Episode 6 Junior Doctors: Your Life in Their Hands

This programme contains some strong language

Emergencies.

Bad behaviour.

Bedside battles.

Alfie, Alfie, 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, 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

-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.

# What a feeling

# To let it all go... #

-Yeah!

-For the past three months, eight junior doctors have been

living and working together in London.

Wow!

Ben and Amieth.

-Aki, Andy and Lucy.

-Any more for any more?

Milla, Sameer and Priya are coming to the end of their current jobs.

I'd make a pretty amazing, hotshot, competent, secretary.

The junior doctors will soon be moving to new departments

as part of their ongoing training.

'Sometimes, I feel like a doctor, when I just get on with it.

And then, sometimes, you're a bit like,

"Right, I'm not quite sure what's going on here."

You know, it feels a bit like being a student again.

Now in the final weeks of their placements...

Thank you for being so nice to me!

PAGER BEEPS

..they'll need to stand on their own two feet.

-A patient has fainted.

-You could commit suicide?

I don't know how to do it. It's a situation that I've never been in.

Prove they can tackle more than just the basics.

Good afternoon, my name's Ben Allin. It's like a kick in the nuts.

Can we get some fluid? Get some oxygen as well.

And finally feel like doctors.

It takes a few hours for the fluid to drain.

I can't stick a needle into his chest without his consent.

That's assault, and I could go to jail for something like that.

The junior doctors are entering the final stage

of their current jobs on the wards.

-Oh, your first night's tonight?

-Yeah.

-Are you excited?

-I'm scared.

You'll be fine.

Andy is about to start his first set of night shifts.

-I didn't realise you were starting nights tonight.

-I know.

Don't worry. They're not all bad.

You learn quite a lot, which is more satisfying than just another day.

It'll be nice to feel like I'm doing a bit more medicine,

-but clearly with that comes stress.

-You'll be all right. You'll feel better when they're out of the way.

-So all of today, I've been absolutely

-BLEEP

-it about nights.

I think the scary thing about nights is you just, yeah, are much less supported.

It sounds like you've got to step up a bit,

so it's sort of like a last big test, really.

Andy has been working in General Surgery for the past three months.

Now, as part of the night team, he'll be on the front line

for any surgical emergencies across the whole hospital.

Hi.

I feel scared, that's what I feel like. Oh, well. Let's just go for it!

For first year, Andy, adjusting to life as a doctor

has been a steep learning curve.

PAGER BLEEPS

He's struggled to meet his own high expectations.

And now, Andy's got to overcome his biggest hurdle.

After I've done that first set of nights,

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

Right, let's just run through this list.

I'm going to go in and see this lady...

On the night shift, Andy's getting a handover from his team.

See you soon.

My SHO, he was like,

"We're going to get a bit of sleep and then you can run the show."

So I was just a bit like, "Oh, God!"

It was going pretty well until now, now that's been said.

So yeah, just hope that it'll be quiet.

# Who's gonna save the world toni-i-i-ight? #

-Andy's called to an urgent case.

-So tell me what's been going on then.

Um, at five o'clock today, this cramp started.

If I move or if I cough or if I laugh or anything like that,

-then it really hurts.

-Point to me exactly where.

The middle, just here. Underneath the belly button, round here.

I need to have a feel of your tummy now.

22-year-old Christabel has severe abdominal pains.

Ow!

-Ow!

-That's painful there, is it? I think you should come into hospital.

You seem to be in a lot of pain. Something might be going on.

It could be appendicitis, it could be something ovarian, potentially.

-Just want to make sure.

-Thank you.

-Brilliant. See you soon.

Eh, some x-rays, maybe an ultrasound...

Andy wastes no time and immediately orders further investigations.

I've got a patient in A&E I've just requested some x-rays for.

All right, cheers, thank you. Bye-bye.

It's really quite different to being on days, because I'm seeing patients.

It's actually awesome! It's not going to be awesome when

I start getting more and more patients through, I'm sure.

It's 5.30am. Nine hours into Andy's shift.

So far, it's been a quiet night.

If you look straight ahead for me. PAGER BLEEPS

But then, an emergency.

It's his patient, Christabel.

The patient I saw earlier has fainted.

Her abdominal pains have taken a turn for the worse.

Hi.

Hi, had a faint, didn't you?

He's the first doctor on the scene and needs to take charge.

Can we get fluids in, please? Can we get some gelofusine?

Get some oxygen as well, please. All right.

So we're just going to give you a bit of oxygen and some fluids.

And it'll help you feel a bit better, all right?

OK. No, what's been going on with your chest?

OK.

Can we get an ECG as well? Thanks.

After stabilising Christabel with fluids,

Andy calls his senior for back up.

She's had a faint and her blood pressure's dropped.

She's looking very pale.

I just thought I'd call you sooner rather than later about this,

cos I think she looks quite unwell.

I think she might have bled from somewhere, actually.

Heart rate's 45.

BP's lower than before. Thank you.

All right, see you soon. Bye-bye.

If Andy's right and it's internal bleeding,

it could be fatal.

'She's obviously in quite a bad way. Really, really pale.

'She just looked like someone that had lost quite a lot of blood.'

We thought at first it could be an appendix or an ovarian problem.

Think it's more likely to be an ovarian or gynaecological problem.

Possibly a bleed from a cyst.

OK.

A specialist team now takes over her care.

Yeah, so that was pretty scary, actually.

This night's been quite a bit of a rollercoaster really,

a bit weird, like.

An hour of sitting around and literally nothing to do,

and then you get a bleep

and someone looks like they're on the verge of dying. It's crazy.

But, um, it's pretty good to be honest.

I'd rather do that than do really boring paperwork jobs all day.

Like, this is just awesome.

The night shift over, it's been the biggest challenge

Andy's ever had to face.

It's just quite reassuring, really,

that I don't lose it in a situation like that.

It's nice to do some stuff like this, do some emergency stuff,

where you actually sort of make a bit of a difference.

Yeah, it feels like you're doing proper doctor stuff.

Andy's made it through the night, but for the other doctors,

it's the start of a new day.

Bye!

Look at you go!

At the hospital, the general medical ward has been first year Lucy's base

for the past three months.

She's been treating elderly patients who have a range of illnesses.

Are you the new doctor everybody's excited about?

-I don't think so.

-Are you?

-That won't be me!

She has impressed with her great bedside manner and caring attitude.

You're looking a bit brighter. Are you feeling a bit better?

At times, perfectionist Lucy has found it difficult to achieve

her own high standards.

It's just complete BLEEP, basically.

You're 97 and doing everything on your own. Can't complain!

I shall be 100 soon!

Suspected stroke victim, Rosemary, is Lucy's next patient.

Isn't it a miserable crowd?

Every time you've been in a hospital, if you wave to them,

they don't wave back. They don't smile.

-The miserable buggers!

-You need to spruce them up!

She'd been living independently until she was rushed into hospital.

-Right.

-If a happy person comes, will you send them along this way?

-Of course I will!

-Goodbye.

-Nice to see you.

-'Really lovely lady, 97.'

-Oh, she's lovely!

I think she's had a stroke while she was in a bath.

-Yeah.

-Couldn't get out.

We're treating her for a UTI, her antibiotics are due to finish today.

She's medically very well.

It's just about getting her home safely.

-Rosemary is well enough to leave hospital.

-Hello!

But Lucy is still worried about her patient.

I wonder whether I'll be able to manage when I get home?

Well, that's exactly why I want to talk to you.

You see, I haven't got anybody to help.

Only one niece, and she's got three children.

I'm just a burden to you relations. Oh, I don't know.

You could commit suicide, couldn't you? That would be easy!

-That would NOT be easy!

-I've often thought about it.

I'm concerned with somebody that's SO well,

and had such an interesting life, that you're getting

to the point that you think that you want to see yourself off.

I don't want to send you home

and you be thinking that you're going to go and do something to yourself.

When somebody is so blunt about the fact that

they feel like a burden on people,

and actually, that feeling is so strong

it makes them think that they don't want to live any more,

when somebody says that you, it's quite, it's quite shocking.

And I certainly feel quite responsible.

I want to have a situation where you're going to feel happy when you get back,

and you don't feel like you're a burden to people,

and that you can live normally, and enjoy yourself.

It's one thing to learn about facts from a book,

or to learn how to examine a patient, or interpret blood tests.

But then when you're faced with a REAL person

and the consequences of getting something wrong,

that's really very hard,

and it comes as one of the many things in medicine,

that come with experience.

As a junior doctor with limited experience,

finding a solution for this new challenge won't be easy.

I think we could maybe get a bit of help at home for you.

That's what I don't like, I don't want people to bother...

People do this for a job, so you're not burdening them.

I can't help but think that if we get home and get used to the idea,

to accept help, she could flourish again.

I don't know how to do it, it's a difficult one,

it's a situation I've never been in before.

Back at home, Lucy can't get her job off her mind.

-All right, Lucy?

-Long-time no see, Andy Pandy.

-Indeed.

-How were nights, did you survive?

-Awesome, I had a really good time.

-They're not bad.

-What about you?

But, God, it's just, it's quite hard work at the moment.

It's just, you know.

Do you ever feel that you get a bit too emotionally attached?

Or start to worry too much when your patients have left hospital and stuff?

No, I don't think I've become emotionally attached,

you just hope that they're doing OK.

And they put their trust in you, don't they?

I feel like I owe them something, really.

-Hello.

-Hi.

You deciding what kind of takeaway to get, are you?

It's been a long day and I'm being lazy.

Have an Indian takeaway, with curry and naan and poppadoms and chutney.

-The housemates are settling in for the night.

-See you later, guys.

But Andy is heading to work, back on the nightshift.

-All right, how's it going?

-Good, how are you?

Good, yeah.

His first priority is to find out what's happened

to his emergency patient, Christabel.

Has she, like, had surgery or anything?

Oh, my God!

This is actually the first really, like,

really seriously ill person I've had to deal with.

Christabel's scans show that Andy's suspicions

of a bleeding ovarian cyst were right.

All around the outside, that's the blood.

And you can see all the organs being compressed by a load of blood.

And there's a cyst from the ovary

which is probably what she's bled from.

This is probably the first time I've had to deal with something that was really serious,

and it's nice to know that I was doing the right thing.

You know, it felt good, actually, yeah.

-Hi, how you feeling?

-Um, better.

-Brilliant.

When I saw you last I was worried, you looked pretty ill.

So, home soon?

Um, yeah, I think Mum is taking me home,

back to the countryside to recuperate.

But the doctors told me

I can't really have much partying or anything for three weeks.

Probably a good idea, considering what you've been through.

Nice to meet you anyway. Yeah, hope everything goes well.

-Thanks so much, Andrew.

-Best of luck with everything.

-Thank you.

-All right, see you soon, bye.

I just remember him running around a lot and looking quite sweaty,

because I felt he was really MY doctor, kind of thing, and looking after me.

Like all junior doctors,

the nightshift is providing Andy with valuable experience.

It certainly takes away, you know, some of the monotony of the daytime

when you're literally just doing paperwork.

This is just, you know, you are only seeing the sick patients.

And yeah, it's what being a doctor is about, really,

or what people do it for. So, it's given me a bit more passion

to go forward and carry on, really, definitely.

Three floors down in A&E.

Put in just a few more stitches to hold the wound together.

Amieth is also hoping to build on his experience as a junior doctor.

So, I understand that you had some problems with your lungs

and your breathing, is that right?

Can I have a listen to your chest, then.

As a second-year doctor at the end of his placement,

Amieth needs to show his bosses that he's progressed to the next level,

advanced procedures.

His latest patient has serious breathing problems.

So, this increase in symptoms is over the last few days?

All right. Are you a former smoker or a smoker?

Never smoked in your life.

Yeah.

Pretty big.

He's got a large amount of fluid in the right side of the chest,

compressing the right lung. The right lung should be here,

but all of this white stuff here is fluid.

Removing that should hopefully help with his symptoms of breathlessness.

But treating patients in A&E has been a big adjustment for Amieth.

At the sharp end of acute medicine,

he's had to deal with everything from heart failure to head wounds.

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

I think we should stitch first.

Now, he needs to prove that he can treat more complex cases on his own,

like fluid around the lungs.

You've had some fluid in the chest in the past?

And when was the last time you came in and had a drain?

Yeah, will probably take some of the fluid from the lungs

just to see under the microscope what it is.

If we're sticking a drain in,

then that's actually putting the tube into the chest

and attaching it to an underwater seal

so that the fluid can drain out.

Aki did one, I think, in his first week,

he's been bragging about it ever since.

A chest drain is an invasive procedure,

that will slowly drain the fluid overnight.

We're going to clean the skin, then put in a tube

to try and train some of fluid from the lung.

It takes a few hours for the fluid to drain.

The patient is refusing treatment.

For personal reasons he needs to get home,

and can't stay in hospital overnight.

Amieth tries to get the patient to understand

that without a chest drain his breathing problems could get worse

and become life-threatening.

It's really important to not force treatments to patients,

even if we think that they're for the best.

I can't stick a needle into his chest without his consent.

That's assault, and I could go to jail for something like that,

in theory, and it's not nice to do things to a patient

-that they don't want.

-His senior, Jamie, has to intervene.

He's not very happy to stay overnight,

but last time he had it aspirated,

and that was a painful procedure, and he doesn't like that either.

What we need to know is that you will actually agree to this,

because we don't want to bully you into this, all right?

The reason for doing it is to get this fluid off,

to help you to breathe a bit better.

Hand on heart, would you want us to do this

or do you want us to not do this?

You want us not to do this?

It's incredibly difficult for a junior doctor to deal with,

as soon as a patient withdraws consent you have to stop what you're doing.

There's no way to know how far to push it,

that's something that you learn with time,

and you often will have to pull in someone more senior

to help you out in those situations.

We have got to get that fluid out.

It's not the outcome Amieth had hoped for.

And in general medicine, Lucy is also encountering problems.

Rosemary, we're seeing you know. Hello, come on, we're seeing you now.

She's struggling to find a solution for Rosemary, it's serious,

having contemplated suicide,

Rosemary's also refusing to accept help at home.

I'm a very private person, I don't want people to keep on...

Pestering you?

I did have one, "What can I do now? Did I get that right?"

-Did it annoy you?

-You understand, I don't know what to do.

-I completely understand what your saying.

-I'm useless.

But Lucy's not giving up.

Hello, David Erskine? Is this Rosemary Clement's niece?

Hello, I'm one of the doctors that's caring for her at the moment.

She speaks to Rosemary's closest relative to discuss options.

I'm pleased I've spoken to you.

With cases like Rosemary's there's not an easy answer,

and there's not a right answer.

Because there's loads of options, I think you've just got to get,

get what seems to be the best possible solution.

Lucy has arranged for Rosemary's niece to come in for a meeting.

She doesn't want anyone coming to her house

because she doesn't want to be a burden.

But she doesn't want to accept help from people that it's their job.

Social Services and the mental health team have also been invited.

They all agree, the best solution is to get some extra help at home.

The decision has come to discharge her home

and live as she was doing before, but to introduce a little bit of care.

It's probably an arrangement they'll play by ear.

Her family is supportive as well.

Rosemary's niece was able to convince her aunt that

getting some extra help at home wouldn't be a burden on anyone.

Hello. Just me.

-My niece was arranging something with some charity person.

-She did.

You are happy with that?

-Yes.

-I'm pleased.

I think Lucy copes really well with Rosemary's case.

She has great communication skills,

she spoke to her niece, she liaised well with all the other teams.

She did a really good job.

-I feel I can manage.

-That's good. I am pleased you feel you can manage.

It's a breakthrough for Lucy, but back in A&E, progress is slow.

Only one night. It won't be a long time - one night.

Desperate to get home, Amieth's patient is still refusing

to stay overnight for a chest drain.

I have done it in the past with a green cannula

and a three-way tap syringe.

If we say, we will take out what we can

and keep you for a couple of hours and send you back, regardless.

Is that what you want?

-There was a three-way tap in the box.

-Finally, a deal is struck.

The only alternative is a more painful

but faster procedure that will allow him to get home tonight,

but he's only giving Amieth one hour.

Cold cleaning on your back, OK?

Amieth gets the chance to perform this tricky procedure.

He sticks a three-inch needle into the space around the patient's lungs and syringes out the fluid.

Sharp scratch.

That's it. It's coming out now.

The procedure is a success

and Amieth beat the deadline, taking just 40 minutes.

Due to Amieth's very strong wrist action,

he managed to pull off about 1,600mls of fluid

just using a needle and syringe.

Would we have allowed him to do it three months ago? Probably not.

We try to let people step into it. He has built up to this.

There were some jealous second years who were keen to take his place.

Just taking my pleural fluid for a walk.

-We have 1,400.

-It's a good amount of fluid to get out.

Hopefully, it will help.

He sat in the corridor singing It Is A Long Way To Tipperary.

I think the registrars and seniors will be quite happy that

I showed I knew what I was doing.

The registrar walked off and let me get on with aspirating the fluid.

It's a busy department and they had other things to do.

Next time, obviously, they'll be happier I can do it on my own.

If there is a next time.

I felt quite comfortable, confident in what I was doing

and I knew we would be successful.

For the past three months,

Ben has been working with children in a paediatric surgery.

Now in his second year,

Ben has to choose the area he wants to specialise in,

and he's set his sights on paediatric surgery.

I find working with kids incredibly rewarding.

Just seeing what the surgeons there do,

seeing the operations they perform.

You can make a huge difference with something that you're able to do,

and like I say, that's something I want to be part of.

Ben needs to line up a job for his third year,

but paediatric surgery

is one of the most competitive areas to break into,

and trying to make his mark in this skilled specialty hasn't been easy.

I can't do it!

Alfie, Alfie.

-He got off to a rocky start.

-Sorry.

Basics that he'd mastered on adults in his first year...

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

..were a struggle on children.

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

It's 11 weeks since he started,

and Ben's about take blood from baby Kemi.

Probably best if we get you holding her,

with her legs wrapped around you, and then one arm poking out,

so she can't see what we're going to do.

Paediatrics, you're helping a child.

A lot of the kids associate you with pain, and the fact that

you'll be putting needles in, doing operations and causing them pain,

and they're too young to know you're helping.

Aww. All clean!

Kemi was born four months premature,

and has been in and out of hospital ever since.

Having had 30 operations in her short life,

her veins have been used so many times

that finding a healthy one to take blood isn't easy.

BABY CRIES

Ben's got it on his first attempt.

Sorry!

-There we are, all done. That was easier than expected!

-Yep.

-All built up for it to be a nightmare.

-Yeah, I know!

He's making progress.

I'm sorry!

But if Ben wants to clinch his dream job in the competitive field of paediatrics, he needs to stand out.

Yeah. I didn't know, I just put it on there because I didn't know

if you had a Chelsea and Westminster one that you use.

He's volunteered to present the results of some research for his boss, Simon Clarke,

one of the most respected paediatric surgeons in the UK.

There is an audience of 100 plus surgeons from around Europe.

It's always a bit nerve-wracking, the first time, but the most important thing about doing a presentation

is simplicity, and make sure your audience doesn't fall asleep.

Yeah.

It's going to be good for your future career.

Getting involved in some form of academic work is pretty important.

There's a lot of people applying for very few posts,

and there aren't many paediatric surgeons in the UK.

It's a very, very small specialty.

Ben will have to present it at a conference of senior paediatricians from across Europe.

It is daunting. I've never failed at anything so far.

I don't intend to start now. I was always lucky at university.

I kept up a reasonable social life, I did well in my exams,

I got good marks I was always happy with.

I guess failing would be a bit of a kick in the nuts.

Ben is taking on the biggest challenge of his career so far.

Like Ben, Andy also has high hopes for the future.

He wants to be a surgeon.

Huge. I want a smaller one!

Energised by his stint on nights, he's back on the day shift.

Doing the nights was really invigorating.

I'm a bit more confident with things that crop up on the wards.

It means I can deal with them a bit quicker,

which then allows me to hopefully get to surgery.

To be a surgeon, Andy needs to get as much experience as he can.

Hi, nice to meet you. My name's Andy.

I'm one of the doctors from the surgical team.

44-year-old Angela is having a gastric bypass to help her lose weight.

Today you're having a gastrectomy converted into a bypass.

-Is that right?

-Yeah.

-Brilliant, OK.

Any other medical problems with your health at all?

I'm diabetic, and I've got high blood pressure.

-Is that type 2 diabetes?

-Yeah.

-Yeah.

-It's diet-managed, though.

Diet-managed, OK. I need to just have a listen to your heart and your lungs, if that's all right.

Nice, big breaths in and out through your mouth.

A gastric bypass is basically where you reroute

the top of the stomach and connect it to the small intestine,

bypassing the stomach, that's why it's called bypass.

So you basically have a smaller, a much smaller or almost non-existent stomach,

so you feel less hungry, you eat less food, and obviously lose weight.

It's a technically challenging operation,

and Andy's desperate to see how it's done.

All ready to go, finished prep clerking a little bit late,

but it just happens. That's medicine!

Try to get there as soon as possible, really.

Ready, guys?

Hi, Mr Bonanomi. How are you?

Andy's mentor, Mr Bonanomi, is the lead surgeon.

To reward his hard work, he offers Andy a golden opportunity to assist.

The first step is to watch and hold the camera.

OK? And progressively, then, you can assist

with the surgery and go step-by-step.

OK, brilliant, sounds good.

This is Andy's chance to show his potential.

Yeah, should be good fun.

It's complex keyhole surgery.

Using a tiny camera to guide the way, Mr Bonanomi will connect

the top of the patient's stomach to the small intestines,

and Andy's job is to hold the camera.

It's a crucial role.

He needs to focus the camera so Mr Bonanomi can see what he's doing.

But it's not easy for a rookie surgeon.

Andy soon gets the hang of it.

Scissors, please.

He's done well, and Mr Bonanomi now asks him to stitch up the incisions.

-Andy, you carry on like this, and at the end, you make a knot. OK?

-OK.

-OK, well done.

-Sounds good, cheers.

Andy has helped for the first time on a gastric bypass surgery,

and I must say that he was quite confident, he did well,

and I'm very happy about how he performed,

and I think it should have been a nice experience for him.

-Good, that's it.

-OK?

-Yep.

-Cool.

It felt great to be doing some surgery.

I was really happy. I got to do the camera work.

I was like his eyes, really, which was one of the hardest things ever.

Well, I thought it was!

It was like playing a computer game, or something.

The operation is a success all round.

Stop it, will you?!

-Hello, there.

-Hi.

-Hi, Angela. How are you doing?

-I'm all right, thanks.

Did you actually do part of the operation on her?

I wasn't actually doing anything.

I was holding the camera for Mr Bonanomi and his registrar to see.

That's got to be scary stuff.

It's amazing, watching it being done, actually.

The skill the surgeons have at doing it is something else.

-Not a time for shaky hands, is it?

-No, it's not, certainly, yeah!

-OK, best of luck with everything.

-Yeah.

Hope it all goes well.

-I'll probably see you in the next few days, anyway.

-OK.

-Nice to see you, as well.

-Brilliant, thank you very much.

Nice to meet you both. I'll see you all soon.

-Wish you every success in your career.

-Thanks very much.

-Good luck.

If you're interested in surgery,

then it's certainly a huge bonus to get to go in and get involved, if that's what you want to do.

And it's not for everyone, but for me,

it reminds me what you're working towards,

because that's the sort of thing that's really good fun.

A success for Andy.

Hi there. Can I add on a test to a blood sent, please?

Fellow housemate Aki is also hoping to leave the Acute Assessment Unit on a high.

There's a tender spot on the inside of that.

Critical cases from A&E get sent here.

It's high-pressure, with a rapid patient turnover,

and one of the most challenging wards for a junior doctor.

I think my confidence has grown,

but not to the level at which I like it to be.

I think that will come with time.

Aki's job is to come up with the correct diagnosis for the patients under his care.

You came in with chest pain?

Mm-hmm. Went to bed with a niggling pain.

Woke up, felt the same, then I was driving

from about half seven onwards,

and it just steadily got worse and worse.

-Can you point to where the pain was?

-Just there.

52-year-old security van driver Dave has been sent up from A&E with a suspected heart attack.

It felt as if someone had taken my lungs out,

given them a good kicking, and put them back in.

OK. Have you been abroad recently?

-Yes, I came back from Cuba two weeks ago.

-OK.

I'm just going to lower this a little. That's fine.

-You look quite red. Is that normal?

-Sunburn.

-Oh, sunburn, from Cuba.

-Yes.

-All right.

-I thought it was a tan, actually(!)

-OK, sorry. That's what I meant!

But mastering the science of diagnosing patients

hasn't come easily to Aki.

-He's not always impressed his seniors.

-Umm.

And he's had gaps in his medical knowledge.

I don't want to make mistakes. A mistake can be catastrophic.

Open your mouth for me.

Now coming to the end of his placement,

Aki needs to show his bosses he can make the right diagnosis.

Right, I'm just going to lower this a little bit.

Aki does an ECG to check the patient's heart rhythm,

and more tests to investigate further.

Looking at his ECGs, and looking at this chest X-ray,

and after examining him,

I have a suspicion that he might actually have a chest infection.

That might be causing the pain instead of anything coming from the heart.

Aki's diagnosis of a chest infection

is different to A&E's original suspicions of a heart attack.

-I'll be back with my boss about your plan.

-Good news.

Are you free, like a bird?

He needs to present his findings to his senior as quickly as possible.

I couldn't see any ischaemia, or any signs of infarction.

Any abnormalities?

-In the ECGs?

-Yep. Axis?

-It's deviated to the left.

-Yes.

-Chest X-ray.

-There's increased shadowing on both bases.

-I thought maybe worse on the right.

-What about the size of his heart?

It's AP erect, so I can't really comment,

-but it does look quite large.

-Yep. OK.

Because his white cells were raised,

I thought it could have been some kind of pneumonia, maybe.

-Could be.

-He did go to Cuba, and it has been two weeks.

I was thinking maybe atypical pneumonia.

Aki's ruled out a heart attack.

It's not a diagnosis any doctor wants to get wrong.

My name is Suzie Pomfret. I'm one of the registrars that's on.

Aki's been telling me a bit about what's been happening with this pain.

His senior does the same examination as Aki.

You've got some shadowing on your X-ray,

and your bloods show that you've got an infection on board,

so we were going to treat you for pneumonia.

OK? We're going to give you some oral tablets for pneumonia.

-Any questions?

-Erm, no. None at all.

-You sure?

-Yeah.

-OK, I'll see you a bit later.

-OK, thanks very much.

Aki has got the diagnosis right,

and they can begin to treat the patient for pneumonia.

-You treated him perfectly well.

-Thank you very much.

Good. I think that went well.

It is really nice to hear praise,

and it's really nice to get encouragement.

One of my seniors did once say

"You need to hold onto all the small victories and build from it."

-Good night.

-Thanks very much, Aki.

-It's my absolute pleasure!

-THEY LAUGH

Seriously, eight o'clock this week has been the highlight of my life.

-Really?

-Absolutely.

-Because you get to see Kate and I?

-That's right.

He's doing really well. There's the people that will go the extra mile in life,

and you have the people that care just that little bit more,

and you can see that Aki's one of those.

The clerkings I've seen have been really good and, I'd say,

on the higher end of the average house officer clerking

that I've seen in my experience to date as a doctor.

-Take care. Thanks for everything.

-If you could check her bloods.

I promise you, I'll check her bloods.

-Thank you very much. Good night.

-Well done.

-Thanks.

It's a good result for Aki.

Back at home, the other junior doctors are enjoying some downtime.

-Oh, no!

-Oh, no, Priya!

-Boom!

-Shake hands. Good game.

But there's no rest for Ben. He has to prepare for his big presentation.

I was up at about quarter to five this morning.

Couple of hours work before going in.

Tired, and hungry, now.

Today, Ben will present his study at a conference of top paediatric surgeons.

It's quite a big deal for me.

Once I'm up on the stage, I'll be absolutely petrified.

I'll be up there, in front of them,

having to try and answer questions

on work that I've done before, so it's all,

it's exciting for me,

it's quite a big deal for me, but it's also terrifying.

Hopefully it'll go not too bad.

If he succeeds, it will boost his chances

of clinching his dream job next year.

If he fails, it could scupper them.

-You've got too many gaps here.

-Oh, yeah.

-Don't forget to enunciate your words.

-Yeah.

His boss, Mr Clarke, gives him some last-minute advice.

Just don't feel like you're rushing it, don't worry.

When you're a bit nervous, sometimes, when you do your first one,

you tend to speed up, because you just want to get out of here!

Essentially, the worst thing that could happen is that I stand up on stage

and look like an absolute fool for seven minutes,

don't know what I'm talking about, and people ridicule me with questions.

Ben will have to present the research

to some of the most respected paediatric surgeons in Europe,

and Mr Clarke has a front row seat. The pressure is on.

It's a long wait. Ben's the last on the programme.

It's his turn. Ben will have to speak for seven minutes.

Good afternoon. My name's Ben Allin,

I'm one of the SHOs at Chelsea and Westminster.

Thank you for giving me the opportunity to talk to you today.

I briefly want to discuss some work that we've carried out,

looking at whether laparoscopic inguinal hernia repair

is comparable to the open approach in a neonatal population.

Ben is the most junior doctor to present today.

..making it even more prudent to try and avoid a second operation in this patient population.

But he pulls it off without a hitch.

-Thank you very much.

-APPLAUSE

Terrified!

That was why I was so impressed. You looked extremely composed!

Thank you very much.

That was great. Got a really good photograph of you!

He's probably the most junior person that's stood up today.

Everybody else are professors, consultants,

senior registrars from all around Europe.

He wasn't fazed by any of them, so definitely, he can come back and do it again!

I think we're going to the pub! I feel like going to the pub.

It's an impressive achievement for Ben, and a cause to celebrate.

Hello!

The end of the junior doctors' placements are fast approaching,

and back at the house, Milla is hosting a special evening.

I think this is a really nice way to just celebrate

the fact that we're coming towards the end of our first rotation.

I think my housemates are really going to see a side of me

that they've not seen before.

I think this party will be totally ridiculous.

I think all Milla's friends are going to turn up with fur coats.

Rahs with champagne and swords!

I've brought a bottle of cava, so we'll see if that cuts the mustard!

Hello! Hi! I'm very well. Thank you so much for coming.

-Hello!

-How are you?

-Fine. I'm very well.

With the help of a few of her friends,

Milla's going to introduce all the housemates to the art of sabrage

- opening champagne bottles with a sword,

a practice she takes very seriously.

No, guys, we've got to be really serious about it.

We're not messing about.

Woah, we've got a lot of champagne!

-I know. There's lots of it that needs drinking now.

-Right.

So I think that's the plan.

Time to begin.

Ladies and gentlemen. Welcome, everyone.

A very good friend of mine introduced me to the art a few years ago, and since then,

I've been initiated to the Confederation of the Golden Sabre.

I think you'll have a lot of fun, especially if you enjoy champagne as much as I do.

Are you ready?

CHEERING

-Just go across the bottle.

-Priya, come on!

CHEERING

With long hours and clashing shifts, this is the first time

since they started that all eight junior doctors have been able to get together at one time.

We certainly have not been doing enough fun things while we've been working.

We're all in our twenties, after all,

and we just have to make the most of life now.

These are the days that we need to be happy,

and we need to be enjoying life to its fullest.

To surviving our first placement! Well done, congratulations.

# Today I don't feel like doing anything

# I just wanna lay in my bed. #

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

in their current jobs before they move to their new placements.

Milla's getting stuck in in dermatology.

Tell him I'll need a syringe.

Priya is back in surgery.

Three o'clock, seven o'clock, 11 o'clock.

Sir?

For Sameer, it's wake-up time on the stroke unit.

Sir, I'm going to move your leg. Just let me know if that hurts.

-Does that hurt?

-Ow! God Almighty! Doesn't it hurt!

Sorry to wake you.

And in paediatrics, Ben has an important day ahead.

It's lively around here this afternoon!

His boss, Mr Clarke, is inviting him to theatre to assist in an operation.

I'll let you make the incision, and you tell me the layers you're going through as you're doing it,

and then I will take over at the appropriate moment.

Fair enough, OK.

He's giving Ben the chance to make the first incision.

Nice and shallow. That's fine.

It's a delicate operation to drain the fluid

that's gathered around the testicle of a three-year-old boy.

Mr Clarke allows Ben to continue on his own.

Not in my direction!

In your direction, preferably.

Ben extracts the sack of excess fluid and bursts it like a balloon.

-Regular?

-Just a regular knot, but with a double on one end.

-OK.

Yes, that's it.

Until now, Ben has only ever assisted in operations.

-An improvement on eight weeks ago. Well done.

-Thank you very much.

Under Mr Clarke's supervision, he's done most of the operation on his own.

Have you done that before, explored to the groin?

No, that's the first time. Thank you very much.

Quite scary, the first time!

Nice to be standing on the surgeon's side of the table,

as opposed to the assistant's side of the table.

I was just excited to be getting the opportunity to do it.

It was a bit scary, knowing that he could be expecting me to do bits and pieces,

and maybe expecting more of me than I can necessarily do, but it was good.

Go on, jump down.

When Ben first came to us, like any doctor who arrives on paediatrics,

is moving into another universe altogether.

Without doubt, we've watched him grow in confidence.

Ben is a logical thinker, he's efficient,

and he works well in a team,

so I think he's got all the makings of a good surgeon, and I hope

we've been able to help him along the way over the past few months.

Do you hear it go ba-boom, ba-boom?

In general medicine, Lucy's patient Rosemary is leaving.

-Hello. I'm going home!

-I know you are! I know. You look lovely!

I can't... I want a mirror to put... Do you know where my eyebrows are?

-Do I know where they are?

-Yes.

-I think I can probably guess.

Lucy's worked her way through a tough case,

and 97-year-old Rosemary is going home happy.

-I wanted to come and wish you luck.

-And you too.

And say it's been an absolute pleasure looking after you.

-I've enjoyed it.

-I like your personality.

-Oh, that was very nice of you. Safe journey back.

-Thank you.

Don't have too much fun!

When somebody says thank you, it makes your day.

It's hugely important to me that

I'm doing the right thing by my patients, and for them,

and getting involved in their care, because at the end of it all,

you want them to go home well, and you want them to go home happy.

It's a new beginning for Rosemary.

But for Lucy, her time on general medicine is coming to an end.

See you later.

Lucy has got that special quality about her

that not only is, you know,

she's obviously very intelligent, you know,

about being a doctor itself,

but she's also very respectful of the people that she's looking after.

She sees them as a whole, and that's really important.

I'd rather get the 49 bus.

Oh, 49 bus?

I'll be sad to leave here.

It's been a lovely, lovely first job, but I think when you start to settle into something,

that's the time to go, particularly when you're a junior doctor,

because there's more to learn and more to see.

So, it's been a great first experience. I'll miss it dearly.

But I think I'm kind of ready for the next thing now.

See you tomorrow.

-On the eve of their last shifts.

-Hello!

The junior doctors have an important guest, Sir Peter Rubin,

from the General Medical Council, who oversees all doctors in the UK.

I remember what it's like to be a new doctor.

I graduated in 1974, back in prehistory, when dinosaurs roamed the earth(!)

He's come to congratulate them on making it through a challenging first few months.

No matter what preparation you've had or what shadowing you've done,

there's a real wake-up call when you realise you are THE doctor.

You'll have some tough learning experiences.

It does get easier, but you do keep learning, my goodness, you keep learning.

This is your golden age.

You'll look back on this time with great fondness.

The friends you make now will be friends for life,

and what a privilege that is.

What a privilege. Thank you, guys, very much.

APPLAUSE

Hey, Ben. Are you sad to be leaving your favourite job in the world?

-It is my favourite job in the world.

-I'm excited to wear scrubs tomorrow.

-You on general surgery?

-Yeah.

Across the hospital, all the junior doctors are finishing their last shifts.

-Come back and visit!

-We will. I'll be back.

I have never felt so fulfilled

and so responsible as I have done over the last few months.

Aki is leaving the Acute Assessment Unit.

Alison, goodbye.

Oh, this is sad. We're going to miss you, young man.

-Thank you, Alison.

-I am definitely going to miss Aki.

He's become part of the team,

and you do develop working relationships

with people, and he's been a pleasure to work with, really.

I won't forget the roots, you know, what made me who I am.

It's the nurses here on AAU!

Compared to day one, when I actually thought I was a fraud doctor,

and I just thought I was an extension of some kind of odd medical student,

I think, on my last day of AAU, I do feel like I'm a doctor,

and on my next day off, I'm going to change my credit card to Dr!

For many, like Lucy, in general medicine, leaving won't be easy.

-Are you going?! See you!

-You've been fantastic.

-Thank you.

-I've really enjoyed it.

-It's Lucy's last day today.

Sorry, I'm quite tearful. I'm quite sad to see her go.

I hope she realises how good she is,

and she's just been an amazing member of the team.

I'm going to miss her.

Sorry!

Oh, it's been great. I've loved it.

-You look really sad.

-I am sad!

-Oh, well.

-Right. Go home, everybody. It's late.

-Take care. I'll see you soon.

-Thanks, Kate.

Oh, you've been lovely!

I just feel really privileged, actually.

And, although it's hard work to get here,

I can't imagine doing anything else with my life.

It's the end of the first chapter in their medical careers.

Over the past four months, the junior doctors have learnt how to deal with serious emergencies.

All right, sweetheart.

Challenging cases.

-It's just a question...

-No, it's not helpful.

-Can I just move on to...

-No, can you just move back?

Any pulse?

They've had to face the harsh reality that they can't save every patient.

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

-They've had highs.

-I am so happy!

And lows.

I'm going to get my colleague to have a go. I'm sorry. I know it's really painful.

-Just complete

-BLEEP,

-basically.

And times they'll never forget.

Oh, my God. This is the best job ever!

And they're only at the start of their medical careers.

Today, all the junior doctors are beginning new jobs.

They'll move departments every four months to help them build up a variety of skills.

It feels like I'm going back to school

every time I start something new in medicine.

Priya is taking over Aki's role on the Acute Assessment Unit.

Things seem to be settling down a little bit,

so we'll try and get you a bit more mobile tomorrow.

I think the change between when I first started and now is immense.

I've developed so much in this short span of time,

and when you look at the old Priya, and look at the current Priya,

I think now is when I actually am allowed to be called Doctor.

And Lucy's joining Priya on the Acute Assessment Unit.

-I walked past the wrong ward.

-Did you?

I was like, "I'm on the wrong ward!"

It's a change of pace from general medicine.

All done. Do you want me to prescribe the blood?

I think this job's going to be quite good for me, because you don't know the patients as well,

and it's high turnover, and that's the stuff that I find quite difficult,

so I think that kind of challenge will be good, now.

-Mr Collier, do you mind if I get scrubbed up?

-No, absolutely.

Sameer is learning how to wield the surgeon's knife in plastic surgery.

I think you've got your mask on back to front.

Really? Seriously?

This is the first time I've been in theatre

since I've qualified as a doctor, which is quite exciting.

So many months in,

it's a bit difficult remembering how to scrub up.

How have things been going with the chemo?

-Any problems from it at the moment?

-It has worked.

-Good news.

Second year Ben has moved from caring for children to treating adults with cancer.

There will be times when patients get to you, and it's pretty upsetting.

Moving on to a new job is always hard,

and I think it's been even harder this time,

because I'm moving from a job that I absolutely love,

a job that I want to do long-term, to one which I'm sure I'll enjoy and will be incredibly useful,

and it's a great skill to learn, but one that I don't necessarily want to do, long-term.

Amieth is stepping into the intensive care unit,

and has made up his mind about where his future lies.

I've just sent off my application for my next round of jobs,

which is anaesthetics, and so hopefully, I'll get an offer

and some interviews and things.

So, maybe you'll see me in theatres one day,

just in the anaesthetic room, at the head end of the bed, looking after the patients.

Hello? I don't really know what cardiology's going to be like.

-I think it'll be quite interesting.

-PAGER BEEPS

First beep of the day.

Andy has moved out of surgery...

Nice big breaths in and out through your mouth.

..and into medicine, treating patients with heart conditions in cardiology.

Feel your pulse. Just going to have a listen to your heart.

I'm always making sure I'm doing the right thing, but I am, now,

a lot more confident, and I can go into work thinking I know what I'm doing,

if someone gets ill, I'll be able to deal with it, I think.

So, yeah, I'm a lot more confident than I was before.

Aki and Milla are working together,

and stepping into Andy's old job in general surgery.

Hello? Hi. My name's Dr Marinova. I'm one of the surgical house officers.

You're my first surgical patient!

-I'm honoured!

-So am I!

Fantastic. I might not be doing the life-saving surgery myself,

but just the fact that you're there, and the little things that you do,

do actually help, I think just make it the most incredible job in the world.

This is the letter that the GP will get,

and this is a copy for you, so you know what's happened.

I just want to make this year a good one,

and look back on it and think that I've grown, not just as a doctor, but as a person as well.

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