Episode 4 Junior Doctors: Your Life in Their Hands

Emergencies.

Bad behaviour.

Bedside battles.

Alfie, Alfie.

And buckets of blood.

It's a tough job being a doctor.

It's even tougher when you're young.

Am I right or not?

I feel like a child, really. In your their eyes, you probably are.

Untried...

I don't want to scare you. It's my second day.

The first time any of us do anything, we're going to be BLEEP.

..and inexperienced.

-Everyone's in the same boat.

-Push it through, twiddle, twiddle.

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.

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

Come on.

Come on, Lucy.

You seriously throw like a girl.

Our eight newly-qualified doctors are living and working together.

Amieth and Ben have been doctors for just 12 months.

Suddenly you need to know what you're doing,

or at least seem like you know what you're doing.

With just six weeks' experience are Sameer,

Milla and Andy.

We know the white coats will look terrible.

Lucy, Priya and Aki.

It's, like, in your face, isn't it?

All are striving to live up to their new identities as doctors.

They must earn the trust of their patients...

-You can't help me?

-I would like to help you.

-I just need your

-BLEEP

-help.

-Pulse, blood pressure?

-..the respect of their colleagues...

AMT?

I would have thought the AMT would be nine or ten.

You can't guess it, Aki.

..and learn that being a doctor doesn't always fit the image.

It's just complete BLEEP, basically.

# Birds flying high... #

It's a giant leap from student to doctor.

The juniors are starting to think about image

and how doctors should dress.

I think first impressions are quite important.

We all have to wear smart clothes.

That kind of image shows the professionalism of the doctors.

I don't think you need to wear a uniform to be a good doctor

but I think a lot of our job is managing people's expectations

and one thing that they expect

is you to be turned out in a certain way.

I think traditionally, people imagine doctors to be old and crusty

with a white coat on, and flying around on a ward round.

I think that's quite different now.

# And I'm feeling good

# River running free You know how I feel... #

Are you excited?

At the hospital,

the management has its own ideas about looking professional.

We do think it's important.

You may not think it's a fashion accessory, as you've alluded to,

but in the small number of other trusts that have done this already,

the junior doctors have actually got to like it.

To help them look the part,

all the junior doctors must now wear white coats.

-I actually quite like it. How does it look, Aki?

-You look the part.

-That's not the look I'm going for.

-How do I look?

-You look OK.

-Thanks!

I feel like a man.

Oh, that's funny, because you look like one.

You look lovely.

But for one, white coats are definitely not in vogue.

I guess it's quite disappointing

that the white coat covers your outfit.

Down in A & E, Amieth escapes the white coat.

Hello, this is Amieth. I'm one of the doctors in A & E.

'If you look around A & E, we're all wearing scrubs.

'Scrubs are certainly much easier to wear.'

I don't have to worry about ironing or washing my clothes so much,

so that's certainly much easier.

But the shapeless blue scrubs are not popular with some patients.

They look as if they've just come out of Wormwood Scrubs.

He's a right bobby-dazzler.

Bobby-dazzler, aren't you?

I understand that you've come in with a cough

and some breathing problems.

And Bob James is Amieth's first patient.

What's been going on, please? How long has it been lasting?

When was that?

Short of breath.

What do you take for diabetes, normally?

So you just control it with your diet, watching what you eat?

Right.

His chest still sounds a bit wheezy,

but he himself feels more comfortable.

Right, OK.

Baffled by Bob's symptoms, Amieth asks for advice.

Well, do you think he can go home?

Well, I wasn't sure, really. Um...

-He looks OK in the bed, but I think...

-Is this him?

Yeah, he's put his oxygen mask back on.

He didn't have it on when I was there.

'I would have hoped, at this stage'

of his time in A & E, he would have been making decisions

with a little bit more autonomy

and a little bit more confidence in himself.

Second-year doctors like Amieth are expected to diagnose

and treat patients themselves...

..but Amieth hasn't always got it right...

We're going to get a scan of the head

to make sure there's no bleeding in the brain.

-You want to do it when he's bleeding that much?

-Yeah, I think so.

-Have you seen the back of him?

-Yeah.

-All the way down the back?

-Shall we stitch first, then?

I think we should stitch first.

Now we just have to make small talk for a few minutes.

..and he's still struggling.

We're not going to be able to get him well enough in four hours,

so let's get him upstairs.

Although Amieth thought Bob's infection wasn't serious,

his senior disagrees.

I've just had a chat to one of my seniors

and he felt that it might be sensible

for you to come into the hospital for maybe a day,

so that we can give you some good strong antibiotics into the vein

to really help get rid of this chest infection,

and once you're a little bit better with your breathing,

then we can get you back home with some oral tablets

-to finish the course.

-OK.

While Amieth wrestles with the demands of A & E,

housemate Lucy is about to face her next big challenge...

-Do you want me to reinstate it, then?

-The morning dose...

..her very first night shift.

Eye patches and earplugs.

I've ordered those.

Oh, well done.

Bring food.

What kind of food - nibbles?

The worst thing is to be hungry at 4am because you're tired,

-and so you just get more and more angry. You need grumpy nuts.

-Yeah.

'The first nights aren't fun. It feels like you're on your own.'

Any problems occur, you're the first port of call,

and it's very different to the ward work.

Ward work, as you'll see, is just coordinating a lot of admin stuff

and actually, a lot of the medical decisions are made by higher.

But on nights, that's when you actually have to make some decisions

and that's a tough one to start with.

So far, her organisational skills

have helped Lucy stay ahead of the game.

# Bounce

# Bounce... #

I'm quite exacting. I've just got very set ideas.

I'm very definite about how I want things to be done and why.

The organisation of my room looks like this.

Coats. Summer coats.

Going-out shirts. Normal shirts. Work skirts. Other skirts.

Shoes I don't wear that much and love go in boxes.

Weekend shoes and work shoes.

Oh, and at the end I've got belts.

Maybe a touch of OCD, maybe.

I keep lists on my phone, like lists and lists and lists.

Stuff I need to take home, places I need to go,

errands to run, people to contact.

You know, just all normal stuff.

Just a few lists,

because lists make me feel better about myself.

When I start something, even if I don't enjoy it,

I make sure I finish it,

because it's just not in me to leave things half done.

Her first job of the night - the handover from fellow doctor Michael.

Would you mind, with that list, keeping it?

-Not at all.

-There's stuff from the weekend handover list

that I just want to check off against it

to make sure we've at least chased it - if not today, tomorrow.

Yes, of course. You've got another list, under there?

As well as Michael's list of patients to work through,

Lucy is on call for all medical wards across the hospital.

Emergency bleeps will have to take priority over her precious lists...

-BLEEPING

-..throwing any planning to the wind.

Hi, it's Lucy, the on-call medic.

I don't know anything about this patient,

so if you'd like to tell me about him...

If he feels OK and somebody can go with him, I can't see a problem.

OK, thanks.

Can somebody go out for a BLEEP smoke? I don't BLEEP know!

-Thanks for all your help.

-I hope it's all right. See you in the morning.

I've handed over quite a lot of stuff to Lucy,

so I hope it's all right for her.

Hopefully she won't get as many bleeps as I did today.

No, Gwen.

And what bed, sorry? Right, I'll be there in a moment.

-Have you got her ECG?

-Yeah, everything's there.

-OK. I'm just...

-Also...

INDISTINCT

Yes, back in a minute.

This time, she has to go.

You're feeling what, sorry, lovely?

Yeah?

Down in where, sorry?

The right corner.

Here?

And it's worse when you breathe in?

The patient has a severe chest pain.

Have you ever had any pain like this before?

No? And it's made worse when you breathe in?

Is it sharp?

Unsure about a diagnosis, she calls for advice.

We've got a patient here, a 70-year-old patient,

who I've just been to see,

because she had a drop in saturations of 86%,

but she's still complaining of a sharp pain in her left side.

Just to make sure I'm doing the right thing, a bit of reassurance.

I don't really want to be seeing her on my own,

not having had any advice at all.

She's got ongoing chest pain.

So it's just for a bit of reassurance, I think.

Quickly, Lucy gives the registrar a briefing.

We started treating her for a chest infection

-but her chest X-ray wasn't convincing.

-OK.

She's also got heart failure.

No, not when you examine her, and she's moving normally as well.

When you sit her forward, she's fine.

She's not complaining of any pain on movement.

It's a false alarm,

as it turns out to be a simple case of indigestion.

Not a great start to Lucy's night.

SIREN WAILS

While Lucy toughs it out on nights, Aki and Andy reminisce

about life before medicine.

When I was at school, I was in this pop-punk band.

-Really?

-Yeah.

-That's hilarious. Same.

-No, bullshit.

-I was.

-No, you weren't.

I was in a shit punk band called Zapruder.

-What?

-And we did gigs around Leeds and stuff.

-Zapruder?

The camera guy that filmed the assassination of JFK.

-What did you play in your band?

-I played bass, cos...

-Nice.

..it was less strings than the guitar,

so I thought it'd be easy.

-Do you like my meat earring?

-Yeah, lovely.

And I wanted to sing but they wouldn't let me.

-I think that's wise.

-Yeah!

-HE LAUGHS

Did you do gigs and stuff, then?

Yeah, we thought we were so good.

-You thought we you were going to make it, didn't you?

-Yeah.

We thought, you know, "Screw GCSEs - let's become rock stars."

In lower sixth, I organised this tour to Japan.

-What?!

-So we gigged around in Tokyo for a week.

-You're joking?

-No, for real.

-That's amazing.

-So you made it big in Japan?

-Well, I wouldn't say big.

We made it TO Japan.

-Create dreams or save lives.

-True.

Aki, you know what?

Screw being a doctor - let's become rock stars.

# Cos we all just wanna be big rock stars

# And live in hilltop houses driving 15 cars

# Hey, hey I wanna be a rock star... #

Back at the hospital,

Lucy is attempting to get through the patients on her list.

BLEEPING

As soon as you start doing something, you get bleeped.

But the beeps keep coming and the workload grows.

I don't like leaving it, you see.

So... It might be here, actually.

The difficulty is, being on call, you're in lots of different rooms

and you're unsure about where they keep everything.

Right. So, I need to go and answer my bleep thing.

That's my next job.

# Two hands... #

So, this is a lady in bed B1...

BLEEP

Ah! Nope... Five new messages.

'You can't anticipate what's going to come up,'

and flexibility is not my greatest strength.

# Clap your hands if you're working too hard... #

Righty-ho, if you wouldn't mind just leaning forward for me...

Carry on with your nebulisers. If you feel more short of breath,

let the nurses know - each hour we'll monitor your oxygen levels. Perfect.

BLEEP

# Two hands, what you supposed to do with two hands? #

I got four bleeps just then.

BLEEP

While Lucy tries to reduce her patient list,

her housemates enjoy some time away from the hospital.

I think you did an awesome job organising all this, seriously.

Serious, man, I'm happy about the turnout.

Tell us about the biggest balls-up you've made in the last 12 days!

I've lost my pen somewhere.

BLEEP

Sorry, sweetheart, you look... Are you all right?

Back at the hospital, Lucy's finally getting on top of her list.

-I'm going to put this pillow underneath...

-Yes.

If you can keep it slightly higher, that might do it. Yeah.

You develop a plan about what you're going to do,

then it gets usurped by something on the bleep!

ALARM BLARES

And her plans are scuppered by an emergency.

Oh! Right, let's go in...

-Lucy is just going to hold your hand.

-All right, sweetheart.

A man with a bowel obstruction needs urgent attention.

We're going to pass this tube into your stomach -

when you feel it in the back of your throat...

It is something Lucy has never done before...

Can you feel it in the back of your mouth?

..inserting a tube into the patient's stomach.

When we get this tube in, the vomiting will stop, I promise.

Have we got another tray to drain this into?

Thank you.

It's all right - everything's sorted now.

Right...

-Because...

-Because I've not had time.

-Yeah.

It's the end of her shift,

but Lucy hasn't managed to stay on top of her patient list.

It went down the pan at the last minute.

I was quite enjoying it until about five, and then...

I've not even looked at the clock since five, that's how BLEEP it is.

-I'm really sorry there's so much.

-Don't be sorry.

-I handed over more than that last night.

-I don't think you did.

It's complete BLEEP, basically.

Handing over unseen patients to the day team

is not what Lucy calls success.

-How was it?

-At home, Aki is keen to find out

how she coped with her first night shift.

God, I feel like I look like a pile of spanners.

-Lucy, you look beautiful.

-Oh, shut up!

-I'm surprised you've done a night shift!

-I actually scare myself.

-My reflection is awful.

-How was it?

-It was a bit crap.

-Expand.

-Obviously a massive handover, but you get bleeped all the time.

-Yeah.

You end up with job lists that are literally pages and pages long.

It's just crap.

Not the best ever. How was your Saturday night, more to the point?

We went to a house party,

then we went to Shoreditch.

It was a good night.

-Came back at, like, five.

-And you went to that last night?

-Yeah.

Oh, my God - that sounds like heaven!

It's nice to know there's something beyond Chelsea and Westminster Hospital!

Radio Chelsea and Westminster broadcasting live on Channel 6

-from the second floor...

-The hospital's in-house radio

often broadcasts interviews with staff.

This week, it's featuring junior doctors Aki and Amieth.

..you can find out more about the people working to make you better.

-Aki, you said you'd been thrown in at the deep end.

-Mm-hmm.

Did you find that university and studying

helped prepare you for what it's really like?

I don't think anyone can learn anything at university of what...

I mean, how it actually applies in hospital is very, very different.

It is an apprenticeship. It doesn't matter how many hours of work

you put in at home, working on your desk,

you just really have to learn, erm, on the job.

How do you make a good impression to colleagues and patients?

There's a really steep learning curve when you first start practising.

Your colleagues don't really expect you to know everything,

it's easy to get on with your colleagues

if you're honest with them and always try your best.

I made sure that I got stuck in, did everything that was asked for,

erm, and make sure that you keep a smile on your face,

even though you're 12 hours through your day, and exhausted.

You just keep ploughing on - you don't want anyone grumpy around you.

Aki has always suffered from a lack of self-confidence.

Go! Go on, Aki!

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

Woo!

'Maybe academically I wasn't that bright.'

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

It's disgusting!

In terms of academia, I think I know where my limits are.

Gaps in his knowledge have shown up on the ward.

Before we do that, which trial evidence to you know of

for the use of Atorvastatin?

Erm...

There was a time when I knew so many studies.

When was that time?

-About two months ago.

-That time's come and gone already!

It's only your first day!

Aki's back on the ward, eager to prove his medical knowledge.

Hello. I'm just going to find out how you came into hospital -

-would that be OK?

-Fine.

-Would it be OK if I take a seat...?

His next patient is 79-year-old Monica.

Skin cancer on your tongue - is that right?

They put a new tongue in? Wow.

Where did you start feeling dizzy?

Back home. OK.

OK.

Right.

So, usually you can walk around, do your shopping, absolutely fine?

Once he's got the relevant information,

Aki has to present it to his senior.

-So, the problem today, dizziness.

-That's right.

OK - pulse, blood pressure?

Yep. It was there, sorry, it's by the bedside,

-the obs is by the bedside.

-Do you remember what they were?

Erm, the...

sats were normal - it was pretty much normal, I do remember this.

-Did you do a lying/standing blood pressure?

-No.

-OK.

-AMT?

-I haven't done that, I've got that to do.

-OK.

-Sorry.

Erm, I would have thought the AMT would be nine or ten.

No point guessing, you've got to take it.

Having missed out a number of checks, it's back to the patient,

-where his senior, Nidi, must do them.

-Can I listen to your heart?

-Sure.

-Nidi grills Aki on his medical knowledge.

..proprioception and...erm,

hand...

and, er, yeah, propriosection.

N-no?

The...

'I did feel like I let her down a bit.

'When your seniors kind of go over things, you think, "Oh, damn,

'"I forgot to do this or that."'

Further down the line, if this continues,

I'll be quite frustrated with myself.

In A & E, Amieth's starting to take his own decisions

about patient symptoms.

His next patient is a 24-year-old soldier.

You've suddenly developed severe back pain today

-but you've had pain for some time, is that right?

-Yes.

Start at the beginning and tell me what's been going on.

Right.

-Did you feel any pains going down either of your legs at all?

-No.

No, OK. So it just stayed in the back.

Can you lift this leg straight up in the air, please?

I'm not 100% sure that this is what's going on.

There could be other things causing the back pain.

So first things first, we'll give him some pain relief.

Amieth goes for the strongest painkiller, morphine.

A little scratch.

I thought that was quite difficult

because I couldn't actually feel his veins.

I saw a vague hint of blue and aimed for it,

and it just happened to go in.

It was quite lucky.

After getting a line into the patient,

he runs his plan past his consultant.

This is the first time he's come to medical attention with back pain.

I've written him up for some morphine because he is very sore.

No.

Her advice is to use a less powerful painkiller.

Amieth needs to cancel his instructions.

No.

He's got there just in time.

No, we'll keep it spare and try codeine first.

-Because I spoke to the consultant and that's what she suggested.

-OK.

I don't think it was a bad decision

but I don't think he was thinking of the long-term plan

as in, if morphine relieves the pain, what are we going to do then?

Send him home? He can't go home with morphine.

I think if he went back and saw the patient again

he would manage that quite differently.

As a junior in acute admissions,

Aki is dealing with a wide range of patients.

A Korean woman with a suspected stomach ulcer is next.

Hi, I'm going to introduce myself. Dr Fukutomi, or Aki.

I'm going to start by taking some bloods, if that's OK.

Whilst we're talking they can be analysed.

Aki is pleased to learn

that she speaks his native language, Japanese.

TRANSLATED FROM JAPANESE

SHE LAUGHS

I think, once upon a time, I could say I was bilingual.

My Japanese is getting very rusty.

I really like these opportunities

to kind of top up my Japanese vocab skills.

She asked a lot of questions about where I was from,

if both my parents were Japanese, things like that,

which I guess I don't get with other patients.

For Aki, speaking Japanese has turned his thoughts to home.

I think because my family are so far away,

I naturally become closer to my friends

and they do become more of a family.

When you get forms which say "next of kin",

I'd put my friend instead of a family member,

just because it's easier.

I think I'd like to be a bit closer to my father.

We don't really see each other or even keep in contact.

Since becoming a doctor,

Aki has had no contact with his father.

But now, missing home, he decides to call.

TRANSLATED FROM JAPANESE

"HANGING UP" JINGLE

Me and my dad have never really been very close.

I don't think there's anything in particular that...

..I might see him be proud of

or he would be really proud of that I've done yet.

With his family on the other side of the world,

friends for Aki are very important.

I think I'm naturally closer to my housemates and my friends.

I think they know a lot more about me

than any of my family members do, to be honest.

We should start a band or something.

Probably the least musical band to ever form. But, yeah.

Who's going to sing? Cos I can't.

-Lucy can sing a bit, can't she?

-Probably.

Yeah. We could call ourselves

Lucy Hollingworth and the Gastric Bands.

How about that?

Hey, are you all right?

A new day, and Andy is on the general surgery ward.

-It's good to see you.

-All right?

-I'm good, how are you?

Sorry?

Oh, right. Thank you.

Like many junior doctors, he's been struggling with his confidence.

-Did I not communicate it to the nurses clearly?

-It's not your fault.

If you've told the nurse, then what can you do?

-As long as I made it clear.

-Yeah.

-This is you.

-Yeah.

You've written it clearly, they have no excuse.

But maybe I wasn't clear enough verbally. I thought I said but...

But nurses should be reading the notes, Andy,

-don't blame yourself.

-All right.

She'll be through here.

On the ward, Andy is called to an elderly patient

who's waiting to hear if he needs an operation.

What I'm going to do is take some blood from you.

If you're improving and you're feeling better,

you might not need this ERCP.

Part of Andy's job as a junior doctor

is to reassure him.

So...

So the condition you've got,

which we think is inflammation of your gall bladder and gallstones,

that's what we think it is.

Correct.

We can investigate that by putting a tube down,

and then looking for these...

Yes, that I knew, I knew that.

But you meant they might not do even that?

What you've got can resolve itself, OK?

It can. So what we're doing is checking your bloods to see if it is.

-Oh, yes, oh, yes.

-It does look like it's getting better by itself.

It looks like it.

We need to keep taking bloods to see if it is getting better.

Of course, say no more.

Despite being just 23,

Andy is the main support for patients like Luigi.

Brilliant. So we'll get...

-Of course.

-Thank you for everything.

I'm very sorry about that.

He seemed quite emotional

when he was talking about his personal life.

Yeah, a lot of the people that come into hospital

are at the age where they might be losing relatives, friends.

I think sometimes it's quite nice for them to have someone to talk to

or even just to let them know what's going on with our investigations.

Sometimes, as junior doctors, we are that port of call.

It's easy to think that we're just doing routine investigations,

ordering things, the house bitches as it were.

But we can make a big difference, I think.

-What does that say?

-Bloods this morning.

The blood test results are back

and for Luigi, it's good news.

We've taken the catheter out, we'll do the paperwork.

In a few hours, we'll let you go home.

Thank you so much, thank you.

Take care.

See you soon, Mr Rossi. Bye-bye.

Downstairs in A & E, another busy shift for Amieth...

The abdomen is very soft, non-tender.

..as he makes progress diagnosing patients on his own.

Next for Amieth is George,

a patient constantly in and out of A & E

complaining about a swollen hand.

-Look at the size of my arm.

-Yeah, it's gone very swollen.

-Can you move your hand at all, open it at all?

-I can open it with help.

With help from the other hand.

-What about the elbow, is your elbow normal?

-It's right up to the arm.

The elbow is fine.

What sort of treatment have you had for your hand?

-They won't give me nothing.

-OK.

So you had an X-ray yesterday.

Amieth consults the notes and decides not to do any further tests.

So what's wrong with my hand, can you please tell me?

I don't know what's wrong with your hand.

I see that you've come in yesterday, the day before and a couple of days before that...

Yeah.

..and no-one's been able to really help you with your hand.

-No, no-one will help me. They don't know what's wrong with it.

-No.

I saw that you had an X-ray yesterday

and that there was no breaks in the hand.

Yeah, but they can't find what's wrong with it.

It doesn't look red or infected,

but it is swollen and it's not moving very much.

It's not moving at all.

In terms of the swelling,

the best way to get rid of that would be elevation.

That would be to give you a sling.

But there's no medications as such that would help this hand.

It's absolutely killing me.

I can offer you some painkillers if you need them.

-What painkillers can you give me?

-The normal tablets you take.

But in terms of the hand swelling,

apart from elevation, I can't offer you anything to reduce that.

No, no, so you can't help me?

No-one can help me with this arm.

Why can't no-one help me?!

I would like to help you.

I need some help, I need some BLEEP help.

-I know.

-And no hospital's helping me.

I'll find someone for you now.

He's come in multiple times with a swollen hand.

Rather than send the patient away,

Amieth decides to seek help.

A senior doctor checks the patient and performs an ultrasound scan.

We've got this clot in one of the veins.

It's causing the blood to back up.

It's the blood clot that's causing the pain in George's arm.

He's been seen by multiple doctors,

and I was under the impression that he had been fully investigated.

The ultrasound scan was one of the things that I had considered

but I had wrongly assumed that it would already come back normal.

I'm a little bit disappointed that I didn't suggest it myself,

but I was wrong to assume that these tests had already been done.

Lucy is back on nights.

That's great, OK.

And there's a special delivery for her.

Just one minute.

-Is it gorgeous?

-Oh, I wouldn't know.

Lovely.

Slimmer?

Wow, God.

Can you imagine if it doesn't fit, doesn't even meet?

Lovely! Does it look nice?

Thank you. Hand-delivered!

OK, thank you very much.

-Who was that?

-I don't know!

I was already hot but now I'm boiling!

God, I can't wear this all day, it's ridiculous!

-What's up, Luce?

-Hello.

So I've now got an extra-small coat.

And when I said, "It's too hot,"

they said, "You can wear the coat with no blouse on."

-Nice.

-Apparently you're supposed to wear them like a tunic.

-Oh, is it?

Hilarious.

-So I can wear it without a shirt on?

-I wouldn't do that.

-Nobody wants to see it, OK?

-That's so sexist!

After a frustrating first night shift,

Lucy is determined to get on top of things and make this night a success.

-What's the story?

-He's got a gastric ulcer.

He had an AGD today, he's bleeding,

he's been having two units transfusion

which was supposed to finish at about 11 o'clock.

Lucy and registrar Philip attend to a patient

showing signs of internal bleeding.

Show me your tongue.

It's a bit dry.

Do you suffer from any chest problems? Bronchitis, asthma?

Can I have some gloves?

No, do you want me to phone the lab?

The patient is in urgent need of a transfusion,

and his blood type needs matching immediately.

Is it be possible to cross-match another four units?

He's got very low blood pressure

and we think he might be bleeding out.

I can run down with them, would you prefer that?

-I think I would.

-Yeah. OK. See you in a minute.

Hello, can I get an urgent analysis of these bloods, please?

Thanks to Lucy's swift action,

a transfusion stabilises the patient.

But then Lucy's called to another patient struggling to breathe.

Hello, sir.

I'm one of the doctors. My name's Lucy.

I believe you're starting to feel a little bit breathless.

Is that right?

More than usual?

After a quick examination,

Lucy is concerned enough to ask registrar Phil for a second opinion.

He's had increasing shortness of breath since this afternoon.

He's saturated at 94% at the moment on two litres.

On examination, his trachea is pretty difficult to feel,

but I think it might be deviated to the left.

He's hyperresonant on his right side where the drain's inserted.

-Where is he?

-D2.

-Right, good.

-You've done the right thing though.

-Thank you.

If you'd left it any longer...

Good. Well spotted.

I don't trust myself, that's the thing.

-You know the story of the stuff?

-Eh? Yeah.

'There were a fair few emergencies that happened on the ward

'and she dealt with it very well.'

She probably didn't realise it,

but she probably saved the life of someone

who had a blocked chest drain

by promptly coming to get me to assess the patient.

I was quite impressed with that. Lucy's done pretty well, actually.

For Lucy, it's confirmation that she can cope with being on call night or day.

He had a chest drain in because he had some air

between his lung and chest wall a few days ago.

It's still in there. It's still draining away.

Sometimes, if the chest drain isn't draining very well,

the air pocket builds up and pushes your lung over.

'He needed seeing cos if we'd left him, it would have got worse.

'I was pleased I went to see him.'

Phil did say, "Well done." That's always nice.

A pat on the back during a night shift.

How was the rest of the night?

It was fine. Yeah, it was fine.

# I think I got a fever

# I'm hot Somebody better cool me down... #

In accident & emergency, after a challenging shift,

Amieth again has to deal with a patient on his own.

What I'm going to do is, I'm going to get some local anaesthetic

and it will numb the area.

SHE GASPS IN PAIN

Hind has gashed her foot on broken glass.

This time, Amieth doesn't need to call for help.

When I put the anaesthetic in, it will sting.

It's important to wash it out

to make sure there's no glass trapped in there.

OK?

He knows exactly what to do.

Why don't you put your legs back up on the bed?

-Where are you going to inject it?

-Where?

-Yeah.

-Just around the wound.

It will sting to begin with and then it will go numb

and you won't feel anything.

It's important to make sure there's no glass trapped in there.

The cut looks a little bit deep.

I think so, but now that the local anaesthetic is in,

the stitches won't hurt.

Amieth neatly stitches Hind's foot.

Normal tablet painkillers that you can buy over the counter.

-Visit your GP practice nurse to have the stitches removed.

-OK.

The dressing will prevent it from rubbing.

Even if it hurts, I should be able to put pressure on it?

You should be able to put pressure on it.

Amieth's finally satisfied he can trust his own judgement.

The stitches are there to support the wound so it can heal itself.

It's the best way of healing wounds.

I know it's a bit unpleasant to have them put in, but...

-OK?

-Thank you so much.

-You're welcome.

He looked after me very well, very caring, made me patient,

and even though I'm always terrified and scared of injections etc,

stitches, it was a great experience with him. He was good.

Cherry, thank you.

'There is quite a big difference'

between Amieth now and, say, seven weeks ago when he first started.

'He's built up his confidence.

'He's seen some cases without having to ask quite so much.

'Over the next two months, I'd like to see him continue'

to develop and feel more confident and independent

in his management of patients.

Its A & E's night out and Amieth is invited.

A chance for the team to get to know him.

Nice to see you all not wearing scrubs as well.

It will be interesting to see Amieth out of work,

because he's still very quiet and shy, I think, in work.

It will be interesting to see the other side of him.

Hey, hey, hey!

-You said you hadn't played for ten years!

-I haven't.

-Yeah, right.

Have you been practising secretly?

'The impression I get from him when he's at work,'

there's a guard on him in some ways

'and he's let that down today, which is quite nice.'

The FY2 beat the registrar.

Bowling's a great leveller.

Finally, Amieth is part of the team.

It's nice being out of the hospital and getting a chance to know them

more socially and seeing them wear something that's not blue pyjamas.

On the acute assessment unit, Aki is under pressure.

I'm really behind. I need to get to know all these patients.

A lot of them are new.

And a lot of things haven't been done since last night

so I just need to get on top of everything.

Today, the pressure is even greater

because on the ward is one of the hospital's most senior doctors,

Dr Morgan.

OK, if you don't mind, would you be able to tell me

what's been going on in the last few days?

The first patient on Aki's list is Mr Scanlon.

Would you say your tummy pain is the main problem...

that's stopping you from doing anything?

-Is that the main problem?

-And I'm full of gas all the time.

You know, constantly burping.

A couple of days ago, after treatment for a stomach ulcer,

Mr Scanlon was discharged.

Have you been able to eat anything?

-A bit of toast this morning and an egg that stayed in.

-OK.

-Let me know if I'm causing any pain.

-Makes me want to burp.

-OK.

-See you later.

-See you later.

My honest answer is that he stopped his medications

and I think one of them he should have continued.

So, I'm a bit worried that there might be

a little bit of a problem, but this is just my impression.

Dr Morgan's here, so why don't we present the one

-you've just spoken to me about?

-OK.

Presenting to Dr Morgan will give Aki the chance

to demonstrate his medical knowledge.

'Junior doctors do find it very nerve-racking'

when they first present to consultants

and it's probably nerve-racking

for the first six months to a year, I would have thought.

The more worried you are about presenting to a consultant,

the more flustered and nervous you get.

I just need to prepare myself, make sure I'm ready for it.

Aki must now present his diagnosis to Dr Morgan.

-I've got another one over in the next bay.

-Let's deal with him.

-OK.

It's a 46-year-old gentleman who was discharged on 16th September

after being diagnosed with a GI bleed.

And it was stopped, Dr Steel did an endoscopy.

-Let's go and have a look.

-OK.

Having listened to Aki, Dr Morgan double-checks the patient.

The blood tests are good.

-Fantastic.

-Aki has got it right.

At last, his medical knowledge hasn't failed him.

-Let's give him a small dose of the meds. Let's give him 20.

-OK.

-OK?

-Yep, no problem.

-Good.

-Thank you.

It was really nice when Dr Morgan reviewed Mr Scanlon

and agreed with my diagnosis.

It's a nice feeling when your seniors agree with you

and you feel like you've actually contributed

and you came up with something that is the right answer.

Hello!

Two months into the job

and the junior doctors can make the most of a rare night out together.

SLURRED SINGING

It's a karaoke evening and a reminder for Aki of life in Japan.

If you go out to get drunk, people go, "Shall we do karaoke?"

-Yeah, nostalgia.

-Are you not homesick?

Yeah, but in another way,

it's the kind of like we are in Tokyo right now.

-It's kind of nice...

-You have to take us all!

Oh, my God, you guys should come, you'd love it.

My confidence has grown, I would say, significantly.

I think the future is bright.

Cheers, guys!

And perfectionist Lucy has learnt that sometimes,

near-perfect will do.

When you start out,

it's like when you get the first bit of post through

when you first start on your first day and you say,

"Hi, I'm Lucy, I'm one of the doctors." And you just think,

"Oh, no, this is just way too big for me."

But, actually, you grow into it.

It is quite nice to see your development, you know, when I think,

this is something that I didn't know what I was doing a few weeks ago.

I didn't know how to approach it or I felt nervous.

And now I'm doing it for the second time and I know what I'm doing.

-Next time...

-So, it's all done?

No, not yet, that was just the anaesthetic.

After weeks at the bottom rung of the ladder...

I'll be here for half an hour.

I've got to stick my finger up someone's bum.

..the juniors begin to wonder if it's all worth it.

I'm quite tired and almost a bit disinterested.

I've had days when I've thought, "Is this what I want to do?

"Is this right for me, medicine?"

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