Episode 7 Junior Doctors: Your Life in Their Hands

'Cardiac arrest, A and E.'

Emergencies...

We've got paddles on.

..bad behaviour...

No, I'm not going in!

..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 really cos in their eyes I think you probably are.

Untried...

I don't want to scare you...

-This is the first time you've done this?

-Yes.

-..and inexperienced.

-'Everyone's in the same boat...'

-Push it through, twiddle, twiddle.

..no-one knows what they're doing.

Last summer, eight junior doctors

moved into this house in west London...

My coffee maker.

Essential for nights.

..all about to start new jobs.

I work for KFC, I've done a bit of waitering

but I've never been a doctor.

At one of London's busiest hospitals.

I've now got this badge that has my massive name on it and "Dr",

so there's no hiding it from now on.

Now, together with previously unseen footage...

This might be a bit uncomfortable.

..we look back at the highs...

This is just awesome!

..the lows...

-Oh, my God.

-He's dead.

-Oh, God.

..at the good times.

Oh, well done! Isn't she wonderful?

..and the bad...

It's quite scary to see how quickly patients can deteriorate.

..as over four months our juniors found out

what it took to be doctors.

Oh, my God, this is the best job ever!

# We've got to hold on to what we've got

# It doesn't make a difference if we make it or not... #

These eight juniors are coming to the end of their first jobs

at Chelsea and Westminster Hospital.

# We'll give it a shot!

# Whoa we're half way there

# Whoa... #

THEY LAUGH

They have a rare night out all together to celebrate...

Where in medical school was I taught how to pull spikes out of hands?

..and reflect on some of the toughest weeks of their lives.

I've had, you know, LOTS of night shifts,

lots and lots of on calls and weekends and things

and I finally feel like I know what I'm doing and that I'm a doctor.

I don't want to move on!

THEY CHATTER

But just a few months ago they weren't feeling so confident.

Just hours before they started as doctors,

the juniors were feeling the pressure.

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

There's nothing you can do about it,

you've just got to get on with it, I guess, haven't you?

Hopefully they'll be all right.

Of them all, Milla faced the toughest challenge

and every junior doctor's biggest fear - the notorious nightshift.

How do you guys feel about nights?

How would you feel if you were in my position?

I feel sorry for you, like, to have to go on nights.

You know, that's, erm... That's balls!

It's put my days on call next week into perspective.

I don't feel so bad about them now.

-I would say that days are worse than nights.

-Oh, blooming heck!

Can you not keep that to yourself?

this is a little bit of a medical bungee jump, I guess.

Of course I'm worried because, you know, we are looking after people

and it's going to be me who's going to have to, you know,

do what ever it is to help them throughout the night.

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

Oh, right. Oh, I'm so sorry. Oh, right, OK. So, I'm early?

OK. OK, thank you.

I'm going to go and get changed.

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

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

-What you think, Mummy?

-Oh, I love it!

-Fantastic.

My interest in medicine started

when I was around about six years old.

Cos I love my parents so much

I always wanted them to be alive for ever

so I wanted to create this medicine of life and to actually...

Well, have them around for ever, I guess.

It's a little bit of a shock to suddenly not be at home at all.

'I'm very, very close to my mother

'and we do lots and lots of things together.'

Unfortunately, my father had a stroke a couple of months ago,

so things have been a little bit difficult

but because we're such a close unit with coping with things very well.

I never expected our lives will change so dramatically

after your daddy's stroke.

Of course, at the beginning it will be very difficult

but I am sure that you will do well.

'It'll be a bit of a shock'

because I've been going to see Daddy every day at the hospital.

So, I think I'm just, sort of, trying to get to grips with the fact that

I'm not going to be able to do that because I'm starting a full-time job.

-Hello, is it Mr Awar?

-Yes.

Hi, I'm one of the doctors on call tonight.

-OK, I need to take some blood.

-Yes.

-Yes...?

on the nightshift, our junior doctors were part of a skeleton team

and the first port of call

for any medical problems across the hospital.

OK.

'Cardiac arrest, A and E. Cardiac arrest, A and E...'

Oh, my God, I don't have a card!

There was an emergency in A&E.

'Cardiac Arrest...'

They called for back up from the night team.

The patient's heart had stopped and was in cardiac arrest.

Milla had only recently qualified

but already she faced her first A&E crash call.

-Hi, Milla, how's it going?

-Hello.

As Milla arrived, her housemate, second-year Ameith,

was working late in A&E.

He and the team had restarted the patient's heart.

-Would you mind getting a another grey cannula from the...

-The grey?

..and another 20ml syringed as well.

The team had to get fluid in

to boost the dangerously low blood pressure.

Squeeze his leg for me.

-Is it going in?

-Yeah, it's going in.

-Because the veins crap, isn't it?

Ameith injected fluids but the patient crashed again.

After two cardiac arrests,

the chances of survival were falling rapidly.

Can you get adrenaline, please?

-Adrenaline going in.

-Thank you.

They managed to restart the heart again but the pulse was very weak.

Let's get one person's finger on the pulse. If they could stay with that.

Milla checks the heartbeat manually,

by monitoring the pulse in the wrist.

PH 6.99...

It was now her responsibility to call out

if the patient's heart stopped again.

I still need to continue. Yes, thank you.

Are you doing your job? It's the most important job going.

After almost an hour, against the odds,

the team stabilised the patient.

Thank you very much.

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

-Anything else I can do?

-No. Thank you very much.

-Thanks very much.

'When you get there it's quite overwhelming'

because, as a medical student, you always, sort of, get there

and stand back, whereas this is the time that you get in there

and you do everything that you can.

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

doing it as a doctor.

It wasn't always life-and-death emergencies

that the new doctors had to deal with.

They still had to master the basics.

We are your new doctors. So, my name is Lucy.

At 22, Andy was the youngest doctor starting in the hospital.

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

-Hi, I'm Sophie, I'm the Sister.

He joined trauma and orthopaedics on the surgical ward.

Hello, Mr Straw.

Right, erm...

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

if that's all right?

Andy's first challenge

was to fit a device called a cannula to his patient.

The tricky but essential procedure.

OK, so, sharp scratch coming up.

He had to find a vein

and insert a hollow needle for medicine to be injected through.

Right, that's not in.

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

-Are you all right there?

-Fine.

-Good.

After several failed attempts,

and worried about hurting the patient, Andy stopped.

Right, on second thoughts,

I think you need to a bit of a half an hour break there.

Just because, obviously, it's quite painful. All right? Is that OK?

-That's fine.

-OK. I'm sorry I didn't manage to get that in there.

OK?

I couldn't get it in.

I think it was four times, so I'm going to come back later.

Give him a bit of a break because, obviously, is not that nice, erm...

having someone repeatedly stab you with a needle.

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

but sometimes you've got to be determined with them

and, you know, not give up, I guess.

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

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

I'm 22, erm, so I'm probably one of the youngest,

if not the youngest doctor starting at Chelsea and Westminster Hospital.

ALL: Cheers!

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

I just really wanted to get straight into it. Get involved, get working.

-You can't grow a beard?!

-It's true, I...

Mate, how long have you been growing that?

I think my biggest weakness is not being able to grow any facial hair!

I'm a competitive person. If were playing on the Xbox, or something,

I always really get into it and want to win.

Look, the game is not fun if you lose every time!

Andrew James Steval.

I'm so proud of you.

'I know I should be able to do the job'

but I am going to be absolutely terrified. It's going to be scary.

Like everyone starting work for the first time,

Andy had plenty to prove

but first he had to find a vein in Mr Straw.

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

OK, erm, if I don't get it in in the first few goes

then I will get someone else to have a go, if you want?

Just that, erm...

sometimes it just helps with a fresh pair of eyes, you know?

Yeah?

All right, two goes, yeah?

All right.

Yeah, I didn't manage to get it in again,

so that's kind of annoying but, you know, erm...

I'm sort, I guess I'm glad I persisted, you know,

cos you've just got to do it

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

and then, yeah. Er...hey, next time!

Andy wasn't the only one having difficulties.

All the junior doctors were struggling in one way or another

in their early weeks.

-Oh, dear.

-Sorry!

Oh, Ameith.

If you don't put it on properly,

-it just opens up and falls out as it's just has done in my hand.

-Oh!

Which trial evidence do you know of

-for use of atorvastatin in acute coronary syndrome?

-Erm...

There was a time when I knew so many studies.

-I know this doesn't help.

-When was this time?

-About two months ago.

That time has come and gone already!

It's only your first day! That's not good.

Well, no, there's a reason for it.

No, no, don't worry, we don't have to talk about it in that case.

Erm, OK, can I just move on...

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

OK. May I ask why.

OK, I understand.

Now is the time for a quick blood test.

A sharp scratch now.

'I still think I dread practical jobs,

'but I'm going to have to get used to it, so...'

Getting in my practice early is probably a good thing.

If treating adults was tricky,

then treating kids threw up a whole new set of challenges.

Hi there, Alfie. Hiya.

26 year-old Ben was starting in his dream department,

paediatric surgery.

Let's see if we can find veins.

One of his first challenges was to fit a cannula

to five-year-old Alfie.

I'm going to spray this on your arm, OK? Cold spray. Ready?

It should make it all go numb in a minute.

-What is that?

-It's a little needle.

I need to put in your hand to give you medication.

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

I'll tell you what, let's put this down.

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

Look at Mummy, there we go.

-It hurts.

-Lie your head back.

Look round at Mummy.

-Think what nice treats she's going to get you for this.

-Alfie...

-I can't do it.

-HE SOBS

-There we go.

-Look at Mummy.

-I can't...

HE CRIES

Alfie, Alfie, Alfie, Alfie.

-Get off my hand.

-Alfie, Alfie, Alfie, Alfie.

It's going to be very quick, all right?

-MUM:

-Lay down. Lay down.

-Alfie, Alfie.

-Sorry, I'll give him a minute. MUM:

-Alfie.

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

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

Will you be big and brave and strong for us?

-Don't be silly.

-I don't like it here.

-I know you don't. Come on.

-There we go.

'He was very keen at the beginning'

to watch and see what was going on. If I'd been thinking a bit more

I would probably have 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.

It's frustrating at the end of a long day.

Ben had to tell his new boss Simon Clark.

-OK, why was he so difficult?

-We had four people holding him down.

-Thumping you?

-Not me, thumping Mum and Dad.

-We got the cannula in and then...

-Welcome to Paediatrics.

I'll come and see you later.

When we know, we'll let you know.

As well as practical skills,

the doctors also had to learn to build relationships with patients.

-Something Lucy needed to pick up quickly.

-Hello, sir.

I just need to take a blood test today

to make sure that your clotting is OK.

-Is that all right?

-That's fine.

On the general medicine ward she had to learn to cope

with older patients with long-term conditions.

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

Sharp scratch now, sir. There we go.

All good. Right, all done.

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

Even though she had just started,

Lucy was already making a good impression.

'Lucy is doing incredibly well.'

She is one of those doctors I think were born with

a stethoscope around the baby neck.

-Enjoy your dinner.

-Thank you very much.

She is very kind to the patients. She will be fantastic, actually.

But it wasn't all plain-sailing for Lucy.

One patient, Robert, was causing her concern.

How are you feeling at the moment?

Do you?

Let me shut the curtains, we'll have a proper chat.

Still in her early twenties, Lucy was expected

to be able to offer emotional support

to patients three times her age.

What are you nervous about?

What is just around the corner?

I don't think so.

I know it's a little bit miserable being here.

It's just a matter of keeping going.

And you look good.

You do.

The secret is, Robert, I like having you here.

We want to keep you.

But I certainly don't want you to be nervous.

I know. I know it's human nature.

I don't think it's very pleasant for anybody being in hospital.

I'm sorry it's been like that.

I know you do.

You've been in here for about two and a half weeks.

Because you have been in for that long,

I want to carry on and make sure you get home

and stay at home and you're well.

I think we can do that. Honestly, I do.

'Don't you just want to take him home?'

I just want to give him a cuddle.

He's lovely, he's one of my favourites.

You shouldn't really have favourites, should you? But I do.

I'll see you later.

Right, my friends, I'm off.

After a long day on the wards, the juniors could head home.

They were all living together in a house in west London...

-You're crap at table tennis anyway.

-..where they could relax...

Come on.

Come on, Lucy.

-We seriously throw like girls.

-..share their experiences...

-Long time no see, Andy Pandy.

-How's it going?

It's quite hard work at the moment, and relentless.

Loads of people around, loads of people I can call,

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

"How do I do this?

"Can you do this for me?" Do you know what I mean?

..and let their hair down.

CHEERING

Thank you.

CHEERING

MUSIC: "Part Rock Anthem" by LMFAO

Hey, how's it going?

# Happy birthday to you... #

As the weeks progressed,

the juniors began to get to grips with the basics.

Any pain at the moment in your tummy?

But to succeed, they also had to take on more responsibility

and build their confidence.

Something Andy struggled with.

'Sometimes you're, like, "I'm not sure what's going on here"

'and it feels like being a student again.'

I feel like I've learned about that much of what it takes

to be a doctor out of infinity, you know?

He was responsible for overseeing patients going into surgery,

but one had chosen to ignore instructions not to eat or drink.

-Did I not communicate to the nurses clear enough?

-It's not your fault.

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

-I know, yeah.

As long as I made it clear enough.

Sophie, he's been munching away on that as well.

-He's only had a little bit.

-Just say from nine.

And four milligrams of Milky Way.

'Andy's doing very well.'

All his time he's right with what he's done,

but he doubts himself a lot.

My role is supporting him and encouraging him

in his decisions because he's quite hesitant

which is normal, it's a massive responsibility.

Sophie, when I say theatre and operator,

I just go to theatre?

Is it like theatre reception, do you think?

'The nurses are amazing, they're really friendly,'

know their stuff, yeah, I wouldn't say we rely on them, but...

No, of course we rely round them.

But, like, we need their help a lot as junior doctors.

The juniors quickly found out

just how much they had to depend on the nurses.

Can I possibly borrow you? I've never done it before.

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

# Help me, baby... #

-Am I right or not?

-It's twist and pull, isn't it?

The nurses are will always give you sound advice.

All right, shall we stitch first them?

If their diagnosis is completely wrong, we will say,

"Hang on, don't you think about this."

The nurses have seen it all before.

They need to listen to what they're saying.

What enema do you give and we'll prescribe the one that you use,

because we are both new.

-Usually phosphate.

-Just phosphate enema?

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

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

I am referring, not "I would like to refer," I am referring.

A big mistake they can make is to upset the nurses very early on.

That makes their life a lot more difficult.

I don't think it happens that often. Well, not that often.

It wasn't just the nurses they had to win over,

the juniors also needed to prove themselves to their new bosses.

In the Acute Assessment Unit,

Aki needed to impress registrar, Dr Mukherjee

-Chest drains are quite nasty. So really deep anaesthetic.

-OK.

-I haven't done this before.

-I will talk you through it.

-OK.

She asked him to drain fluid from a patient's chest.

-An advanced procedure for a junior.

-Oh, my God.

-What's up?

Chest drain, have you done one?

-Yes, you'll love it.

-I am sure I will(!)

See you tomorrow.

Lucy was one of the first to hear the news.

Hey, guys.

-About to do a chest drain?

-You are?

-Cool.

-Excited. See you later.

Excited(!)

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

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

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

-This is the first time you have done this.

-Yes.

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

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

It was Aki's job to drain it under the watchful eye of Dr Mukherjee.

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

You'll get some Oramorph coming.

Go straight through. Sharp scratch here.

First, Aki had to anaesthetise the whole area.

Stop there, draw back.

Next, he had to pierce the chest from behind

avoiding vital organs and several major blood vessels.

-So...

-With your needle, you're going to go straight in,

perpendicular to the skin.

-Like that?

-Mm-hm.

-We're going to give it a try now.

-Can you feel that?

Hold the needle. Remember not to let go of that guard.

Finally, using a wire, he needed to guide the tube

carefully into the chest.

-Push it through, twiddle, twiddle, twiddle.

-Sorry.

-How are you doing there?

-It's hurting a bit.

-Is that bearable?

-Just. Only just.

If Aki had got it right, fluid could be drained from the patient's chest.

Take a big breath in for me, please. You can see it's swinging.

Good, well done. Congratulations.

-Thank you very much.

-Your first drain.

It was my first drain.

I'm really, really proud of Aki.

He did really well.

There are bits that can go wrong

like losing the wire in the chest. He held on to it.

The patient was comfortable as well

and that's really satisfying.

A job well done.

That was...really cool.

Job done.

MUSIC: "Edge Of Glory" by Lady GaGa

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

and to do it right.

I am so happy.

Oh, my God, it's the best job ever.

It's Lady GaGa and Edge Of Glory

on Radio Chelsea and Westminster.

We are pleased to be joined in the studio

by some of the hospital's newest recruits.

After overcoming their first few challenges as doctors,

Aki and Amieth were asked to share their experiences on hospital radio.

Which of you has the toughest job?

A&E, I imagine would be a pretty tough call.

I mean, A&E's got the tough rota,

but it's also quite difficult for the first year doctors.

I'm in my second year, so I have a little bit of experience.

But for people like Aki,

it can be tough making that leap to working as a doctor.

I think I have been thrown in at the deep end.

Acute Assessment Unit is very busy.

At the moment, I'm holding my ground...ish.

If you were in a desk job,

making a mistake in your first week, it's not the end of the world.

Here you're dealing with people who are sick

and the decisions you're making on a daily basis have a real impact.

Yes, when I started we had to write on one piece of paper

what we wanted to achieve this year.

And on another piece of paper what we were dreading.

I think about 99% of people wrote

they were dreading that they were going to hurt someone.

But people who are senior to you supervise you well.

They're normally very good for answering questions

and they would rather you asked them for advice

than just guess on your own.

What you can do for people like giving them pain relief,

stopping them feeling sick or feeling unwell,

is actually really rewarding.

You see the benefits before you see the problems.

Amieth, you have selected the next record today.

Do you want to introduce it for us?

Yes, I wanted a nice, chilled out song to relax.

So I picked a nice Bob Marley song, Fussin' And Fighting.

MUSIC: "Fussin' And Fighting" by Bob Marley

Just.... Yeah?

As the juniors began to master the technical skills...

Do you like the plaster off fast?

-If you pull it gently it hurts.

-OK, fine.

..they soon found they were in constant demand.

-I have never used one of these.

-Double press the green button.

And it is definitely going to go off, right?

It will definitely go off.

..And at the mercy of their new pagers.

BLEEPING The bleeping system that we have

mean that doctors carry a pager

that can be activated from any of the phones throughout the hospital.

I've just been bleeped, it's Lucy.

-Hi, it's Ben, I was just bleeped.

-This is my new best friend, Mr Bleep,

who is constantly ringing.

He basically doesn't stop bothering me.

Usually when doctors have bleeps for the first time,

they feel they are a proper doctor.

This is too complicated. It is so complicated.

I am just trying to figure out how it works.

58522, that's here, isn't it?

I think I've just bleeped myself.

On the other hand, they are contactable,

and normally when it goes off it means they have got to go

and do something for a patient and that can be quite scary as well.

BLEEPING

-For you.

-Normally, leave you bleeper on the side.

BLEEPING

At the start you're really happy

when you get bleeped the first few times.

It's a new experience, it's really fun.

Now when it goes off, my heart sinks a bit.

Especially when you get a busy day and the bleep keeps going off.

You learn to hate the bleep.

BLEEPING

I was just bleeped.

It is the bane of my life.

I hate the noise it makes, that it interrupts everything that you do.

I hate how demanding it is.

Some people have got jobs to do!

The more patients they saw,

the more efficient and more experienced the juniors became.

But they shad to cope with new and challenging experiences every day.

We have put her on Cetirizine, I think.

Milla moved from nights to days and started on a new department.

Dermatology. Treating skin conditions.

Hi, Catherine.

Did you find the scaly monsters?

My name is Dr Marinova.

I'm one of the dermatology house officers.

Her patient, Catherine, has had a bad attack of psoriasis

made worse by emotional stress.

And they have improved quite a lot, have they, with your therapy?

They were... Soles of my feet, bleeding.

When I'd soak them and take them out,

I could get off nearly a dessert-spoonful of hard skin

-off the soles of my feet.

-Right. Every day?

Every couple of days. That's how bad they were.

Milla tried to find out what may have triggered the attack.

I mean, is the only time this has happened?

Is this really affecting you?

Life has never been as cruel as it is.

My husband, last year, was very sick.

They put him in the stroke ward,

they put a nappy on him and a catheter.

He stayed for the six or eight weeks.

When he came home to me, that's what he was in, a catheter nappy

and a Zimmer frame.

That was a shock. Within six weeks to go from being...

From being out in the pub having a jig around, to that.

If it was really, really hard.

I can actually relate, to be honest with you.

My dad had a really serious stroke a couple of months ago

-so I know exactly what you mean.

-That's not the end of it.

Seven months ago, my lovely young son got hit by a car.

Oh, my God.

-He's dead.

-Oh, God.

So that's...

-Everything at once.

-That has brought it all back.

But I'm there or thereabouts.

Thank you so much for telling me.

Once it's out of your system,

it's the best thing that could happen to me today.

It's not a bad thing, it's a good thing to talk about him

because he was lovely.

Handling an emotional case like this was a revelation for Milla.

'I am shocked as to how open patients are.

'That made me think about my family as well

'and everything we are going through.'

Just because you think there's one thing going on in your life,

you realise that there are worse things that could happen.

There are more serious things that could happen.

It is sad. That has done me good, so there you go.

-I have offloaded my sadness to somebody else.

-Thank you so much.

The doctors were developing the skills

to communicate with their patients.

Some were even starting to form bonds.

You know when you start to know things about somebody,

you just get to know them day to day?

Those are the patients I get a soft spot for.

I don't get that at all because most of my patients are just in and out

so I don't get much time to bond with them.

I get overly close to mine because they're there for months.

You wouldn't realise this, but patients that are really nice,

grateful, I think get a better standard of care in hospital.

I think subconsciously the nurses, the doctors,

everyone around gives them more time.

And is more willing to go that extra mile for them

because they genuinely have affection towards that patient.

I found that it's often when you meet people's families

that you get a feel for them.

You'll see people's families in A&E because they come in with a relative.

I only really see relatives as a useful means

of finding out what has been going on with patient.

-You are ridiculously practical.

-Like a machine.

In A&E you don't have time to be all pally,

"Can now offer you a cup of tea," to the family.

I love that stuff. I would be shit in A&E.

Do you go, "Hello, you are a relative.

"You must be a communication tool,

"to communicate with the patient, good to me you, sir."

Something like that. In my most robotic voice.

While Amieth could stay emotionally detached from his patients in A&E...

Could you come and look at this man's rash?

..some of the other juniors found it harder to keep their distance.

One of Lucy's favourite patients, Robert,

had taken a turn for the worse.

He has got a funny rash and he's been...

He's had funny skin issues since he's come in, but this is different.

Robert, sweetheart. It's Lucy.

We're just going to have a quick look at your rash. OK?

Hello, I'm Kate, I'm another one of the doctors.

We're all looking at your rash. Just on your tummy.

It's here. This has changed, this is new. It wasn't like that.

This is different, this is all new. His arms started like this.

HE GROANS SOFTLY

'He's really poorly, isn't he, today?'

Really poorly.

He has deteriorated over the last 24 hours

and he is so much more drowsy than he normally is.

It's not normal for him to be like that.

Just keeping an eye on him really

and getting the right people looking at him as well.

We'll have to see how he goes.

All the juniors had struggled

through their first few months as doctors,

but now needed to prove they could stand on their own two feet.

It was Andy's turn to take on the notorious night shift.

My SHO was like, "We're going to get a bit of sleep

"and you can run the show."

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

It was going pretty well until now.

Now that has been said.

So, yeah, just hope it will be quiet.

It wasn't long before Andy was called to an urgent case in A&E.

-Tell me what's been going on.

-At 5:00pm cramp started.

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

then it really hurts..

Point to me where it hurts.

The middle, just here. Underneath the belly button.

Let's have a feel of your tummy.

22 year old Christabel had severe abdominal pains.

SHE GROANS

That's painful? 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.

I just want to make sure. Brilliant. See you soon.

-Some X-rays...

-Andy ordered further investigations.

I have a patient in A&E, I've just requested some X-rays for.

Cheers, thank you.

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

It is actually awesome.

It won't be awesome when I start getting more patients I'm sure.

BLEEPING Shit.

The patient I saw earlier has fainted.

Christabel's condition was deteriorating rapidly.

Hi, you had a faint, didn't you?

As the only doctor on the scene, Andy had to take charge.

Can we get some fluids? Get some oxygen as well, please.

All right.

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

That will help you feel a bit better, all right?

No. What has been going on with your chest?

All right. OK.

Can we get an ECG as well? Thanks. All right.

-Have you been vomiting at all?

-No.

After stabilising Christabel with fluids,

Andy called for back-up.

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

because I think she looks quite ill.

I think she might have bled from somewhere, actually.

The heart rate is 45.

BP is lower than before. Think you. See you soon.

Christabel needed life-saving treatment, urgently.

This lady is quite unwell,

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

I think it is more likely to be an ovarian

or gynaecological problem now. Possibly a bleed from a cyst.

Andy's suspicions were proved right

and Christabel was sent for emergency surgery.

Yes, that was pretty scary, actually.

You get a bleed and someone looks like

they're on the verge of dying. It's crazy.

It's pretty good, to be honest.

I would rather do that then do really boring paperwork jobs all day.

This is just awesome.

All right. I'll come down as soon as I can.

Milla was also learning to stand on her own two feet.

There's a lot to be done.

Only a few hours after visiting her father recovering from a stroke

she had to treat patients with similar conditions.

Are you all right? Are you OK?

PATIENT WAILS

Do you have any pain anywhere? Nothing?

She's deteriorating. She's in peri-arrest.

The patient was in peri-arrest. Their vital signs were unstable...

-She was at 156.

-..and could go into full cardiac arrest.

We can't understand why she's so agitated. Hello.

Hi, is that Ty?

Milla called in a senior doctor for back-up.

I was just doing something else

and one of the ladies became very distressed.

Her heart rate has gone up to 156.

It's all right. Relax. Relax. It's OK. Just relax.

With no clues to the cause,

Milla needed to get some tests done as fast as possible.

These bloods have to be done right now, because they're really urgent.

So that's why I had to physically bring them down to the lab,

rather than waiting for somebody to pick them up.

We need to keep this oxygen on your face.

It's helping with the breathing, you need to keep it on, OK?

Milla's quick word had helped stabilise the patient,

who could now be sent to the intensive care unit

for further treatment.

Quite scary to see how quickly patients can deteriorate.

You just saw the heart rate going up and up.

It just was happening within a matter of minutes,

suddenly she was really quite unwell.

Milla had proved she could now deal with very sick patients.

But it was also an uncomfortable reminder

of her own father's condition.

You can't help but just sort of wonder, you know, that somebody else

has seen my dad in the hospital in the middle of the night like that.

It does sort of put things a lot more in perspective,

especially when you see patients with similar conditions.

Again.

All the juniors were starting to take on more responsibility...

-Bye.

-He doesn't want you to go.

-No.

..even when confronted with the unexpected.

In A&E, a 17-year-old barmaid had arrived

with her hand impaled on a spike for receipts.

It's gone almost all the way through to the other side, actually.

It's gone in very deep.

A chance for Amit to prove to his colleagues

that he was ready to take charge in emergency cases.

Sharp scratch. SHE MOANS

That the worst of it over.

As the anaesthetic kicked in, the team got to work.

Make sure you keep all the receipts.

Amit and his registrar discussed the plan of action.

You could just take it out.

What we'll do is we'll get a decent pair of pliers.

It's very deep, though.

Once we get her sedated and get the bandage off,

we'll have a good look at it.

To be perfectly honest, a decent pair of B&Q pliers

-will be the most effective thing in yanking it out.

-All right.

I'll give them a toolbox, then.

Pliers? You're just going to scare the patient.

Luckily for Amit, the A&E department had a box of emergency tools.

Saw.

A saw?

-This one? You just put it onto there.

-They're quite large.

-Wire cutters.

-That's what you would use to cut, like, bike chains.

That looks pretty good.

The patient was sedated, but still conscious.

Armed with his pliers, Amit had to be fast and accurate.

-Get a good grip, I'll hold the hand, and...it's out.

-Yeah, OK.

A bit further down and a bit more in the middle.

That's it. Right, now...

OK. Ready? Go.

SHE GROANS

Big breaths, honey, big breaths. All done. It's all done.

Big breaths. Just relax. Big breaths.

Just try and relax a little bit.

-You've taken it out?

-Managed to get it out, yes.

-Well done, you.

And sedation worked pretty well.

She was sedated enough to pull it out

but then woke up as soon as we did it, so that was perfect.

Very impressive. Thank you, that's very good.

As well as gaining the respect of their colleagues,

the juniors were experiencing other rewards of the job.

Seeing their patients get better.

Hello.

Lucy's long-term patient Robert had made a full recovery.

I like your pyjamas, they're snazzy. They're blue.

-They show every stain.

-Oh, yeah, they do, don't they?

-Yeah.

-You'll have to do iron them out later.

-Will I?

-Are you feeling all right?

-Not too bad.

-Not so bad?

Are you not so sure? Because you look nice, you got nice rosy cheeks.

Oh, well, it's thinking about you.

'I will miss him, because he's lovely.'

He's always a friendly face on the ward round

and so grateful for any input.

-Oh, you're all ready to go.

-Yes.

I will hopefully, in the nicest possible way, not see you again,

because you'll stay fine.

You do get fond of patients that have been here so long,

but he's an old man, he should be enjoying his life,

so it was actually really nice and satisfying to see him leave.

After four months in their new jobs,

the juniors were finally feeling like fully-fledged doctors.

What's up, Dr Fukutomi?

Mastering the technical skills...

Sharp scratch.

Fantastic. You all right there?

..developing their bedside manner...

-It's getting better.

-Looks like it.

We will keep taking your bloods to make sure it is getting better.

Say no more.

-I'm sorry about this.

-Don't worry about it, old boy.

This might be a bit uncomfortable.

-That it?

-Thank you, sir, that's fine.

-Thank God for that.

Your final blood test, we are happy with the result, so therefore,

we're happy that you can go home.

..and impressing their colleagues.

-Well done.

-I'll try to get everything done before I go.

We appreciate it.

Ben is a logical thinker, he's efficient, and 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 over the last few months.

Have you got it?

Priya is still learning

and going through the steps that anyone would do as a junior doctor,

but day by day, I can see there is improvement, and she will go far.

Oh, well done. Yes.

Isn't she wonderful?

OK, see you later, bye-bye.

I just did what is the impossible.

I managed to take blood from Mrs Tristholt. This is like gold dust.

All too soon, their placements were at an end.

They don't look like they have reacted.

And it was time for the juniors to move on.

It's Lucy's last day today. She's been absolutely amazing.

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

She's just been an amazing member of the team. I'm going to miss her.

-Are you going? See you!

-You've been fantastic.

I think when I started, I really did doubt my ability to be a good doctor.

It's just complete shit, basically.

Four months on, I just feel really privileged, actually.

And although it's hard work to get here,

I can't imagine doing anything else.

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

It is my favourite job in the world.

Starting was terrifying, because I didn't know what I was doing.

BOY WAILS

-Alfie, it will be very quick.

-I'm not listening.

It is so lively the whole time, so unpredictable, so varied.

And the last few months has made me realise

it's definitely what I want to do.

-It's been nice working with you.

-OK, yeah. Cheers, mate.

I think I've grown and developed as a doctor, certainly.

Have you noticed any discharge coming out of the ears?

'I feel more able to deal with a lot of different problems.'

I don't really know because I had vodka with cotton.

I've enjoyed all the hands-on stuff that you get to do.

It is a very tiring rota, so I am quite glad to get to the end of it.

-Alison, bye.

-Oh, this is sad.

We're going to miss you, young man.

Day one, I thought I was a fraud doctor...

-Clear.

-Hang on, oxygen away.

..and I just thought I was an extension

of some kind of odd medical student.

I think my last day there, I do feel like I'm a doctor

and my next day off, I'm going to go and change my credit card to "Dr".

As they finished their placements, there was no let-up for the juniors.

They all started new jobs in new departments.

Hello.

I don't know what cardiology will be like.

I think it'll be interesting.

BLEEPING First bleep of the day.

I guess you worry when you are starting work in a job like this.

Mr McGhee, just be really careful with that...

'And it's been all right, you know?'

I can go into work thinking I know what I'm doing.

If someone gets ill, I can deal with it.

So I am a lot more confident than I was before.

-You've got your mask on back to front.

-Seriously?

-Yeah, serious.

I've made a lot of progress and I'm more used to the role now.

Can you say "red lorry, yellow lorry"?

'And what I've learned most of all is not to take things personally.'

-I find that offensive.

-Well, no, there's a reason for it.

I know - the reason's offensive.

When you going to a job that is quite difficult and requires long hours...

-I'll do my best.

-See you later, sir.

-Thank you very much.

..it makes you realise what you're actually capable of

and makes you feel good inside.

You've got warm hands.

There we go.

'Initially, I felt that maybe medicine isn't for me.'

-Ouch.

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

'I thought I was a bit bumbling.' Shit, where's my phone?

'Didn't know how to get things done.'

And now I've grown to love it - and I do - and I, without a doubt,

can say that medicine is the right vocation for me.

Great, well, you're my first surgical patient.

It's been an incredibly steep learning curve

over the last few months.

The steepest part has certainly been the on-calls in the night.

'Cardiac arrest.'

But I think there's absolutely no comparison

to where I was on day one.

There just isn't.

The last few months have been some of the toughest of their lives.

-But a major achievement for the juniors.

-Job done.

And after a successful start to their careers,

there's much to celebrate.

To the future. To our incredible future in medicine. Cheers.

Cheers, everybody.

# Oh

# Gold

# Always believe in your soul

# You've got the power to know

# You're indestructible

# Always believe in

# Cos you are gold Gold

# Glad that you're bound to return

# Something I could have learned

# You're indestructible

# Always believe in

# Gold. #

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