0:00:02 > 0:00:04- Trauma...- Give me another milligram.
0:00:04 > 0:00:07- He's got a pulse. A strong pulse.- Any pain up here?
0:00:07 > 0:00:10- Tears...- That's all right.
0:00:10 > 0:00:13And intense pressure.
0:00:13 > 0:00:15Changing the oxygen over.
0:00:16 > 0:00:19Just another day on medicine's front line.
0:00:23 > 0:00:25They're young.
0:00:25 > 0:00:26They're untested.
0:00:26 > 0:00:29This is my first patient ever.
0:00:29 > 0:00:33And from their very first day, work is a matter of life and death.
0:00:33 > 0:00:36- Don't let me die.- We're not going to let you go anywhere.
0:00:36 > 0:00:39For a junior doctor, fresh out of medical school,
0:00:39 > 0:00:42it's time to put theory into practice.
0:00:43 > 0:00:46No, I haven't.
0:00:46 > 0:00:48We're following seven junior doctors
0:00:48 > 0:00:51over their first three months on the job.
0:00:51 > 0:00:53- Sharp scratch.- Oooh!
0:00:53 > 0:00:56It's all about the glamour. It's all about the bums.
0:00:56 > 0:00:58Where there's a first time for everything.
0:01:01 > 0:01:05I didn't really know what to do. It's having the confidence, isn't it?
0:01:05 > 0:01:07And first impressions count.
0:01:07 > 0:01:10I'm afraid I didn't get it first time either.
0:01:12 > 0:01:15They will share their personal highs...
0:01:15 > 0:01:18Every day you do make a little difference to someone and you get a kick out of that.
0:01:18 > 0:01:20..and professional lows.
0:01:20 > 0:01:24It's the first patient that I've had that's died.
0:01:24 > 0:01:26They are - party animal Tom...
0:01:26 > 0:01:31- We can pretend to be doctors. - I think I've been doing that for the last week.
0:01:31 > 0:01:32Arty Emily.
0:01:32 > 0:01:36I want to have a pizza and I want to cry and I want to go to bed.
0:01:36 > 0:01:42- Competitive Jen.- I've worked for a long time for this. It needs to just happen now.
0:01:42 > 0:01:43Young dad Tristan.
0:01:43 > 0:01:48The balancing act between father and doctor will be a lot more difficult.
0:01:48 > 0:01:50And second years...
0:01:50 > 0:01:52Italian mountain medic Ed.
0:01:52 > 0:01:55The first time I came to Liverpool and people started talking
0:01:55 > 0:01:59to me on the bus, I thought they were foreign. I was pretty sure they weren't English.
0:01:59 > 0:02:01Straight-talking Keira.
0:02:01 > 0:02:04Sorry about that. I don't usually struggle with this.
0:02:04 > 0:02:06And confident charmer Oli.
0:02:06 > 0:02:09Keep looking straight up my nose. I saw you sneak a peek there.
0:02:11 > 0:02:15They're working here, at the Royal Liverpool University Hospital,
0:02:15 > 0:02:19in a city where men have the lowest life expectancy in England.
0:02:19 > 0:02:21I get this wrong and I kill the patient.
0:02:21 > 0:02:24And the highest number of alcohol-related illnesses.
0:02:26 > 0:02:28Oh, dear. Feeling a bit sicky?
0:02:28 > 0:02:30They've had five years of training.
0:02:30 > 0:02:33But are the junior doctors really ready?
0:02:33 > 0:02:35For this hospital, in this city.
0:02:36 > 0:02:39It doesn't get any tougher.
0:02:39 > 0:02:42Hey, they're here to look after you, lad. Give it a rest.
0:03:05 > 0:03:07It's so exciting. Shall we go in?
0:03:07 > 0:03:09Tom and Jen, friends from medical school,
0:03:09 > 0:03:12are sharing this house with some of the other junior doctors.
0:03:12 > 0:03:16This room will feel like home when I can no longer see the floor.
0:03:16 > 0:03:20And thoughts of what lie ahead are never far away.
0:03:20 > 0:03:23- Scared?- Yeah, I'm terrified, actually.
0:03:24 > 0:03:28- I keep getting butterflies in my tummy.- Do you?- Yes, when I think about it I do.
0:03:28 > 0:03:32The others have arrived for dinner and in less than 24 hours,
0:03:32 > 0:03:37they're all starting new jobs at one of the most demanding hospitals in the country.
0:03:37 > 0:03:40- This is it, guys. Good luck.- Cheers!
0:03:45 > 0:03:46For Jen, Tom,
0:03:46 > 0:03:49Tristan and Emily,
0:03:49 > 0:03:51tomorrow will be their first day as qualified doctors.
0:03:51 > 0:03:54I hope I don't just freeze in the middle of something where
0:03:54 > 0:03:56everyone's looking at me and be like,
0:03:56 > 0:04:03"what does this mean, Tom?" and all I can hear is, you don't know, you don't know. And I'll just be like...
0:04:05 > 0:04:07Oli has spent a year on the wards already
0:04:07 > 0:04:09and knows how they're feeling.
0:04:09 > 0:04:13I think I was beeping the medical registrar. "I've got this patient with this,"
0:04:13 > 0:04:17and they're like, "Have you done this?" No. "Have you done this?" No.
0:04:17 > 0:04:24Have you even done this? No. "Do that and come back." But then it becomes routine and it's fine.
0:04:24 > 0:04:28Italian Ed has never worked in a UK hospital before
0:04:28 > 0:04:30and he'll be straight in as a second year.
0:04:30 > 0:04:31I am feeling a bit nervous.
0:04:31 > 0:04:35Just being left alone with violent patients. That has never happened to me.
0:04:35 > 0:04:37That's something that scares me a lot.
0:04:42 > 0:04:46Everything that I've done before as a student has just become real,
0:04:46 > 0:04:48because now is the time when I'm going to the doctor.
0:04:48 > 0:04:51I'm going to be the person who is making the decisions
0:04:51 > 0:04:55of the first-year junior doctor on the ward, which is massive.
0:04:55 > 0:04:58It's much bigger than anything I've encountered before.
0:04:58 > 0:05:01- I'm actually going to bed now. I'm shattered.- OK. Night night.
0:05:01 > 0:05:05- See you in the morning.- See you in the morning.- Make me a cup of tea?
0:05:05 > 0:05:06I will.
0:05:06 > 0:05:09I think there's a million and one things to make sure that you get
0:05:09 > 0:05:10right on your first day.
0:05:10 > 0:05:14It has everything from making sure that you look good with your seniors
0:05:14 > 0:05:19and establishing the right attitude with the patients
0:05:19 > 0:05:22and to make sure everybody's happy that you're there rather
0:05:22 > 0:05:24than thinking that you're a massive pain,
0:05:24 > 0:05:26just cos you don't know what you're doing.
0:05:34 > 0:05:36ALARM BEEPS
0:05:37 > 0:05:40Today is the day that thousands of junior doctors
0:05:40 > 0:05:42across the country have been preparing for.
0:05:42 > 0:05:46In Liverpool, first-day nerves are hitting home.
0:05:46 > 0:05:50I feel like I'm living in a little bit of a dream, to be honest with you.
0:05:50 > 0:05:52Nobody expects us to be, you know,
0:05:52 > 0:05:55child prodigies the day we book on to the award.
0:05:55 > 0:05:58- Bye-bye.- Take care.
0:05:58 > 0:06:00These are my first-year clothes.
0:06:00 > 0:06:02I've been wearing them for the last year
0:06:02 > 0:06:04and they can now go right in the bin.
0:06:11 > 0:06:13Everything they've trained for begins here.
0:06:15 > 0:06:16It's crunch time.
0:06:18 > 0:06:22The enormity of what's about to happen has just suddenly
0:06:22 > 0:06:23dawned on me.
0:06:23 > 0:06:24Emily.
0:06:24 > 0:06:27You bloody fool. You'll get us killed.
0:06:32 > 0:06:36- I'm going to be the F2 on AMU for the next four months. - Oh, right?- Oliver.
0:06:36 > 0:06:39I'm Emily, one of the F1s. I've just started today.
0:06:41 > 0:06:43Welcome, everybody.
0:06:43 > 0:06:46This will be an exciting four months for you.
0:06:46 > 0:06:50A steep learning curve but you will learn a phenomenal amount when you're here.
0:06:50 > 0:06:54Second-year Ed is starting in the Emergency Department
0:06:54 > 0:06:58but the Italian junior doctor has never worked for the NHS and is
0:06:58 > 0:07:01under extra pressure to figure out the British way of doing things.
0:07:01 > 0:07:03What scares me at the moment is being able to actually
0:07:03 > 0:07:08work in the system. Managing to fit in and implement the policies the hospital has.
0:07:08 > 0:07:12It's not the only thing about his new job that's worrying him.
0:07:12 > 0:07:17The main fear about today is that I haven't seen an X-ray in six months
0:07:17 > 0:07:20so I really need to get up to reading these things again.
0:07:20 > 0:07:24It's so easy to miss out obvious things when you don't practise them.
0:07:24 > 0:07:27Ed will be starting off with a 10-hour shift
0:07:27 > 0:07:31in one of the country's busiest emergency departments.
0:07:31 > 0:07:35For a junior doctor with no experience of working in a British hospital,
0:07:35 > 0:07:36there'll be nowhere to hide.
0:07:43 > 0:07:47People see me as the guy who is always either studying or climbing.
0:07:49 > 0:07:52Knowing the risks involved does not stop me
0:07:52 > 0:07:54very much from taking the risks.
0:07:57 > 0:08:02Being calm is something that I try to do in any situation.
0:08:02 > 0:08:06- My friends say that I am a bit of a perfectionist.- Perfect.
0:08:06 > 0:08:10The job I'm doing at the moment is doctor in a little town
0:08:10 > 0:08:12up the top of a mountain.
0:08:12 > 0:08:14Around 2,000 people live in the area.
0:08:14 > 0:08:17I'm the only doctor around there so I deal with everything.
0:08:17 > 0:08:20That can be from first aid to just a simple prescription.
0:08:20 > 0:08:22Martine and I have been together for four years.
0:08:22 > 0:08:25She's ready to take the chance and move over to the UK.
0:08:25 > 0:08:29- To fast understanding of Liverpudlians.- To Liverpudlians.
0:08:32 > 0:08:35I don't know so much about the NHS, that's for sure.
0:08:35 > 0:08:39I haven't been working in the UK and I'm looking forward to seeing
0:08:39 > 0:08:43how well I adapt to the situation because at the moment, I'm an outsider.
0:08:53 > 0:08:55With Ed, he's going to find this quite an eye-opener.
0:08:55 > 0:08:58It's very different to what he experienced working in the mountains
0:08:58 > 0:09:01in a small village with very little support.
0:09:01 > 0:09:04Left wrist has gone, fracture broken.
0:09:04 > 0:09:07Possible dislocation of the right shoulder.
0:09:07 > 0:09:10Whereas here he will see inner-city medicine
0:09:10 > 0:09:12with lots of problems
0:09:12 > 0:09:15with smoking and drinking and drug taking.
0:09:15 > 0:09:17I'm sure he'll learn very quickly.
0:09:17 > 0:09:21Give him a loud call and when he responds, just bring him through to here.
0:09:21 > 0:09:23It's crunch time for Ed.
0:09:23 > 0:09:27He's got his first patient, a man who's come in with a knee injury.
0:09:27 > 0:09:30- So do you want to tell me what happened?- I stepped off the van.
0:09:30 > 0:09:37- My knee twisted.- Yeah. OK. No problems before that? - No.- No problems in the knee?- OK.
0:09:37 > 0:09:41Ed must perform an immediate examination.
0:09:41 > 0:09:45The ligament here is very tough and very thick. Does that hurt if I let press there?
0:09:45 > 0:09:49- That's sore there.- OK?
0:09:49 > 0:09:51But he's not sure what to do next.
0:09:59 > 0:10:04This is my first patient ever here, so I don't know exactly what to do.
0:10:06 > 0:10:09I don't know anything about this, this is my first day here.
0:10:09 > 0:10:13So you'd probably be better speaking to one of these wonderful senior doctors.
0:10:13 > 0:10:17With his patient waiting, Ed finally goes to find senior consultant
0:10:17 > 0:10:20Doctor Demnitz, who confirms an x-ray is needed.
0:10:20 > 0:10:23But Ed's got a confession to make.
0:10:23 > 0:10:26I'm not very good at examination of the knee.
0:10:26 > 0:10:29Orthopaedics in general is something I need to work up on a bit.
0:10:29 > 0:10:32- But I did...- We can work on that.
0:10:32 > 0:10:36The x-ray is booked in, but will Ed be able to understand the results?
0:10:36 > 0:10:39- The request is there, they'll call you.- All right.- OK.
0:10:43 > 0:10:47Like Ed, also starting her second year in the emergency department
0:10:47 > 0:10:51is Keira, and her patient has undergone a terrifying ordeal.
0:10:51 > 0:10:55- What's been going on? - Basically, I was assaulted.
0:10:55 > 0:10:58A young man has come into hospital after being beaten up.
0:10:59 > 0:11:03Still fearing for his safety, he has asked not to be identified.
0:11:03 > 0:11:07Well, cos they couldn't actually do more damage to my face,
0:11:07 > 0:11:12- they were kicking me everywhere.- So, where were you hit and/or punched?
0:11:12 > 0:11:16On my left side and my right side and my arm.
0:11:16 > 0:11:18And your arm? OK.
0:11:22 > 0:11:24- Any blurring or double vision?- No.
0:11:26 > 0:11:29As the man has suffered serious head injuries,
0:11:29 > 0:11:31Keira must perform a thorough examination.
0:11:31 > 0:11:35How many fingers am I holding up?
0:11:35 > 0:11:36Two.
0:11:36 > 0:11:38And examine some of his other injuries.
0:11:40 > 0:11:43- Any pain there?- No.- You've probably bruised some ribs
0:11:43 > 0:11:46but they don't feel like they're broken, you've obviously had
0:11:46 > 0:11:48a bit of a smack.
0:11:48 > 0:11:50Is your nose all right as well?
0:11:50 > 0:11:52Is it a bit swollen?
0:11:52 > 0:11:53- No. Oh... - HE WINCES
0:11:53 > 0:11:55- Yeah?- Yeah.
0:11:55 > 0:11:57So the most important thing now is to get you
0:11:57 > 0:12:00in for your scan of your head, OK?
0:12:03 > 0:12:07His scan is clear, but the patient must be stitched up.
0:12:07 > 0:12:10I'm going to have to pop a bit of numbing stuff in now.
0:12:10 > 0:12:13It won't be the most comfortable thing when I'm injecting it,
0:12:13 > 0:12:15but the pain will soon go away. OK?
0:12:17 > 0:12:18- How's that?- OK.
0:12:20 > 0:12:22As bad as you thought it was going to be?
0:12:22 > 0:12:25To be honest, I'm kind of used to pain anyway.
0:12:25 > 0:12:28PAINED MOANING FROM NEARBY BED
0:12:28 > 0:12:32Maybe you could have a word with this gentleman across the road, eh?
0:12:32 > 0:12:34People are often very reticent about what details
0:12:34 > 0:12:38they give about alleged assaults and I tend not to really ask.
0:12:38 > 0:12:42If people aren't going to tell me, then I tend not to ask.
0:12:42 > 0:12:45- Sorry. That a bit sore?- Yeah. - HE WINCES
0:12:45 > 0:12:47Sorry, love.
0:12:47 > 0:12:49I'll do some plastic surgery on you, eh?
0:12:52 > 0:12:54Sorted.
0:12:54 > 0:12:57After three stitches, she's all done.
0:12:57 > 0:12:58Thank you.
0:12:58 > 0:13:00All right, love.
0:13:00 > 0:13:03Oh, God, did you just smack your head on that? Are you OK?
0:13:03 > 0:13:07- You didn't smack where you...? - No. It got me there.
0:13:09 > 0:13:12It's the kind of case that Keira is expecting more of
0:13:12 > 0:13:14while in the emergency department.
0:13:14 > 0:13:17Certainly we are getting a fair number of shootings
0:13:17 > 0:13:19and stabbings and stuff that come in.
0:13:19 > 0:13:21Problems with living in a big, inner-city area.
0:13:24 > 0:13:27Tristan is starting work on Gerontology,
0:13:27 > 0:13:30which specialises in dealing with elderly patients.
0:13:30 > 0:13:33Just squeeze my fingers as tight as you can.
0:13:33 > 0:13:36But he's the first of the junior doctors to go on call,
0:13:36 > 0:13:39so he could end up having to assist in any urgent cases
0:13:39 > 0:13:41on any ward, at any time.
0:13:41 > 0:13:45One of his next patients is a man who needs a rectal examination.
0:13:45 > 0:13:47It'll be the first one Tristan has done
0:13:47 > 0:13:49since qualifying as a doctor.
0:13:49 > 0:13:53Starting off as a medical student, yeah, it's something
0:13:53 > 0:13:54that you don't want to do.
0:13:54 > 0:13:57I don't think anyone particularly likes doing them,
0:13:57 > 0:14:02but, to me, it's just another part and parcel, comes with the job.
0:14:02 > 0:14:04Hey. Back again.
0:14:04 > 0:14:06I'll just pull the curtains round.
0:14:07 > 0:14:09So, just for the time being,
0:14:09 > 0:14:13if you could just roll over to your left-hand side and lie on your left.
0:14:13 > 0:14:14OK.
0:14:15 > 0:14:17I'll just explain what's going to happen.
0:14:17 > 0:14:20So, if you lie on your left-hand side like you're doing.
0:14:20 > 0:14:23And we'll just pull your trousers down slightly.
0:14:23 > 0:14:25And I'll just inspect and area
0:14:25 > 0:14:30and I'll need to insert a gloved finger to just check the area.
0:14:30 > 0:14:34- And then it'll be over very quickly. Is that all right?- Yeah, go on.
0:14:34 > 0:14:35You tell me if it's painful.
0:14:35 > 0:14:37We'll just pull your things down now, is that OK?
0:14:37 > 0:14:39Yeah, go on.
0:14:39 > 0:14:43'We're worried that he's a had a bleed from his intestines.'
0:14:43 > 0:14:47It's not very pleasant for the patient, but it's obviously important.
0:14:47 > 0:14:49Right.
0:14:49 > 0:14:50Finger going in now.
0:14:56 > 0:14:58OK, that's all over.
0:15:03 > 0:15:05Right, you can pull your things up.
0:15:06 > 0:15:08'It really depends on the patient,'
0:15:08 > 0:15:12how much they're really freaked out by having a rectal exam.
0:15:12 > 0:15:14Some people, it's the worst thing in the world.
0:15:14 > 0:15:17Some people, they know it's just medical and they get on with it.
0:15:17 > 0:15:19Some people have had so many
0:15:19 > 0:15:22because they come in with the sort of thing that they know
0:15:22 > 0:15:26it's going to happen already before you've even broached the topic.
0:15:26 > 0:15:29- Everything was fine on that. There was nothing abnormal.- OK-doke.
0:15:29 > 0:15:30OK.
0:15:31 > 0:15:34While Tristan gets to grips with his first patient,
0:15:34 > 0:15:38Jen, Tom and Emily are settling into their new jobs.
0:15:38 > 0:15:40Hello. My name is Emily.
0:15:40 > 0:15:44- What's your name?- Anna.- Anna. Hiya. I'm one of the new F1s.
0:15:44 > 0:15:45I don't know where anything is,
0:15:45 > 0:15:48do you know where the forms are for biochemistry?
0:15:48 > 0:15:52I have a lot to do on my first day.
0:15:52 > 0:15:56I have a list as long as my arm. Probably longer, actually.
0:15:56 > 0:15:58Technically supposed to leave at four o'clock
0:15:58 > 0:16:01but I don't think I'll get out of here probably before about eight.
0:16:01 > 0:16:05After an hour, Ed is still dealing with his first case.
0:16:05 > 0:16:07Just being shockingly slow with this patient,
0:16:07 > 0:16:10it was a stupid thing, he's been here an hour.
0:16:10 > 0:16:15Could have been done in half an hour, but anyway. First patient, so.
0:16:15 > 0:16:19The x-ray results are back in, but he isn't sure how to interpret them.
0:16:19 > 0:16:23He has to look for senior consultant Doctor Demnitz to help him out.
0:16:25 > 0:16:28I'm sorry to pester you, I just want to send this poor guy home.
0:16:28 > 0:16:31But Doctor Demnitz wants to know what Ed learnt in Italy
0:16:31 > 0:16:32and puts him to the test.
0:16:32 > 0:16:35Can you remember what sits inside the knee joint,
0:16:35 > 0:16:36just to the side here?
0:16:36 > 0:16:39There are a couple of spongy pads that sit there.
0:16:39 > 0:16:42That would be cartilage.
0:16:42 > 0:16:44OK, what particular cartilage?
0:16:44 > 0:16:48- Articular cartilage?- No, what particular? What do we call that?
0:16:48 > 0:16:51It's a semi-lunar shape.
0:16:52 > 0:16:55- Half-moon shape.- Ah, the...
0:16:55 > 0:16:58What do you call them now in English?
0:16:58 > 0:17:00- Begins with an M.- Yeah. Erm...
0:17:02 > 0:17:04God, oh...
0:17:04 > 0:17:08- Nah, no.- OK. The menisci. - Menisci, yeah. Thank you.
0:17:10 > 0:17:13There's no sign of a fracture, which is good news for the patient
0:17:13 > 0:17:17who is finally discharged with just a twisted knee.
0:17:17 > 0:17:20But has the morning so far been good news for Ed?
0:17:20 > 0:17:23Junior doctors at this level have got a lot to learn.
0:17:23 > 0:17:26And the only way we can help them
0:17:26 > 0:17:30along with that is to supervise them because everything they see,
0:17:30 > 0:17:33they're not the kind of things they've come across before.
0:17:33 > 0:17:35- All right.- Cheers.- Take care. Goodbye.
0:17:35 > 0:17:39But Ed's not happy with how things have gone with his very first patient.
0:17:39 > 0:17:41This is all new.
0:17:41 > 0:17:45I just need to settle down and understand how things work here.
0:17:45 > 0:17:48'There are definitely loads of things I've got to get better at
0:17:48 > 0:17:49'in this environment.'
0:17:51 > 0:17:54The first day on the wards is over
0:17:54 > 0:17:56and the junior doctors head for home.
0:17:56 > 0:17:59We'll have a nice relaxing evening and probably have a glass of wine
0:17:59 > 0:18:01and a bit of a chill between us.
0:18:01 > 0:18:04Then on with it tomorrow with a little more confidence, hopefully.
0:18:04 > 0:18:06'It was daunting to be a doctor on the ward,
0:18:06 > 0:18:08'for people to come up to me and say,'
0:18:08 > 0:18:11"Doctor, can you do this?" And I was there thinking, "Wow. Um...
0:18:11 > 0:18:13"You want my opinion? I mean, I could give it to you.
0:18:13 > 0:18:17"I certainly have an opinion because I've had the training, but you want it?"
0:18:20 > 0:18:23People definitely gave me some compliments on my shoes,
0:18:23 > 0:18:27which is nice, rather than my medical prowess, which was fine.
0:18:28 > 0:18:32I am so glad to be home. It's been a long day. How was your day?
0:18:32 > 0:18:35Fairly uneventful but that's probably a good thing, like,
0:18:35 > 0:18:37I literally just did... Hello.
0:18:37 > 0:18:40- Hello. How was your day? - I'm very tired.
0:18:40 > 0:18:42Are you? Em's just telling us about hers. Go on, Em.
0:18:42 > 0:18:45I did stuff today, but nothing exciting.
0:18:45 > 0:18:47Like, literally just loads of paperwork.
0:18:47 > 0:18:50Have you had loads of paperwork to do as well?
0:18:50 > 0:18:53- No, I just got all the first years to do it instead.- Oh, nice.- Yeah.
0:18:53 > 0:18:57- I spent half my day on your ward today.- I know.
0:18:57 > 0:19:01- It was nice seeing you. - The feeling was not mutual!
0:19:05 > 0:19:07After a difficult first day,
0:19:07 > 0:19:10Ed is back home with his girlfriend, Martina.
0:19:10 > 0:19:13He's very scared to make mistakes.
0:19:13 > 0:19:16That's the first thing. The second thing is that he really needs
0:19:16 > 0:19:18to get used to the system.
0:19:18 > 0:19:20The fact that there are a huge amount of things
0:19:20 > 0:19:24I don't know about means that there are many things I've got to learn
0:19:24 > 0:19:28and work on, and I'm going to have to fix that as soon as possible.
0:19:38 > 0:19:42It's a new day and on Upper Gastro Intestinal, the stomach ward,
0:19:42 > 0:19:46first year Jen is looking after a 72-year-old patient.
0:19:47 > 0:19:49He's concerned that the medicine he's been taking
0:19:49 > 0:19:51is upsetting his stomach.
0:19:51 > 0:19:54- When did you start that? - Beginning of last week.
0:19:54 > 0:19:56- And why was that? - They gave me the runs.
0:19:56 > 0:20:01She changed them over to them and they done the opposite.
0:20:01 > 0:20:02You stopped taking these tablets
0:20:02 > 0:20:05- because they were causing you to get a bit blocked?- Yes.
0:20:05 > 0:20:07But Jen's not so sure it's the tablets.
0:20:07 > 0:20:10She goes to ask for advice from a senior and discovers that
0:20:10 > 0:20:13the patient's recently been diagnosed with bowel cancer.
0:20:13 > 0:20:18He put the symptoms that he was having down to the medication.
0:20:20 > 0:20:22But we know that that's not the case.
0:20:24 > 0:20:29And it's down to the fact that he's most likely got bowel cancer.
0:20:31 > 0:20:35While the patient knows of his condition, he hasn't told his family
0:20:35 > 0:20:38and is reluctant to accept the full extent of his illness.
0:20:40 > 0:20:43More than likely that his family aren't completely aware.
0:20:43 > 0:20:47They might have an idea but they need to be told properly
0:20:47 > 0:20:48what's going to happen.
0:20:48 > 0:20:52With the patient unwilling to tell them himself,
0:20:52 > 0:20:55Jen is faced with doing what every junior doctor dreads -
0:20:55 > 0:20:58breaking bad news to a patient's family.
0:20:58 > 0:21:02So she's called her senior house officer, Andrea Sheel, for support.
0:21:02 > 0:21:04She's on her way up, be about ten minutes.
0:21:04 > 0:21:07So she's asked if you guys don't mind hanging on. Is that OK?
0:21:07 > 0:21:10- Just so you know what's going on and you get an update.- OK.
0:21:10 > 0:21:14I do feel quite bad sitting in, like, metres away from them,
0:21:14 > 0:21:20knowing the diagnosis and prognosis and not giving them any information,
0:21:20 > 0:21:22so it's quite difficult.
0:21:22 > 0:21:26But they're aware that my senior's coming and that she'll explain it
0:21:26 > 0:21:28to them, so I think they're quite happy with that.
0:21:28 > 0:21:33PHONE RINGS
0:21:33 > 0:21:37Luckily for Jen, it's not a situation she needs to face alone.
0:22:10 > 0:22:13It is a hard first experience for any junior doctor.
0:22:13 > 0:22:15That was quite a tough conversation.
0:22:15 > 0:22:17It's the worst part of the job, isn't it?
0:22:17 > 0:22:20- Maybe, sometimes I think I'm a bit too blunt.- No, I thought you were...
0:22:20 > 0:22:24- Otherwise you can end up beating around the bush... - I thought you were so nice to them,
0:22:24 > 0:22:26I honestly do, it's heartbreaking.
0:22:30 > 0:22:34The worst sort of thing about it is the relatives.
0:22:34 > 0:22:37I think that this is when everybody's stood around the bed
0:22:37 > 0:22:39and all they want is good news
0:22:39 > 0:22:42and you've not got any to give them, that's when it's quite hard.
0:22:45 > 0:22:49You can't brush it under the carpet, can you?
0:22:49 > 0:22:53You've just got to focus and carry on. That's all you can do.
0:22:57 > 0:23:00It's going to be a lot for Jen to take in.
0:23:00 > 0:23:03But I specifically wanted her to be involved in that situation,
0:23:03 > 0:23:06because I think the sooner you get used to it,
0:23:06 > 0:23:09dealing with situations like that, the better.
0:23:09 > 0:23:12Obviously it's upsetting for everybody involved
0:23:12 > 0:23:15and I think she's dealt with it really well so far.
0:23:22 > 0:23:26Back at the house, and second year Keira has some advice for Jen
0:23:26 > 0:23:29on handling difficult situations with patients.
0:23:29 > 0:23:33I suppose throughout medical school, empathy's really drilled into you.
0:23:33 > 0:23:35And so when you see families
0:23:35 > 0:23:38and stuff coming in and you naturally empathise with them
0:23:38 > 0:23:40and think, "What would I be like in that position
0:23:40 > 0:23:42"if that was my family member?"
0:23:42 > 0:23:47And it's very difficult not to become very caught up in that
0:23:47 > 0:23:49and emotional amongst them.
0:23:49 > 0:23:53Do I cry? Do I not cry? How would the patient's family react?
0:23:53 > 0:23:56Would they think I was sort of taking it away from their family,
0:23:56 > 0:23:59would they like the fact that I was emotional?
0:23:59 > 0:24:01I don't think it's a good idea to cry,
0:24:01 > 0:24:04it looks like you're out of control and you're the one person
0:24:04 > 0:24:06in that situation that they need to be in control.
0:24:06 > 0:24:09I've sat down with families of patients who I've known very well
0:24:09 > 0:24:12and had a little cry and a little hug with them
0:24:12 > 0:24:15and some people think that would be overstepping the mark
0:24:15 > 0:24:18but it was entirely appropriate in the situation at the time.
0:24:18 > 0:24:20- It's about the situation, isn't it? - Yeah.
0:24:24 > 0:24:26While the others carry on talking,
0:24:26 > 0:24:29Tom has to leave for his first night shift.
0:24:29 > 0:24:33And with fewer senior staff around, it's a huge responsibility
0:24:33 > 0:24:35for any junior doctor to take on.
0:24:35 > 0:24:37I'm feeling quite nervous actually
0:24:37 > 0:24:38because there's slightly less support.
0:24:38 > 0:24:41The major teams are still all in place as they are in the daytime,
0:24:41 > 0:24:45but I think it's a good opportunity to show what I can do, I guess.
0:24:48 > 0:24:52'Having fun and being a bit silly is really big part of who I am.'
0:24:52 > 0:24:53Can you please try it on?
0:24:53 > 0:24:56'I love just being a big kid when I'm outside of hospital.'
0:24:56 > 0:24:58- Are you ready?- Are you ready?
0:25:00 > 0:25:05- Who lives in a pineapple under the sea?- Tom does, Tom does.
0:25:07 > 0:25:11I'm definitely a people person. I really enjoy making new friends
0:25:11 > 0:25:14and at times have probably been a little bit of an attention seeker.
0:25:17 > 0:25:19Hello, how are you? Nice to see you.
0:25:19 > 0:25:21'I'm a little bit needy.'
0:25:21 > 0:25:23I can't be on my own for an afternoon or an evening,
0:25:23 > 0:25:26I always have to call my friends up and drag them round for a DVD.
0:25:26 > 0:25:30'I find my humour funny. Quite a few of my friends find it funny.
0:25:30 > 0:25:32'I don't know if they're laughing with me or at me.'
0:25:32 > 0:25:35As long as they're laughing, I guess it's good enough.
0:25:35 > 0:25:37APPLAUSE
0:25:37 > 0:25:39'The thing that daunts me about starting as a junior doctor'
0:25:39 > 0:25:42is actually doing my first on-call night shift.
0:25:42 > 0:25:44I will see cardiac arrests
0:25:44 > 0:25:46and be part of the team that manage those kind of situations.
0:25:46 > 0:25:48It's crunch time.
0:25:55 > 0:25:59His first night shift and Tom's worst fears come true.
0:25:59 > 0:26:03He's just received his first crash bleep to attend a patient
0:26:03 > 0:26:04in the Acute Medical Unit.
0:26:06 > 0:26:09He needs to get there as quickly as possible
0:26:09 > 0:26:11because the patient's taken a suspected overdose.
0:26:13 > 0:26:16But finding his way around the many wards of the hospital
0:26:16 > 0:26:19for the first time is tricky.
0:26:19 > 0:26:22Where's the AMU? Which way to AMU?
0:26:23 > 0:26:27Sorry, I've got a crash call to AMU. Which way is it?
0:26:27 > 0:26:28OK, thanks.
0:26:34 > 0:26:35Thank you.
0:26:36 > 0:26:40- Did she arrest?- She had a VT. She had a VT. She came around.
0:26:40 > 0:26:43When he arrives, everything is under control
0:26:43 > 0:26:45and he is sent back to the wards.
0:26:45 > 0:26:47All right, cool. See you in a bit.
0:26:54 > 0:26:59But 20 minutes later, he's called to the Heart Emergency Centre.
0:26:59 > 0:27:01Oh, actually, it's that way.
0:27:01 > 0:27:03I keep going the wrong way.
0:27:03 > 0:27:06The patient's been moved there to be monitored.
0:27:06 > 0:27:08Hello.
0:27:08 > 0:27:11Tom must take a blood sample and fit a cannula.
0:27:11 > 0:27:15There's a medication we have to give that you have to give through a really wide needle.
0:27:15 > 0:27:17It's particularly tricky to get wider needles in -
0:27:17 > 0:27:19you have to find the right size vein
0:27:19 > 0:27:22And it's fallen on my shoulders cos, unfortunately, the person
0:27:22 > 0:27:24who tried before wasn't unsuccessful, which... no pressure.
0:27:24 > 0:27:27I understand I've got to pop something into your arm.
0:27:27 > 0:27:28Have you been told?
0:27:28 > 0:27:30I've got to pop a needle into your arm
0:27:30 > 0:27:33so we can give you medication. Is that OK? All right.
0:27:33 > 0:27:36My name's Tom, I'm one of the junior doctors here.
0:27:36 > 0:27:38Do you want to look the other way?
0:27:46 > 0:27:48We're in anyway, we're in, we're in.
0:27:54 > 0:27:56Oh, sorry. Oh!
0:27:56 > 0:27:59Just give me one second. Oh, I'm sorry.
0:28:01 > 0:28:02OK.
0:28:04 > 0:28:07Try not to move your arm, try not to move your arm.
0:28:07 > 0:28:09I'm really sorry, but that's not gone in.
0:28:09 > 0:28:12I'll tell you what, I'll get one of the other people to come and do it.
0:28:12 > 0:28:15OK? Would you be happier with that?
0:28:21 > 0:28:22I'm sorry.
0:28:25 > 0:28:27Unfortunately, after two unsuccessful attempts,
0:28:27 > 0:28:29I've decided that it's probably better
0:28:29 > 0:28:32I call somebody who's got more experience in putting them in
0:28:32 > 0:28:35than me. I don't want to keep putting it in if I'll be unsuccessful.
0:28:35 > 0:28:37It's not fair.
0:28:37 > 0:28:39Tom reports back to the senior doctor.
0:28:39 > 0:28:42I tried twice, none successfully.
0:28:42 > 0:28:44If they need it done then they need it done,
0:28:44 > 0:28:47- so you need to get over the...- OK. - Cos if they're unwell,
0:28:47 > 0:28:50if you need to try ten times, you try ten times.
0:28:50 > 0:28:54- Would you mind trying...?- I'll do the line if you try the ABG.- OK.
0:28:54 > 0:28:56Sure. Ideal.
0:28:58 > 0:29:01She's told me that she's happy to try and pop this needle in,
0:29:01 > 0:29:02but in the meantime she wants me
0:29:02 > 0:29:05to take another sample of blood from this girl's wrist.
0:29:05 > 0:29:07She just said, "You're going to have to get it done,"
0:29:07 > 0:29:09so I'm going to try and get on with that now.
0:29:09 > 0:29:11It's a difficult situation for any new doctor.
0:29:11 > 0:29:14The good news is that one of the senior doctors is going to come
0:29:14 > 0:29:16pop that thing in your arm and she'll do it quickly.
0:29:16 > 0:29:20The other news is that I've got to take a sample from here, all right?
0:29:20 > 0:29:24And it's really important that we do it cos you've been really unwell.
0:29:24 > 0:29:26It's one of the most important tests we do
0:29:26 > 0:29:29but it doesn't feel very much. I'm sorry.
0:29:29 > 0:29:30Is that all right?
0:29:33 > 0:29:34And once we've got these things in,
0:29:34 > 0:29:37you should be able to have a bit of sleep.
0:29:37 > 0:29:38We need to get it done, that's all.
0:29:44 > 0:29:45Keep losing your pulse.
0:29:45 > 0:29:48I want to make sure I've got it before I go in.
0:29:51 > 0:29:53I'm sorry.
0:29:55 > 0:29:59Got it. That's the good news, is that I've got it.
0:29:59 > 0:30:02That won't happen again now. OK?
0:30:08 > 0:30:09Success.
0:30:12 > 0:30:14I don't feel like there's anything I did wrong
0:30:14 > 0:30:16I don't feel like I didn't contribute my fair part.
0:30:16 > 0:30:19I just feel like at that stage of real tiredness,
0:30:19 > 0:30:24I found it really demanding intellectually as well as physically.
0:30:24 > 0:30:27- I'm just dreaming about my bed. - (LAUGHS)
0:30:33 > 0:30:37While Tom gets some sleep, it's the start of a run of day shifts
0:30:37 > 0:30:40for second year Oli on the Acute Medical Unit.
0:30:47 > 0:30:51- Right , keep looking straight at my nose. I saw you sneak a peek there. - (SHE LAUGHS)- You can't cheat.
0:30:51 > 0:30:57He's proving to be a natural when it comes to charming his patients.
0:30:57 > 0:30:59Sharp scratch.
0:30:59 > 0:31:01- Didn't feel that. - Good.
0:31:01 > 0:31:04- I'll keep my job after all. - (SHE LAUGHS)
0:31:04 > 0:31:07If you can get a rapport with them and crack a few jokes,
0:31:07 > 0:31:10it's nice to be able to interact with them and put them at ease.
0:31:10 > 0:31:13I think that's one of the most important things you can do.
0:31:13 > 0:31:15We don't want to get ahead of ourselves and start saying
0:31:15 > 0:31:18- it's this or that till we've got all the information.- Oh, no.
0:31:18 > 0:31:24A very nice chap. I felt at ease with him. A nice bedside manner. (LAUGHS)
0:31:24 > 0:31:27But it's not just the patients who have been won over.
0:31:27 > 0:31:31I think he is quite popular with the nurses, yes.
0:31:31 > 0:31:34CHATTER LAUGHTER
0:31:34 > 0:31:36SHE LAUGHS
0:31:36 > 0:31:39I'm probably old enough to be his mum, so it's no good for me.
0:31:41 > 0:31:43A new day and a new patient,
0:31:43 > 0:31:47who's about to put Oli's charm to the test.
0:31:47 > 0:31:51She's come into hospital suffering from breathing difficulties.
0:31:51 > 0:31:53- Julie Hancock? - Yes.
0:31:54 > 0:31:58I've got your repeat prescriptions here somewhere. here we go.
0:31:58 > 0:32:00- Has there been... - (SHE COUGHS)
0:32:00 > 0:32:03Sounds nasty, doesn't it.
0:32:03 > 0:32:06So how far could you walk now without getting short of breath?
0:32:06 > 0:32:10- I mean, can you walk any distance? - No.
0:32:10 > 0:32:12Have you had any chest pain at all?
0:32:12 > 0:32:14- I have had chest pain. - OK, tell me about that.
0:32:14 > 0:32:18It's been up here and then it's been down here.
0:32:18 > 0:32:20- So on the left side up here and down here.- Yeah.
0:32:21 > 0:32:23And this wheeze I can hear, that's normal for you, is it?
0:32:23 > 0:32:26- Well, on a good day. - On a good day. OK.
0:32:26 > 0:32:29The shortness of breath is a long-term thing with you.
0:32:29 > 0:32:31- I've got emphysema. - You've got emphysema.
0:32:31 > 0:32:34- How often do you use the nebulisers at home.- From time to time.
0:32:34 > 0:32:36When was the last time you used one?
0:32:36 > 0:32:37Last night.
0:32:37 > 0:32:40I jumped up early this morning to get to my doctor's.
0:32:40 > 0:32:42- Do you smoke at all? - Yes.
0:32:42 > 0:32:45- How many d you smoke? - Between five and seven a day.
0:32:45 > 0:32:47Have you always smoked that much?
0:32:47 > 0:32:49- I used to smoke about 50 a day. - OK.
0:32:49 > 0:32:55- How long did you smoke 50 a day for? - I started to smoke from the age of nine or ten.
0:32:55 > 0:32:57- So probably about 40 years. - Yes.
0:33:00 > 0:33:06Oli needs to examine her to see if the problem is anything other than her emphysema.
0:33:06 > 0:33:08SHE INHALES DEEPLY
0:33:08 > 0:33:12Is this the normal size for your tummy or is this blown up a bit?
0:33:12 > 0:33:14Let's have a look at your ankles.
0:33:14 > 0:33:19- Sorry. Where is the pain on your chest.- Round my kidney parts.
0:33:19 > 0:33:21Is it painful if I press there?
0:33:21 > 0:33:22Ow!
0:33:22 > 0:33:25Have you ever had a blood test taken from the wrist before?
0:33:25 > 0:33:27- It's painful. - Yeah.
0:33:27 > 0:33:32- Is it all right if I come back and do one of those on you?- No.
0:33:32 > 0:33:39- If I ask very nicely? - I've had one of them done and it's very painful.
0:33:39 > 0:33:43I'll bring the stuff back ready to do it and we'll have a look and see what your pulse is.
0:33:43 > 0:33:45If it hurts, you can punch me.
0:33:45 > 0:33:47All right?
0:33:47 > 0:33:52- Fantastic. Stick here, I'll everybody back in a minute. - All right.
0:33:52 > 0:33:56Oli needs to take some blood from the artery in her wrist to measure her blood gases,
0:33:56 > 0:34:00a test that's carried out when a patient is struggling to breathe.
0:34:00 > 0:34:02It's an arterial sample from the wrist,
0:34:02 > 0:34:05which it sounds like she's had before and didn't like.
0:34:05 > 0:34:09It's often a bit more difficult from there, so...
0:34:09 > 0:34:10we'll see how that goes.
0:34:13 > 0:34:16It's not the first time he's performed this procedure,
0:34:16 > 0:34:19- but he knows it's not going to be easy.- Right.
0:34:19 > 0:34:22And so does she.
0:34:22 > 0:34:24Ready? Sharp scratch.
0:34:25 > 0:34:27SHE GROANS
0:34:27 > 0:34:28Argh!
0:34:28 > 0:34:31Ah!
0:34:32 > 0:34:34SHE GROANS
0:34:34 > 0:34:38- All done. Put some pressure on there for me. - SHE GROANS
0:34:38 > 0:34:42- You toerag!- Sorry? - You toerag!- Toerag! (LAUGHS)
0:34:42 > 0:34:43You didn't punch me, anyway.
0:34:43 > 0:34:46- No, I'm not that type of person. - OK. Fair enough.
0:34:50 > 0:34:53Not good at all. It really hurts.
0:34:53 > 0:34:55SHE GROANS
0:34:57 > 0:34:58Nice doctor. Toerag.
0:35:00 > 0:35:04I can handle being called a toerag, I've been called a lot worse.
0:35:04 > 0:35:06With the worst over for all involved,
0:35:06 > 0:35:10the blood is analysed and Julie is sent home with the all clear.
0:35:10 > 0:35:12Some people just aren't a fan of needles.
0:35:12 > 0:35:15I think that one, because of the angle that you go in at
0:35:15 > 0:35:19and the fact you're doing it from the wrist, people tend to like it a lot less.
0:35:19 > 0:35:22And it's a chance for Oli to retreat to the safety of his paperwork.
0:35:22 > 0:35:26Probably get through the whole lot in about, I don't know,
0:35:26 > 0:35:29six or seven years, so might as well get started now.
0:35:31 > 0:35:38While second year Oli is taking everything in his stride,... Tom is still finding his feet.
0:35:38 > 0:35:43It's his second night shift and he's only 3 hours in when his crash bleep goes off.
0:35:43 > 0:35:44BLEEPING
0:35:48 > 0:35:54He's been called to the Haematology Ward where a patient is in cardiac arrest.
0:35:57 > 0:36:00It's kind of exciting. "Oh, gosh! I've got a bleep!"
0:36:00 > 0:36:03You get this naive excitement.
0:36:10 > 0:36:12BLEEPING
0:36:30 > 0:36:34You go into situations where there's a real-life patient on the bed with chest compressions going on,
0:36:34 > 0:36:38which are immensely important to keep the heart pumping blood,
0:36:38 > 0:36:43but at the same time to see it in real life it's quite hard hitting.
0:36:43 > 0:36:46BLEEPING
0:36:53 > 0:36:56It was very daunting, unlike anything I'd experienced.
0:36:56 > 0:37:00Even though I've seen cardiac arrests in hospital before, I didn't feel responsible before.
0:37:00 > 0:37:03And although I've had a lot of training in how to manage them
0:37:03 > 0:37:06when you see it for the first time it's kind of scary.
0:37:06 > 0:37:07BLEEPING
0:37:14 > 0:37:18We went on for 20 minutes of resuscitation before it was decided
0:37:18 > 0:37:23that the situation the patient was in wouldn't really be recoverable
0:37:23 > 0:37:25in spite of the best efforts of the team.
0:37:25 > 0:37:28- So it was called. - The man didn't survive.
0:37:29 > 0:37:36Very sadly the patient's 15-year-old daughter who was on her own on the ward is being informed now.
0:37:36 > 0:37:38It's been a hard shift for Tom.
0:37:38 > 0:37:43Two emergency calls in total does have a toll on a person,
0:37:43 > 0:37:46especially somebody who's new and just coming into the role.
0:37:46 > 0:37:49He will be physically exhausted by that
0:37:49 > 0:37:54because you're using every sort of emotion.
0:37:54 > 0:37:56And Tom and all the other junior doctors
0:37:56 > 0:37:57will probably have to cope with that.
0:38:00 > 0:38:04Back home after his shift, Tom is still thinking about the patient who died.
0:38:04 > 0:38:09He only had one relative, his 15-year-old daughter, she was on her own.
0:38:09 > 0:38:11- Oh, my God! - So that was horrible.
0:38:11 > 0:38:12That's really sad.
0:38:14 > 0:38:19- And it does sit in your head. - Especially cos it's someone you wouldn't expect to just die.
0:38:19 > 0:38:24I didn't think about while I was seeing other patients, you focus on other stuff,
0:38:24 > 0:38:26but it's when you're not focusing that you think about it again.
0:38:26 > 0:38:31- Yeah.- And it just kind of gets you. Even when I took five minutes later to have my sandwich,
0:38:31 > 0:38:35- I was, like, "It's really sad." - It is sad, yeah.
0:38:35 > 0:38:40- I don't think anyone really gets used to that. It's sad all round. - Yeah.
0:38:44 > 0:38:49It's the following morning and Ed is starting his second shift in the Emergency Department.
0:38:49 > 0:38:54He's feeling the pressure of being a new doctor in a new country.
0:38:54 > 0:38:57It's proving a bit difficult.
0:38:57 > 0:39:03I've got to get the hang of... how thorough certain things are here
0:39:03 > 0:39:06rather than what I've been taught.
0:39:06 > 0:39:10There's more at stake today that just the health of the patients.
0:39:10 > 0:39:15After a shaky start on his first shift, Ed's seniors are going to be monitoring him closely.
0:39:15 > 0:39:20Within our department, we're providing them with 24 hour senior supervision and support,
0:39:20 > 0:39:24but they are expected to see patients from the offset on their own.
0:39:24 > 0:39:25Now, having not worked within the UK,
0:39:25 > 0:39:30Edward is finding that difficult because he's unaware of the systems and the treatments in place.
0:39:30 > 0:39:35Ed's next case is a man who seems to be disorientated and confused.
0:39:35 > 0:39:39Can you close your eyes, please. No, you. Like this.
0:39:39 > 0:39:41Eyes closed.
0:39:41 > 0:39:44No, no. If you can close your eyes.
0:39:44 > 0:39:47Keep both closed. Both closed! That was good.
0:39:47 > 0:39:49OK, keep them both closed.
0:39:50 > 0:39:56I've got a confused patient. He's not able to tell me where he lives, what he does, why he's here.
0:39:56 > 0:40:00He doesn't know where he is, but he is able to perform simple tasks.
0:40:00 > 0:40:04Unsure of his next move, Ed goes to Dr Raj for help.
0:40:04 > 0:40:07- Have you gone through each nerve. - No, I haven't.
0:40:07 > 0:40:09Right. So do a full neurological examination.
0:40:09 > 0:40:15- Saying he can speak and his eyes are OK doesn't mean his neurological exam is normal.- OK.
0:40:15 > 0:40:17- Yeah?- OK.
0:40:17 > 0:40:21I would probably ask you to follow me during the first examination is that OK?
0:40:21 > 0:40:26- You should be able to do a neurological examination. - It's been a while.
0:40:26 > 0:40:30- Let's go and do a neurological examination. - That would be nice.
0:40:30 > 0:40:34Dr Raj will have to show Ed how to do the examination himself.
0:40:34 > 0:40:37It's a blow for Ed as it is a procedure
0:40:37 > 0:40:42that a second year junior doctor should be able to perform unsupervised.
0:40:42 > 0:40:45- You have completed your training in medicine?- Yes.
0:40:45 > 0:40:49Then you should be able to do a basic examination.
0:40:49 > 0:40:53He's come in with a neurological problem. Confusion is a neurological problem.
0:40:53 > 0:40:56So he needs a neurological examination.
0:40:56 > 0:40:59And when you do a neurological examination,
0:40:59 > 0:41:03you can 't test some nerves and not others in a neurological examination.
0:41:03 > 0:41:06Yeah?
0:41:06 > 0:41:08You all right, love?
0:41:08 > 0:41:11It has become clear to Dr Raj and the hospital
0:41:11 > 0:41:14that there is a big difference between what Ed has been taught in Italy
0:41:14 > 0:41:17and what the department expects of him.
0:41:17 > 0:41:23Speaking to colleagues it's quite obvious that it would be unfair on him and on patients in particular
0:41:23 > 0:41:27to allow him to carry on seeing those patients
0:41:27 > 0:41:30when we feel he would be out of his depth.
0:41:30 > 0:41:36With the priority being patient welfare and making sure Ed gets the training and support he needs,
0:41:36 > 0:41:39the department has come to a difficult decision.
0:41:39 > 0:41:43It was apparent from day one that we were having to spend a lot of time with Ed
0:41:43 > 0:41:46and we've made the decision
0:41:46 > 0:41:51that I'm going to be taking him off the rota.
0:41:51 > 0:41:54- Goodbye. - See you.- Goodbye.
0:41:57 > 0:42:02It would be unsafe to allow him to carry on seeing those patients from the offset on his own
0:42:02 > 0:42:07without providing him with some extra training.
0:42:14 > 0:42:20Back home, and Ed's coming to terms with the news that his time in the Emergency Department is over.
0:42:20 > 0:42:23Dr Raj seems very to the point immediately,
0:42:23 > 0:42:25not a wasted word or anything like that.
0:42:25 > 0:42:28He's very quick in what he does and I can see he's an outstanding doctor.
0:42:28 > 0:42:32You can see some things about people in three days,
0:42:32 > 0:42:37but you can't possibly evaluate six years of medical training
0:42:37 > 0:42:40and six months of work... in two days.
0:42:40 > 0:42:42I don't think that's possible.
0:42:42 > 0:42:46You can have all the experience you want to but people can have good days, bad days.
0:42:46 > 0:42:50Give them a week at least. A week is not too much.
0:42:50 > 0:42:54The hospital have decided that Ed should be moved from front-line medicine
0:42:54 > 0:43:00and redo his first year in a department where he can get intensive training and supervision.
0:43:00 > 0:43:04This means Ed will have to become a first year junior doctor again.
0:43:04 > 0:43:09I had a fleeting image of myself saying, "OK, never mind about this,
0:43:09 > 0:43:13then I'll just go back to my job in the mountains in Italy."
0:43:13 > 0:43:16But, of course, you are in the thick of emotion and you've just been told
0:43:16 > 0:43:21you're going to be moved to another department and your training will last one year longer.
0:43:23 > 0:43:26But I need to stay here.
0:43:26 > 0:43:31I've got a job, it's fine. I'll do my best to just get on top of it.
0:43:31 > 0:43:37It's a turn of events that Ed could never have predicted.
0:43:37 > 0:43:41But there's more bad news to deal with.
0:43:41 > 0:43:46Ed's father, who has been unwell for a while, has taken a turn for the worse
0:43:46 > 0:43:51and Ed must leave the country immediately to see him.
0:43:56 > 0:43:59Back at the hospital, it's business as usual.
0:43:59 > 0:44:04On the colo-rectal ward, which specialises in looking after patients with bowel conditions,
0:44:04 > 0:44:07Emily is dealing with her first case.
0:44:07 > 0:44:09It's quite busy. Lots to do today.
0:44:09 > 0:44:13So I'm just going to try and get some blood off this woman.
0:44:15 > 0:44:20But it's the kind of blood sample that needs to be sent to the lab packed in ice
0:44:20 > 0:44:24and first Emily needs to find the ice machine.
0:44:24 > 0:44:27It's a massive faff cos they're on the fifth floor
0:44:27 > 0:44:31and all the ice machines are broken, so I've got to go to the ninth floor to find one.
0:44:31 > 0:44:36About half my day is spent running around looking for something.
0:44:36 > 0:44:40- I need to find some ice. - It's down the other end. There's an ice machine -
0:44:40 > 0:44:42Right the other end? Thank you.
0:44:42 > 0:44:46Knowing where everything is is a problem when you're starting any new job.
0:44:46 > 0:44:47Every ward is laid out differently,
0:44:47 > 0:44:50so whenever you go onto a new ward you have to learn where everything is.
0:44:50 > 0:44:53Hiya. Have you got any ice I can have, please.
0:44:53 > 0:44:56I don't work here. I'm guessing that's the ice machine.
0:44:56 > 0:44:58Oh, wicked. Thank you.
0:45:04 > 0:45:06How do I work it.
0:45:06 > 0:45:08SHE LAUGHS
0:45:08 > 0:45:11Do I have to press a button?
0:45:11 > 0:45:14Oh!
0:45:14 > 0:45:17Finally, she can take the sample.
0:45:17 > 0:45:19She needs blood from the patient's wrist
0:45:19 > 0:45:24to record the levels of oxygen and carbon dioxide in her body.
0:45:24 > 0:45:27Sorry, that was more of a faff than I thought it would be.
0:45:27 > 0:45:30Feeling better today?
0:45:30 > 0:45:33- A lot better. - Are you? Good. Good.
0:45:33 > 0:45:38Taking blood from a patient is one thing she feels confident about.
0:45:38 > 0:45:44All through medical school I worked as a phlebotomist, which gave me loads of practice at taking blood.
0:45:44 > 0:45:46A phlebotomist is somebody who takes blood for a living.
0:45:46 > 0:45:51So it's made me not too scared of doing it as a doctor, which is quite helpful I think.
0:45:55 > 0:45:56OK. Sharp scratch.
0:46:02 > 0:46:04- Marvellous! - OK.
0:46:04 > 0:46:07- Easy. - Easy-peasy.
0:46:07 > 0:46:10But if the blood isn't analysed within 60 minutes of being taken,
0:46:10 > 0:46:15the sample will be ruined and Emily must start again from scratch.
0:46:15 > 0:46:20Hello, I'm trying to get a porter to 5B to take an ABG for me. Is that possible, please.
0:46:20 > 0:46:22Got an hour. The clock's ticking.
0:46:22 > 0:46:30Happy she's done a good job, Emily leaves the sample waiting for collection.
0:46:30 > 0:46:33But with the ice slowly melting, will it make it on time?
0:46:38 > 0:46:43Junior doctor Jen is spending her first three months on a surgical ward.
0:46:43 > 0:46:46She's up for the challenge and wants to be the best.
0:46:46 > 0:46:48Hold that.
0:46:52 > 0:46:54My life motto is "work hard, play hard".
0:46:57 > 0:47:03I've wanted to be a doctor for as long as I can remember.
0:47:03 > 0:47:06I definitely consider myself a competitive person.
0:47:06 > 0:47:08There's nothing I love more than a challenge
0:47:08 > 0:47:10or the opportunity to beat somebody.
0:47:13 > 0:47:17I love going shopping, getting new makeup,
0:47:17 > 0:47:24I like having my hair done. So there is a side of me that's a bit of a girl as well.
0:47:24 > 0:47:26My mates are really important to me.
0:47:26 > 0:47:30On a night out, I like to have a few drinks.
0:47:30 > 0:47:32ALL: Cheers!
0:47:32 > 0:47:36I think every medic is familiar with the bars and clubs in Liverpool.
0:47:36 > 0:47:40Medicine is very much the priority in my life.
0:47:40 > 0:47:44My greatest fear with starting work
0:47:44 > 0:47:49is that I'm not gonna be as good as I expect to be.
0:47:49 > 0:47:55Jen's only been on the ward for a few days, but her assertive and confident nature is shining through.
0:47:55 > 0:47:58Organisation's definitely the key to this job.
0:48:03 > 0:48:06You do then list. You sort it out. You've pulled it out!
0:48:06 > 0:48:12OK, you can go back to your bed now, you're not attached to that any more. Yeah.
0:48:12 > 0:48:18I'm not a bossy person. Let's get a cannula in, let's put a bag of saline up.
0:48:18 > 0:48:21If something needs doing, I want to make sure it's done.
0:48:21 > 0:48:24Bring them in in a minute, I'm just gonna get the blood results up.
0:48:24 > 0:48:29Her dream job is to work in surgery and she's keen to get some hands-on experience.
0:48:29 > 0:48:32- I wanna do anaesthetics. - Do you?
0:48:35 > 0:48:38Will I be able to get involved a bit? That'd be cool!
0:48:38 > 0:48:43Going into surgery would be exciting cos I like to do hands-on things,
0:48:43 > 0:48:45given the practical element of the job.
0:48:45 > 0:48:51I'm a surgical house officer. This is the first year on and you don't often get into theatre,
0:48:51 > 0:48:53but, yeah, excited.
0:48:53 > 0:48:59Getting into surgery in your first week is unusual for a junior doctor,
0:48:59 > 0:49:04but Jen's impressed her bosses enough to make it happen after only a few days.
0:49:04 > 0:49:06Jen's fitted in really well in the team.
0:49:06 > 0:49:12She seems to have a level of maturity above her age I'd say.
0:49:12 > 0:49:15She's just taken it all in her stride, really.
0:49:15 > 0:49:18Hiya. I'm going into Mr Hartley's theatre.
0:49:18 > 0:49:22- Which theatre is she in? - Theatre 6.
0:49:24 > 0:49:28Consultant Surgeon Mr Hartley is in charge of today's procedure.
0:49:33 > 0:49:36Increasingly, it's almost like a privilege to be allowed
0:49:36 > 0:49:40to come into a theatre and be exposed to what goes on up here.
0:49:44 > 0:49:49The patient is having stomach surgery to control acid reflux
0:49:49 > 0:49:54and his stomach needs to be repositioned to cover part of his oesophagus.
0:49:54 > 0:49:58Jen's first task is to insert the patient's cannula.
0:49:58 > 0:50:00This one?
0:50:00 > 0:50:02Yeah, just there.
0:50:02 > 0:50:05Yeah.
0:50:05 > 0:50:07Thank you.
0:50:12 > 0:50:17So the leaky valve, the one that doesn't work, is just here.
0:50:17 > 0:50:20- Right.- So that's the bit we're going to repair.
0:50:20 > 0:50:26Mr Hartley wants to see if Jen's been paying attention in medical school.
0:50:26 > 0:50:29Suppose we thought, "Where's the needle?! We don't know where it is!"
0:50:29 > 0:50:31What might you try to do to find a lost needle?
0:50:31 > 0:50:34- Get an X-ray? - Yeah, just X-ray the patient.
0:50:34 > 0:50:36Very impressed.
0:50:40 > 0:50:42Jenny, what do you think? Have you seen one of those before?
0:50:42 > 0:50:45- No, I haven't. - Yeah.
0:50:45 > 0:50:47Pretty amazing.
0:50:49 > 0:50:51- Thanks very much. Bye! - Thanks a lot.
0:50:51 > 0:50:56Jen's on a high from her first surgical experience as a junior doctor.
0:50:56 > 0:50:58I've really, really enjoyed surgery.
0:50:58 > 0:51:02And I have definitely noticed... the buzz from surgery.
0:51:02 > 0:51:06I understand why people enjoy it and want to do it as a career.
0:51:23 > 0:51:29Back on colo-rectal and Emily has a long list of patients to see and bloods to take.
0:51:29 > 0:51:32It's over 30 minutes since she left her ice sample on another ward
0:51:32 > 0:51:37and she's needs to check it's been taken to the lab.
0:51:37 > 0:51:41I'm just going down and back to B5 to check that ABG's gone off,
0:51:41 > 0:51:44because I'm paranoid it's still sat in the side.
0:51:44 > 0:51:48When Emily returns to the ward, her worst fears are confirmed.
0:51:48 > 0:51:50(GASPS)
0:51:50 > 0:51:52Why?!
0:51:54 > 0:51:55Can I still send that?
0:51:57 > 0:52:00- It's all right to send. - Are you sure?
0:52:00 > 0:52:02Yeah. Send a porter.
0:52:02 > 0:52:05This is so ridiculous!
0:52:05 > 0:52:09It's enough for laid-back Emily to lose her cool.
0:52:09 > 0:52:11BLEEPING
0:52:11 > 0:52:15It's annoying that if you ask someone to do a job for you it doesn't get done.
0:52:15 > 0:52:17Especially with something that has a time limit on it
0:52:17 > 0:52:20like a blood test that you can't really leave hanging around.
0:52:20 > 0:52:26Hello. I rang half an hour ago for a porter to pick an ABG up, do you know where they are?
0:52:26 > 0:52:31I think from now on, I'm actually going to stand with the blood and not go anywhere.
0:52:35 > 0:52:37Oh, it's melting!
0:52:37 > 0:52:40Are you gonna take it up to them?
0:52:40 > 0:52:43No, cos I don't have time to take it up.
0:52:43 > 0:52:46It'd take you five minutes.
0:52:46 > 0:52:50- Getting up there and getting it analysed, five minutes.- You think?
0:52:50 > 0:52:53Save the patient getting stabbed again.
0:52:53 > 0:52:56All right. If it takes me any longer, I'm blaming you.
0:52:56 > 0:52:57All right.
0:52:57 > 0:53:01- Oh, will you tell the porter when he comes.- All right.
0:53:07 > 0:53:15The Junior Doctors have made it through the week and Tom's in the mood to party.
0:53:15 > 0:53:17It's Friday!
0:53:17 > 0:53:20- Oh, my God! - Cham-pagne!
0:53:20 > 0:53:21SHE LAUGHS
0:53:21 > 0:53:23Whoo!
0:53:23 > 0:53:28- Cheers, everyone! - Here's to Friday and the weekend.
0:53:28 > 0:53:32- I was the last one home... for once. - For once!
0:53:32 > 0:53:37I'm starting to feel relieved because everything's starting to fall into place.
0:53:37 > 0:53:41I've got two or three patients I have world-class banter with.
0:53:41 > 0:53:45I'm happy. I feel like I'm in my niche now.
0:53:52 > 0:53:56- ALL CHEER - While Tristan spends some well deserved time with his family,
0:53:56 > 0:54:01over at the house, some of the other junior doctors are gearing up for a big night out.
0:54:01 > 0:54:05After a long week, I'm actually letting my hair down.
0:54:12 > 0:54:15I feel like I've learnt so much in the first two weeks,
0:54:15 > 0:54:18imagine what I'll be like after I've done six months.
0:54:18 > 0:54:21I feel like I'm progressing,
0:54:21 > 0:54:27which is a really nice feeling, rather that like I'm floundering.
0:54:27 > 0:54:29HE LAUGHS
0:54:29 > 0:54:34Everyone's going through stressful times and there are bad days and times when you get exhausted.
0:54:35 > 0:54:38And everyone knows that and is in the same position, so everything pulls together.
0:54:38 > 0:54:41Doctors are a really good support system for each other.
0:54:41 > 0:54:43I definitely think I've earned this night out.
0:54:43 > 0:54:47- You've worked so hard this week. - I'm beyond tired.- Hmm.
0:54:49 > 0:54:53I think the biggest thing you learn is how to work as a team.
0:54:54 > 0:54:57You have to work like a well-oiled machine.
0:54:57 > 0:55:01That's a big thing I've taken away from the first couple of weeks.
0:55:13 > 0:55:15It's been physically challenging,
0:55:15 > 0:55:20it's been intellectually challenging and very emotionally challenging too.
0:55:22 > 0:55:27At the end of this week I don't feel like I'm, fooling anyone when I tell them I'm a doctor.
0:55:27 > 0:55:29Night.
0:55:29 > 0:55:32Next week on Junior Doctors.
0:55:32 > 0:55:37- Argh!- Unflappable Jen tackles a tricky procedure on her first nightshift.
0:55:37 > 0:55:40I didn't really know what to do when he was panicking.
0:55:40 > 0:55:44Tom has another stab at perfecting his needle technique.
0:55:44 > 0:55:47Don't worry. Just crack on.
0:55:47 > 0:55:51I'll be particularly pleased to see the back of those after the three attempts.
0:55:51 > 0:55:56And Emily feels the pressure when she's the first doctor on the scene of a cardiac arrest.
0:55:56 > 0:55:59The senior doctor said, "Right, does everyone agree this is futile?"
0:55:59 > 0:56:02I hope that I get over crying,
0:56:02 > 0:56:06but I hope that I always feel a little bit for them.
0:56:17 > 0:56:20Subtitles by Red Bee Media Ltd