thank you very much for your help.

You're welcome.

A&E is full of the ups and downs, really,

people living and dying in the same room.

Unfortunately we were unsuccessful today.

It's sad,

and sometimes there's nothing you can do, despite everything you try.

That's his first major cardiac arrest in our department.

I thought he dealt with it quite well.

It's quite a fraught situation,

it's emotionally quite stressful and demanding,

and he kept his cool quite well.

PHONE RINGS

Hello...

Yes, I only just started today.

I have some background about her.

First year, Aki, is starting in one of the busiest wards in the hospital, the acute assessment unit.

He is taking a call from an outside line.

Can you give me two seconds, I'll go and get her notes.

One rule that all doctors should know, it's illegal to give

patients' confidential information out to callers.

She had a Troponin rise and also a rise in Amylase.

So, we think she's had a myocardial infarction and also...

Sorry, I'm not sure.

I can put you through to the registrar,

who's been looking after her for a bit longer.

She might be able to give you a better idea.

Can you just hold on and I'll just go and speak to her.

Needing more information about the patient,

Aki goes to his senior doctor.

Sorry to bother you. There's a doctor on the phone from the insurance company.

She wants to know what investigations we've done.

I've been giving her a bit of information.

I don't know if you want to talk to her.

That's the phone.

Patient confidentiality is crucial because my patient is placing

a trust in me and any other doctor that comes to see them.

You must be cautious in knowing what you can and can't say.

One of the nurses says, "Are you looking after this patient?"

I was like, "Yeah, I guess I am."

She said, "OK, there's another doctor on the line."

I knew I shouldn't have picked it up, but I did.

The responsibility is on me.

A mistake in front of the new boss isn't the start Aki hoped for.

Like Aki, Andy's day hasn't started well.

I was just coming in to ask you, at some point if I could put that thing in again.

I'll try and get it in this time, the cannula.

Time for him to have another go at finding a vein in Mr Straw.

I'm afraid so, but I've done lots in the past.

If I don't get it in in the first few goes,

then I'll get someone else to have a go, if you want.

Just that sometimes it helps with a fresh pair of eyes, you know.

Yes.

All right. Two goes, yes?

All right, I'll grab the stuff.

Then after two goes... But we'll get it first time, promise.

Any luck with the cannula?

About an hour ago, I had a few misses.

I'm going to try again.

But, are you any good at cannulas?

No.

OK, fine, no problem.

Something I've got to get really good at, so I'm going to have another few goes on my own.

HE SIGHS

I grew up in Otley, which is a small market town, near Leeds.

I like to play football, go for a drink, see my friends and stuff.

I'm 22.

I'm probably one of the youngest,

if not the youngest doctors to start at Chelsea and Westminster Hospital.

I was the youngest in my year, I didn't take a gap year.

Really wanted to get straight into it, get involved, get working.

-You can't grow a beard.

-That's true.

-How long?

-My biggest weakness is not being able to grow facial hair.

I'm quite a competitive person.

If we're playing on the Xbox, I always get into it and want to win.

It's not fun if you lose every time.

Andrew James Steval.

So proud of you.

I know I should be able to do the job

but I am going to be terrified.

As the youngest doctor in the hospital, Andy has plenty to prove.

He's got two more chances at finding a vein in Mr Straw.

Time for needle number one.

Needle number two and Andy's last chance.

Yes, didn't manage to get it in again. That's kind of annoying.

You know...

I guess I'm glad I persisted because you've just got to do it.

I'm going to get one of the others to come and have a go.

Then, yes... Hey, next time.

I don't think her blood tests are back or she might not have had them done this morning.

Andy's not the only one struggling.

After his mistake with the phone call, Aki needs to show new boss, Dr Mukherjee, he's on top of things.

Before we do that, which trial evidence do you know of for use

of statins in acute coronary syndrome?

Erm...

There was a time when I knew so many studies.

I know this doesn't help.

-When was that time?

-About two months ago.

That time has come and gone, already! It's only your first day.

Aki's finding it tough going and, never a top performer,

he's had to work hard to become a doctor.

I was born in Tokyo.

When I was three moved to the wonderful country of Shropshire.

# What kind of person should you be

# When you want to make people accept you? #

My friend, he described me once, as Kensington meets rock 'n' roll.

I think I'm very sociable.

During med school, I wouldn't say I was the top examination results.

Maybe, academically, I wasn't that bright.

ALL: Whoo!

I don't feel like a real doctor yet. I need to get drunk first.

It's disgusting.

There are a lot of people who got better grades, but did better in exams.

And, I'm a bit worried about the consultants

and my seniors grilling me about types of disease and I'm not going to know

and it will be very embarrassing.

This is the crunch time.

Mistakes can be fatal.

Back in the hospital, Aki's being tested again.

It's a chance on him to make up for his shaky start.

What do you look for in a patient?

-Chest pain.

-Yes.

-Syncope.

-OK, what if they were dizzy or fainted?

-Shortness of breath.

OK, good.

He's assisting with a 54-year-old man, admitted with a dangerously, irregular heartbeat.

You've made sure we consulted the patient and made sure he understands what we are doing?

Yes.

Under supervision from senior doctor, Ramiz Khamis, this is Aki's chance to prove himself.

Are you all right, sir?

-If you got a lot of hair, what do you think may happen?

-It could burn.

Yes, it could cause a nasty smell afterwards, which is not very nice.

Aki's responsible for forcing the patient's heart

back to a normal rhythm, with a single electric shock.

All right, that'll do.

OK.

Just take three nice deep breaths for me, all the way in and all the way out.

-Are you ready?

-Yes.

-OK.

-So you know what you're doing?

-One shock.

-So make sure everyone is clear. Say it loud.

-Clear.

-Well, hang on. Oxygen away.

-Oxygen away.

Checked the top, the middle and the bottom of the bed.

-Make sure you're not touching the bed.

-Charge.

-Charge.

-Are you all away from the bed?

-Yes.

-OK. Say, "shocking."

-Shocking.

-All right? Were we successful? Did it work?

-I think so.

-Of course it did, well done.

-That's it.

-It's amazing.

It's a better start for Aki.

He's beginning to feel more like a doctor.

The only time I've touched one of those machines is on a mannequin and not on a real person.

It's a very different feeling.

When you're on a mannequin, it doesn't matter what you press.

You don't kill anyone.

With a real patient you're always a bit wary of what you're doing

and you have to be absolutely sure.

All right, my friends, I'm off.

After a day of mixed results on the hospital front line,

the juniors head home.

All right, Emily, I'm off. See you tomorrow?

-Yeah.

-All right, see you soon.

On his way out, Andy bumps into Aki,

just back from fixing his patient's heart.

-Really?

-It was a patient with atrial flutter.

-Did they sort of, like... Did they show you how to do it?

-Yeah.

-The Reg was there, telling me what to do step by step.

-What?

-And then you just press the button?

-Pretty much.

-Sweet!

-The patient's better, so that's good. How was your day?

-Yeah, good.

Just did general jobs.

-All right, are you coming this way?

-I don't finish till ten.

So, we're good.

-Bye.

-All right, see you in a bit, man.

I met Aki just coming down the stairs. He said he had done, like...

He cardioverted someone, which is quite cool.

It uses the defibrillator. It's like a cool thing to do.

Yeah, I guess I'm a bit jealous

because that's a really cool thing to do.

Maybe on AAU, he gets to do more of that kind of stuff.

# My mirror disappoints me

# And

# Am I the only one?

# It's all I need, all, all I need

# Is you, smiling. #

Not all the juniors are clocking off.

First year Milla is just arriving.

Sorry to bother you, I'm just starting on medical on-call tonight.

Oh, I'm so sorry.

Oh, right. OK, so I'm early.

OK, thank you.

Thrown in at the deep end, she's kicking off her career

with a gruelling 12-hour night shift.

This is by the Queen's hat maker, isn't it? I love this one.

I think I would describe myself as a bit of a Chelsea girl, yeah.

-# She's class. #

-What do you think, Mummy?

# Candy for the eye and a twinkle in her smile. #

-Oh, I love it.

-Fantastic!

I love going to balls. I get invited to many of them.

Elton John better invite me to his.

# Her daddy's rich

# You can see she comes from money but she's still a little honey. #

My interest in medicine started when I think I was

around about six years old.

It sounds a little bit silly, but because I love my parents

so much, I always wanted them to be alive forever.

So, I wanted to create this medicine of life

and to actually have them around forever, I guess.

It's wonderful.

The Chelsea hospital, you know, I've only ever wanted to work there.

So, I am really happy.

Yeah, I think I'm ready emotionally as well as intellectually

for the responsibility that being a doctor comes with. Yeah.

# Posh girls have manners... #

Now, Milla is facing one of the toughest tests

of any junior doctor - working nights.

I've never actually had to use one of these. It sounds really silly.

-It's a bit awkward.

-OK.

-But you just double press the green button.

Double press the green to stop it.

Every time her pager goes off,

someone somewhere needs her attention.

-But it's definitely going to go off?

-It will definitely go off.

-OK.

-You'd be very lucky if it never went off.

-So, this is how begins?

This is how begins.

In a hospital with up to 400 patients,

Milla could be called to deal with almost anything.

-BEEP

-Ah-ha! And there is my first beep.

OK.

Hello. Hi.

Somebody called me up to come and certify I think a death.

-For?

-To certify a death. Somebody.

A patient has died and the death must be confirmed by a doctor,

even one with just a few hours experience.

Can I borrow...? Can I possibly borrow you?

I've never done it before.

So, I just want to know exactly what I need to do.

OK.

And can you...? I've never...

I mean, it's my first night, my first shift,

so I've never had to certify a death.

So...

If you can help me out, I'd be most grateful.

Before she can sign the death certificate,

Milla must be sure there is no trace of life.

OK.

Just so you know...

First, she checks for a heart beat.

Then checks again.

He was still warm.

I think that was kind of... is probably part of the really

scary bit, because you, kind of, expect him to have a pulse.

So, it's quite weird.

Yeah, and just to look into his eyes and stuff, too.

Yeah, quite shocking, actually.

I guess I didn't really expect that on my first night.

Back at the house, the other junior doctors can relax.

What's the most awesome thing you've done so far?

OK, so there was a patient, who had an operation,

but one of the stitches on the inside got infected so,

the surgeon was like, "Do you want to take it out?"

He literally watched me, supervised me, guided me,

made sure there was no room for error.

-Wow!

-What was the most exciting thing you did?

Prescribed someone laxatives so they're no longer constipated.

-Oh, wow(!) Life-changing.

-That was quite life-changing, actually.

After a long day on the wards, Lucy is one of the last to get home.

Hello!

-Hello.

-Come in.

-Oh, God!

That was...a hard day.

Basically went food shopping to make myself feel better.

So I bought Jammie Dodgers that I ate on the way home because I walked.

And I bought curry. I can never do that.

-What, like a ready-made one?

-Yeah.

-So, how were your days anyway?

-It was all right.

I missed a few cannulas, which was annoying

because I hate not doing things.

I want to be good at things.

I'm the kind of person that likes to be good at things.

It's just frustrating for me not to be able to do it every time.

So, I'm going to go in tomorrow and just get better.

I really want to get better at stuff.

You've got 24 hours to do your discharges.

If you don't do it in time,

the whole discharge process could collapse.

24-year-old Lucy is starting her life as a doctor in rheumatology

and general medicine.

She'll be treating elderly patients with a wide range of illnesses,

including joint diseases like arthritis.

Those things I'm dreading are things that I should be able to do

and I should feel comfortable about.

So, just dead simple stuff like bloods and cannulas.

Everything else I feel quite comfortable

being uncomfortable about.

I don't want to come away kicking myself over something

that really should have been quite straightforward.

-Hello, sir.

-Hi again.

-Hello.

Right, I just need to take a blood test today,

just to make sure that your clotting is OK.

Is that all right?

Lucy's first patient has a bacterial infection

and she needs some blood for testing.

It's her first attempt at the tough task of getting

a needle into a vein.

Good, good. That's nice for us.

Really?

I've not done it yet, that's why!

Sharp scratch now, sir.

-There you go, all good.

-A success.

-Right, all done.

Thank you very much.

That's very nice. Did you bring these with you?

Are you giving them away to too many people?

I don't feel like I've done anything to take it.

Well, thank you very much.

Did I put my stethoscope down? Oh, I've got it on!

Bye.

I still think I dread practical jobs, despite having done my first blood.

But the patient was so understanding that he gave me this lovely

picture of an English rose, which I think I will put on the ward wall.

For everybody to enjoy. So, that was very nice of him.

She's a true English rose. Yeah.

My name is Andy. I'm one of the junior doctors here in the wards.

While Lucy hits a vein, it isn't always so straightforward.

Andy has yet to be on target.

-Hello, there.

-Hi.

-Mr McGee, are you all right?

-You look in a bit of pain.

-I am.

-Is it your knee?

-Yes.

-Yeah.

-Now he has another patient,

another cannula and another chance to prove himself.

So, let's pull this around.

It's hard to see what's a vein and what's a bruise from somewhere

-where someone has already stubbed you.

-Yeah, exactly.

-With a needle.

Sharp scratch.

Andy's patient, Paul, urgently needs painkillers after knee surgery.

It's important Andy quickly gets it right.

-You all right there?

-Yeah, don't worry about that.

-It's the knee that's hurting.

-Yeah, I realise that.

-I had it for a second there, actually.

-Did you?

With a bit of luck, that should be in there.

-But I'll just check by flushing it with some salty water.

-Lovely.

There we go. I'm pretty sure it is.

Sometimes the hardest bit is getting the sticker on.

Well, I messed the sticker up, but the hard bit is done,

so I'll just get something to stick it down with.

-Just be really careful with it.

-Yep.

-Really careful.

-Yep.

-That's good. Sorry.

-Lovely.

-I'll be back in a second.

That was the first cannula I've put in as a doctor.

Yeah, it felt good.

It felt good to get it in. I got it in the first time, which is good.

No problems.

Success. But the patient is unaware

of just how much is new cannula means to Andy.

Mr McGee, just be really careful with that cannula.

-It's not actually stuck down properly yet.

-OK.

-Be really careful.

-I just need to get something.

-OK, no problem,

just be careful of the cannula, or it'll pull out. I'm going to...

Like Andy,

all the juniors are beginning to find their feet in their new jobs.

I'm going to put my finger up your bottom.

Just untangle myself.

Oh, quite a few people in the waiting room today.

As the day comes to an end,

it's a first night shift on A&E for Amieth.

Looks like it's going to be a pretty busy night.

We just had an ambulance in.

And quite a few ambulances have pitched up just before we arrived.

With patients backing up, his skills and speed are going to be tested.

I think, what will have to do, is have quick turnover.

So, take a history and get the tests going,

any of investigations that you need,

and perhaps even move on to the next person whilst you're figuring out

what's going on with the first. Does that make sense?

A bit of multi-tasking. Any questions?

A&E is a varied mix between very poorly people who require

emergency treatment in the resuscitation room

to our walk-in patients.

We try and get through the minor patients as quick as we can.

If something really major comes in, you're not than having

patients waiting for hours in the waiting room.

A good start. 15 minutes in, Amieth has already seen a patient

and is admitting them to another ward.

You just need to voom, voom, quick, quick.

Quick, it needs to go straight upstairs.

Hello, it's Amieth, I'm one of the A&E SHOs.

I have a patient I'd like to refer to you, please.

There's no option.

I am referring.

-It's not, "I'd like to refer," it's, "I am referring."

-OK.

Don't give them a get-out clause.

He needs to be making decisions and he needs to be making them swiftly.

Patients sitting in an A&E department while they're being

discussed over periods of time are not getting the treatment they need.

We need to be making quick, rapid, safe decisions.

The patients keep on coming. Next, it's 26-year-old Ekaterina.

-I had the worst ear pain in my life yesterday night.

-OK.

Is it affecting both ears or just one ear?

The pain was mostly in this ear, but I can't hear anything in this ear.

-But I did try house-remedy kinds of things.

-What did you try?

My mom told me a mixture. It's like mainly alcohol.

It's vodka, which I put in my ears.

So I might have like cotton or something.

Did you have any problems hearing in that ear

before you put vodka into it?

-No. Basically, I've taken a couple of paracetamols and so on.

-Yeah.

Did that help with the pain? Or are you still having pain in your ears?

I don't know. Yesterday night nothing really seemed to help,

-but now it's OK.

-It's OK.

-It's still very uncomfortable.

Have you noticed any discharge coming out of the ears at all?

I don't really know because I had vodka with cotton in there

-until I came here.

-Right.

Amieth checks Ekaterina's vodka-soaked ear.

-Sorry.

-It is super irritated.

-Yeah.

I can't see any bits of cotton wool in there.

There's no obvious signs of infection in the ears or in the middle ears,

but sometimes you get referred pain to the ears,

so it can still cause pain in the ears.

Are you 100% sure that there is nothing in this ear?

-Like no cotton?

-I couldn't...

-Cos I can't hear anything.

It's as if I had something stuck in that ear.

I couldn't see any cotton.

It doesn't look like there's any wax or cotton in there.

He's still at the very slow stage of going through things

very methodically.

He'll need to speed up and start to get the instincts of who's well,

who's not well and deciding very quickly whether he can admit

patients to the medical doctors, surgical doctors,

or whether to keep them down here for further tests, treatments, etc.

Painkillers and things you can usually get from the chemists cheaper

than on prescriptions.

Amieth sends her on her way with a more conventional treatment

for an infected ear.

-Hope you're not too late for work today.

-No. Thank you very much. Bye.

I've never heard of people putting vodka in their ears,

so it is quite amusing. I didn't keep a straight face,

but that was OK because she knew it was a slightly unusual thing to do.

While Amieth tries to get up to speed in A&E...

..upstairs Milla is learning just how busy the night shift can be.

You asked me to come and see somebody?

Oh, dear.

-BEEPS

-Sorry.

# Don't stop, don't stop, don't stop. #

OK. OK. Yeah, so many things to do.

And then your bleep starts going off again and again, just like this.

-BEEPS

-It's just one bleep after another.

Do you normally have any tummy problems?

But you don't have any medical conditions?

OK, can you tell me a bit about them?

Yes, you do. Oh, dear.

Oh, my God, I'm not going to get my jobs done.

I had dinner at like six o'clock and it's now 2am, so this is my cereal.

Now, where is this ward? Have I just come from it? Yes? OK.

I have absolutely no idea what time it is.

And that is my call to run off and answer my ten million bleeps.

-Is anyone coming to the hospital?

-Yeah, I'm going.

I'll just come with my toast.

I don't feel any different to when I was a medical student.

But I'm not that much different. I mean, really, a month ago I was

a medical student, so I've not changed at all since then.

So, it's just getting all the really basic stuff in order at the moment.

I haven't had anything that challenging to sort out.

But now, Lucy is facing one of the biggest challenges for a new

junior doctor.

Is there a maximum dose that we can give them? Thank you.

Today, she is on-call across the whole hospital.

She is the first stop for anyone needing a doctor.

It's a huge responsibility for a junior only just graduated.

BEEPS

5851.

Hello, I've just been bleeped. OK, and what has happened to her, sorry?

A nurse has paged Lucy. A patient has collapsed.

Have you called the crash team?

She's not breathing or she is breathing?

It would be the crash team, but you need to tell him it's a peri-arrest.

The patient is breathing, but if Lucy is right,

she may be in peri-arrest,

with a falling heartbeat and blood pressure,

a sign her heart may be about to stop completely.

If she has collapsed, she is peri-arrest.

You need to call the crash team.

Am I right? It would be a peri-arrest call.

Call the crash team and say it's a peri-arrest and that you need them.

OK, thank you, bye. Am I right or not?

-Did she stop breathing?

-She stopped breathing,

but she came back round and she's breathing again.

I'm just going to go see the patient and see what's going on.

Lucy heads off to see for herself.

Hello. I just spoke to somebody about a patient

that apparently collapsed.

Lucy arrives to find she is the first doctor present.

With no choice, she takes charge.

Lucy checks the patient's vital signs...

Her heart rate is 46 now.

Yeah.

..monitors her risk of cardiac arrest

and gives her oxygen to breathe.

After ten minutes, the patient comes round.

Lucy make sure she's stable.

I'll come and see you in a few minutes, OK?

-OK.

-Thank you.

I still feel largely unprepared, like I'm useless,

but in the end, I'm sure that this kind of experience really helps.

So, it's just about doing it and trying to do your best.

I don't know whether I did all good job or not, but I tried.

While Lucy is showing she is ready to take on new responsibilities...

So, you have the borders of the mid-auxiliary line.

..Aki still wants to prove himself to Dr Mukherjee.

-Chest drains are quite nasty, so really deep anaesthetic.

-OK.

-Just so you know, I haven't done this before.

-I'll talk you through it.

-OK.

And she has asked him to drain fluid from a patient's chest.

It's an advanced and difficult procedure for a junior

-in his first week.

-Yeah, my God.

-What's wrong?

-Chest drain.

-Have you done one?

-Yeah, you'll love it.

-I'm sure I will.

All right, see you tomorrow.

-Lucy is one of the first to hear the news.

-Hey, guys.

-Hi.

-I'm about to do a chest drain.

-You are?

-Yeah.

-Cool.

-No!

-I'm excited. See you later.

Exciting.

Aki's first job is to put his patient at her ease.

I'm not cheating you here, I'm going to be really honest with you.

This is... I don't want scare you.

This is the first time you've done this.

Yes. And it's my second day.

The patient has breast cancer that has spread to her lungs.

It causes a dangerous build-up of fluid in her chest.

It's Aki's job to drain it.

We're going to get some pain relief even before we've started.

OK? So you're going to get some oramorph coming.

-So, go straight through.

-Yeah.

-So, sharp scratch here.

First, Aki anesthetizes the whole area.

Now stop there, draw back.

Next, he must pierce the chest from behind,

avoiding vital organs like the heart and several major blood vessels.

-So...

-In and then with your needle,

you're going to go straight in, perpendicular to the skin.

Like that.

-OK, or going to give it a try now.

-Can you feel that?

-No.

Hold the needle and remember not to let go of that guard.

Finally, using a wire, he must guide the tube carefully into the chest.

OK, so push it through. Twiddle, twiddle, twiddle.

-Sorry.

-How are you doing there?

-It's hurting.

-Is that bearable?

-Just.

-OK.

If Aki's got it right,

fluid can now be drained from the patient's chest.

Take a big breath in for me, please.

You can see it's swinging, yeah? Good. Well done.

-Congratulations.

-Thank you very much.

-Your first drain.

-It was my first drain.

-I'm really, really, really proud of Aki.

He did really, really well. There are bits that can go badly wrong,

for example, losing the wire in the chest.

And he didn't, he held onto it.

And, actually, the patient was really comfortable as well.

And that's really satisfying. So, no, job well done.

That was really cool.

Job done.

It's really nice to do something for the first time,

and to do it right.

I am so happy.

I think every year I have a moment where I think,

"Oh, my God, this is the best job ever."

Aki finishes for the day.

-Hi.

-Hey.

-Hello.

As Milla's night shift begins, he hands the patient over to her.

-I'm really happy, I just put a chest drain in.

-Oh, my gosh! Wow!

That's exciting.

I just requested an X-ray, just to check that it's in the right place,

-so if you could just review that.

-Oh, right, yeah.

-Have a good night.

-Thank you.

Hello, my friend, I'm just going to put a little needle in your hand.

OK?

As the night shift starts, Amieth is back in A&E,

while upstairs...

-I need to take some blood.

-Yes.

-Is that OK?

Milla is part of the team covering the rest of the hospital.

That's it.

Fantastic. OK.

BEEPS

'Cardiac arrest, A&E.

'Cardiac arrest, A&E.'

Oh, my gosh! I don't have a card! Shit!

There's an emergency in A&E.

'Cardiac arrest, A&E.'

They've called for backup from the night team.

The patient's heart has stopped, they are in cardiac arrest.

It's Milla's first ever crash call to A&E,

but she's four floors up and on the other side of the hospital.

Less than 10% of cardiac arrest victims survive.

Every second counts.

-Hi, Milla.

-Hello. Let me know if you need me to do anything, yes?

As Milla arrives,

Amieth and the team have managed to restart the patient's heart.

-Do you mind getting another grey cannula from in there?

-Grey?

And another 20 ml syringe, as well.

The team must get fluid in to boost the dangerously low blood pressure.

Amieth injects fluids, but the patient crashes again.

After two cardiac arrests,

the chances of survival are falling rapidly.

They manage to restart the heart again. But the pulse is very weak.

OK, so let's get one person's fingers on the pulse,

if they could stay with that.

Milla checks the heartbeat manually

by monitoring the pulse in the wrist.

PH 6.99.

It's now her responsibility to call out

if the patient's heart stops again.

It says -24.

I still need to continue. Yes, thank you.

It's the most important job going.

After almost an hour, the team stabilizes the patient.

With her first crash call over, Milla can head back to the wards.

-Anything else I can do?

-No, thank you very much.

-Thanks very much.

When you get there, it's quite overwhelming

because as a medical student, you get there and you stand back,

where as this is the time that you get in there.

And you do everything that you can.

So it's a very different feeling, I think, doing it as a doctor.

I've been looking forward to tonight so much.

It's Friday night.

Are you going to get trashed?

No, I'm just going to have a good chat and a dance.

It's the end of their first few shifts as doctors.

And the juniors get a chance to let off steam.

-It's been hard, but brilliant.

-It's nice when the patient is so kind.

When you discharge them and they go, "Thank you so much for your help."

And you're like, "Oh, he's talking to me"!

What has been your best memory?

Just, like, feeling that you fit in a bit more with the team.

It's nice to come in the morning and people remember your name.

They'll be, like, "Hi, Andy." Or, "Hi, Adam."

In which case, they're not actually remembering my name. But it's close.

-Ready?

-Yeah.

I think I'm slowly feeling like a doctor.

I'm definitely not confident to treat patients by myself at all.

But I'm slowly working my way.

It still feels a bit strange when people say Dr Steval.

I still feel a bit like I'm a bit of a fraud in that respect.

But I guess I'm doing the job, so I guess I must be a doctor.

Good tequila.

Next time on Junior Doctors...

-Can Ben cut it treating kids?

-I can't do it!

HE CRIES Alfie, Alfie.

-Can Amieth make the right calls in A&E?

-Have you seen the back?

-Yeah.

-All the way down the back?

-All right, shall we stitch first?

And Priya faces some tough challenges.

Your line has come out, we need to put another one in.

I said to her, "I want the nurse." Please don't touch it.

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