Episode 2 Junior Doctors: Your Life in Their Hands

Emergencies...

..bad behaviour,

bedside battles,

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, because in their eyes,'

I think you probably are.

-I don't want to scare you.

-..Untried...

It's my second day.

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, dear.

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

Clear.

Sharing this house in London...

I'm crap at table tennis anyway.

..are eight junior doctors.

Second years Ben and Amieth have been qualified for just 12 months.

I thought, "Oh, my God, what am I going to do?"

First years Aki, Sameer, and Lucy...

He was like, "Thanks a lot," when I put his catheter in.

..Milla, Andy and Priya have been doctors for two weeks.

Men should stay at home and do the cooking, women should go out and become good doctors.

Now they're finding out how tough life on the wards can really be...

-Have you seen the back of him?

-Yeah.

All the way down the back.

Your line's come out and we need to put another one in.

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

There should be a disclaimer on every doctor's forehead that says,

-"Everything we try and do is in your best interests."

-..and face the reality

that they can't save everyone.

I don't think there's anything extra we could have done, really.

Everybody has got to die, and I think that's what she wanted,

to drift away, and that's exactly what she did.

It's morning in South-West London.

At the house they're sharing, our eight newly-qualified doctors

get ready for their next shifts at the Chelsea and Westminster Hospital.

Second-year Ben is working in paediatric surgery.

Working with kids is something he's always wanted to do.

I've been looking forward to it for years.

I'm nervous, because all the skills are different.

Because you're working on tiny little kids...

I'm a little bit nervous as well, but really excited about starting.

Hello, who's your favourite Star Wars character?

Darth Vader.

The Chelsea and Westminster's children's wards

look after over 75,000 kids a year...

We're just taking the bandages off.

..many of them born with life-threatening conditions.

Don't start crying on us.

Four-month-old Yaseen has been on the ward since birth.

Today, he's being prepared for a stomach operation.

Ben needs to take blood for testing,

but getting it from such a tiny baby is a tricky job.

Perhaps a bit lower down? Because he's holding it high.

You're not giving us any more, are you?

It's even tougher under the watchful eye of a worried mum.

I'm sorry.

Yaseem.

OK, OK.

BABY CRIES

'It's a nightmare getting blood from teeny, teeny little babies.

'It is completely different from taking it from an adult.'

You've got a tiny needle and little drips of blood to try and collect,

it's a completely different process and one that I need to learn.

Not all Ben's patients are so small.

You all right there, Alfie?

Hiya. Right, you still got that magic cream on?

Alfie is five years old.

He needs a hollow needle, called a cannula, inserted into a vein,

before a vital bowel operation tomorrow.

I'm going to spray it on your arm, OK?

Ready? It should make it all go numb in a minute.

It's a chance for Ben to practise on a larger patient,

with bigger veins.

What's that?

It's a little needle that we need

to put in your hand,

to give you some medication, OK?

Do you want to hold Mummy's hand and lie back whilst we do it?

It's all right.

You've got the cream on there, so it shouldn't hurt.

It should be all right.

-You don't need to watch.

-Look at Mummy, there we go.

It hurts!

That's it, lie your head back, there you are,

look round at Mummy, there you are,

and think what nice treat she's going to get you for this.

I can't do it!

HE SOBS

Alfie...

Ben might be eager to work with kids, but Alfie has other ideas.

Alfie, Alfie...

OK.

Get off, get off me!

Alfie, Alfie...

-Come on, lay down, lay down.

-Alfie, Alfie?

It's all right, give him a minute. Alfie...

I don't want it on there. I don't want it!

Alfie, we'll do it very quickly, get it over and done with.

Can you be big and brave and strong for us?

Don't be silly.

I don't like it here!

I know you don't, but come here, and me and you will go for a walk.

He was very keen at the beginning to watch and see what was going on.

If I'd been thinking a bit more, I'd have probably got him lying down

and not watching at all to start with,

so he didn't see the needle the first time and freak out.

But he has to have his operation tomorrow, it's a big operation,

it's been planned with a specialist team

coming in from another hospital, so it's frustrating.

-I think we need to X-ray that.

-OK.

The thing that we're worried about is a break.

Like Ben, second year Amieth is trying to prove himself

in a new department with unique challenges.

He's working in A&E,

where life-and-death decisions are made every day.

The first emergency of the day is coming in.

We need to do a 12 V, is anyone able to do a 12 V for us?

A man is suffering severe breathing difficulties.

-Shall we sit you up a little bit?

-Sit up a little bit more, sir.

Everything else is normal. Amieth, if you could get a line.

OK, I'm taking the keys off. I'm going to pop them in your pocket.

Amieth must find a vein, to get some blood for essential tests.

I'm just going to put a needle into your hand, OK?

So I'll just put this stretchy thing around you.

Can you make a fist ten times? Ten times.

I'll run that and I'll come back and do the line.

He finally gets a line in

and can test the blood.

PH 7.41.

The results show the patient is out of immediate danger.

But as the team stabilise him, another call comes in.

PHONE RINGS

This time, it's not an emergency - it's Amieth's personal mobile.

Stop ringing me!

PHONE CONTINUES TO RING

I'm not going to answer it.

'My mobile phone kept ringing, which was a little bit embarrassing.'

Every time it rings, I think to myself,

should I stop what I'm doing and cancel it,

or should I ignore it and let it ring?

Because it does make a lot of noise.

It's a bad habit I should address.

Amieth will have to work extra hard to impress his boss, Doctor Cleaver.

Oh, Amieth. This is the problem with doing it like that.

When you take the seal off the tube, one of the pitfalls

is that you loosen the top of the tube. OK?

-It's still a bit wobbly, actually.

-It's still a bit wobbly.

'Amieth has had quite a busy day today. There were a few issues.'

He struggled to put the lid on one of the blood tests, firmly down,

so when he handed them to me, there was blood everywhere.

And in a resus situation,

there's nothing worse than a phone going off.

It would be something I'd like him to avoid in future.

Just a few learning points.

'Lots of slip-ups today.'

Blood leaking out of the bottle,

and my phone kept going off.

This was a little bit of a calamitous day.

Can I have a look at your hands then, Alfie?

Back in Paediatrics, time's running out

for Ben to fit a cannula to Alfie before his essential bowel surgery.

It will be very quick and then it'll all be done, OK?

I don't want it!

-He's not going to do it.

-It's not going to go in with him doing that.

Get off me, get off me!

All of these things that you have had done...

I'm not listening.

All these things...

I'm not listening!

..and you're getting upset over this!

I'm not listening!

I can put it in his foot,

but I don't think he'll like that any more than his hand.

Do you want me to do it in your foot instead?

Alfie, can we come to a deal?

I won't put the big needle in. I'll just use a tiny little...

-No, no!

-Alfie, listen to me.

No!

I'm not doing it.

Ben's not used to failure. He's always been driven to succeed.

I'm the first person in my family to do medicine.

You feel like you can do something and make an immediate difference.

Yeah. With you, it's the God complex!

The family are pleased.

Grandparents are happy, parents were happy that I was going into medicine.

I've been playing rugby since I was about 11,

and that's what I do to relax.

Rugby is one of those things that you have to put 100% into.

I always expect 100% of myself.

Ben is pretty competitive.

I mean, he will not stop. He's freakishly driven.

I got good grades, I was always happy with how I did at med school.

Touch wood, I didn't fail anything, and I hopefully won't now.

Back on the children's ward,

Ben has to admit to senior surgeon Simon Clarke

that he can't get a cannula into Alfie.

No, he's not had any bloods or cannulas because he was so agitated.

Why was he so difficult?

-Just not cooperative?

-Just not cooperative.

-Four people holding him down.

-Thumping you?

-Not me, just his mum and dad.

-Welcome to Paediatrics. OK.

We're not going to do any of the bloods or cannulas now,

they'll wait till he's asleep and they'll do them all in theatre.

-It seemed the more sensible option.

-Is he going down at 2:30?

I don't know when he's going down...

This time, they'll put the cannula in

after Alfie's under general anaesthetic.

Alfie, we'll get you down later on.

We're not going to put any needles in you today.

-Not until you're asleep.

-Aah!

It's a relief for Alfie and for Ben.

See you later, Alfie.

For some of our junior doctors, it's the end of another tough day.

Hello, Priya.

Oh, hello, stranger.

For others, it's just the start.

This will be the first night shift for 24-year-old Priya.

I do feel really nervous, Amieth.

Fine, I've been in the hospital for a week now,

but I've had to do, sort of, day-to-day tasks with a team,

and loads of people around.

Loads of people I can call.

But now it's just a quiet hospital at night

and I don't want to keep annoying my SHO and be like,

"How do I do this? I can't do this." Do you know what I mean?

It's often a case of keeping the patient comfortable,

and alive,

until the regular team comes in in the morning.

I'm going upstairs, I'll see you later.

-Wish me luck.

-Good luck.

'I feel that at night time, you don't really have that much of...comfort.'

In the day, there's the security of having other medical staff around

that you can ask, or you can ask one of your colleagues,

if you don't want to ask someone more senior.

But every time the bleep goes off, my heart sinks.

I'm like, "Oh, no, not another bleep!"

And going it alone as a doctor is an especially big step for Priya,

who's used to being protected by her family.

There are certain career options that I have considered in my life.

One of the more fun ones is becoming a Bollywood actress,

and that was something that I held on to for such a long time,

from my younger years.

Even recently, I know it's really sad, but I'll watch videos of songs

and then I'll re-enact them in front of the mirror.

I always felt that, yes, definitely, ultimately, I would become a doctor.

It was a given from a very young age.

# My mama told me when I was young... #

-Beautiful!

-Oh, thanks, Mum.

-Oh!

My family is very important to me and I hold the motto -

family first. I'm very, very close to them.

They give me so much love and appreciation. I lean on them a lot.

I like to think they lean on me a bit, too.

-Tea?

-Yes...

'She is still the family's baby,'

so we look after her very well.

# ..I'm beautiful in my way... #

I get pampered, bless my parents.

They do everything for me. It's really, really naughty.

Even when I try to tell them not to,

because I'm 24 now, I can do this myself,

they're like, "No, we will do this for you."

And they see me as a little Bollywood princess at times.

# The night is alive

# You can feel the heart beat... #

'Broadcasting live on Channel 6

'from the second floor of'

the hospital, here on the Fulham Road.

Throughout the night,

Priya will be the first port of call for patients on the surgical wards.

A big responsibility for a junior doctor

with just two weeks' experience.

BLEEPING

Good evening, surgical F1, on call. Got a bleep.

Cannula? OK, that's fine.

Just remind me, what's it for, fluids or antibiotics?

OK. Thanks, bye-bye.

Priya has been called to see 72-year-old Mrs John,

recovering after a stomach operation.

She needs to be given medicine by drip,

so Priya will have to find a vein and use a needle.

Mrs John, how are you?

The line's come off in your arm,

so I'll need to put in another one.

I'll try. I'll find it.

Why do you prefer that one?

Like many of her fellow juniors, Priya hasn't had much experience

doing this important, but tricky procedure.

OK, I tell you what, I'll try here,

-but if I don't get it, I'll have to try over there, OK?

-OK.

You have very thin veins here.

But I'll give it a go.

OK, Mrs John, sharp scratch coming up.

Ouch.

I'm sorry, I know it's painful.

Ow, ow, ow.

No, I'm afraid not.

With no success, Priya calls her senior house officer for advice.

I got bleeped to do a cannula and this lady won't let me do it in her arm whatsoever,

and she hasn't got good veins in her hand,

and she said, "If you can't do it in my hand, I want you to ask somebody else to."

So...

I'll have another go.

And then if she refuses?

OK, that's fine. I'm happy to have another go, it's just that, you know,

she seems very annoyed, but, OK.

No, that's fine. I'll tell her.

That was my SHO.

She was saying that you shouldn't let your patient boss you around,

you should do it where it's best for you to get access.

And where I get access is best for her as well.

Hello, Mrs John, I've just had a word with one of my seniors

and she said that the best place is the arm,

and unfortunately, she can't come and she's told me to try over here.

It's important we get this line in

so you can have your antibiotics.

OK, well, I'm the doctor that's on call. It's your choice.

I can't stress that it's important for you to have the antibiotics,

and right now, there's nobody else that can do it. My senior's busy.

In your arm?

All right, Mrs John. Sharp scratch.

The more you shake, the more it will hurt.

Just keep your arm still.

OK, that's fine.

-You are going to have to wait, I'm afraid.

-OK.

'It was unsuccessful.'

I persuaded her into letting me put it in her arm,

then I put the tourniquet on her arm, and looked for a vein,

and my heart just sank when she had bad veins in her arm too.

So now I feel really, really, really deflated.

-Hi, David.

-How's it going?

-Good.

-Have a good day.

-See you.

See you later.

Hi, I'm the on-call F1 for trolleys.

Today, first year Sameer is working on call across the whole hospital.

Hello. So, I'm just going to

ask you a few questions.

He's been paged to see Ms Jamedar, who's suffered a fall.

Can you tell me where you are?

Sameer must check for any possible damage to her brain,

by asking some simple questions.

I want you to remember this address -

42 West Street. Can you say that to me?

And can you count backwards from 20?

Can you say "British constitution"?

Can you say, "red lorry, yellow lorry"?

Can you keep saying it?

All right, thanks for bearing with me.

-OK.

-OK? And I'll see you later.

Red lorry, yellow lorry. Red lorry,

yellow lorry. So that's the thing,

I don't want to be hypocritical

and judge her when I can't say it myself!

# I don't know who you are... #

I'd describe myself as fun, fair...

um, but not funfair.

Maybe you'd like a new suit.

That's what Dad wears.

Oh, no. Is it?

-Actually, you don't want to end up looking like Dad.

-No.

He is an enigma.

# ..Are you from another world...? #

I can't say I know that much about him,

and that's strange, being his sister.

My parents are threatening to get me an arranged marriage.

I don't want to be swapped into some random marriage,

in exchange for, like, a cow or a microwave.

# ..Beautiful stranger

# How do you do? #

I don't feel like a real doctor yet.

I think once you're making decisions independently

and you're managing patients on your own,

is when you really feel like a real doctor.

I think at the moment, I feel like a fake doctor.

# Club Tropicana drinks are free

# Fun and sunshine

# There's enough for everyone... #

Wham! and Club Tropicana on Radio Chelsea and Westminster,

chosen by Andy, one of the two junior doctors.

As two of the newest doctors,

Sameer and housemate Andy are being interviewed on hospital radio.

It's broadcast to entertain patients and staff on the wards.

Does it really feel like you're actually doctors yet?

I haven't actually done any notes yet.

I think, after I've done that first set of notes,

I might feel more ready to be, yes, I'm a doctor.

Sometimes, I feel like a medical student trapped in the hospital.

Trapped in the hospital?

Are you not enjoying yourself? Here's a question,

if you could be the personal doctor

to anyone in the world, famous or otherwise, who would it be and why?

Sameer?

I'd like to treat extraterrestrials,

because I think in the future,

when the humans come in contact with the alien master race,

it will be interesting to kind of learn about their anatomy.

-LAUGHTER

-Right, that was very unexpected.

-Fantastic. Are you are a sci-fi fan, Sameer?

-No.

-Right, OK.

I'd like to treat Sameer,

so I can explore what's going on in his brain, possibly.

For you guys, if you weren't doctors,

what would be your ideal job?

I'd be Batman.

LAUGHTER

And why, Sameer? Why would you be Batman?

I went into medicine so I could help people from disease

and if I couldn't do that, I would like to help them from...

save them from organised crime.

Right, and drive a cool car?

Yes, an environmentally friendly car.

For Priya, it's the end of a long night shift.

She's learning fast that challenging situations

can be a difficult part of the job.

Hi, did you bleep me?

-Yes.

-Which patient is it?

-In six.

-In six.

She's been called back to see Mrs John,

who was less than impressed with Priya's last visit.

This is the lady who I tried

to cannulate yesterday,

um, and I didn't manage to get it in

and she got really, really angry.

She needs another cannula.

So, this should be interesting.

Good morning, how are you?

How are you feeling, Mrs John?

Your line's come out

and we need to put another one in.

OK, may I ask why?

OK, I understand. You need to have your antibiotics

at eight in the morning, that's the reason we need the line.

I'll ask the nurse...

OK. OK.

OK. That's fine.

'It was a bit embarrassing when she said, "I don't want you to do it."

'It's important not to take it personally.'

I didn't take it as if she was having a go at me.

It was more a combination of how she was feeling, not feeling that great,

and then having me, who probably wouldn't have got it in,

just about to go and annoy her.

Her experience with Priya means junior doctors

get little sympathy from Mrs John.

Absolutely, they need to learn and they need to be given a chance,

but they've either got a feel for it or they haven't.

And you don't keep looking for a vein and, can you find it, can you find it?

You've either got it, or you haven't got it, I'm sorry.

Hiya, how you doing? All right?

-Come to do the crem form for me?

-Yes.

All the juniors are trained to save lives.

But Sameer is finding out that dealing with death

is also an inevitable part of being a doctor.

Thank you.

He's in the mortuary, where dead bodies are stored.

Before a body can be cremated,

it must be checked for dangerous foreign objects by a doctor.

Today, it's Sameer's responsibility. He's never done this before.

You don't think it's going to be risky?

Pacemakers are explosion risks. Shouldn't be anything like that?

I think it is.

Because it's not part of a doctor's normal duties,

they are paid just over £70 for each cremation form they fill out.

I just feel quite uncomfortable with the fact

that I'm getting money for this.

I know a lot of people will give it to charity because I think

they'd feel strange about accepting this money,

um, as part of, you know,

the death of a patient.

I think I feel the same way.

He was a bit nervous, but that's expected.

I think there's a difference between

if you're on the ward, somebody dies and they're kind of,

freshly dead, for want of a better expression.

Decomposition, it's just a smell you get with the dead.

Some people might just hate the smell of death.

Thanks, Sameer. Cheers, cheers.

So you're not allowed to have anything to eat.

Upstairs, in the children's ward,

Ben has another chance to improve on putting young patients at ease.

-Shall we sit this bed up a bit?

-Which button?

-Which button is it?

Press that one.

-Which one?

-That one.

Go on, keep pressing. Is that far enough?

There we go. Right.

Three-year-old Gabriella is in for life-saving surgery

and Ben will be assisting.

I've been in theatre a few times

as a student, but first paediatrics, since qualifying.

It's always nice to get to theatre

as much as possible.

Gabriella was born with a defect.

Her intestines were outside her body.

Much of her bowel had to be removed.

Now she is partly fed through a tube under her skin.

Ben is helping to put in a new line, under the careful eye

of surgeon Simon Clarke and his team.

It's the sort of condition that... 30, 40 years ago,

before TPN, intravenous food was commonplace,

patients like Gabriella didn't make it.

This is the line we're going to put onto the tunnel

and when we pull it through the line, we'll then be under the skin

and we can feed the end into the vein, which we've already isolated.

Ben helps pull the intravenous line through Gabriella's skin.

So you're going to pull on the tunnel. I'm going to feed the line.

-Ready, everyone?

-Yes.

-Let's go.

-OK.

Keep pulling. Good. Pull it, but make sure

you don't touch anything with that bit of line.

Can you reach over? Thank you.

Now the line is in, Ben has to carefully stitch Gabriella's wound.

-OK?

-Personally, I'd never want to pick up the skin with tipped forceps

-because you leave little bruises all along there.

-OK.

-So, if you just use your finger on the skin.

-OK.

That's good, but it's difficult to make it look nice

when you've gone through a scar.

-You've probably made it look nicer than I did.

-Well done.

-Thank you.

The operation has gone well.

And after being frustrated with other challenges on the wards,

it's a positive step for Ben.

It's nice to be in surgery and get some hands-on experience.

I was expecting to hold little bits for someone else.

Mr Clarke was really good about letting me do stuff

and got me far more involved than I thought I'd be able to.

No, it was a great experience.

He showed a lot of skill that he'd picked up along his first

foundation year, so I couldn't

ask for more in a foundation doctor.

So far, so good.

Also making a positive start in her new job is housemate Lucy.

You need to chase her blood results.

Do you want to type in the number and I'll give you it?

She's working in General Medicine and Rheumatology.

They deal with many elderly patients with chronic and incurable conditions.

She wants to die, she wants to be left alone.

She doesn't want to eat or drink anything,

so that has to be addressed,

and whether we give her fluids and go down that road...

I am worried. We can't get her to drink anything.

Well, as soon as we've split jobs, we'll come and examine her.

-OK. I'll leave it with you.

-Thank you.

-Thank you.

A patient has said she just wants to die.

It's Lucy's job to try and motivate her to take food and water.

Hello. My name's Lucy.

Now, I hear you're not drinking very much at the moment.

We're worried that you're not passing enough urine.

Listen, I know it's a little bit of a bother,

but it's important that you do. If you could drink a little bit more when you remember,

even if you don't feel thirsty, then that would be lovely.

I will come and see you again in a little while.

I want you to carry on drinking.

Just try to encourage as much oral intake as possible.

If you can just prompt her as much as you can, that would be great.

'When you see old people who are having a tough time and they're'

deteriorating mentally and physically

and they say that they want to give up, I understand that

because I think if that was one of my family saying that to me,

you can't help but understand their position.

People don't say they want to give up for no reason.

So although it's a difficult one,

and I think it's something that you become more used to

as you go along, I think it's trying your hardest to understand

their thinking, and that makes it, sometimes, a little bit easier.

All the junior doctors are discovering

that they will face life-and-death situations every day.

Sameer is back on call across the whole hospital.

And this call is a major emergency - a cardiac arrest.

The patient's heart is failing.

OK, adrenaline, please.

Sameer's job is to support the emergency team.

The patient urgently needs fluids.

They must find a vein, insert a line, and get fluids flowing.

With the line in, Sameer takes over chest compressions.

The team fight to restart the heart.

But the odds are against them.

Fewer than 10% of cardiac arrest victims survive.

It went on for about 40 minutes

and we were trying to get a pulse back, but we failed in the end

and the patient died.

It didn't feel like an hour, it felt like five minutes.

It felt really quick... I can't believe that that was an hour.

I feel...quite bad,

but I don't think there's anything extra we could have done.

Losing patients is a reality all junior doctors

must come to terms with.

It was a bit... It's a bit weird and you kind of feel sad,

especially because you're watching him

and you're looking at him as you're doing all this.

I guess, as you have more of these experiences,

you learn to cope with them better.

Um...yeah.

In the evenings, there's a rare chance for some of the junior doctors to catch up.

-Are you eating a ke-bab?

-A ke-bab?!

I'm not feeling like cooking.

That's a serious amount of food for one person.

Yeah, but I don't have to eat it all today, do I?

The encounter with her unhappy patient, Mrs John,

is still on Priya's mind.

I had one patient who, literally, was like, "No, I don't want anything

"from you... You really, really hurt me the other day," implying that

I was rubbish, and I said, "Would you mind letting me have a go?"

And she said, "No, I absolutely refuse."

And it sort of made me feel really crappy, but then again,

I thought of it like this. It was half five in the morning,

I had just woken her up,

and she's in hospital, she's obviously not feeling well anyway.

Cos when I'm ill, I know I get very princess-y and moany.

-When you're ill?

-When I'm ill, I do!

Priya is back on the General Surgery ward.

-Is she here now?

-Yeah.

-OK, I might just go and see her.

Today, she's prepping someone for a life-saving operation.

It's a chance to regain her confidence in dealing with patients.

Is it OK if I just ask you get on to the bed so I can examine you?

Just lie back.

Four years ago,

Bridget had surgery to remove part of her intestine affected by cancer.

Tomorrow, she must undergo a further operation.

I see you have a scar from your previous removal of the bowel.

-Any pain, at the moment, in your tummy?

-Not really.

No, OK, I'm just going to press down, let me know

if there's any pain.

-Does that hurt?

-Sensitive.

OK, that's fine.

I think so. I don't know the exact details...

The scar, yes.

I must admit, I'm not entirely sure

whether you're having the keyhole or the actual cut.

With Bridget convinced she can have keyhole surgery,

which is less scarring, Priya has to check what the procedure will be.

She said, "Oh, it's keyhole, isn't it?" That threw me off.

I spoke to one of the SHOs and he said that your operation

is going to be with a cut and not keyhole.

As you've had so many previous operations,

it would be hard to access the areas.

I just dread being bed-ridden, so... I just don't know!

What can I do?

Well, if you're offered that, I'm not entirely sure.

I mean, based on my knowledge, I would have assumed it would

have been an open approach, with a cut,

but if somebody's spoken to you about this,

I just may not be aware that there could be a keyhole option for you.

They did say that they would start off with laparoscopic and then,

if it wasn't possible to complete the operation,

there may be a small incision. So...

All I can do is keep my fingers crossed,

because I don't know what's going to happen.

Rest assured, whatever approach they take,

it's in your best interests and it's the best thing for you at that time.

'It's hard dealing with people's

'expectations at times, especially if they'

were hoping for something that's near impossible,

especially because you want to keep the patient happy

and you have to respect their right to say yes or no.

But when options are limited,

you know you're going to disappoint the patient.

Over in A&E, after his calamitous day,

Amieth still needs to prove himself to his new colleagues.

The next job on his list - a man with a badly bleeding head.

Could you tell me what happened to you today?

I fell down about 15 or 20 stairs.

Oh, really? OK.

-And at the bottom, I hit the wall with my head.

-OK.

-I just went.

-I honestly don't know why.

-OK.

Since then, how do you feel, apart from the fact you're bleeding?

-I've got a severe headache.

-OK.

Stick out your tongue.

With head injuries, it's crucial to look for brain damage,

so Amieth runs through the standard checks.

Close your eyes and when I touch you, say "Yes."

Yes.

Follow it with your eyes and let me know if you see two or not.

-No.

-I think you're probably going to need some stitches in your head

to help with the bleeding,

but I think it might be sensible to get the scan first

-just to make sure there's no bleeding inside the skull, OK?

-OK.

While Amieth is keen to send the patient for a head scan

before stitching, a nurse disagrees.

Yeah, I think so.

Yeah.

All right, shall we stitch first, then?

All right, can I do it?

'In A&E, you're never surprised to see patients covered in blood,'

but surprised at the decision by a junior doctor to send

somebody to a different department.

A lot of doctors will think,

"Right, I've got a patient,"

and they'll just look at the statistics and do all the numbers

and they think, "Ah, this is what I've been taught at university,"

but actually, you have to step back and say, "Actually,

"the patient needs this before they can go anywhere."

-Have you had a look at the wound yet?

-No, not yet.

Amieth's boss, registrar Jamie Fryer,

is called in to check the wound.

Now, sir, the problem with heads

is that they've got such good blood supply

that when they bleed, they really bleed.

-Can you see where the wound is?

-Yeah.

The best way of sorting out these sorts of bleeds is to put

some good pressure on for a while.

I think we'll be able to make you pretty again!

So now we just have to make small talk for a few minutes!

Pressure will help stop the bleeding,

but Amieth still needs something to help impress his new team.

'It's usually the simple steps first'

and in this patient's case,

what Amieth probably failed to realise

is that the bleeding hadn't stopped.

On hindsight, he really should have double-checked that first.

Upstairs, Lucy is back on the ward to see the elderly patient

who wanted to die.

She was quite stable this morning.

We're treating her for an infection

because she had recurrent infections,

and she ended up dying this afternoon.

Um...but she completely stopped eating,

and I think that was a voluntary thing, really.

You could encourage her to take very small amounts,

but I think she was starting to suffer from the effects of not eating,

and I think she just drifted off.

I think everybody's got to die and I think she wanted to drift away,

and that's exactly what she did.

Every junior must learn to cope with the death of their patients.

-Back at the house, Lucy confides in Milla.

-I had my first death today.

-What happened?

-She was old, she didn't really want any treatment.

Yeah, I think she was fed up, really. It was understandable.

You do get to a point where dying is going to happen soon-ish

and you want it just to be...

quiet.

I've never really had to deal with it

-in my family.

-I don't think it's anything that

-you'll ever feel comfortable with.

-No.

It is just something that you have to grin and bear and do it,

because it's one of your jobs.

A new day in the hospital and a new challenge for Priya.

Today, she's assisting in theatre.

I guess it will be an exciting experience.

I get to scrub in as well, which is nice.

There we go, that is beautiful.

The team are operating on Priya's patient, Bridget,

to remove a cancerous tumour.

Another 3A, please.

Bridget had wanted less-invasive keyhole surgery, but the team

have decided it can only be done through a large incision.

It's supposed to be in relation to the right renal vein.

So we need to get the...

Maybe behind it...

Yeah, you're right.

I think you've got the lump in your hand.

I think you're right.

See what's going on?

Yes.

That's the tumour.

I'm wondering if this is the thing.

-That's it. That's the tumour.

-Yeah.

With the tumour removed,

and under supervision from Professor Allen-Mersh,

Priya has the responsibility of stitching the wound,

and determining how much of a scar is left after the operation.

-You see this layer where the skin ends and the fat starts?

-Yes.

-That's where to go into.

-OK.

Push it in and bring it out. All right?

OK. And then...over here?

Yeah. In.

Now she at least looks like a surgeon.

You'll stab your finger. Push away.

Yes. Yay!

OK?

Pull it. Beautifully done.

All right? That's a nice clean dressing for the patient.

It's gone well for Priya,

but she's worried about what the patient will think.

I think she expected keyhole surgery,

which is highly, highly unlikely and

just before the operation, we did explain again. The consultant came and told her and said,

this is the situation, so hopefully she's come to terms with that,

but the last thing you want is something that you didn't really want in the first place.

But I think when you look at the risk and benefit,

there's either have the cancer in, with no new scar,

or take part of it out with a scar.

Hello? A&E.

Downstairs, Amieth's on another busy shift in Accident and Emergency.

We've got a computer that tells us how long a patient's been here.

They can't be here more than four hours.

So when it's busy, like today, there's lots of patients to see,

we need to really crack on through them quickly and that can be quite

a pressurised situation.

Amieth needs to prove to his seniors that he can deal with patients quickly

and without any mistakes.

I understand that you've been having some pains in the chest

and that's why you've come into the hospital today, is that right?

PHONE RINGS

Oh, great(!)

PHONE RINGS

I think it's just a sprain, OK?

-You don't need to rest it for a long time, maybe just the weekend.

-OK.

Take regular painkillers. And crutches, to help with the weight.

-Is that it, am I done?

-Done.

-Thank you!

-All right.

There's a constant stream of people today, but we've managed to get through them quickly.

So the next gentleman is 40 years old,

of no fixed abode, and he's come in with...

some injury to the nose.

He's well known to Accident and Emergency services across London, apparently.

Why did you save him for me, as such?

It's part of your introduction into A&E.

-Hello.

-SNORING

Hello! Come on, open your eyes. Wake up.

SNORING CONTINUES

Oh...

Hello.

Oh...

I'm one of the doctors.

Oh...

Any pain at the moment?

We can get you that.

It's just a question of sobering him up and sending him on his way,

I think. We'll see if we can get him that sandwich.

You have to really kind of get stuck in and fight quite hard against

the tide of patients. I think he's done very well.

Things are looking up for Amieth,

But he's still got more patients to see.

This is a gentleman who's injured his right hand,

who punched a door or something Wednesday night.

He's seen patients really very well and he's referring people that

he needs to refer, often without having to ask

and just letting me know about it,

which is exactly what I want to see.

While Amieth's finally starting to show his potential,

Ben's seeing the results of his surgery.

Hey, Gabriella.

First is three-year-old Gabriella, who Ben helped operate on.

-Can we have a little look?

-Yep.

-Yeah, are you going to show me?

It looks fine. When it's changed, it will look beautiful.

-Yeah.

-Obviously, make sure... You know this, don't you?

-Make sure it's always got the curl in it.

-Yeah.

-Is it home, or is it back to...?

-I think you're going back to your local hospital.

-Yeah.

OK, Gabriella.

-See you later.

-Bye!

'It feels good to be able to help patients.'

You want to make a difference to people's lives.

It's a fantastic feeling. It's nice to have been involved in that.

That's the essence of medicine, trying to help people.

That's certainly why I do it and I think why most medics do it,

to try and make a difference.

With Gabriella's operation a success, Ben's next patient

is five-year-old Alfie, also recovering after surgery.

So today, just drink slowly, and then we'll go from there.

Alfie didn't like Ben's last attempt to use a needle on him.

Someone needs to bleed him again,

just to check that after the operation, everything is still OK,

so we're going to do that with the registrar.

But it falls to Ben to take on the task.

It won't hurt, darling. Not this time, it won't.

Just going to take the plaster off for you, Alfie.

They're just going to get it out of the way.

ALFIE CRIES

We're doing it. It's nearly done.

-It's hurting, it's hurting!

-Really good.

-Try and take your mind off it.

-Ow!

It's done, Alfie.

You were a superstar. All done.

Despite Alfie's tears, Ben manages to take his blood.

All sorted. All sorted.

Alfie is doing very well.

He should, hopefully, if he doesn't have a temperature, go home tomorrow.

He doesn't need to be subjected to me taking blood from him any more.

-Bridget Lavelle.

-Ah...

-Today, Priya will also find out if the operation

she helped with has been a success.

Bright-eyed, bushy-tailed,

after your big operation.

The patient is Bridget. She wanted keyhole surgery to remove a tumour.

But the team had to make an incision, which Priya then stitched up.

I wasn't happy to hear it hadn't been all done in the first place.

You're a very hard person to please.

Anyway, let me have a look at your tummy and see how it's going.

That's lovely.

This could not have been done through the keyhole.

Impossible to do it that way.

Despite seeing her patient through life-saving surgery,

Priya is finding out the hard way that being a doctor means

you can't please everyone.

There should be a disclaimer on every doctor's forehead that says,

"Everything we try and do is in your best interests."

If we are going to give a cut in the tummy instead of keyhole surgery,

it's not because we want to, or we particularly enjoy that.

It's because it's the best option for you at that point.

After four weeks on medicine's front line,

our junior doctors finally get what they've all been waiting for.

Apparently, it's pay day.

I got a bit over-excited last night before I went to bed

and checked my account about 2am.

It hadn't quite hit it yet.

Hopefully, by the end of today, it will be there.

The annual wage for a junior doctor is around £25,000.

I'm really excited because I haven't ever had money put into my account

from anybody other than my parents.

It's just amazing.

What I'll be spending my money on mainly is repaying my student debt.

Let's have a look.

Oh, wow! OK, it's more than I expected, which is very nice.

I think I might have to go shopping now!

We can finally spend our pay cheques.

This is going to be really fun.

-I absolutely love this. The colour's so me.

-That's so you.

-It's fantastic.

-Do you feel like you really deserve that pay cheque?

-Yeah.

We have seriously worked for every penny of it.

It's so stressful and it's just been so overwhelming

that I think it's really well deserved.

We should have some nice lunch somewhere as well.

-A little reward at the end of that horrible month.

-Yeah.

Amieth is also treating himself in his own way.

I need some butter, I need some onions.

I should probably get some tomatoes, maybe an apple.

Got to put food on the table, you know.

Well, hello, boys!

We can be ladies of leisure. We can just relax.

Cheers, guys.

Having celebrated their first pay cheques,

the life-and-death struggles they faced

make some of the junior doctors ask big questions.

Lucy, if it was your last day on Earth, who would you sleep with?

-That's morbid, but weird.

-You're not dodging this question, Lucy.

I don't think I'd sleep with anyone. I'd dance in the rain naked.

Who would you want to take you out for dinner?

That's so random. My family, of course.

There's no doubt about it.

I'm incredibly close to my mother.

We're talking about it as though...

We're perfectly well,

and we can go off and do whatever we wanted to do

and it would be over tomorrow.

Whereas, actually, in reality,

you'd be quite unwell, feeling quite sick.

We all know we're going to die. It's the only bloody guarantee, isn't it?

-The only thing certain in life is death.

-And taxes.

-And taxes, yeah.

Next time, the Junior Doctors face some challenging cases.

She's impaled her hand on a spike.

When you're young and inexperienced, it's hard to take charge...

It's not helpful. It's a loaded question I find offensive.

..appear confident...

It's just a matter of keeping going.

-I should know.

-..and on top of things.

No-one's died yet, which is good, but maybe I'm being a bit too careful.

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